Diseases of the arm muscles: symptoms, treatment.

Most shots and vaccines, including the Covid-19 vaccine, cause adverse reactions after injection. As a rule, they go away within a few days and almost all are harmless to the patient. In addition to common symptoms such as fever, chills, weakness and headache, many patients report severe pain at the injection site. Moreover, pain in the arm after vaccination against coronavirus is one of the most common symptoms in patients. In this article we will look at what causes pain at the injection site and what can be done about it?

Landouzy-Dejerine progressive muscular dystrophy

Facioscapulohumeral progressive muscular dystrophy of Landouzy-Dejerine is a hereditary disease, the onset of which occurs in adolescence, and progression develops gradually over 20 years. The early childhood form of the disease occurs between the ages of 3 and 6 years and progresses rapidly; this form is characterized by the presence of contractures, muscle pseudohypertrophy and scoliosis in the thoracolumbar region. The early childhood form is a variant of progressive Landouzy-Dejerine muscular dystrophy. The early form can be combined with epilepsy, sensorineural hearing loss, and retinal vascular pathology. Scapulohumeral muscular dystrophy occurs without affecting the facial muscles, which progresses moderately at the age of 12-40 years.

Symptoms of the disease:

- Eyelids that do not close tightly;
— Mask-like appearance of the face “sphinx face”;
- Thickening and protrusion of the lips “tapir lips”;
— Weakness of the muscles of the shoulder girdle and face;
— Limitation of range of motion in the shoulder joint “pterygoid blades”;
— Paresis of the muscles of the shoulder and forearm.

Diagnostics consists of the following components:

— Examination, which predetermines the further diagnostic path;
— Determination of the enzyme creatine phosphokinase (CPK) in the blood, the level of activity of which is increased by 1.5-2 times;
— Electromyography – signs of primary muscle damage are characteristic;
— Muscle biopsy – excessive unevenness in the diameter of muscle fibers, centrally located nuclei and proliferation of endomysial connective tissue;
— Detection of antibodies to the protein emerin;
— Prenatal diagnostics – analysis of DNA markers.

Pain in the arms and shoulders: what does the symptom indicate?

Home / About painful problems / Pain in the arms and shoulders: what does the symptom mean?

Where does it hurt?

Aching pain in the hands during weather changes, numbness in the fingers, acute pain in the elbow or wrist, a feeling of heaviness and stiffness in the muscles of the shoulders and neck are symptoms that give cause for concern. Some are the result of a certain lifestyle, sedentary work and monotonous load on the hands. Others arise from chronic joint diseases, which especially often affect the fingers. Still others appear with age due to weakening of muscles and physiological wear of joints. And the most dangerous ones can be signs of serious diseases.

Causes of pain and its manifestations

Pain is a physiological response to injury and the accompanying inflammation of the tissues of the arms and shoulders: from bones to peripheral nerves. Painful sensations are varied and depend on many factors: the cause of the pathology, concomitant diseases, the patient’s age and others. Unpleasant sensations can be local, for example, felt in the shoulder joint or hand, or they can cover the entire shoulder girdle.

One of the most dangerous conditions that can cause arm pain is myocardial infarction. With it, discomfort begins in the chest area and spreads to the left arm. A similar condition can occur during an attack of angina.

Bursitis, or inflammation of the joint capsule of the shoulder, elbow or wrist, occurs as a result of excessive stress on the joint. Most often this occurs either during sports or is an occupational pathology. Sharp pain in the shoulder or elbow is accompanied by swelling and redness, which are caused by the inflammatory process.

Inflammation of the joints during arthritis is characterized by a local increase in temperature and swelling. The pain in this pathology does not subside even at rest and can intensify at night1. With arthrosis, on the contrary, unpleasant sensations intensify with exertion and can subside if you take a comfortable position.

Severe shoulder pain is characteristic of periarthritis of the shoulder joint. In right-handed people, the right hand most often suffers, since a large load falls on it. This disease is characterized by inflammation of the outer tissues of the joint - ligaments, muscles, cartilaginous surfaces of bones. As a rule, inflammation develops due to professional stress on the hands or one-time physical activity associated with raising and lowering the hands, for example, when carrying out seasonal work in summer cottages.

