medsovetМедицинский СоветMeditsinskiy sovet = Medical Council2079-701X2658-5790REMEDIUM GROUP Ltd.10.21518/2079-701X-2022-16-2-146-151medsovet-6756Research ArticleПРАКТИКАPRACTICEРадикулопатия у пациента с диабетической полинейропатией: сложности диагностики и терапииRadiculopathy in diabetic polyneuropathy patients: difficulties in the diagnosis and therapyhttps://orcid.org/0000-0003-4411-7051ДевликамоваФ. И.DevlikamovaF. I.

 д.м.н., профессор кафедры неврологии 

 420012, Россия, Казань, ул. Муштари, д. 11 

 Dr. Sci. (Med.), Professor of the Department of Neurology

11, Mushtari St., Kazan, 420012, Russia 

fdevlikamova@mail.ruhttps://orcid.org/0000-0002-1430-9741МаксимовЮ. Н.MaksimovYu. N.

 к.м.н., доцент, доцент кафедры неврологии 

 420012, Россия, Казань, ул. Муштари, д. 11 

 Cand. Sci. (Med.), Associate Professor, Associate Professor of the Department of Neurology 

11, Mushtari St., Kazan, 420012, Russia 

yuri_maximov@mail.ruhttps://orcid.org/0000-0001-6883-7649ХайбуллинаД. Х.KhaibullinaD. Kh.

 к.м.н., доцент, доцент кафедры неврологии 

 420012, Россия, Казань, ул. Муштари, д. 11 

 Cand. Sci. (Med.), Associate Professor, Associate Professor of the Department of Neurology 

11, Mushtari St., Kazan, 420012, Russia 

dina.khaibullina@mail.ruКазанская государственная медицинская академия – филиал Российской медицинской академии непрерывного профессионального образованияРоссияKazan State Medical Academy – a branch of the Russian Medical Academy of Continuing Professional EducationRussian Federation20221403202202146151Copyright © Девликамова Ф.И., Максимов Ю.Н., Хайбуллина Д.Х., 20222022Девликамова Ф.И., Максимов Ю.Н., Хайбуллина Д.Х.Devlikamova F.I., Maksimov Y.N., Khaibullina D.K.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.med-sovet.pro/jour/article/view/6756

Нейропатическая боль (НБ) нередко встречается в клинической практике. Она может возникать при повреждении различных невральных структур, таких как периферические нервы, спинномозговые корешки, спинной мозг и структуры головного мозга. В зависимости от уровня повреждения НБ делится на центральную и периферическую, при этом периферическая НБ более распространена. При диагностике НБ наиболее ценными являются результаты физикального исследования пациента. С целью изучения состояния периферического нейромоторного аппарата больным проводится стимуляционная электромиография (ЭМГ) с анализом проведения по моторным и сенсорным волокнам вызванного кожного симпатического потенциал. Для верификации уровня и стадии патологического процесса нередко используется ЭМГ с использованием игольчатых электродов. Трудности в постановке диагноза возникают в случае сочетания у пациента нескольких видов нейропатической боли и коморбидной патологии. Для лечения НБ используются антидепрессанты, антиконвульсанты, опиоидные анальгетики, препараты для местного обезболивания, ботулинический токсин типа А. Для лечения диабетической полинейропатии используются препараты альфа-липоевой (тиоктовой) кислоты. Наличие у пациента нескольких нозологий, каждая из которых имеет индивидуальные проявления НБ, определяет тактику его лечения, что рассмотрено на примере двух клинических случаев.

