RU2729436C1 - Method of complex treatment of glossalgia - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: invention refers to medicine, particularly to dentistry, namely to methods of treating glossalgia. Physiotherapeutic treatment is combined with drug therapy with antidepressants, anxiolytics, vitamins, dental gel, such as Phenazepam 0.5 mg at night, Amitriptyline 25 mg 2 times a day, Milgamma 2 ml intramuscularly, Cholisal in form of applications. As a physiotherapeutic treatment laser radiation of red spectrum of action and negative pressure of the manipulative holder of complex KAP-"Parodontolog" on painful zones of tongue are used. It is exposed to continuous laser radiation of wave length 0.65 mcm with further transition to laser beam modulation at first frequency of 1 Hz in the middle of the course, and then 10 Hz to its end and negative pressure with minimum pressure of 0.45 kgf/cm². Middle rate discharge is gradually increased to 0.55 kg/cm² and then to 0.65 kgf/cm² to its end. Total exposure time is increased by ascending order from 5 to 15 minutes. Complete therapeutic course makes 8–10 daily sessions.

EFFECT: method enables prolonging the remission, analgesia, considerably reducing the paresthesia sensations, improving microcirculation and correction of the patient's psychoemotional status.

1 cl, 2 ex

Description

The invention relates to medicine, in particular to dentistry, and in particular to methods of treating glossalgia.

Glossalgia is considered a polyetiological disease, and its treatment should be focused on correcting the shifts that are detected in this disease.

At present, a combination of physiotherapeutic effects is widely used in the complex treatment of many diseases. The principle of the unidirectional action of the applied physical factors leads to the potentiation of the positive therapeutic effect, as well as to the lengthening of the aftereffect period.

Vacuum laser therapy has a massaging effect, expands the capillaries of the tongue, brings blood cells closer to the source of laser radiation, and the latter improves their rheology.

Thus, the assessment of the effect of vacuum laser therapy on microcirculatory blood circulation in dentistry, as well as obtaining the effectiveness of using vacuum laser therapy in the treatment of glossalgia is urgent.

A known method for the treatment of glossalgia (patent RU No. 2165776, A61N 1/32, 04/27/2001) by combined exposure to currents of supratonic frequency on the pathological focus and hirudotherapy.

The disadvantages of this method include the presence of medical contraindications, such as taking drugs that reduce blood clotting, diseases accompanied by reduced blood clotting (hemophilia), low blood pressure, allergy to the components of enzymes secreted by leeches.

A known method for the treatment of glossalgia (patent RU No. 2208444, A61K 35/62, 20.07.2003) combines the effects of massage and hirudotherapy.

However, the weaknesses of the method are the need for specially trained personnel for the massage technique, the negative attitude of patients to the placement of blood-sucking animals in the oral cavity.

There is a known method for the treatment of glossalgia (patent RU No. 2202329, A61H 39/06, 20.04.2003), which combines the effect of hypothermia on the area of the tongue and roller applicators filled with liquid nitrogen on biologically active points.

The disadvantages of this method are associated with its technical features, such as the use of specially manufactured equipment, in particular roller applicators.

There is a known method for the treatment of glossalgia (patent RU No. 2297233, A61N 1/34, 20.04.2007), combining the effects of drug therapy, DENAS-therapy apparatus and topical application of a 20% solution of mummy in the form of applications on the tongue.

The disadvantages of this method include the duration of the procedure (30 minutes), during which the patient experiences inconvenience in terms of aesthetics due to the need to sit with his tongue out and periodically wipe the saliva that is released. And also there is a high probability of the patient developing allergic reactions to bee products.

A known method of physiotherapeutic treatment of glossalgia (patent RU No. 2614209, A61N 1/32, 23.03.2017), in which pulsed stimulation by currents is used - mesodiencephalic modulation.

The weak side of the method is the complexity of its use in medical organizations providing primary health care (polyclinics), due to the special application procedure - in the first three days, two procedures are performed with a minimum interval of 6 hours.

