RU2067446C1 - Method for treating pain syndrome in the cases of trifacial neuralgia and extremity stump phantom pain - Google Patents

Abstract

FIELD: medicine. SUBSTANCE: method involves applying combined therapy using 3 preparations diuretic one, sedative one and biogenic stimulation agent administered at permissible therapeutic doses. The diuretic preparation like Triampur is administered at a dose of 1 tablet daily during the first 3 days with following dose reduction to 0.5 tablet daily till the end of 30 days course. The sedative preparation like Relanium is administered at a dose of 0.005 g increasing or reducing the dose in cycle during 30 days within some known limits depending on individual reactivity of the nerve system. The biogenic stimulation agent like for example aloes tincture is administered intravenously at a dose of 2 ml during 155 days. The mentioned combined therapy course is repeated in 6 months. EFFECT: removed pain syndrome.

Description

 The invention relates to medicine, in particular to neurology.

 In practice, numerous methods of treating these pathologies are known. In accordance with the generally accepted view of trigeminal neuralgia, as well as phantom pains of the stump of the lower extremity, belong to the manifestations of the pathology of the peripheral nervous system (I.P. Antonov, 1979, Minsk; V.E. Grechko, Moscow, 1984; A.Ya. Popelyansky, 1979, Minsk). A common technique in the treatment of these diseases is copying the pain syndrome.

 Moreover, due to relapses of the pain syndrome, which are common, the disease lasts for years and even decades (A.Ya. Vovchenko, Leningrad, 1974; N. F. Adashchin, Minsk, 1983).

 The pain syndrome in these diseases is relieved by various medications (N.K. Zagubelok, Moscow, 1969; A.E. Vovchenko, Leningrad, 1974; A.E. Grechko, Moscow, 1984).

In these publications, an attack of pain in trigeminal neuralgia is stopped by such known means as analgin, amidopyrine, promedol, vit. B ₁ , B ₁₂ . Subsequently, anticonvulsants began to be used (diphenin, tegretol, finlepsin, stazenin, trimethine, sodium hydroxybutyrate, hydrocartisone, xadiphon, physiotherapy, ИРТ, various nerve blockade, surgical treatment (V.A. Karlov, Moscow, 1990; V.E. Grechko, Moscow, 1984; N.K. Zagubelyuk, Moscow, 1969; V.S. Lobzin, Tashkent).

 Treatment in these cases can be divided into symptomatic and pathological (Karlov V.A. Moscow, 1988; V.E. Grechko, Moscow, 1984; N.K. Zagubelyuk, Moscow, 1969; V.S. Lobzin, Tashkent).

 Among recent works offering pathogenetic treatment by the blockade method, this treatment according to A.S. N 1666118, bulletin N 28, 07/30/91.

 Judging by the sources presented, relapses of pain occur periodically after more or less long periods of remission (from 1 month to 3 years).

 The etiology and pathogenesis of trigeminal neuralgia remain controversial to date, it is no coincidence that therefore, various methods of conservative treatment have recently been applied taking into account the pharmacodynamic properties of drugs and the anatomophysiological features of the structure of the trigeminal nerve (V.E. Grechko, G.M. Nesterenko, 1987, V.A. Karlov, 1988, Moscow).

 The analogs given below can be called such only according to the purposefulness of the methods for relieving pain, as for the solution itself, the therapeutic complex used in the claimed method differs from the following. With phantom pains of the stump of the lower extremities, the main treatment is the use of various medications in combination with analgesics. If there is no result, local novocaine blockades of the neurovascular formations of the stump, nerves and nerve trunks are produced, novocaine is injected into the arteries of the affected area. To prolong the therapeutic effect of novocaine blockades, chemical denervation is used with alcohol, phenol, and antispasmodics. Then they proceed to the removal of nerves in the cult, neurotomies, resection of the sympathetic trunk and its nodes (N.N. Vaks, Kharkov, 1972; E.A. Bova, Moscow, 1972; I.P. Antonova, 1979, Minsk).

 As a rule, relapse of pain in these cases occurs after a short time. According to N.N. Burdenko and D.V. Uvarov, one third of patients undergoing amputation of limbs go to treatment facilities for persistent pain in a cult or absent limb.

