Nociceptive bill in neurology. Nociceptive bill

nociceptive bill- a whole medical term, which is victorious for describing the pain of physical training. Butts can be used for sports injuries, dental procedures and arthritis. Nociceptive pain is the most widespread type of pain that people see. Vona develops, if on specific pain receptors (nociceptors) they infuse heat, chemical words or physical injuries.

Who has a likelihood of nociceptive and neuropathic pain?

Nociceptive bill invoke the gostr and develop in response to the singing situation. Vona pass, if a part of the organism is renewed. For example, nociceptive beats pass through the evil ankles, if the brush grows.

Organism to revenge specials nerves, Called nociceptors, as they appear to be stimulating, as well as to stimulate the body, as well as a strong sinter, or cold, a vice, injuries or chemicals. Cyber-juvenile signals are transmitted along the nervous systems to the brain, which can lead to nociceptive pain. Tse vidbuvatsya duzhe shvidko in the mode of the real hour, that people clean up their hands, like a hot oven. Nociceptors can be found in internal organs, if the signals are not easy due to the importance and the stench can not be seen. Information, about getting nociceptive pain, can help the body to cleanse and recover itself.

So is it neuropathic?

Neuropathic bill- a whole medical term, which is victorious to describe the pain, how to develop, if the nervous system is posed, or not just right through the ailment or injuries. You may be aware of nociceptive pain, so as not to develop at all on a specific basis, for example, a stimulus. People can suffer from neuropathic pain, and they can feel pain every day. Tsei stan is called a phantom pain, as it can develop in people by amputation. Neuropathic pain is thought to be in the nerves and is chronic. Bagato develops and becomes ill with neuropathic pain, including:

• diabet;
• insult;
• cancer;
• cytomegalovirus;
• amputation.

diagnostics

It is more important to correct it properly, even more importantly, because of neuropathic ab nociceptive pain.

Chronic bile across the wider scarg is widened, but in 90% of cases there can be no identification of a physical reason. Most often the symptoms that people see when , - the price of neuropathic score.

A diagnostic test is used to break down a diagnostic test to help patients with neuropathic and nociceptive pain. This test is widely used in Denmark for the assessment of neuropathic pain in cases of illness and disease, including rheumatoid arthritis.

When the questionnaire is filled in, the sick person will be prompted for 9 meals. The food is asked to evaluate the diagnosis of pain on a scale from 0 to 5. The same needs to be answered, as it is more likely to be: from -1 to +1. Chim vische otsinka, tim vische rivn neuropathic pain, yaku lyudin vidchuvak.

People with diabetes are advised to follow the symptoms of neuropathic pain, especially in the legs. Neuropathic test lower kintsivkakh It is even broader in people with diabetes and is the main cause of amputation. Neuropathic pain in people with diabetes is often corrected because of the onset, weakness or sickness. You can be more comfortable at night to make your sleep easier.

Treatment of nociceptive and neuropathic pain

The most widening systems, in which nociceptive beads develop, are cystkovo-myazov, yak, including adolescents, oysters, shkira, tendons and cysts. Internal organisms, such as the intestines, lesions and heart, can cause nociceptive pain, as well as smooth muscles.

Approximately half of all people with diabetes experience diabetic peripheral neuropathy (DPN), which is a nerve pain, legs and arms are feared. Fingers start to mend ailments first. People with diabetes can also develop neuropathy in some parts of the body, including the anterior part of the stegon, the area near the eyes and wrist. Many people with cancer experience neuropathic pain in their backs, legs, breasts and shoulders through puffin, which can affect the spinal cord. Stink can also be seen with neuropathic pain through medication or surgery. Lower part the back is one of the areas, where people can perceive both neuropathic and nociceptive pain.

Symptoms and symptoms

It is important to mother on respect, that people can perceive neuropathic and nociceptive pains at once. Brutal respect for the keys of intelligence, it is possible to polish the life of people, who suffer from pain, and help to correct the correct treatment.

Oscillations of nociceptive characteristics can be devel- oped more or less differently. More can be found at the moment of injury, or more can be wrong, or it can take an hour for physical ones.

Lіkuvannya nociceptive pain lie in the cause. On the basis of neuropathic pain, nociceptive pain is often a good choice for opiates, such as codeine.

Symptoms of neuropathic pain

People with neuropathic pain report the following symptoms:

• hospri, scho shooting, baking or prickly pains;
• pokolyuvannya;
• onіміння;
• overly sensitiveness;
• insensitivity to heat or cold;
• myazova weakness;
• bіl, tо go out at night.

Yak і with nociceptive pain, one of the first and most important stages of the treatment of neuropathic pain є the treatment of the main illness.

Individuals with diabetic peripheral neuropathies are guilty of taking drugs to help control diabetes. Likar can be a sign of a disease, a chance to change a person with an injury, or a tie to a person with a disease.

People with oncological illnesses who suffer from neuropathic pain can be helped by prophylaxis, anesthetics and antidepressants. Likuvannya will be found in the singular cause of pain.

According to the estimates, 42.2-78.8% of people who have undergone an amputation of a child will suffer from phantom pains. To show you how to prevent neuropathic pain in phantom pain with one of the shortest methods є prevention. I will take away the painful drugs before the amputation, but the new men will have the development of phantom pains.

literature

1. Ortiz-Catalan, Max; Sander, Nichlas; Kristoffersen, Morten B .; Håkansson, Bo; Brånemark, Rickard Treatment of phantom limb pain (PLP) based on augmented reality and gaming controlled by myoelectric pattern recognition: a case study of a chronic PLP patient (2014) // Neuroprosthetics - vol. eight
2. Cappelleri J. C. et al. Measurement properties of painDETECT by average pain severity // ClinicoEconomics and outcomes research: CEOR. - 2014 .-- T. 6. - S. 497.
3. Dubin A. E., Patapoutian A. Nociceptors: the sensors of the pain pathway // The Journal of clinical investigation. - 2010. - T. 120. - No. 11. - P. 3760.
4. Nicholson B. Differential diagnosis: nociceptive and neuropathic pain // The American journal of managed care. - 2006. - T. 12. - No. 9 Suppl. - S. S256-62.
5. Spahr N. et al. Distinguishing between nociceptive and neuropathic components in chronic low back pain using behavioural evaluation and sensory examination // Musculoskeletal Science and Practice. - 2017 .-- T. 27 .-- S. 40-48.
6. Subedi B., Grossberg G. T. Phantom limb pain: mechanisms and treatment approaches // Pain research and treatment. - 2011 .-- T. 2011 rock.

More syndromes in neurological practice Oleksandr Moiseyovich Vein

1.6. Nociceptive and neuropathic problems

At the presentation of pathophysiological mechanisms, the development of nociceptive and NEUROPATIC values ​​is promoted.

nociceptive bill vinikak todі, if the ear tissue is used on the peripheral pain receptor. The causes of this pain can be the most traumatic, infectious, metabolic and malignant diseases (carcinomatosis, metastasis, neoplastic diseases), which also trigger the activation of peripheral pain receptors. Nociceptive bill is the most common gostry bill, due to the powerful characteristics (div. "Gostra and chronic bil"). As a rule, a large variety of evidence is obvious, if it is good, it is localized and it is easy to describe it as ailing. Protect, visceral pain, less clearly localized and described, as well as visualized pain can be considered nociceptive. If you develop nociceptive pain as a result of a new ear, or if you become ill, you should be sympathetic to a sick person and be described in the context of many painful experiences. Typical for the whole type of pain ї їх a quick regression of a nasty bureaucrat and a short course of treatment with adequate diseases. Slid, however, admittance, but a trivial hour progresses peripheral development can lead to dysfunction of the central nociceptive and antinosceptive systems on the spinal and cerebral conditions, so that the objectivity of the maximum peripheral development is possible.

