RU2701596C1 - Method of rehabilitation of patients with chronic pain in joints and spine - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: invention refers to medicine, namely to physiotherapy and balneology, and can be used for restorative treatment of concomitant diseases of joints and spine in patients with cardio- and cerebrovascular pathologies, including in the elderly. Rehabilitation of patients with cardiovascular and bronchopulmonary diseases with accompanying chronic pain syndromes of the spine and / or joints – shoulder, hip, knee, ankle, including in the elderly, includes mud cure for 20 minutes every other day, with a temperature application of 38–40°. Additionally includes climatic treatment, massage, therapeutic gymnastics and terrenkur as part of restorative sanatorium treatment. Mud therapy is represented by natural mud-volcano pelites of the Bulganak deposit by course of 8–10 procedures. Bipolar electrophoresis of the comparative water of the Bulganak deposit is prescribed as a mud cure method directly in the area of pain manifestations. Compresses of mud-volcano water of the Bulganak deposit are assigned to the mud cures with location of the compress in the area of maximum pain manifestations.

EFFECT: method provides more effective rehabilitation of patients by reducing or reducing pain intensity, improving mobility and volume of motions, muscular force and other physiological parameters of motor activity.

3 cl, 1 tbl, 3 ex

Description

Improving the methods of treatment and rehabilitation of patients with chronic pain in the joints and spine are among the priority problems of medicine, due to their high prevalence and the resulting disability. Symptoms of chronic pain in the joints and spine, along with local pains and limited mobility of the joints, are also accompanied by astheno-depressive manifestations and a deterioration in the quality of life in general. In people of older age groups, spinal osteochondrosis and osteoarthrosis are the most common causes of chronic pain. General disability due to the consequences of dorsopathies and arthropathies in Russia reaches 2.2%.

The method of rehabilitation of patients with chronic pain in the joints and spine relates to medicine, namely to physiotherapy and balneology, and can be used for the rehabilitation treatment of concomitant joint diseases in patients with cardio and cerebrovascular pathology, including elderly people. Drug therapy in this group of patients is characterized by insufficient effectiveness and the development of individual drug intolerance, allergic and adverse reactions, which significantly reduces the effectiveness of treatment. Therefore, widespread in the treatment of chronic pain in the joints and spine, along with pharmacotherapy, methods of physiotherapy. It is especially effective to use various types of therapeutic muds and natural coolants (ozokerite, naphthalan), which, according to the criteria of evidence-based medicine, belong to level B [Ponomarenko GN, 2012]. The use of local thermoapplications of therapeutic mud in the rehabilitation of patients with diseases of the musculoskeletal system provides a moderate stimulating effect of metabolic processes in the form of improved trophism in the area of exposure, accelerated regeneration. The effectiveness of peloid therapy increases with the additional use of electric light therapy methods.

It should be borne in mind that conducting thermal mud therapy is accompanied by an increase in blood supply to peripheral vessels and redistribution of blood, an increase in heart rate, an increase in minute and shock output, and peripheral vascular resistance. Therefore, for mud therapy there is an extensive list of contraindications, which include, first of all, coronary heart disease, hypertension and other cardiovascular diseases, often combined with chronic diseases of the joints, especially in the group of elderly patients. Peloid therapy in thermal conditions is also not indicated for patients with diseases of the joints with concomitant pathology of peripheral vessels - varicose disease of the lower extremities, lymphovenous insufficiency, chronic thrombophlebitis. In these cases, it is recommended to reduce the temperature of the application of dirt to 15-30 ° C [Ponomarenko GN, 2013].

In this regard, therapeutic mud, especially with general effects and long courses, are used by patients only without exacerbation of the main pathology and with normal indicators of the cardiovascular system [Razumov AN 2009; Gerasimenko M.Yu. et al., 2015]. The use of gentle low-temperature methods of therapeutic mud reduces the risk of complications of peloid therapy [Velichko N.E., 2003]. It has been shown that the use of weakly sulfide medium-mineralized silt mud in a gentle mode in patients with arterial hypertension allows, according to Holter monitoring, to achieve an improvement in central hemodynamics, a daily profile of blood pressure and quality of life. Adverse reactions in the form of a deterioration in cardiac hemodynamics are recorded, however, only in single patients [Abramovich SG et al., 2012].