 At the same time, in recent years there has been a clear increase in the number of amputations performed due to injuries, as well as gangrene, developing in connection with flying diseases, vascular embolism of no limbs. So, 80% of amputations of the lower extremities are associated with atherosclerosis of the vessels of the lower extremities; 11.6% with injury; 8.4% with other diseases (A.N. Kishkovsky, Leningrad, 1975; V.S. Kazantseva, Novosibirsk, 1972; I.P. Grokhovsky, Moscow, 1983). Despite the use of ganglion blockers, antipsychotics, physiotherapeutic procedures, improvement of surgical methods, treatment does not lead to the elimination of pain. The methods are ineffective, since the above therapeutic measures give only a short-term effect (G.S.Kazantseva, Novosibirsk, 1972; N.P. Grokhovsky, Moscow, 1983; A.N. Kishkovsky, Leningrad, 1975) and the disease often takes a relapsing character .

 The aim of the invention is the elimination of relapse of pain. The goal is realized by the appointment of combination therapy of three drugs - a diuretic, sedative and biogenic stimulant in therapeutically acceptable doses, while a diuretic agent, for example, triampur, is prescribed 1 table. per day for the first three days, followed by a decrease to 0.5 tab. per day until the end of the 30-day course; a sedative, for example, relanium, is prescribed from 2 to 5 times a day for 0.005 g, cyclically increasing or decreasing the dose within the above limits depending on the individual reactivity of the nervous system for 30 days; a biogenic stimulant, for example, aloe extract, is prescribed in oil of 2 ml for 15 days with a repeat of the above combined therapy after 6 months. To this, the maintenance dose of the diuretic drug is 0.5 tablets. appoint 1 time in 3 days for 2-3 months after the main course.

 To prove the conformity of the claimed solution to the criterion of "inventive step", we present a comparative analysis of the essential features of the proposed method against the background of known methods of conservative treatment of trigeminal neuralgia and treatment of phantom pains of the lower extremities. Surgical treatments are beyond our scope, therefore, they will not be analyzed.

 In the sources available to the applicant, the treatment is carried out as follows.

Trigeminal neuralgia is treated as follows; appoint:
1. Sodium oxybuterate iv 40-50 mg per 1 kg of weight A.E. Grechko, Moscow, 1984
2. Tegretol A.E. Vovchenko, O. N. Savitskaya and other Leningrad, 1974
3. Comprehensive treatment of amidopyrine + epidrine + analgin in the area of the nerve exit I. P. Gorzov, A. E. Zanger, Transcarpathia, 1986
4. Hydrocartisone NK Zagubelyuk, Moscow, 1969
5. The complex of finlepsin + antihistamines + antiaggregation drugs + drugs that improve metabolic processes, phosphoden - V.A. Karlov, R.S. Megdyaev, Moscow, 1988
Finibut V.A. Karlov
7. DNA V.S. Lobzin, Tashkent, 1988
8. Trimethine according to a certain scheme V. S. Lobzin
9. Blockades with a solution of Sergienko (novocaine + pyramidone + analgin + DN ₂ O V.I. Kary, Odessa, 1975
10. Introduction of hot water to the Meckel cavity L.Ya. Livshits, Kazan, 1966
Phantom pains are treated as follows.

 In the treatment of phantom pains, conservative treatment with the use of ganglioblockers, antipsychotics, physiotherapeutic procedures, a combination of analgesics with other medications is used, after their unsuccessful use, local novocaine blockades of the neurovascular formations of the stump and nerve trunks, chemical denervation by phenol, alcohol, surgical treatment methods ( N.N. Vaks, Kharkov, 1972; E.A. Bova, Moscow, 1972; I.P. Antonov, 1979; G.S. Kazantseva) and radiation therapy (Kishkovsky A.N. 1975). For conservative methods of treating phantom pain and inflammation of the trigeminal nerve, as can be seen from the sources cited, it is characteristic to relieve pain by analgesics, anticonvulsants of the carbomazenin group in combination with drugs that improve metabolic processes, while taking tranquilizers and sedatives to relieve tension in the psychoemotional sphere. But, as mentioned above, in all cases, when a positive effect is achieved as a result of a comprehensive pharmacocourse, remission, even relatively long up to 3 years, ends with new painful attacks.

