Kovtun I. I.

CLINICAL AND EXPERIMENTAL MEDICINE

Scentific article

A treatment of acute pain syndrome (APS) must be performed at early stages in order to return a patient to active lifestyle, prevent recurrent relapses and chronic pain syndrome. Pain syndrome is caused by struc­ tures of nociceptive system. The reason of pain can be anatomical structure which is innervated by nonmedullated fibers or a substance which has R substance as a specific pain mediator. Cartilage tissue destruction in interverter­ bal disks and interverterbal joints is one of the most important factors which cause pain in the back. Objective. A purpose of this investigation was to determine dynamics of clinical indexes, markers medication of cartilage tissue metabolism and nociceptive system in patients with acute pain syndrome, caused by discogenic lumbosacral radiculopathy on treatment with the use of cartilage protector. Materials and Methods. It was examined 26 patients (14 men, 12 women) with acute pain syndrome, caused by discogenic lumbosacral radiculopathy from 27 to 51 years old. Control group contained 20 apparently healthy people of corresponding sex and age. Basic therapy was prescribed to all patients such as diclofenac sodium in a dose of 75 mg intramuscularly during 7 days daily, neuromuscular relaxant – tolperisone in a dose of 100 mg intramuscularly during 10 days daily, vitamin products – thiamin hydrochloride in a dose of 100 mg, pyridox­ ine hydrochloride in a dose of 100 mg daily, cyancobalamin in a dose of 1 mg intramuscularly in a day during 5 days and cartilage protector – chondroitin sulfate, which is administered intramuscularly daily in a dose of 200 mg № 14. Treatment course lasted 14 days; complex examination was performed to all patients on the 1st and 14th days of observation. It was determined markers medication of cartilage tissue metabolism in blood serum in healthy people and patients before and after treatment such as oxyproline concentration, unrelated proteins fucose, glycosaminoglycans, proteolytic activity, and antitrypsin and substance R level. There were unified scales such as visual analogue pain scale (VAPS), Roland Moris enquirer in order to determine pain syndrome, disturbance of patients’ lifestyle and control of used therapy. Results. According to visual analogue pain scale a rate of pain syndrome corresponds to severe one in patients before treatment. Substance R concentration, marker of nociceptive system exposure, in blood serum increased indexes in control group in 312 times. Also in blood serum of patients with acute pain syndrome there was deter­ mined an increase of oxyproline by 57 %, unrelated proteins fucose by 130 %, glycosaminoglycans by 47 %, proteo­ lytic activity by 39 % and decrease of antirtipsin level by 26 %. After treatment it was noted decrease of pain syndrome rate according to visual analogue pain scale with 7,1 ± 0,32 points (acute pain) to 4,8 ± 0,28 points (mild pain), decrease of oxyproline concentration by 28 %, unre­ lated proteins fucose by 23 %, glycosaminoglycans by 27 %, total proteinase by 16 %. It should be noted oxyproline concentration, glycosaminoglycans in blood serum of patients after performed treatment there were not different as findings in group of healthy patients. It was not determined significant changes of substance R concentration in patients by us. A significance of substance R concentration exceeded a rate of healthy patients in 296 in blood serum after treatment. Positive dynamics of clinical and biochemical indexes after treatment in patients was provided by an improvement patients’ lifestyle by 35,7 % and in average there were – 7,2 ± 0,34 points (according to Roland Moris enquirer). Conclusions/ Treatment with cartilage protector chondroitin sulfate lead to decrease in pain syndrome rate (from acute to mild one according to visual analogue pain scale), recovery of cartilage tissue metabolism and im­ provement of patients’ lifestyle with acute pain syndrome, determined by discogenic lumbosacral radiculopathy.

pain syndrome, radiculopathy, substance P, cartilage tissue metabolism

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«Bulletin of problems biology and medicine» Issue 3 part 2 (111), 2014 year, 144-147 pages, index UDK 616. 833. 2:616. 21