RU2559170C1 - Method for secondary prevention of glossodynia - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: physiotherapeutic treatment involves dynamic electrical neurostimulation (DENS). The 10-minute exposure covers trigger points on the tongue according to the patient's complaints. That is followed by covering auricular points for 5 minutes for both conchs. The exposure course makes 10 sessions. A follow-up examination is performed 20 weeks after the conducted course. A microcirculation value (MV) is determined. A pain intensity is recorded according to the Visual Analogue Scale (VAS). That enables determining the necessity of the repeated preventive course of DENS.

EFFECT: method enables eliminating patient's pain, building treatment confidence, avoiding a drug therapy, improving the efficacy of preventive measures, achieving stable remission ensured by the combined physiotherapeutic exposure covering the trigger points on the tongue and auricular points of the conchs.

2 cl, 1 tbl, 2 ex

Description

Method for secondary prevention of glossodynia

The invention relates to medicine, in particular electrotherapy, and can be used in dentistry for the prevention of repeated manifestations of glossodynia symptoms.

To define a pain symptom in the oral cavity, various terms are used in the prior art: stomatopyrosis, glossopyrosis, stomatodynia, glossalgia, glossodynia, vegetosis of the tongue, oral dysesthesia. With this syndrome, the patient complains of a burning sensation, in the ICD-10 the diagnosis "K 14.6 Glossodynia" is highlighted.

Despite certain achievements in the diagnosis and treatment of glossodynia, the development and improvement of rehabilitation medicine programs for this pathology, the creation of prevention programs remains an urgent problem. There are no methods for preventing relapse of the disease.

A known method of treating glossalgia (patent RU No. 2297233). Against the background of drug therapy, an additional 20% mummy solution is used in the form of applications on the tongue. Then, on the painful zones of the tongue, they are exposed to the DENAS-therapy apparatus (“Guidelines for the dynamic electroneurostimulation therapy with DENAS apparatuses”, V. V. Chernyshev, V. Malakhov et al., Yekaterinburg, 2002 - 245 pp.). The course of treatment is 6-8 days. The method can significantly reduce treatment time and increase periods of remission. However, the authors did not identify criteria for the end of the period of remission.

It is known to use non-medications such as electroconvulsive therapy (ECT) and transcranial magnetic stimulation (TMS) for the treatment of pharmacologically resistant non-paroxysmal prosopalgia, such as trigeminal neuropathy, glossodynia, dental plexalgia (Fischenko O.N. Treatment of acute exacerbations of chronic non-paroxysms and transcranial magnetic stimulation: abstract of Candidate of Medical Sciences, 01/14/11, Moscow, 2011). The author found that ECT has a significant positive effect on the clinical picture and the severity of pain in patients with glossodynia and psychogenic prosopalgia.

Disadvantages of the work: the authors use the method to treat the disease, however, the methods of primary and / or secondary prevention of glossodynia are not considered in the work.

The positive effect of dynamic electroneurostimulation (DENS) on the functional state of sensory formations of the oral cavity during outpatient treatment is known (Borisova EG The effect of dynamic electroneurostimulation (DENS) on the functional state of sensory formations of the oral cavity // Journal of Reflexotherapy. - 2007. - No. 2 (20). - S.29-30; Borisova EG Diagnostics and treatment of pain syndromes of the face and oral cavity on an outpatient basis // Voronezh: Publishing house-polygraph center of Voronezh State University. - 2011. - 128 p.) . In these works, prevention issues are not covered and developed.

A known method of treating glossalgia (US Pat. RU No. 2428224). The method includes exposure to auricular points (AT) of acupuncture. After a day, the effect on AT 4 is alternated with the help of a remote electrode of the DiaDENS apparatus and red light of semiconductor laser radiation from the Svetozar apparatus. The impact from the apparatus “DiaDENS” is carried out in the “Therapy” mode, with a frequency of 77 Hz, for 2 minutes. The exposure from the Svetozar apparatus is carried out at a wavelength of 665 nm for 1 minute. The course of treatment is 7-8 days. The method reduces the time of the procedure and treatment time, increases the duration of remission, improves the quality of life of the patient.