This justifies the development of effective options for mud treatment procedures in patients of this category with a minimal likelihood of complications and side effects. Therefore, it is more rational and in demand to conduct peloid therapy not only in the form of thermal applications, but also for the external use of mud balneological preparations containing water-soluble fractions of therapeutic mud. Modern effective balneotherapy products of high quality are of natural (non-synthetic) origin. An important advantage of such tools is the non-invasiveness of medical procedures, their comfort, simplicity and physiology. Excessive technogenic effects are not used for their preparation. The advantages of percutaneous balneotherapy are the absence of adverse reactions associated with the oral administration of a particular medication; minimal risk of systemic toxicity; the possibility of immediate cessation of treatment if adverse reactions develop by removing the drug from the surface of the skin; improvement of compliance (adherence to treatment) of patients; the possibility of use in concomitant diseases, including in combination with other methods [V. Yezhov, 2009]. These data allow us to conclude that the use of balneological products, the chemical composition and degree of mineralization of which has, in comparison with other types of mud, less stressful biotropic parameters, it is preferable in patients with a cardiological profile, as well as in patients of older age groups, if they have a combined pathology various organs and systems.

During the patent information search, among the methods of rehabilitation of patients with chronic pain in the joints and spine, based on the use of peloid therapy, the following patents are identified that are closest to the claimed method.

A method for the mud therapy of chronic bronchitis in patients with chronic pain due to concomitant osteoarthritis (patent Ru 2146955) is described, which consists in conducting mud course applications on the joint area in combination with DMV therapy. Both procedures are carried out daily with a multi-hour interval to reduce the frequency and severity of balneoreaction and complications from the cardiovascular system, increase the effectiveness of treatment and the duration of remission. But the additional purpose of DMV therapy, as a method based on the use of electromagnetic field energy, which has a high risk of negative effects on hemodynamics, limits the use of this method for combined cardiovascular pathology. In addition, the developers, offering a many-hour interval between the indicated procedures, base this recommendation on the data obtained in the working conditions of the sanatorium-dispensary of an industrial enterprise, and do not take into account that it is difficult to achieve such many-hour intervals between procedures in the actual working conditions of medical institutions.

In the method of reconstructive treatment of patients with osteoarthritis (patent RU 2196626), bipolar electrophoresis of a 0.09-0.15% solution of sodium humate is proposed - an aqueous extract of plant residues, peat, silt, manure or brown coal. However, sodium humate is significantly inferior in its potential healing properties to the native types of mud, which are not subject to any additional technogenic treatment after extraction, preserving the original natural physicochemical properties and multicomponent composition of bioactive substances, and possessing a wider therapeutic potential, which allows you to influence the various pathogenesis links of a wide range of diseases.

A method for the treatment of patients with hypertension in combination with osteoarthrosis in the elderly is proposed (patent RU 2322963). It uses a whole range of balneotherapy, peloid and physiotherapy procedures - sedentary or four-chamber sodium chloride baths, peat mud applications on affected joints, magnetic laser therapy and electrosleep. However, the combined use of two types of thermal effects and two electrical procedures contradicts the compatibility rules of physiotherapy for cardiac pathology, since such procedural overload has the potential risk of developing negative reactions in elderly patients.

As a prototype, a method of mud therapy was selected (Patent No. 2290915, RF, IPC А61Н 33/04. Method of mud therapy / Ivanov MG, Vladimirsky EV, Gordeeva VD, Ilyina SL, Stakheeva G.A. - Application 2004138263/14, 12/27/20047. Published on 10.01.2007), the essence of which is the application of silt sulfide mud for 10-20 minutes every other day, with a thickness of the mud cake of 1.5-2.0 cm in the ratio of dirt with brine 1: 2, at t = 38-44 ° C, course 6-10 procedures. The authors indicated that this method can effectively treat various diseases by improving the absorption of biologically active substances while reducing the consumption of mud and can be used to treat pathologies of the cardiovascular system, diseases of the musculoskeletal system, nervous system, digestive organs, and also treatment of dermatological, gynecological and urological diseases.

Signs that coincide with the main features of the prototype are the use of natural healing mud as a way to treat various diseases, including pathology of the cardiovascular system and diseases of the musculoskeletal system.