Treatment for arm and shoulder pain

Since pain in the arms and shoulders can be a symptom of the development of a serious pathology, in case of any manifestations it is necessary to consult a doctor.

You can relieve pain at home, especially if it is caused by minor injuries, such as a bruise or sprain, using cold compresses and compression bandages.

To relieve pain from arthrosis, polyarthritis and other diseases, you can use local non-steroidal anti-inflammatory drugs, such as Aertal® cream based on aceclofenac.

Aertal® cream is used to treat local pain due to traumatic injuries and inflammatory diseases of the musculoskeletal system, including sports injuries and periarthritis2. It suppresses the development of edema and erythema, regardless of the etiology of inflammation. The cream should be applied to the affected area with light movements three times a day.

__________________________

1 Diseases of the joints. Guide for doctors / Ed. IN AND. Mazurova. – St. Petersburg: SpetsLit., 2008. Ps. 111-154.

2 AIRTAL® (AIRTAL®) instructions for use.

About the cream

Airtal® cream has anti-inflammatory, analgesic and anti-edematous effects.

Injuries

Country injuries: protective measures and first aid

Chronic pain

Back pain: causes and treatment

Obstetric paralysis of the upper limb

Obstetric paralysis develops as a result of damage to the brachial plexus and the nerve roots that form it during childbirth.

There are three types of paralysis depending on the level of damage to the brachial plexus:

1. Upper - Duchenne-Erb, symptoms: the arm hangs passively, movements in it are absent or are preserved only in the hand, the arm is brought to the body and rotated inward, the hand is in the position of palmar flexion. If you lift the child, the handle hangs back.

2. Lower – Dezherina-Klumpke, symptoms: there is no movement of the hand and fingers, the arm hangs down and the child carries it, supporting it with a healthy hand.

3. Mixed - Erb-Klumpke and Klumpke-Erb type.

The prognosis is usually favorable and depends on the degree of paralysis and early treatment.

Why do muscles hurt without exercise?

“Why do my muscles hurt if I don’t play sports and don’t experience any physical activity at all?”

Yana, Minsk.
— According to statistics, about 2% of residents of economically prosperous countries constantly suffer from muscle pain. In most cases, this is due to the formation of persistent muscle spasm. It is provoked by injuries, where muscle tension is a response of the body, prolonged non-physiological position of the body (for example, sitting at an uncomfortable table or carrying a bag on one shoulder), and emotional stress.

The origin of the pain itself may be different.
The most common form of myalgia is fibromyalgia, which occurs in ligaments, tendons, and fibrous muscles. This often results in insomnia. In almost two thirds of patients who come to see a neurologist, muscle pain is combined with stiffness in the morning and asthenic syndrome. Fibromyalgia typically affects the neck, back of the head, shoulders, muscles near the knees, and chest. Women are more predisposed to this disease. Pain is aggravated by emotional or physical overload, prolonged lack of sleep, hypothermia, and chronic diseases. Another common cause of muscle pain is inflammation of muscle fibers - myositis. It is often a complication after severe infections. In addition, pain in the muscles can be the first sign of diseases such as polymyositis, polymyalgia rheumatica, brucellosis, influenza, toxoplasmosis, cysticercosis, trichinosis, and also occur with alcohol and other intoxications, diabetes mellitus, primary amyloidosis, rheumatism, osteomyelitis. As for the legs, it may be a matter of flat feet, which the patient may not even know about. The bottom line: the arches of the feet become flat, walking is more difficult - the legs become “heavier”. The pain can cover their entire lower part. Very often, the legs hurt when the condition of the blood vessels is disturbed, when the blood flows poorly and flows to the tissues, the nerve receptors are irritated. The case may be associated with thrombophlebitis (then the pain is jerky, there is a burning sensation along the affected vein, worse in the calves). With atherosclerosis, there is also a feeling as if the legs are being squeezed in a vice. They lead to pain and diseases of the spine, including osteochondrosis. Not to mention the fact that muscles can ache when the load on the lower limbs increases due to excess body weight. Those who are overweight and have small feet or lower legs are especially affected. On the other hand, muscle pain can be a complication of fasting. Kyphosis, stomach ulcers, systemic autoimmune diseases, influenza, and tonsillitis also often occur with muscle pain. It sometimes accompanies pregnancy. Changes in a woman’s body necessarily affect the muscles. Moreover, smooth muscles are more involved in the process (uterine walls, intestines, blood vessels, hair follicles, abdominal muscles). The skeletal muscles also bear a burden, because a woman’s weight is constantly increasing. It’s hard on your back because the center of gravity in the body shifts. What can we say about the legs! And they respond with muscle cramps and pain in the evenings. To prevent and alleviate all these unpleasant phenomena, you should take vitamins with microelements and do special exercises. It’s better to physically prepare your body for pregnancy in advance.

