Pain medicine <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> Interdisciplinar Academy of Pain Medicine en-US Pain medicine 2414-3812 <p><a style="background-color: transparent; color: #007ab2; font-family: &amp;quot; noto sans&amp;quot;,arial,helvetica,sans-serif; font-size: 14px; font-style: normal; font-variant: normal; font-weight: 400; letter-spacing: normal; orphans: 2; text-align: left; text-decoration: underline; text-indent: 0px; text-transform: none; -webkit-text-stroke-width: 0px; white-space: normal; word-spacing: 0px;" href="" rel="license"><img style="border-width: 0px;" src="" alt="Creative Commons License"></a><br style="background-color: transparent; color: #000000; cursor: text; font-family: &amp;quot; noto sans&amp;quot;,arial,helvetica,sans-serif; font-size: 14px; font-style: normal; font-variant: normal; font-weight: 400; letter-spacing: normal; orphans: 2; outline-color: #2d8ac7; outline-style: solid; outline-width: 2px; text-align: left; text-decoration: none; text-indent: 0px; text-transform: none; -webkit-text-stroke-width: 0px; white-space: normal; word-spacing: 0px;"><span style="display: inline !important; float: none; background-color: transparent; color: #000000; cursor: text; font-family: 'Noto Sans',Arial,Helvetica,sans-serif; font-size: 14px; font-style: normal; font-variant: normal; font-weight: 400; letter-spacing: normal; orphans: 2; text-align: left; text-decoration: none; text-indent: 0px; text-transform: none; -webkit-text-stroke-width: 0px; white-space: normal; word-spacing: 0px;">This work is licensed under a </span><a style="background-color: transparent; color: #007ab2; font-family: &amp;quot; noto sans&amp;quot;,arial,helvetica,sans-serif; font-size: 14px; font-style: normal; font-variant: normal; font-weight: 400; letter-spacing: normal; orphans: 2; text-align: left; text-decoration: underline; text-indent: 0px; text-transform: none; -webkit-text-stroke-width: 0px; white-space: normal; word-spacing: 0px;" href="" rel="license">Creative Commons Attribution 4.0 International License</a></p> Diagnostics, treatment, rehabilitation and prevention of vertebral syndromes caused by traumatic elements <p>Vertebral pain occurs due to many reasons, thus complicates diagnostics, treatment, rehabilitation. The spectrum of pathomorphological changes in vertebral segments that can lead to lesions of the segmental nervous and vascular structures should be considered. We propose to define and classify these pathoanatomical changes. Traumatic elements are pathomorphological changes in vertebral segments, due to an injury or vertebral diseases and may cause irritation, partial or total compression of segmental nervous and/or vascular structures due to their size and direction.</p> <p>We also suggested algorithm for the diagnostics, treatment, rehabilitation and prevention of pain and other disorders in the spine. Diagnostic algorithm mentioned in the article allows to choose the right methods of treatment, rehabilitation and prevention. We can conclude that pathoanatomical changes directed towards the segmental nervous and vascular structures may act as traumatic elements. Severity of clinical manifestation of spine pathology more depends on the severity of traumatization of segmental nervous or vascular structures. It’s impossible to differentiate traumatic elements as irritating or compressing ones by changes on X-ray and MRI.</p> P F Kolisnyk S P Kolisnyk ##submission.copyrightStatement## 2018-10-22 2018-10-22 3 3 6 15 10.31636/pmjua.v3i3.1 Discogenic low back pain: interventional treatment <p>Low back pain (LBP) is one of the most common causes of disability in the adult population. A significant place in its genesis is occupied by a degenerative-<br>dystrophic diseases of intervertebral discs. The article highlights the classification and mechanism of discogenic pain origin. Various types of interventions are<br>described for this pathology: indications, specificities of carrying out manipulations and therapeutic effects, efficiency and possible complications of procedures.</p> V I Smolanka V M Fedurtsya B B Pavlov ##submission.copyrightStatement## 2018-11-22 2018-11-22 3 3 16 26 10.31636/pmjua.v3i3.2 Cardiac toxicity of coxibs: mechanisms of development and their prevention <p>Development of highly selective COX-2 inhibitors – coxibs has proved a decreased risk of gastrointestinal toxicity, which was typical for non-selective NSAIDS, according to the evidence-based medicine. But such situation caused an imbalance in the impact on the synthesis of arachidonic acid metabolites: inhibition of COX-2 vasodilatatory prostacyclins and activation of thromboxane synthesis by platelets, which is accompanied by the increase in the frequency of thrombotic complications – myocardial infarctions and strokes. Some meta-analyses have proved this association: the higher is COX-2 inhibitors selectivity – the higher are CV-risks and cardiovascular toxicity of coxibs. Discontinuation or limitation of indications of coxibs, assessment of risk / benefit ratio is recommended in the conditions of comorbidity of CVS pathology, pain syndromes in rheumatology. Drugs of choice are moderately selective COX-2 inhibitors = meloxicam and nimesulide.