Interventional methods for the treatment of chronic pain. Pain management service. How does the procedure work?

April 28 – from 10.00 - 15.00 brain ring “Pseudoradicular syndromes of the hand”

Location:

Clinic of Nervous Diseases named after. A.Ya.Kozhevnikov 1MGMU named after. I.M. Sechenov, Moscow, st. Rossolimo 11, building 1, floor 2 lecture hall; Directions: metro station "Park Kultury".

Registration of listeners is from 8-45 in the clinic museum (2nd floor).

The preparation of documents for training on the cycle is carried out by IPO methodologist Elena Evgenievna Lapteva, work phone - 8495 6091400 (ext. 2198)

mob. tel. 8 926 063 68 54

email mail

Inquiries by phone:

8 916 073 3223 Mikheeva Natalia Alekseevna

e-mail: This email address is being protected from spambots. You must have JavaScript enabled to view it. "> This email address is being protected from spambots. You must have JavaScript enabled to view it.

P R O G R A M M A 2 9 C I C L A

16 April (Monday) INTRODUCTION TO ALGOLOGY

8.45 - 9.00 Registration of students and paperwork in room 401 (4th floor)

9.00 - 11.00 Physiology and pathophysiology of pain. Methods of diagnosis and treatment. Barinov A.N.

11.00 - 11.10 break

11.10 - 13.30 Master class "Interventional methods of diagnosis and treatment of pain." Barinov A.N. (1 group), Makhinov K.A. (2nd group), Rozhkov D.O. (4th group), Shor Yu.M. (3rd group)

13.30 -14.00 Back pain - review of modern European recommendations. Romanenko V.I.

14.00-14.30 Lunch

14.30-16.00 Master class "Interventional methods of treating musculoskeletal pain." Egorov O.E. (1 group), Rozhkov D.O. (3rd group), Vakhnina N.V. (2nd group), Barinov A.N. (3rd group)

16.00 - 16.30 Cervicogenic pain syndromes: diagnosis and treatment. Vakhnina N.V.

16.30 - 17.00 First aid for complications of interventional therapy. Barinov A.N.

17.00 - 18.00 Workshop on models “Interventional methods of treating pain”. Barinov A.N., Makhinov K.A., Manikhin D.S., Rozhkov D.O.

April 17 (Tuesday) TREATMENT OF MUSKELETAL PAIN

9.00 - 10.00 Pelvic pain. Coccydynia. Makhinov K.A. office 401 (4th floor)

10.00 -12.00 Master class “Interventional methods of treating back pain and pelvic pain using EMG, X-ray, CT and ultrasound navigation” Egorov O.E. (3rd group), Rozhkov D.O. (2nd group), Makhinov K.A. (1 group), Barinov A.N. (4 group)

12.00 - 13.00 Diagnosis and treatment of shoulder pain. Barinov A.N. room 235 (2nd floor)

13.00-14.30 Lunch / Clinical conference of the National Clinical Hospital: “Paraproteinemic polyneuropathy”

14.30-15.30 Master Class. Joint pain in the practice of a neurologist: interventional therapy and kinesiotherapy. Rozhkov D.O. room 235 (2nd floor)

15.30 - 15.40 break

15.40- 18.00 Master class: "Short-term psychological interventions: hypnotherapy." Demonstration of the procedure in patients with chronic pain, practical lessons by hypnotic induction. Efremov A.V.

April 18 (Wednesday) annual scientific and practical conference "Back pain - an interdisciplinary problem 2018"

April 19 (Thursday) CONTACT ANATOMY

at the Department of Human Anatomy at st. Mokhovaya, house 11, building 10 from 10.00 to 15.00 will take place

NEUROANATOMY MASTER CLASS ON THE APPLICATION OF INTERVENTION TECHNIQUES ON BIOLOGICAL SUBSTANCES

April 20 (Friday) SYNERGY AND LEGAL ASPECTS OF INTERVENTION METHODS

09.00 - 9.40 "Psychopharmacotherapy and psychotherapy of chronic pain" Romanov D.V.

9.40 - 10.30 Master class “Psychological interventions for chronic pain: indications and possibilities” Golovacheva V.A.

10.30-13.00 Master class “Interventional methods of treating pain” Egorov O.E. (4th group), Makhinov K.A (3rd group), Barinov A.N. (2nd group), Shor Yu.M. (1 group)

13.00-13.30 Lunch

13.30-14.10 "Psychological aspects of pain syndrome. Basic approaches to psychotherapeutic work" Zhuravskaya N.Yu.

14.10-15.00 Master class “Combination of minimally invasive and psychotherapeutic methods of treating pain” Barinov A.N., Zhuravskaya N.Yu., Pushkarev D.F.

15.00 - 15.40 Biological Feedback(BFB therapy). Kostrygina E.N.

15.40 -16.20 Interventional therapy in comorbid patients. Makhinov K.A.

16.20 - 16.30 break

16.30 - 18.00 Workshop"Legal aspects of intervention therapy." Alekseev A.V.

09.00 - 10.30 Chronic headaches: classification, differential diagnosis, treatment approaches. Sergeev A.V.

10.30 - 10.40 Break

10.40 - 11.10 Muscle component in the pathogenesis of headache. Rozhkov D.O.

11.10-12.00 Master class: “Interventional treatment of headaches” Sergeev A.V., Barinov A.N., Makhinov K.A., Rozhkov D.O.

12.00-14.30 Master class: "Botulinum therapy for chronic migraine." Artemenko A.R.

14.30-15.00 Lunch

15.00 - 15.40 Facial pain. Mingazova L.R.

15.40 - 17.00 Master class: "Interventional methods of treating facial pain." Mingazova L.R., Makhinov K.A., Barinov A.N.

17.00 - 18.00 Psychopharmacotherapy of headache and facial pain from the position of a psychiatrist. Petelin D.S.

April 22 (Sunday) TUNNEL AND PSEUDORADICULAR SYNDROMES

09.00-10 .30 Diagnosis and treatment of tunnel syndromes. Akhmedzhanova L.T.

10.30 - 11.30 Neurosurgical treatment of tunnel syndromes. Evzikov G.Yu.

11.30-11.40 break

11.40-12.10 Ultrasound diagnostics and navigation of interventional methods for the treatment of neuropathies, plexopathies, enthesopathies, tendonitis and articular syndromes. Vuytsik N.B.

12.10-14.00 Master class “Interventional therapy of pain syndromes using ultrasound navigation” Vuytsik N.B., Barinov A.N., Makhinov K.A., Rozhkov D.O.

14.00-14.30 Lunch

14.30-17.00 Interventional methods of treating pain in rheumatology. Zhilyaev E.V.

17.00-17.10 break

17.10-18.00 Pharmacology of agents for local injection therapy, drug-drug interactions. Rational pharmacotherapy of pain. Davydov O.S., Barinov A.N.

April 28 (Saturday)– Brain-ring “Pseudoradicular syndromes of the hand”

Interventional pain management techniques, sometimes referred to as “no-scalpel surgery,” are essentially highly precise, minimally invasive surgical procedures.

Interventional pain management techniques, sometimes referred to as “no-scalpel surgery,” are essentially highly precise, minimally invasive surgical procedures. They allow you to obtain a long-term therapeutic effect even where use medicines ineffective or impossible. At the same time, the small volume of interventions allows patients to easily tolerate them, so hospitalization is not required in the vast majority of cases. The Pain Clinic specialists successfully use interventional treatment methods in their practice, relieving patients of chronic pain.