Bil, as a result of a change in the somatosensory (peripheral and (or) central) nervous system and is reported to neuropathic. Unimportant for the deyak, in our opinion, the lack of distance of the term "neuropathic", a trace of adolescence, which can be blinded with damaged not only in peripheral sensitive nerves (for example, with neuropathies) rіvnyakh from the peripheral nerve to measles great pіvkul. Below is a short reversal of the causes of neuropathic pain in the persistence of symptoms (Table 1). In the midst of a glimpse of illnesses, there is a form, for some pain syndrome is the most characteristic and occurs more often. Tse - trigeminal and postherpetic neuralgia, diabetic and alcoholic polyneuropathy, tunnel syndrome, Syringobulbia.

Neuropathic pain for your own key characteristics Significantly rіznomanіtnіshe nociceptive. The price is equal to the level of space, character, triviality of battle and cost, by the same somatic and psychological factors. at different forms fight nervous system At the early stages and stages of the development of the pathological process, the fate of the other mechanisms in the genesis of pain may also be different. However, depending on the level of the nervous system, both peripheral and central mechanisms of pain control are included.

The mental characteristics of neuropathic pain are persistent in nature, great triviality, ineffectiveness of analgesics for reduction, due to vegetative symptoms. Neuropathic pains are often described as baking, prickly, or nasty or shooting.

For neuropathic pain, characteristic sensory phenomena are: paresthesia - spontaneous or vicious sensory non-specific symptoms; dysesthesia - inappropriate spontaneous abnormalities of seeing; neuralgia - b_l, which expands along the course of one abo-decile nerves; hyperesthesia - sensitiveness is adjusted to a specific non-painful stimulus; allodinia - non-painful irritation yak painful; hyperalgesia - the pain reaction to the painful moan is adjusted. Remain three witnesses, who are vicious for the meaning of hyperpathy, to use the term hyperpathy. One of the types of neuropathic pain is causalgia (the appearance of intense swelling pain), which is most common in complex regional pain syndrome.

Table 1

Equivalent pain and cause of neuropathic pain

Mechanisms of neuropathic pain in lesions of the peripheral and central lanks of the somatosensory system and development. Transmission of mechanisms of neuropathic pain in peripheral injury include: post-denervation hypersensitivity; generation of spontaneous large pulses from ectopic waves, which are formed during the regeneration of lean fibers; epaphytic broadening of nerve impulses along with demilinated nerve fibers; sensitivity to neuromas of genital sensory nerves to norepinephrine and other chemical agents; Decreased antinociceptive control in posterior rose with lengthened micelinated fibers. Peripheral changes in afferent painful sweat can cause destruction in the balance of the upper spinal and cerebral apparatus, so that they can play a role in pain control. At the same time, cognitive and emotional-affective integrative mechanisms of pain relief are obligatory included.

One of the options is NEUROPATIC pain and central pain. Before them, it is possible to recognize pain, which is diagnosed when the central nervous system is affected. With a whole type of pain, it can be attributed to a higher degree, a partial or subclinical damage to the sensorimotor sensitivity, often for all associated with a different type of spinal path on the spinal and (or) cerebral worms. However, there is a trail of adolescence, especially neuropathic pain, both central and peripheral, and the appearance of direct correlation between the steps of neurological sensory deficiency and variability of pain syndrome.

When sensory afferent systems of the spinal cord are pooled, it can be localized, unilateral or diffusion bilateral, and the zone of the lower level of the urazhenny is flushed. More permanent and have a busty, prickly, well-ditched, inodi cramatic character. On a whole background, there may be a change in the nature of paroxysmal focal and diffuse pain. An unprecedented pattern of pain descriptions in ailments with partial lesions of the spinal cord, those in front of them: when a lot of temperature stimuli are applied in the zone of sensitivity of the patient to the contact of healthy sides in the other zones. I will call this phenomenon allocheiria ("іnsha hand"). In practice, the symptom of Lermitt (paresthesia with elements of dysesthesia in Russia in the world) shows an increase in the sensitivity of the spinal cord to mechanical injections in the minds of demiєlіnіzatsії rear stovpіv. Danikh about analogous manifestations during demilinizatsiya spinotalamicheskikh shlakhiv in Danish hour is not.

Uninvolved on the great representation of antinocceptual systems in the brain, it is very painful to get rid of it. At the same time the bridge and lateral viddiliv dovzhastogo brain more often, lower structures, supervise algic manifestations. The central pain of bulbar walking is described in syringobulbia, tuberculoma, puffins of the stovbur to the brain, in rosy sclerosis.

Dejerine and Russi (1906) described intensive painful pain within the framework of the so-called thalamic syndrome (superficial and glial hemianesthesia, sensitive ataxia, other than hemiplegia, mild choreoathetosis) in the area of ​​inflammatory disease. A common cause of central thalamic pain є Sudden battle thalamus (ventroposterio-medial and ventroposterio-lateral nuclei). In special robots, who analyzed 180 cases of thalamic syndrome in right-handers, it was shown that twice as many cases of diagnostics were found in patients with severe right-handed symptoms (116 types), not even (64 types) (S. Nas. Tsіkavo, scho vyavlena overlapping right-handed localization is more typical for cholovіkіv. It has been shown by some foreign robots that thalamic ones, behind the nature of the pain, are not uncommon in the presence of not only the green hillock, but rather of the afferent somatosensory paths. One of the most common causes of ciches of pain is also a blight. More pain is defined by the term "central post-stroke bill", which is approximately in 6-8% of cases of GPMC (Wall P. O., Melzack R., 1994; Polushkina N.R., Yakhno N.N., 1995). Thus, the classic thalamic syndrome is one of the options for central post-stroke pain.

Mechanisms of central pains are foldable and are not implanted until the end. Before the last few years, they demonstrated the great possibilities of the functional plasticity of the central nervous system during the tests on the old ravines. Otrimanі danі can be zagrupuvati with an offensive rank. Dissection of the somatosensory systems and lead to disinhibition and appearance of spontaneous activity of deafferent central neurons on the spinal and cerebral lines. The changes in the peripheral lance of the system (sensitive nerve, posterior cortex) inevitably lead to changes in the activity of thalamic and cortical neurons. The activity of the deafferent central neurons does not change only very well, but rather clearly: in the minds of deafferentation, the activity of the central neurons, as they do not think that they are sleeping before the pain is eliminated, is fixed. In addition, in the minds of the "blockade" of the viscid pain flow (the reduction of the somatosensory path), the afferent projection of neuronal groups on all levels (back horns, stovbur, thalamus, cortex) will collapse. At the same time, new visual projections and new receptive fields are formed quickly. Vvazhayut, when the process is going through the process more quickly, then it’s better for everything not to be molded, but to see a spare or “disguised” (active great people) Shlyakhu. Maybe you’re going to have negative thoughts in your minds. However, it is postulated that the sensation of such a "pragmatic" before the oblique preservation of the flow of nociceptive affection of the field is necessary for normal robotic anti-nocicept systems. In the morning, due to the lesions of the systems of large afferentation, the lack of efficiency of the lower antinociceptive system and the periaqueductal speech, the great nucleus of the suture and DNIK, is associated with the lack of efficiency. Term deafferentation of pain acceptance for designation of central pain, such as in case of severe afferent somatosensory paths.