Signs that hinder the achievement of the expected result (stopping or reducing the severity of pain, improving mobility and range of motion, muscle strength and other physiological parameters of physical activity, increasing the compensatory-adaptive capabilities of the body, the effectiveness of rehabilitation of patients and their quality of life) are the presence of a significant proportion of patients with chronic joint pain syndromes of moderate or severe cardiological diseases, which inhibits their use of mud eniya using silt sulfide mud - especially in coronary heart disease and hypertension, and does not, in this connection, to carry them this kind of treatment modalities. The limiting point for the use of mud therapy is also the elderly age of patients, which increases the risk of developing negative side reactions during rehabilitation measures. In the prototype method, it was not taken into account that the use of a temperature of 44 ° C can cause undesirable hemodynamic reactions in elderly patients with concomitant cardio and cerebrovascular pathology and other diseases. The method of mud therapy does not determine the types of joint pain, their locality or prevalence, ignores the factor of possible individual intolerance to thermal and electrical procedures.

The basis of the claimed method is the task of improving the rehabilitation of patients with common cardio and respiratory diseases associated with chronic joint pain, by reducing the possible risk of negative hemodynamic and other adverse reactions during mud therapy to stop or reduce the severity of pain, improve mobility and range of movements, muscle strength and other physiological parameters of motor activity, increase the reserve capacity of the body, e ciency rehabilitation of patients and their quality of life.

The problem is solved in that in a method for the rehabilitation of patients with chronic joint pain, which includes the use of mud therapy in combination with climatotherapy, classical massage, therapeutic gymnastics and terrencourt, as part of rehabilitation spa treatment of patients with cardiovascular and bronchopulmonary diseases with concomitant diseases of the joints, including the elderly, as a method of rehabilitation of functions, activities and patient participation in the ICF domains - b280 “Feelings “no pain”, b710 “Functions of joint mobility”, b730 “Functions of muscle strength”, d450 “Walking”, as the method of mud therapy, natural bulging pelites of the Bulganak field are prescribed using local applications, compresses or bipolar electrophoresis of the water sludge of the bulganak field.

Between the set of essential features of the claimed method and the technical result, which is the rehabilitation of the functions, activities and participation of patients in the domains of the "International Classification of Functioning, Disability and Health" (ICF) b280 "Sensation of pain", b710 "Functions of joint mobility", b730 " Functions of muscle strength ”and d450“ Walking ”, the following causal relationship is revealed: the additional use of peloid therapy with native volcanic pelites of the Bulganak field and their water sludge which are characterized by relief or reduction of pain, improvement of joint mobility and range of motion, muscle strength and other physiological parameters of motor activity, increase of the compensatory-adaptive capabilities of the body, the effectiveness of rehabilitation of patients and their quality of life, allows to achieve higher efficiency of medical rehabilitation of patients with chronic joint pain, combined with cardiovascular and bronchopulmonary pathology, and reduce impaired function, evaluated according to criteria M CF

According to the modern classification of mineral waters and therapeutic muds, volcanic muds are natural colloidal organic-mineral formations that have a therapeutic effect on the human body due to their plasticity, high heat capacity and slow heat transfer, the content of biologically active substances [Adilov VB, Berezhnov E.S., Bobrovnitsky I.P. et al., 2000]. The most significant accumulation of mud volcanoes of Crimea is located on the Kerch Peninsula (the village of Bondarenkovo, former Bulganak, Leninsky district of the Republic of Crimea).

Sopochnye pelitas are characterized by fine dispersion and moisture capacity, bactericidal activity, special ionic and mineral composition, whose components are among the vital or conditionally necessary elements. They contain sodium bicarbonate and chloride-sulfate-sodium ions, an increased amount of boron, bromine, iodine, lithium. They do not have an unpleasant odor, do not cause allergic or other adverse reactions, long-term preserve and do not lose their healing properties for at least 6 months.

