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OBJECTIVE: A complex examination of patients with chronic myofascial pain syndrome (MPS). MATERIAL AND METHODS: This study included 136 patients with MPS (66 men and 70 women). Pain was assessed using a Visual Analogue Scale (VAS). Investigation of profiles of natural antibodies (nAbs) to specific opioid peptides (ß-endorphin and orphanin), biogenic amines (dopamine and serotonin), surface electromyography (SEMG) of m. errector spinae at the L3-L4 level bilaterally were performed. Measurements were done at 1st, 10th and 21st days of treatment. RESULTS: There was a significant decrease in pain intensity (by 71% in men and by 63% in women) accompanied by a decrease in muscle tension by 10-25% in group values of SEMG amplitudes, and by 34-38% as assessed by individual dynamics of SEMG amplitudes. All nAbs levels were elevated or high in the 1st day. The dynamics of nAbs levels was multidirectional. At the 21st day, there was the increase in the incidence of patients with high nAbs levels to opioid peptides (39-41% women and 33-39% men) and patients with normal nAbs levels to serotonin (59% men and 52% women), while the levels of nAbs to dopamine decreased to normal levels in women (56%) and remained elevated (50%) or highly elevated (17%) in men. CONCLUSION: The dynamics of immune indicators correlates with pain intensity that possibly reflects the pathological changes in neural/humoral interactions in chronic pain. In this regard, monitoring of nAbs levels is prognostically relevant for assessment of risk of pain chronification.

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Prognostic immuno-biochemical tests to assess the severity of the condition of patients with cardiac diseases were developed. A comparative analysis of clinical and laboratory blood parameters, which are used in practice for the diagnosis and prognosis of diseases, and an analysis of the content of natural antibodies (n-Abs) to ß-endorphin, bradykinin, histamine, dopamine, and serotonin were performed. A significant correlation between the level of n-Abs, the main biochemical parameters, and the content of blood corpuscles was revealed. The practical importance of the combined use of immunological and biochemical tests to increase the reliability of prediction of the severity of heart pathologies was established.

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AIM: To compare immunochemical and clinical parameters in patients with chronic radicular and myofascial back pain. MATERIAL AND METHODS: A study included 92 patients (55 men and 37 women) with radicular pain syndrome and 97 patients (33 men and 64 women) with myofascial pain syndrome. Pain status was assessed with the differential visual analogous scale (at rest, on movement, at night and during spontaneous pain). Tensor algometry was used to measure pain intolerance thresholds at day and night. Levels of natural antibodies (nAB) to endogenous pain regulators (ß-endorphin, orphanin, serotonin, dopamine, histamine and angiotensin) were determined in the blood serum by ELISA. Patients were examined at admission to the hospital, on 10th and 21st days of treatment. RESULTS AND CONCLUSION: There was a significant decrease in pain syndrome in all patients to the 21st day. Pain intensity was higher in patients with radicular pain syndrome (р<0.05) in all functional states. Pain intolerance thresholds were initially reduced in both groups. No significant between-group differences in the dynamics were not found either in men or women. Women had lower pain intolerance thresholds compared to men. An analysis of nAB profiles to pain regulators showed that they were correlated with higher and high indices, with the predominance of nAB to ß-endorphin, orphanin and histamine in both groups. The increased levels of antibodies circulate in the blood serum of patients with dorsalgia for a long time can further be a factor of pain chronification.

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The dynamics of possible markers of pain syndrome: pain pressure thresholds of intolerance (PTI) and natural antibodies to mediators of pain processing (nAbs) in blood serum at dorsalgia was studied. We have shown that most men and women had reduced PTIs. Night PTIs were lower than daytime PTIs regardless of the gender. The study of the content of nAbs to opioids and biogenic amines by ELISA have shown a prolonged maintenance of their elevated and high levels that could evoke long-term effect in pain chronization. Thus, the pressure algometry and ELISA of nAbs to pain processing mediators make it possible to assess the individual pain status objectively and, on this bases, to propose personal schemes of treatment.

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Authors studied changes in the levels of antibodies to endogenous bioregulators (Ab) to Β-endorphin, orphanin, serotonin, dopamine and angiotensin in 36 healthy people and 109 patients with dorsopathy with chronic pain syndrome. The association of these immunological indicators with age and sex was found. It has been concluded that the levels of Ab to endogenous bioregulators may be considered as a marker of algic system pathology that does not depend on age and is sex-related.