Therapeutic blockade

With this treatment, drugs are most often administered directly to the pathological focus responsible for the occurrence of pain. Quickly and effectively - the method of therapeutic blockade meets these conditions.

PRP therapy

The essence of the PRP therapy method is to inject platelet-rich plasma obtained from the patient’s own blood into the site of injury. The therapeutic effect of PRP therapy is based on the ability of human platelets to stimulate the processes of restoration of damaged tissue. PRP therapy allows you to avoid additional medication load and does not cause allergic or toxic reactions.

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Interventional methods for the treatment of chronic pain syndrome in cancer patients

V.V. Bryuzgin

GURONTS them. N.N. Blokhin RAMS, Moscow

Contacts: Vladimir Vasilievich Bryuzgin [email protected]

The use of non-invasive methods for treating chronic pain syndrome in cancer patients is effective in 80-90% of patients. In other cases, invasive, interventional pain relief techniques should be used. These include neuroablative and neuromodulatory procedures. Neuroablation is defined as the physical interruption of pain transmission pathways by surgical, chemical or thermal methods and includes lytic and other types of blockades. Neuromodulation is the dynamic and functional suppression of pain pathways resulting from intraspinal or intraventricular administration of opioids and other chemical agents.

Key words: oncology, pain, pain relief, interventional techniques

Intervention treatments for chronic pain syndrome in cancer patients

N.N. Blokhin Russian Cancer Research Center, Russian Academy of Medical Sciences, Moscow

Noninvasive treatments for chronic pain syndrome benefit in 80-90% of cancer patients. Invasive, intervention procedures for analgesia should be used in other cases. These include neuroablative and neuromodulatory measures. Neuroablation is defined as the physical suspension of painful impulse transmission pathways by a surgical, chemical, or thermal method and comprises lytic and other blocks. Neuromodulation is the dynamic and functional suppression of pain impulse pathways by the intraspinal or intraventricular administration of opioids and other chemicals.

Key words: oncology, pain, analgesia, intervention procedures

The use of the principles of the WHO “analgesic ladder” in the treatment of chronic pain syndrome (CPS) is effective in no more than 80-90% of patients. It follows that there is a certain category of patients who can benefit from interventional treatment of cancer pain, the basis of which is invasive interventions. Designed by wide range interventional procedures used when pain cannot be controlled using a combination of drugs included in the analgesic ladder.

The use of interventional methods for controlling cancer pain requires the participation of qualified specialists, the development of equipment for the use of these methods and monitoring of patients. Patients who are candidates for interventional treatment require special care and follow-up. Most procedures are performed in the departments of anesthesiology or neurosurgery with the participation of endoscopists and radiologists. To use methods for relieving cancer

pain requires special training and conditions that allow continuous monitoring.

Most methods are aimed at influencing the nervous system. In this regard, an x-ray examination performed immediately before the procedure is of great importance, the purpose of which is to identify the cause of pain, as well as to prevent complications that may develop as a result of the use of therapeutic method. It is also important to verify objective pain assessments, which will help select the appropriate intervention method. In addition, it is necessary to determine the emotional and psychological status of the patient. Such an examination will help the doctor both in deciding whether to carry out interventional treatment and in choosing a specific method of therapy. When choosing the required method, the pain mechanism should be determined - nociceptive or neuropathic. Interventional methods are prescribed only if they are no longer effective. conservative methods pain treatment. The WHO “ladder” is usually used even after it has proven ineffective

all the drugs listed in it are considering the use of interventional methods. However, in some cases it is possible to use procedures at earlier stages. Candidates for the procedures must not have general contraindications such as sepsis or coagulopathy.

Interventional methods are divided into 2 categories: neuroablative and neuromodulatory. Neuroablation is defined as the physical interruption of pain transmission pathways through surgical, chemical or thermal methods. Neuromodulation is the dynamic and functional suppression of pain pathways as a result of intraspinal or intraventricular administration of opioids, or through stimulation. Comparing neuroablation and neuromodulation is hardly useful. In the algorithm for the use of interventional pain treatment, all methods have their own indications and occupy a certain place as part of an integrated approach.

Neuromodulation

In 1979 J.K. Wang et al. for the first time demonstrated the effectiveness of intrathecal bolus injections of morphine in the treatment of pain in cancer patients. T.L. Yaksh and T.A. Rudy presented the physiological rationale for pain reduction resulting from intraspinal opioid administration as modulation of suppressive mechanisms in spinal cord. As spinal opioids were introduced into practice, methods and equipment for catheter administration of drugs continued to be improved. The main routes of intraspinal administration of opioids are epidural and intrathecal. The administration of spinal opioids using special systems has several potential advantages: very low doses of opioids can maintain adequate pain relief and prolong the duration of analgesia. With the spinal route of opioid administration, the likelihood of developing potential side effects, characteristic for oral and parenteral use. Sedation is less pronounced, which allows you to keep patients in a more active and controlled state. A thorough clinical evaluation is necessary to determine the method of opioid use. This is also important from a prevention point of view. possible complications, some of which may be due to the wrong choice of method of drug administration. When examining patients, attention is paid to such factors as general and mental condition, life expectancy, nature and origin of pain, skin condition

above the impact zone, the patient’s surroundings. The success of spinal opioid use depends mainly on proper patient selection.

Spinal opioid delivery systems are used in the following cases:

Ineffectiveness or inadequacy of oral and other less invasive methods;

Better provision of pain relief and quality of life compared to other methods;

Stability of the general and mental state patient;

Greater economic feasibility of spinal injection.

Contraindications to spinal opioid administration include low platelet counts, bleeding disorders, local infection, physiological abnormalities that prevent pain from being properly assessed (metabolic encephalopathy), structural abnormalities, neurodegenerative disorders and behavioral abnormalities (drug addiction, psychiatric disorders), and the use of pain as reasons for receiving more medicines, increased attention and medical care.

Great importance when selecting patients has a life expectancy. The use of complex, programmable pumps is unlikely to be appropriate in patients with short life expectancy. It seems appropriate to use catheters with special ports in this category of patients. The use of pumps can be effective in patients with a life expectancy of several months to several years. Clinical effectiveness spinal administration of opioids depends on the following factors:

Characteristics of the patient, including life expectancy, origin of pain, age, body weight, structural features of the spinal canal;

The choice of route of administration is intrathecal or epidural;

Physical and Chemical properties drugs;

Administration technique - bolus or long-term infusion;

Characteristics of the administration system - internal or external;

System cost.

Not all pain is relieved by spinal opioid administration. The route of administration and choice of drugs vary depending on the effect of opioids. Use of opioids alone

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unlikely to be effective for neuropathic pain, sudden pain when lifting heavy objects, bone pain, or pressure ulcer pain. However, a patient should never be considered deliberately opioid-resistant. Many patients with neuropathic pain respond to spinal opioids. There is also no correlation between the specific source of pain and the degree of pain relief. It is necessary to carry out full examination spinal canal. It is possible to identify a large lesion in the epidural space or compression of the spinal cord or nerves. The ability of the patient and medical staff to work with the patient should also be assessed. necessary equipment and perform related tasks.