If muscle pain does not go away or is very severe, you need to make an appointment with a rheumatologist, traumatologist or neurologist. There are certain patterns that give the doctor food for thought. For example, muscle pain at night is most often associated with cramps. They are especially common in caviar. Causes: muscle strain during the day, lack of magnesium, calcium and potassium in the diet, the primary phase of diabetes. Before visiting the doctor, you can try to diversify your diet with greens, radishes, and carrots. Exercises for the legs, which are done right in bed, are very useful. Before going to bed, you should warm the sore spot with a heating pad, but not very hot.

Each disease has its own treatment, which must be prescribed by a doctor. But in any case, ointments for pain and an anesthetic liquid containing novocaine, menthol, alcohol and anesthesin help. Mountain arnica extract is an effective remedy for compresses and rubbing. Bee and snake venom are used for myositis, radiculitis, muscle and ligament injuries. A competent massage can alleviate the condition. Non-hormonal anti-inflammatory drugs not only dull pain, but also relieve inflammation, although such drugs cannot be taken for a long time due to side effects.

Olga PERESADA, Professor of the Department of Obstetrics and Gynecology of BelMAPO, Doctor of Medical Sciences.

Soviet Belarus No. 250 (25132). Wednesday, December 28, 2016

Tips and tricks after vaccination

As with any vaccination, the patient should follow some recommendations after receiving the coronavirus vaccine.

After vaccination, it is not recommended to wet the injection site for three days and try to leave it dry. It is also not recommended to drink alcohol and overload the body with physical activity.

In addition, try to adhere to the following recommendations:

Avoid open sunlight, as well as baths and saunas.
Once again, do not wet or heat the vaccine injection site.
Try to wear loose, breathable clothing to prevent the injection site from sweating and from rubbing against the fabric.
In the shower, do not rub the injection with a washcloth and try to avoid getting soap and shampoo on it.
Do not apply various ointments, creams to the vaccination site, do not treat it with brilliant green or iodine, as this can worsen the situation.
Do not scratch or scratch the sore area.

As mentioned earlier, pain in the arm after vaccination against coronavirus goes away within a week. However, if over time the pain does not go away, but rather becomes stronger, then you should immediately consult a doctor. It is also worth visiting a specialist if the injection site begins to become inflamed, the redness is quite large, or swelling appears.

Thus, the causes of pain in the arm after vaccination against coronavirus can be very different, but with proper care and lifestyle they will not lead to dangerous consequences. Be healthy!

Why is it necessary to treat hand myositis?

Myositis of the shoulder or forearm that has just begun can be cured quite quickly with the help of manual techniques and physical therapy. A different picture is observed in advanced cases: treatment will be long and will not be possible without medications.

In addition, by ignoring myositis of the hand, you can get its chronic form - frequent attacks at the slightest provocation.

And the most unpleasant thing: the muscles of the hand, subject to frequent inflammation, noticeably weaken, and their gradual atrophy cannot be ruled out.

That’s why you need to treat hand myositis from an experienced specialist, and once cured, don’t forget about prevention!

Treatment

Stable positive results in the treatment of hand myositis are achieved by techniques of manual therapy, acupuncture and massage.

