CLINICAL AND DIAGNOSTIC SIGNIFICANCE OF THE ANATOMICAL SHORT LEG

В статье изучены клинические и диагностические значимости анатомической короткой ноги у 150 пациентов с деформацией стоп, патологией крупных суставов нижних конечностей, а у 24 пациентов было произведено эндопротезирование тазобедренных и коленных суставов. Они страдали хроническими болевыми синдромами, принимали консервативное лечение без эффекта. У всех наблюдавшихся при обследовании выявили наличие разницы в длине ног в 10 и более мм, соответственно перекоса таза с искривлением позвоночника. Одной из основных причин асимметрий осанки, повышенной утомляемости и хронических болей опорно-двигательной системы является нераспознанная структуральная разница в длине ног. При такой ситуации всякое мануальное и фармакологическое лечение носит лишь симптоматический характер. Решение механической проблемы требует механического подхода путем биомеханической коррекции с помощью индивидуальных ортезов стопы по системе Формтотикс. The article describes the clinical and diagnostic significance of the anatomical short leg in 150 patients. Hip and knee arthroplasty was performed in 24 patients. The patients had chronic pain syndrome. All those observed during the examination revealed the presence of a difference in the length of the legs of more than 10 mm. In this situation, pharmacological treatment is symptomatic. One of the solutions to the problem is to correct the difference in leg length with the help of individual Formtotics orthoses.

PHARMACY CONSULTING: NEW DRUG FORMS AND NEW OPPORTUNITIES

Pain syndrome of various origins and varying intensity is the most common and leading reason for seeking medical care in the world. The main drugs for the relief of both acute and chronic pain syndrome from the 20th century to the present are non- steroidal anti-inflammatory drugs (NSAIDs). More than 30 million people worldwide receive them every day. Along with pain, other common indications for NSAIDs are fever and inflammation. All NSAIDs differ in the degree of effectiveness, form of release, speed of onset of clinical effect and dosage. That is why one of the fundamental tasks of the pharmacist, in the framework of pharmacy counseling, is to provide the patient with quality medicines and teach them how to use them rationally. With the rapid development of medical and information technologies in the modern world, the fulfillment of this task becomes more and more important, complex and responsible action. The appearance, on the pharmaceutical market innovative NSAIDs in accelerated-release dosage’s forms (for example, Ketorol® Express), makes it possible to expand the pharmacy list.

Prevalence of chronic pain syndrome in patients who have undergone hallux valgus percutaneous surgery: a comparison of sciatic-femoral and ankle regional ultrasound-guided nerve blocks

Background Chronic pain syndrome (CPS) is a common complication after operative procedures, and only a few studies have focused on the evaluation of CPS in foot-forefoot surgery and specifically on HV percutaneous correction. The objective of this study was to compare postoperative pain levels and incidence of CPS in two groups of patients having undergone femoral-sciatic nerve block or ankle block regional anaesthesia before hallux valgus (HV) percutaneous surgery and the association between postoperative pain levels and risk factors between these patient groups. Methods A consecutive patient series was enrolled and evaluated prospectively at 7 days, 1, 3 and 6 months after surgery. The participants were divided into two groups according to the regional anaesthesia received, femoral-sciatic nerve block or ankle block, and their outcomes were compared. The parameters assessed were postoperative pain at rest and during movement by the numerical rating scale (NRS), patient satisfaction using the Visual Analogue Scale (VAS), quality of life and return to daily activities. Statistical analysis was performed. Results One hundred fifty-five patients were assessed, 127 females and 28 males. Pain at rest (p < 0.0001) and during movement (p < 0.0001) significantly decreased during the follow-ups; at 6 months, 13 patients suffered from CPS. Over time, satisfaction remained stable (p > 0.05), quality of life significantly increased and patients returned to daily activities and work (p < 0.0001). No significant impact of type of anaesthesia could be detected. ASA 3 (p = 0.043) was associated to higher pain during movement; BMI (p = 0.005) and lumbago (p = 0.004) to lower satisfaction. No operative-anaesthetic complications were recorded. Postoperative pain at rest and during movement improved over time independently of the regional block used, with low incidence of CPS at last follow-up. Among risk factors, only a higher ASA was associated to higher pain during movement, while higher BMI and lumbago to lower satisfaction. Conclusions Both ultrasound-guided sciatic-femoral and ankle blocks were safe and effective in reducing postoperative pain with low incidence of CPS at last follow-up. Trial registration Clinical Trial NCT02886221. Registered 1 September 2016.

Sleep disorders and their correction in patients with chronic back pain

Back pain and insomnia (insomnia) significantly impair the quality of life of patients. Pain contributes to the development of sleep disorders and vice versa, poor quality sleep increases pain. Sleep disorders are widespread in the population, and in chronic pain syndrome, almost 70% of patients suffer from insomnia. The National Sleep Association singles out pain as one of the leading causes of sleep disorders. The article discusses a typical clinical case of the combination and interaction of chronic pain syndrome and insomnia. A patient with acute back pain developed a sleep disorder for which therapy was not carried out. The prescribed standard therapy for back pain, which included a non-steroidal anti-inflammatory drug, muscle relaxant, made it possible to relieve pain in a short time. However, the patient’s insomnia not only persisted, but also progressed, which led to the appearance of symptoms of asthenia in the form of fatigue, irritability, decreased performance, and ultimately significantly reduced the quality of life. In order to normalize sleep, the patient was prescribed a histamine H1 receptor blocker from the ethanolamine group, namely the drug Doxylamine. Follow-up observation for 1 year showed no exacerbation of back pain and sleep disturbances. In the treatment of patients with chronic back pain, it is necessary to pay attention to the presence of sleep disturbances and provide appropriate therapy. Today, three groups of hypnotics are used in clinical practice: melatonin receptor agonists (insufficient effectiveness in acute sleep disorders), benzodiazepines (addictive and addictive), and antihistamines. The modern drug Doxylamin belongs to the group of antihistamine hypnotics, has a good efficacy and safety profile and is included in the domestic recommendations for the treatment of insomnia.