There was a significant pathophysiological peculiarity of neuropathic and nociceptive pain. Special robots have demonstrated that the activity of certain anti-pain systems was evident in the presence of nociceptive pain, but not in neuropathic pain. It’s not possible to bind it, but in case of nociceptive pain of the central mechanisms (spinal and cerebral) it doesn’t get involved in the pathological process, while in case of neuropathic pain, it’s not a mediocre country. Analyzes of robots, attributing to the development of efficacious effects (neurotomy, rizotomy, chordotomy, mesencephalotomy, thalamotomy, leukotomy) and stimulation methods of pain (CHENS, acupuncture, stimulation syndrome As soon as the procedure for ruining the nerve paths, right from the beginning, is the most effective in the treatment of nociceptive pain, then the stimulus-Zion methods, navpaki, are more effective in neuropathic pain. However, in the implementation of stimulation procedures, they are not opiate, but, as long as not specified, mediator systems.

See the visibility in the walkways drug therapy nociceptive and neuropathic pain. For the relief of nociceptive pain, in the presence of intensity, non-narcotic and narcotic analgesics, non-steroidal anti-apical and muscle anesthetics.

In therapy of neuropathic pain, analgesics, as a rule, are ineffective and not stagnant. Vikoristovytsya drugs from the other pharmacological groups.

For the treatment of chronic NEUROPATHIC pain with drugs Vibor є antidepressant (tricyclic antidepressants, Ingibitories of vocal accumulation of serotonin), which help to improve serotoninergic activity (McQuay, H. et al. Zastosuvannya cich zasobіv was pummeled by the lack of serotonіnu systems of the brain in case of chronic chronic pain, which, as a rule, with depressive disorders.

In the therapy of young types of neuropathic pain, antiepileptic drugs (carbamazepin, diphenin, gabapentin, sodium valproate, lamotrigine, felbamate) are widely used (Drewes A. M. et al., 1994). The exact mechanism of the analgesic process is unavoidable, it is not postulated that the effect of these preparations in dressings: 1) stabilization of neuronal membranes for the reduction of the activity of the voltage-dependent channels; 2) activating the GABA system; 3) from the setting of NMDA receptors (felbamate, lamiktal). The development of drugs, selectively blocking the NMDA receptor, which may lead to transmucosal pain, in one of the priority areas (Weber S., 1998). In this hour, the antagonism of NMDA receptors (ketamine) is not known wide sucking in the therapy of pain syndromes through the number of unpleasant side effects, Due to the participation of cych receptors in the realization of mental, motor and other functions (Wood T. J., Sloan R., 1997). For example, for chronic neuropathic pain, drugs from the amantadine group (for patients with parkinsonism), so that they will be able to get a good anti-sickness blockage for allergic reactions, 1998

Drugs that are anxiolytic and antipsychotics can also be used to treat neuropathic pain. Tranquilizers are recommended, as a head rank, in case of swelling of anxiety disorders, and antipsychotics - in case of hypochondriacal discord, associated with pain syndrome. It is not often a matter of being vicious in combination with other drugs.

Central muscle relaxant (baclofen, sirdalud) for neuropathic pain, vikoristovyyak drugs that stimulate the GABA system of the spinal cord, order with relaxation of the muscles, give an analgesic effect. Good results are eliminated in cases of postherpetic neuralgia, CRPS, diabetic polyneuropathy.

In a number of new clinical patients, for the treatment of chronic neuropathic pain, the drug mexiletine, an analogue of lidocaine, is injected into the robot with natural-caliber canals in the peripheral nerve. It has been shown that at a dose of 600-625 mg per dose, mexiletine has a clear, painless effect in ailments with pain syndrome in diabetic and alcoholic polyneuropathies, as well as in post-stroke central pain (Wright JM, Oki JC, Graishama L., 1995; Sakuta M., 1995).

Special clinical studies have shown that in case of neuropathic pain the level of adenosine in the blood and blood is significantly lower than normal, so as with nociceptive pain there is no change in adenosine. Analytical effect of adenosine in the presence of the most severe symptoms in patients with neuropathic pain (Guieu R., 1996; Sollevi A., 1997). This is a tribute to the lack of activity of the purine system in neuropathic pain and the adequacy of adenosine in cichs with adenosine ailments.

In one straight line in rozrobtsi effective treatment neuropathic pain є implantation of calcium channel blockers. In the early pre-existing ailments on VIL infection, who suffer from neuropathic pain, a good sensitizing effect on the removal of a new blocker of Kaltsev channels SNX-111

The problem is pain and pain. Nociceptive and anti-social systems.

bil- a kind of psychophysiological, motivational and emotional camp of a people, who is victorious with a series of overpowering podraznikiv.

bil- a signal about the ruinous action of teens, or about the steps of the sour hunger of fabrics, which will ruin their life. From the point of view of the lykar, there is a very important incentive, the zavdyakov who are a man to turn to a likar.

Show pain.

1) Psychic phenomena. Tse experiencing pain, how to wrap up with free visions and emotions at the sight of fear, restlessness, anxiety.

To form a specific behavior.

2) Rukhovi appearances:

a) in the viglyad, the tone of the muscles and the advanced readiness to the defensive actions.

b) in viglyadі zakhisnyh defensive reflexes, as in case of overwhelming pain can galmuvatisya.

3) Vegetative manifestations Connected with the activation of a sympathetic system for pain, as it infuses on the internal organisms, which causes a reaction in vigilance, for galvanizing activity, changes in heart rate, tone of the heart, sweating, etc.

Portrait of pain.

Sub'actively painful teasing of supravodzhute:

a) seen at viglyadі thorny, laughing, low, baking, itching stanіv. You can see nudoti.

b) self-respect- the backbone of nezduzhannya, deviations of attitudes, right up to the incidence of affective stanіv. Self-feeling is tied with vegetative snakes.

See I hurt:

1) somatic→ surface (shkіra)

gliboka(M'yazi, kistki, slopes, with the resulting fabric);

2) viscelyarna(Різні organi, speedy smooth m'yazіv, which is supervised by ishemієyu).

See the pain.

1) Beat in the stomach. Internal organisms are kindly sick with pain receptors, and sometimes pain in the abdomen can mask psychogenic discomfort, when there is a decrease in the number of opiates. But the most frequent beat in the belly is the inheritance of poisoned organs of etching.

Gastro pain can be diagnosed in case of anatomical malfunctioning of internal organs (perforation of the virazka, intercourse of the intestine, impaired blood flow, etc.).

The most common cause of abdominal pain is impairment of the motor function of the intestinal tract.

More receptors are localized in the oyster balls of the empty organs, and in the liver, nirtsi, and selets - in the capsule of the organ. To that, it is overwhelmingly stretching, or fast superfluous, with large impulses.

Mechanism of pain diagnostics in case of spasms of the travoductus, gum or pancreatic ducts, anatomical sphincters of dressings manifestations of spastic dyskinesia, Damage to the evacuation function. In cich vipadkah preparations, which relax smooth muscles, know more.

2) Head bill.Її 20 types. Zazvychay stupid, disgustingly localized.

Factor її wiklikayut: lack of sleep internal organs, Stretching abo spasm of arteries, veins, pushing of the intracranial vise.

3) m'yazy bill - with convulsive fast muscular tissue, ischemia, stretching, but not with injections, tears of the tissue.

4) Increasing the sensitivity of the nervous system(Ganglіolіti, sympathetic).