During the massage procedure, vital processes in the arm muscles are restored and normalized - blood circulation and lymph flow, inflammation and spasm are relieved, lumps are resolved, muscle elasticity is restored and pain is relieved.

The course begins with gentle procedures, then the effect is made more energetic - especially in pain points. The procedure relaxes the patient and he does not feel any discomfort.

does not treat hand myositis. If you notice symptoms of the disease, immediately contact your doctor.

Cosmetic procedures are contraindicated during pregnancy and lactation.

Musculoskeletal pain

Musculoskeletal pain (MSP) is extremely common and accounts for approximately one third of all acute and chronic pain syndromes. Their localization is very diverse, but the most favorite places are the lumbar and sacral spine, lower leg, shoulder girdle and neck. Moreover, in half of patients with MBS, pain occurs in several areas simultaneously [1]. SMS can occur at any age, both in the elderly and in young, able-bodied people, and are often found among students and schoolchildren. Patients suffering from pain experience constant restrictions on motor activity, which sharply reduces their quality of life, and professional and everyday activities deteriorate. Thus, pain is not only a medical, but also a social problem.

SMS (myofascial) occurs due to dysfunction of skeletal (striated) muscle tissue associated with muscle overload and muscle spasm. The reasons underlying the occurrence of this muscle spasm can be very diverse. Muscles respond with tension to any pathological impulse, being a nonspecific indicator of the pathological process, which is why myofascial pain is so common. This type of pain can be associated not only with pathology of vertebral segments or extravertebral structures (joints, ligaments, etc.), but also with pathology of internal organs. The latter should cause particular concern. Almost any somatic pathology can be accompanied by myofascial pain syndrome, since pain impulses from the affected organ lead to protective tension in the muscles surrounding it. Therefore, identifying the causes of myofascial pain always requires a detailed analysis: complaints, medical history and illnesses of the patient, data on general somatic, neurological, orthopedic and mental status. Only by excluding severe somatic pathology, such as tumors and metastases, abscesses, infectious and other diseases, can we talk about “benign” SMB.

The prerequisite for the development of such SMS is functional disorders in the musculoskeletal system and disruption of compensation for natural age-related aging processes. Risk factors for the development of BMS include [1]:

age;
heavy physical labor (especially long-term static loads, heavy lifting, body turns and vibration);
psychosocial aspects (monotonous work, dissatisfaction with working conditions);
anxiety and depressive disorders;
obesity;
smoking;
drug addiction;
severe scoliosis;
history of headaches.

MPS is characterized by both acute and chronic pain syndromes. The initial pain that occurs is usually acute, sharp, intense, and it goes away when the irritant is eliminated and the damaged tissue or organ is restored. This pain performs a protective function, warns the body of danger and ensures the activation of systems aimed at eliminating the damaging factor. However, pain does not always occur in response to damage: often it has already been eliminated, but pain remains, no longer being a protective, but a damaging factor in the body. A component of such “pathological pain” is necessarily present in patients with chronic pain syndromes. Chronic pain often becomes an independent disease, being the only symptom that bothers the patient for a long time, and often its cause cannot be determined. Chronic pain affects an average of 15–20% of the population, and most often this pain is associated with musculoskeletal problems [2].

In addition to dividing pain according to the time factor into acute and chronic, the identification of local, radiating and referred pain and the determination of the mechanisms of its development (nociceptive, neurogenic, dysfunctional) are of great importance for differential diagnosis and determination of therapeutic tactics.

Local pain is always felt in or near the affected part of the body. It is usually associated with a pathological process affecting pain receptors (nociceptors) in the skin, muscles, tendons, ligaments, joints and bones. This is nociceptive (somatogenic, somatic) pain. The main mechanisms of such pain are inflammation and muscle spasm. It is often constant, but can change its intensity with movement and change in body position, can be sharp or aching, dull, and often diffuse in nature. Nociceptive pain disappears when the damaged organ or tissue is restored and responds well to therapy with narcotic analgesics.

