Fannane Aymane, Makarenko O. V.

PAIN SYNDROME IN EXPLOSIVE BAROTRAUMA: PATHOPHYSIOLOGICAL MECHANISMS, CLINICAL CHARACTERISTICS, TREATMENT PRINCIPLES

---

Show/Download

About the author:

Fannane Aymane, Makarenko O. V.

Heading:

LITERATURE REVIEWS

Type of article:

Scientific article

Annotation:

Acoustic barotrauma (ABT) has gained particular relevance in recent decades due to the increasing impact of technogenic and military factors associated with blast wave exposure. Acoustic barotrauma is considered a complex of functional and morphological disturbances affecting the auditory organ, vestibular apparatus, and central neu ronal structures, arising as a result of abrupt fluctuations in atmospheric or hydrostatic pressure, exposure to blast shock waves, as well as intense impulsive or prolonged high-intensity noise. Pain syndrome in ABT, particularly in combat conditions, is often characterized by a prolonged course with a tendency toward chronicity and the develop ment of a neuropathic component. Gabapentin and pregabalin are structural analogs of γ-aminobutyric acid (GABA) that exhibit high affinity for the α2δ-1 subunit of voltage-gated calcium channels. Their pharmacological action involves reducing the presynaptic release of excitatory neurotransmitters, including glutamate, substance P, and norepinephrine, thereby suppressing both peripheral and central sensitization. In the context of acoustic barotrauma, these agents are of particular im portance, as they are capable of reducing pathological neuronal activity in the dorsal cochlear nucleus and auditory brainstem structures, which is associated not only with pain development but also with manifestations such as tin nitus and hyperacusis. Another important class of agents used in the treatment of neuropathic pain is antidepressants. Their analgesic effect is mediated through modulation of descending antinociceptive pathways, which originate in cortical and sub cortical regions of the brain and are mediated via the periaqueductal gray and raphe nuclei. Activation of serotoner gic and noradrenergic neurons leads to increased concentrations of these neurotransmitters in the dorsal horn of the spinal cord, where they inhibit the transmission of ascending nociceptive signals.

Tags:

Bibliography:

