ABSTRACT INTRODUCTION. A review of the social, psychological and medical issues of chronic pain syndromes in children and adolescents. The impact of chronic pain on daily activity, academic performance and morbidity in adulthood in this category of patients is analyzed. MATERIAL AND METHODS. A systematic search was conducted on the RSCI and PubMed database for the period from 2000 to 2023 on the topic of chronic pain syndromes in children and adolescents, which yielded 761 matches on key features, of which we analyzed 24 sources. DISCUSSION. The review presents information according to which, in the pathogenesis of chronic pain syndromes in children and adolescents, a significant role is given to both the characteristics of the antinociceptive system and socio-psychological aspects. The main factors involved in the formation of chronic pain syndromes are presented. CONCLUSION. Chronic pain in children and adolescents has its own medical, psychological and social characteristics, which affect not only the current state of health, but also has a significant impact on later life. KEYWORDS: children, adolescents, chronic pain, medicalization of pain, depression

Pain syndrome is one of the most common reasons to seek medical help. The paper considers an issue of pain syndrome in patients with various diseases. Various pathogenetic variants of dorsalgia development in the setting of inflammatory and degenerative-dystrophic changes are presented. The main biomechanical and biochemical processes associated with the pain syndrome are summarized. Several features of the course and therapeutic methods of the back pain syndrome associated with ankylosing spondylitis, osteoarthritis, as well as gouty and rheumatoid arthritis are considered. The paper outlines general principles of therapy for acute and chronic nociceptive pain syndromes. Medicinal and non-medicinal therapeutic methods are discussed. Since specific and non-specific inflammatory reactions represent a key pathogenetic mechanism in most of the reviewed cases of acute and chronic pain syndrome, anti-inflammatory drugs play a leading role in the condition therapy. We considered the possibility to use nonsteroidal anti-inflammatory drugs (NSAIDs) and B vitamins. KEYWORDS: back pain, osteoarthritis, ankylosing spondylitis, rheumatoid arthritis, chronic pain syndrome, acute pain syndrome. FOR CITATION: Barulin А.Е., Kurushina O.V., Puchkov A.E. Clinical aspects of management of patients with acute and chronic pain. Russian Medical Inquiry. 2024;8(10):576–581 (in Russ.). DOI: 10.32364/2587-6821-2024-8-10-5

Tremor are involuntary, rhythmic, oscillatory movements of a body part. The diagnosis of tremor is based on clinical information obtained from the history and physical examination. The most common types are enhanced physiological tremor, essential tremor, and parkinsonian tremor. The first step in evaluating a patient with a tremor is to classify the tremor based on its activation state, topographic distribution, and frequency. We analyzed the medical records of 99 patients who applied with complaints of tremor to the Regional Clinical Hospital, which showed that the most common diagnoses in patients with tremor were Parkinson's disease (44.4 %) and essential tremor (15.1 %).

Achievements in integrative areas of medicine can significantly supplement the traditional ideas about the etiopathogenesis of temporomandibular joint dysfunction, based on the positions of occlusal and neuromuscular theories and mainly limited to consideration of the elements of the stomatognathic system. The article presents the results of a study of data on the influence of the state of the spine on the pathogenesis of diseases of the temporomandibular joint and data on the effectiveness of the treatment of combined pathology of the joint and posture according to publications in domestic and foreign literature over the past 15 years. Expanding the view on the structure and function of the maxillofacial region and the role of craniopostural and craniovisceral relationships requires the development of a unified methodological approach to the diagnosis of patients with dysfunction of the temporomandibular joint, which will help reduce the number of diagnostic errors and the risk of chronic pain phenomena.

In recent decades, there has been an increase in the prevalence and medical and social burden of osteoarthritis (OA) and nonspecific back pain in all countries of the world. The First Multidisciplinary Bilateral Russia-Uzbekistan Expert Council presented innovations in the prognosing, personalized prevention and adjuvant therapy of degenerative-dystrophic diseases of the joints and spine, the evidence base for the effectiveness and safety of the use of drugs that modify the course of OA (Disease-modifying osteoarthritis drugs, DMOADs): chondroitin sulfate, glucosamine sulfate, undenatured type II collagen for adjuvant pharmaconutraceutical support – prevention and adjuvant therapy (treatment) of OA and nonspecific lumbosacral pain. The expert counsil resolution presents an optimized algorithm for the management, prevention and adjuvant therapy of OA and non-specific back pain, maintaining the function of healthy joints after intense physical activity with the inclusion of the drug Chondroguard solution for intra-articular and intramuscular administration (INN – chondroitin sulfate) and a new pharmaconutraceutical from the DMOADs group – TRIO trademark Chondroguard® (Chondroguard®TRIO).

