[Personalized patient-oriented approach to the treatment of musculoskeletal pain syndrome using over-the-counter medications. Resolution of the Expert Council (May 28, 2023)]. / Personalizirovannyi patsientoorientirovannyi podkhod k lecheniyu skeletno-myshechnogo bolevogo sindroma s ispol'zovaniem bezretsepturnykh preparatov. Rezolyutsiya ekspertnogo soveta (28 maya 2023 g.).

Diseases of the musculoskeletal system in Russia affect 19.2 million people. Untimely diagnosis and inadequate therapy of pain syndrome negatively affect the daily functioning and quality of life of patients, and create significant socioeconomic problems. The most common variants of musculoskeletal pain (MSP) are osteoarthritis (OA) and low back pain (LBP). OA is seen in 57.6% of individuals over 65 years of age. It should be noted that chronic pain syndrome, rather than anatomical and degenerative changes detected by imaging studies, determines to a greater extent the quality of life of patients with OA and prognosis during the course of the disease. The global burden of disability associated with LBPD increased in all age groups between 1990 and 2019 and was highest in the 50-54 age group.

[B vitamins and brain dysfunction]. / Vitaminy gruppy B i mozgovaya disfunktsiya.

An unbalanced diet and some other factors are the reason for the extreme prevalence of hypovitaminosis among the population of both developing and developed countries. The metabolic relationships of B vitamins determine the more frequent occurrence of poly-, rather than monovitamin deficiency. Since B vitamins play an important role in the processes of energy production and in the functioning of neurotransmitter systems, the first symptoms of such polyhypovitaminosis are signs of brain dysfunction: asthenia, depression, anxiety, cognitive disorders. Correct diagnosis of polyhypovitaminosis based on the identification of risk groups of patients and the determination of their subclinical or early manifesting signs of brain dysfunction is the most important task of a practicing physician. Detection of insufficient intake and vitamin content, as well as verification of the onset of symptoms of brain dysfunction and the appointment of adequate therapy can significantly increase the effectiveness of treatment, as well as prevent asthenic, psycho-emotional and cognitive disorders in patients with polyhypovitaminosis.

[Topical therapy of acute nociceptive pain: results of an open randomized clinical trial of the domestic drug Alental cream]. / Topicheskaya terapiya ostroi notsitseptivnoi boli: rezul'taty otkrytogo randomizirovannogo klinicheskogo issledovaniya otechestvennogo preparata Alental' krem.

OBJECTIVE: Evaluation of the therapeutic efficacy, safety and tolerability of the drug Alental cream for external use (VERTEX, LLS, Russia) compared with the original drug - Aertal cream for external use (Gedeon Richter, LLS, Hungary) for local therapy of acute nociceptive pain syndrome in patients who have suffered traumatic ankle injury. MATERIAL AND METHODS: The study included 131 patients who had suffered an injury to the soft tissues of the ankle joint. The 1st comparison group received the drug Alental cream, the 2nd group - Aertal cream. The duration of therapy was 7 days. The effectiveness of the drugs was evaluated during treatment based on the dynamics of the intensity of pain syndrome and other symptoms of trauma, as well as the assessment of these changes by the doctor and the patient. The safety analysis included the registration of adverse events according to clinical and laboratory studies. RESULTS: Alental cream in terms of therapeutic efficacy was equivalent to the registered original preparation Aertal cream. The analysis of the assessment of the dynamics of clinical and laboratory parameters, the safety of treatment, including the frequency of adverse events, did not reveal significant differences between the two drugs. CONCLUSIONS: Alental cream can be used as a means for local therapy of acute nociceptive pain syndrome in traumatic soft tissue injuries.

[Pain, emotion, cognition. Pathogenetic relationships and effects of therapy with nonsteroidal anti-inflammatory drugs]. / Bol', emotsii i kognitsii. Patogeneticheskie vzaimosvyazi i effekty terapii nesteroidnymi protivovospalitel'nymi preparatami.

