RU2415662C1 - Method of treating patients with chronic fatigue syndrome - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: invention relates to medicine, namely to physiotherapy, balneology. Method includes sparing or sparing-training mode of motor activity, nutrition in accordance with diet No 5, intake of low-mineralised, low-carbonate sulfate-hydrocarbonate sodium-calcium mineral water and making mineral baths. In making mineral baths low-carbonate sulfate-hydrocarbonate sodium-calcium mineral water is used at temperature 36-37°C. Baths are made for 12-15 minutes, 8-10 procedures per treatment course. Additionally carried out is segmental-reflex massage of zones with a large number of biologically active points and gradual extension of impact zones. During the first procedure massage of cervical-collar zone is performed. During the second procedure - massage of cervical-collar zone and paravertebral zones of spine. During the third procedure and all following procedures massage of said zones, as well as massage of palms and region of radiocarpal joint and feet is carried out. Massage procedures are carried out daily. A course consists of 10 procedures.

EFFECT: method increases treatment efficiency due to improvement of adaptation, energy exchange and immune system.

2 ex, 5 tbl

Description

The invention relates to medicine, in particular to the section of internal diseases, and relates to increasing the effectiveness of rehabilitation treatment of patients with chronic fatigue syndrome by increasing the adaptive capabilities of the body by therapeutic physical factors.

A known correction adjustment method, in particular in patients with chronic fatigue syndrome (CFS), consists in the fact that, against the background of a sparing or sparing-training regimen of motor activity, diet is prescribed according to diet No. 5, the intake of low-carbonate, low-mineralized sulfate-bicarbonate calcium-sodium mineral Slavyanovskiy spring water (Zheleznovodsk type of mineral water) 200-250 ml per dose, as well as mineral baths from low-mineralization, low-carbonate sulphate-bicarbonate calcium-sodium howl of mineral water at a water temperature of 36-37 ° C for 10-15 minutes, for a course of treatment of 8-10 procedures (patent No. 2256456 from 07.20.2005, authors: Tovbushenko MP, Anashkin VV, Didkovsky N .BUT.). Published: July 20, 2005. Bull. No. 20.

This method of treatment causes favorable changes in the state of adaptation and reduces the severity of the clinical manifestations of the disease. However, this method is not effective enough for significant violations of the adaptation processes, does not always allow to achieve the desired effect. An analysis of the nature of adaptive disorders, their relationship with the development of the pathological process, the nature of the influence of therapeutic physical factors on the body suggests that massage of reflex-segmental zones in combination with balneological factors will increase the body's adaptive capabilities and the effectiveness of treatment of patients with chronic fatigue syndrome.

The technical result of the proposed method is to increase the adaptive capabilities of the body, which contributes to greater treatment effectiveness - the disappearance or reduction of the clinical manifestations of the disease, improve well-being, activity and mood, increase the working ability of patients.

The specified technical result is achieved by the fact that a method of treating patients with chronic fatigue syndrome is used, including a gentle or sparing-training regimen of motor activity, diet nutrition No. 5, ingestion of low-mineralized, low-carbonate sulphate-bicarbonate sodium-calcium mineral water and holding mineral baths using mild-carbonate sulfate-bicarbonate calcium-sodium mineral water at a temperature of 36-37 ° C for 12-15 minutes, 8-10 procedures per treatment course, distinguishing yy that additionally prescribe massage of the reflex-segmental zones according to the following method: during the first procedure - massage of the cervical-collar zone; during the second procedure - the area of the cervical-collar zone and spine (paravertebral zones); during the third procedure and all subsequent ones - massage of the above zones, as well as massage of the hands (including the area of the wrist joints) and feet with exposure to biologically active points of these zones; massage procedures are carried out daily in an amount of 10 per treatment course.

The method is as follows: the patients are assigned a gentle or gentle-training regimen, diet nutrition No. 5, ingestion of low-carbonated, low-mineralized sulfate-bicarbonate calcium-sodium mineral water of Slavyanovsky source of 200-250 ml per dose, and also mineral baths from a low-mineralized, low-carbonated sulfate-bicarbonate calcium-sodium mineral water at a water temperature of 36-37 ° C for 10-15 minutes, the course of treatment is 8-10 procedures. In addition, patients with chronic fatigue syndrome are prescribed massage according to the reflex-segmental technique developed during the study.