Neuropathic pain (NP) is not uncommon in clinical practice. NP can occur when various neural structures are damaged, such as peripheral nerves, spinal roots, spinal cord, and brain structures. Depending on the level of damage, NP is divided into central and peripheral. At the same time, peripheral NP is more common. When diagnosing NP, the results of a physical examination of the patient are the most valuable. In order to study the state of the peripheral neuromotor apparatus, patients undergo stimulation electromyography with an analysis of the conduction along motor fibers and sensory fibers caused by the skin sympathetic potential, and EMG using needle electrodes is often used to verify the level and stage of the pathological process. Difficulties in making a diagnosis arise when a patient has a combination of several types of neuropathic pain and comorbid pathology. For the treatment of NP, antidepressants, anticonvulsants, opioid analgesics, drugs for local anesthesia, botulinum toxin type A are used. Alpha-lipoic (thioctic) acid preparations are used in the treatment of diabetic polyneuropathy. The presence of several nosologies in a patient, each of which has individual manifestations of NP, determines the tactics of treating a particular patient, which is considered on the example of two clinical cases.

больболь в спиненейропатическая больрадикулопатиякомпрессионно-корешковый синдромдиабетическая полинейропатияскелетно-мышечная больболевой синдромдиагностикалечениеpainback painneuropathic painradiculopathyradicular compression syndromediabetic polyneuropathymusculoskeletal painpain syndromediagnosistreatmentReferencesvan Hecke O., Austin S.K., Khan R.A., Smith B.H., Torrance N. Neuropathic pain in the general population: a systematic review of epidemiological studies. Pain. 2014;155(4):654–662. https://doi.org/10.1016/j.pain.2013.11.013.van Hecke O., Austin S.K., Khan R.A., Smith B.H., Torrance N. Neuropathic pain in the general population: a systematic review of epidemiological studies. Pain. 2014;155(4):654–662. https://doi.org/10.1016/j.pain.2013.11.013.Давыдов О.С., Кукушкин М.Л. Фенотипы невропатической боли. Патогенез. 2018;16(3):151–153. https://doi.org/10.25557/2310-0435.2018.03.151-153.Davydov O.S., Kukushkin M.L. Phenotypes of neuropathic pain. Patogenez (Pathogenesis). 2018;16(3):151–153. (In Russ.) https://doi.org/10.25557/2310-435.2018.03.151-153.Jensen T.S., Baron R., Haanpää M., Kalso E., Loeser J.D., Rice A.S.C., Treede R.-D. A new definition of neuropathic pain. Pain. 2011;152(10):2204–2205. https://doi.org/10.1016/j.pain.2011.06.017.Jensen T.S., Baron R., Haanpää M., Kalso E., Loeser J.D., Rice A.S.C., Treede R.-D. A new definition of neuropathic pain. Pain. 2011;152(10):2204–2205. https://doi.org/10.1016/j.pain.2011.06.017.Schaefer C., Mann R., Sadosky A., Daniel S., Parsons B., Nieshoff E. et al. Burden of illness associated with peripheral and central neuropathic pain among adults seeking treatment in the United States: a patient-centered evaluation. Pain Med. 2014;15(12):2105–2119. https://doi.org/10.1111/pme.12502.Schaefer C., Mann R., Sadosky A., Daniel S., Parsons B., Nieshoff E. et al. Burden of illness associated with peripheral and central neuropathic pain among adults seeking treatment in the United States: a patient-centered evaluation. Pain Med. 2014;15(12):2105–2119. https://doi.org/10.1111/pme.12502.