The clinical experience of the method showed that more than 70% of patients within six months after the course of treatment have a relapse of the disease. The severity of the pain syndrome may be less than during the initial treatment, nevertheless, this causes significant anxiety to the patient, increases neuropsychiatric disorders, and gives rise to disbelief in the success of treatment.

EFFECT: development of a method for secondary prevention of glossodynia, which allows to increase the effectiveness of preventive measures, to exclude the use of pharmacotherapy by expanding the arsenal of physiotherapeutic effects in dentistry.

The technical result is achieved by performing the following stages of the study. The physiotherapy apparatus “dual-band neuro-adaptive stimulator” (DENAS) was applied to the pain zones of the tongue depending on the complaints made during the initial treatment: back, lateral surfaces, tip of the tongue. Duration 10 minutes, then an external therapeutic electrode of the DiaDENS-DT apparatus performed auricular DENS-therapy (ADT) on both auricles for 5 minutes each. General course - 10 sessions of 20 minutes.

The DiaDENS-DT device is manufactured by the DENAS MS Corporation of Yekaterinburg, permission for the use of the new medical technology Dynamic Electroneurostimulation FS No. 2010/015 dated January 27, 2010 was issued by the Federal Service for Supervision of Health and Social Development.

Patients were examined for microcirculation of the tongue using laser Doppler flowmetry. An important pathogenetic factor in the occurrence of glossodynia is tissue hypoxia due to a violation of microcirculation in the tongue, which is recorded at the preclinical stage. Objective recording of the state of capillary blood flow is important both for assessing microcirculation disorders and for observing the dynamics of various pathological conditions, for which we used the method of laser Doppler flowmetry (LDF).

Laser Doppler flowmetry is based on measuring the Doppler component in the spectrum of the reflected laser signal scattered by moving particles, which makes it possible to measure the amount of tissue perfusion with blood. Under our supervision, there were 58 patients with SJPR between the ages of 45 and 70 years. LDF-metry was carried out using a laser analyzer of capillary blood flow "LAK-02".

Dynamic monitoring of the state of microcirculation was carried out three times. The first measurement in the acute period of glossodynia at the initial treatment, then at the end of the main course of treatment and at the repeated treatment of patients in connection with the end of the period of remission.

- среднеквадратичное отклонение амплитуды колебаний кровотока от среднего арифметического ПМ, отражающее усредненную колеблемость потока эритроцитов, Кv - коэффициент вариации, характеризующий соотношение между изменчивостью перфузии (флаксом) и средней перфузией. СКО и Кv отражают общую подверженность тканевого кровотока регуляции. Кроме того, у пациентов регистрировали выраженность болевых ощущений по визуально аналоговой шкале (ВАШ). Контрольную группу сравнения, в которой однократно выполняли те же исследования, составили 10 практически здоровых лиц, не предъявлявших жалоб на боли и жжение языка.In the analysis of LDF-grams, microcirculation (PM) indicators were determined, which reflects the level of perfusion of a unit volume of tissue per unit time, units of measure are relative perfusion units (perf. Unit),

- the standard deviation of the amplitude of blood flow fluctuations from the arithmetic mean PM, reflecting the average fluctuation of the erythrocyte flow, Kv is the coefficient of variation characterizing the relationship between the variability of perfusion (flux) and average perfusion. RMS and Kv reflect the overall susceptibility of tissue blood flow regulation. In addition, the severity of pain was recorded in patients on a visually analogue scale (VAS). The control control group, in which the same studies were performed once, consisted of 10 practically healthy individuals who did not complain of pain and burning of the tongue.

Glossodynia patients were observed for at least 6 months after the initial course of treatment. The period of remission was individual. The duration of the period after which the painful manifestations characteristic of glossodynia resumed ranged from 24 to 39 weeks. The results of the study are shown in the table.

From the table it follows that the parameters of blood flow and the intensity of pain at the end of the individual period of remission is less pronounced than during the initial treatment. In the greatest degree closer to the level of the primary acute period, PM and YOUR indicators.

The results of these observations served as the basis for appointing patients to undergo a follow-up examination 20 weeks after the end of the initial course of treatment. It was found that the parameters of blood flow and the degree of pain vary individually, in varying degrees of severity. In those patients in whom the PM did not exceed 10.5 perf. units and YOUR 3 points, the period of remission lasted at least another 12-15 weeks. If the indicators were higher than the figures, then the duration of remission was shorter.

