RU2703328C1 - Method of treating occupational stress - Google Patents

Abstract

FIELD: medicine.SUBSTANCE: invention refers to medicine, namely to restorative medicine, physiotherapy, and can be used for treating occupational stress. That is ensured by applying cathodes on the forehead region and anodes on mastoid processes. Gaskets under electrodes are soaked with water. Gaskets on anodes are additionally wetted with 2 ml of 1 % solution of serotonin adipinate. Contact is exposed to constant bipolar electric current in form of a sequence of rectangular pulses, current intensity from 0.2 to 2 mA until light sensations of tingling on skin under the location of electrodes. Constant component of electric current is used in ratio 1:5 with pulse component. Current frequency 77.5 Hz in frequency modulation mode ±2.5 Hz. Duration of pulses duration is 3 ms. Duration of procedure is 20 minutes, therapeutic course is 5 days. Musical-speech suggestion accompanying is performed. Additionally, aminalol tablets are orally administered.EFFECT: method provides higher effectiveness of restorative treatment ensured by intensified anti-stress effects of transcranial electric stimulation as a result of complex direct synergetic action in declared doses and regimens for opioidergic, serotoninergic, GABA-dopaminergic stress-relieving systems.1 cl, 2 tbl

Description

The invention relates to medicine, namely to restorative medicine, physiotherapy.

A known method of stimulation of the antinociceptive system [SU, copyright certificate N15222500 A61N 1/32, 1985]. The method consists in the fact that the effect is carried out on the forehead and mastoid processes (i.e. transcranially), on which current-conducting electrodes with cloth moistened pads are placed. For a therapeutic effect, first a direct current is applied, and then rectangular pulses of the same polarity are added to it with a frequency of 70-80 Hz with a pulse duration of 3-4 ms and a ratio of constant and pulse currents (average value) as 2-5: 1. In this case, the total current strength is changed from 5 to 25 mA with a duration of exposure of 25 - 35 minutes.

The disadvantages of the method are:

1. low stimulation efficiency of the opioidergic and serotonergic mechanisms of the antinociceptive system, since a wide frequency range is used that goes beyond the individual resonance characteristics of the excitation of the human opiodergic system (OS), which makes stimulation ineffective in individual patients.

2. Transcranial electrostimulation (TES) is usually used in the complex treatment of diseases, monotherapy has little effect on the level of anxiety, depression, which occurs during occupational stress.

The closest is a method of transcranial electrical stimulation of the endorphin mechanisms of the brain [RF patent No. 2159639 IPC ⁸ A61N 1/36 A61N 1/34, publ. B. N33, 2000] Contact the area of the forehead and mastoid processes of the patient with an electric current of 0.2-5 mA in the form of a sequence of monopolar rectangular pulses with a front and slice duration of not more than 20 μs, followed by a period of 12.9 + 0.4 ms with a duty cycle of 3.2-3.7 for 15-40 minutes A further increase in the effectiveness of transcranial electrical stimulation (TES) was achieved by combining it with positive musical-speech suggestive influences (MRSV). It is known that MRSV can also to some extent stimulate the secretion of endorphins. MRSV includes three main stages: preparatory, relaxation and final. At the first stage (3-5 minutes before the start of electrical stimulation and 5-7 minutes from the beginning of the session), the patient is given positive information about the upcoming session, reducing anxiety before an unfamiliar procedure (removing the nocebo effect), as well as instructions for setting the optimal current value. At the second stage (15-20 minutes), suggestive speech influences are conducted against the background of specially selected music, orientation to relaxation and the accumulation of positive emotions. At the third stage (5-7 minutes), the suggested suggestion is aimed at the gradual mobilization of forces and the subsequent transition to active activity. At this stage, instructions are also given to memorize the suggestive part of the procedure in order to use it for autogenic training. MRSV is implemented in hardware in the form of a reproducible device for implementing a method of a musical-speech signal synchronized in time with electrical stimulation.

The disadvantage of this method is that the potentiation of the antistress effects of TPP occurs only through the OS, and it is known that potentiation of the effects of TPP is possible by acting on other stress-limiting systems (SLS): GABA-dopaminergic, serotonergic. An applicable exposure time of 40 minutes is not possible under the conditions of the production process, given the presence of an established interval of 30 minutes. For these characteristics of electric current (in the form of monopolar rectangular pulses with a front and a cutoff of no more than 20 μs, followed by a period of 12.9 + 0.4 ms with a duty cycle of 3.2-3.7) the presence of individual resonant characteristics of the excitation of the human OS is taken into account, however, such characteristics of the electric current will reduce the efficiency of the joint tempering of electrophoresis and TPP, pre respect electrophoresis given constant (galvanic) current. [Catcher B.C. Electrophoresis of medicinal substances: Manual for specialists. - Minsk, 2010. - 404 p.].

The technical task is to increase the effectiveness of rehabilitation treatment for employees with occupational stress due to the effect on the SFS by TES and the strengthening of the anti-stress effects of TES, affecting the opioidergic, serotonergic, GABA-dopaminergic systems.