 Tables 1 and 2, taken from an article by A.E. Vovchenko (collection of scientific works of the Bekhterev Scientific Research Institute, L. 1974), show the therapeutic efficacy of tegretol (carbomazenin) in patients with trigeminal neuralgia and the duration of remission (Table 2) in these patients after discontinuation of treatment.

 As can be seen from the data presented, the average duration of remission is within 12.6 weeks, ranging from 1 week to 24 weeks. At the same time, only one patient had a maximum remission duration of 6 months (24 weeks), which is 3.03% of Table 1, cited in the same publication, only confirms these results, emphasizing the relatively low efficiency of the method.

 For comparison, we present our own data on the treatment of trigeminal neuralgia by known and claimed methods (Table 3).

 From table 3 it is seen that 33 people were under observation. The observations were carried out in an ordinary clinical hospital, where the author worked for 18 years. These circumstances led to the empirical choice of multiple examinations of the same patients at the annual medical examination. The same conditions made it possible to conduct a comparative analysis of the duration of remission during treatment with various known medication methods and the claimed method.

 As can be seen from table 3, according to the history of patients, relapses of the disease were many times with a recurrence frequency ranging from 5 months to 2 years. After treatment with the claimed method, from 3 to 5 years, 29 people (87%) did not have relapse of the pain syndrome according to long-term results, and only 4 people had short pains, stopped by 1-2 single-dose analgesics.

 The results achieved allow us to talk about the effective rehabilitation of lost function.

 Tab. 4 shows the effectiveness of the treatment of phantom pains by known methods and according to the claimed solution. Repeated observations were carried out in the conditions of one clinic at the dispensary examination of patients. The contingent of observed participants in the Second World War, invalids of the Soviet Army, etc. Known methods included various medications, blockades, etc.

 Often, patients underwent the entire spectrum of known treatments without a visible result.

 Data on the effectiveness of known methods are given from the history of the patient.

 As can be seen from the data in Table 4, after treatment with the claimed method in 2–3 courses, no recurrence of phantom pain was observed, while remission was achieved by known methods within 1 year with a prolonged persistent pain syndrome.

 In none of the cases of treatment of trigeminal neuralgia, as well as the removal of phantom pains known from sources available to the applicant, the claimed combination of symptoms is described, i.e. a combination of three drugs - diuretic, sedative and biogenic stimulant, used in the claimed mode. The combined effect of 3 drugs not only relieves pain, but at the end of the course gives a long-term remission, and after a second course it practically eliminates relapses of the pain.

 The combination of the claimed features provides a higher level of positive effect in the treatment compared to known methods.

 Thus, the claimed method gives a qualitatively new positive effect, and the totality of its features is not similar to any of the known solutions, whence the author concludes that the proposed solution meets the criterion of "inventive step". The totality of the above characteristics is not described in any of the sources available to the author, from which we can conclude that the criterion of "novelty" is met. The author himself never reported or published the cited data.

 The so-called criterion of "industrial applicability", and in medicine this is the possibility of applying the method in practical health care, is provided by known means of the pharmacological complex used by the claimed method.

 The possibility of practical application is confirmed by the extensive practice of the author, who treated over 150 patients over an 18-year period, 133 of them with trigeminal neuralgia and 17 phantom pains.

 Each of them at the end of the course of treatment, mainly inpatient, had signs of good rehabilitation of lost functions.

 The method is safe and available to every medical institution where there is a neurologist or competent therapist. The author carried out control studies of the electrolyte balance and some patients upon admission, after 10 days and at the end of the course of treatment.

 Table 5 shows the control of "K" and Na "-th balance in 10 patients treated by the claimed method in a hospital in January-February 1992.

 The table shows that electrolyte metabolism is not disturbed while taking treatment according to the claimed method. Indicators "K" and Na "remain in the background.