Bil vinikє attacks. You may be able to cope with the flow of emotions, unwelcoming factors, or changes of meteoums. Supports reduced tactile sensitivity, sverblyachkoy, judgmental reactions, sweaty, trophic dispensations.

5) Phantom pain- more pain in the daytime amputation of kintsivkah.

6) causal pain. There are a lot of baking pains that appear in the operative cicatrices when there is some light and noise.

7) Visceral pain.

Bolova sensitivity.

temple- in autonomic nerves, breeches, oxymes, mucous membranes, arteries, organ capsules.

low- at the veins, m'yazi heart, ale not at the pericardium, speech to the brain.

Helping the visceral bill is the goal of the internal organs. It is disgusting to localize, small growths: stupid, heaving, prickly, ryuchy, low. With the butt, you can serve kishkov or nirkova kolki, superimposed on stretching the slash.

8) Imagine pain.

A) Tse vyscerokutannye pain. They are found in the singing areas when the internal organs are affected. Tse zoni Zakharina - Geda. The image can be displayed:

1) in a dermatome with a sick organ;

2) Behind the boundaries of a type dermatome.

B) Viscero-visceral reflexes. I feel pain in a healthy organ when an organ becomes ill. For example, in case of myocardial infarction, it is in the area of ​​the appendix.

Features of pain relief.

Phenomenon of subiliac pain manifest itself in the appearance of "early" and "dying" pain.

With a short-hour super-strong subset of symptoms, the diagnosis of pain is evident with precise localization. Tse is tied with the pain signal carried out according to the requirements of the A pain path.

Then pour the wine, unassigned localization, feeling pain. It is tied with the extensions of the zhwilyah group S.

Iakshcho is a non-ruhomist (a head is embedded), seeing the pain of a disease. dumb painful vision and with a general Russian of a friend.

The serpent of painful sensitivity.

1) Hyperalgesia- increased sensitivity to pain. Painless stimulation to get sick.

2) Analgesia- the visibility of painful sensitivity. Anomalous shkidliv for the body. Maybe I’ll be in the air and on the back.

Cause: Visibility of elements in the way of carrying out, more information or advancing the threshold of painful sensitivity.

Adaptations to pain is dumb... It’s not possible to lose the efficiency of the economy (it’s more dull, and so on). When overmixed, you may feel the pain may be weakened.

Types of reactions to the bill.

1) Active type of reaction manifest itself in the activation of chemical reactions.

Tse manifest:

a) in the activation of the SAS (sympathoadrenal system) and by increasing the increase in heart rate, AT, overgrowth of hemodynamics, activation of energy exchange, and improvement of perspiration.

b) in the galvanic activity of the organs, which take part in the regular reactions;

c) in advanced motor activity;

d) at formulated emots_y;

e) at the formulated behavioral reaction, which is straightforward for a joke at the outset of the situation.

2) Passive type of reaction.

With strong painful teasing, painful shock develops. Basically - the form of heart failure is important. The whole type of reaction to a large number of dressings is based on the associated adaptive reactions.

Nociceptive and antinociceptive systems.

nociceptive pain relief system. MAє receptor, provincial viddil and central representative. mediator systems of systems - R.

antinociceptive system- the system of zestoluvannya in organism, which exists by way of infusion of endorphins and enkephalin (opioid peptides) on the opioid receptor of the developmental structures of the central nervous system: paravascular system, middle of the cerebral cavity

Characteristics of the nociceptive system.

Peripheral view of the pain analyzer.

The representations of pain receptors, as for the proposition of Ch. Sherlington, are called nociceptors (from the Latin word "nocere" - ruinuvati).

Tsi high-threshold receptors that respond to different types of officials. Behind the mechanism of nociceptor development, one has to mechanonoceptoryі chemonoceptory.

mechanoreceptor roztasovany is important in shkіrі, fascias, darkened bags and mucous membranes of the herbal tract. The price of the nerves for the end of the group A Δ (delta; performance speed 4 - 30 m / s). Respond to deforming in flux, which is detected when stretching or squeezing fabrics. Most of them are good to adapt.

chemoreceptor roztasovani also on skirts and mucous internal organs, in the walls of other arteries. Presented by strong nerve endings of the group With a speed of 0.4 - 2 m / s. React to chemical words and inject, to create a deficiency of O2 in the tissues, to disrupt the oxidation process (tobto for algogen).

Prior to such speeches, the following should be applied:

1) fabrics algogen- serotonin, histamine, AH and іnshі, to be established when the ogryadny clines are ruined from the resulting fabric.

2) plasmovi algogen: bradykinin, prostaglandini. Determine the function of modulators, increase the sensitivity of chemonoceptors.

3) takhikinov when the ears are injected, they are seen from the end of the nerves (speech R). Pour the muscle onto the membrane receptor of the same nerve end.

The discovery of specific nociceptors and specific ways of carrying out a large amount of information allowed pain specificity theory(Frey M., 1895 p.). isnu i nonspecific theory of pain.

As a matter of fact, to the point of theory, it seems that the pain is formed when there are even strong stimuli on the receptors specific to them (for example, light, the sound can wickle more visually).

In the Danish hour to get involved, how offended and the theory is fair.

Providnikovaya viddil.

Ineuron- quietly in the sensitive ganglion of common nerves, how to innervate the senses of the body.

IIneuron- in the posterior horns of the spinal cord. The information provided by Bolova will be carried out in two ways: specific(Lemniskova) i nonspecific(Extralemniskova).

specific way repair from the intercalated neurons of the spinal cord. At the warehouse of the spinal thalamic tract, the impulse reaches the specific nuclei of the thalamus, (III neuron), the axon of the III neuron reaches measles.

nonspecific way carry information from the plug-in neuron to the brain structures. There are three main tracts, neospinothalamic, spinothalamic and spinomesencephalic. Destruction of the cic tracts comes to the nonspecific nucleus of the thalamus, to go in the force of measles of the great ponds.

Corky viddil.

specific way end in the somatosensory zone of measles.

Here you can see the form hostile, as if localized pain. In addition, for the release of the connection with the motor cortex, the motor activity is released when there is a lot of teasing, and the learning and development of the behavior program in case of painful injection is learned.

nonspecific way project in the measles area. Especially significant is the projection into the orbital-frontal area of ​​measles, as it takes part in the organization of the emotional and autonomic components in pain.

Characteristics of the antinociceptive system.

The function of the antinociceptive system and field in control over the activity of the nociceptive system and overloading. The interjugal function is manifested in the improvement of the halmic inflow of the antinociceptive system to the nociceptive system in response to a painful stimulus that is growing in strength. In case of overpowering painful supporters, a painful shock may develop, since the mobility of the antinociceptive system is not without intercourse.

The antinociceptive system is represented by the structure of the structures that have grown on the lower levels of the central nervous system.

First rіven representations by a complex of structures of the middle, large and spinal cord, before which periaqueductal syra rechovina, suture nuclei and reticular formations, as well as the gelatinous substance of the spinal cord... Destruction of the structures along the downward paths gave a galvanic inflow to the "pain gate" of the spinal cord (to the other neuron through the passage of a large amount of information), bringing in a higher rate of information.

The structure of the rivnya is integrated into a morphological and functional “system of decaying galvanic control”. mediators є serotonin and opioid.

other rіven views hypothalamus, Kotriy:

1) nadaє decaying galvanic infusion on the nociceptive structures of the spinal cord;

2) activating the system of "low-level galvanic control", that is, the first level of the antinociceptive system;

3) halmuthalamic nociceptive neurons. Mediators of the rivnya є catecholamines, adrenergic speeches and opioid.

third rivnemє the bark of the great pivkul, and the II somatotropic zone itself. To a great extent, a role is introduced in the formulation of the activity of the antinociceptive system and the formulation of adequate responses to the factors that make you feel better.