Massage technique for reflex-segmental zones: during the first procedure - massage of the cervical-collar zone; during the second procedure - massage of the cervical-collar zone and the spine (paravertebral zones); during the third procedure and all subsequent ones - massage of the above zones, as well as massage of the hands (including the area of the wrist joints) and feet with exposure to biologically active points of these zones. Massage procedures are carried out daily, in the amount of 10 per treatment course.

The method can be illustrated by the following examples.

Patient S.N.Zh. 48 years old, was treated at the Zheleznovodsk Clinic from 08/26/08 to 09/18/08 with a chronic severe fatigue syndrome, secondary immunodeficiency associated with chronic herpes virus infection (Epstein-Barr virus, type VI herpes virus). On admission, they were worried about weakness, fatigue, decreased ability to work, low-grade fever, muscle pain, and headaches. About 15 years has been observed with respect to ULC, which proceeds without pronounced and frequent exacerbations. She was treated on an outpatient, inpatient and sanatorium-resort basis. Over the past 10 years, there has been observed about chronic fatigue syndrome, the diagnosis was made in the laboratory of clinical immunology of the Research Institute of Physical and Chemical Medicine (Moscow). Sent to the Zheleznovodsk clinic for spa treatment. On examination, the patient is of the correct physique, satisfactory nutrition, pulse 68 beats. per minute, rhythmic, blood pressure 110/70 mm Hg, above the lungs - auscultatory vesicular breathing, the boundaries of relative cardiac dullness within normal limits, cardiac tones rhythmic. The tongue is moist, the stomach is of the correct form, evenly participates in the act of breathing, is painless on palpation in all departments. During the examination, a general blood test: hemoglobin 125 g / l, white blood cells 5.5 × 10 ⁹ , eos. 5, pal. 0, seg. 62, lymph. 27, mon. 6, ESR 17 mm / hour, clinical analysis of urine without pathological changes. Biochemical blood test: lactate 2.3 mmol / l, pyruvate 0.10 mmol / l, SDH-1080 units, a-GFDG560 units, ЩФ215,1Е / l, MDA, in erythra. 10.24 μmol / L, ATP 496 μmol / L, ADP 168 μmol / L, AMP 72 μmol / L, energy charge 0.72 units, ATP / AMP 6.88, total nucle. 736 μmol / L ECG - rhythm sinus, EOS is not rejected, the voltage is reduced, impaired repolarization of the left ventricle. EGDS - cicatricial deformity of the bulb 12p. intestines, Helicobacter pylori denied. (-). The state of adaptation of the body according to cardiac rhythmography and hematological parameters according to L.Kh. Garkavi et al. - stress adaptation processes. According to the anamnesis, clinical, laboratory, instrumental and functional studies, the diagnosis was established: chronic fatigue syndrome of moderate severity with stress of adaptation processes. In the clinic, the patient was assigned a sparing regimen of physical activity, diet nutrition according to diet No. 5, drinking treatment with mineral water from the Slavyanovskiy source 200 ml 3 times a day 45-50 minutes before meals, mineral baths, slightly carbonated, sulphate-bicarbonate calcium-sodium at a water temperature of 36 -37 ° C for 15 minutes, 10 treatments per treatment course, massage according to the technique of reflex-segmental effects. Upon repeated examination after treatment, a significant decrease in general weakness, fatigue, the disappearance of myalgia, headaches was noted. Complete blood count: hemoglobin 134 g / l, white blood cells 5.2 × 10 ⁹ , eos.6, pal. 2, seg. 54, lymph. 38, mon. 4, ESR 16 mm / hour; clinical analysis of urine without pathology. Biochemical blood test: lactate 1.0 mmol / l, pyruvate 0.075 mmol / l, SDH-1061 units, a-GFDH 520 units, alkaline phosphatase 161.3 U / l, MDA in red blood cells 9.208 μmol / l, energy charge 0 , 8 units, ECG-sinus rhythm, 75 beats. in min, EOS is not rejected, the voltage is normal, impaired repolarization of the left ventricle. The state of adaptation processes is within the normal range. Thus, as a result of the treatment, there is a positive dynamics of both subjective symptoms and the data of functional and laboratory research methods, indicating an improvement in the clinical condition and adaptive processes of the body.