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Forty-four patients with low back pain caused by a radix syndrome (mean age 46.18±9.11 years) have been examined. Patients have been stratified by sex. The pain syndrome has been assessed in 1st, 10th and 21st by the VAS, pressure pain measurement and laboratory tests for measuring neurotransmitter levels. It has been shown that women endure a pain worse as assessed not only by the questionnaires but also by the pressure pain measurement especially at night. The analysis of blood serum revealed higher levels of ß-endorphin, serotonin, dopamine that were correlated (р<0.05) with the pain level, their amount decreasing with the reduction of pain.

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Optimal conservative therapy of discogenic lumbosacral radiculopathy is a matter of debates. Contemporary guidelines recommend measures that predominantly have an influence on nociceptive mechanisms. However the mixed nature of pain in patients with discogenic radiculopathy requires approaches used for treatment of neuropathic pain. We carried out an open pilot study on efficacy of the anticonvulsant gabapentin in 25 patients with discogenic lumbosacral radiculopathy who were divided into two groups (with duration of pain episode 1 month or less and more than 1 month). Gabapentin was used in increasing doses up to 3600 mg/day. To the end of 8-week trial, the significant reduction of pain and restricted mobility was found. The reduction of symptoms was more rapid in the group with earlier onset of treatment. In both groups, the reduction of vertebral syndrome and neuropathic pain characteristics was noticed as well. The clinically significant effect was found in 59% of patients with early onset of treatment with gabapentin and in 51% of patients with later onset. These results suggest that early use of gabapentin (tebantin) holds promises for treatment of discogenic radiculopathy.

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An open controlled study of efficacy of the vitamin B complex (milgamma) has been performed in 38 patients with vertebrogenic lumbosacral radiculopathy suffered from moderate or severe pain during 1 month or longer. Patients have been randomized into 2 equal groups: in the main group milgamma has been prescribed in the combination with diclofenac; patients of the control group have received diclofenac only. Treatment efficacy has been assessed by clinical scales in the 10th and 24th days, and by the results of telephone interview after 3 and 6 months. A trend to higher efficacy of the treatment of the main group compared to that of the control group assessed with the Visual Analogue Scale was observed during all the study but the difference reached the level of statistical significance only to the 24th day. The assessment of qualitative characteristics of pain with the Neuropathic Pain Scale revealed decreasing of intensive, acute and sensitive pain only in patients of the main group. The moderate or substantial improvement was noted in 66% patients received the combination therapy and only in 34% patients received diclofenac. At the 3rd months, between-group differences were still significant (the pain was absent or minimal in 63% patients of the main group and 34% of the control one). The results revealed the potentiation of analgesic effect of diclofenac by the vitamin B complex. Using of milgamma in combination with NSAIDS leads to the rapid and long-standing regress of pain syndrome in patients with lumbosacral radiculopathy.

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Sixty patients with chronic vertebrogenic lumbalgia or lumboischialgia with exacerbation for at least 1 month were included in the study. A main group consisted of 40 patients and a control group of 20 patients. All patients took diclofenac in dosage 100 mg per day from the 1st day. Versatis was prescribed to patients of the main group from the 6th day. One-three plates were applied to the most painful spine areas and low extremities for 12 h during 5 days. To assess treatment efficacy, scales for measuring back pain, vertebral syndrome, neuropathic pain (NPS) as well as the Global Impression scale (CGI) and quality of life (EQ-5D) were used. A significant clinical effect was observed in 63% of patients of the main group: the additional reduction of pain by about a quarter, decrease of vertebral syndrome intensity, improvement of functional activity - spinal flexion-extension, ability to standing and quality of life. The NPS revealed that the use of versatis resulted in the significant decrease of "neuropathic" characteristics of pain; this effect remained after the end of treatment. The anesthetic effect of plates emerged in 1,2+/-1,1h after application, reached the maximum after 3,8+/-2,0 h, and continued during 4,7+/-2,2 h after removing the plates from the skin. The safety of lidocaine-coated plates was observed.

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One hundred and six patients with dorsalgia of lumbar-sacral spine have been examined and treated. The developed and tested optimal methodology for using biofeedback, reflex therapy and manual therapy in a combined treatment of patients of different age in acute and chronic stages of the disease raised treatment efficacy. Combined treatment, including biofeedback, manual therapy, acupuncture of patients with dorsalgia, provides rapid arrest of pain syndrome, reduction of high tonicity of paravertebral muscles, motion volume increasing in lumbar spine region. Biofeedback allows patients to self-regulate muscle tone, therefore prevent further possible exacerbations.

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