Intraspinal analgesia is performed via the epidural and intrathecal routes. Potential advantages of epidural administration include appropriate localization and no risk of spinal fluid leakage and associated spinal headache. The range of drugs for this route of administration is wider, which allows the use of drugs not belonging to the opioid class to enhance the analgesic effect. However, with epidural insertion, the incidence of complications associated with the catheter is much higher than with its installation in the intrathecal space. In a fairly significant number of cases, fibrosis develops around the tip of the catheter in the epidural space and, as a result, the catheter becomes blocked. As a rule, after 2-3 months the development of epidural fibrosis is observed. Thickening of the dura and fibrotic reactions in the epidural space can lead to impaired kinetics in the dura and the need for increased dosage as a result of the development of pseudotolerance. Some patients experience burning pain during an epidural injection. The cause of this sensation may be the presence of fibrosis, inflammation or infection of the epidural space. This type of pain is sometimes so unbearable that patients choose to suffer from the pain caused by the underlying disease and request removal of the system. The occurrence of burning pain during injection and the development of fibrosis are the main reasons for choosing the intrathecal route of administration in patients responding to opioids. Advantages of intrathecal administration include reduced risk of catheter obstruction, absence of fibrosis or burning pain associated with injection, reduced risk of catheter dislodgement, longer and more intense pain relief, and reduced opioid dosage. In general, the dose for intrathecal administration is 10% lower than that

for epidural. Intrathecal administration of opioids reduces the incidence of complications associated with the use of spinal administration systems. It should be noted that side effects, including nausea, vomiting and urinary retention, are more pronounced at the beginning of intrathecal therapy. Initially, only opioids were administered intrathecally, but this route of administration is now also used for bupivacaine and other drugs. Intrathecal administration has a number of disadvantages. There may be cerebrospinal fluid leakage and post-spinal headache. If the implanted system for intrathecal administration of drugs is removed for any reason, a cerebrospinal fluid fistula may develop. This complication is rare and requires careful treatment.

Preparations for intraspinal use

Ideally, a drug for intraspinal use should provide long-lasting analgesic effect, no or minimal side effects, no spinal cord toxicity during long-term therapy, no pain during injection, and should be compatible with available delivery systems. Morphine remains the drug of choice due to its long action, high quality of analgesia, availability and relatively low cost. A number of other drugs are also used for intraspinal administration, such as bupivacaine, keto-rolac, clonidine, midazolam and droperidol. Currently, several types of systems are used for drug administration. They can be classified into the following groups:

Percutaneous implantable epidural catheters;

Subcutaneous tunneled epidural or intrathecal catheters;

Implanted epidural or intrathecal catheters connected to a port;

Implanted intrathecal manual pumps;

Implanted intrathecal

or epidural infusion pumps;

External pumps.

Percutaneous epidural catheters are mainly used for acute intra- and postoperative pain and in obstetric practice. In addition, they are used before implantation of an indwelling catheter to determine the effectiveness of the method and method of use, as well as in patients with a life expectancy of several days. However, there are reports of the reliability and safety of long-acting

use of percutaneous catheters. If a percutaneous catheter is used before installing an indwelling catheter, catheterization is performed under fluoroscopic control. The catheter can be connected to an external infusion pump. It is easy to install and remove, which is both an advantage and a disadvantage of the method. The advantages of epidural subcutaneous or intrathecal catheters include ease of placement when treating patients with poor general condition and short life expectancy, negligible risk of infection compared to percutaneous catheters, the ability to perform the injection by a non-medical worker and attach an external pump. Disadvantages of subcutaneous tunneled epidural and intrathecal catheters include dislodgement or migration, catheter kinking and obstruction, infection, skin irritation from dressings, and problems with skin cleansing. Fully implanted epidural or intrathecal catheters connected to ports may remain stable for longer and pose a lower risk of infection. Disadvantages of this type of catheter include the need for multiple punctures of the skin, kinking and obstruction of the catheter. Additional surgery is required to remove or replace the port. Special needles are used to puncture the port, and the number of injections that can be made through 1 port is limited. Fully implantable infusion systems have the advantage of maintaining more low level morphine concentrations in cerebrospinal fluid and plasma compared with a mechanical pump that can only be used for bolus injections. They remain stable for a long time and can be used in the treatment of patients experiencing pain not only of oncological origin. Types of implantable infusion pumps range from rate-controlled infusion pumps to program-controlled pumps. Programmable pumps are more suitable for non-cancer patients. For cancer patients with a short life expectancy, they may be prohibitively expensive, although some studies have shown these devices to be cost-effective after only 3 months of use, even in cancer patients. More and more varieties of external portable infusion systems are appearing - from relatively cheap syringe devices with a simple on-demand switching system to expensive programmable ones.

ours - with replaceable plastic tanks. The patient or their loved ones can easily manage external devices at home, including changing catheter dressings, changing medication reservoirs, managing the pump and monitoring for side effects. If treatment is carried out over a long period of time, these requirements may pose a problem.

Side effects and complications when using spinal drug administration systems

Complications associated with the use of infusion systems and side effects of opioids must be discussed separately. Side effects that have been reported with other routes of opioid administration are also observed with spinal administration. They may be independent of the opioid dose (urinary retention, itching, sweating, sedation) or dose-dependent (nausea, vomiting, dysphoria, euphoria, central depression, hypotension and tachyphylaxis). Long-term use requires dose escalation. It is incorrect to consider each dose increase as a consequence of the development of tolerance; one should distinguish between true and pseudo-tolerance. In cancer pain, there is a constant increase in nociceptive stimulation. The need to increase the dose during long-term treatment may be due to disease progression, increased pain resistant to opioids over time, or the occurrence of changes in the epidural or subarachnoid space. These phenomena are usually considered pseudotolerance. Various studies have shown the possibility of developing tolerance towards others pharmacological effects opioids other than pain relief; such selective tolerance is beneficial for the patient. In case of development of tolerance to morphine, substances such as lysine acetylsalicylate, calcitonin, somatostatin, ostreotide, and droperidol can be used. Accidental overdose of the drug when administered through an injection port can lead to respiratory depression. Itching is observed only during the intraspinal injection. Nausea and vomiting occur less frequently in patients who have previously received opioids compared to patients who have not used these drugs. Usually these symptoms subside during the infusion. 20-40% of patients (mostly men) experience urinary retention. This symptom especially common in the first 2 days and may require catheterization Bladder. As a rule, these side effects do not require treatment.

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cessation of treatment and disappear within a few days. There is an opinion that the danger of side effects and tolerance is exaggerated.

The development of complications may be due to a number of factors independent of the choice of system, route of administration and method of drug use. Infusion system complications can be divided into complications related to timing, site of catheter placement, specific components of the system, and rare ones.

Complications associated with time are early (bleeding at the site of surgical intervention, hematomas that occurred along the installation of a tunnel infusion system, epidural hematomas, the development of infection in the early period, leakage of cerebrospinal fluid, post-spinal headache, edema) and late (obstruction of the catheter, port or pump, kinking and displacement of the catheter, malfunction or pump failure, late development of infection, fibrosis and burning pain at the injection site).

Complications at the catheter site can be epidural (burning pain at the injection site, hematoma, abscess, formation of a fibrous membrane around the catheter) and intrathecal (cerebrospinal fluid leakage, dural fistula, headache, meningitis).

Complications related to system components may be caused by the insertion of a catheter, port, or pump. The former include the formation of clots, kinking, kinking, displacement, occlusion and migration of the catheter, the latter include port obstruction, leakage of its membrane, mechanical damage to the pump, disruption of its operation, and catheter disconnection.

Rare complications include the occurrence of skin necrosis and the development of skin reactions to percutaneous and subcutaneous tunnel devices.

