medsovetМедицинский СоветMeditsinskiy sovet = Medical Council2079-701X2658-5790REMEDIUM GROUP Ltd.10.21518/ms2023-234medsovet-7695Research ArticleПОДДЕРЖИВАЮЩАЯ ТЕРАПИЯSUPPORTIVE THERAPYОценка интенсивности боли: инструменты и их клиническое применениеАssessment of pain intensity: tools and their clinical usinghttps://orcid.org/0000-0003-4401-1599КареловА. Е.KarelovA. E.

Карелов Алексей Евгеньевич, д.м.н., председатель Комитета по лечению боли Федерации анестезиологов и реаниматологов России,профессор кафедры анестезиологии и реаниматологии имени В.Л. Ваневского, руководитель университетского центра лечения боли 

191015, Россия, Санкт-Петербург, ул. Кирочная, д. 41

Aleksei Е. Karelov, Dr. Sci. (Med.), Head of Pain Management Committee of Russian Federation of Anaesthesiologists and Reanimatologists,Professor of the Department of Anesthesiology and Intensive Care named after V.L. Vanevsky, Chair of Pain Management Center

41, Kirochnaya St., St Petersburg, 191015, Russia 

a.karelov@mail.ruhttps://orcid.org/0000-0001-7195-6307РязанкинаА. А.RyazankinaA. A.

Рязанкина Алла Алексеевна, главный внештатный специалист Северо-Западного ФО по паллиативной медицинской помощи, доцент кафедры онкологии; научный сотрудник научного отделения  анестезиологии, реаниматологии и алгологии

 191015, Россия, Санкт-Петербург, ул. Кирочная, д. 41

197758, Россия, Санкт-Петербург, пос. Песочный, ул. Ленинградская, д. 68 

Alla А. Ryazankina, Chief freelance specialist of the North-Western Federal District for Palliative Care, Associate Professor of the Departmentof Oncology; Researcher of the Scientific Department of Anesthesiology, Intensive Care and Algology

41, Kirochnaya St., St Petersburg, 191015, Russia

68, Leningradskaya St., Pesochnyy Settlement, St Petersburg, 197758, Russia 

alla-rjazankina@mail.ruhttps://orcid.org/0000-0001-7402-672XСемкичевВ. А.SemkichevV. A.

Семкичев Владимир Александрович, к.м.н., доцент кафедры анестезиологии и реаниматологии имени В.Л. Ваневского

 191015, Россия, Санкт-Петербург, ул. Кирочная, д. 41 

Vladimir А. Semkichev, Cand. Sci. (Med.), Associate Professor of the Department of Anesthesiology and Intensive Care named after V.L. Vanevsky

41, Kirochnaya St., St Petersburg, 191015, Russia 

vladimir.semkichev@szgmu.ruhttps://orcid.org/0009-0004-3117-9450КареловД. А.KarelovD. A.

Карелов Дмитрий Алексеевич, студент

194100, Россия, Санкт-Петербург, ул. Литовская, д. 2 

Dmitrii А. Karelov, Student

2, Litovskaya St., St Petersburg, 194100, Russia 

d.kareloff@mail.ruhttps://orcid.org/0000-0002-6127-0798ЗаболотскийД. В.ZabolotskiiD. V.

Заболотский Дмитрий Владиславович, д.м.н., заведующий кафедрой анестезиологии, реаниматологии и неотложной педиатрии имениВ.И. Гордеева

194100, Россия, Санкт-Петербург, ул. Литовская, д. 2 

Dmitry V. Zabolotskii, Dr. Sci. (Med.), Head of the Department of  Anesthesiology, Intensive Care and Emergency Pediatrics named after V.I. Gordeev

2, Litovskaya St., St Petersburg, 194100, Russia 

zdv4330303@mail.ruhttps://orcid.org/0000-0003-0390-8498КулеваС. А.KulyovaS. A.

Кулева Светлана Александровна, д.м.н., главный детский специалист-онколог Комитета по здравоохранению Санкт-Петербурга, ведущий научный сотрудник научного отдела инновационных методов терапевтической онкологии и реабилитации, заведующая детским онкологическим отделением; заведующая кафедрой онкологии, детской онкологии и лучевой терапии

197758, Россия, Санкт-Петербург, пос. Песочный, ул. Ленинградская, д. 68 

194100, Россия, Санкт-Петербург, ул. Литовская, д. 2 

Svetlana А. Kulyova, Dr. Sci. (Med.), Chief Pediatric Oncologist of the St. Petersburg Health Committee, Leading Researcher of the ScientificDepartment of Innovative Methods of Therapeutic Oncology and Rehabilitation, Head of the Pediatric Oncology Department; Head of the Department of Oncology, Pediatric Oncology and Radiation Therapy

68, Leningradskaya St., Pesochnyy Settlement, St Petersburg, 197758, Russia;