Яхно Н.Н., Кукушкин М.Л., Давыдов О.С., Данилов А.Б., Амелин А.В., Алексеев В.В. и др. Результаты Российского эпидемиологического исследования распространенности невропатической боли (EPIC Study). Лечение невропатической боли. Consilium Medicum. Неврология (Прил.). 2008;(2):64–70. Режим доступа: https://omnidoctor.ru/library/izdaniya-dlya-vrachey/consilium-medicum/cm2008/nevro2008_pril/nevro2009_2_pril/rezultaty-rossiyskogo-epidemiologicheskogoissledovaniya-rasprostranennosti-nevropaticheskoy-boli-ep/.Yakhno N.N., Kukushkin M.L., Davydov O.S., Danilov A.B., Amelin A.V., Alekseev V.V. et al. The results of the Russian epidemiological study of the prevalence of neuropathic pain, its causes and characteristics in the population of outpatients who referred to a neurologist. Consilium Medicum. Neurology (Suppl.). 2008;(2):64–70. (In Russ.) Available at: https://omnidoctor.ru/library/izdaniya-dlya-vrachey/consilium-medicum/cm2008/nevro2008_pril/nevro2009_2_pril/rezultatyrossiyskogo-epidemiologicheskogo-issledovaniya-rasprostranennostinevropaticheskoy-boli-ep/.Яхно Н.Н., Кукушкин М.Л., Чурюканов М.В., Сыровегин А.В. Результаты открытого мультицентрового исследования «МЕРИДИАН» по оценке распространенности болевых синдромов в амбулаторной практике и терапевтических предпочтений врачей. Российский журнал боли. 2012;(3–4):10–14. Режим доступа: https://painrussia.ru/russian-Journal-of-Pain/36%2012.pdf.Yakhno N.N., Kukushkin M.L., Churyukanov M.V., Syrovegin A.V. The results of open multicentral study “Meridian” for assessment of pain syndromes prevalence in ambulatory and therapeutic preferences of physicians. Russian Journal of Pain. 2012;(3–4):10–14. (In Russ.) Available at: https://painrussia.ru/russian-Journal-ofPain/36%2012.pdf.Bennett M.I., Attal N., Backonja M.M., Baron R., Bouhassira D., Freynhagen R. et al. Using screening tools to identify neuropathic pain. Pain. 2007;127(3):199–203. https://doi.org/10.1016/j.pain.2006.10.034.Bennett M.I., Attal N., Backonja M.M., Baron R., Bouhassira D., Freynhagen R. et al. Using screening tools to identify neuropathic pain. Pain. 2007;127(3):199–203. https://doi.org/10.1016/j.pain.2006.10.034.Bouhassira D., Attal N., Alchaar H., Boureau F., Brochet B., Bruxelle J. et al. Comparison of pain syndromes associated with nervous or somatic lesions and development of a new neuropathic pain diagnostic questionnaire (DN4). Pain. 2005;114(1–2):29–36. https://doi.org/10.1016/j.pain.2004.12.010.Bouhassira D., Attal N., Alchaar H., Boureau F., Brochet B., Bruxelle J. et al. Comparison of pain syndromes associated with nervous or somatic lesions and development of a new neuropathic pain diagnostic questionnaire (DN4). Pain. 2005;114(1–2):29–36. https://doi.org/10.1016/j.pain.2004.12.010.Jiang M.-S., Yuan Y., Gu Z.-X., Zhuang S.-L. Corneal confocal microscopy for assessment of diabetic peripheral neuropathy: a meta-analysis. Br J Ophthalmol. 2016;100(1):9–14. https://doi.org/10.1136/bjophthalmol-2014-306038.Jiang M.-S., Yuan Y., Gu Z.-X., Zhuang S.