The method is as follows:
Treatment is carried out strictly under the supervision of a neuropathologist or therapist who is able to clinically assess the state of the central nervous system.

 The treatment regimen is semi-bed, outpatient or inpatient, since taking sedatives requires rest, prolonged sleep.

 The main course of treatment is 30 days. After clarifying the diagnosis, the patient is prescribed combination therapy of diuretic and sedative in moderate doses according to the following scheme: the first 4-5 days, diuretic, for example, triampur 1 table. 1 time a day, in the morning. At the same time, sedative, for example, Relanium 1 tab. (0.05 mg) three times a day. From the 6th day, the dose of diuretic is reduced to 0.5 tablets. per day and remains so until the end of the course of treatment.

 At the same time, from the 5th-6th day in patients, as a rule, there may be an increase in the reactivity of the central nervous system in moderate limits in the form of sleep disturbances or increased heart rate, small fluctuations in blood pressure or short-term convulsive contractions of the calf muscles, a feeling of discomfort in the gastrointestinal tract or moderate fluctuations in the emotional sphere in each case individually. In this regard, the dose of sedative should be increased by 5 tablets. (for example, relanium at 0.05 tab. x 5 times a day) for 2-3 days. After the reduction or disappearance of the above phenomena, the dose of Relanium is again returned to the original (1 tablet three or two times a day).

 However, in case of any stressful situations for the patient, for example, when meteofactors affecting the patient negatively, with the possibility of mental overload during treatment, the dose of the sedative also increases. That is, the dose of a sedative varies cyclically depending on the state of the central nervous system.

 From the second week from the start of treatment to the reducible therapeutic complex, one of the biostimulants is additionally prescribed one of the extract of aloe or Fibs 2 ml / m N 15.

 Starting from the second half of the course (from about 15-16 days from the start of treatment), the patient should be recommended to activate the motor regime (morning and evening walks in the air with an increase in their duration as the patient's condition improves). The course of treatment lasts 30 days, then the patient is recommended a maintenance dose of a diuretic (for example, triampur) at 0.5 tablets. 2 times a week, for 2-3 months. Treatment should be repeated after six months, and if necessary, a third time.

 During treatment, you need to adhere to traditional recommendations, which are followed when taking diuretics: limiting excessive intake of fluid, salt. Additional precautions: avoid overheating of the body, and more specifically the head, i.e. prolonged exposure to direct sunlight, frequent washing of the head with hot water, some types of physiotherapeutic procedures.

 Example 1 illustrates the treatment of a patient with trigeminal neuralgia of the claimed method.

 Patient D. 63 years old (table 3 N 33), was admitted to the department in 1988 for bouts of neuralgia of the II-III branches of the trigeminal nerve on the left.

 Complaints upon receipt of paroxysmal unbearable pain in the upper and lower jaw on the left. Attacks lasting several seconds during the day are repeatedly provoked by talking, eating, washing your face.

 In addition, the patient was disturbed by poor sleep, increased irritability. According to the patient, relapses are repeated for 8 years. Previously, the patient received outpatient and inpatient treatment with well-known methods (analgesics, finlepsin, vitamin therapy, gang-blockers), which gave temporary relief with a remission period of 5-6 months. Due to the ineffectiveness of drug treatment, at the insistence of the patient, healthy lower molars on the left were removed.

 A comprehensive examination in the department revealed a syndrome of neuralgia of the II and III branches of the trigeminal nerve on the left with a trigger zone in the region of the upper lip on the left, hypertension II art. (the initial fluctuation in blood pressure within 170 / 100-200 / 110 mm Hg, the patient was recommended complete emotional and physical rest. At the same time, analgesics, anticonvulsants, vitamin therapy, physiotherapy, and IRT, traditionally used, were not prescribed.

 Treatment according to the claimed method: assigned triampur 1 table. 1 time a day, in the morning, Relanium 0.05 tab. 3 times a day. From the second day of treatment, a dream was established, three days after the start of treatment, the intensity of the pain decreased, and therefore the patient began to eat and chew relatively non-rigid foods, A / D 150/90 mm Hg.

