Features of diagnosis, treatment and curation of patients with neuropathic pain syndrome of traumatic genesis

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Abstract

BACKGROUND: The existing international and national clinical recommendations for the treatment of neuropathic pain syndrome are based mainly on the experience of providing care to patients with non-traumatic genesis of neuropathic pain. Approaches to the diagnosis, treatment and curation patients with neuropathic pain syndrome due damage of the nervous system as a result of wounds received during hostilities may differ from those in patients with somatic diseases.

AIM: To systematize the features of medical care and improve the methodological approach of curation patients with traumatic neuropathic pain syndrome.

MATERIALS AND METHODS: The practical experience of providing assistance to the wounded with traumatic lesions of the peripheral nervous system (including patients with phantom pain syndrome) accumulated by the staff of the Department and the Clinic of Nervous Diseases Military Medical Academy for 2022–2023 is summarized.

RESULTS: The features of inpatient routing, diagnosis, treatment and organization of medical care for patients with traumatic neuropathic pain syndrome at the stage of a specialized medical institution are systematized. The practical aspects of the curation patients with neuropathic pain due to wounds received during hostilities, related to the appointment of medications (including narcotic analgesics), regional anesthesia and the provision of neurosurgical care are highlighted. A separate emphasis is placed on the importance of assessing the mental state and quality of sleep of the wounded with neuropathic pain syndrome, the features of drug correction identified disorders. Practical recommendations for the treatment of patients based on the results of assessing the severity neuropathic pain syndrome using a daily graphic pain diary are presented.

CONCLUSION: The revealed differences in therapeutic and diagnostic approaches in providing medical care to the wounded with traumatic neuropathic pain syndrome, the importance of interdisciplinary interaction different specialties doctors (neurologists, surgeons, traumatologists, neurosurgeons, psychiatrists) at the early stages of treatment indicate the need to develop separate recommendations for the treatment of neuropathic pain in victims of armed conflicts.

About the authors

Sergey V. Kolomentsev

Military Medical Academy

Author for correspondence.
Email: skolomencev@yandex.ru
ORCID iD: 0000-0002-3756-6214
SPIN-code: 6439-6701

M.D., Ph.D. (Medicine), the Head of the Neurological Department of the Clinic of Nervous Diseases

Russian Federation, Saint Petersburg

Igor' V. Litvinenko

Military Medical Academy

Email: litvinenkoiv@rambler.ru
ORCID iD: 0000-0001-8988-3011
SPIN-code: 6112-2792
Scopus Author ID: 35734354000
ResearcherId: F-9120-2013

M.D., D.Sc. (Medicine), Professor the Head of the Department and Clinic of Nervous Diseases

Russian Federation, Saint Petersburg

Nikolay V. Tsygan

Military Medical Academy

Email: 1860n@mail.ru
ORCID iD: 0000-0002-5881-2242
SPIN-code: 1006-2845
Scopus Author ID: 37066611200

Dr. Sc. (Med.), Docent, Deputy Head of the M.I. Astvatsaturov Department and Clinic of Nervous Diseases

Russian Federation, Saint Petersburg

Albert R. Bulatov

Military Medical Academy

Email: albert_br@mail.ru
ORCID iD: 0000-0001-7180-4389

M.D., Ph.D. (Med.), lecturer, M.I. Astvatsaturov Department and Clinic of Nervous Diseases

Russian Federation, Saint Petersburg

Alexey I. Gayvoronsky

Military Medical Academy

Email: don-gaivoronsky@ya.ru
ORCID iD: 0000-0003-1886-5486
SPIN-code: 7011-6279
Scopus Author ID: 57198886709

M.D., D.Sc. (Medicine), Professor of the Neurosurgery Department

Russian Federation, Saint Petersburg

Anna V. Kolomentseva

Military Medical Academy

Email: antonova401@mail.ru
ORCID iD: 0009-0004-8741-3306

M.D., neurologist, Neurological Department of the Clinic of Nervous Diseases

Russian Federation, Saint Petersburg

Natalia Y. Polushina

Military Medical Academy

Email: nkotovaya@yandex.ru
ORCID iD: 0009-0001-3527-201X

M.D., neurologist, Neurological Department of the Clinic of Nervous Diseases

Russian Federation, Saint Petersburg

Aleksandr V. Ryabtsev

Military Medical Academy

Email: ryabtsev26@gmail.com
ORCID iD: 0000-0002-3832-2780
Scopus Author ID: 57202361039
ResearcherId: AAD-3948-2019

M.D., lecturer, Neurological Department of the Clinic of Nervous Diseases

Russian Federation, Saint Petersburg

Vladimir A. Panov

Military Medical Academy

Email: v.a.panov@mail.ru
ORCID iD: 0009-0004-6593-9606
SPIN-code: 8934-7899

M.D., Ph.D. (Medicine), the Head of the Resuscitation and Intensive Therapy Department of the Clinic of Nervous Diseases

Russian Federation, Saint Petersburg

Evgeniy I. Shermatyuk

Military Medical Academy

Email: sherma1@mail.ru
ORCID iD: 0000-0002-4163-1701

M.D., senior resident of the Neurological Department of the Department and Clinic of Nervous Diseases