-L. Corneal confocal microscopy for assessment of diabetic peripheral neuropathy: a meta-analysis. Br J Ophthalmol. 2016;100(1):9–14. https://doi.org/10.1136/bjophthalmol-2014-306038.Haanpää M., Attal N., Backonja M., Baron R., Bennett M., Bouhassira D. et al. NeuPSIG guidelines on neuropathic pain assessment. Pain. 2011;152(1):14–27. https://doi.org/10.1016/j.pain.2010.07.031.Haanpää M., Attal N., Backonja M., Baron R., Bennett M., Bouhassira D. et al. NeuPSIG guidelines on neuropathic pain assessment. Pain. 2011;152(1):14–27. https://doi.org/10.1016/j.pain.2010.07.031.Давыдов О.С., Яхно Н.Н., Кукушкин М.Л., Чурюканов М.В., Абузарова Г.Р., Амелин А.В. и др. Невропатическая боль: клинические рекомендации по диагностике и лечению Российского общества по изучению боли. Российский журнал боли. 2018;(4):5–37. https://doi.org/10.25731/RASP.2018.04.025.Davydov O.S., Yakhno N.N., Kukushkin M.L., Churyukanov M.V., Abuzarova G.R., Amelin A.V. et al. Neuropathic pain: clinical guidelines on the diagnostics and treatment from the Russian Association for the Studying of Pain. Russian Journal of Pain. 2018;(4):5–37. (In Russ.) https://doi.org/10.25731/ RASP. 2018. 04.025.Baron R., Binder A., Wasner G. Neuropathic pain: diagnosis, pathophysiological mechanisms, and treatment. Lancet Neurol. 2010;9(8):807–819. https://doi.org/10.1016/S1474-4422(10)70143-5.Baron R., Binder A., Wasner G. Neuropathic pain: diagnosis, pathophysiological mechanisms, and treatment. Lancet Neurol. 2010;9(8):807–819. https://doi.org/10.1016/S1474-4422(10)70143-5.Colloca L., Ludman T., Bouhassira D., Baron R., Dickenson A.H., Yarnitsky D. et al. Neuropathic pain. Nat Rev Dis Primers. 2017;3:17002. https://doi.org/10.1038/nrdp.2017.2.Colloca L., Ludman T., Bouhassira D., Baron R., Dickenson A.H., Yarnitsky D. et al. Neuropathic pain. Nat Rev Dis Primers. 2017;3:17002. https://doi.org/10.1038/nrdp.2017.2.Строков И.А., Фокина А.С., Головачева В.А., Кочетов А.Г. Эффективность тиолепты при диабетической полинейропатии (по данным исследования ЭТИКА). Журнал неврологии и психиатрии им. C.C. Корсакова. 2013;(5):36–40. Режим доступа: https://www.mediasphera.ru/issues/zhurnal-nevrologii-ipsikhiatrii-im-s-s-korsakova/2013/5/downloads/ru/031997-7298201357.Strokov I.A., Fokina A.S., Golovacheva V.A., Kochetov A.G. Efficacy of thioleptа in diabetic polyneuropathy: results of the study ETIKA. Zhurnal Nevrologii i Psikhiatrii imeni S.S. Korsakova. 2013;(5):36–40. (In Russ.) Available at: https://www.mediasphera.ru/issues/zhurnal-nevrologii-i-psikhiatrii-im-S-SKorsakova/2013/5/downloads/ru/031997-7298201357.Finnerup N.B., Attal N., Haroutounian S., McNicol E., Baron R., Dworkin R.H. et al. Pharmacotherapy for neuropathic pain in adults: a systematic review and meta-analysis. Lancet Neurol. 2015;14(2):162–173. https://doi.org/10.1016/S1474-4422(14)70251-0.Finnerup N.B., Attal N., Haroutounian S., McNicol E., Baron R., Dworkin R.H. et al. Pharmacotherapy for neuropathic pain in adults: a systematic review and meta-analysis. Lancet Neurol. 