Stress-induced disorders

© 2020, Media Sphera Publishing Group. All rights reserved. The review analyses the diseases and conditions caused by acute and chronic stress. The authors describe the pathogenesis of stress-induced disorders from the perspective of imbalance between stress-realizing and stress-limiting systems (sympathetic and parasympathetic nervous systems). The effects of acute and chronic stress on the cardiovascular, respiratory, and immune systems, the contribution of stress to the pathogenesis of skin diseases, the gastrointestinal tract, post-stroke disorders, headaches, and dizziness are considered. The authors highlight the role of gamma-aminobutyric acid (GABA) as the main mediator of stress-limiting systems in protecting the nervous system and target organs from the damaging effects of acute and chronic stress. The authors recommend aminophenylbutyric acid hydrochloride, an analogue of GABA, as a drug with protective effect on organs and systems that are exposed to the negative effects of acute and chronic stress. Aminophenylbutyric acid hydrochloride (anvifen) is successfully used in both adults and children, has good tolerance, has no significant drug interactions and side-effects

Effective neuroprotection and organ protection: Activation of the endogenous mechanisms of sanogenesis

© 2020, Ima-Press Publishing House. All rights reserved. The review sets out modern ideas about the mechanisms of action of gamma-aminobutyric acid (GABA) in the central nervous system and other organs and systems. Current experimental and clinical studies have shown that GABA has numerous effects: neuroprotective, antihy-pertensive, antidiabetic, antitumor, anti-inflammatory, antimicrobial, anti-allergic, hepatoprotective, nephroprotective and enteroprotective, and others, which are currently the subject for study by biologists, physiologists, and physicians. Synthetic GABA analogues are widely used in clinical practice. One of these drugs is aminophenylbutyric acid hydrochloride (Anvifen®) that has demonstrated high efficiency and safety in clinical practice

Diabetic encephalopathy: current insights and potential therapeutic strategies

Objective. To study the effect of alpha-lipoic acid (ALA) on cognitive functions in patients with non-insulin dependent diabetes mellitus type 2 (DM-2) and thick fiber polyneuropathy. Material and methods. The MoCA test was used to assess cognitive functions, and vibrometry («Somedic» vibrometer) was used to assess the function of thick fibers. Patients in group 1 (n=37) received alpha lipoic acid (ALA) in a dose of 600 mg per day for 16 weeks, patients in group 2 (n=41) started taking ALA 8 weeks after the start of the study. Results. Comparison of both groups showed an increase in the indicators of the MoCA test in group 1 after 8 weeks (p=0.0025) with a further plateau and an improvement in vibration sensitivity after 16 weeks (p=0.023). The improvement in the MoCA test in group 2 also began after 8 weeks. Conclusion. The authors recommend ALA in polyneuropathy as a drug that also has a positive effect on cognitive functions in DM-2 and dipyridamole for the treatment of patients with diabetic encephalopathy and cerebral small vessels disease and stroke

Neuroinflammation and neuropathology

The review highlights the current understanding of the role of autoimmune neuroinflammation in the pathogenesis of vascular, neurodegenerative and other diseases of the nervous system. The mechanisms of the response of the resident cells of the central nervous system (microglia, astrocytes) and peripheral cells of the immune system are considered. Possible therapeutic potential of phosphodiesterase inhibitors, which have antiplatelet properties and the ability to suppress autoimmune inflammation, are out-lined. The authors consider dipyridamole, an inhibitor of phosphodiesterase, as a promising drug

Active scars in clinical presentation of postoperative persistent syndrome (Failed back surgery syndrome)

Objective. To assess the role of postoperative scar trigger zones in patients with postoperative persistent syndrome (POPS), effec-tiveness of lidocaine/prilocaine cream and manual treatment methods. Material and methods. Three groups of patients were examined and treated: 1) «early POPS» (e-POPS, n=23), pain after surgery decreased, but continued to significantly disturb the patient; 2) «middle POPS» (m-POPS, n=42), complete regression of pain af-ter surgery with subsequent recurrence within 6—12 months; 3) «late POPS» (l-POPS, n=31) — pain relapse occurred later than 12 months after surgery. Examination included manual diagnosis of skin and soft tissue thresholds within the scar area, tensoalgom-etry with a 1 mm2 nozzle. Treatment included 2 stages: 1) lidocaine/prilocaine cream application on postoperative scar for 2 hours daily for 5 days; 2) manual therapy with soft tissue stretching and pressure. Results. All patients showed a decrease in physiological barrier of skin and soft tissues around the scar by 5—10 mm. Tensoal-gometry revealed scar trigger zones (STZ) in all patients of the e-POPS group with reproduction (complete or partial) of typical pain pattern. The same STZs were found in all patients of other subgroups, but pain pattern reproduction was found in a smaller number of patients (m-POPS subgroup — 13 out of 42, l-POPS subgroup — 2 out of 31). Tensoalgometry data (kg/cm2): e-POPS before treatment — 21.2±12.5, after the first stage of treatment — 64.3±19.5 (p=0.00045), after the second stage of treatment — 87.6±13.5 (p=0.0054); m-POPS before treatment — 51.5±23.2, after the first stage of treatment — 71.5±31.7 (p=0.0054), after the second stage of treatment — 91.4±34.9 (p=0.0043); l-POPS before treatment — 61.3±33.6, after the first stage of treatment — 81.7±41.7 (p=0.035), after the second stage of treatment — 88.7±42.5 (p>0.05). Conclusion. Lidocaine/prilocaine cream showed a good analgesic effect for 4 hours in all patients. Manual therapy also significantly increased pain thresholds, except for the l-POPS group. These patients had a significant effect after lidocaine/prilocaine cream application. The authors recommend lidocaine/prilocaine cream in addition to conventional manual therapy for the treatment of active scars. This cream is characterized by high efficacy, safety and good tolerance