Referred pain spreads within the dermatomes associated with the innervation of damaged spinal structures or internal organs. Often referred pain is caused by pathology of internal organs (Zakharyin-Ged phenomenon), for example, in diseases of the pancreas, aortic aneurysm, coronary heart disease, pathology of the gastrointestinal tract (GIT), kidneys, and gynecological diseases. The intensity of pain resulting from damage to internal organs usually does not change with movements in the spine. There is still no comprehensive explanation of the mechanisms of referred pain. It is assumed that it is formed due to the convergence (direct or indirect) of somatic and visceral afferent axons on the same groups of neurons of the central nervous system (CNS), at the level of the dorsal horn of the spinal cord, in the thalamus or sensitive zone of the cortex.

Myofascial pain syndrome is a variant of nociceptive local pain, as well as the most common cause of referred pain. The source of pain is considered to be myofascial trigger points, which can form in muscles, fascia or tendons. The trigger point is a local area of very high sensitivity; upon palpation, it is felt as a compaction or cord. Pressure on an active trigger point provokes sharp local pain with a flinch (jumping symptom) and pain in a distant but strictly defined place (referred pain). Each such point has its own zones of reflected pain. Referred pain is usually dull, aching, deep, and may be accompanied by paresthesia, limitation of movements and forced positioning in the lower back, arm or neck [3, 4].

There are the following criteria for diagnosing myofascial pain syndrome [5]:

A. “Big” criteria (all 5 signs must be present):

complaints of regional pain;
palpable “tight” cord in the muscle;
area of increased sensitivity within the “tight” cord;
characteristic pattern of referred pain or paresthesia;
limitation of range of motion.

B. “Small” criteria (one of three signs must be present):

reproducibility of pain or paresthesia on palpation of the trigger point;
local contraction of the affected muscle during palpation or injection into a trigger point;
reduction of pain when stretching a muscle, or during a therapeutic blockade, or injection with a “dry” needle.

It is obvious that myofascial syndromes can form in any muscle and cause pain in various parts of the body. Favorite places for the formation of trigger points are the muscles of the head and neck, shoulder girdle and lower back, which leads to the development of headaches, lumbago in the shoulder blade and neck, pain radiating to the buttock, thigh, foot, etc., forced position, such as torticollis .

It is believed that the formation of a trigger point is caused by repeated microtrauma or acute trauma that disrupts the structure and function of muscle fibrils. Intense or prolonged physical activity, especially with untrained or “unwarmed” muscles, leads to increased tension and the formation of tears at the muscle attachment points, in the muscle fibers and in their connective tissue sheaths. The appearance of pain and tonic muscle contraction is promoted by reflex tension in spinal pathology (dystrophic processes in the spinal segments, radiculopathy, developmental anomalies) and diseases of internal organs, suboptimal motor stereotype (poor posture, postural strain), hypothermia. Often, spasmed muscles become a secondary source of pain, which, in turn, triggers a long-term vicious circle “pain - muscle spasm - pain” [1] and the formation of chronic pain syndrome.

Radiating pain occurs when a root or nerve is damaged and is characterized by greater intensity and distal spread to the area of the corresponding dermatome. This pain is neurogenic in nature (neuropathic pain), that is, it is associated with damage or dysfunction of the nervous system, and not pain receptors. The neurogenic type includes pain due to mono- and polyneuropathies, trigeminal neuralgia, brain injury, etc. Such pain is usually accompanied by sensory disturbances, motor and autonomic disorders (decreased blood flow, impaired sweating in the painful area), and often cause emotional disturbances. Characteristically, pain occurs in response to mild stimuli that under normal conditions do not cause pain (allodynia). Neurogenic pain is unresponsive to morphine and other opiates in usual analgesic doses, indicating a difference in the mechanisms of neurogenic and opioid-sensitive nociceptive pain [6]. Neurogenic pain that occurs with radiculopathy is almost always accompanied by tension in the corresponding muscles and myofascial pain syndrome.

A separate group of pain syndromes consists of dysfunctional pain. They are based on changes in the functional state of the parts of the central nervous system involved in pain control. The main influence on their occurrence is exerted by emotional, social and psychological factors. The main difference from nociceptive and neuropathic pain is the inability to identify the cause or organic disease that explains the pain. Examples of such pain include fibromyalgia, tension headaches, and psychogenic pain in somatoform disorders [7]. Dysfunctional pain is usually present in the structure of any chronic pain syndrome and requires separate specific therapy.

