Pain syndrome accompanies absolute majority of diseases, therefore problems of adequate anesthesia remain acute not only for urgent conditions but also for everyday medical practice. Modern approaches of anesthetic therapy should consider not only pathogenic mechanisms of evolving pain syndrome by a certain patient but also necessity to administer drug combinations. It allows potentiating an analgesic effect, to decrease effective dosages of individual drugs and minimize adverse effects. The administration of non-steroidal anti-inflammatory drugs together with B vitamins and tolperisone is justified in a marked pain syndrome with a spastic component and/or spasms of skeletal muscles, muscle contractures, myofascial pain syndromes, as well in rehabilitation therapy after orthopedic and traumatology surgeries. The article considers pathogenic details of such combined therapy, discloses mechanism of synergic action of the proposed drug combination.
Distal symmetric painful diabetic neuropathy is the most frequent clinical form of diabetic neuropathy. The condition appears as a result of alteration of the structure and function of nervous fibres as a consequence of hyperglycaemia. Hyperglycaemia determines the metabolism of glucose on alterative pathways and generates increased oxidative stress, mechanisms that cause an accelerated apoptosis of the neurons and a high intensity of lipid peroxidation. Pathogenic treatment of diabetic neuropathy includes limited options, two of them are: Benfotiamine (inhibits the metabolism of glucose on hexosamine pathway, reducing the formation of advanced glycosylation end products) and alpha-lipoic acid (has a scavenger effect on free radical species). The study included 120 patients with distal symmetric painful diabetic neuropathy randomized in 3 treatment groups. We evaluated the effect of oral administration for 8 weeks of Benfotiamine in a dosage of 300mg/day in monotherapy, of alpha-lipoic acid in a dosage of 600 mg/day in monotherapy, respectively of both -in combined therapy - on the parameters that are used to determine the severity of distal symmetric painful diabetic neuropathy: Diabetic Neuropathy Symptoms score, Neuropathy Disability Score and the intensity of lower limb pain on the visual analogue pain scale. All the three therapies were effective with a statistically significant improvement of these parameters, but the combined therapy with alpha-lipoic acid and Benfotiamine was superior to the monotherapy with alpha-lipoic acid or Benfotiamine.
The issues of structural organization, function and diagnosis of diseases of the temporomandibular joint have long attracted the attention of not only morphologists, dentists, maxillofacial surgeons, but also doctors of related specialties. Temporomandibular disorders are among the most common non-odontogenic pain syndromes in the maxillofacial region and are considered a variant of musculoskeletal pain syndrome. Based on the analysis of the results of clinical and functional studies, an algorithm for the management of patients with terminal dentition defects complicated by signs of painful dysfunction of the temporomandibular joint was proposed. Therapeutic measures, depending on the degree of painful dysfunction of the temporomandibular joint, included the following stages: occlusive splint therapy; physiotherapy treatment with dynamic electroneurostimulation; prosthetic treatment of end defects of the dentition; stabilization of the spatial relationship of the jaws. Complex therapeutic measures are aimed at normalizing the functional activity of the dentoalveolar apparatus by restoring the uniform distribution of the occlusal load.
This chapter on neuropathic pain discusses the classification, clinical features, and evidence-based management of major neuropathic pain syndromes (painful polyneuropathy, diabetic neuropathy, post-herpetic neuralgia, HIV neuropathy, cancer neuropathic pain, phantom pain, traumatic neuropathic pain, chronic radiculopathy, central neuropathic pain, and trigeminal neuralgia).
The analysis of treatment efficiency of the patients with muscular-tonic pain syndrome of lumbosacral localization who were in outpatient treatment at the Department of therapy of pain syndromes at Russian B.V. Petrovsky Scientific Center of Surgery was carried out. Therapy was carried out in two groups. Patients of the 1st group received the Tizanidine 4-8 mg/day, the reflex therapy in 4-6 sessions each day or at intervals of 1-2 days was used for patients of 2nd group. The authors evaluated the effectiveness of complementary application of reflex therapy. The use of reflex therapy can improve the effectiveness of the treatment.
Combined therapy of pain syndromes: rationale and prospects for potentiation of effects