Some complications can be resolved without removing the system, but complications such as infection, catheter occlusion or migration, or port or pump malfunction should be taken seriously. Drug delivery system infections typically occur at the catheter exit site, port site, or pump site. Superficial infections at the catheter exit site are observed in 6% of patients. The occurrence of epidural abscess and meningitis is associated with the injection site. Epidural infection and epidural abscess can be caused by hematogenous spread or the development of a superficial infection at the port site introduced during drug administration. Meningitis in most cases develops with intrathecal catheter placement.

A number of studies have shown that the incidence of infection with intrathecal catheter placement is approximately 4%, and with epidural placement - 9%. System occlusion may be caused by a blocked port, pump, or catheter. Catheter blockage, in turn, is caused by the formation of a clot, the development of fibrosis around the tip of the catheter, the presence of foreign particles in the injection solution and kinking of the catheter. Catheter displacement is also a pressing problem. In patients with a fully implanted system, catheter displacement requires removal of the entire system. Although certain measures can be taken, this complication poses a serious problem. A retrospective analysis showed that catheter dislodgement occurs in approximately 8% of patients. It is also possible for valve failure in hand pumps or malfunction of the pump. In these cases, it is necessary to remove the pump.

Thus, the use of systems for spinal drug administration should be based on the principle of optimal benefit with minimal harm to the patient. The three-step analgesic “staircase” technique proposed by WHO is effective in 80-90% of cases; this means that 10-20% of patients require other interventions to control pain. The development of new and improvement of existing methodological approaches and algorithms is of great importance for the proper use of interventional methods in the treatment of cancer pain.

Neuroablative methods in the treatment of cancer pain

Neuroablative methods have been used in the treatment of cancer pain for more than 100 years. The introduction of imaging technology and endoscopic surgery has improved the accuracy and efficiency of these methods. Development of new, more effective drugs, methods of their administration (transdermal use of opioids), as well as the use of long-acting opioids and adjuvant agents have led to the fact that neuroablative methods have become less used. However, they still have an important place in the treatment of intractable pain. The use of these methods became justified after all the analgesics listed in the “analgesic ladder” turned out to be ineffective. In addition, it is required that the patient's life expectancy be short and the pain be localized to one part of the body. The use of neuroablative methods is indicated for somatic or visceral pain. For neuropathic pain, they are used to block sympathetic pathways. Although neuroablative methods are usually prescribed after

Since the inadequacy of all “staircase” analgesics has been established, in certain situations it is possible to use them at earlier stages. Local pain caused by the innervation of the trigeminal nerve can be relieved either by neurolytic blockade or by radiofrequency thermocoagulation of the Gasserian ganglion. Also, at earlier stages of the process, before the surrounding anatomical structures are destroyed, a block of the solar plexus or splanchnic nerves can be performed. Advantages of neuroablative methods: less intensive follow-up monitoring compared to neuromodulation, higher economic efficiency, the possibility of use in patients with short life expectancy. Disadvantages: potential risk of permanent loss of motor function; paresthesia and dysesthesia (observed more often); the need for the participation of a highly qualified doctor, the ability to perform only with localized pain.

Conductor blockade with neurolytics

Neurolytic drugs are chemical substances which have a destructive effect on the nerves; these include 50-100% alcohol, 5-15% phenol, glycerin and hypertonic saline solution. The oldest neurolytic is alcohol, which is administered to block the solar plexus, gasserian ganglion, sympathetic chain, or intrathecally. Alcohol is used in several concentrations - from 50 to 100%. Alcohol does not selectively destroy nerves. Phenol is most often used in glycerol solutions in the form of a hyperbaric solution in concentrations from 5 to 15%. It also acts on the nerve non-selectively, but the effect of phenol is more reversible compared to the effect of alcohol. Glycerin is used only for blockade peripheral nerves, however, its duration of action is shorter.

Neurolysis of the trigeminal ganglion

The method of percutaneous administration of absolute alcohol through the foramen ovale to block the trigeminal nerve ganglion (Gasserian ganglion) was first used by F. Hartel in 1912. Later, this procedure began to be performed using radiofrequency coagulation, the technique of which was described by W.H. Sweet and J.G. Wepsik in 1974, and using glycerol injection into the area located behind the gasser node. Trigeminal ganglion blockade is usually performed for idiopathic neuralgia, but this technique is also used in the treatment of pain secondary to the presence of malignant tumors in the region. The best results are obtained by using the method at earlier stages before the destruction of regional anatomy.

mic structures of the tumor. The duration of its action is from several months to several years. The procedure is performed under fluoroscopic control. The fluoroscope makes it easy to see the foramen ovale; a neurolytic solution (alcohol or phenol), the volume of which should not exceed 1 ml, is administered in small portions. Otherwise, the solution may enter the brain stem and cause serious complications. Currently, instead of neurolytic solutions, radiofrequency exposure is more often used. This method provides more accurate localization of the effect on the nerve and avoids the development of complications associated with the penetration of the neurolytic solution into the brain stem. Neurolysis of the trigeminal ganglion may be accompanied by complications. In any case, as a result of neurolysis, numbness of the face develops. It is necessary to inform the patient about this subsequently before the procedure. The patient may perceive this phenomenon not as a complication, but as a result of exposure. As a result of destruction of the optic branch of the trigeminal nerve, loss of the corneal reflex is possible.

Intercostal nerve block

In the textbook G. baba published in 1922, it is given detailed description intercostal nerve blockade technique, which is used almost unchanged today. Intercostal nerve block is the most effective method in treating pain. It is used to relieve pain from rib fractures and cancer metastases. Typically, the procedure is performed with the patient lying on his stomach, which makes it possible to identify the ribs by palpating the intercostal spaces from the back. In the classical approach, the intercostal nerve block is performed posteriorly, in the costal angle, lateral to the sacrovertebral muscle group. The use of a fluoroscope greatly facilitates this procedure. The needle is inserted all the way into the lower edge of the rib and pushed down. It is recommended to pre-administer local anesthesia, for example, a 2% lidocaine solution. Then you can introduce 6-8% phenol, 3-5 ml. The main complications are the development of pneumothorax and penetration of the solution into blood vessel. It should be noted that careful execution of the procedure reduces the risk of pneumothorax.

Intrathecal and epidural neurolytic blockade

Intrathecal neurolysis has been used since 1931, when this operation was first used by A.M. Dogliotti. IN last years intrathecal administration of alcohol and phenol began to be used less frequently due to the risk of developing such complications.

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tions, such as loss of motor and sensory functions. The purpose of the procedure is to irrigate the posterior sensory nerve root with a neurolytic solution of alcohol or phenol. Depending on the position of the patient, small portions of the solution are administered: when using hypobaric alcohol, the patient takes the position with the painful side up, and when administering phenol, down. In order to prevent severe complications from occurring, the procedure must be performed by a highly qualified specialist. Phenol can also be administered epidurally. Recently, the procedure has been carried out under fluoroscopic control: first it is necessary to visualize the tip of the catheter as it moves towards the root, then inject 6% water solution phenol. The risk of complications (loss of sensory or motor function) in this case is lower than with intrathecal administration.