The article presents the records of the study of the influence of drug and non-drug treatment on the possibility of correcting biomechanical changes in patients with chronic pelvic pain syndrome. The possibilities of increasing the therapy effectiveness by using an original method based on direct visual biofeedback are shown. The study involved 60 patients; the average age was 42 (18-65 years). The duration of treatment was 21 days. Subjective pain perception, pain area, biomechanical changes, and muscle syndrome index were analyzed. It was found out that after complex treatment with biofeedback the indexes of subjective pain perception, pain area, muscle syndrome as well as the biomechanics study parameters significantly improved.

Хроническая боль — распространенная, сложная и не до конца изученная проблема современной медицины, которая оказывает значительное влияние на индивидуума и общество в целом. В настоящее время это состояние рассматривается как сложный симптомокомплекс, обладающий своими этиологическими, патогенетическими и прогностическими особенностями, а не просто как сопутствующий симптом других заболеваний. Однако при всей распространенности указанного симптомокомплекса, а значит, и актуальности информации о нем системная оценка уровня распространенности этой патологии в Российской Федерации практически отсутствует, главным образом в связи с тем, что в традиционных утвержденных статистических учетных и отчетных формах, используемых в системе здравоохранения, нет выделения указанного состояния. Таким образом, настоящая статья посвящена обсуждению особенностей классификации, методов оценки и статистического учета различных форм болевых синдромов в Российской Федерации. Мировая статистика подтверждает постоянный и неуклонный рост распространенности хронической боли, что отражается в росте и числа случаев отдельных форм болевых синдромов, и показателя DALY. Но для того чтобы разработать планы лечения и стратегии профилактики, хроническую боль необходимо рассматривать в контексте социальных, биологических, психологических и физических факторов. Для этого необходимо вести постоянный учет как новых случаев хронических болевых синдромов различной локализации, так и их распространенности в целом на популяционном уровне, проводить оценку факторов риска возникновения данной патологии, а также степени успешности купирования боли. В настоящее время в Российской Федерации эти вопросы остаются недостаточно разработанными, что и является предметом обсуждения в данной работе.

ЦЕЛЬ ИССЛЕДОВАНИЯ Изучить особенности болевых проявлений, двигательного стереотипа, психоэмоционального статуса, дыхательной сферы и вегетативной нервной системы у лиц молодого возраста для выявления группы риска развития обострения дорсопатии. МАТЕРИАЛ И МЕТОДЫ С помощью оригинальной методики тестирования двигательного стереотипа человека из общей группы молодых лиц (n=918) в возрасте 18—35 лет сформированы две исследуемые группы: группа риска (мужчин — 42, женщин — 62), включающая лиц с признаками дорсопатии преимущественно грудного отдела позвоночника и дыхательными нарушениями, и группа контроля (мужчин — 46, женщин — 60), состоящая из здоровых лиц. В обеих группах проводили вертеброневрологический осмотр, оценку психоэмоционального и вегетативного статуса, исследование дыхательного цикла. Достоверность различий показателей между группами определяли по t-критерию Стьюдента. РЕЗУЛЬТАТЫ В группе риска биомеханические изменения (асимметрия осанки, сколиотическая деформация, функциональная разница в длине ног) регистрировались в среднем на 42% чаще, чем в группе контроля. Смещение общего центра тяжести позвоночника отмечено у 90 и 23% лиц группы риска и группы контроля соответственно. В группе риска отмечается дисфункция преимущественно грудного региона позвоночника (59% случаев), что сочетается с включением вспомогательной мускулатуры в акт дыхания и изменениями показателей дыхательного цикла (укорочением длительности фаз вдоха и выдоха) по сравнению с нормальными показателями здоровых лиц. Такие изменения отмечены на фоне симпатикотонии в виде тенденции к повышению соотношения LF/HF по данным кардиоинтервалографии, а также более высокого общего балла по вопроснику для выявления признаков вегетативных изменений А.М. Вейна в группе риска при сохранении вегетативного баланса в контрольной группе. Анализ психоэмоционального статуса выявил также преобладание слабовыраженных тревожно-фобических проявлений у лиц группы риска по сравнению с группой контроля (p<0,05). ЗАКЛЮЧЕНИЕ Биомеханические перестройки у молодых лиц двигательного стереотипа в сочетании с психоэмоциональными изменениями, дыхательной и вегетативной дисфункцией могут рассматриваться в качестве донозологических признаков дорсопатии.