Russian Federation, Saint Petersburg

Peter A. Polezhaev

Military Medical Academy

Email: polezhaev76@gmail.com
ORCID iD: 0009-0009-7771-2229

resident, Neurological Department of the Clinic of Nervous Diseases

Russian Federation, Saint Petersburg

Anna A. Kirpichenko

Military Medical Academy

Email: ann04.111998@mail.ru
ORCID iD: 0009-0005-3112-5716

resident, Neurological Department of the Clinic of Nervous Diseases

Russian Federation, Saint Petersburg

Marina S. Yaroslavtseva

Military Medical Academy

Email: gutsumarina@gmail.com
ORCID iD: 0009-0007-0920-6979

resident, Neurological Department of the Clinic of Nervous Diseases

Russian Federation, Saint Petersburg

References

  1. Bykova IYu, Efimenko NA, Gumanenko EK, eds. Military Field Surgery: National Guide. Moscow: GEOTAR-media Publ.; 2009. 816 p. (In Russ.)
  2. Bel’skikh AN, Samokhvalov IM, eds. Instructions for military field surgery. Moscow: GVMU Publ. House; 2013. 474 p. (In Russ.)
  3. Odinak ММ, Zhivolupov SA. Diseases and injuries of the peripheral nervous system (generalization of clinical and experimental experience): a guide for doctors. Saint Petersburg: SpetsLit Publ.; 2009. 367 p. (In Russ.)
  4. Kolomentsev SV, Polezhaev PA, Gaivoronsky AI, et al. Modern concepts of treatment of phantom limb pain. Bulletin of the Russian Military Medical Academy. 2023;25(3):515–527. (In Russ.) doi: 10.17816/brmma340914
  5. Huskisson EC. Measurement of pain. Lancet. 1974;2(7889): 1127–1131. doi: 10.1016/s0140-6736(74)90884-8
  6. Hartrick CT, Kovan JP, Shapiro S. The numeric rating scale for clinical pain measurement: a ratio measure? Pain Practice. 2003;3(4):310–316. doi: 10.1111/j.1530-7085.2003.03034
  7. Davydov OS, Yakhno NN, Kukushkin ML, et al. Neuropathic pain: clinical guidelines for diagnosis and treatment of the Russian Society for the Study of Pain. Russian journal of pain. 2018;16(57):5–41. (In Russ.) doi: 10.25731/RASP.2018.04.025
  8. Finnerup NB, Haroutounian S, Kamerman P, et al. Neuropathic pain: an updated grading system for research and clinical practice. Pain. 2016;157(8):1599–1606. doi: 10.1097/j.pain.0000000000000492
  9. Fillingim RB, Loeser JD, Baron R, Edwards RR. Assessment of Chronic Pain: Domains, Methods, and Mechanisms. J Pain. 2016;17(9):10–20. doi: 10.1016/j.jpain.2015.08.010
  10. Ito E, Inoue Y. [The International Classification of Sleep Disorders, third edition. American Academy of Sleep Medicine. Includes bibliographies and index]. Nihon Rinsho. 2015;73(6):916–923. (In Japanese)
  11. Poluektov MG, Shuvakhina NA, Lamkova IA. The relationship between pain and sleep in clinical practice. Russian Medical Journal. 2019;27(9):56–60. (In Russ.)
  12. Strygin KN, Poluektov MG. Insomnia. Medical Council. 2017;(S):52–58. (In Russ.) doi: 10.21518/2079-701X-2017-0-52-58
  13. Mohamadi A, Chan JJ, Lian J, et al. Risk Factors and Pooled Rate of Prolonged Opioid Use Following Trauma or Surgery: A Systematic Review and Meta-(Regression) Analysis. J Bone Joint Surg Am. 2018;100(15):1332–1340. doi: 10.2106/JBJS.17.01239
  14. Danilov AB, Davydov OS. Epidemiology of neuropathic pain. Russian Journal of Pain. 2007;4(17):12–16. (In Russ.)
  15. Smith BH, Torrance N, Ferguson JA, et al. Towards a definition of refractory neuropathic pain for epidemiological research. An international Delphi survey of experts. BMC Neurology. 2012;12:29. doi: 10.1186/1471-2377-12-29

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2. Fig. 1. Algorithm for diagnosing neuropathic pain in accordance with existing clinical guidelines

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3. Fig. 2. Extended regional (conduction) anesthesia with a long-acting local anesthetic in a patient with intractable NBS as a result of a gunshot wound to the right brachial plexus

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4. Fig. 3. Prolonged epidural anesthesia with permanent delivery of local anesthetic through an air pump dispenser in a patient with phantom pain

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5. Fig. 4. Ultrasound navigation when performing a blockade of the left stellate ganglion. 1 — injection needle; 2 - anterior scalene muscle; 3 - common carotid artery; 4 - longus colli muscle; 5 - transverse process of the 6th cervical vertebra; 6 - stellate ganglion

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6. Fig. 5. Horner’s syndrome on the left (ptosis, miosis, enophthalmos) is a sign of a correctly performed blockade of the stellate ganglion

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7. Fig. 6. Compression of the right sciatic nerve by a bone fragment of the femur after a gunshot comminuted fracture: 1 - femur; 2 - bone fragment; 3 - peroneal portion of the sciatic nerve (hypoechoic structure, nerve fascicles are not visualized); 4 - tibial portion of the sciatic nerve (the structure of the fascicles is preserved); 5 - zone of pronounced perineural edema

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