2015;14(2):162–173. https://doi.org/10.1016/S1474-4422(14)70251-0.Moore R.A., Derry S., Aldington D., Cole P., Wiffen P.J. Amitriptyline for neuropathic pain in adults. Cochrane Database Syst Rev. 2015;2015(7):CD008242. https://doi.org/10.1002/14651858.cd008242.pub3.Moore R.A., Derry S., Aldington D., Cole P., Wiffen P.J. Amitriptyline for neuropathic pain in adults. Cochrane Database Syst Rev. 2015;2015(7):CD008242. https://doi.org/10.1002/14651858.cd008242.pub3.Gallagher H.C., Gallagher R.M., Butler M., Buggy D.J., Henman M.C. Venlafaxine for neuropathic pain in adults. Cochrane Database Syst Rev. 2015;2015(8):CD011091. https://doi.org/10.1002/14651858.CD011091.pub2.Gallagher H.C., Gallagher R.M., Butler M., Buggy D.J., Henman M.C. Venlafaxine for neuropathic pain in adults. Cochrane Database Syst Rev. 2015;2015(8):CD011091. https://doi.org/10.1002/14651858.CD011091.pub2.Lunn M.P., Hughes R.A., Wiffen P.J. Duloxetine for treating painful neuropathy or chronic pain. Cochrane Database Syst Rev. 2009;(4):CD007115. https://doi.org/10.1002/14651858.CD007115.pub2.Lunn M.P., Hughes R.A., Wiffen P.J. Duloxetine for treating painful neuropathy or chronic pain. Cochrane Database Syst Rev. 2009;(4):CD007115. https://doi.org/10.1002/14651858.CD007115.pub2.Wiffen P.J., Derry S., Bell R.F., Rice A.S., Tölle T.R., Phillips T., Moore R.A. Gabapentin for chronic neuropathic pain in adults. Cochrane Database Syst Rev. 2017;6(6):CD007938. https://doi.org/10.1002/14651858.CD007938.pub4.Wiffen P.J., Derry S., Bell R.F., Rice A.S., Tölle T.R., Phillips T., Moore R.A. Gabapentin for chronic neuropathic pain in adults. Cochrane Database Syst Rev. 2017;6(6):CD007938. https://doi.org/10.1002/14651858.CD007938.pub4.Wiffen P.J., Derry S., Moore R.A., Aldington D., Cole P., Rice A.S.C. et al. Antiepileptic drugs for neuropathic pain and fibromyalgia – an overview of Cochrane reviews. Cochrane Database Syst Rev. 2013;2013(11):CD010567. https://doi.org/10.1002/14651858.CD010567.pub2.Wiffen P.J., Derry S., Moore R.A., Aldington D., Cole P., Rice A.S.C. et al. Antiepileptic drugs for neuropathic pain and fibromyalgia – an overview of Cochrane reviews. Cochrane Database Syst Rev. 2013;2013(11):CD010567. https://doi.org/10.1002/14651858.CD010567.pub2.Derry S., Rice A.S., Cole P., Tan T., Moore R.A. Topical capsaicin (high concentration) for chronic neuropathic pain in adults. Cochrane Database Syst Rev. 2017;1(1):CD007393. https://doi.org/10.1002/14651858.CD007393.pub4.Derry S., Rice A.S., Cole P., Tan T., Moore R.A. Topical capsaicin (high concentration) for chronic neuropathic pain in adults. Cochrane Database Syst Rev. 2017;1(1):CD007393. https://doi.org/10.1002/14651858.CD007393.pub4.van Nooten F., Treur M., Pantiri K., Stoker M., Charokopou M. Capsaicin 8% Patch Versus Oral Neuropathic Pain Medications for the Treatment of Painful Diabetic Peripheral Neuropathy: A Systematic Literature Review and Network Metaanalysis. Clin Ther. 2017;39(4):787–803.e18. https://doi.org/10.1016/j.clinthera.2017.02.010.van Nooten F., Treur M., Pantiri K., Stoker M., Charokopou M. Capsaicin 8% Patch Versus Oral Neuropathic Pain Medications for the Treatment of Painful Diabetic Peripheral Neuropathy: A Systematic Literature Review and Network Metaanalysis. Clin Ther. 2017;39(4):787–803.e18. https://doi.org/10.1016/j.clinthera.2017.02.010.Duehmke R.M., Derry S., Wiffen P.J., Bell R.F., Aldington D., Moore R.A. Tramadol for neuropathic pain in