Of course, most pain is of a mixed nature, and determining the presence of one or another component is necessary for the correct selection of therapy.

SMS therapy

Therapy for MPS is complex; both pharmacological and non-pharmacological methods are important in it [8].

Among the latter, interventions that help relax spasmodic muscles are especially recommended: post-isometric relaxation, massage, manual therapy, acupuncture, transcutaneous electrical stimulation, physical therapy [9]. The good effect of rehabilitation procedures aimed at muscle relaxation is further evidence that the basis for the formation of MPS is a dysfunction of the muscle. However, during the period of acute pain, it is better to avoid active manipulations and maintain rest and bed rest, and begin physical procedures in the subacute period [10].

The most common pharmacological therapies are the use of muscle relaxants, non-steroidal anti-inflammatory drugs (NSAIDs) and analgesics. The idea of prescribing muscle relaxants is obvious - by relieving muscle tension, we eliminate the cause of pain and break the vicious circle of “pain - muscle spasm - pain”. Baclofen, tolperisone, tetrazepam, tizanidine are used, each of the drugs has its own characteristics, for example, tizanidine has a fairly pronounced central analgesic effect, tolperisone has analgesic properties and has a vasodilator effect, which increases blood flow to the stenotic muscle. To eliminate pain, especially in the acute period, a variety of analgesics (NSAIDs, metamizole sodium, paracetamol, etc.) are widely prescribed; their effect can be enhanced by adding small doses of anticonvulsants, such as carbamazepine.

Nociceptive pain responds well to NSAID therapy. Due to the combination of analgesic and anti-inflammatory properties, they are successfully used to relieve acute pain in MPS. However, long-term use can lead to a number of complications from the gastrointestinal tract, hematopoietic organs, and kidneys. Therefore, when choosing an analgesic, one should be guided not only by the effectiveness, but also by the safety of the drug. For example, when treating patients with peptic ulcers, diabetic or other nephropathy, NSAIDs should not be overprescribed. Recently, selective NSAIDs, cyclooxygenase (COX) 2 inhibitors, such as Amelotex (meloxicam), have increasingly come into practice. The main therapeutic effects of NSAIDs - analgesic, anti-inflammatory and antipyretic - are based on reducing the synthesis of prostaglandins from arachidonic acid through inhibition of the COX enzyme. COX exists in two forms: COX-1 is constantly present in all tissues, COX-2 is synthesized against the background of inflammation. Most NSAIDs and non-narcotic analgesics inhibit both types of COX. Blocking COX-1 is responsible for most adverse drug reactions. Three groups of selective COX-2 inhibitors are currently registered in the Russian Federation: sulfonanilide derivatives - nimesulide; representatives of coxibs - celecoxib, valdecoxib; oxicam derivatives - Amelotex (meloxicam).

Amelotex occupies an intermediate position between non-selective and highly selective NSAIDs. The drug selectively blocks COX-2 in the area of inflammation and blocks COX-1 to a much lesser extent, thus the synthesis of prostaglandin, which protects the gastrointestinal mucosa, remains intact. A distinctive feature of the action of Amelotex is its “chondroneutrality”; unlike other NSAIDs, it does not have a negative effect on cartilage, which is important to consider in the treatment of patients with osteoarthritis and osteochondrosis. The results of clinical trials showed that meloxicam has an optimal balance of effectiveness and safety [11]. It is characterized by a long action (half-life of about 20 hours), which makes it convenient for the treatment of chronic pain syndromes. Amelotex has three formulations: parenteral for the treatment of exacerbations of MPS, oral for longer-term use, and an over-the-counter gel for external use, which is especially relevant for the treatment of local pain syndromes [12].