The problem is solved in a method of treating occupational stress by a complex effect on the SLS, which consists in placing cathodes on the forehead area, anodes on the mastoid processes, gaskets under the electrodes, moisten with water, contact force with a constant bipolar electric current in the form of a sequence of rectangular pulses, current from 0.2 to 2 mA to the appearance of light tingling sensations on the skin under the electrodes, they perform musical-speech suggestive accompaniment, moreover, The plates on the anodes are additionally wetted with 2 ml of a 1% solution of serotonin adipate, using the constant component of the electric current in the ratio of 1: 5 with the pulse component, the current frequency of 77.5 Hz in the frequency modulation mode +/- 2.5 Hz, the pulse repetition time of 3 ms, the duration of the procedure is 20 minutes course of 5 days, taking Aminalon tablets at a dose of 250 mg - 3 times a day, course of 14 days.

A method of treating occupational stress is as follows. First, a preliminary conversation is held with the patient about the goals of treatment and the expected reactions and effects. A course of 14 days of aminalon is used at a dose of 250 mg - 3 times a day before meals. The session begins with the connection of a thermal power station and the cathodes are applied to the frontal region, the gaskets are moistened with water, the anodes are moistened with the mast, the gaskets are moistened with water and an additional solution of 1% serotonin adipinate (CA) 2.0 ml A pulsed bipolar current is used with a gradual increase in the current strength from 0.2 to 2 mA until a sensation of slight tingling, burning sensation, a distinct, painless vibration under the electrode. Use direct current, based on the ratio of constant and variable component 1: 5. The current frequency is 77.5 Hz with a frequency modulation mode +/- 2.5 Hz. The pulse duration is 3 ms, the session is accompanied by MRSV. The duration of the procedure is 20 minutes, the course is 5 procedures.

According to the theory of stress by Hans Selye: stress is nothing more than a general adaptation syndrome that develops as a result of exposure to a person from adverse environmental factors. The general adaptation syndrome, which determines the pathogenesis of various syndromes and diseases, can be explained by stress, the initial phase of which is interpreted as psychoemotional stress. [Merson F.Z., Pshennikova M.G. Adaptation to stress and physical stress - M // Medicine. - 1988. - T. 250.] The body has stress control mechanisms, the so-called SLS, which include central, relatively slow GABA-ergic, serotonergic and opioidergic factors [Khadartsev A.A. et al. Pathophysiology of stress as a balance of stressogenic and anti-stress mechanisms // Bulletin of Neurology, Psychiatry and Neurosurgery. - 2012. - No. 7. - S. 016-021]. The effects of TPP are realized due to the action on the opioidergic and serotonergic mechanisms of the antinociceptive system. Potentiation of the effects of TPPs is possible by acting on the serotonergic and GABAergic systems. [Lebedev V.P., Malygin A.V. TES therapy: transcranial electrical stimulation of the brain's defense mechanisms. Development of a method and apparatus, application in medical and rehabilitation processes // BioMedpribor-2000: proceedings conf. - 2000. - S. 45-50.]

Known drug used for electrophoresis and affecting serotonin receptors - 1% CA. When given in the introduction, normally it does not penetrate the blood-brain barrier, but is able to penetrate in ionic form using transcerebral electrophoresis (TE). The safety and effectiveness of TE SA are proven. [SU, copyright certificate, No. 1088729, 1984. Bull. No. 16.] With this method, direct current is used according to the orbital-occipital technique, which ensures the accumulation of the drug in separate areas of the brain interelectrode space. Constant continuous electric current (galvanic) in comparison with other currents has the greatest electrogenic movement of matter, i.e. movement caused by the action of an electric field during the procedure [B. Clerk. Electrophoresis of medicinal substances: Manual for specialists. - Minsk, 2010. - 404 p.]. The optimal position of the electrodes, providing a current supply to the antinociceptive system, is the fronto-mastoid position used in TPPs [Lebedev V.P., Malygin A.V. TES therapy: transcranial electrical stimulation of the brain's defense mechanisms. Development of a method and equipment, application in medical and rehabilitation processes // BioMedpribor - 2000: proceedings conf. - 2000. - S. 45-50.]. It follows from the foregoing that this position of the electrodes can be used for the purpose of the electrogenic movement of SA ions to the antinociceptive system, with the goal of potentiating the effects of TES.

It has been established that in humans the resonant characteristics of the excitation of the OS lie in the range 75 Hz - 80 Hz, the maximum excitation in the majority of the population is 77.5 Hz. Since individual patients have different positions of the maximum of OS excitation, and its determination is not possible on an outpatient basis, to increase the proportion of patients and improve the effect, it is not a constant frequency of electric current of 77.5 Hz that is used, but its modulation. For example, in the prototype, the period of stimulating impulses in the process of exposure is applied within ± 0.4 ms of the statistically average. In order to avoid inrush currents (since the average current is the quotient of dividing the amplitude of the pulses by the duty cycle), when changing the period, the condition of constant duty cycle must be strictly observed, although the duty cycle value itself can be chosen by anyone within the above limits. Given this position, we apply the frequency modulation mode +/- 2.5 Hz.