 On the fifth day of treatment, the pain was completely relieved. After removing the pain, the dose of triampur was reduced to 0.5 tablets. per day and this dose remained unchanged until the end of inpatient treatment. Along with the 3rd day, the patient was prescribed aloe extract at 2.0 v / m N 15.

 To control the balance of electrolytes in the blood, an analysis of "K" and "Na" was performed at the beginning of treatment (initial), after 10 days and by the end of treatment (Na: 143.0; 137.0; 140.0; K: 4.9; 5.0; 4.0 in mmol / L).

 In the second week of treatment, the patient again had insomnia, moderate headache, fluctuations in blood pressure within 170 / 100-190 / 110 mm Hg. Art. After prescribing additional doses of relanium at 0.05 between morning and dinner, and between lunch and evening medications on the third day, the patient’s sleep returned to normal, headaches disappeared, blood pressure decreased to 130 / 90-135 / 90 mm Hg. Art. attacks of pain did not resume, subjectively, the patient's condition improved.

 After this, the dose of Relanium is reduced to the original, i.e. 0.05 two to three times a day. Attacks of neuralgia in the hospital were not repeated until the end of discharge. From the middle of treatment, the patient was additionally recommended the activation of the motor mode in the form of walks in the mornings and evenings with a moderate increase in their duration.

 In 1986-1987 an additional 2 courses of treatment were carried out.

 The patient was re-examined in 1989 and in 1991. There was no relapse of the pain syndrome.

 Example 2 illustrates the treatment of a patient with trigeminal neuralgia of the claimed method.

 Patient M., 47 years old, was admitted in 1984. with complaints of intolerable paroxysmal pain in the upper jaw on the right. Attacks of pain were sudden, spontaneous. Due to the frequency of attacks, the patient limited himself in food, talked a little, was constantly waiting for the resumption of new "backache", Sick for 4 years.

 According to the patient, during these 4 years with attacks for relief they took up to 3 tablets. Finlepsin at the reception.

 After the examination, the diagnosis was made: neuralgia of the second branch of the trigeminal nerve on the right.

 Along with other examinations to control the balance of electrolytes in the blood, an analysis of "K" and "Na" was carried out before treatment, 10 days after treatment and at the end of treatment. The patient was recommended half-bed rest.

 Verashpiron at a dose of 0.025 mg once a day in the morning and 0.01 mg three times a day at nozepam were prescribed as a diuretic. Then, from the 5th day, the dose of verashpiron was reduced to 0.5 tablets. and this dose was left until the end of treatment.

 Two days after the start of treatment, attacks of pain began to bother the patient less often, their intensity subsided. In this case, the patient did not take any painkillers to relieve seizures. On the 6-7th day of treatment, fluctuations in blood pressure up to 160-170 / 90 mm Hg were noted. (initial 130/90), fatigue, mood decline appeared.

 The patient was prescribed additional doses of nosepam up to 5 tablets. per day (0.01), after one week the above phenomena disappeared, after which the dose of nozepam was reduced to the original (1 table. 2-3 times a day).

 In parallel, starting from 3-4 days, the patient began to take Fibs 2 ml IM 15 injections. The attacks of pain of neuralgia completely stopped after one week from the moment of treatment and did not resume again.

 The results of blood tests on "K" and "Na": initial 4.9; 148.0; 10 days after the start of treatment 5.0; 149.0; and at the end of treatment 4.9; 151.0, i.e. within normal limits.

 The patient was discharged in satisfactory condition. Subsequently, the treatment was repeated twice. Within 5 years from 1985 to 1990, the patient was examined twice. There was no relapse of pain.

 Example 3 illustrates the treatment of a patient with phantom pains of a stump of the right lower limb.

 Patient S., born in 1947, was admitted to the department with a diagnosis of phantom pain of the right stump of the lower limb (amputation at the level of 2/3 of the thigh) due to the increase in attacks of pain, suffers for 11 years.

 From the anamnesis: the patient regularly received medical treatment (ganglion blockers, antipsychotics, analgesics), local novocaine blockade of the neurovascular formations of the stump, and spa treatment. Remissions in a patient after treatment are short 5-6 months, often after drug treatment the patient was discharged home without improvement. In subsequent years, the patient received mud therapy twice in Crimea, after which remission lasted until the 1st year.