adults. Cochrane Database Syst Rev. 2017;6(6):CD003726. https://doi.org/10.1002/14651858.CD003726.pub4.Duehmke R.M., Derry S., Wiffen P.J., Bell R.F., Aldington D., Moore R.A. Tramadol for neuropathic pain in adults. Cochrane Database Syst Rev. 2017;6(6):CD003726. https://doi.org/10.1002/14651858.CD003726.pub4.Cooper T.E., Chen J., Wiffen P.J., Derry S., Carr D.B., Aldington D. et al. Morphine for chronic neuropathic pain in adults. Cochrane Database Syst Rev. 2017;5(5):CD011669. https://doi.org/10.1002/14651858.CD011669.pub2Cooper T.E., Chen J., Wiffen P.J., Derry S., Carr D.B., Aldington D. et al. Morphine for chronic neuropathic pain in adults. Cochrane Database Syst Rev. 2017;5(5):CD011669. https://doi.org/10.1002/14651858.CD011669.pub2Gaskell H., Moore R.A., Derry S., Stannard C. Oxycodone for pain in fibromyalgia in adults. Cochrane Database Syst Rev. 2016;9(9):CD012329. https://doi.org/10.1002/14651858.cd012329.Gaskell H., Moore R.A., Derry S., Stannard C. Oxycodone for pain in fibromyalgia in adults. Cochrane Database Syst Rev. 2016;9(9):CD012329. https://doi.org/10.1002/14651858.cd012329.Строков И.А., Оганов В.В. Патогенез, диагностика и патогенетическая терапия диабетической полиневропатии. Неврология, нейропсихиатрия, психосоматика. 2021;13(3):99–106. https://doi.org/10.14412/2074-2711-2021-3-99-106.Strokov I.A., Oganov V.V. Pathogenesis, evaluation and pathogenetic therapy of diabetic polyneuropathy. Nevrologiya, Neiropsikhiatriya, Psikhosomatika. 2021;13(3):99–106. (In Russ.) https://doi.org/10.14412/2074-2711-2021-3-99-106.Papanas N., Ziegler D. Efficacy of α-lipoic acid in diabetic neuropathy. Expert Opin Pharmacother. 2014;15(18):2721–2731. https://doi.org/10.1517/14656566.2014.972935.Papanas N., Ziegler D. Efficacy of α-lipoic acid in diabetic neuropathy. Expert Opin Pharmacother. 2014;15(18):2721–2731. https://doi.org/10.1517/14656566.2014.972935.Mijnhout G.S., Kollen B.J., Alkhalaf A., Kleefstra N., Bilo H.J.G. Alpha lipoic Acid for symptomatic peripheral neuropathy in patients with diabetes: a meta-analysis of randomized controlled trials. Int J Endocrinol. 2012;2012:456279. https://doi.org/10.1155/2012/456279.Mijnhout G.S., Kollen B.J., Alkhalaf A., Kleefstra N., Bilo H.J.G. Alpha lipoic Acid for symptomatic peripheral neuropathy in patients with diabetes: a meta-analysis of randomized controlled trials. Int J Endocrinol. 2012;2012:456279. https://doi.org/10.1155/2012/456279.Ziegler D., Nowak H., Kempler P., Vargha P., Low P.A. Treatment of symptomatic diabetic polyneuropathy with the antioxidant alpha-lipoic acid: a meta-analysis. Diabet Med. 2004;21(2):114–121. https://doi.org/10.1111/j.1464-5491.2004.01109.x.Ziegler D., Nowak H., Kempler P., Vargha P., Low P.A. Treatment of symptomatic diabetic polyneuropathy with the antioxidant alpha-lipoic acid: a meta-analysis. Diabet Med. 2004;21(2):114–121. https://doi.org/10.1111/j.1464-5491.2004.01109.x.Dy S.M., Bennett W.L., Sharma R., Zhang A., Waldfogel J.M., Nesbit S.A. et al. Preventing Complications and Treating Symptoms of Diabetic Peripheral Neuropathy. Rockville (MD): Agency for Healthcare Research and Quality (US); 2017. Available at: http://www.ncbi.nlm.nih.gov/books/NBK442335/.Dy S.M., Bennett W.L., Sharma