A known method for the treatment of glossalgia (patent RU No. 2428224, A61N 1/32, 09/10/2011), selected by the authors as a prototype. The method includes the impact on the auricular points (AT) of acupuncture. Every other day, the impact on AT 4 is alternated with the help of an external electrode of the DiaDENS apparatus and the red light of semiconductor laser radiation from the Svetozar apparatus. The impact from the device "DiaDENS" is carried out in the "Therapy" mode, with a frequency of 77 Hz, for 2 minutes. The exposure from the device "Svetozar" is carried out with a wavelength of 665 nm for 1 minute. The course of treatment is 7-8 days.

The weaknesses of the method is the patient's uncertainty in the success of treatment due to a short physiotherapeutic effect (1 minute; 2 minutes) against the background of the absence of drug therapy, which reduces the effectiveness of the treatment.

The objective of the invention is to improve the quality of life of patients.

The technical result of the invention is an increase in the duration of remission, analgesia, a significant decrease in paresthetic sensations, an improvement in microcirculation, and correction of the patient's psychoemotional status.

The stated technical result is achieved by the fact that during the complex therapy of glossalgia against the background of drug treatment, physiotherapeutic is used. Antidepressants, anxiolytics, vitamins, and dental gel are used as drug therapy. As a physiotherapeutic effect, laser radiation of the red spectrum of action and the negative pressure of the manipulation holder of the KAP-"PARODONTOLOG" complex on the painful zones of the tongue, revealed during the initial treatment of the patient, are used. For this, continuous laser radiation with a wavelength of 0.65 μm is used, followed by a transition to modulation of the laser beam, first with a frequency of 1 Hz in the middle of the course, and then 10 Hz to its end, and negative pressure with a minimum discharge of 0.45 kgf / cm ² , gradually increasing in the middle of the course to 0.55 kgf / cm ² , and then to 0.65 kgf / cm ² by the end. The total exposure time increases in an ascending pattern from 5 to 15 minutes, and the full course of treatment is 8-10 daily sessions.

In this case, a stable technique is used - the manipulation holder remains in one place during the entire exposure time, and after the formation of a visually fixed hematoma, the vacuum is released and the laser irradiation is continued.

The procedure for performing vacuum laser therapy favorably differs in its ease of implementation, availability to a large number of patients due to the possibility of using it in dental clinics, dental clinics, as well as painlessness and safety, since the parameters of laser radiation and negative pressure are optimally calibrated and are not able to negatively affect the human body, and also requires minimal space in the dentist's workspace.

The developer and manufacturer of the KAP- "PARODONTOLOG" hardware periodontist complex is TRIMA LLC, Saratov (registration certificate dated April 27, 2009 No. FSR 2009/04538 issued by the Federal Service for Surveillance in Healthcare). There is also a Declaration of Conformity (date of adoption 05/19/2017), according to which the complex "KAP-PARODONTOLOG", TU 9444-025-26857421-2008, meets the requirements of GOST R 50267.0-92, GOST 50444-92 (pp 3,4), GOST R 50723-94, GOST R 50276.0.2-2005. One of the medical indications for the use of the KAP-"PARODONTOLOG" complex is the treatment of glossitis, glossalgia ("Hardware physiotherapy in dentistry. A guide for doctors." SPb .: SpetsLit, - 2019, - p. 182).

As a result of the studies carried out, it has been established that this mode of exposure most optimally solves the therapeutic tasks, while achieving maximum clinical results.

65 patients with glossalgia of varying severity were observed. In the course of special studies, the presence of the alleged therapeutic effects was confirmed by clinical improvement in 63 patients (97% of the total), identified on the basis of a decrease in the frequency and intensity of patient complaints, and on the basis of the positive dynamics of the laboratory indicator - an increase in the oxygen saturation of hemoglobin according to the results of pulse oximetry. Only in two cases of the disease with glossalgia (3% of the total) there was a preservation of the frequency of patient complaints, but with a lower intensity, with a positive dynamics of the laboratory indicator - an increase in the oxygen saturation of hemoglobin.

In practice, the method for the complex treatment of glossalgia is as follows. Against the background of drug therapy, which consists in the appointment in accordance with medical indications of anxiolytics (Phenazepam 0.5 mg, 1 tablet at night for 15 days), antidepressants (Amitriptyline 25 mg, 1 tablet 2 times a day for 1 month), vitamins ( Milgamma 2 ml intramuscularly daily for 10 days) and dental gel (Cholisal - applying the gel 3 times a day after meals in the form of an application for 7-10 days), physiotherapy is used.

