No 7 (2017)

Lumbal pain syndrome caused by degenerative vertebral column pathology is one of the most often reasons for applying for both outpatient and inpatient care; also it is one of the most common temporary disability reason. One of the basic ground for lumbal pain syndrome occuring is osteoartritis, damaging mainly the small joints of vertebral column. Modern possibilities of treatment lumbal pain patients by means of slow-acting medicaments' use (SYSADOA) for symptomatic treatment of osteoarthritis are considered. Data concerning the efficacy of medicine Artra use for lumbal pain patients are also considered.

Musculoskeletal pain accounts for about a third of all acute and chronic pain syndromes and is one of the most common reasons for patients to seek help from specialists of various profiles. However, the use of non-steroidal anti-inflammatory drugs does not always eliminate pain in the myofascial pain syndrome, which necessitates the use of co-analgesics. In the article the possibilities of muscle relaxant tolperisone in therapeutic and surgical practice in the treatment of myofascial pain syndrome at the stage of providing primary health care are considered.

Complex regional pain syndrome is the least studied syndrome of chronic neuropathic pain, manifesting itself by constant intensive pain in extremity in combination with local vegetative disorders and trophic disturbances. Mostly it arises after different peripheral traumas. Therapy of pain syndrome is one of the most significant and difficult aspects of complex regional pain syndrome therapy. There are not so many scientific data, proving the efficacy of complex regional pain syndrome pharmacotherapy. From the viewpoint of evidentary medicine, for such a purpose could be effective anticonvulsant drugs, corticosteroids, biophosphonates and ketamine. Recommendations for opioids use, use of calcitonine, anti-depressants and also sympathetic blocks are ambiguous. No one of the separately used methodics of pharmacological, physical and psychological treatment could not be compared for its efficacy with interdisciplinary complex approach of curation patients with chronic pain syndromes. Complex biopsychosocial rehabilitation is more effective for restarting daily and working activity of patients.

Chronic pain is one of the most challenging issues of modern neurology, which is caused by the widespread prevalence of pain syndrome accompanying various diseases, especially among the working age population, negatively affecting patients' quality of life. The pathophysiology of chronic pain has been well studied and a wide range of drugs is currently being used both for relief of acute pain and for the treatment of chronic pain. Nevertheless, there is a need for the use of analgesics with high analgesic activity, which are capable of providing a continuous analgesic effect, having a narrow spectrum of adverse effects and simple to use in practice. A powerful opioid analgesic fentanyl meets these requirements. For many years fentanyl TTS has been used primarily for relief of cancer chronic pain. Now the use of fentanyl TTS is increasingly considered for non-cancer chronic pain. This article presents the results of using fentanyl TTS for chronic vertebral pain syndrome and osteoarthritis.

The article provides the analysis of models of relationship between the neurologist and the patient with chronic pain. Advantages of shared decision making model are shown.

The review is devoted to the problem of alcohol polyneuropathy (APNP) and includes the data about its prevalence, clinical characteristics and pathogenetic mechanisms. Also modern strategies of APNP treatment including pathogenetic therapy by α-lipoic acid, medicine use are considered. It is specially accentuated, that in case of APNP therapeutic measures are more effective at asymptomatic stage of the disease when peripheral nerves' damage is reversible.

Gastroesophageal reflux disease is one of the most common chronic pathology of digestive system. Modern diagnostical methods and timely treatment let to prevent the progression of the disease and development of its life-dangerous complications. Gastroesophageal reflux disease treatment should include combined therapy based on proton pump inhibitors, antacids/alginates and prokinetics. At the same time, multicomponent mechanism of bismuth medicaments' action provides the defence of mucosal tunica from different harmful damaging factors, and their antihelicobacter activity lets to overcome Helicobacter pylori’s resistance to antibiotics increasing the efficacy of pharmacotherapy.

Trimetazidine is related to those medicaments, which mechanism of action is aimed at myocardium metabllism improvement. The main mechanism of action of the medicine is connected with its possibility to suppress long-chain mitochondrial 3ketoacyl-coenzyme A-tiolaze, due to which fatty acids' pinch and oxydation are suppressed with sumultaneuos activation of glucose metabolism. Trimetazidine farmacological characteristics are considered, results of its clinical trials are discussed. Obtaind data prove, that the medicine can be used for curation of patients with different diseases, firstly cardiovascular diseases, in particular for stable stenocardia treatment, and also in case of stenocardia and diabetes melitus combination. The ability of trimetazidine to normalyze metabolic processes is fixed. That, possibly, slows the heart remodelling down.