Patient F.S.N., 57 years old, and / b No. 2392, was treated at the Zheleznovodsk clinic from December 29, 2007 to January 21, 08, with a moderate chronic fatigue syndrome against a background of chronic bacterial infection and severe immune dysfunction (secondary immunodeficiency). Considers herself a patient for 3-4 years, associates the development of the disease with psychoemotional overloads. The disease is characterized by general weakness, fatigue, decreased ability to work, and low-grade fever. Since 2007, he has been observed at the Research Institute of Physicochemical Medicine (Laboratory of Clinical Immunology) in Moscow, where the examination was diagnosed with chronic fatigue syndrome. Sent for spa treatment in the Zheleznovodsk clinic. Upon admission to the clinic, they were worried about weakness, increased fatigue, fatigue, dizziness, and a sharp decrease in working capacity. The patient is of proper physique, low nutrition, skin is pale pink, pink mucous membranes, pulse 88 beats. in minutes, rhythmic, blood pressure 140/80 mm Hg Above the lungs - auscultatory vesicular breathing, the boundaries of relative cardiac dullness within normal limits, cardiac sounds are rhythmic, moderately muffled, tongue moist, abdomen of regular shape, evenly involved in breathing, painless on palpation. During the examination: a general blood test - hemoglobin 122 g / l, leukocytes 4.4 × 10 ⁹ , eos. 4, fell. 2.5, seg. 68, lymph. 26, 5, mon. 2.5, ESR 4 mm / hour; wedge. an. urine - ud. weight 1010, clear full reaction acidic, no protein, no sugar, flat small epithelium, white blood cells 2-4 p / zren., mucus nezn. qty. Biochemical blood test: lactate 2.6 mmol / l, pyruvate 0.078 mmol / l, MDA in erythra. 8.9 μmol / L, ATP 560 μmol / L, ADP 139 μmol / L, AMP 68 μmol / L, energy charge 0.80 units, ATP / AMP 8.2, total nucle. 767 μmol / L ECG - rhythm sinus, 88 beats. in minutes, the EOS is not rejected, the voltage is normal. The state of adaptation according to cardiac rhythmography and hematological indicators according to L.Kh. Garkavi is the voltage of adaptation processes. According to the anamnesis, clinical, laboratory, instrumental and functional studies, a diagnosis was established - a syndrome of chronic fatigue of a moderate severe course with a strain of adaptation processes. In the clinic, the patient received a sparing regimen of physical activity, diet, drinking treatment with mineral water from the Slavyanovsky source, 200 ml 45-50 minutes before a meal, mineral baths, slightly carbonated, sulphate-bicarbonate calcium-sodium at a water temperature of 36-37 ° C for 15 minutes , 8 procedures per treatment course, massage of reflex-segmental zones according to the developed technique. After the treatment, he notes an improvement in well-being, a decrease in general weakness, fatigue. When re-examination after treatment, hemoglobin 136 g / l, white blood cells 4.8 × 10 ⁹ , eos. 2, fell. 8, seg. 50, lymph. 33, mon. 7, ESR 6 mm / h, general urine analysis without pathology. Biochemical blood test: lactate 1.8 mmol / l, pyruvate 0.062 mmol / l, MDA in erythra. 8.0 μmol / L, ATP 584 μmol / L, ADP 176 μmol / L, AMP 62 μmol / L, energy charge 0.83 units, ATP / AMP 9.4, total nucle. 823 μmol / L Adaptation state - satisfactory. As a result of the treatment, there is a positive dynamics of subjective symptoms, as well as data from functional and laboratory research methods, indicating a positive therapeutic effect.