Physiotherapeutic effect is carried out by a complex of apparatus of a periodontist KAP-"PARODONTOLOGIST" on painful zones of the tongue, depending on the complaints presented during the initial treatment - the lateral surfaces of the tongue, the tip of the tongue, the back, while the working end of the tip of the manipulation holder with the fiber located inside is installed on the tongue in the area of influence ... The units of vacuum therapy and laser therapy, prepared for operation, are put into operation and, after sucking the working end of the handpiece, visually control the formation of hematoma and observe a characteristic spot of laser radiation. The tip is held in one place until a visually fixable hematoma is formed, then, using the valve key on the handle of the manipulation holder, the vacuum is released and laser irradiation is continued. A stable technique is used - the tip remains in one place during the entire exposure time. In this case, the initial procedures begin with sparing modes - continuous laser radiation, followed by a transition to modulation of the laser beam, first with a frequency of 1 Hz in the middle of the course, and then 10 Hz to its end, the minimum rarefaction is 0.45 kgf / cm ² , gradually increasing in the middle course up to 0.55 kgf / cm ² , and then up to 0.65 kgf / cm ² to its end; initial procedures are carried out with a total exposure of 5 minutes. At the end of the course, the exposure time is increased to 15 minutes. The course is 8-10 daily sessions.

Thus, combined vacuum-laser therapy is carried out while simultaneously exposing the mucous membrane of the tongue to laser radiation of the red region of the spectrum and negative pressure generated inside the replaceable tip of the manipulation holder.

The method of complex treatment of glossalgia ensures the achievement of the set technical result, which consists in increasing the duration of remission, analgesia, significantly reducing paresthetic sensations, improving microcirculation, and correcting the patient's psycho-emotional status.

Clinical example 1. Patient D., 48 years old, came to the dental clinic with complaints of a burning sensation of the tip of the tongue that disappears during a meal, a feeling of "heaviness" in the tongue, dry mouth, sleep disturbances, a constant state of anxiety, tearfulness, headaches ... From the anamnesis of the disease it follows that patient D. was treated by a neurologist, a psychiatrist, the prescribed treatment was ineffective, considers herself a patient for a year. Objectively: the tongue is pale pink, the papillae are not enlarged, the sensitivity is impaired. Diagnosis: glossalgia, mixed form. Complex treatment was prescribed:

1. Medical treatment:

a) Phenazepam 0.5 mg 1 tablet at night for 15 days;

b) Amitriptyline 25 mg 1 tablet 2 times a day for 1 month;

c) Milgamma 2 ml intramuscularly daily for 10 days;

d) Holisal - application of the gel 3 times a day after meals in the form of an application for 8 days.

2. Physiotherapy treatment:

Prescribed 8 daily sessions of vacuum laser therapy:

1, 2 session - laser therapy - continuous mode of laser radiation, wavelength - 0.65 microns, vacuum therapy - vacuum 0.45 kgf / cm ² ; total exposure 5 minutes.

3-5 sessions - laser therapy - modulation of a laser beam with a frequency of 1 Hz, wavelength - 0.65 microns, vacuum therapy - a vacuum of 0.55 kgf / cm ² ; total exposure 10 minutes.

6-8 sessions - laser therapy - modulation of a laser beam with a frequency of 10 Hz, a wavelength of 0.65 microns, vacuum therapy - a vacuum of 0.65 kgf / cm ² ; total exposure 15 minutes.

The vacuum laser therapy was well tolerated, no negative reactions were observed during the course of treatment.

As a result of the complex treatment, there was a decrease in repetitive and analgesic symptoms, normalization of sleep, reduction of headaches and irritability, disappearance of dry mouth, improvement of the general well-being and psycho-emotional state of the patient.

Along with the subjectively determined improvement, the positive dynamics of the clinical state of patient D. was also determined according to the data of special research methods.

The improvement in the psychological state of patient D. was determined using the SAN questionnaire (well-being, activity, mood) and the VAS scale (visual analogue scale) of pain, which allows assessing pain syndrome in points and objectifying treatment results (reducing the VAS score from 8 points to 2 points after the course of complex treatment).