Scientists of the Azerbaijan Scientific Research Institute of Balneology have proven a number of therapeutic effects of the use of hilar pelit of Azerbaijan deposits in the form of a reduction in pain with the restoration of peripheral nerve function, anti-inflammatory and decongestant effect, improvement of trophism and microcirculation [Efendieva F.M. et al., 2013]. Applications of the pelvic pelitis are more easily tolerated than other heat treatment procedures; they gently regulate the functional state of the body, especially in debilitated patients. Having a more gentle effect on the body, compared with silt mud, volcano pelites are promising as a method with a minimal risk of developing hemodynamic responses and are promising for prescribing with moderate cardiac arrhythmias, compensated forms of cardiac pathology and other concomitant diseases, usually limited for other types heat and mud treatment. Sopochnye pelit, unlike silt mud, contain a large proportion of the liquid mud in the form of water sludge, the so-called tap water. It is easily separated from the rest of the mass even with short settling, and therefore does not require special equipment for fractionation. Aqueous solutions of pelit as a medical preparation does not precipitate during long-term storage (up to six months or more). This feature allows us to recommend the liquid fraction of the mud of mud for use as an external balneological preparation and for percutaneous administration by the method of bipolar electrophoresis. To increase their diffusion through the skin, preliminary or simultaneous appointment of electrotherapy methods is carried out. This allows you to eliminate the effect of the thermal factor while maintaining the specificity of the method and therapeutic effect. Transdermal administration of natural biologically active substances of therapeutic mud helps to improve the functional state of patients. The most justified for achieving this goal is the use of local electrophoresis of water sludge pelit in the affected joint, which has a decongestant effect, reducing exudative processes. The analgesic effect of electrophoresis of silt mud extract is much higher compared with galvanization. Electrophoresis enhances the diffusion of water-soluble components of therapeutic mud, which increases the effectiveness of peloid therapy. It is shown that the colloidal salt composition of silt mud extracts does not deteriorate under the influence of galvanic (direct) current lines of force. Dissociation of macro- and micronutrient salts into metal and ammonium cations and anions of acid residues in the aqueous medium facilitates their penetration through intact skin during electrophoresis from both the cathode and anode [L. Shustov, 1996].

The method is as follows. At the sanatorium and rehabilitation phase of rehabilitation of chronic pain in the joints and spine, including the elderly, mud treatments are prescribed in combination with climatotherapy, classical massage, medical gymnastics and terrencourt, and for mud therapy the hills of the Bulganak deposit are used in the form of three options Procedures: local applications of colic pelitis in the presence of diffuse joint pain; bipolar electrophoresis with water sludge of the pelvic pelitis for the direct action of a mud balneotherapy in the areas of skin projection of maximum pain; compresses with water sludge pelvic pelitic with individual intolerance to electrotherapy.

In the presence of chronic pain in the joints, the local application of native sapillary pelites is carried out by preheating the bag with mud in a heating cabinet for the required time (up to 2 hours) to bring it to a temperature of 38-40 ° С. It was noted that an increase in temperature above 40 ° C caused hemodynamic reactions in elderly patients. The heated mud is laid out on cheesecloth (or on non-woven material), the ends of the material, in order to keep the mud cakes on the body area, are tied crosswise or stacked in an envelope. The procedure is carried out in a comfortable position for the patient - lying on his back. When exposed to the spinal region, a medical oilcloth (or a dense plastic film) is placed directly on the couch, then an envelope with dirt is placed on them. The patient rests on the application, after which it is carefully wrapped. When exposed to the area of the joints of the extremities, the mud envelope is placed in the appropriate area, covered with a medical oilcloth and wrapped in a warm scarf / blanket. Duration of exposure - 20 minutes, for a course of 8-10 procedures.

For the direct action of a mud balneotherapy in the areas of skin projection of maximum pain, first, palpation in the area of projection of the affected joint or corresponding spine determines the area of greatest pain, in the area of which bipolar electrophoresis of tap water is used (water sediment of capillary pelites); use rectangular electrodes with cloth pads, the area corresponding to the size of the joint, the electrode-cathode is placed in the area of the area of greatest pain, and the electrode-anode is transverse (when acting on the joint) or longitudinally (when acting on the spine), the specified location of the electrodes throughout the course treatment is not changed, compresses are preliminarily placed under each electrode in the form of two-layer gauze or paper napkins-napkins moistened with warm tap water at a temperature of 38-40 ° С (flow rate of water per procedure - 10 ml), the electrodes are fixed with sandbags (when applied to the lower back or back) or an elastic bandage (when exposed to the joints of the limbs), for the stable introduction of biologically active substances that make up the composition of the running water the polarity of the electrodes throughout the course of the procedures does not change, the direct duration of the electrical procedure is 10 minutes, after its completion, the electrodes with gaskets are not removed for another 10 minutes - treatment with compresses of the running water continues, then the electrodes and the compressor sy removed, the total time of the procedure - 20 minutes every day or every other day, for a course - 8-10 procedures.

A variation of the method is the application of compresses of running water (water sludge) with its preliminary heating in a closed container to 38-40 ° C, then the gauze required for compress size, folded in 3-4 layers is immersed in heated nozzle water and slightly wrung out, gauze compress moistened with warm mud solution is placed on the corresponding part of the body, while the patient is lying on his back or stomach, on top of the gauze layer is covered with a slightly larger medical oilcloth and wrapped in warm plates com / blanket. If necessary, the compress is fixed with a bandage, with the correct (tight) application of the compress, its inner layer remains moist during the procedure, the heat generated by the compress causes blood flow in the area of moisturized skin, accelerates metabolism, and increases skin permeability to salt ions, contained in the mud hood, when the compress is loosely applied, as well as in cases where its wet layer is not completely covered, evaporation occurs and, instead of warming, the compress can cool the skin for a long time be exposure - 20 minutes.