OBJECTIVE:To study the use of Cellex in a population of patients aged 45 to 75 years with ischemic stroke and TIA, with a history of type 2 diabetes mellitus (T2DM), with diabetic distal symmetric polyneuropathy.MATERIAL AND METHODS:The study involved 80 patients (men - 52.5%, women - 47.5%) in the rehabilitation period of stroke, including TIA, developed in T2DM. The patients were divided into 2 groups (40 people in each): in the 1st group, patients received Cellex 1.0 ml subcutaneously 1 time per day in addition to routine practice; the 2nd group received only routine practice. Cellex was prescribed in the form of two 10-day treatment courses with a break of 1 month. The range of patients examination during the whole study period (4 visits, 65 days) included an assessment of neurological symptoms (NIHSS, NISLL, DN-4, TSS scales), neurophysiological examination (EMNG), analysis of daily activity (SF-36 questionnaire, the Rivermead Mobility Index, the Modified Rankin Scale), the emotional state assessment on the scale and the effects of therapy on the Clinical Global Impression Scale.RESULTS AND CONCLUSION:The clinical efficacy of the drug was shown in the form of an improvement of clinical parameters and data on EMNG of the lower extremities on the 60th day of the study. Improvement was observed in 17.5% of patients in the 1st group, while in the 2nd group deterioration was observed in 15.0% of patients, as evidenced by the presence of statistically significant differences. The study drug was also shown to be well tolerated and safe.CONCLUSION:The use of the Cellex is effective and safe in patients with T2DM in the recovery period of stroke.

This review discusses current data on CNS lesions in infections with the new coronavirus that causes COVID-19. The pathogenetic mechanisms leading to infection of the brain and spinal cord are presented. Published studies and meta-analyses published by autumn 2020 are assessed. The authors present results from their own clinical observations of various types of CNS infection in COVID-19 virus disease. Particular attention is paid to certain common forms of CNS lesion such as encephalitis, cerebrovascular pathology, and headache. A form of acute hemorrhagic necrotic encephalopathy is identified, which is a quite rare but fatal pathology comorbid with COVID-19. A description of our own clinical observation of acute necrotic encephalopathy is presented. The importance of further studies of the effects of the coronavirus on the CNS and possible approaches to treatment and rehabilitation of this category of patients is emphasized.

В статье рассматриваются предикторы формирования стойких биомеханических нарушений у лиц с хроническими болевыми синдромами тазового региона. Приведен обзор наиболее часто встречающихся мышечно-тонических нарушений тазового региона у пациентов с синдромом хронической тазовой боли. Представлен оригинальный метод коррекции биомеханических изменений тазового региона у лиц, испытывающих длительные статические нагрузки. Представлено оригинальное устройство для реализации метода коррекции на основе биологической обратной связи. Сделаны выводы о потенциальном положительном влиянии метода на статодинамические показатели биомеханики и течение хронического болевого синдрома тазового региона.

This review examines the current data on central nervous system damage in cases of the new coronavirus infection caused by the COVID-19 virus. The pathogenetic mechanisms leading to damage to the brain and spinal cord are considered. The analysis of available research articles and meta-analyzes published up to fall 2020 is carried out. The authors provide the results of their own clinical observations of various forms of damage to the central nervous system in cases of COVID-19 virus disease. Particular attention is paid to certain common forms of damage to the central nervous system, such as encephalitis, cerebrovascular pathology, and headaches. A form of acute hemorrhagic necrotizing encephalopathy is distinguished, which is a rather rare but fatal pathology, comorbid with the COVID-19 virus. The data of our own clinical case of acute necrotizing encephalopathy are presented. The importance of further studying the effect of coronavirus on the central nervous system and possible mechanisms of therapy and rehabilitation for this category of patients is emphasized.