In the prototype, the reduction of the irritating effect of electric current on the skin at the electrodes location without changing the stimulation efficiency of the OS is achieved using bipolar pulses obtained from a sequence of monopolar pulses by eliminating the constant component of the spectrum of the pulse sequence, in our proposed method the current is bipolar, thereby the efficiency of the prototype method is preserved . An example of a study:

A randomized clinical trial was conducted in parallel groups. Within 4 months, the psycho-functional status, the functional state of the body (FSO), the vegetative status (AF) of the employees of the industrial enterprise JSC NPO Splav were examined with complaints of poor health. 76 employees with occupational stress were selected for the study. The study did not include employees with the presence of acute and chronic diseases according to the clinical examination. Of these, 38 women and 38 men. The age of the patients ranged from 38 to 64 years. The average age of men is 54 ± 1.6 years, the average age of women is 47 ± 2.2 years. Registration of stress level, FSO was carried out using test methods. The following were used: psychological stress scales (“PSM-25”), a functional state questionnaire (“SAN”). The FSO assessment was carried out on the Simon 111 Integral Monitoring System hardware-software complex, the indicators of the functional state of the body were studied: cardiac reserve (CR), adaptive reserve (AR), integral balance (IB), vegetative status indicators: Baevsky stress index (INB ), sympathetic activity index (NSA).

The employees are divided into 2 groups: the main group (OG) (38) and the control group (KG) (38), the groups are comparable by gender and age. Exhaust gas Treatment according to the proposed method: TPP with MRSV, together with TE SA and taking Aminalon. CG conducted sessions of thermal power plants with MRSV. The TPP was carried out by the Magnon DKS apparatus (FSR Registration Certificate 2011/11238 dated 12/07/2015). After treatment, hardware-software control of treatment effectiveness, repeated testing, and calculation of the p-criterion were carried out.

Results: OG and KG were in a state of emotional stress, decreased functional state of the body, had increased activity of both the sympathetic and parasympathetic nervous systems. (Table 1, Table 2)

1. IS is normal - 0 ± 100%, represents the sum of percentage deviations from the norm of all studied indicators. The greater the deviation in the negative direction, the lower the level of functioning of the body. In patients with critical IB, the dominus may decrease by 700%. The greater the deviation in the positive direction, the higher the level of functioning of the body. For athletes of a high level in a calm state, at the peak of a sports form, IB can reach 300-700%, and immediately after competitions or grueling training, the dominus can drop 400%, but within a few hours or days it returns to its previous level. According to information security, one can judge the effectiveness of rehabilitation measures and the physiological cost of the load.

2. CR is normal - 5 ± 1 cu, reflects the ratio of the duration of the phases of the cardiac cycle - diastole time, electric systole time, mechanical systole time, in patients in critical conditions decreases to unity. In well-trained athletes in a calm state, CR can reach ten, and at maximum physical exertion it can drop to unity. CR during exercise is consumed (reduced) to maintain a high information security. After intense or daily physical work, the CR is always lower than that of a rested worker. Therefore, CR, like IB, reflects the physiological cost of the load. With an increase in CR, AR also increases.

3. AR is normal - 500 ± 100 cu, reflects the total balance of information security and CR. For athletes of a high level in a calm state at the peak of a sports form, it can reach 1500 cu After the disease or during the prenosological course of the disease, the AR can decrease to 200 cu, but within a few hours or days after rest or the use of restorative techniques, it again returns to its previous level. In patients who are in critical condition, it can decrease to 50 cu

4. INB - characterizes the activity of the parasympathetic department of the autonomic nervous system (norm - 80-300 cu);

5. ISA - characterizes the activity of the sympathetic department (norm 30-70).

After the treatment, 89% of the studied hypertension and 68% of the studied hypertension have a decrease in stress level and an improvement in FSO. Compared to CG, a significantly greater decrease in stress level, a greater improvement in FSO activity, normalization of autonomic status in the form of a decrease in the activity of the sympathetic nervous system, and an increase in the activity of the parasympathetic nervous system are observed in OG. Adverse effects were not recorded.

The proposed method for the treatment of occupational stress is an effective integrated non-invasive method in the treatment of PS. The effect of the joint effect is realized through a complex effect on the SLS, leading to the normalization of the autonomic nervous system, psycho-functional state.

Claims (1)

A method of treating occupational stress, which consists in applying cathodes to the forehead, anodes on the mastoid processes, gaskets under the electrodes, moisten with water, contact them with a constant bipolar electric current in the form of a sequence of rectangular pulses, current from 0.2 to 2 mA until light sensations appear tingling on the skin under the location of the electrodes, perform musical-speech suggestive accompaniment, characterized in that the pads on the anodes are additionally moistened with 2 ml of a 1% solution erotonina adipate, using the constant component of the electric current in a ratio of 1: 5 with pulse component, current frequency of 77.5 Hz in the frequency modulation mode ± 2.5 Hz, pulse duration of 3 msec, duration of procedure 20 minutes course of 5 days, with an additional receiving Aminalon tablets.