At the end of the procedure, the mud application (or compress) is removed from the surface of the body, placed in a waste container and disposed of in the usual manner, the skin is carefully wiped with a dry cloth, without washing.

Indications. Chronic joint and spinal pain caused by joint diseases (primary and secondary osteoarthritis of the lower and upper extremities with residual synovitis, moderate muscle contractures) and / or spine (cervicalgia, chronic myofascial pain, osteochondrosis of the cervical spine) of moderate severity, 1- 2 degree of dysfunction.

Contraindications Severe forms of musculoskeletal diseases (3 tbsp); progressive acute synovitis (fever, hyperemia, edema, lymphadenitis); lesions of the skin in the area of procedures; general contraindications for physiotherapy, including any acute inflammatory processes, uterine fibroids, varicose veins in the legs, hemorrhoids.

The proposed method was applied in 202 patients with a profile for sanatorium-resort treatment on the southern coast of Crimea of cardiovascular and pulmonary pathology with concomitant chronic pain syndromes in the joints (118 patients) and the spine (84 patients). The selection of patients for the study was carried out by the method of continuous sampling. Patients who did not meet the following selection criteria were excluded from the study: 1) the duration of treatment is less than 18 days, 2) the patient does not have informed consent for the use of the studied factors and methods for evaluating the results. Against the background of a comprehensive spa treatment, the effectiveness of applications with hinge pelits was studied (87 patients); bipolar electrophoresis of the water sludge of the pelvic pelitis (54 patients), compresses of the water sludge of the pelvic pelitis (61 patients). The average values of the initial parameters of the groups did not differ significantly.

To determine the feasibility of administering peloid therapy with mucous mud for concomitant chronic pain in the joints and spine in elderly patients with cardiac, cerebrovascular and respiratory pathologies, clinical and laboratory research data were evaluated, including the use of specialized rehabilitation scales for motor functional testing and assessment of impaired motor behavioral activity and participation . A comprehensive examination was carried out before and at the end of the course of sanatorium-resort rehabilitation. Evaluation of the effectiveness of medical rehabilitation of patients was carried out in accordance with the criteria of the ICF [V. Mizin et al., 2017] according to the degree of disturbance of the main functions, activities and participation: b134 “Sleep functions”, b152 “Functions of emotions”, b2401 “Dizziness”, b280 “Sensation of pain”, b4100 “Heart rate”, b4101 “Heart rate of abbreviations ", b4103" Blood supply to the heart ", b4200" Increase in blood pressure ", b440" Respiratory functions ", b455" Functions of exercise tolerance ", b4550" General physical endurance ", b4552" Fatigue ", b4601" Sensations associated with functioning cardiovascular and respiratory systems ", b540" General metabolic functions ", b710 Function joint mobility », b730« function in muscle strength, "D415« Maintaining the position of the body ", the D430« Lifting and carrying objects' d450 «Walking», d599 «Self», as well as the quality of life index according to the SF-36 questionnaire.

All patients received an individually shown complex of sanatorium-resort rehabilitation treatment, which included the following procedures (on average for one treated): air baths - 13.0; sunbathing - 6.8; sea bathing - 6.7; medical gymnastics - 18.4; massage - 7.6; inhalations and other types of aerotherapy - 4.9; health path - 7.9; electric therapy - 8.8. Patients also received maintenance therapy, an average of 51 daily doses of medication during the treatment period in the sanatorium.

Evaluation of the effectiveness of spa rehabilitation was also carried out on a traditional scale (significant improvement, improvement, without improvement and deterioration).

The research results were analyzed using methods of variation statistics using a standard computer program for mathematical analysis (Microsoft Excel). Reliable differences (p <0.05) of the values of the studied parameters and their dynamics were taken as a criterion for assessing the effects of peloid therapy. The statistical nature of the distribution of the obtained data among the groups of patients studied is close to normal.

