Pain medicine 2019-03-05T22:40:37+02:00 Oleksandr Marchuk Open Journal Systems <p>"Medicina bolu" is a science-and-practice periodical for medical professionals. The main highlighting issue is pain, but not the only one, because in medicine there are no situations where a phenomenon is strictly isolated. Sign up for a print edition and follow up on the site to keep up with important and useful information.</p> <p>Thematic interests of the journal<br>Fundamental aspects of pain (clinical physiology, pathophysiology, pharmacology).<br>Applied aspects of pain (epidemiology, pain assessment, innovative methods of diagnosis and treatment, clinical pharmacology).<br>Clinical aspects of pain (acute pain, chronic pain, perioperative pain, posthumous pain, neuropathic pain, dysfunctional pain).<br>Clinical and anatomical approach to pain (headache, orofacial pain, neck and back pain, toothache, musculoskeletal pain, myofascial pain, fibromyalgia, visceral pain, pelvic pain, cardialgia, etc.).<br>Interdisciplinary approach to pain (in anesthesiology, in surgery, in pediatrics, neurology, vertebrology, in the clinic of internal diseases, oncology, rheumatology, gerontology, gastroenterology, traumatology and orthopedics, otorhinolaryngology, dentistry, obstetrics, gynecology and urology, in the palliative and hospice medicine).<br>Treatment and rehabilitation of patients suffering from pain (pharmacotherapy, physical rehabilitation, medical rehabilitation, alternative methods of treatment, means of psychological and psychotherapeutic influence, invasive methods of pain relief, organization of pain relief).<br>Separate clinical cases and their clinical examination.</p> Fundamentals of the modern theory of the phenomenon of "pain" from the perspective of a systematic approach. Neurophysiological basis. Part 1: A brief presentation of key subcellular and cellular ctructural elements of the central nervous system. 2019-03-05T21:46:21+02:00 V I Poberezhnyi O V Marchuk O S Shvidyuk I Y Petrik O S Logvinov <p>The phenomenon of “pain” is a psychophysiological phenomenon that is actualized in the mind of a person as a result of the systemic response of his body to certain external and internal stimuli. The heart of the corresponding mental processes is certain neurophysiological processes, which in turn are caused by a certain form of the systemic structural and functional organization of the central nervous system (CNS). Thus, the systemic structural and functional organization of the central nervous system of a person, determining the corresponding psychophysiological state in a specific time interval, determines its psycho-emotional states or reactions manifested by the pain phenomenon.</p> <p>The nervous system of the human body has a hierarchical structure and is a morphologically and functionally complete set of different, interconnected, nervous and structural formations. The basis of the structural formations of the nervous system is nervous tissue. It is a system of interconnected differentials of nerve cells, neuroglia and glial macrophages, providing specific functions of perception of stimulation, excitation, generation of nerve impulses and its transmission.</p> <p>The neuron and each of its compartments (spines, dendrites, catfish, axon) is an autonomous, plastic, active, structural formation with complex computational properties. One of them – dendrites – plays a key role in the integration and processing of information.</p> <p>Dendrites, due to their morphology, provide neurons with unique electrical and plastic properties and cause variations in their computational properties. The morphology of dendrites: 1) determines – a) the number and type of contacts that a particular neuron can form with other neurons; b) the complexity, diversity of its functions; c) its computational operations; 2) determines – a) variations in the computational properties of a neuron (variations of the discharges between bursts and regular forms of pulsation); b) back distribution of action potentials.</p> <p>Dendritic spines can form synaptic connection – one of the main factors for increasing the diversity of forms of synaptic connections of neurons. Their volume and shape can change over a short period of time, and they can rotate in space, appear and disappear by themselves. Spines play a key role in selectively changing the strength of synaptic connections during the memorization and learning process.</p> <p>Glial cells are active participants in diffuse transmission of nerve impulses in the brain. Astrocytes form a three-dimensional, functionally “syncytia-like” formation, inside of which there are neurons, thus causing their specific microenvironment. They and neurons are structurally and functionally interconnected, based on which their permanent interaction occurs. Oligodendrocytes provide conditions for the generation and transmission of nerve impulses along the processes of neurons and play a significant role in the processes of their excitation and inhibition. Microglial cells play an important role in the formation of the brain, especially in the formation and maintenance of synapses.