</p> O O Yakovleva A O Zhamba I O Doroshkevych T K Vitruk ##submission.copyrightStatement## 2018-11-23 2018-11-23 3 3 27 32 10.31636/pmjua.v3i3.3 Anesthesia in children with comorbid pathology - clinical assessment of the most common pathological conditions in the practice of anesthesiologist <p>Currently, there is an increase in the number of children who have multiple connected or “independent” pathological conditions, hospitalized to General hospitals with severe pain. It significantly worsens the disease course and complicates differential diagnosis in these patients, requires a deeper treatment approach. Thus, it requires attention and discussion and is urgent to cover the concept of comorbidity, combined with pain syndrome in Pediatrics. In this article is carried out the analysis of comorbid pathology in surgery from the point of view of the children’s anaesthetist. There were allocated comorbidities that are commonly encountered in daily practice and are of danger in surgical practice. We have analyzed analgesia for obesity, blood diseases, congenital heart defects, concomitant respiratory diseases – during surgery and in the postoperative period. To improve the efficiency of medical care for these patients it is important to develop an algorithm of physician's actions in the most common comorbid conditions. It is concluded that there is a need for additional studies for further clarifying the optimal management of pain and the effect of pain in case of comorbidities.</p> Y M Babina ##submission.copyrightStatement## 2018-11-23 2018-11-23 3 3 33 43 10.31636/pmjua.v3i3.4 The comparison of effectiveness of two variants of preventive anesthesia/analgesia in cancer surgery <p>Despite modern drugs and technologies in medicine, the questions of adequate analgesia in the postoperative period remain quite relevant. The effectiveness of preventive analgesia in the perioperative period remains a contentious issue.</p> <p>The study included 53 oncosurgical patients. Gr.1 received dexketoprofen in combination with paracetamol for perioperative analgesia before the operation, Gr.2 the same medication was given before closing the operating wound. Anesthesia in both groups included an inhaled (Sevoran) and an extended epidural.</p> <p>The study showed that the pain intensity on ANI monitoring and the total dose of fentanyl was less in Gr.1, compared to Gr.2. Cortisol plasma level and the level of glycemia in the perioperative period were less in patients in Gr.1 than in Gr.2. Pain intensity after surgery during first postoperative day was lower in Gr.1, then in Gr.2.</p> <p>The administration of multimodal analgesia with paracetamol and dexketoprofen prior to the surgical interventions provides for the best quality of perioperative analgesia in oncological surgical interventions.</p> I I Lisnyy ##submission.copyrightStatement## 2018-11-23 2018-11-23 3 3 44 50 10.31636/pmjua.v3i3.5 Endoscopic transforaminal lumbar microdiscectomy. A retrospective analysis of 180 clinical cases <p>The authors performed retrospective analysis of 180 clinical cases of surgical treatment of lumbar herniated discs in patients who underwent endoscopic transforaminal microdiscectomy. This technique allows minimally invasive insertion of the endoscope into the spinal canal under local anaesthesia to decompress the nerve root by removing hernial protrusion under visual control. However, this technique is not universal and cannot be applied to all patients. Considerable practical experience has shown that the surgeon may encounter certain technical difficulties in cases of cranial or caudal sequester migration and in some cases when the access at L5–S1 level is complicated due to the high standing of the iliac crest. However, if there are correct indications, this technique allows to solve the problem of radicular compression syndrome in a short time.</p> V. K. Piontkovskyi I V Fishchenko ##submission.copyrightStatement## 2018-11-23 2018-11-23 3 3 51 56 10.31636/pmjua.v3i3.6 Trigeminal nerve block under the ultrasound control in the pain medicine <p>The leading clinical manifestation of trigeminal neuralgia is pain syndrome. Recently, an integrative biopsychosocial approach has been proposed in the study of pain. Trigeminal neuralgia is marked by a significant prevalence, often severe course, lack of sufficiently effective methods of treatment. The aim of the article was to introduce the technique of trigeminal nerve block under the ultrasound control. When the trigeminal nerve block is performed, the terminal sections of its three main branches are to be anesthetized. The maximum full and wide blockade can be achieved with the block of the Gasser's node, but performance of this procedure is complicated, requires a special qualification of a neurosurgeon and fluoroscopic control due to the complexity of the innervation of the head, the presence of mutually overlapping zones and commision. The most frequent indications for trigeminal nerve block are diagnostic, therapeutic and surgical blockades. It is recommened to consider the need for a combination of blocks, when anesthesia is planned. Double navigation with a neurostimulator is used for the accuracy of the needle positioning improvement. In this case, we expect a motor response from the masticatory muscle. Thus, the trigeminal nerve block under the ultrasound control can be used in the management of pain syndrome in trigeminal neuralgia.