As a result of the spa treatment rehabilitation treatment, the majority of patients showed a positive dynamics in their health status. In the course of peloid therapy using various options for applying the procedures of the pelvic pelitis - applications, electrophoresis or compresses, a change in a number of parameters characterizing their functional state was observed in the groups of patients. The dynamics of the main manifestations of chronic pain syndrome in 43 patients with concomitant pathology of the spine and joints was analyzed based on the data of the standard rehabilitation questionnaire Oswestry (version 2.1a), which allows us to assess the severity of pain, impaired mobility and various types of physical activity of the patient [Cherepanov EA, 2009 ]. In tab. Figure 1 shows the average values of the domains of “body functions” (b) and “activity and participation” (d), according to the ICF criteria, for which their reliable dynamics were established.

Note: * the dynamics is reliable.

The proposed method for the rehabilitation of patients with chronic pain in the joints and spine can significantly reduce the degree of violation of the leading functions for this pathology according to the ICF domains - b280 "Pain Intensity", b134 "Sleep Functions" and improve the quality of life in the form of expanding activities and patient participation by domain MKF - d599 “Violation of self-service”, d430 “Restriction of lifting objects”, d450 “Violations of walking”, d415 “Restriction of sitting”, d920 “Restriction of leisure”, d465 “Restriction of long trips”. This set of positive changes was also manifested in the reliable dynamics of the average total score (for all the indicated parameters, p <0.05). At the same time, there was no negative effect on the functions of emotions, cardiovascular and respiratory systems, cerebral circulation and metabolism in the ICF domains b152 “Functions of emotions”, b2401 “Dizziness”, b4100 “Heart rate”, b4101 “Heart rate”, b4103 “Blood supply to the heart”, b4200 “Increase in blood pressure”, b440 “Respiratory functions”, b455 “Functions of exercise tolerance”, b4550 “General physical endurance”, b4552 “Fatigue”, b4601 “Sensations associated with the functioning of the cardiovascular and respiratory oh systems ”, b540“ General metabolic functions ”, as well as the index of quality of life according to the questionnaire SF-36.

To illustrate the results of applying the proposed method for the rehabilitation of patients with chronic pain in the joints and spine, we give three clinical examples.

Example 1. Patient I., 60 years old. Clinical diagnosis: Coronary heart disease, angina pectoris, II functional class. Circulatory failure H1. Hypertension II Art. Concomitant disease - arthrosis of the right knee joint, moderate arthralgia, the first degree of dysfunction with chronic joint pain, incomplete remission. I entered a spa treatment with complaints of shortness of breath and pain in the heart, an accelerated heartbeat when climbing to the 4th floor, constant pain in the right knee joint. Upon admission to the clinic, the condition is satisfactory. The boundaries of the heart are not extended. Heart sounds are rhythmic, muffled, the emphasis of II tone on the aorta. Pulse - 70 beats / min. ECG - rhythm 82 beats / min., Sinus, horizontal position of the electrical axis of the heart. Signs of myocardial ischemia of the apical lateral wall of the left ventricle. Indicators of cardiohemodynamics: heart rate - 82 in min., GARDEN - 145 mm Hg, DBP - 90 mm Hg, PAD - 55 mm Hg. In the ICF domains, pathological values of functions are noted (at a norm of 0): b134 “Sleep functions” - 2, b152 “Functions of emotions” - 2, b2401 “Dizziness” - 2, b280 “Sensation of pain” - 3, b4100 “Heart rate” - 2, b4101 “Heart rate” - 0, b4103 “Blood supply to the heart” - 2, b4200 “Increase in blood pressure” - 1, b440 “Respiratory functions” - 0, b455 “Functions of exercise stress” - 1, b4550 “ General physical endurance "- 2, b4552" Fatigue "- 2, b4601" Sensations associated with the functioning of the cardiovascular and respiratory systems "- 2, b540" General metab personal functions ”- 1, b710“ Functions of joint mobility ”- 3, b730“ Functions of muscle strength ”- 2, d415“ Maintaining the position of the body ”- 2, d430“ Lifting and moving objects ”- 2, d450“ Walking ”- 2, d599 "Self-service" - 1. On the third day of the patient's stay in the sanatorium, he began a course of treatment with the proposed method. The complex of 21-day rehabilitation treatment included the use of applications of the pelvic pelitis on the area of the right knee joint, 38-40 ° С, 20 min., For a course of 9 procedures. The patient rated the treatment effect as good. From the 4th day of treatment, the patient's pain in the knee joint decreased, mobility improved, heart pain and shortness of breath also decreased. On the ECG on day 20, there was a decrease in apical myocardial ischemia. As a result of the rehabilitation treatment in four ICF domains, the normalization of the initially pathological functions was noted (their value reached 0 points): b134 “Sleep functions”, b152 “Functions of emotions”, b2401 “Dizziness”, b455 “Functions of exercise tolerance”. The severity of the following initially pathological functions by ICF domains decreased: b280 “Sensation of pain” - from 3 to 1, b4552 “Fatigue” - from 2 to 1, b4601 “Sensations associated with the functioning of the cardiovascular and respiratory systems” - from 2 to 1 , b710 “Functions of joint mobility” - from 3 to 2, b730 “Functions of muscle strength” - from 2 to 1, d415 “Maintaining the position of the body” - from 2 to 1, d430 “Lifting and moving objects” - from 2 to 1, d450 “Walking” - from 2 to 1. The severity of a number of initially impaired functions during the course of treatment did not undergo changes in the ICF domains (remained on upper level): b4100 “Heart rate” - 2, b4101 “Heart rate” -0, b4103 “Blood supply to the heart” - 2, b4200 “Increase in blood pressure” - 1, b440 “Respiratory functions” - 0, b4550 “General physical endurance ”- 2, b540“ General metabolic functions ”- 1. The patient was discharged with improvement.

