Динаміка маркерів ноцицептивної системи та больового синдрому в процесі лікування болю у нижній частині спини, обумовленого дискогенною радикулопатією

Abstract

Проведено клініко – неврологічне обстеження 26 хворих (11 жінок, 15 чоловіків) віком від 34 до 54 років із хронічним больовим синдромом у стадії загострення, обумовленим наявністю гриж та протрузій міжхребцевих дисків до 0,5 см. У хворих досліджували динаміку рівня концентрації субстанції Р як маркера ноцицептивної системи, у сироватці крові пацієнтів на фоні базового лікування. Аналіз результатів дослідження виявив, що субстанція Р може служити маркером інтенсивності больового синдрому, обумовленого дискогенною радикулопатією; Проведено клиниконеврологическое обследование 26 больных (11 женщин, 15 мужчин) в возрасте 34 - 54 лет с хроническим болевым синдромом в стадии обострения, обусловленным наличием грыж и протрузий межпозвонковых дисков до 0,5 см. У больных исследовали динамику уровня конце- нтрации субстанции Р, как маркера ноцицептивной системы, в сыворотке крови пациентов на фоне базового лечения. Анализ результатов исследования выявил что субстанция Р может служить маркером интенсивности болевого синдрома, обусловленного дискогенной радикулопатией; Nowadays it is known the formation of pain sensitivity is determined by the structures of nociceptive system. Nociceptors can be stimulated and activated in response to mechanic stretching and nerve’s compression and in response to chemical irritation by prostaglandins and other mediators of inflammation. A source of pain may be anatomical structure which is innervates as nonmyalenized fibers or that containing P substance. It has been indicated painful impulses assist in P substance synthesis, which is considered as a specific pain mediator. Objectives. The aim of the investigation was to study the dynamics P substance level, as a marker of nociceptive system, in blood serum of patients with painful syndrome, which is caused by discogenic radiculopathy against the background of therapy. Materials and Methods. 26 patients (11 females, 15 males) who had painful syndrome in the lower part of back, which was caused by discogenic radiculopathy were exmined. The age of patients was from 34 to 54 years. A control group was made up by 20 healthy persons of the same age and sex. Conventional therapy was administered to all the patients: non-steroidal anti-inflammatory preparation as sodium diclofenac in a dose of 75 mg intramuscularly per day for 7 days, miorelaxant – tolperizon 100 mg intramuscularly daily for 10 days, vitamin preparations – thiamine hydrochloride 100 mg, pyridoxine hydrochloride 100 mg, cyanocobalamin 1mg intramuscularly per day for 5 days. The course of treatment lasted 14 days, and the complex examination of all the patients was carried out in a day and in 14 days of investigation. The patients were subjected to clinical and neurological examination, MRT of lumbar and sacral spine, the determination of P substance concentration in blood serum. We used unified scales, visual analogue scale of pain (VAP), Roland-Moris questionnaire, Tomayer and Shober tests in order to provide an objectification of painful syndrome, pain intensity, to estimate the volume of active movements in lumbar part of spine as well as the disturbances of patient’s activity. Results. Clinical manifestations of compressive syndrome were accompanied by compression L5 (26,92%) and S1(73,08%) of rootlets. Main clinical symptom was a pain in lumbar and sacral part of spine irradiating to lower limb. Antipain scoliosis was often developed (76,92%), reduced (30,77% ) ahilovyi reflex disappeared or reduced (42,31%); hypoesthesia detected in an area of damaged rootlets (76,92%), hyperesthesia (23,08%), muscles hypotension (15,38%). Distinct symptoms were tension Lesage (in average contained 32.1± 1.82 degrees), functional disturbances of spine according Tomayer and Shober tests (correspondingly 2,7+0,17 sm 32,96± 1,64 sm). According to the performed treatment all patients had strong pain (according to VAP) and in average contained – 7,4± 0,31 degrees. Painful syndrome in lower part of back is caused by disturbances of life’s activity of patients. A presence of restrictions was present in these patients according Roland-Moris questionnaire (in average 11,69± 0,54 degrees). P substance concentration, markers of nociceptive system, in blood serum of patients before treatment was 18,79± 2,96 mg/ml, that in 371 times is higher in comparison with control (0,048± 0,006 mg/ml). There were a reduction of an intensity of painful syndrome (according to VAP) in 1,6 times, reduction of P substance concentration in blood serum in 1,45 times, an improvement of functional activity of spine according Roland-Moris questionnaire (in 1,5 and 1,7 times) after performed therapy in all patients. Received therapeutic effects testified an improvement of life activity in the patients that was proven by data of Roland-Moris questionnaire. Conclusions: 1. It has been detected patients who have pain in lower part of back which is caused by discogenic radiculopathy demonstrates the increase of substance P concentration in 370 times in comparison with the control group of patients. 2. Basic conventional treatment results in clinical improvement and reduction P substance concentration in 1,45 times.