Pain medicine 2022-09-05T22:02:10+03:00 Oleksandr Marchuk Open Journal Systems <p>"Medicina bolu" is a science-and-practice periodical for medical professionals. The main highlighting issue is pain, but not the only one, because in medicine there are no situations where a phenomenon is strictly isolated. Sign up for a print edition and follow up on the site to keep up with important and useful information.</p> <p>Thematic interests of the journal<br>Fundamental aspects of pain (clinical physiology, pathophysiology, pharmacology).<br>Applied aspects of pain (epidemiology, pain assessment, innovative methods of diagnosis and treatment, clinical pharmacology).<br>Clinical aspects of pain (acute pain, chronic pain, perioperative pain, posthumous pain, neuropathic pain, dysfunctional pain).<br>Clinical and anatomical approach to pain (headache, orofacial pain, neck and back pain, toothache, musculoskeletal pain, myofascial pain, fibromyalgia, visceral pain, pelvic pain, cardialgia, etc.).<br>Interdisciplinary approach to pain (in anesthesiology, in surgery, in pediatrics, neurology, vertebrology, in the clinic of internal diseases, oncology, rheumatology, gerontology, gastroenterology, traumatology and orthopedics, otorhinolaryngology, dentistry, obstetrics, gynecology and urology, in the palliative and hospice medicine).<br>Treatment and rehabilitation of patients suffering from pain (pharmacotherapy, physical rehabilitation, medical rehabilitation, alternative methods of treatment, means of psychological and psychotherapeutic influence, invasive methods of pain relief, organization of pain relief).<br>Separate clinical cases and their clinical examination.</p> Chronic pain in cancer patients 2022-09-05T20:44:45+03:00 Anastasiia Moisieienko Oleksandr Marchuk Ivan Lisnyy Dmytro Dmytriiev <p><strong>Background.</strong> Pain is a complex clinical sign that is highly variable in both intensity and perception by patients. Often, a combination of symptoms and signs can indicate a pain syndrome specific to oncology. Virtually all patients with malignant diseases experience recurrent episodes of acute pain, which may accompany previous surgery, invasive procedures, or complications such as pathologic fractures or disease progression. Chronic pain is a huge economic burden on society, both in terms of health care and lost productivity.<br>Effective treatment of chronic pain results in significant improvements in general and psychological wellbeing and functioning of cancer patients and reduces the burden of chronic pain on health services.<br><strong>The purpose</strong> is to clarify the problems of the prevalence of chronic pain in cancer patients, the complexity and variability of the pathophysiological mechanisms of the development of pain syndrome, to consider modern approaches to the management of patients with chronic pain.<br><strong>Materials and methods.</strong> Modern foreign guidelines for the management of cancer patients with pain syndrome, written in English, data from metaanalyses, reviews and clinical studies were used.<br><strong>Conclusions.</strong> Data from a 2016 crosssectional study to determine the prevalence and impact of depression on health care costs in patients with complex chronic pain indicated that patients with chronic pain are at increased risk of developing depressive disorder of varying severity. About onethird of the study sample had major depression, and the overall prevalence of depression among individuals with chronic pain was higher than 50% [3].<br>Up to 75% of all cancer patients with chronic pain have nociceptive (somatic or visceral) or neuropathic syndromes, which are a direct consequence of the development and progression of the neoplasm. Other causes include anticancer drugs and disorders unrelated to the disease or its treatment.<br>Several systems are used to classify the pain syndrome, in particular — ECS-CP, IASP, ACTTION-APS.<br>Today, in the management of cancer patients with chronic pain, the WHO threestep analgesic ladder is used: the first two steps are paracetamol and NSAIDs, mild opioids (control of mild and moderate pain), the third is opioids. The selection of opioids, their dosage and titration features should take into account the individual characteristics of the patient in order to avoid overdose and addiction.<br>In addition to the abovementioned drugs, studies are being conducted to determine the effectiveness and feasibility of using medical cannabis as an alternative means, the use of which will improve the general condition of patients by relieving pain, and preventing the development of opioid addiction.<br>Interventional techniques (neurolytic blockades, neuraxial infusions, trigger point injections, spinal cord stimulation, intrathecal drug administration, and vertebral augmentation) are also used to control chronic pain. The application of physical and psychosocial methods in the comprehensive management of such patients is studied.</p> 2022-09-05T00:00:00+03:00 Copyright (c) 2022 Multimodal analgesia as a component treatment of complications in a child after penetrating orbital injury 2022-09-05T21:23:00+03:00 Yaroslav Semkovych M Semkovych Taras Меlnyk N Gavrylyshyn <p><strong>Introduction. </strong>Every year, about 2,000 children turn to ophthalmologists with eye damage of varying degrees of severity. The main causes of eye damage in children: active games with sticks, accidental contusions, injuries with sharp objects, unfortunate falls, fights, burns with chemical substances. Penetrating injuries occupy a special place a mong other eye injuries for two reasons. First of all, in the case of penetrating injuries, very delicate inner membranes and structures of the eye maybe damaged, which leads to serious complications. These cond point is the dangerof such formidable complications of the wound process as end ophthalmitis, sympathetic inflammation, etc.</p> <p><strong>Background. </strong>We present a case of treatment of a penetrating wound of the orbitin a child who was treated in the Department of Anesthesiology and Intensive Care, CNE “Ivano-Frankivsk Regional Children’s Clinical Hospital of Ivano-Frankivsk Regional Council”.</p> <p><strong>Results.