Patient I.L.I., 56 years old, was treated at the Zheleznovodsk Clinic from 05/29/08 to 06/21/08 with a moderate chronic fatigue syndrome against the background of secondary immunodeficiency associated with a chronic stressful situation. On admission, they were worried about weakness, fatigue, decreased ability to work, joint pain, muscle pain, headaches. The patient considers himself over the past 5 years, in 2003, when examined at the Altai Medical University (Barnaul), he was diagnosed with chronic fatigue syndrome. Sent to the Zheleznovodsk clinic for spa treatment. On examination, the patient is of the correct physique, satisfactory nutrition, pulse 62 beats. per min, rhythmic, blood pressure 140/90 mm Hg, above the lungs - auscultatory vesicular breathing, the limits of relative cardiac dullness within normal limits, cardiac tones rhythmic, impaired left ventricular repolarization. The tongue is moist, the stomach is of the correct form, evenly participates in the act of breathing, palpation is moderately painful in the epigastrium. During the examination, a general blood test: hemoglobin 136 g / l, white blood cells 4.8 × 10 ⁹ , eos. 2, fell. 0, seg. 58, lymph. 32, mon. 8, ESR 4 mm / hour, clinical analysis of urine without pathological changes. Biochemical blood test: lactate 1.8 mmol / l, pyruvate 0.089 mmol / l, a-GFDH 660 units, alkaline phosphatase 216.4 U / l, MDA in erythra. 9.9 μmol / l, energy charge 0.7 units The state of adaptation is the stress of adaptation of the body. According to the anamnesis, clinical, laboratory, instrumental and functional studies, the diagnosis was established: chronic fatigue syndrome of moderate severity with stress of adaptation processes. In the clinic, the patient was assigned a sparing regimen of physical activity, dietary nutrition according to diet No. 5, drinking treatment with 200 ml of mineral water from the Slavyanovsky spring. 3 times a day for 45-50 minutes before meals, mineral baths, slightly carbonated, sulphate-bicarbonate calcium-sodium at a water temperature of 36-37 ° C for 15 minutes, 10 treatments per treatment course, massage of reflex-segmental zones according to the developed technique. When re-examination after treatment, a significant decrease in the degree of clinical manifestations of the disease was noted. Complete blood count: hemoglobin 146 g / l, white blood cells 5.4 × 10 ⁹ , eos. 2, fell. 5, seg. 45, lymph. 46, mon. 3, ESR 4 mm / hour, clinical analysis of urine without pathology. Biochemical blood test: lactate 1.3 mmol / l, pyruvate 0.07 mmol / l, a-GFDH 540 units, alkaline phosphatase 160.2 U / l, MDA in erythra. 8.8 μmol / l, energy charge 0.82 units, ECG - sinus rhythm 70, beats. in minutes, the EOS is not rejected, the voltage is normal, the ECG is within the normal range. The state of adaptation of the body is satisfactory. Thus, as a result of the treatment, there is a positive dynamics of both subjective symptoms and the data of functional and laboratory research methods, indicating an improvement in energy and adaptation processes.

The method was tested in the conditions of the Zheleznovodsk Clinic of the Federal State Institution Pyatigorsk State Research Institute of Physics and Medicine of the Russian Federation on two groups of patients — the main group (35 people) and the control group — control group (30 people) who received treatment according to the new method of the invention and the prototype. Patients with SCI were admitted to the Zheleznovodsk clinic after examination and diagnosis from the Research Institute of Physical and Chemical Medicine (Moscow) and the Altai Medical University of Roszdrav (Barnaul). The clinical characteristics of patients are shown in table 1.

According to the data in the table, the distribution of patients according to the main clinical indicators in the main and control groups was identical. In the clinical picture of the disease, pronounced general weakness and other typical signs of CFS, as well as signs of impaired autonomic regulation, prevailed. Headaches, irritability, sleep disturbance, sweating, palpitations were observed in two third of patients, general weakness - in 100%. Myalgia was noted in 62.3% of patients, joint pain - in 67.3%, periodic numbness in the limbs - in 38.7% of the observed. In some patients, allergy manifestations were also noted in the form of intolerance to various odors and skin rashes (17.8% of patients). There were also mildly expressed dyspeptic symptoms (heartburn, nausea, bitterness in the mouth), aching pains in the epigastric region and in the right hypochondrium, blood pressure from 100/60 to 140/90 mm Hg. - in 27.5% of patients.

Table 1 Clinical characteristics of patients in the main and control groups of patients Indicator I main group n = 35 II comparison group n = 30 Total n = 65 abs. (%) abs. (%) abs. (%) Floor Male 12 34.3 eleven 36.7 23 35,4 Female 23 65.7 19 63.3 42 64.6 Age up to 30 years 7 20,0 5 16.7 12 18.5 from 31 to 50 years old 16 45.7 fourteen 46.7 thirty 46.2 from 51 and> years 12 34.3 eleven 36.7 23 35,4 Social status does not work 6 17.1 2 6.7 10 15.3 employee 26 74.3 24 80.0 fifty 77.0 workers 3 8.6 four 13.3 5 7.7 Location City thirty 85.7 23 76.7 53 81.5 Village 5 14.3 7 23.3 12 18.5 Disease duration up to 3 years 10 28.6 9 30,0 19 29.2 up to 5 years 9 25.7 7 23.3 16 24.6 over 5 years 16 45.7 fourteen 46.7 thirty 46.2 Accompanying illnesses Focal infections 7 20,0 5 16.7 12 18.5 Of cardio-vascular system 8 22.8 6 20,0 fourteen 21.5 Digestive organs 22 62.8 eighteen 60.0 40 61.5 Genitourinary sphere 5 14.3 four 13.3 9 13.8 Allergic manifestations four 11,4 2 6.7 6 9.2 The presence of the virus (Epstein-Barr, herpes) fourteen 40,0 10 33.3 24 37.0