Neuroadenolysis of the pituitary gland

In patients with hormone-dependent tumors, such as thyroid or breast cancer, complicated by the development of multiple metastases, in some cases pituitary neuroadenolysis is possible. This procedure was first performed in the 1970s by G. Motsa. The intervention is performed under fluoroscopic control. The patient is in a supine position. The needle is inserted into the pituitary gland through the nasal and sphenoid cavity. After specifying the position of the needle, 0.5-6 ml of pure alcohol is injected in order to destroy the pituitary gland. The most common complications of this procedure are headache, hypothyroidism, adrenal hypofunction and diabetes insipidus. Recently, the procedure is rarely used.

Blockade of sympathetic nerves with neurolytics

A connection has been established between the sympathetic nervous system and nearby CHD, including CHD with oncological diseases. Blockade of sympathetic nerves can be used in the treatment of cancer pain in the presence of neuropathic syndrome that has developed as a result of surgery, chemotherapy, radiation therapy or infiltration of the brachial or lumbosacral plexus, as well as visceral pain resulting from organ damage abdominal cavity. To treat neuropathic pain syndrome in cancer patients, blockade of the stellate, thoracic or lumbar ganglion is used, and to eliminate visceral pain that develops as a result of damage to the organs of the upper and lower abdominal cavity, blockade of the splanchnic, solar, hypogastric and azygos nodes is prescribed.

Stellate ganglion block

Selective blockade of the stellate ganglion was first described by H. Sellheim, and then by M. Kappis (1923) and F. Brumm and F. Mandl (1924). Stellate ganglion blockade is indicated for cancer patients if they have burning pain radiating to the upper limb. The effectiveness of the procedure increases significantly when combined with thoracic sympathetic blockade. The procedure is also indicated for postherpetic neuralgia. A contraindication is a previous contralateral pneumonectomy, which is accompanied by an increased risk of pneumothorax. The procedure is also contraindicated in patients who have recently suffered a myocardial infarction. Several techniques have been developed that are used with the patient in the supine and prone position. Previously, the procedure was performed blindly, but fluoroscopic guidance is now used. The ganglion is located at the junction of the vertebral body and the transverse process of Cw. The needle is brought to the indicated point. First, local anesthesia is performed, and if it is effective, a neurolytic solution is administered. Currently, stellate ganglion blockade is performed using high-frequency thermocoagulation. The two main complications of stellate ganglion block are the development of pneumothorax and penetration of the solution into the spinal canal. Another type of complication encountered is the possibility of persistence of Horner's syndrome. When neurolysis is performed under fluoroscopic control, the potential risk of complications becomes minimal.

Sympathetic neurolysis Tp-Tsh

Previously, Tp-Tsh sympathectomy was performed surgically. With the development of imaging techniques, this procedure has become much more common. In 1979, H. Wilkinson described a technique for performing radiofrequency thermocoagulation with minimal complications. Sympathetic blockade at the level of Tn-Tsh is indicated for pain mediated by the sympathetic nervous system. Contraindications are respiratory failure and thoracic aortic aneurysm. The procedure is performed with the patient lying on his stomach under fluorographic control. 2-3 ml of phenol is added to the sympathetic chain or radiofrequency thermocoagulation is performed. The main complication is the development of pneumothorax. Sometimes intercostal neuritis occurs. In this case, sensory and motor stimulation is carried out before the main effect.

Splanchnic nerve block

For the first time, the method of blocking the splanchnic nerve using an anterior percutaneous approach was described

M. Carr1B in 1914. Recognition of the effectiveness of splanchnic nerve blockade in the treatment of patients who do not respond to solar plexus blockade has led to increased interest in this technique. Splanchnic nerve blocks are effective in reducing pain in the upper gastrointestinal (GI) tract, including the stomach and pancreas. The procedure is performed with the patient lying down under fluoroscopic control. For unilateral pain, the splanchnic nerve is blocked on the same side, but the pain is mostly bilateral, so the blockade is performed on both sides. For the 1-needle technique, it is recommended to use small (5-8 ml) doses of absolute alcohol. According to many researchers, the use of alcohol as a neurolytic agent is more effective in terms of the duration of the blockade than the use of phenol (6-10%). The location of the splanchnic nerves in a fairly narrow space allows the use of radiofrequency exposure. To block the splanchnic nerve, the needle is inserted so that it is adjacent to the middle third of the lateral surface of the vertebral body TX1-TX11. Radiofrequency exposure is carried out after a trial stimulation of sensitivity, during which the patient must confirm stimulation in the epigastric region. The splanchnic nerve block procedure can have minor, major, and severe complications. Regarding complications weak degree may include hypotension and diarrhea, which are usually reversible. The development of moderate complications, such as pneumothorax, when performing the procedure under fluorographic control is unlikely and is also reversible. Serious complications such as paraplegia are rare.

Solar plexus block

In 1914, M. Kappis introduced a technique for performing percutaneous blockade of the solar plexus. Subsequently, other methods of performing the block were developed, for example, posterior, transaortic, intradiscal and anterior approaches. Innervation of the abdominal organs begins in the anterolateral horn of the spinal cord; on the way to the sympathetic chain, the spinoventral tracts join the white communication branches. Pain impulses from internal organs abdominal cavity are transmitted by afferent nerves, which are part of the spinal nerves, but accompany the sympathetic nerves. The solar plexus is located anterior to the aorta and epigastrium, immediately in front of the diaphragm. It

formed by fibers of the preganglionic splanchnic nerves, parasympathetic preganglionic branches of the vagus nerve, some sensory branches of the phrenic and vagus nerves and sympathetic postganglionic fibers. The postganglionic nerves of these nodes innervate all organs of the abdominal cavity with the exception of part of the transverse and left sections colon, rectum and pelvic organs. Any pain originating from the visceral structures that innervate the solar plexus nerves can be effectively treated with a blockade of the solar plexus. These structures include the pancreas, liver, gallbladder, omentum, mesentery and the section of the digestive tract from the stomach to the transverse colon. Blockade of the solar plexus leads to increased motor function of the stomach. This may be positive effect treatment in patients with chronic constipation caused by the use of analgesics. Isolated cases of diarrhea and, less commonly, nausea and vomiting were observed. However, solar plexus blockade is not recommended for patients with intestinal obstruction. Typically, 50-100% alcohol is used for neurolysis. In the past, the procedure was performed blindly, although this practice continues in some clinics today. To avoid the development of complications, it is recommended to carry out the blockade under fluoroscopic control. The procedure is performed transaortically with 1 or 2 needles. U experienced doctors complications are rare. Due to the proximity of the location, it is vitally important organs, and also with the introduction of a large volume of neurolytics, the development of side effects and complications is possible. Minor complications include hypotension, diarrhea, and back pain. These complications disappear within a few days. Moderate complications include mechanical or chemical damage to organs located near the node and irritation of the genitofemoral nerve. Serious complications include paraplegia that occurs when the needle is incorrectly positioned near the spinal nerves, subarachnoid injection, neurolytic solution entering a blood vessel, kidney damage, perforation of a tumor cyst, and peritonitis. Despite the risk and the possibility of complications, solar plexus block, when performed correctly, is one of the most effective methods implementation of neurolysis. The time to maximum pain reduction varies from case to case. In most patients, the pain disappears immediately and completely; in others, it subsides gradually over several days. Carrying out repeated

Mammoloia

Mammoloia

procedures allows you to achieve pain relief again. The effect lasts for several months.