 Due to the impossibility of re-treatment in the Crimea with the next relapse of phantom pains, the patient was admitted to the department. At admission, the patient complained of severe bouts of unbearable pain, tugging in nature, making it difficult to walk, irritability, often turning into aggressiveness, sleep disturbance.

 According to the medical documents submitted to the patients (outpatient records, extracts from the medical history, the treatment carried out was: general restorative, painkillers, various types of physiotherapeutic procedures and spa treatments.

 After generally accepted clinical examinations and consultations of the surgeon, the patient is prescribed treatment according to the claimed method. The patient is recommended rest. In the diet, intake of liquid and salt is limited.

 Hypothiazide 50 mg was prescribed once a day for 3 days, after the pain was reduced by 4-5 days, the dose of hypothiazide was reduced to 25 mg per day until the end of the course of treatment. At the same time, Relanium was prescribed at 0.05 mg three times a day.

 On the 5-6th day of treatment, the pain syndrome completely disappeared, but on the 9-10th day with a change in the weather, phantom pains appeared, although they were less intense than when they arrived. Complaints of insomnia, anxiety, general anxiety. In this connection, the dose of sedative (Relanium 0.05 mg) was increased up to five times a day (0.05 mg x 5). After removing the above phenomena after 3 days, the dose of Relanium was reduced to the initial dosage and remained unchanged until the end of treatment. The patient was prescribed aloe extract 2 ml N 15 v / m.

 The patient’s condition for discharge improved significantly, he began to feel much more cheerful, there was an interest in others. During the course, electrolyte metabolism indicators were: initial "K" 3.4; "Na" 137.0; on the 29th day "K" 4.3. "Na" 144.0 in mmol / L /.

 Upon completion of treatment, he was discharged home in satisfactory condition. After one year, in 1987, on the recommendation of the patient twice repeated the named course of treatment.

 From 1988 to 1992, the patient was examined twice, no relapse was observed.

 When exposed to a diuretic in the first 4-5 days of treatment and further, the nervous system is overexcited in the form of fluctuations in blood pressure, increased intestinal motility, increased heart rate and other changes. Therefore, the use of sedatives from the first days of treatment in therapeutic acceptable doses and subsequent increase in their doses prevents the occurrence of the above phenomena and thereby keeps the normal functional state of the affected organ or system at an optimal level.

 Biogenic stimulants (aloe extract, Fibs, etc.) in this case act on the pathology of the internal organs and central nervous system as absorbable.

 Thus, combination therapy from a diuretic, sedative and biogenic stimulant complexly affects the central nervous system, namely, certain affected brain centers associated with the affected organ, and thereby improves the nervous and functional regulation of these organs, the connection of which is well known and theoretically confirmed ( see Atlas A. I. Sandrigailo Anatomical and Clinical Atlas of Neurology, Minsk, 1978, pp. 243, 245, 247, 250, 254, 255, 256).

 Given this, this method can be used in the treatment of diseases such as: other types of neurology, neuritis, radiculitis, arachnoiditis, hypertension of nervous origin, chronic hepatocholecystitis, gastritis, colitis, menstrual irregularities, metabolic disorders, neurodermatitis, heart rhythm disturbances.

Claims (2)

 1. A method of treating pain syndrome with trigeminal neuralgia and phantom pains of stump of limbs using medications, characterized in that within 30 days a complex of medicines with diuretic and sedative effects, as well as biogenic stimulants, diuretics are started with an average a single dose daily for 3 5 days, followed by a decrease to half of a single dose per day until the end of the course, the introduction of sedatives is carried out in therapeutically acceptable single doses 2 5 times a day, cyclically increasing or decreasing the dose to the end of the course, while simultaneously administering a course of treatment with a biogenic stimulator.  2. The method according to claim 1, characterized in that after the main course of treatment, maintenance therapy with diuretic and sedative agents is carried out with a half single dose for 2 to 3 months with an intake interval every 3 days.

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