Mechanism of activity of antinociceptive system.

The antinociceptive system has put its own way for help:

1) endogenous opioid speech: endorphin, enkephalin, and dynorphin. Tsi speech, zv'yazuyutsya with opioid receptors, visible in the tissues of the body, especially in the central nervous system. In case of interaction with the receptor of the vine, pre - abo postsynaptic galvanization in the nociceptive system. I will become an inheritance of analgesia or hypoalgesia;

2) In the mechanism of regulating pain sensitivity, take on the fate and non-opioid peptides: neurotensin, angiotensin II, calcitonin, bombesin, cholecystokinin, which are rich in origin and galvanic effect on the conduct of painful pulses. The speech is established in different types of the central nervous system and the receptor on neurons that switch pain pulsation may appear.

Skin blocking pain: neurotensin - visceral pain; cholecystokinin - when there are some thermal teasers.

3) In the relief of singing types of pain, take on the fate and non-peptic speech: serotonin, catecholamines.

In the capacity of the antinociceptive system and development of a number of mechanisms, there are one type of one according to the triviality of the neurochemical nature.

terminovy ​​mechanism- to activate without a median pain stimulus and be aware of the participation of structures of decaying galvanic control, Zd_ysnyuєtsya serotonin, litter, adrenergic speech.

The whole mechanism will provide a competitive analgesia for a very weak development, as soon as one hour on the other receptive field, for a strong one.

short-range mechanism to be active during short-term action on the organism of pain factors. The center is in the hypothalamus (ventromedial nucleus) the mechanism is adrenergic.

Yogo role:

1) interconnecting the viscous noceptive flow on the spinal cord і supraspinal івні;

2) will provide analgesia in the event of a given nociceptive and stress factors.

long-acting mechanism to be active in the trivial action on the organism of nocogenous factors. The center is lateral and the supraoptic nucleus of the hypothalamus. Mechanism is operational. Dіє through the structure of decay galvanic control. Ma efekt pislyadії.

functions:

1) obmezhennya viscid nociceptive flow at all levels of the nociceptive system;

2) regulation of activity of structures of decay control;

3) no way to see the nociceptive information from the outward flow of afferent signals, from the evaluation and from the emotional information.

fine mechanism post-life activity of the antinociceptive system. The centers of fine control are located in the orbital and frontal areas of the measles of the great diseases. Neurochemical Mechanism - Opioid and Peptidergic Speeches

Theoretical bases of antibiotics and anesthesia.

Znebolyuvannya can be reached by pouring into the nociceptive or antinociceptive systems.

Into the nociceptive system build up to the offensive:

1) regulation of the micro-middle stock of the nerve end (for example, acetylsalicylic acid neutralizes prostaglandin);

2) the blockade of the carrying out of the stimulation at the lower levels of the pain analyzer.

For the localization of the blockade, Miscev Providnikov and general anesthesia (anesthesia).

anesthesia- the whole infusion on the system of pain and testimony.

Earlier, you can see the testimony, because of the painful reaction. Є the number of stages of development of anesthesia: from anesthesia to galmuvannya.

Bioelectrical manifestations during anesthesia.

1) PP does not change, but you can decrease during trivial action.

2) EPSP - changes to 1/10 of the normal value for the destruction of the mediator's vision in the synapses of the nociceptive system and in the synapses of the central nervous system.

3) The sensitivity of the postsynaptic membrane decreases as the channel breaks down for Na.

Membrane theory of anesthesia.

The determination of the membrane penetration for Na + is tied to the definition of the narcotic speech in the lipid ball of the membrane and the changes in the powers and minds of the robotic channels.

I'm pouring into the antinociceptive system.

With the help of zebolyuvannya it is possible to improve the antinociceptive system:

1) stimulation of opiate viroblast;

2) blocking of opioid receptors by narcotic speech. Tsim in full reach:

a) blocking the pain in the thalamus;

b) inflow into the reticular formation, and then regulate sleep, emotions, moods, memory.

Ale trivale drug consumption:

1) lowering the sensitivity of opioid receptors and the dose to be delivered to the patient;

2) to decrease і to creep up the rotation of the moisture fall.

Znebolyuvannya can be reached, pouring into the biological active points, And also by the method of suggestive therapy (induction, the introduction of a placebo to replace the sickly speech).

At the presentation of pathophysiological mechanisms, the development of nociceptive and neuropathic problems is pro- posed.

nociceptive bill vinikak todі, if the ear tissue is used on the peripheral pain receptor. The causes of this pain can be the most traumatic, infectious, metabolic and malignant diseases (carcinomatosis, metastasis, neoplastic diseases), which also trigger the activation of peripheral pain receptors. Nociceptive bill is the most common gostry bill, due to the powerful characteristics ( see Gostra and Chronicle). As a rule, a large variety of evidence is obvious, if it is good, it is localized and it is easy to describe it as ailing. Protect, visceral pain, less clearly localized and described, as well as visualized pain can be considered nociceptive. The emergence of nociceptive pain as a result of a new ear or falling ill is sensible to the sick person and is described in the context of many painful experiences. Typical for the whole type of pain ї їх a quick regression of a nasty bureaucrat and a short course of treatment with adequate diseases. Slid, however, admittance, but a trivial hour progresses peripheral development can lead to dysfunction of the central nociceptive and antinosceptive systems on the spinal and cerebral conditions, so that the objectivity of the maximum peripheral development is possible.

Bil, as a result of a change in the somatosensory (peripheral and / or central) nervous systems, as a result of a change in somatosensory neuropathic... A trace of adolescence, which is more likely to be a problem, as it can be blinded with damaged peripheral sensitive nerves (for example, with neuropathies), or with pathology of the somatosensory systems on all the great peripheral nerves. Below is a short reversal of the causes of neuropathic pain (Table 1)... In the midst of a glimpse of illnesses, there is a form, for some pain syndrome is the most characteristic and occurs more often. Tse - trigeminal and postherpetic neuralgia, diabetic and alcoholic polyneuropathies, tunnel syndromes, syringobulbia.

Neuropathic pain for their clinical characteristics is significant for the development of nociceptives. The price is equal to the level of space, character, triviality of battle and cost, by the same somatic and psychological factors. In the case of advanced forms of damage to the nervous system, at the early levels and stages of the development of the pathological process, the fate of the new mechanisms in the genesis of pain may also be different. However, depending on the level of the nervous system, both peripheral and central mechanisms of pain control are included.

The mental characteristics of neuropathic pain are persistent in nature, great triviality, ineffectiveness of analgesics for reduction, due to vegetative symptoms. Neuropathic pain is often described as heaving, prickly, or nasty or shooting.

For neuropathic pain, characteristic sensory phenomena are: paresthesia - spontaneous or sensory wickedness; dysesthesia - inappropriate spontaneous abnormalities of seeing; neuralgia - b_l, which expands along the course of one abo-decile nerves; hyperesthesia - sensitiveness is adjusted to a specific non-painful stimulus; allodinia - non-painful irritation yak painful; hyperalgesia - the pain reaction to the painful moan is adjusted. Remain three witnesses, who are vicious for the meaning of hyperpathy, to use the term hyperpathy. One of the types of neuropathic pain is causalgia (the appearance of intense swelling pain), which is most common in complex regional pain syndrome.