</p> E A Glazov D V Dmytriiev E Y Dmytriieva Y K Otkalenko ##submission.copyrightStatement## 2018-11-23 2018-11-23 3 3 57 66 10.31636/pmjua.v3i3.7 Pain management in obstetrics and gynecology <p>The problem of acute postoperative pain is present throughout the lifetime of surgery and, unfortunately, does not lose its relevance today. Inadequate pain control in the postoperative period leads to negative consequences. Multimodal analgesia is currently the method of choice for postoperative anesthesia. The basis is the prescription of paracetamol (Infulgan®) in combination or without NSAIDs with the addition of methods of regional analgesia and, in case of insufficient effect, the use of opioid analgesics lies in the basisi of this method. Choosing one or another scheme of multimodal analgesia is determined, above all, is due to the invasiveness of the surgical intervention performed.</p> Ye V Grigimalsky A Y Garga ##submission.copyrightStatement## 2018-11-23 2018-11-23 3 3 69 73 10.31636/pmjua.v3i3.8 Manifestations of pain symptoms in reduced occlusion <p>This article presents the analysis of the relevant literature highlighting the mechanisms of the development of malocclusion and pain symptom at the reduced occlusal vertical dimension. In this case, the key complaint presented by patients is permanent steady pain described as dull, stabbing, or compressing by its character. Most often, the pain is localized within the paratoid-masticatory area as well as buccal, temporal and frontal areas, and irradiates to the upper and lower jaw or the teeth that often leads to performing unnecessary dental manipulations; to the region of the temporomandibular joint (TMJ); to the ear that sometimes is accompanied with fullness and tingling in the ears. In some cases this pain can irradiate to the hard palate and tongue. Many patients note the growing intensity of pain when chewing. Some patients experience episodic increase in pain when there are pain attacks described as compressing or stabing in the background of steady dull pain. The pain gets more intense even at the slightest movements of the head, lower jaw, or when speaking. The duration of the pain attack is approximately 20–30 minutes. A few minutes before the onset of the attack, all patients notice the emergence of somes forerunning symptoms, e.g. hyperlsalivation, paresthesia, toothache. The attacks can be provoked by conversation, overcooling, and emotional tension. It has been experimentally proven that a prolonged muscle contraction, which is often observed during emotional stress, can cause pain in the regions mentioned above. But whether will it arise or not and to what extent, it depends on the state of adaptive capacity of the body and dentofacial system. When the adaptive capacity of the body and the dentofacial system as its part are weakened, the local background for the occurrence of pain symptoms in the maxillofacial area may be: affective states (depression, anxiety), prolonged chewing load, and prolonged neck muscle tension during dental manipulations.</p> <p>Among the local factors that can cause pain, malocclusions rank the leading place. For example, a hyperbalancing contact is a sign of impaired muscle activity and coordination during the maximal closure of teeth in the lateral position of the mandible, and occlusal contacts on the balancing side affect the distribution of muscle activity during parafunctional closure, and this redistribution can impact on the temporomandibular joint (Andres K. H. et al.).</p> <p>Occlusion abnormalities may result from reduced occlusal vertical dimension, deformation of the dentitions caused by periodontal disease, partial loss of teeth, pathological tooth wearing, as well as due to improperly inserted fillings, unfit inlays, onlays, crowns.</p> <p>Reduced occlusal vertical dimension can also cause otalgia and some other otorhinolaryngological problems, pathogenesis of which is quite debatable and controversial in current literature. J. S. Costen considered hearing loss, tingling and other ear symptoms are associated with pressure produced by the head of the mandible joint onto the auditory tube. Reducing the vertical occlusal dimension results in increasing pressure of the head of the mandible joint onto the subtle bone arch of the articular fossa, which separates the cavity of the joint from the dura mater; this can trigger dull pain in the spine.</p> <p>It is important to remember that pain is a symptom that most often makes patients to search for a dental care. Pain is one of the first clinical manifestations of the body decompensation. Patients with TMJ dysfunction who experience the pain symptom is to a greater or lesser extent make up a group of patients who require a special integrated approach in their treatment.</p> M Ya Nidzelsky V M Sokolovskaya ##submission.copyrightStatement## 2018-11-23 2018-11-23 3 3 74 78 10.31636/pmjua.v3i3.9