</strong> A 9-year-old child&nbsp; was admitted to the ophthalmology department for treatment with complaints of pronounceds well in gand hyperemia of the eye lids, exophthalmos on the right, massive purulent discharge from the right eye, reduced movements of the right eye ball, hyperthermia. On the same day, she was operated on for phlegmon of the right orbit against the background of a penetrating wound of the right orbit of unknown etiology. Detoxification, multimodal, antibacterial, antiaggregant, immunoreplacement therapy was started. On the 10th day, the child was transferred to the ophthalmology department for further treatment, from where the child was discharged homein a satisfactory condition on the 27th day of the hospital stay.</p> <p><strong>Conclusions. </strong>The child's recovery was achieved thanks to timely hospitalization, targeted antibacterial therapy, the use of multimodal anesthesia, immunoreplacement therapy, the use of nonspecific detoxification methods, and adequate rehydration therapy.</p> 2022-09-05T00:00:00+03:00 Copyright (c) 2022 Surgical aspects of acute abdominal pain syndrome in children 2022-09-05T21:43:25+03:00 Viktor Konoplitskyi Vasyl Pohorilyi Yevhenii Chornyi <p>Acute abdominal pain, which is the leading symptom in the clinic of most diseases of the digestive tract, can be a manifes-tation of acute surgical pathology, trauma or an acute infectious disease. All these pathological conditions, in addition to varying degrees of expressiveness of the painful abdominal syndrome, are accompanied by the formation and development of a true or false “acute abdomen”, which is usually accompanied by symptoms of peritoneal irritation. The article discusses the mechanism of for-mation and spread of abdominal pain syndrome, etiopathogenesis of pain syndrome formation in acute surgical pathology in chil-dren. The most characteristic causes of acute abdominal syndrome in children depending on age are presented. A correctly performed differential diagnosis of acute abdominal pain ensures adequate treatment, including emergency surgical intervention on the or-gans of the abdominal cavity.</p> 2022-09-05T00:00:00+03:00 Copyright (c) 2022 Experience in the use of prolonged analgesic peripheral nerve blocks as part of multimodal analgesia regimens in the treatment of patients with gunshot wounds of the limbs 2022-09-05T21:56:27+03:00 N Mamay S Voitenko D Tymchyshyn <p>The use of regional analgesic techniques as part of multimodal analgesia regimens provides better control of acute pain. Effective anesthesia is one of the key tasks in the treatment of the wounded at all stages of medical care.</p> <p>Three clinical cases of the use of prolonged regional analgesic blockades as part of a multimodal analgesia regimen in the treatment of patients with gunshot wounds of the extremities are presented. Catheterizations of the perineural space of the peripheral nerves were performed using ultrasound imaging.</p> <p>Clinical case 1 - a patient with a gunshot shrapnel through wound of the left tibia with gunshot comminuted fractures of both bones of the lower third of the left tibia and the upper third of the fibula of the left tibia, was admitted two days after the injury. Performed catheterization of the perineural space of the left sciatic nerve in the popliteal fossa, constant infusion of 0.25&nbsp;% bupivacaine solution at a rate of 5 ml per hour using a perfusor. A satisfactory analgesic effect was observed, narcotic analgesics were not prescribed.</p> <p>Clinical case 2 - a patient with a gunshot shrapnel through wound of the left shoulder with a gunshot comminuted fracture of the left humerus in the middle third and with damage to the neurovascular bundle, was admitted more than 6 weeks after the injury. Performed catheterization of the perineural space of the left brachial plexus interscalene access, continuous infusion of 0.25&nbsp;% bupivacaine solution at a rate of 5 ml per hour using a perfusor. However, in the absence of complaints of soreness at the fracture sites and postoperative wounds, the patient began to be disturbed by neuropathic pain.Satisfactory analgesic effect was observed sporadically, narcotic analgesics were prescribed. On the second day of observation, dislocation of the catheter was detected.Considering that the patient was more concerned about pain in the distal part of the limb, catheterization of the perineural space of the left brachial plexus was performed by supraclavicular access, and a constant infusion of 0.25&nbsp;% bupivacaine solution was started at a rate of 5 ml per hour using a perfusor. Satisfactory analgesic effect was observed sporadically, narcotic analgesics were prescribed.</p> <p>Clinical case 3 - a patient with a gunshot shrapnel through wound of the left thigh with a gunshot comminuted fracture of the left femur in the lower third and with damage to the popliteal artery, was admitted three weeks after the injury. Performed paravertebral catheterization of the left lumbar plexus, constant infusion of 0.25&nbsp;% bupivacaine solution at a rate of 5 ml per hour using a perfusor. In combination with oral analgesic adjuvants (effect on neuropathic pain), a satisfactory analgesic effect was observed without the prescription of narcotic analgesics.After repeated surgical treatment with the installation of the VAC-system on the posterior surface of the thigh, an unsatisfactory effect of non-opiate analgesia was observed, and narcotic analgesics were additionally prescribed.</p> 2022-09-05T00:00:00+03:00 Copyright (c) 2022 How to overcome post-COVID syndrome? 2022-09-05T22:02:10+03:00 Kateryna Dmytriieva Yurii Rudyi Yaroslav Luchenko Rostyslav Kravets Irina Ruda <p>SARS-CoV-2 infection was a pandemic that resulted in high mortality and morbidity worldwide. A significant proportion of patients who recover from COVID-19 have persistent or new symptoms that last for weeks to months. This condition is called "post COVID syndrome". Post-covid syndrome can have different symptoms. We usually encounter them immediately after overcoming the infection. Some patients have symptoms months after recovery. The article deals with the general characteristics, causes, risk factors, clinical signs of post-covid syndrome and known ways of overcoming it.</p> 2022-09-05T00:00:00+03:00 Copyright (c) 2022