Neurolysis of the hypogastric plexus

The first attempts to interrupt the sympathetic pathways in the pelvic region were made at the end of the 19th century. (1899) M. Jaboully and G. Ruggi. In 1990, R. Planearte et al. described a method of blocking the hypogastric plexus. The superior hypogastric plexus is a continuation of the aortic plexus in the retroperitoneum below the aortic bifurcation. It is formed almost exclusively by sympathetic nerve fibers. The anatomical localization of the superior hypogastric plexus, the predominance of sympathetic nerve fibers in its composition and their role in transmitting most pain signals from the pelvic organs make this structure an ideal target for neurolysis for cancer pain arising in the pelvic organs. The procedure can be performed from a lateral approach, using 2 needles, trying to achieve the LV-SI level. It is also performed intradiscally under fluoroscopy control. The use of this technique makes it possible to achieve long-term pain relief in patients with malignant tumors of the pelvic organs.

Block of the azygos ganglion

The first report of azygos ganglion blockade performed to relieve perineal pain was published by R. Planearte et al. in 1990. The azygos ganglion is the lowest node of the sympathetic trunk. Neurolysis of the azygos nerve relieves visceral and sympathetic pain in the perineum associated with development malignant tumor in the pelvic area. The procedure is indicated when pain, reminiscent of tenesmus, in patients with colostomy, with burning localized pain, however, the duration of pain relief is less than that when using other methods of blocking the sympathetic nerves. Several techniques have been developed to perform this procedure, including lateral and transdiscal approaches. All of them require fluoroscopic control. Potential complications include rectal puncture, neurolytic injection into the nerve root and rectal cavity, and neuritis resulting from nerve root injection.

Radiofrequency thermocoagulation in the treatment of cancer pain

The use of electric current in the treatment of pain is not a new method. The first report of percutaneous direct current applied through a needle inserted into the extinguishing

serov ganglion, for the relief of trigeminal neuralgia was published by M. Kirschner

Since then, the methodology and equipment for carrying out this procedure have been constantly developed and improved. In 1965, S. Mullan et al.

And H.L. Rosomoff et al. described the procedure for performing percutaneous lateral chordotomy for unilateral cancer pain. A few years later, in 1974, W.H. Sweet and J.G. Wepsic used radiofrequency current to treat trigeminal neuralgia. In 1975, Shealy used a radiofrequency probe to interrupt the transmission of innervation through the posterior main branch of the segmental nerves. Uematsu in 1977 described a technique for transcutaneous radiofrequency treatment of the dorsal root ganglion. The development of small diameter electrodes (22 gauge) has improved the safety of radiofrequency exposure. In recent years, Skuijter has been a recognized pioneer in the development of new methods, such as the use of pulsed radio frequencies.

Radio frequency exposure is carried out by alternating electric current with a frequency of 500,000 Hz. When the generator is turned on, it occurs in the circuit electricity, which passes through body tissues that act as resistance. When current passes through a resistance, heat is generated. In areas of the highest current density at the end of the electrode, heating reaches a maximum. The heating caused by the radiofrequency current produces localized lesions, allowing for selective nerve blockade. The destructive effect of heat on nerve tissue observed at a temperature of 45 oC. As a rule, heating is used up to 60 °C. Currently, the method of radiofrequency thermocoagulation is used in the treatment of various non-malignant and malignant pain syndromes. The application of the radiofrequency thermocoagulation method began with the development of the percutaneous lateral cordotomy procedure by S. Mullan et al. and H.L. Rosomoff et al. .

The main types of radiofrequency thermocoagulation used in the treatment of cancer pain are:

Percutaneous cordotomy;

Radiofrequency thermocoagulation of the gasserian ganglion;

Percutaneous rhizotomy;

Percutaneous radiofrequency sympathectomy.

Percutaneous cordotomy. Currently

percutaneous cervical cordotomy is one of the most important neuroablative techniques used in the treatment of oncological

checal pain. However, in recent years it has become less common. After the introduction of intraspinal methods into practice, the number of patients referred for percutaneous chordotomy decreased significantly. Only a few people in the world perform this operation. However, cordotomy still has a role in treatment severe pain in cancer patients. The goal of percutaneous cordotomy is to interrupt the spinothalamic pathway in the anterolateral quadrant, which is the main ascending nociceptive pathway of the spinal cord. Cordotomy is performed in cervical spine at the level of C1-C11 - in the place where the fibers of the lateral spinothalamic tract are concentrated in the anterolateral quadrant, which allows precise action on the desired areas: fibers emanating from the lumbosacral segments are located in the posterolateral quadrant, while the fibers of the thoracic and cervical nerves are more ventral. Cordotomy is performed without anesthesia, and the patient helps the doctor to perform constant control the position of the electrode in the spinal cord. The procedure can be performed under fluoroscopic control. First, a contrast agent is injected into the subarachnoid space to visualize its upper and lower boundaries, as well as its surface. Recently, the technique of performing cordotomy under control has become widespread. computed tomography. Percutaneous cordotomy is indicated only in the presence of unilateral pain of malignant etiology. Contraindications are the occurrence of bilateral pain and pain beyond the level >Cy, with a patient's life expectancy >1 year, as well as impaired pulmonary function and the presence of vertebral and epidural metastases. Percutaneous cordotomy is often accompanied by the development of serious complications. When applying pressure too close to the pyramidal tract, there is a risk of loss of mobility. It is also possible to develop paraplegia. In the first 48 hours after the procedure, transient urinary retention may occur. Cases of a specific syndrome have been described in which the patient can breathe independently while awake, but his breathing stops during sleep. The most unpleasant complication is dysesthesia, in which the patient feels an unpleasant feeling on the side of the body in which the pain was previously localized. This sensation usually appears after a few months. Percutaneous hordotomy is the most dangerous procedure of all percutaneous neuroablation methods and should only be performed by a very experienced specialist.

Transcutaneous radiofrequency treatment trigeminal ganglion. Typically, for pain associated with damage to the trigeminal nerve, neurolysis of the gasserian ganglion is performed. However, radiofrequency exposure is considered a less risky procedure than neurolysis. When using phenol or glycerin, there is a danger of the solution entering the brain stem, which leads to serious consequences, for example, nausea and vomiting that does not stop for several days. Thermocoagulation allows you to influence the nerve more accurately. Typically, in cancer patients, all 3 branches of the trigeminal nerve are affected, and all of them must undergo thermocoagulation. The procedure is the same as for neurolysis. Before nerve damage occurs, the patient must be able to respond to sensory stimulation. To localize the branches of the trigeminal nerve, current stimulation with a frequency of 50 Hz is used. After this, sedatives are used on the patient and all 3 branches of the nerve are affected. The complications that arise with this procedure are similar to those with neurolysis.

Percutaneous rhizotomy of the dorsal root ganglion. Partial rhizotomy of the dorsal ganglion is permitted only after successful completion of the diagnostic block. In the past, neurolytics were used for this, but their use has now been sharply reduced. The main problem is damage nerve root when passing the needle and during radiofrequency thermocoagulation. In this regard, this procedure is carried out only if all other methods are ineffective.

Percutaneous lumbar and thoracic radiofrequency sympathectomy. In the treatment of pain in cancer patients, radiofrequency thermocoagulation of the lumbar and thoracic sympathetic pathways is rarely used. Typically, for pain accompanied by involvement of the sympathetic pathways and arising, as a rule, under the influence of chemotherapy or radiotherapy, neurolytics are used. conclusions

Interventional treatments play a clearly defined and beneficial role in the treatment of chronic heart disease in a certain group of cancer patients. Optimizing the use of these techniques largely depends on the preparedness of specialists performing such procedures, their technical equipment, and the possibility of further monitoring and monitoring of patients. All these circumstances together make it possible to relieve pain from a significant group of cancer patients who do not receive help. traditional methods medicinal pain relief.