As a result of the treatment, in both groups of patients there was a reliable favorable dynamics of the main clinical manifestations of disadaptation and the underlying disease — the disappearance or decrease of general weakness, headaches, irritability, depressive manifestations, as well as symptoms such as myalgia, arthralgia, pharyngitis, dyspeptic and pain syndromes. The dynamics of the main clinical manifestations in the observed patients are presented in tables 2 and 3.

table 2 The dynamics of the clinical symptoms of patients of the first group under the influence of spa treatment (n = 35) Indicator Dynamics of indicators Presence of a sign before treatment, number of patients% The disappearance of the symptom after treatment, the number of patients% General weakness 35 one hundred 19 54.3 Headache thirty 85.7 fourteen 46.7 Dizziness 17 48.6 12 70.6 Irritability 26 74.3 12 46.2 Sleep disturbance 24 68.6 13 54,2 Asteno-neurotic syndrome 31 88.6 fifteen 48,4 Myalgia 24 68.6 12 50,0 Joint pain 25 71,4 eleven 44.0 Dyspeptic syndrome 22 62.8 17 77.3 Epigastric pain 13 37.1 8 61.5 Pain in the right hypochondrium fourteen 40,0 9 64.3 Palpation tenderness fifteen 42.8 8 53.3 Swollen lymph nodes 8 22.8 2 25.0

A comparative analysis of clinical manifestations in two groups of patients (the main and comparison groups) indicates more favorable shifts in the condition of patients in the main group using natural healing factors and massage techniques for reflex-segmental zones (Table 4). So, after treatment, manifestations of general weakness in the main group ceased to disturb 54.3% of patients, in the comparison group - 26.6% of patients (p <0.05). In the main group of patients, compared with the control group, a more significant dynamics of such symptoms as headache (46.7 and 22.7% of patients, respectively, p <0.05), sleep disturbance (54.2 and 20.8% of patients, p <0.01), myalgia (50 and 23.5% of patients, p <0.05), joint pain (44 and 33.3% of patients, respectively, p> 0.05).

Table 3 The dynamics of the clinical symptoms of patients in the comparison group under the influence of spa treatment (n = 30) Indicator Dynamics of indicators before treatment after treatment abs. % abs. % General weakness thirty one hundred 8 26.6 Headache 22 73.3 5 22.7 Dizziness eleven 36.6 5 45.4 Irritability 19 63.3 6 31.5 Sleep disturbance 24 80.0 5 20.8 Asteno-neurotic syndrome 23 76.7 10 43.5 Myalgia 17 56.6 four 23.5 Joint pain eighteen 60.0 6 33.3 Dyspeptic syndrome eleven 36.6 6 54.5 Epigastric pain 9 30,0 four 44,4 Pain in the right hypochondrium 7 23.3 3 42.8 Palpation tenderness fourteen 46.6 5 35.7 Swollen lymph nodes 5 16.6 one 20,0

When comparing the indicators of energy metabolism in both groups, the advantage of the medical complex with massage of reflex-segmental zones was observed. In this group, a more pronounced increase in the level of ATP and energy charge was observed (Table 5).

Positive changes in the indicators of the immune status of patients in terms of phagocytosis and phenotypic characteristics of immunocompetent cells were noted, and the positive dynamics of these tests was more pronounced in the main group.