Table 1... Equivalent pain and causes of neuropathic pain

Mechanisms of neuropathic pain in lesions of the peripheral and central lanks of the somatosensory system and development. Transmission of mechanisms of neuropathic pain in peripheral injury include: post-denervation hypersensitivity; generation of spontaneous large pulses from ectopic waves, which are formed during the regeneration of lean fibers; epoptotic broadening of nerve impulses and demilinated nerve fibers; sensitivity to neuromas of genital sensory nerves to norepinephrine and other chemical agents; Decreased antinociceptive control in posterior rose with lengthened micelinated fibers. Peripheral changes in afferent painful sweat can cause destruction in the balance of the upper spinal and cerebral apparatus, so that they can play a role in pain control. At the same time, cognitive and emotional-affective integrative mechanisms of pain relief are obligatory included.

One of the options for neuropathic pain is central pain. Before them, it is possible to recognize pain, which is diagnosed when the central nervous system is affected. With a whole type of pain, it is associated with an additional, partly or subclinical damage to sensorimotor sensitivity, often for everything connected with a different type of spinal path on the spinal and / or cerebral lines. However, there is a trace of adherence, especially neuropathic pains, both central and peripheral, and the appearance of a direct correlation between the steps of neurological sensory deficiency and a variety of pain syndrome.

When sensory afferent systems of the spinal cord are pooled, it can be localized, unilateral or diffusion bilateral, and the zone of the lower level of the urazhenny is flushed. More permanent and have a busty, prickly, well-ditched, inodi cramatic character. On a whole background, there may be a change in the nature of paroxysmal focal and diffuse pain. An unprecedented pattern of pain descriptions in ailments with partial lesions of the spinal cord, of the anterior-posterior condition: with the application of painful and temperature stimuli in the zone of sensitivity of the patient to the contact of healthy sides on the other zones. I will call this phenomenon allocheiria ("іnsha hand"). In practice, the symptom of Lermitt (paresthesia with the elements of dysesthesia in Russia in the country) appears to increase the sensitivity of the spinal cord to mechanical infusions in the minds of the demilization of the back stumps. Danikh about analogous manifestations during demilinizatsiya spinotalamicheskikh shlakhiv in Danish hour is not.

Uninvolved on the great representation of antinocceptual systems in the brain, it is very painful to get rid of it. At the same time, the bridge and lateral views of the large brain, more often than not, are supervised by algic manifestations. The central pain of bulbar walking is described in case of syringobulbia, tuberculoma, puffins of the stovbur to the brain, in case of rosy sclerosis.

Dejerine i Russi described the intense pain in the framework of the so-called thalamic syndrome (superficial and glib hemianesthesia, sensitive ataxia, hemiplegia, mild choreoathetosis) for infarction in the area of ​​the visual hillock. The most common cause of central thalamic pains є sudinny lesions of the thalamus (ventroposteriomedial and ventroposteriolateral nuclei). In special robots, who analyzed 180 types of thalamic syndrome in right-handers, it was shown that twice as many of them were found to be twice as frequent in patients with severe right-handed symptoms (116 types), or less (64 types) ... Tsіkavo, scho vyavlena overlapping right-handed localization is more typical for cholovіkіv. It has been shown by some foreign robots that thalamic ones, behind the nature of the pain, are not uncommon in the presence of not only the green hillock, but rather of the afferent somatosensory paths. One of the most common causes of ciches of pain is also a blight. More pain is denoted by the term "central post-stroke bill", which is approximately in 6-8% of cases of GPMK ... Thus, the classic thalamic syndrome is one of the options for central post-stroke pain.

Mechanisms of central pains are foldable and are not implanted until the end. Before the last few years, they demonstrated the great possibilities of the functional plasticity of the central nervous system during the tests on the old ravines. Otrimanі danі can be zagrupuvati with an offensive rank. Dissection of the somatosensory systems and lead to disinhibition and appearance of spontaneous activity of deafferent central neurons on the spinal and cerebral lines. The changes in the peripheral lance of the system (sensitive nerve, posterior cortex) inevitably lead to changes in the activity of thalamic and cortical neurons. The activity of deafferent central neurons does not change only a little bit, ale and clearly: in the minds of deafferentation, the activity of some central neurons, as they do not think that they are sick before they go to sleep. In addition, in the minds of the "blockade" of the viscid pain flow (the reduction of the somatosensory path), the afferent projection of neuronal groups on all levels (back horns, stovbur, thalamus, cortex) will collapse. At the same time, new visual projections and new receptive fields are formed quickly. Vvazhayut, how about the process of being able to see it more quickly, then it’s better for everything not to be molded, but to see a spare or “disguised” (active in a great people) way. Maybe you’re going to have negative thoughts in your minds. However, it is postulated that the sensation of such a "pragmatic" before the oblique preservation of the flow of nociceptive affection of the field is necessary for normal robotic anti-nocicept systems. In the morning, due to the lesions of the systems of large afferentation, the lack of efficiency of the lower antinociceptive system and the periaqueductal speech, the great nucleus of the suture and DNIK, is associated with the lack of efficiency. Term deafferentation of pain acceptance for the development of central pain, as well as in case of severe afferent somatosensory paths.

There was a significant pathophysiological peculiarity of neuropathic and nociceptive pain. Special robots have demonstrated that the activity of certain anti-pain systems was evident in the presence of nociceptive pain, but not in neuropathic pain. It’s not possible to bind it, but in case of nociceptive pain of the central mechanisms (spinal and cerebral) it doesn’t get involved in the pathological process, while in case of neuropathic pain, it’s not mediocre. Analyzes of robots, attributing to the development of efficacious effects (neurotomy, rizotomy, chordotomy, mesencephalotomy, thalamotomy, leukotomy) and stimulation methods of pain (CHENS, acupuncture, stimulation syndrome As well as procedures for ruining nerve paths, rightly from the beginning, the most effective in the treatment of nociceptive pain, the stimulation methods, navpaki, are more effective in neuropathic pain. However, in the implementation of stimulation procedures, they are not opiate, but, for the time being, mediatorial systems.

To find out the visibility in the course of drug treatment of nociceptive and neuropathic pain. For the relief of nociceptive pain, in the presence of intensity, non-narcotic and narcotic analgesics, non-steroidal anti-apical and muscle anesthetics.

In the therapy of neuropathic pain, analgesics, as a rule, are ineffective and not stagnant. Vikoristovytsya drugs from the other pharmacological groups.

For the treatment of chronic neuropathic pain with drugs Vibor є antidepressant and anticonvulsant. Stagnation of antidepressants (tricyclic antidepressants, ingibitories of vigorous uptake of serotonin) is explained by the lack of serotonin systems in the brain in case of chronic pain, sometimes working, as a rule, with depressive disorders.

In the therapy of young types of neuropathic pain, antiepileptic drugs (carbamazepin, diphenin, gabapentin, sodium valproate, lamotrigine, felbamate) ... The exact mechanism of the analgesic process is unclear until the end, but it is postulated that the effect of these dressing preparations is: 2) activating the GABA system; 3) from the setting of NMDA receptors (felbamate, lamiktal). Development of drugs, selectively blocking the NMDA receptor, which may lead to pain transmistosis, in one of the priority areas ... In the current hour of antagonism of NMDA receptors (ketamine), there is no widespread presence in the therapy of pain syndromes due to the number of uncomfortable side effects associated with the participation of these receptors in the realization of mental and motor functions. ... Singing hopes for patients with chronic neuropathic pain with drugs from the amantadine group (vicious with parkinsonism), so that they will be able to get a good anti-sickness blockage for NMDA receptors. .