OBJECTIVE: To study the dynamics of pain intensity in comparison with changes in the severity of depression and cognitive deficits when using non-steroidal anti-inflammatory drugs and/or central muscle relaxants in patients with chronic non-specific back pain. MATERIAL AND METHODS: Sixty patients (26 men and 34 women), aged 42 to 59 years, with chronic non-specific back pain were examined. All patients were divided into three groups. In the first group, dexketoprofen was used at a dose of 75-100 mg per day for 10 days. Patients of the second group received dexketoprofen according to a similar scheme, as well as tolperisone (200-450 mg per day) for 30 days. Patients of the third group took diclofenac sodium (100 mg per day) for 10 days. The intensity of pain, its affective component, the severity of asthenic, depressive, anxiety manifestations and cognitive disorders were tested at baseline and on the 10th and 30th days. RESULTS: Pain significantly decreased in all patients, more significantly in the first and second groups. The analgesic effect in the first and third groups was unstable, and the improvements achieved by the last test were partially reduced. In patients of the first and second groups, regression of anxiety and depressive symptoms was observed from day 10 to the end of observation. At the same time, the emotional assessment of pain in patients of the first group decreased by the 10th and increased by the 30th day of observation. By the end of the study, patients of the second group showed positive dynamics of indicators of asthenia and cognitive disorders. CONCLUSIONS: The most effective analgesic therapy using a combination of dexketoprofen and tolperisone was accompanied by a positive dynamics of depressive manifestations and cognitive disorders. The choice of an algorithm for treating pain should take into account the need and possibility of treatment its biological and psychological (affective, cognitive) components.

[Tardue scales in the diagnostic of spasticity]. / Shkala Tard'e v diagnostike spastichnosti.

Diagnosis, treatment and rehabilitation of patients with spasticity remain a challenge, in which standard methodological approaches have not yet been developed. One of the most promising solutions to this problem is the use of the Modified Tardieu scale (MTS). The article describes the method of working with MTS tested in the examination, treatment and rehabilitation of patients with acute cerebrovascular accident (n=112) and patients with multiple sclerosis (n=17). The original version of MTS has been translated into Russian. The use of MTS assessment system allows the diagnosis of the main elements of the clinical picture of the damage to the central nervous system, such as paresis, spasticity, violation of proprioception, as well as the qualitative and quantitative assessment of the dynamics of rehabilitation and treatment of spasticity with botulinum neurotoxin (BoNT).

[Manual differential diagnosis of migraine and cervicogenic headache]. / Manual'naia differentsial'naia diagnostika migreni i tservikogennoi golovnoi boli.

AIM: To study the informative nature of manual therapy for differential diagnosis of migraine and cervicogenic headache (CH). MATERIAL AND METHODS: The authors analyze two clinical cases of patients with a previously established diagnosis of migraine, with the duration of the disease of over ten years and neuroimaging signs of degenerative-dystrophic changes in the upper cervical spine. In both cases, there was no hereditary history and low efficacy of the previous drug therapy was noted. The informative value of the tests performed by methods of manual medicine followed by manipulation procedures of neck structures for the differential diagnosis of migraine and CH was assessed. RESULTS: Despite the absence of complaints, both patients demonstrated the limitation of the volume of neck movements during the tests performed by methods of manual medicine. After a course of manipulation procedures, headaches in both patients were completely stopped for a period of six to ten months. The analysis of literature suggests that manipulative effects on neck structures in cases of migraine can reduce the intensity and the duration of pain, and the frequency of attacks by no more than 20%. The therapeutic effectiveness of manual therapy for CH is much higher; this method provides an opportunity to reduce the severity of these pain characteristics by 30-80%. These results are the basis for changing the previously established diagnosis to CH. CONCLUSION: The complex of diagnostic and therapeutic techniques of manual therapy is an important tool for the differential diagnosis of migraine and CH.