With topical use of NSAID-containing drugs, the likelihood of developing adverse reactions is reduced. Local forms of NSAIDs are safer than tablets; in addition, their use makes it possible to reduce the dose of drugs taken orally and parenterally [13]. When applied topically, Amelotex gel reduces or eliminates pain in the area where the gel is applied, including in the joints at rest and during movement. Helps increase range of motion. Ointments and gels with other analgesics, pepper plaster, and mustard plasters are also used locally. Compresses with dimethyl sulfoxide, procaine, NSAIDs and hydrocortisone have a good effect.

Invasive methods of influence - blockades on trigger points - are highly effective in eliminating myofascial trigger points. Injections may contain an analgesic (novocaine blockade), NSAIDs, corticosteroids, botulinum toxin, or be drug-free - “dry needle” [9, 14]. After puncturing the trigger point, the main symptoms (local and referred pain, “jumping symptom”) disappear and the muscle cord relaxes. Ischemic compression of the trigger point with a finger (acupressure) has a similar effect - as the pain decreases, the pressure on the point is increased, the pressure time is individual in each case.

To enhance the analgesic effect, NSAIDs are recommended to be used in combination with B vitamins, since vitamins of this group can potentiate the effect of NSAIDs, and, in addition, they themselves have analgesic activity. B vitamins are involved in many metabolic processes in the body, nucleotide synthesis, folic acid metabolism, catecholamine synthesis, they normalize metabolic processes necessary for normal hematopoiesis and the development of epithelial cells. It is also known about the active neurotropic effect of B vitamins, which are necessary for the synthesis of the myelin sheath of nerves, the conduction of nerve impulses and the implementation of synaptic transmission, i.e. for the normal functioning of the central and peripheral nervous system. Thus, B vitamins are effective for both nociceptive and neuropathic pain.

Today on the Russian market there is a combined injection drug CompligamV. This is a high-dose injection solution of neurotropic vitamins: B1, B6 and B12, which includes lidocaine. Due to this combination, the drug immediately has both a neurotropic and pronounced analgesic effect. It should be noted that the presence of lidocaine makes injections of the drug CompligamB much less painful than injections of conventional B vitamins. CompligamB can be used in complex therapy of both chronic and acute MBS, combined with NSAIDs. The combination of Amelotex + CompligamB can enhance the analgesic effect, reduce the duration of exacerbation of the disease and the timing of taking NSAIDs [15]. The latter is very important because it makes it possible to reduce the likelihood of adverse drug reactions, especially in patients at high risk (patients with peptic ulcers, hematological diseases). This combination treatment is superior in efficacy and safety to non-selective NSAIDs, such as diclofenac, as demonstrated in clinical trials [16].

Since patients with MPS may have neuropathic and dysfunctional components as part of the pain syndrome, it must be remembered that these pains have a development mechanism different from nociceptive ones; their distinguishing feature is their poor response to therapy with non-narcotic analgesics and NSAIDs. In this case, the potentiation of the analgesic effect and the pronounced neuroprotective effect of CompligamB may be very useful. In the complex treatment of chronic neuropathic and dysfunctional pain, drugs acting on the central nervous system are widely used: tricyclic antidepressants and selective serotonin reuptake inhibitors, or serotonin and adrenaline; anticonvulsants; opioid analgesics; small doses of antipsychotics. It is possible to use NMDA receptor antagonists, such as amantadine, which also has a positive effect on symptoms such as allodynia and hyperalgesia. Localized pain may respond to therapy with topical preparations containing biologically active substances from capsicum.

An important point in the treatment of pain syndrome is not only its effective relief, but also the prevention of further development of the pathological process, taking measures aimed at restoring structural and functional damage. To reduce the severity and prevent further development of the disease, chondroprotectors and neurotropic vitamins are used, primarily B vitamins. The use of the drug CompligamV for preventive purposes as a neuroprotector is quite justified in patients prone to MBS.

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N. V. Latysheva1, Candidate of Medical Sciences A. A. Pilipovich, Candidate of Medical Sciences A. B. Danilov, Doctor of Medical Sciences, Professor

State Budgetary Educational Institution of Higher Professional Education First Moscow State Medical University named after I.M. Sechenov Ministry of Health of the Russian Federation, Moscow

1 Contact information