Drugs that are anxiolytic and antipsychotics can also be used to treat neuropathic pain. Tranquilizers are recommended, as a head rank, in case of swelling of anxiety disorders, and antipsychotics - in case of hypochondriacal discord, associated with pain syndrome. It is not often a matter of being vicious in combination with other drugs.

Central muscle relaxants (baclofen, sirdalud) for neuropathic pains can be treated with drugs that stimulate the GABA system of the spinal cord, order a relaxation of the muscles, and give an analgesic effect. Good results are eliminated in cases of postherpetic neuralgia, CRPS, diabetic polyneuropathy.

In a number of new clinical patients, for the treatment of chronic neuropathic pain, the drug mexiletine, an analogue of lidocaine, is infused into the robot with sodium-caliber canals in the peripheral nerve. It has been shown that in a dose of 600-625 mg per dose, mexiletine produced a clear, painless effect in ailments with pain syndrome in diabetic and alcoholic polyneuropathies, as well as in post-stroke central pain .

Special clinical prescripts have shown that in case of neuropathic pain there is a level of adenosine in the blood and a significant decrease in adenosine level in the normal range, so that in case of nociceptive pain there is no change in adenosine. An analgesic effect of adenosine in the presence of the most severe symptoms in patients with neuropathic pain ... This is a sign of the lack of activity of the purine system in neuropathic pain and the adequacy of the intake of adenosine in cichs with adenosine ailments.

One of the steps in the development of an effective treatment for neuropathic pain is the introduction of calcium channel blockers. In early pre-illnesses on VIL-infection, who suffer from neuropathic pain, a good sensitizing effect on the removal of a new blocker of Kaltsev canal SNX-111, at all

Recent experimental robots have shown the role of immune system in the onset of neuropathic pain ... It has been established that when peripheral nerves are depleted in the spinal cord, cytokines (interleukin-1, interleukin-6, alpha-factor necrosis of swelling) are violated, which causes persistent pain. Blocking cytokines changes in bile. With the development of a straight line to connect new perspectives in the development drugs for the treatment of neuropathic chronic pain.

Chapter 2. Bil: from the pathogenesis to the choice of the drug

Bil є most often and foldable according to sub-active sprinkles with scargo children. In 40% of all first-born animals, up to the liquor, there was a kind of scargo. There is a great breadth of pain syndromes to be wrapped in significant material, social and spiritual costs.

As the saying goes, the committee on the classification of the International Association for the Vivification of Pain makes it impossible for me to feel sensory and emotional, because we cannot describe such fabrics in any way. At the same time, it’s important to be admitted that it’s possible to see the pain not only when it’s worn out, but when it’s out there, it’s because it’s about the important role of psychic officials in the form.

Classification of pain

Bil - the understanding is classically and pathogenetically foldable and heterogeneous. Vona look for intensity, localization and according to their sub-active manifestations. Bіl can be strіlyaє, oppressive, pulsating, ryzhuchoi, as well as post-period chi periodical. All the significant changes in the characteristics of pain are rich in what is tied to the very cause, but it is anatomical region, in which there is notional impulse, and it is even more important for the purpose of causing the pain of the other person.

One of the most important factors in the rational phenomenon is the pain on the hospital and chronic (Fig. 8).

Gostry bil- the price of a sensory reaction with the further inclusion of emotional-motivational vegetative and other factors in the case of impaired organism. branch very painful They are tied, as a rule, with a whole lot of painful pains of surface abnormal tissues and internal organs, damage to the functions of smooth muscles. Gostry bolovy syndrome develops in 80% of cases, ma zhisne, in front of the juvenile value, so as to inform about the “poppy” and sniffing people to live in for the reason of causing pain and usunenia. The triviality of a painful pain begins with an hour of renewal of fabrics and / or damaged functions of smooth joints and does not last for 3 months. Gostriy b_l call for a good buy with analgesics.

In 10-20% of vypadkіv gostry bіl go to chronіchnuyu, as it is usually 3-6 months. However, the head view of chronic pain from the hotel is not a watchman, but obviously neurophysiological, psychophysiological and clinical sportsmanship. Chronic b_l does not have a chronic character. Chronic bile in the last years of rock began to be seen not only as a syndrome, but as a type of nosology. Її form і і іntrimіku lie in a larger world in terms of a complex of psychological officials, lower in the nature and intensity of peripheral nociceptive in flux. Chronic bile can be taken for the completion of the processes of ignition, so that it is not unrecognizable as a result of the process (the manifestation of nociceptive infusion). Chronic patients cannot be bought with analgesics and often lead to psychological and social maladjustment of patients.

One s for any reason, As a result of chronic pain, є lykuvannya, inadequate cause і pathogenesis of pain syndrome. Usunennya cause of painful pain and / or the most effective way of treatment is a problem of preventing the transformation of painful pain into chronic.

Significance for the successful treatment of pain is more important for the pathogenesis. Naybilsh is often seen nociceptive bill This is the case with subtypes of peripheral pain receptors - "nociceptors", which are localized practically in all organs and systems ( coronary syndrome, Pleurisy, pancreatitis, slug slope, nirkova kolka, Suglobovy syndrome, shkіri shkіri, zyvazok, m'yazіv, etc.). Neuropathic bill winery is a common type of somatosensory nervous system (peripheral and central).

Nociceptive pain syndromes are most often hospitable (opic, porous, sore, sad, fracture, stretching), or may be chronic in nature (osteoarthritis). In case of any kind of pain, the factor, which is very clear, is, as a rule, obvious, but it is clearly localized (call it into the zone). Describing the nociceptive beat, the patients most often confess with the names "squeeze", "low", "pulsating", "laughing". In the treatment of nociceptive pain, a good therapeutic effect can be eliminated with the signs of simple analgesics and non-steroidal anti-fatigue diseases. With the elimination of the cause (reduction of the development of "nociceptors"), nociceptive pains pass.

The causes of neuropathic pain can be a decrease in the afferent somatosensory system, whether it be correct, from peripheral sensitive nerves and ending with the bark of great diseases, as well as a breakdown in the descending antinocular systems. If the peripheral nervous system is severe, it is called peripheral pain, and if the central nervous system is severe, it is called central (Fig. 9).

Neuropathic bele, which is diagnosed in cases of hypoglycemic disorders of the nervous system, is characterized by patients with a fatigue, as well as cold and supernatant symptoms (hyperaesthesia, functions of nerves) characteristic symptom neuropathic pain є allodinia - a phenomenon that is characterized by pain in the face of painless stimulus (stroking with a penzel, cotton wool, temperature official).

Neuropathic pain is characteristic of chronic pain syndromes in the developmental etiology. At the same time, combine the spilny pathophysiological mechanisms of the formulation and pain relief.

Neuropathic pain is disgustingly susceptible to standard analgesics and NSAIDs and often leads to severe maladjustment of patients.

A practicing neurologist, traumatologist, oncologist has pain syndromes, in cool paintings both the symptoms of both nociceptive and neuropathic pain are susceptible to pain - "change of pain" (Fig. 10). Such a situation can be found, for example, with the compression of the chubby nerve stove, teased mіzhkhrebtsevoy gryzhey spinal nerve(Radiculopathy) abo with compression of a nerve in the cyst abo m'yazovuyu channel(Tunnel syndrome). In patients with severe pain syndromes, it is necessary to inject on offense, nocicept and neuropathic, pain components.