[Combination of central and peripheral muscle relaxants in the treatment of post-stroke spasticity]. / Kombinatsiia miorelaksantov tsentral'nogo i perifericheskogo deistviia v lechenii postinsul'tnoi spastichnosti.

AIM: To study the electromiographic (EMG) parameters and to evaluate the therapeutic efficacy of a combination of central (baclofen, baclosan) and peripheral (incobotulotoxinA, xeomin) muscle relaxants in the treatment of post-stroke spasticity (PSS). MATERIAL AND METHODS: Ninety-six patients with PSS of upper and lower limbs were divided into 2 groups: the first group (n=56) was treated with xeomin and the second (n=40) received combined therapy of xeomin and baclofen. Xeomin was administered according to the pattern of spasticity. The total dosage reached 800 U. Baclofen was used orally in a dose of 10 mg 3 times a day. The scales of paresis and spasticity assessment (MRCS, MAS and Tardieu), activity and participation of patients in everyday life (Bartel, Rankin, Rivermead mobility Index, comfortable walking test, LASIS) were used. EMG and transcranial magnetic stimulation (TMS) were performed. M-response, H-reflex, F-wave, central conduction time were determined. The total duration of the study was 120 days. Patients were assessed at 4 points. RESULTS AND CONCLUSION: Potentiation of peripheral and central muscle relaxants and prolongation of the effect of xeomin was revealed (it was expressed in the reduction of the number of injection sessions from 7-8 to 5-6). The use of xeomin in a total dosage of up to 800 U has shown its efficacy and safety for the treatment of spasticity of the upper and lower limbs. The results of EMG and TMS shed a light on the mechanisms of the therapeutic effect of combined (xeomin+baclosan) and monotherapy (xeomin) spasticity.

[Spasticity: from pathophysiology to treatment]. / Spastichnost': ot patofiziologii k lecheniiu.

The article presents modern views on the pathophysiology of spasticity, which is a frequent disabling consequence to the upper motor neuron (UMN) damage. Morphological and functional system of motion organization and the changes after the UMN damage is considered. The authors analyze existing definitions of spasticity. Stages of spasticity development are described in the context of neuroplasticity as well as in the framework of pathogenesis and sanogenesis. Existing ideas of its pathogenesis are compared with the typical clinical symptoms. The occurring pathological processes in muscles, tendons and joints that can aggravate the development of spasticity and complicate the diagnosis are considered. In addition, the main pathological spasticity patterns are described and the current development of diagnostic techniques is estimated. A review of main methods of spasticity treatment is presented. Special attention is paid to the botulinum neurotoxin type A (BoNT) preparations and central action muscle relaxants. The pathophysiological basement for complex treatment of spasticity as a part of the general rehabilitation process is given, so that the BoNT can be considered as the obligatory element of standard rehabilitation programs.

[Comorbidity of type 2 diabetes mellitus and low back pain]. / Komorbidnost' sakharnogo diabeta 2-go tipa i boli v spine.

Diabetes mellitus (DM) and back pain are widespread and often develop simultaneously. In patients with DM 2 type, the incidence of back pain is increased. The association of DM with the severity of pain and the frequency of its chronization and recurrence has been revealed. The most likely mechanism of such an association is the lesion of intervertebral discs mediated by the accumulation of advanced glycation end-products (EGP). In DM the concentration of EGP increases significantly; they initiate ectopic calcification, a decrease in cell density in the end plates, and changes in vertebras. Cells of the pulpous nuclei begin to produce pro-inflammatory cytokines and chemokines that trigger the processes of angio- and neurogenesis. Dorsopathies develop due to other etiological factors, but the mechanisms of systemic inflammation are similar. Thus, DM and back pain are comorbid pathologies with common elements in pathogenesis. To prevent the development of dorsopathy in DM 2 type it is considered promising to use drugs that reduce the intensity of accumulation of AGP and inhibitors of pro-inflammatory cytokines, for example, symptomatic slow acting drugs.