</p> <p>Thus, the CNS should be considered as a single, functionally “syncytia-like”, structural entity. Because the three-dimensional distribution of dendritic branches in space is important for determining the type of information that goes to a neuron, it is necessary to consider the three-dimensionality of their structure when analyzing the implementation of their functions.</p> 2019-02-21T00:00:00+02:00 ##submission.copyrightStatement## Modern approaches to diagnostics and treatment of migraine in children 2019-03-05T22:32:30+02:00 P V Kovalchuk O V Katilov S O Panenko <p>This article reviews modern approaches to diagnostics and treatment of a very common and simultaneously underestimated and often maltreated disorder in children. It is fallacious management of migraine masked behind the diagnoses such as autonomic vessel dysfunction and vascular headache here in Ukraine. This is a tremendous problem and it should be solved with appropriate information spread across the medical community.</p> <p>Up-to-date classification according to the International Headache Society, diagnostic criteria, differential diagnosis, investigation and treatment strategies are presented in the article. All supported data are com-pliant with guidelines of developed countries with evidence-based medicine (US, Canada, Great Britain, Japan, Australia, New Zealand) enhanced with new trials and approved methods. Migraine management is a rapidly evolving concept, where major changes were done during recent years (transcranial Deep Brain Stimulation, vagus stimulation, CGRP-receptor mono-clonal antibodies).</p> <p>Considering disorder incidence and its impact on life quality and the existence of options for alleviating symptoms, this information is important for physicians who work with children, especially for general practitioners, pediatrics, pediatric and adult neurologists.</p> 2019-02-21T00:00:00+02:00 ##submission.copyrightStatement## Pudendal neuralgia: diagnostics and treatment 2019-03-05T22:32:39+02:00 V I Ilyashenko <p>The article considers the main causes of the occurrence of pudendal neuralgia. The criteria for diagnosing this state are described in detail. We present basic methods of treatment of pudendal neuralgia starting with comprehensive preservative treatment (physical therapy, medication, blockade), which in most cases are effective. And in case of its ineffectiveness or relapse of the pain syndrome, issues of conduction of pulsed RF-frequency therapy of the nerve are examined. Currently, the possibility of using hyaluronic acid preparations, botulinum toxin for the treatment of sexual neuropathy, as well as cryoanalgesia is being studying. The surgical decompression of the sexual nerve is possible in case of inefficient conservative treatment.</p> 2019-02-21T00:00:00+02:00 ##submission.copyrightStatement## Refractory neuroblastoma, victory over pain (clinical case) 2019-03-05T22:35:50+02:00 O O Kalinchuk T G Korol S S Blazhko N U Kosechenko <p>Neuroblastoma is a malignant tumor that develops from the stem cells of the sympathetic ganglia and the adrenal medulla and belongs to the group of neuroendocrine tumors. It is most often localized in the adrenal glands and the retroperitoneal space, less – in sympathetic ganglia of the neck and thoracic cavity. Pain syn-drome is one of the leading manifestations in patients with disease progression. Unlike other patients, a pain syndrome in oncological patients is not a temporary or periodic sensation, it has no physio-logical expediency, it does not have a protective mechanism, but, on the contrary, pain in this group of patients leads to inadaptation, distorted perception of pain and small impulses, most importantly, accompanied by various disorders of the functions of the central nervous system in the patient’s body.</p> 2019-02-21T00:00:00+02:00 ##submission.copyrightStatement## Submission of the use of the method of preemtive analgesia with acetaminophen for perioperative period in children 2019-03-05T22:40:37+02:00 D V Dmytriiev O V Marchuk V L Vitkovskyi V Yu Kebenko <p>In the structure of postoperative anesthesia in children, as well as in other age groups, the main place is occupied by narcotic analgesics; the route of administration is traditional– intramuscular. The purpose of the study was to in-crease the effectiveness of postoperative analgesia with opioid analgesics in children. The study was conducted in 37 children with a mean age of 3.2 ± 0.8 years operated on tumors in the peritoneal space (27 children, 73%), kidney tumors (8chil-dren, 22%) and ovarian tumors (2 children, 5%). Comprehensive study of the reactions of pain behavior, physiological parameters and laboratory stress tests showed that the use of the scheme of analgesia based on acetaminophen 30 mg/kg and the method of continuous infusion of drugs (fentanyl in a dose of 5 μg/kg/h) for postoperative anesthesia leads to effective analgesia after traumatic operations in the neonatal period. The use of the method of continuous intravenous infusion of opioid analgesics leads to a pronounced, to varying degrees, sedation and respiratory depression, which enables children to adapt well to the apparatus of mechanical ventilation after various surgical interventions.</p> 2019-02-21T00:00:00+02:00 ##submission.copyrightStatement##