medsovetМедицинский СоветMeditsinskiy sovet = Medical Council2079-701X2658-5790REMEDIUM GROUP Ltd.10.21518/ms2024-309medsovet-8475Research ArticleТЕРАПИЯ БОЛИPAIN THERAPYЦервикобрахиалгия и люмбоишиалгия: единый эффективный подход к решению проблемыCervicobrachialgia and lumboischialgia: A single effective approach to solving the problemhttps://orcid.org/0000-0002-2752-4109ГоловачеваВ. А.GolovachevaV. A.

Головачева Вероника Александровна, к.м.н., доцент кафедры нервных болезней и нейрохирургии Института клинической медицины им. Н.В. Склифосовского

119991, Москва, ул. Трубецкая, д. 8, стр. 2

Veronika A. Golovacheva, Cand. Sci. (Med.), Associate Professor of the Department of Nervous Diseases and Neurosurgery, Sklifosovsky Institute of Clinical Medicine

8, Bldg. 2, Trubetskaya St., Moscow, 119991

xoxo.veronicka@gmail.comhttps://orcid.org/0000-0002-2845-7323ГоловачеваА. А.GolovachevaA. A.

Головачева Анжелика Александровна, ассистент, аспирант кафедры нервных болезней и нейрохирургии Института клинической медицины им. Н.В. Склифосовского

119991, Москва, ул. Трубецкая, д. 8, стр. 2

Anzhelika A. Golovacheva, Assistant, Postgraduate Student of the Department of Nervous Diseases and Neurosurgery, Sklifosovsky Institute of Clinical Medicine

8, Bldg. 2, Trubetskaya St., Moscow, 119991

angelika.golovacheva@gmail.comhttps://orcid.org/0009-0000-7209-1245БеляеваС. Д.BelyaevaS. D.

Беляева София Денисовна, студент Института клинической медицины им. Н.В. Склифосовского

119991, Москва, ул. Трубецкая, д. 8, стр. 2

Sofia D. Belyaeva, Student of the Sklifosovsky Institute of Clinical Medicine

8, Bldg. 2, Trubetskaya St., Moscow, 119991

belyeva.sonya@bk.ruПервый Московский государственный медицинский университет имени И.М. Сеченова (Сеченовский Университет)РоссияSechenov First Moscow State Medical University (Sechenov University)Russian Federation20241408202401286–94Copyright © Головачева В.А., Головачева А.А., Беляева С.Д., 20242024Головачева В.А., Головачева А.А., Беляева С.Д.Golovacheva V.A., Golovacheva A.A., Belyaeva S.D.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/8475

Описан клинический случай пациента с хронической скелетно-мышечной цервикобрахиалгией и люмбоишиалгией, которые являются одними из самых распространенных заболеваний в неврологической практике. Показаны факторы развития и хронизации скелетно-мышечной боли: катастрофизация боли, тревожность, кинезиофобия, гиподинамия, длительное пребывание за компьютером, длительные статические позы, коморбидные заболевания – хроническая инсомния, эпизодическая головная боль напряжения с вовлечением перикраниальных мышц. Ранее не отмечалось эффекта от терапии, снижения боли и возвращения к прежней повседневной активности, не оценивались и не корректировались факторы хронизации боли, не проводилась образовательная беседа о причинах заболевания и прогнозе, в качестве лечения пациенту предлагалась только фармакотерапия, не рекомендовались занятия по лечебной гимнастике, пациент не получал рекомендаций по эргономике и двигательной активности в течение дня. В Клинике нервных болезней Сеченовского Университета пациенту был предложен комплексный подход к лечению, включающий образовательную беседу, кинезиотерапию, кинезиотейпирование, курс препарата Дифендум (диклофенак калия). Кинезиотерапия – современный, доказанно эффективный метод лечения хронической скелетно-мышечной боли. Она включает лечебную гимнастику, тренинг правильных поз, рекомендации по эргономике и образу жизни. В качестве фармакотерапии препаратом выбора стал Дифендум (диклофенак калия) – нестероидное противовоспалительное средство, широко применяемое в российской неврологической практике и обладающее доказанной эффективностью и безопасностью в терапии скелетно-мышечных болей. Важно отметить, что Дифендум был назначен пациенту с первых дней лечения одновременно с началом занятий по кинезиотерапии. На фоне фармакотерапии у пациента наблюдалось быстрое облегчение болевого синдрома, что способствовало формированию приверженности к рекомендациям по повышению физической активности, эргономике и занятиям по лечебной гимнастике. В результате комплексного лечения удалось относительно быстро и эффективно помочь пациенту. Через 5 дней лечения он сообщил о снижении болевого синдрома и повышении функциональной активности. Через 3 мес. боль полностью регрессировала, нормализовался сон и эмоциональное состояние, повысилась повседневная активность. Наблюдение за пациентом в течение 6 мес. показало стойкий терапевтический эффект.

The presented clinical case describes a patient with chronic musculoskeletal cervicobrachialgia and lumbosciatica, which are some of the most common neurological disorders. The authors identified the factors contributing to the onset and chronification of musculoskeletal pain: pain catastrophization, anxiety, kinesiophobia, physical inactivity, spending too much time in front of the computer, long-term static postures, comorbid diseases – chronic insomnia, episodic tension-type headache with pericranial tenderness. No therapeutic effect, pain reduction and returning to previous daily activity were earlier observed, the pain chronification factors were not assessed or corrected, no awareness conversations about the causes of the disease and prognosis were held, the patient was only offered pharmacotherapy as treatments, no therapeutic gymnastics was recommended, and no recommendations for ergonomics and motor activities for daily life were provided to the patient. A complex approach to the treatment, including awareness conversations, kinesiotherapy, kinesiotaping, Difendum (diclofenac potassium) therapy course were offered to the patient at the Sechenov University Clinic of Nervous Diseases. Kinesiotherapy is a modern, efficient yet proven method for treating chronic musculoskeletal pain. It includes therapeutic gymnastics, an exercise program for posture correction, recommendations for ergonomics and lifestyle. Difendum (diclofenac potassium) has become a drug of choice within the pharmacotherapy course. It is a non-steroidal anti-inflammatory drug that is widely used in Russian neurological practice and has a proven efficacy and safety profile in the treatment of musculoskeletal pain. It should be noted that Difendum was prescribed to the patient from the first days of treatment at the same time as he started to take a kinesiotherapy training course. The patient experienced a rapid pain relief while taking pharmaceutical therapy, which played an important role in supporting adherence to recommendations for increasing physical activities, ergonomics and therapeutic gymnastics. The complex treatment provided a relatively quick and efficient relief to the patient. After a 5-day course of treatment, he reported a decrease in pain syndrome and an increase in functional activities. After 3 months, the pain completely regressed, sleep and emotional state returned to normal, and daily activities improved. A 6-month follow-up examination showed a persistent therapeutic effect.

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