Nociceptive and antinociceptive systems

Symptoms of pain are based on evidence of two systems: nociceptive (NS) and antinociceptive (ANS) (Fig. 11).

The nociceptive system (є viscid) prevents pain from peripheral (nociceptive) receptors to measles in the brain. The antinociceptive system (є low) is designed to control pain.

At the first stage of pain formation, activation of pain (nociceptive) receptors occurs. Prior to the activation of the pain receptors, one can induce, for example, ignition process... Tse wiklikє conduction of painful impulses to the posterior horns of the spinal cord.

At the segmental spinal stage, modulation of nociceptive afferentation is observed, as it works in the inflow of lower antinocceptual systems on the development of opiate, adrenergic, glutamate, purinic rear horn... A whole large impulse is then transmitted to the dissection of the central nervous system (thalamus, cerebral cortex), and processing and interpretation of information about the nature and localization of pain are processed.

However, the pain relief in the meaning of the world lies in the activity of the ANS. The ANS of the brain plays a key role in the formulated pain and the change in reaction to the disease. It is obvious that it is widely represented in the brain and is included in the development of neurotransmitter mechanisms (noradrenaline, serotonin, opioid, dopamine). The ANS is not isolated, but, in conjunction with itself and with the other systems, does not regulate the stench of sensitivity, but is connected with the pain of vegetative, motor, neuroendocrine, behavioral and behavioral problems. The conditions allowed for the examination of the system, but not only the characteristics of pain perception, but not only the characteristics of the painful perception, but also the psychological, physiological and behavioral characteristics. The fall in the activity of the ANS is more likely to develop or change.

Preparations for the treatment of pain

Preparations for the treatment of pain are associated with the reduction of pain mechanisms. The rationalization of mechanisms in the form of pain syndrome allows for an individualized treatment. For nociceptive pain from the most painful side, nonsteroidal protivopalny drugs (NSAP) and opioid analgesics were recommended. For neuropathic pain, primed є antidepressants, anticonvulsants, medical anesthetics, As well as blockers of caliber channels.

Non-steroidal antiapalny drugs

If in the pathogenesis of pain syndrome I have a role to play with the mechanisms of ignition, then the most significant role in the reduction of NPZP. Їх vikorystannya allows you to stifle the synthesis of algens in small tissues, which will lead to the development of peripheral and central sensitization. In addition to the disease, the preparation from a group of non-steroidal anti-fiery anti-fatigues may cause anti-fatigue and anti-fatigue effects.

There is a modern classification of refineries in the transfer of food items to a small group, so that the selectivity of cyclooxygenase enzymes 1 and 2 types, which take part in a number of pathological processes.

It is important that the antibiotic effect of the preparation from a group of non-steroidal anti-inflammatory dressings in the main one is injected onto the COG2, and the slurry-intestinal preparation is accelerated into the COG1. However, the last few years have emerged and are the mechanisms of analgesic drugs from the group of non-steroidal anti-inflammatory drugs. So, it has been shown that diclofenac (Voltaren) can give an analgesic effect not only through COX-fallen lands, ale and іnshі peripheral, but also central mechanisms.

medical anesthetics

Replenishment of adequate nociceptive information in the central nervous system can be reached when there are fewer muscle anesthetics, which may not only prevent sensitization of nociceptive neurons, but rather normalize the memory of the brain The order of the cym of muscle anesthetics relaxes the transversely dark musculature, assimilates pathologic straining of the musculature, as well as the additional pain.
Before muscular anesthetics, it is necessary to make speeches, so that the time-consuming loss of tissue sensitivity as a result of blocking the conduction of impulses in the nerve fibers is used. The most widespread among them were lidokain, novokain, articain and bupivakain. Mechanism of muscular anesthetics dressing with blocking of Na + -channels on the membranes of nerve fibers and galvanizing the generation of potential in children.

anticonvulsant

It was trivial to develop nociceptors or peripheral nerves to develop peripheral and central sensitization (hypertension).

It is very effective anticonvulsant anti-convulsions, which can become stagnant for pain relief, may cause the point of application. Diphenin, carbamazepin, oxcarbazepin, lamotrigine, valproate, topromat are the head of the rank, the activity of the potential-fallow natural channels is attributable, and the spontaneous generation of ectopic nerves is likely to occur. The efficacy of these medications was demonstrated in patients with trigeminal neuralgia, diabetic neuropathy, phantom-pain syndrome.

Gabapentin and pregabalin galvanize the input of calcium into the presynaptic terminal of nociceptors, by itself reducing glutamate vikide, so that to reduce the malignancy of nociceptive neurons of the spinal cord (change) The drugs also modulate the activity of NMDA receptors and reduce the activity of Na + channels.

antidepressant

Antidepressants and drugs from a group of opioids are used to improve antidepressants. With the treatment of pain syndromes in the main drug, the mechanism of dressings with the blockade of the vocal congestion of monoamines (serotonin and norepinephrine) in the central nervous systems. The antidepressant effect of antidepressants can be partly speculative and indirect analgesic, so as to improve the mood I am friendly to assess pain and change sore sleep... In addition, antidepressants are potential for narcotic analgesics, which increase spores to opioid receptors.

myazovi relaxanti

M'yazovi relaxanti stasis in vipadkas, if injections in formvannya pain to bring m'yazovy spasm. Slide means that relaxant meats are injected on the spinal cord, and not on the spinal cord.
In our country, tizanidine, baclofen, medocalm, as well as preparations for the benzodiazepin group (diazepam) are found for the treatment of malignant spasms. It will be an hour after the relaxation of the mucous membranes in the treatment of myofascial pain syndromes to become stagnant in the botulinum toxin type A. Baclofen is an agonist of GABA receptors, driving the activity of intercalated neurons to the spinal cord.
Tolperisone blocking the Na + -і Ca 2+ -channels of interneurons of the spinal cord and reducing the wickedness of large mediators in the neurons of the spinal cord. Tizanidine is considered to be a relaxant of the central diya. The place is located in the spinal cord. Stimulating presynaptic a2-receptor, inducing vivile amino acids, stimulating receptors to N-methyl-D-aspartate (NMDA-receptor). As a result, synaptic transmission is induced in the spinal cord. Oscillations of the male mechanism are attributed to the overwhelming muscular tone, when the muscular tone is reduced. In addition to muscle relaxant powers, tizanidine also has a central analgesic effect, along with the bends.
Cob tizanidine for disintegration for the elimination of myazovy spasm in case of advanced neurological problems (with traumatic ears brain and spinal cord, rosy sclerosis, strokes). However, it’s not bargaining to eat a cob of yogh zasosuvannya buli vyavleni analgesic powers tizanidin. In the Danish hour of storing tizanidin in monotherapy and in complex treatment painful syndromes were widespread.

Selective activators of neuronal calibers (SNEPCO)

A fundamentally new class of drugs for the treatment of pain syndromes є selective activators of neuronal calibrated channels - SNEPCO (Selective Neuronal Potassium Channel Opener), which infuses into the sensitization of neurons in the posterior horn for the development of stabilization of the membrane.

The first representative of the whole class of lykarsky zasobiv is flupirtin (Katadolon), which volodya has a wide range of valuable pharmacological authorities, who are clearly aware of these types of noxious drugs.

At the beginning of the day, the details of the victories are about pharmacological authorities and the mechanism of Katadolon's work, presented the results of the progress of its effectiveness and safety, to discuss the information about the drug intake in the new lands of the world, a recommendation was given for the use of Catadolon in the case of advanced pain syndromes.