1. Wang J.K., Nauss L.A., Thomas J.E. Pain relief by intrathecally applied morphine

in man. Anesthesiology 1979;50:149-51.

2. Yaksh T.L., Rudy T.A. Analgesia madiated by a direct spinal action

of narcotics. Science 1976;192:1357-8.

3. Hartel F. Lie leitungsanesthesie und injektionsbehandlung des ganglion gasseri und der trigeminusaeste. Arch Klin Chir 1912;100:193-292.

4. Sweet W.H., Wepsic J.G. Controlled thermocoagulation of trigeminal ganglion and rootlets for differential destruction of pain fibers: I. Trigeminal neuralgia.

J Neurosurg 1974;40-3.

5. Hakanson S. Trigeminal neuralgia treated by the injection of glycerol into the trigeminal cistern. Neutosurgery 1981;9:638-46.

6. Labat G. Regional anesthesia: it's technical and clinical application. Philadelphia:

W. B. Saunders, 1922.

7. Dogliotti A.M. Traitement des syndromes douloureux de la peripherie par l "alcoolisation sus-arachnoidienne des racines posterieures a leur emergence de la moelle epiniere. Presse Med 1931;39:1249-54.

8. Morrica G. Chemical hypophysectomy for cancer pain. In: Bonica J.J. ed. Advances in Neurology. Vol. 4. NY: Raven

9. Kappis M. Weitere erfahrungen mit der symphatektomie. Klin Wehr 1923;2: 1441.

10. Brumm F., Mandl F. Paravertebrale injektion zur bekaempfung visceraler schmerzen. Wien Rhein Aschsch 1924;37:511.

11. Wilkinson H. Percutaneous radiofrequency upper thoracic sympathectomy: a new technology. Neurosurgery 1984;15:811-4.

12. Kappis M. Erfahrungen mit lokalanasthesie bei bauchoperationen. Verch Dtsch Ges Circ 1914;43-87.

13. Jaboully M. Le traitement de la neuralgie pelvienne par paralyse due sympathique sacre. Lyon Med 1899;90-102.

14. Ruggi G. Della sympathectomy mia al collo ed ale abdomen. Policlinico 1899; 103.

15. Plancarte R., Amescua C., Patt R.B., Allende S. Presacrale blockade of the ganglion of Walther (ganglion impar). Anesthesiology 1990;73; abstr 751.

16. Kirschner M. Zur electrochirurgie. Arch Klein Chir 1931;167-761.

17. Mullan S., Hekmatpanah J.,

Dobbin G., Beckman F. Percutaneous intramedullary cordotomy utilizing the unipolar anodal electrolytic lesion.

J Neurosurg 1965;22:548-53.

18. Rosomoff H.L., Carrol F., Brown J., Sheptak P. Percutaneous radiofrequency cervical cordotomy technique. J Neurosurg 1965;23:639-44.

19. Baker L., Lee M., Regnard C.

et al. Evolving spinal analgesia practice in palliative care. Palliat Med 2004;18(6):507-15.

20. De Oliveira R., dos Reis M.P.,

Prado W.A. The effects of early or late neurolytic sympathetic plexus block on the management of abdominal or pelvic cancer pain. Pain 2004;110(1-2):400-8.

21. Kite S.M., Maher E.J., Anderson K. et al. Development of an aromatherapy service at a Cancer Centre. Palliat Med 1998;12(3):171-80.

22. Levy M.J., Topazian M.D., Wiersema M.J. et al. Initial evaluation of the efficacy and safety of endoscopic ultrasound-guided direct ganglia neurolysis and block. Am

J Gastroenterol 2007;102(8):1759-64.

23. Perry G.F., Shane B. Interventional approaches to treating cancer pain. ASCO, 2009 educational book; p. 583-9.

24. Plancarte R., De Leon-Casaola O.A. Neurolytic superior hypogastric plexus block for chronic pelvis pain associated with cancer. Reg Anesth Pain Med 1997;22:562-8.

In St. Petersburg they will tell you how to overcome pain

On October 4-6, the VII All-Russian Scientific and Practical Conference “Interventional Methods for the Treatment of Chronic Pain” will be held at the St. Petersburg Hotel, at which Russian specialists and foreign colleagues will discuss how to quickly and effectively alleviate the condition of patients suffering from chronic pain syndrome .

Foreign guests of the event will be expert doctors from Israel. One of them is Itay Gur-Arie, director of the pain clinic. medical center Sheba in Tel Hashomer. Israeli methods of diagnosing and treating chronic pain are widely known throughout the world, but not all clinics have the opportunity to invite foreign doctors to exchange experience or send specialists for training abroad. In Russia, the educational mission in the field of treatment of chronic pain was undertaken by the medical holding "Medica", having managed not only to provide the necessary knowledge to its own specialists of the Pain Treatment Clinic, but also to provide a unique opportunity for doctors in other regions to become acquainted with the latest achievements in the field practical application methods of pain therapy. The list of specialists who will certainly find it useful and interesting to attend the event is unusually wide, because pain can be a concomitant component of almost every disease. Traditionally, among the guests of the conference there are many anesthesiologists-resuscitators, neurologists, surgeons, traumatologists, orthopedists, dentists and rheumatologists, that is, specialists who are most often encountered with the manifestation of pain in a patient.

As a rule, patients who have pain syndrome moved to chronic stage, and taking medications no longer brings adequate relief. Every year there are more and more such patients in Russia, reaching, according to various sources, from 40 to 65% of the population, but the number of specialized treatment centers can be counted on one hand. So, today their number in our country amounts to tens throughout the country, while in the USA it is in the thousands. But indirectly, in addition to the patients themselves, their relatives, who do not know how to alleviate the condition of a loved one, often become victims of pain.

By the way, the MEDICA Pain Treatment Clinic is one of the very first such specialized centers, which opened in St. Petersburg in 2014. His distinctive feature- comprehensive, individual approach to patients. Specialists carry out treatment only after accurately identifying the source of pain and simultaneously with treatment of the underlying disease. At the conference, the doctors of the clinic will share their successful experience of their medical practice: anesthesiologist-resuscitator Ivanov M., neurologist-cephalgologist Toropova A., neurosurgeon Volkov I. and botulinum therapist Samorukova E.

This year the event program will be dedicated to “Interventional methods of treating chronic pain and international standards patient management." Speakers will talk about the latest research in the diagnosis and treatment of headaches and back pain, chronic pain in children, pain due to cancer and other forms of pain. 2 days of the conference will be devoted to theoretical aspects. On the 3rd day, those interested will be able to take part in a practical master class, where using structured models they will be able to familiarize themselves with the principles of ultrasound diagnostics when carrying out minimally invasive interventions.

This year the conference will be held for the 7th time. From year to year, the growing percentage of its attendance and the lack of knowledge in the field of treatment of chronic pain in Russia are the main indicators of the social significance of the project, speaking in favor of its further development and improvement.

V annual international scientific and practical Seminar

Main partner of the seminar Allergan Company

MEDICA pain treatment clinic together with

Clinical Hospital No. 122 named after. L.G. Sokolova

invite anesthesiologists, neurologists, surgeons,
neurosurgeons, dentists, doctors general practice participate
at the V annual international scientific and practical Seminar

"Interventional methods for the treatment of chronic pain"
September 30 - October 1, 2016.