These observations allowed us to formulate rules that determine the timing of the prophylactic re-treatment of glossodynia. After the completion of the initial course of treatment, a follow-up examination should be prescribed after 20 weeks. If during this period the PM will be above 11.5 perf. units and YOUR more than or equal to 5 points, then appoint an immediate passage of a repeated preventive course of treatment. If the PM indicator is equal to or lower than 11.5 perf. units, but above 10.5 perf. units and YOUR less than 5 points, but higher or equal to 3 points, then the next control examination is prescribed after five weeks, with PM, less than or equal to 10.5 perf. units, and YOUR less than 3 points, the next control examination is prescribed after twelve weeks. If during the period of the next control examination critical values of PM and VAS are reached, a second course of treatment is performed, otherwise the dates of the next control examination are prescribed.

The preventive effect of the proposed method is confirmed by the study of indicators of patients with glossodynia for at least 6 months after the preventive course, we noted a stable remission.

The implementation of the method is illustrated by clinical examples.

Example 1. Patient B-na, 57 years old, is on the clinical records with a diagnosis of “To 14.6 Glossodynia”. She underwent treatment at the Center for Dental Neurology, after which a significant improvement was noted. Indicators before treatment: PM - 14.01 perf. units, YOUR - 8 points. After the course: PM - 9.09 perf. units, YOUR - 3 points. After 20 weeks, the patient appeared for a control examination. PM indicators - 12.01 perf. units, YOUR - 5 points. Complaints about the state of health does not show, burning sensation in the back of the tongue and pain are extremely weak, episodic. Given the critical values of the indicators, the patient was offered a preventive course of glossodynia by DENS on the back of the tongue in accordance with the complaints presented before the initial course of treatment. The duration of one session is 10 minutes, then the external therapeutic electrode of the DiaDENS-DT apparatus affects the auricular points of both auricles for 5 minutes each. General course - 10 sessions of 20 minutes.

After a repeated preventive course of treatment, the patient was observed for 8 months. There are no relapses.

Example 2. Patient Shch-s, 58 years old, is on the clinical records with a diagnosis of "To 14.6 Glossodynia". He underwent treatment at the Center for Dental Neurology, after which a significant improvement was noted. Before treatment, PM indicators are 13.82 perf. units and YOUR - 7 points, after - PM - 8.78 perf. units, YOUR - 2 points. Twenty weeks later, the patient appeared for a follow-up examination. In this case, PM - 10.91 perf. units, YOUR - 3 points. Assigned control examination after five weeks. At the next control measurement PM - 11.7 perf. units, YOUR - 5 points. The patient is offered a preventive course of glossodynia by DENS on the tip of the tongue in accordance with the complaints presented during the initial treatment. The duration of the sessions is 10 minutes, then the external therapeutic electrode of the DiaDENS-DT device to the auricular points of both auricles for 5 minutes each. General course - 10 sessions of 20 minutes.

The patient was observed after a repeated preventive course for 10 months. There are no relapses.

Claims (2)

1. A method for secondary prevention of glossodynia, including physiotherapeutic effects, characterized in that as physiotherapeutic effects carry out dynamic electroneurostimulation (DENS), while they affect the painful areas of the tongue in accordance with the complaints for 10 minutes, and then on the auricular points both ears for 5 minutes each, the course of exposure is 10 sessions; 20 weeks after the course, a control examination is carried out to determine the microcirculation index (PM) and to register the severity of pain according to a visually analogue scale (VAS), the results of which determine the need for a repeated preventive course of DENS. 2. The method according to p. 1, characterized in that during registration during the control examination of PM, greater than or equal to 11.5 perf. units, and the severity of pain according to YOUR, equal to 5 points, consider the passage of a repeated preventive course of treatment, with PM, lower or equal to 10.5 perf. units, and the severity of pain for YOUR less than 5 points, but higher or equal to 3 points, conduct the following control examination after five weeks, with PM, lower or equal to 10.5 perf. units, and the severity of pain in YOUR less than 3 points, a control examination is carried out after twelve weeks.