2, Litovskaya St., St Petersburg, 194100, Russia 

kulevadoc@yandex.ruСеверо-Западный государственный медицинский университет имени И.И. МечниковаРоссияNorth-Western State Medical University named after I.I. MechnikovRussian FederationСеверо-Западный государственный медицинский университет имени И.И. Мечникова; Национальный медицинский исследовательский центр онкологии имени Н.Н. ПетроваРоссияNorth-Western State Medical University named after I.I. Mechnikov$ Petrov National Medical Cancer Research CentreRussian FederationСанкт-Петербургский государственный педиатрический медицинский университетРоссияSt Petersburg State Pediatric Medical UniversityRussian FederationНациональный медицинский исследовательский центр онкологии имени Н.Н. Петрова; Санкт-Петербургский государственный педиатрический медицинский университетРоссияPetrov National Medical Cancer Research Centre; St Petersburg State Pediatric Medical UniversityRussian Federation202328072023011108118Copyright © Карелов А.Е., Рязанкина А.А., Семкичев В.А., Карелов Д.А., Заболотский Д.В., Кулева С.А., 20232023Карелов А.Е., Рязанкина А.А., Семкичев В.А., Карелов Д.А., Заболотский Д.В., Кулева С.А.Karelov A.E., Ryazankina A.A., Semkichev V.A., Karelov D.A., Zabolotskii D.V., Kulyova S.A.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/7695

Боль часто становится сопутствующей проблемой различных патологических состояний и заболеваний. Болевой синдром, связанный с развитием острой патологии и травмой, в большинстве случаев полностью разрешается. Однако боль может принять хроническое течение и стать самостоятельной патологией. Цель настоящей работы – проанализировать современные методы оценки интенсивности болевых ощущений у взрослых и детей, особенности интерпретации полученных результатов и возможных алгоритмов дальнейших действий. Известно, что в подавляющем большинстве случаев интенсивность боли представляет собой динамически изменяющийся показатель. В связи с этим определение интенсивности боли выполняется в нескольких стандартизированных точках. Для количественной оценки боли в помощь пациенту предлагается шкала, на крайних точках которой можно расположить указатель, обозначающий относительную выраженность его ощущений. В практике применяются визуально-аналоговая, визуально-цифровая, вербально-цифровая шкалы. У младших детей такой метод неприменим, поэтому в зависимости от возраста можно использовать лицевую шкалу Wong-Baker, поведенческую шкалу FLACC, шкалу CRIES. Интенсивность боли после хирургического вмешательства в педиатрии может быть оценена с помощью шкалы CHEOPS, объективной шкалы боли OPS, шкалы COMFORT. На финальном этапе интерпретации количественные данные преобразуются в оценку интенсивности боли по рейтинговой шкале, и именно этот результат ложится в основу применения анальгетической лестницы ВОЗ с составлением схемы обезболивания. Традиционно при умеренной и тяжелой боли рекомендуется применение полных опиоидных агонистов. Однако в настоящее время существует альтернатива в виде селективного агониста мю1-опиоидных рецепторов, отличающегося низким риском развития опиоид-зависимых побочных эффектов. В заключение следует сказать, что сегодня наметился определенный прогресс в области терапии болевых синдромов. По нашему мнению, это обусловлено как повышением качества анализа состояния пациентов, страдающих от умеренной и сильной боли, так и появлением новых опиоидных агонистов с высокой селективностью к мю1-подклассу опиоидных рецепторов.

Pain is an accompanied problem for many pathologic conditions and diseases. Such sensations disappear gradually when related to acute pathology or trauma. However, pain can became chronic and acquire traits of self-sustained disease. In practice, many characteristics can be useful for estimation of pain sensation, and the goal of this paper is to analyze of modern methods for intensity pain assessment in adults and children, of interpretation of pain estimation, and of possible algorithm for next steps. In majority cases, pain intensity is changing parameter. Therefore, pain assessment is performed in some standard points of time. For a quantitative assessment of pain, a scale is proposed to help the patient, relative to the extreme points of which a pointer can be placed indicating the relative severity of his sensations. For such purpose visual analog scale, numeric rating scale, and verbal numeric scale can be used. The Wong-Baker Faces Pain Rating Scale, the FLACC scale, the CRIES pain scale can be exploited in small children. In this population the CHEOPS scale, the OPS scale, and the COMFORT scale were recommended to apply after surgery. The final step of interpretation implies that quantitative data converts to ratings. The last ones form to basis of WHO analgesic ladder that is exploited for drugs selection to treat pain, in particular in patients with cancer pain or postoperative pain. From this approach, moderate and severe pain recommends to administer full opioid agonists. However, today there is a good alternative in the form of selective mu1-receptots agonist, which has lower risk of side opioid effects. Thus, in this time, there is some progress in pain management. This progress, in our opinion, is due to improved analysis of the condition of patients suffering from moderate and severe pain, and the emergence of new opioid agonists with high selectivity for the mu1 subclass of opioid receptors.

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