Example 2. Patient K., 56 years old. Clinical diagnosis: Chronic cerebral ischemia, stage I. Hypertension II Art. Concomitant disease - chronic lumbar ischialgia, moderate pain radicular syndrome L5, osteochondrosis of the lumbar spine, X-ray stage II, subacute course, incomplete remission phase. Received a spa treatment with complaints of headaches, dizziness, fatigue, memory loss, constant pain in the lower back and anterolateral surface of the left leg. Upon admission to the clinic, the condition is satisfactory. Pulse - 72 beats / min. ECG - rhythm 76 beats / min., Sinus, horizontal position of the electrical axis of the heart. GARDEN - 140 mmHg, DBP - 85 mmHg, PAD - 55 mmHg In the ICF domains, pathological values of functions are noted (at a rate of 0): b134 “Sleep functions” - 2, b152 “Functions of emotions” - 2, b2401 “Dizziness” - 3, b280 “Sensation of pain” - 3, b4100 “Heart rate” - 2, b4101 “Heart rate” - 0, b4103 “Blood supply to the heart” - 2, b4200 “Increase in blood pressure” - 1, b440 “Respiratory functions” - 0, b455 “Functions of exercise stress” - 1, b4550 “ General physical endurance "- 2, b4552" Fatigue "- 2, b4601" Sensations associated with the functioning of the cardiovascular and respiratory systems "- 2, b540" General metab personal functions ”- 1, b710“ Functions of joint mobility ”- 3, b730“ Functions of muscle strength ”- 3, d415“ Maintaining the position of the body ”- 2, d430“ Lifting and moving objects ”- 2, d450“ Walking ”- 3, d599 "Self-service" - 1. On the fourth day of the patient’s stay in the sanatorium, the treatment was started with the proposed method. The complex of 21-day rehabilitation treatment included the use of bipolar electrophoresis of sludge pelvic sludge in the lumbar spine., In a course of 10 procedures. The patient rated the treatment effect as good. From the 4th day of treatment, pain in the lower back and left leg decreased, articular mobility improved, sleep improved. As a result of the rehabilitation treatment in five ICF domains, normalization of the initial pathological values of the functions was noted (their value reached 0 points): b134 “Sleep functions”, b152 “Functions of emotions”, b2401 “Dizziness”, b455 “Functions of exercise tolerance”, “ Fatigue ”- from 2 to 1. The severity of the following initially pathological functions in the ICF domains decreased: b280“ Sensation of pain ”- from 3 to 1, b4552, b4601“ Sensations associated with the functioning of the cardiovascular and respiratory systems ”- from 2 to 1 , b710 "Joint mobility functions a ”- from 3 to 1, b730“ Functions of muscle strength ”- from 3 to 1, d415“ Maintaining the position of the body ”- from 2 to 1, d430“ Lifting and moving objects ”- from 2 to 1, d450“ Walking ”- from 3 to 1. The severity of a number of initially impaired functions during the treatment did not undergo changes in the ICF domains (remained at the same level): b4100 “Heart rate” - 2, b4101 “Heart rate” - 0, b4103 “Heart blood supply” - 2, b4200 “Increase in blood pressure” - 1, b440 “Respiratory functions” - 0, b4550 “General physical endurance” - 2, b540 “General metabolic functions” - 1. Bol Nye was discharged with improvement.