Visual Sequential Search Test Analysis: An Algorithmic Approach

In this work we present an algorithmic approach to the analysis of the Visual Sequential Search Test (VSST) based on the episode matching method. The data set included two groups of patients, one with Parkinson’s disease, and another with chronic pain syndrome, along with a control group. The VSST is an eye-tracking modified version of the Trail Making Test (TMT) which evaluates high order cognitive functions. The episode matching method is traditionally used in bioinformatics applications. Here it is used in a different context which helps us to assign a score to a set of patients, under a specific VSST task to perform. Experimental results provide statistical evidence of the different behaviour among different classes of patients, according to different pathologies.

Entitlement to cover for chronic pain syndrome under the Accident Compensation Scheme

<p>Sufferers of primary chronic pain syndrome are not currently entitled to cover from New Zealand's Accident Compensation scheme. The Supreme Court decision in Allenby v H, which adopted a wider interpretation of the term "physical injury", presents an opportunity for the courts to reconsider whether chronic pain syndrome should constitute an injury. Policy factors, particularly the need to uphold the integrity of the legislation enacted by Parliament, demand that the status quo exclusion of chronic pain syndrome is maintained. A legislative amendment which clarifies this position is recommended.</p>

Entitlement to cover for chronic pain syndrome under the Accident Compensation Scheme

<p>Sufferers of primary chronic pain syndrome are not currently entitled to cover from New Zealand's Accident Compensation scheme. The Supreme Court decision in Allenby v H, which adopted a wider interpretation of the term "physical injury", presents an opportunity for the courts to reconsider whether chronic pain syndrome should constitute an injury. Policy factors, particularly the need to uphold the integrity of the legislation enacted by Parliament, demand that the status quo exclusion of chronic pain syndrome is maintained. A legislative amendment which clarifies this position is recommended.</p>

The Effect of Psychodrama on Fibromyalgia Syndrome: A Case Report

Fibromyalgia Syndrome (FMS) is a chronic pain syndrome that often coexists with common musculoskeletal pain, sleep disorders, bowel syndrome, mood disorders, and fatigue. Although the aetiology of FMS pain has not been elucidated yet, psychotherapy methods are used in addition to physical methods to treat these pains. This study aims to examine the effect of psychodrama on a 62-year-old patient with back and chest pain and who lived alone. This patient participated in psychodrama group psychotherapy with 8 members who were all female and diagnosed with FMS. An informed consent form was obtained from the case for the study. This research is important because there are very few studies on fibromyalgia complaints with psychodrama group therapy, and it contributes to the literature. Studying the case with past trauma and losses in the psychodrama scene has led to a significant reduction in fibromyalgia complaints. As a result, the patient's pain level decreased from 90% to 32.5%, and the anxiety level decreased from advanced to normal. Thus, psychodrama group psychotherapy was found to be effective in reducing FMS pain.

A patient with chronic pain syndrome

This article describes a clinical case of a patient with chronic pain syndrome on the background of osteoarthritis, with a history of joint replacement. The reason for hospitalization was a fall, after which a constant pain syndrome persisted and a neuropathic component joined, which the patient could not stop with anything.As a result of a comprehensive geriatric assessment, the patient was diagnosed with frailty and the following geriatric syndromes: mild dependence on outside help, chronic pain syndrome, balance disorders, falls, stress urinary incontinence. Non-drug methods of treatment and complex therapy (gabapentin + B vitamins + uridine) and antiosteoporetic therapy were recommended, against which the intensity of the pain syndrome decreased to a mild degree (according to the VAS scale of 2 points at the time of discharge) and a decrease in neuropathy copatterns was noted.

Pharmacoeconomic analysis of the application of strong opioids for the treatment of chronic pain syndrome in patients with pancreatic cancer

Objective: to evaluate the clinical and economic feasibility of opioid therapy based on the analysis of its cost and effectiveness in patients with chronic pain syndrome in pancreatic cancer.Material and methods. An observational prospective study in parallel groups of patients with chronic pain syndrome associated with pancreatic cancer was carried out. The analysis of cost minimization and cost-effectiveness was applied, as well as pharmacoeconomic modeling, which included the construction of a decision tree in patients receiving morphine sulfate (n=45) and fentanyl TTS (n=45) for pain relief. The sensitivity of the obtained data was assessed using one-way analysis.Results. It was shown that the treatment of chronic pain syndrome in patients with pancreatic cancer with opioid analgesics as part of combined treatment is the least expensive in the morphine sulfate group (incremental cost-effectiveness ratio 144.93). Based on the results of modeling, the prognostic factors of influence on the cost of analgesic therapy were determined: the cost of combined analgesic therapy, the cost of treatment of adverse reactions, and the cost-effectiveness ratio.Conclusion. Analgesic therapy of chronic pain syndrome with morphine sulfate in patients with pancreatic cancer is pharmacoeconomically feasible.