medsovetМедицинский СоветMeditsinskiy sovet = Medical Council2079-701X2658-5790REMEDIUM GROUP Ltd.10.21518/2079-701X-2020-9-265-270medsovet-5744Research ArticleКЛИНИЧЕСКОЕ НАБЛЮДЕНИЕCLINICAL OBSERVATIONВозможности ксенонотерапии у онкологической пациентки с тяжелым хроническим болевым синдромом (клиническое наблюдение)The possibilities of using xenon therapy in patients with severe cancer painhttps://orcid.org/0000-0002-0727-5758СарманаеваР. Р.SarmanayevaR. R.

Сарманаева Регина Рашитовна, врач Центра паллиативной помощи онкологическим больным

125834, Москва, 2-й Боткинский пр-д, д. 3

Regina R. Sarmanayeva, doctor palliative care center 

3, 2nd Botkinsky proezd, Moscow,125284

r.sarm@mail.ruhttps://orcid.org/0000-0002-6146-2706АбузароваГ. Р.AbuzarovaG. R.

Абузарова Гузаль Рафаиловна, д.м.н., руководитель Центра паллиативной помощи

125834, Москва, 2-й Боткинский пр-д, д. 3

Guzal R. Abuzarova, Dr. of Sci. (Med.), Head of palliative care center

3, 2nd Botkinsky proezd, Moscow,125284

abuzarova_mnioi@bk.ruhttps://orcid.org/0000-0002-5177-2612БычковаН. М.BychkovaN. M.

Бычкова Наталья Михайловна, к.м.н., заведующая дневным стационаром отдела лучевой терапии

125834, Москва, 2-й Боткинский пр-д, д. 3

Natalia M. Bychkova, Cand. of Sci. (Med.), Head of the Outpatient Department of Radiation Therapy

3, 2nd Botkinsky proezd, Moscow,125284

bychkovanm@mail.ruhttps://orcid.org/0000-0001-8845-9913ХороненкоВ. Э.KhoronenkoV. E.

Хороненко Виктория Эдуардовна, д.м.н., руководитель отделения анестезиологии и реанимации

125834, Москва, 2-й Боткинский пр-д, д. 3

Victoria E. Khoronenko, Dr. of Sci. (Med.), Head of department of anesthesiology and resuscitation

3, 2nd Botkinsky proezd, Moscow,125284

khoronenko_mnioi@mail.ruhttps://orcid.org/0000-0001-5317-0394КузнецовС. В.KuznetcovS. V.

Кузнецов Станислав Владимирович, младший научный сотрудник Центра паллиативной помощи онкологическим больным

125834, Москва, 2-й Боткинский пр-д, д. 3

Stanislav V. Kuznetcov, doctor - neurologist palliative care center

3, 2nd Botkinsky proezd, Moscow,125284

kuznetcov-mnioi@yandex.ruНациональный медицинский исследовательский центр радиологииРоссияNational Medical Research Radiological CenterRussian Federation20203007202009265270Copyright © Сарманаева Р.Р., Абузарова Г.Р., Бычкова Н.М., Хороненко В.Э., Кузнецов С.В., 20202020Сарманаева Р.Р., Абузарова Г.Р., Бычкова Н.М., Хороненко В.Э., Кузнецов С.В.Sarmanayeva R.R., Abuzarova G.R., Bychkova N.M., Khoronenko V.E., Kuznetcov S.V.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.med-sovet.pro/jour/article/view/5744

Основными анальгетиками для терапии хронических болевых синдромов онкологического генеза, согласно рекомендациям Всемирной организации здравоохранения и клиническим рекомендациям Минздрава РФ, являются парацетамол, НПВП и опиоидные анальгетики, которые назначаются ступенчато в комбинации с коанальгетиками и адъювантными средствами; при нейропатической боли применяются габапентиноиды и трициклические антидепрессанты. Как правило, у большинства онкологических пациентов эта ступенчатая схема обезболивания эффективна, однако у 20–30% пациентов не удается достичь приемлемого уровня анальгезии, несмотря на использование у них различных комбинаций анальгетиков из вышеуказанных групп. Как помочь данной категории пациентов? Один из вариантов – применение интервенционных методов обезболивания, но не все пациенты согласны на инвазивные способы из-за возможных неблагоприятных эффектов или в силу разных обстоятельств они могут быть противопоказаны или недоступны. В таких случаях следует искать другие механизмы воздействия на пути проведения боли, такие как NMDA-блокаторы, которые снижают опиоидную толерантность и гипералгезию. Не все препараты этой группы мы можем использовать в практике. Обезболивающие свойства закиси азота проявляются только в наркотических дозах, что делает невозможным применение этого препарата в амбулаторной практике. Другой мощный блокатор NMDA-рецепторов – метадон не зарегистрирован в нашей стране, то же самое касается и канабиноидов. Как вариант, в нашей клинической практике мы использовали ингаляционный анальгетик ксенон, который также является ингибитором NMDAрецепторов. Его безопасность и анальгетический эффект подтверждены в многочисленных исследованиях. Целью публикации является демонстрация успешного клинического случая использования ингаляций смеси инертного газа ксенона и кислорода для лечения тяжелого онкологического болевого синдрома у пациентки, получавшей перорально морфин.

In accordance with the clinical recommendations of the World Health Organization and the Ministry of Health of the Russian Federation, the main analgesics for the treatment of chronic cancer pain are non-opioid and opioid analgesics, given stepwise in combination with co-analgesics and adjuvant drugs. As a rule, this stepwise scheme of painkilling is effective in most cases. However, 20-30% of patients cannot achieve an acceptable level of pain relief despite the use of these analgesics in combination. Is there another way to help such patients? Interventional methods of analgesia are an option, yet not all patients agree to invasive methods due to the possible side effects and unavailability of these methods. In these cases other mechanisms of analgesia are required, such as NMDA receptor antagonists, which reduce opioid tolerance and hyperalgesia. Still not all the drugs of this group can be applied in our practice. Analgesic properties of nitrous oxide can only be found in high anesthetic doses. Another option is metadon, but it is forbidden and cannot be used in our country. Still one more option is ketamine, which has severe side effects. In our clinical practice we decided to use xenon, which has NMDA inhibition effects. Its analgesic effect and safety have been confirmed in numerous studies. This publication aims to demonstrate a successful clinical case when we used xenon and oxygen inhalations course for the treatment of a severe cancer pain with a patient who had been taking morphine by mouth.

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The authors declare that there are no conflicts of interest present.