Example 3. Patient D., 55 years old. Clinical diagnosis: Chronic obstructive pulmonary disease, stage I. Respiratory failure. I degree. Hypertension II Art. Concomitant disease - primary osteoarthritis of the knee, II st, FN II, moderate chronic arthralgia of the right knee, incomplete remission. Received a spa treatment with complaints of dry cough, shortness of breath, fatigue, constant pain in the knee joints, mainly on the right. Upon admission to the clinic, the condition is satisfactory. Pulse - 70 beats / min. GARDEN - 140 mmHg, DBP - 85 mmHg, PAD - 55 mmHg In the ICF domains, pathological values of functions are noted (at a rate of 0): b134 “Sleep functions” - 2, b152 “Functions of emotions” - 2, b280 “Sensation of pain” - 3, b4100 “Heart rate” - 2, b4101 “Heart rate contractions "- 0, b4103" Blood supply to the heart "- 2, b4200" Increase in blood pressure "- 1, b440" Respiratory functions "- 0, b455" Functions of exercise tolerance "- 1, b4550" General physical endurance "- 2, b4552 “Fatigue” - 2, b4601 “Sensations associated with the functioning of the cardiovascular and respiratory systems” - 2, b540 “General metabolic functions” - 1, b710 “Functions of joint mobility” - 2, b730 “Functions of muscle strength” - 1, d415 “Maintaining the position of the body” - 2, d430 “Lifting and carrying objects” - 2, d450 “Walking” - 3, d599 “Self-service” - 1. On the fourth day of the patient’s stay in the sanatorium, the treatment was started with the proposed method. The complex of 21-day rehabilitation treatment included the use of compresses with water sludge of the pelvic pelitis on the area of the right knee joint, for a course of 10 procedures. The patient rated the treatment effect as good. From the 4th day of treatment, pain in the lower back and left leg decreased, articular mobility improved, sleep improved. As a result of the rehabilitation treatment in two ICF domains, normalization of the initially pathological values of the functions was noted (their value reached 0 points): b455 “Function of exercise tolerance”, b4552 “Fatigue”. The severity of the following initial pathological functions by ICF domains decreased: b134 “Sleep functions” - from 2 to 1, b280 “Sensation of pain” - from 3 to 1, b152 “Functions of emotions” from 2 to 1, b4601 “Sensations associated with the functioning of the heart -vascular and respiratory systems ”- from 2 to 1, b710“ Joint mobility functions ”- from 2 to 1, d450“ Walking ”- from 3 to 1. The severity of a number of initially impaired functions during treatment did not undergo changes in the ICF domains ( remained at the same level): b4100 “Heart rate” - 2, b4101 “Heart rate” - 0, b4103 “Cro osnabzhenie heart "- 2, b4200« Increased blood pressure "- 1, b440« respiratory functions "- 0, b4550« General physical endurance »-2, b540« General metabolic functions "- 1. The patient was discharged with improvement.

Thus, the observations showed that the peloid therapy procedures used for chronic joint pain and spinal column pain with pelvic pelitis of the Bulganak deposit (applications, compresses, electrophoresis) were well tolerated, did not cause side effects from the cardiovascular system and did not negatively affect the overall effectiveness treatment of the underlying disease. According to functional testing, there was a positive dynamics of chronic pain, strength and mobility of the affected joints and overall physical endurance, which was reflected positively in increasing the physical activity of patients with chronic pain in the joints and spine. This method of rehabilitation of patients with chronic pain, aimed at improving the effectiveness of medical rehabilitation, can be applied in sanatorium and rehabilitation institutions.

LITERATURE

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Claims (3)

1. A method for the rehabilitation of patients with cardiovascular and bronchopulmonary diseases with concomitant chronic pain syndromes of the spine and / or joints - the shoulder, hip, knee, ankle, including in the elderly, including mud therapy for 20 minutes every other day, with temperature 38-40 ° application, characterized in that it additionally includes climatotherapy, massage, therapeutic exercises and a health path as part of rehabilitation spa treatment, and as a mud cure I prescribe camping natural knoll pelites Bulganakskoe field course 8-10 procedures. 2. The method according to p. 1, characterized in that for the impact directly in the field of pain manifestations, bipolar electrophoresis of the running water of the Bulganak field is prescribed as a mud treatment method. 3. The method according to p. 2, characterized in that compresses of the running water of the Bulganak field with the location of the compress in the region of maximum pain manifestations are prescribed as a mud treatment method.