1. Dursa EK, Barth SK, Schneiderman AI, Bossarte RM. Physical and mental health status of gulf war and gulf era veterans: Results from a large population-based epidemiological study. J. Occup. Env. Med. 2016;58:41-6.
2. Yee MK, Janulewicz PA, Seichepine DR, Sullivan KA, Proctor SP, Krengel MH. Multiple Mild Traumatic Brain Injuries Are Associated with Increased Rates of Health Symptoms and Gulf War Illness in a Cohort of 1990-1991 Gulf War Veterans. Brain Sci. 2017;7(7):79.
3. O’Neil ME, Callahan M, Carlson KF, Roost M, Laman-Maharg B, Twamley EW, et al. Postconcussion symptoms reported by Operation Enduring Freedom/Operation Iraqi Freedom veterans with and without blast exposure, mild traumatic brain injury, and posttraumatic stress disorder. J Clin Exp Neuropsychol. 2017;39(5):449-58.
4. Paik CB, Pei M, Oghalai JS. Review of blast noise and the auditory system. Hear Res. 2022;425:108459.
5. Tarasenko MV, Naumenko OM, Dyeyeva YuV. Urazhennya serednoho ta vnutrishnoho vukha pry minno-vybukhoviy travmi – realiyi sohodennya. Ukr. naukovo-medychnyy molodizhnyy zhurn. 2022;2(130):22. [in Ukrainian].
6. Shvets AV, Podolyan YuV, Holinko MI. Osoblyvosti vidnovlennya funktsionalnoho stanu viyskovosluzhbovtsiv pislya cherepno-mozkovoyi travmy, shcho poyednana z akubarotravmoyu. Zaporizkyy medychnyy zhurnal. 2020;3(120):329-37. [in Ukrainian].
7. Bondarenko YAV. Osoblyvosti akubarotravmy v uchasnykiv boyovykh diy. Ukr. naukovo-medychnyy molodizhnyy zhurn. 2022;2(130):38. [in Ukrainian].
8. United Nations Office on Drugs and Crime (UNODC). World Drug Report 2022. Vienna: United Nations; 2022. Available from: https://www. unodc. org/unodc/en/data-and-analysis/world-drug-report-2022.html.
9. Ministerstva okhorony zdorovya Ukrayiny. Nakaz №200 Pro zatverdzhennya poryadku provedennya zamisnoyi pidtrymuvalnoyi terapiyi khvorykh z opioyidnoyu zalezhnistyu. Kyyiv: MOZ Ukrayiny; 2012. Dostupno: https://zakon.rada.gov.ua/laws/show/z0889-12#Text. [in Ukrainian].
10. Dyachenko LV, Tkachenko IM, Kuzmenko OP. Suchasni pidkhody do farmakoterapiyi opioyidnoyi zalezhnosti: problemy ta perspektyvy. Farmakolohiya ta likarska toksykolohiya. 2021;15(2):45-52. [in Ukrainian].
11. Demiray E, Aydogan HC, Cavlak M, Akcan R, Balseven-Odabasi A, Tumer AR. Otologic Injuries Secondary to Explosive Attack. Indian J Otolaryngol Head Neck Surg. 2022;74(1):569-74.
12. Milenkovic I, Schiefer U, Ebenhoch R, Ungewiss J. Aufbau und Funktion der Hörbahn. Ophthalmologe. 2020;117(11):1068-73.
13. Fík Z, Bouček J. Inner ear disorders. Cas Lek Cesk. 2019;158(6):216-20.
14. Moverman DJ, Liberman LD, Kraemer S, Corfas G, Liberman MC. Ultrastructure of noise-induced cochlear synaptopathy. Sci Rep. 2023;13(1):19456.
15. Teraoka M, Hato N, Inufusa H, You F. Role of Oxidative Stress in Sensorineural Hearing Loss. Int J Mol Sci. 2024;25(8):4146.
16. Kishimoto-Urata M, Urata S, Fujimoto C, Yamasoba T. Role of Oxidative Stress and Antioxidants in Acquired Inner Ear Disorders. Antioxidants (Basel). 2022;11(8):1469.
17. Kurioka T, Mizutari K, Satoh Y, Kobayashi Y, Shiotani A. Blast-Induced Central Auditory Neurodegeneration Affects Tinnitus Development Regardless of Peripheral Cochlear Damage. J Neurotrauma. 2024;41(3-4):499-513.
18. Shulman A, Wang W, Luo H, Bao S, Searchfield G, Zhang J. Neuroinflammation and Tinnitus. Curr Top Behav Neurosci. 2021;51:161-74.
19. Wallace MN, Palmer AR. Neural Plasticity in Tinnitus Mechanisms. Brain Sci. 2023;13(12):1615.
20. Ungewiss J, Milenkovic I, Breuninger T, Ebenhoch R, Schiefer U. Vergleich von Sehbahn und Hörbahn. Ophthalmologe. 2020;117(11):1074 1079.
21. Terrier LM, Hadjikhani N, Destrieux C. The trigeminal pathways. J Neurol. 2022;269(7):3443-60.
22. Lumley MA, Cohen JL, Borszcz GS, Cano A, Radcliffe AM, Porter LS, Schubiner H, Keefe FJ. Pain and emotion: a biopsychosocial review of recent research. J Clin Psychol. 2011;67(9):942-68.
23. Powell JR, Hopfinger JB, Giovanello KS, Walton SR, DeLellis SM, Kane SF, et al. Mild traumatic brain injury history is associated with lower brain network resilience in soldiers. Brain Commun. 2023;5(4):fcad201.
24. Ahmadi R, Kuner R, Weidner N, Keßler J, Bendszus M, Krieg SM. The Diagnosis and Treatment of Neuropathic Pain. Dtsch Arztebl Int. 2024;121(25):825-32.
25. Voloshchuk NI, Denysyuk OM, Pashynska OS, Voloshchuk SYA, Ivanytsya AO. Suchasni uyavlennya pro formuvannya bolovoho syndromu ta pidkhody do yoho efektyvnoyi farmakolohichnoyi korektsiyi. Chastyna 2. Farmakolohiya ta likarska toksykolohiya. 2023;17(3):143-56. [in Ukrainian].
26. Feldman A, Weaver J. Pharmacologic and Nonpharmacologic Management of Neuropathic Pain. Semin Neurol. 2025;45(1):145-56.
27. Kupko N. Farmakoterapiya khronichnoho neyropatychnoho bolyu. NeyroNEWS: psykhonevrolohiya ta neyropsykhiatriya. 2025;6(161):12 5. [in Ukrainian].
28. Derry S, Bell RF, Straube S, Wiffen PJ, Aldington D, Moore RA. Pregabalin for neuropathic pain in adults. Cochrane Database Syst Rev. 2019;1(1):CD007076.
29. Kiekens C. Should Pregabalin Be Used in the Management of Chronic Neuropathic Pain in Adults? A Cochrane Review Summary With Commentary. PM R. 2019;11(12):1360-1363.
30. Kołacz M, Kosson D, Rzepliński R, Olczyk-Miiller K, Mieszczański P, Puchalska-Kowalczyk E, Cichowlas G. Effectiveness of antidepres sants in neuropathic pain management: a retrospective, multicenter cross-sectional analysis. Anaesthesiol Intensive Ther. 2025;57(1):22630.
31. Obata H. Analgesic Mechanisms of Antidepressants for Neuropathic Pain. Int J Mol Sci. 2017;18(11):2483.
32. Huang Y, Chen H, Chen SR, Pan HL. Duloxetine and Amitriptyline Reduce Neuropathic Pain by Inhibiting Primary Sensory Input to Spinal Dorsal Horn Neurons via α1- and α2-Adrenergic Receptors. ACS Chem Neurosci. 2023;14(7):1261-77.
33. Kaye AD, Armistead G, Amedio LS, Manthei ME, Ahmadzadeh S, Bernhardt B, Shekoohi S. Evolving Treatment Strategies for Neuropathic Pain: A Narrative Review. Medicina (Kaunas). 2025;61(6):1063.
34. Israel JE, St Pierre S, Ellis E, Hanukaai JS, Noor N, Varrassi G, Wells M, Kaye AD. Ketamine for the Treatment of Chronic Pain: A Comprehensive Review. Health Psychol Res. 2021;9(1):25535.
35. Li C, Hou W, Ding D, Yang Y, Gu S, Zhu Y. Evidence Mapping Based on Systematic Reviews of Cognitive Behavioral Therapy for Neuropathic Pain. Neural Plast. 2023;2023:2680620.

Publication of the article:

«Bulletin of problems biology and medicine», 2026 Issue 1, 180, 122-131 pages, index UDC 616-009.7-02:616-001.11

DOI:

10.29254/2077-4214-2026-1-180-122-131