SEMINAR TOPIC: "HEADACHE AND FACIAL PAIN"

The theoretical part of the Seminar in 2016 is planned within the framework of the XVIII All-Russian Scientific and Practical Conference with international participation “Davidenkov Readings” (neurology).

The seminar will consist of two parts:

THEORETICAL PART(course of lectures, first day):

Within the framework of the XVIII All-Russian Scientific and Practical Conference with international participation (neurology) “Davidenkov Readings”

Venue of the theoretical part: St. Petersburg, hotel "Park Inn Pulkovskaya" (Pobedy square, 1, metro station "Moskovskaya")
(1st day, September 30) - FOR FREE

11.25-11.30 greeting

11.30-12.00
Topic “Cervicogenic headache: symptoms, diagnosis, treatment, case descriptions”

12.00-12.30 Vladimir Gennadievich Gorelov (England) - anesthesiologist, candidate of medical sciences, chief physician at the pain clinic at Spire Elland Hospital (England). Fellow of the Royal College of Anesthetists; Fellow, Faculty of Pain Medicine, Royal College of Anesthetists; member of the Association of Anesthesiologists; Member of the European Society of Anesthesiologists; Member of the International Headache Society.
Topic “Technique of blocks, radiofrequency ablation performed at the cervical level”

12.30-13.00 Volkov Ivan Viktorovich - neurosurgeon at the MEDICA Pain Treatment Clinic, Ph.D. Member of the Association of Neurosurgeons of Russia; Member of the international association “World Institute of Pain” (WIP); Member of the international association "AOspine".
Topic “Trigeminal neuralgia. Interventional treatment of neuropathic facial pain"

13.00-13.30 Kovpak Dmitry Viktorovich – psychotherapist, Ph.D. Associate Professor of the Department of Psychology and Pedagogy of North-Western State Medical University named after. I.I. Mechnikov. Scientific director of the section of psychotherapy and psychological counseling of the St. Petersburg Psychological Society. Co-chairman of the section cognitive- behavioral psychotherapy Russian Psychotherapeutic Association. Chairman of the Association for Cognitive Behavioral Psychotherapy (ACPT).
Topic "Cognitive-behavioral therapy in the treatment of chronic pain syndrome"

13.30-14.00 discussion, break

14.00-14.30 Budovsky Alexander Ivanovich - chief doctor of the Budovsky Dentistry clinic. Orthopedic dentist. Administrator of the largest dental forum in Russia (Gnathology section).
He studied repeatedly in Germany and England. Constantly participates in seminars and courses on dentistry in Russia.
Topic « Effective diagnostics and treatment of temporomandibular joint dysfunction"

14.30 -15.00 Isagulyan Emil Davidovich - Researcher of the group of functional neurosurgery, Member of the International Association for the Study of Pain (IASP - International Association Study of Pain), International Association for Neuromodulation (INS - International Neuromodulation Society), European Association of Stereotactic and Functional Neurosurgeons (ESSFN - European Stereotactic and Functional Neurosurgeon) . Neurosurgeon of the Research Institute of Neurosurgery named after. acad. N.N. Burdenko, Ph.D.
Topic "Neurostimulation for drug-resistant headache and facial pain"

15.00-15.30 Samartsev Igor Nikolaevich - Assistant at the Department of Nervous Diseases of the V.Med. CM. Kirov, leading specialist of the Pain Treatment Center of the Moscow Medical Academy named after. CM. Kirov, kmn.
Topic “Practical recommendations for the management of a patient with pain in the shoulder area”

15.30-16.00 discussion, break

16.00-16.30 Toropova Anna Albertovna – neurologist, cephalgologist at the MEDICA Pain Treatment Clinic. Member of the Interregional Public Organization of Botulinum Therapy Specialists (MOOSBT).
Topic “Myofascial pain syndrome of the face. Clinic, differential diagnosis, patient management tactics"

16.30-17.00 Lobzina Anastasia Sergeevna - neurologist
Topic"Chronic migraine"

17.00-17.30 Latysheva Nina Vladimirovna – Associate Professor of the Department of Nervous Diseases of the Institute of Postgraduate Education of the First Moscow State Medical University named after. THEM. Sechenova, neurologist at the Clinic of Headache and Autonomic Disorders of Academician Alexander Vein, Ph.D.
Topic « Modern approaches to the differential diagnosis and treatment of chronic migraine"

17.30-18.00 discussion and summing up, closing of the Seminar.
Issuance of certificates (non-state standard)

PRACTICAL PART:

Location: St. Petersburg, Pain Treatment Clinic “MEDICA”, Clinical Hospital No. 122 named after. L.G. Sokolova,
Lunacharsky Ave., 49.

Number of participants in the practical course – no more than 20 people (2 groups of 10 people each)

ATTENTION! 3 SPOTS LEFT IN THE GROUP!
Cost of participation - 50,000 rub.

All participants who have completed training within the practical part (when attending the theoretical part) will be issued a state-issued certificate of completion of thematic improvement.

9.00-14.15 (1 group 9.00-11.30, 2 group 11.45-14.15, 11.30-11.45 coffee break)

Block 1: Technique of interventional procedures using ultrasound navigation

Moderator: Ivanov Marat Dmitrievich - anesthesiologist-resuscitator, leading specialist at the MEDICA Pain Treatment Clinic. Anesthesiologist, Department of Anesthesiology and Resuscitation, Federal State Budgetary Institution Scientific Research Children's Orthopedics named after. G.I. Turner.

Sonoanatomy of the upper, lower limbs, torso (muscles, nerve plexuses, blood vessels).

Ultrasound navigation for invasive manipulations (demonstration of approaches on a model)

Occipital nerve block using ultrasound navigation

9.00-14.15 (1st group 11.45-14.15, 2nd group 9.00-11.30, 11.30-11.45 coffee break)

Block 2: Technique of interventional procedures using X-ray navigation

Moderator: Gorelov Vladimir Gennadievich - anesthesiologist, candidate of medical sciences, chief physician at the pain treatment clinic at Spire Elland Hospital (England).

Blockade/radiofrequency ablation of the medial branches CIII-CVII from the posterior approach (Cerv. medial branch block)

Bipolar radiofrequency denervation of the CII-CIII facet joint

Transforaminal/epidural block of cervical roots (Cerv. nerve root/transforaminal epidural)

Stellate ganglion block

Temporomandibular joint block (TMJ block)

14.15-15.00 Dinner

15.00-18.00 (1st group 15.00-16.30, 2nd group 16.30-18.00)

Block 3: Technique of interventional procedures using X-ray navigation

Moderator:Ivan Viktorovich Volkov - neurosurgeon at the MEDICA Pain Treatment Clinic, Ph.D.

Technical aspects of pulsed radiofrequency ablation of the peripheral branches of the trigeminal nerve

Technical aspects of radiofrequency ablation of the Gasserian ganglion, pterygopalatine ganglion

15.00-18.00 (1st group 16.30-18.00, 2nd group 15.00-16.30)

Block 4: Administration of botulinum toxin for chronic migraine. Hemifacial pain spasm. Clinic, diagnostic algorithm, local injection therapy technique

Moderator: Krasavina Diana Alexandrovna - Associate Professor of the Department of Surgical Diseases childhood"St. Petersburg State Pediatric medical university, Doctor of Medical Sciences, All-Russian trainer in botulinum therapy.

Administration of Botox for chronic migraine