This paper discusses modern approaches to the diagnosis and management of patients with piriformis syndrome. Epidemiological data on the prevalence of this syndrome in neurological practice are presented. The anatomical features of this region, leading to the formation of piriformis syndrome, are described in detail. The authors provide diagnostic criteria based on neurological examination and manual muscle testing and discuss the differential diagnosis of piriformis syndrome. New possibilities of treating this syndrome using a fixed combination of diclofenac and orphenadrine registered in the Russian Federation as a drug for intravenous infusion neodolpasse are discussed in detail. The authors cite materials from their own work, a clinical case of managing a patient with piriformis syndrome using neodolpasse is analyzed.

The review provides scientific data on modern aspects of using the kinesiotaping method in neurological patients. Possible clinical taping methods for myofascial pain and post-traumatic disorders of the musculoskeletal system are considered. The important role in the correction of biomechanical disorders and the rehabilitation potential of the taping method in the treatment and prevention of musculoskeletal pathology has been demonstrated. Experimental and clinical studies of Russian and foreign scientists are presented, indicating the promise of therapeutic and preventive possibilities of kinesiotaping. Conclusions are made about the advisability of using kinesiotaping in an interdisciplinary approach in the treatment of patients with neurological disorders.

Purpose of the study. To establish the relationship between neurophysiological status and the level of efficiency in young people with bruxism.Materials and methods. Two groups of 64 and 53 subjects (males and females) aged 20–35 years old with bruxism and non-bruxers were formed according to questionnaire results and physical examination. The level of efficiency was assessed by the results of sensorimotor tracking of a moving object (the ‘Smile’ model). Spectral analysis was performed for evaluation of the baseline electroencephalograms. Microsoft Excel and Statistica 10.0 programs were used for statistical data processing.Results. The level of efficiency was statistically significantly lower in the hardest test of Smile model among the individuals with bruxism (p < 0.05). The bruxers also demonstrated a significantly lower dominant frequency and maximum amplitude of alpha-rhythm (p < 0.05), and significantly higher dominant frequency of beta2 rhythm (p < 0.05). The dominant frequency and the maximum amplitude of the alpha-rhythm are parameters corresponding to significant coefficients of the regression analysis. A negative relationship was found between the degree of error during sensorimotor tracking and the frequency and amplitude of alpha-rhythm.Conclusion. Regression models present the relationship between the level of efficiency and the alpha-rhythm severity. The regression equations make it possible to determine the functional state of the subject using an electroencephalogram.

OBJECTIVE:To evaluate the efficacy of the drug Tolperisone (Calmirex) in patients with inferior cross syndrome against the background of standard therapy.MATERIAL AND METHODS:The study involved male and female patients aged 25-55 years with inferior cross syndrome. The main research method was clinical, which was supplemented by biomechanical examination and the use of scales and questionnaires (VAS, Oswestry, McGill).RESULTS AND CONCLUSION:The effectiveness of the use of muscle relaxants in the treatment of the lower cross syndrome has been studied and proved with the identification of the most reliable and effective methods for correcting this pathology. The effectiveness of the use of muscle relaxants in the treatment of lower cross syndrome was studied, with the identification of the most reliable and effective methods for correcting this pathology. The presented clinical study of biomechanical and statodynamic disorders of the musculoskeletal system in myofascial pain syndromes, taking into account the peculiarities of the lesion of the sanogenetic and pathogenetic region, will be useful in prescribing personalized treatment not only for neurologists, but also for primary care physicians, chiropractors, osteopaths, rheumatologists and rehabilitologists.

Back pain is one of the most common pain syndromes affecting significantly working capacity and quality of life. In the future, back pain is predicted to grow due to a higher rate of comorbidities and conditions (i.e., obesity, smoking, sedentary lifestyle) and population aging. Therefore, back pain relief is an essential issue for various specialists. However, despite a growing body of studies and published data, the issue of the management of patients with back pain is far from being resolved. This paper discusses the efficacy and safety of various therapeutic strategies for back pain treatment, focusing on B vitamins. Analgesic properties plus the enhancement of painkiller effects and lower risk of pain chronicity (as a result of reduced peripheral and central sensitization) favor including B vitamins into treatment regimens for back pain. The authors also address non-pharmacological approaches to back pain and emphasize that a long-lasting effect of analgesics cannot be achieved without switching from reducing acute pain to preventing future exacerbations. KEYWORDS: back pain, B vitamins, biopsychosocial model, adjuvant treatment, manual therapy. FOR CITATION: Kurushina O.V., Barulin A.E. Back pain: easy is the new difficult? Russian Medical Inquiry. 2021;5(10):642–647 (in Russ.). DOI: 10.32364/2587-6821-2021-5-10-642-647.