Evaluation of the effectiveness of the effect of complex treatment on the microvasculature was carried out by a non-invasive method for diagnosing oxygen saturation - pulse oximetry. Peripheral oxygen suture (SpO2) rose to 98% from the initial 93% before treatment, which favors peripheral oxygen saturation.

Patient D. was observed after complex treatment for 10 months, no relapses of the disease.

Clinical example 2. Patient S., 53 years old, came to the dental clinic with complaints of pain in the anterior 2/3 of the tongue, paresthesia such as burning sensation, tingling of the tongue, crawling creeps that disappear during meals, dry mouth, irritability, tearfulness. From the anamnesis of the disease it follows that patient S. had applied for medical help earlier, an examination was carried out as a result of which no organic pathology was revealed, twice outpatient treatment was carried out after which a relapse of the disease occurred within 6 months. He does not believe in the success of the treatment, considers himself a patient for three years. Objectively: the tongue is pale pink, there is swelling of the tongue, the papillae are not enlarged. Diagnosis: glossalgia, mixed form. Complex treatment was prescribed:

1. Medical treatment:

a) Phenazepam 0.5 mg 1 tablet at night for 15 days;

b) Amitriptyline 25 mg 1 tablet 2 times a day for 1 month;

c) Milgamma 2 ml intramuscularly daily for 10 days;

d) Holisal - application of the gel 3 times a day after meals in the form of an application for 10 days.

2. Physiotherapy treatment:

10 daily sessions of vacuum laser therapy have been prescribed:

1-3 sessions - laser therapy - continuous mode of laser radiation, wavelength - 0.65 microns, vacuum therapy - vacuum 0.45 kgf / cm ² ; total exposure 5 minutes.

4-7 sessions - laser therapy - modulation of a laser beam with a frequency of 1 Hz, wavelength - 0.65 microns, vacuum therapy - a vacuum of 0.55 kgf / cm ² ; total exposure 10 minutes.

8-10 sessions - laser therapy - modulation of a laser beam with a frequency of 10 Hz, wavelength - 0.65 microns, vacuum therapy - a vacuum of 0.65 kgf / cm ² ; total exposure 15 minutes.

The vacuum laser therapy was well tolerated, no negative reactions were observed during the course of treatment.

As a result of the complex treatment, relief of the pain symptom, paresthesia, normalization of sleep, reduction of irritability, reduction of dryness of the oral cavity, improvement of the general well-being and psycho-emotional state of the patient were noted.

The positive dynamics of the clinical state of patient C, along with a subjectively determined improvement, was revealed on the basis of an improvement in the psychological state (SAN questionnaire and VAS scale) - a decrease in the VAS score from 7 points to 1 point - and an increase in the oxygen saturation of hemoglobin (from 93% to 98%) ...

Patient S. was observed after the complex treatment for 1.5 years, no relapses of the disease.

Thus, we have found that the method of complex treatment of glossalgia by combining drug therapy with the use of vacuum-laser exposure in the treatment of glossalgia has a beneficial effect on various etiopathogenetic links that are involved in the formation of a pathological painful circle.

Claims (1)

A method for complex treatment of glossalgia, including carrying out physiotherapeutic treatment, characterized in that physiotherapeutic treatment is carried out against the background of drug treatment with antidepressants, anxiolytics, vitamins, dental gel, such as Phenazepam 0.5 mg at night, Amitriptyline 25 mg 2 times a day, Milgamma, 2 ml intramuscularly, Cholisal in the form of applications, and as a physiotherapeutic treatment, laser radiation of the red spectrum of action and the negative pressure of the manipulation holder of the KAP-"PARODONTOLOG" complex on the painful zones of the tongue detected during the initial treatment of the patient are used, and they are exposed to continuous laser radiation of length waves of 0.65 microns, followed by a transition to modulation of laser radiation, first with a frequency of 1 Hz in the middle of the course, and then 10 Hz to its end and negative pressure with a minimum discharge of 0.45 kgf / cm ² , gradually increasing in the middle of the course to 0, 55 kgf / cm ² , and then up to 0.65 kgf / cm ² to eg At the end, the total exposure time is increased in an ascending manner from 5 to 15 minutes, and the full course of treatment is 8-10 daily sessions.