mrjСовременная ревматологияModern Rheumatology Journal1996-70122310-158XIMA-PRESS, LLC10.14412/1996-7012-2015-2-37-50mrj-622Research ArticleАЛГОРИТМЫ ДИАГНОСТИКИ И ЛЕЧЕНИЯ РЕВМАТИЧЕСКИХ ЗАБОЛЕВАНИЙDIAGNOSTIC AND TREATMENT ALGORITHMS FOR RHEUMATIC DISEASESАнальгетическое лечение с использованием системного а л горитмаAnalgesic treatment, by using a systemic algorithmКаратеевА. Е.KarateevA. E.aekarateev@rambler.ruАлексееваЛ. И.AlekseevaL. I.ФГБНУ НИИР им. В.А. Насоновой, Москва, Россия 115522, Москва, Каширское шоссе, 34АРоссияV.A. Nasonova Research Institute of Rheumatology, Moscow, Russia 34A, Kashirskoe Shosse, Moscow 115522Russian Federation201509062015923750Copyright © Каратеев А.Е., Алексеева Л.И., 20152015Каратеев А.Е., Алексеева Л.И.Karateev A.E., Alekseeva L.I.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://mrj.ima-press.net/mrj/article/view/622

Контроль мышечно-скелетной боли (МСБ) является важной составляющей комплексного лечения системных воспалительных ревматических заболеваний, таких как ревматоидный артрит и спондилоартриты, и главным направлением терапии остеоартроза и неспецифической боли в спине. Развитие боли связано с рядом патогенетических механизмов: локальным воспалением, вовлечением элементов связочного аппарата, стойким мышечным напряжением, биомеханическими нарушениями, дисфункцией ноцицептивной системы. Это определяет необходимость комплексного подхода при проведении анальгетической терапии с комбинированным применением препаратов, обладающих различным механизмом обезболивающего действия. В настоящем обзоре рассматриваются «мишени» фармакотерапии МСБ и основные группы лекарственных препаратов, которые могут на них воздействовать. В статье предлагается алгоритм проведения обезболивающей терапии, основанный на диагностике отдельных элементов патогенеза хронической МСБ и последовательной оценке результатов лечения.

To control musculoskeletal pain (MSP) is an important component of combination treatment for systemic inflammatory rheumatic diseases, such as rheumatoid arthritis and spondyloarthritis, and a major area of therapy for osteoarthritis and nonspecific back pain. Pain development is associated with a number of pathogenetic mechanisms: local involvement; involvement of the elements of the ligamentous apparatus; chronic muscle tension; biomechanical disorders; dysfunction of the nociceptive system. This necessitates a comprehensive approach during analgesic therapy, with combined use of drugs having a different mechanism of analgesic action. This review considers the targets of pharmacotherapy for MSP and the main groups of medications that may affect them. The paper proposes an analgesic treatment algorithm based on the diagnosis of individual elements of the pathogenesis of chronic MSP and on the successive assessment of treatment results.

мышечно-скелетная больостеоартрознеспецифическая боль в нижней части спиныревматическая патология околосуставных мягких тканейцентральная сенситизацияанальгетическая терапиянестероидные противовоспалительные препаратыпарацетамолтрамадолmusculoskeletal painosteoarthritisnonspecific lower back painrheumatic disease of juxta-articular soft tissuescentral sensitizationanalgesic therapynonsteroidal anti-inflammatory drugsparacetamoltramadolmuscle relaxantsReferencesЯхно НН, Кукушкин МЛ, редакторы. Боль (практическое руководство для врачей). Москва: Издательство РАМН; 2012. 512 c. [Yakhno NN, Kukushkin ML, editors. Bol' (prakticheskoe rukovodstvo dlya vrachei) [Pain (a practical guide for doctors)]. Moscow: Izdatel'stvo RAMN; 2012. 512 p.]Яхно НН, Кукушкин МЛ, редакторы. Боль (практическое руководство для врачей). Москва: Издательство РАМН; 2012. 512 c. [Yakhno NN, Kukushkin ML, editors. Bol' (prakticheskoe rukovodstvo dlya vrachei) [Pain (a practical guide for doctors)]. 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The authors declare that there are no conflicts of interest present.