Table 4 Comparative dynamics of the clinical symptoms of patients of the main group and the comparison group as a result of spa treatment Indicator The disappearance of the indicator after treatment (abs. /%) p I main group (n = 35) II comparison group (n = 30) General weakness 19 54.3% 8 26.6% <0.05 Headache fourteen 46.7% 5 22.7% <0.05 Dizziness 12 70.6% 5 45.4% <0.05 Irritability 12 46.2% 6 31.5% > 0.05 Sleep disturbance 13 54.2% 5 20.8% <0.01 Asteno-neurotic syndrome fifteen 48.4% 10 43.5% > 0.05 Myalgia 12 50.0% four 23.5% <0.05 Joint pain eleven 44.0% 6 33.3% > 0.05 Dyspeptic syndrome 17 77.3% 6 54.5% > 0.05 Epigastric pain 8 61.5% four 44.4% > 0.05 Pain in the right hypochondrium 9 64.3% 3 42.8% > 0.05 Palpation tenderness 8 53.3% 5 35.7% > 0.05 Swollen lymph nodes 2 25.0% one 20.0% > 0.05

Table 5 Indicators of energy metabolism before and after treatment in the main and control groups of patients Indicator The main group (n = 35) Control group (n = 30) ATP, micromol / l 522.0 ± 5.41 513.13 ± 7.59 598.7 ± 4.72 530.55 ± 8.8 p <0.01 p> 0.05 AMP, µmol / l 69.4 ± 1.70 65.65 ± 1.3 50.2 ± 1.36 51.68 ± 1.6 p <0.05 p <0.05 ATF / AMF 7.56 ± 0.09 8.2 ± 0.2 12.1 ± 0.07 11.12 ± 0.46 p <0.05 p <0.05 Energy charge, units 0.78 ± 0.03 0.8 ± 0.002 0.84 ± 0.05 0.813 ± 0.003 p <0.01 p <0.05 Note: in the numerator is the indicator before treatment, in the denominator is after treatment.

It was found that in the group of patients treated according to the claimed method, the initially reduced phagocytic activity of leukocytes (FAL) increased from 52.7 ± 2.50% to 59.8 ± 1.10% (p <0.01), phagocytic index (PHIL) - from 1.2 ± 0.09 units. up to 1.9 ± 0.26 units (p <0.05), E-ROCK _o - from 51.6 ± 2.70 to 59.8 ± 2.72% (p <0.01). In patients of the control group, the dynamics of the level of these indicators was less pronounced: a decrease in FAL from 49.7 ± 1.50% to 54.6 ± 1.41%, PHIL from 1.3 ± 0.18 units. up to 1.7 ± 0.21 units (p> 0.05) and E-ROCK _about - from 50.8 ± 2.81% to 55.2 ± 2.93% (p> 0.05).

According to the results of a comprehensive assessment of cardiac rhythmography and hematological parameters according to L.Kh. Garkavi et al. An improvement in the state of adaptation of the organism in the observed patients was determined, and the treatment complex using the massage technique of reflex-segmental zones (the main group of patients) had a more favorable effect. In a comparative aspect, overstrain of adaptation processes after treatment was less frequently detected in the main group of patients compared with the control group (14.3 and 26.7%, respectively, p <0.05). Significantly more often in the main group of patients, a satisfactory state of adaptation was determined (in 40.0 and 20.0%, respectively, p <0.05).

With a general assessment of the effectiveness of the treatment, a positive result (significant improvement and improvement) in the main group of patients using massage of reflex-segmental zones was noted in 88.5% of patients, in the control group - in 66.6% of patients, that is, 21.9 % more (p <0.05).

Thus, typical clinical manifestations of the disease were revealed in patients with CFS against the background of significant violations of adaptation processes, energy metabolism, and the immune system. Spa treatment using natural healing physical factors has a positive effect on the clinical manifestations of the disease and indicators of the state of adaptation, energy metabolism, and immune function. The use of reflex-segmental zones massage in the spa therapy complex according to the technique developed during the study increases the effectiveness of rehabilitation therapy for patients with CFS and can be recommended for use in medical practice.

Claims (1)

A method of treating patients with chronic fatigue syndrome, including a gentle or gentle-training regimen of motor activity, diet nutrition No. 5, ingestion of low-mineralized, low-carbonate sulphate-bicarbonate sodium-calcium mineral water and mineral baths with the use of low-carbonate sulphate-hydrocarbonate calcium-sodium-water at a temperature of 36-37 ° C, for 12-15 minutes, 8-10 procedures per treatment course, characterized in that they additionally carry out segmental-reflex massage of zones with cash chiem large number of biologically active points with a gradual expansion of the impact zones during the first procedure - massage area cervical area; during the second procedure - the cervical-collar zone and paravertebral zones of the spine; during the third procedure and all subsequent ones - massage of the above areas, as well as massage of the hands and the wrist joints, as well as the feet; massage procedures are carried out daily, in the amount of 10 per treatment course.