Failed back surgery syndrome: The role of central sensitization and treatment approaches

Objective. To study a role of central sensitization (CS) in patients with Failed Back Surgery Syndrome (FBSS) after decompression of the lumbar and/or sacral roots. Material and methods. The study included three groups of patients: 1) early FBSS (e-FBSS, n=23), pain after surgery decreased, but continued to significantly bother the patient, or recurred in the first 6 months after surgery; 2) middle FBSS (m-FBSS, n=42), pain after surgery completely stopped, but recurred within 6-12 months; 3) late FBSS (l-FBSS, n=31), if pain relapse occurred more than 12 months later. Neurological status assessment, study of muscle trigger zones (MTZ), postoperative scar trigger zones (TZS), pain assessment according to the Visual Analogue Scale (VAS), CS assessment according to the Russian version of the Central Sensitization Inventory (CSI) were performed. Treatment included the following stages: stage 1 (non-steroidal anti-inflammatory drug (NSAID) meloxicam 15 mg 7 days); stage 2 (aminophenylbutyric acid hydrochloride (APAH) 250 mg 3 times a day 14 days); stage 3 (fluvoxamine 50 mg daily 8 weeks); stage 4 (MTZ and TZS treatment, fitness program). In addition to the previously described 96 patients, 15 patients (4 men and 11 women, aged 36-47 years) with FBSS and widespread pain, corresponding to the criteria for fibromyalgia ACTTION-APS Pain Taxonomy, who took only milnacipran 25-50 mg daily for two months (WSP-FBSS group), were studied. Results. At baseline, CSI and VAS are as follows: CSI=72.2±6.5; VAS=58.5±8.8 in the e-FBSS group; CSI=49.2±9.0; VAS=39.5±5.3 in the m-FBSS group; CSI=18.1±5.9; VAS=18.1±5.4 in the l-FBSS group. All patients have active MTZ and TZS. The differences between MTZ and TZS subgroups were in the reproduction of pain - the appearance of pain characteristic of the patient during stimulation (pressure) of the MTZ or TZS. In the e-FBSS group, there is the low efficacy of NSAIDs, the moderate efficacy of APAH, the high efficacy of fluvoxamine. In the m-FBSS group, the moderate efficacy of NSAIDs and APAH and the high efficacy of fluvoxamine are observed. In the l-FBSS group, there is the high efficacy of NSAIDs. In the WSP-FBSS group, VAS and CSI are 58.8±9.2 mm and 75.1±8.04, respectively, before treatment, 15.51±5.1 mm (p=0.00032) and 25.6±8.2 (p=0.0002), respectively, after 2 months of treatment. Conclusions. In patients with FBSS, MTZ and TZS should be treated taking into account CS. The study shows the efficacy of APAH, fluvoxamine and milnacipran in the presence of CS

Psychometric validation of the Russian version of the Central Sensitization Inventory in adolescents (14-17 years old)

OBJECTIVE: To validate a Russian version of the Central Sensitization Inventory (CSI) in adolescents (14-17 years old). MATERIAL AND METHODS: The study included adolescents aged 14-17 years. Group 1 (n=69) - frequent episodic and chronic tension type headache; group 2 (n=63) - chronic myogenic neck pain; group 3 (n=61) - infrequent episodic tension type headache; group 4 (n=67) - adolescents without pain during the last 6 months. The first stage was linguistic validation of the statements (symptoms) in CSI (100 randomly selected adolescents). Psychometric validation was performed by comparing the indicators of CSI, Pediatric Anxiety Rating Scale (PARS), and M. Kovacs' Children's Depression Inventory. RESULTS: A strong correlation between CSI scores with the PARS indicators (number of symptoms, severity scale, clinical examination scale) and M.Kovacs' Children's Depression Inventory was shown. CONCLUSION: CSI can be used in adolescents from the age of 14, and it is an informative and useful clinical tool for identifying and assessing the severity of central sensitization in pediatrics

Central sensitization inventory — A Russian version

© 2020, Media Sphera Publishing Group. All rights reserved. Objective. To develop and validate a Russian version of The Central Sensitization Inventory (CSI-R). Material and methods. The study included 3 stages: 1) direct and reverse translation, linguistic validation of the questionnaire; 2) assessment of internal consistency, reliability and sensitivity (n=50); 3) psychometric validation in the samples of patients with fibromyalgia syndrome (n=40), chronic widespread pain (n=40), regional chronic low back pain without other specific pain complaints (n=40), and in the control sample of informants with no pain complaints (n=40). Results and conclusion. The Russian version of CSI-R is valid, reliable and can be used in clinical practice as a diagnostic tool for revealing central sensitization. The study of the sensitivity of the questionnaire in patients during drug therapy proved its effective-ness in assessing the dynamics of the disease and the effect of therapy