R., Zhang A., Waldfogel J.M., Nesbit S.A. et al. Preventing Complications and Treating Symptoms of Diabetic Peripheral Neuropathy. Rockville (MD): Agency for Healthcare Research and Quality (US); 2017. Available at: http://www.ncbi.nlm.nih.gov/books/NBK442335/.Ziegler D., Low P.A., Litchy W.J., Boulton A.J.M., Vinik A.I., Freeman R. et al. Efficacy and safety of antioxidant treatment with α-lipoic acid over 4 years in diabetic polyneuropathy: the NATHAN 1 trial. Diabetes Care. 2011;34(9):2054–2060. https://doi.org/10.2337/dc11-0503.Ziegler D., Low P.A., Litchy W.J., Boulton A.J.M., Vinik A.I., Freeman R. et al. Efficacy and safety of antioxidant treatment with α-lipoic acid over 4 years in diabetic polyneuropathy: the NATHAN 1 trial. Diabetes Care. 2011;34(9):2054–2060. https://doi.org/10.2337/dc11-0503.Строков И.А., Фокина А.С. Альфа-липоевая кислота – основное фармакологическое лечение диабетической полиневропатии в стационаре и поликлинике. Медицинский совет. 2016;(17):28–33. https://doi.org/10.21518/2079-701X-2016-17-28-33.Strokov I.A., Phokina A.S. α-Lipoic acid as the main pharmacological drug for inand outpatient treatment of diabetic polyneuropathy. Meditsinskiy Sovet. 2016;(17):28–33. (In Russ.) https://doi.org/10.21518/2079-701X-2016-17-28-33.Воробьева О.В. Альфа-липоевая кислота – спектр клинического применения. Медицинский алфавит. 2012;3(15):71–77. Режим доступа: https://medi.ru/info/3593/.Vorobeva O.V. Alpha-lipoic acid – the spectrum of clinical use. Medical Alphabet. 2012;3(15):71–77. (In Russ.) Available at: https://medi.ru/info/3593/.Шавловская О.А. Эффективность тиоктовой (альфа-липоевой) кислоты в терапии диабетической полинейропатии. Эффективная фармакотерапия. 2016;(12):8–14. Режим доступа: https://umedp.ru/articles/effektivnost_tioktovoy_alfalipoevoy_kisloty_v_terapii_diabeticheskoy_polineyropatii_.html.Shavlovskaya O.A. Efficacy of thioctic (alpha-lipoic) acid in treatment of diabetic polyneuropathy. Effective Pharmacotherapy. 2016;(12):8–14. (In Russ.) Available at: https://umedp.ru/articles/effektivnost_tioktovoy_alfalipoevoy_kisloty_v_terapii_diabeticheskoy_polineyropatii_.html.Ranieri M., Sciuscio M., Cortese A.M., Santamato A., Teo L.D., Ianieri G. et al. The use of alpha-lipoic acid (ALA), gamma linolenic acid (GLA) and rehabilitation in the treatment of back pain: effect on health-related quality of life. Int J Immunopathol Pharmacol. 2009;22(3 Suppl):45–50. https://doi.org/10.1177/03946320090220S309.Ranieri M., Sciuscio M., Cortese A.M., Santamato A., Teo L.D., Ianieri G. et al. The use of alpha-lipoic acid (ALA), gamma linolenic acid (GLA) and rehabilitation in the treatment of back pain: effect on health-related quality of life. Int J Immunopathol Pharmacol. 2009;22(3 Suppl):45–50. https://doi.org/10.1177/03946320090220S309.Logan A.C., Wong C. Chronic fatigue syndrome: oxidative stress and dietary modifications. Altern Med Rev. 2001;6(5):450–459. Available at: https://pubmed.ncbi.nlm.nih.gov/11703165/.Logan A.C., Wong C. Chronic fatigue syndrome: oxidative stress and dietary modifications. Altern Med Rev. 2001;6(5):450–459. Available at: https://pubmed.ncbi.nlm.nih.gov/11703165/.

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