[Primary headache - risk factor or comorbid pathology in cognitive impairment]. / Pervichnaia golovnaia bol' - faktor riska ili komorbidnaia patologiia pri kognitivnykh narusheniiakh.

Currently, the relationship between headache and dementia is considered more widely than just a comorbidity. The severity of migraine and tension-type headache and the severity of cognitive impairment are strongly correlated. Common pathophysiological mechanisms underlie the relationship between primary headache and cognitive impairment. Antinociceptive changes in primary headaches and in glutamate excitotoxicity in dementia developed due to hyper excitability of NMDA receptors are strongly interdependent. It is important in the aspect of possible correction of this pathology by NMDA-antagonists. Memantine not only slows the progression of cognitive symptoms in dementia, but also significantly influences the frequency and severity of primary headache.

[Pathogenetic aspects of the use of cytoflavine in the treatment of сhronic post-traumatic headache]. / Patogeneticheskie aspekty primeneniya tsitoflavina v lechenii khronicheskoi posttravmaticheskoi golovnoi boli.

AIM: To evaluate the results of using cytoflavin in the treatment of chronic post-traumatic headache and analyze possible mechanisms for implementation of therapeutic effects of the drug. MATERIAL AND METHODS: The study included 76 patients (23 men and 53 women) aged 29 - 57 years (mean age - 38.2 ± 8.3). All patients received standard basic therapy with simple or combination analgesics. In addition to standard treatment, 36 patients received cytoflavin in the dosage of two tablets twice a day for 30 days. Results and сonclusion. At the beginning, at the end and 25 days after the completion of treatment, the intensity and frequency of headache as well as the severity of asthenic and depressive symptoms were analyzed. As a result of treatment in the cytoflavin group, there was a significant regression of asthenic and depressive symptoms, which was consistent with the previous studies. Positive changes in the indicators analyzed were correlated with the decrease in the frequency of cephalalgia. Since cytoflavin has no analgesic properties, the results are indirect evidence for the significance of psychopathological factors in the pathogenesis of chronic post-traumatic headache.

[Systematization of primary headache: current and future prospects].

The article is devoted to the current state of the problem of systematization of primary headaches and main clinical forms. The conceptual evolution of ideas about the classification of certain options of cephalgia and identified major trends for its improvement is given. Verification of types and subtypes of individual cephalgia can present a significant challenge even for experienced neurologists, neurosurgeons, and internists. In this regard in most European countries and the US. have set up specialized centers for the treatment of headaches. Concluded that in the short term in the national health care system, including. Including the Armed Forces, it is advisable to create such centers.

[Structural changes in the sensory ganglia of the spinal nerves after repeated magnetic stimulation on the model of ischemic myelopathy].

The aim of this study was to examine the association of morphological changes in the-sensory ganglia of the spinal nerves (SGSN) with the cilinical symptomatology in rats with the experimentally induced ischemic myelopathy (IM), untreated or treated with repeated magnetic stimulation (RMS). The efficacy and mechanisms of RMS action on SGSN were studied by electron microscopy in 16 rats with IM. According to the results of treatment, in SGSN both at a distance from the damaged area (lumbar SGSN) and close to it (cervical SGSN) the morphological signs of regenerative-reparative processes were found in the cells and nerve fibers (restoration of the organelle structure in the cytoplasm o0f neurons and neurolemmocytes, the increase in the number of he latter and fiber remyelination). The expression of the structural changes correlated with the degree of functional recovery.

[The analysis of structural changes and functional characteristics in condition of vascular cerebral lesions].

To 61 patient with vascular diseases of a brain the analysis of structurally functional changes and degrees of conformity to their clinical manifestations is conducted. For 53 patients the correlative connection between clinicotopical and neurophysiological data was detected. In 8 cases the outcomes under the clinical data corresponded to topical consept about localization of the lesion focus. However, the signs of discrepancy were detected by comparison them with neurovisualization methods. Taking into consideration the obtained data the assumption about a capability of secondary neurodynamic focuses formation is permissible in patients with cerebral vessel lesions.