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International neurological journal 7 (69) 2014

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Autonomic dysfunction in exacerbation soflow back pain: clinical associations opportunities of pharmacological therapy

Authors: Moskovko S.P., Kostuchenko A.V., Perova V.P.

Categories: Neurology

Sections: Clinical researches

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Keywords

back pain, autonomic dysfunction, trazodone hydrochloride.

BackgroundChronic low back pain is a leading health and socioeconomic problem. Itmarkedly decreases individuals health status and quality of life. Pain is a syndrome characterized by several neurophysiological changes including that of the autonomic nervous system. Exacerbation soflow back pain is also consistently linked with an increased risk of depression. This study was conducted to evaluate the autonomic status and pain profile in patients with exacerbation soflow back pain and to observe the effect of trazodone hydrochloride.

PurposeThe aim of this study was to study the interactions of autonomic dysfunction with other components of the clinical pattern of exacerbation of chronic low back pain, to identify the opportunities of drug therapy.

Materials and methods. The study involved 230 patients with exacerbations of chronic low back pain (95 men, 135 women). The mean age of patients was 42.91 ± 10.78 years. Patients were divided into two groups: with duration of the disease from 1 to 3 years – 117 (50.9 %), 4 years or more – 113 (49.1 %). A clinical and neurological examination with assessment of pain intensity on Visual analog pain scale (VAS), emotional state – due to Beck’s scale of depression (Beck Depression Inventory), the state of autonomic regulation in examined patients was evaluated using the method of variation pulsometry. Patients received standard combined therapy (vasoactive drugs, vitamins, physiotherapy, massage) according to the background of basic therapy a drug dose of trazodone hydrochloride 50–150 mg/day per os during 7–10 days was administered. Statistical data processing was performed in the statistical package SPSS 20 (© SPSS Inc.).

Results. With complaints of prolonged back pain in patients with exacerbation of chronic low back pain the presence of significant autonomic dysfunction and high levels of depression are set. Using psychometric tests revealed the symptoms of depression in 74.3 % of patients . The changes of variational parameters of pulsometryare due to the with exacerbation of chronic low back pain primarily in the reduction of pNN50% and indicators of variability (SDNN, Cvar) and reducing power of spectrum curve of RR intervals and its components. Indications of estimation by  Baevsky show a decrease of parasympathicotonic impactand a significantin crease in the tension of the sympathetic division of the autonomic nervous system (the index of autonomic balance and the index of tension of regulatory systems were in creased). In patients with disease duration of more than 3 years, there is a predominance of sympathetic influences.

All patients received the course of treatment with trazodone hydrochloride (tryttiko) 50–150 mg per day during 7–10 days. The therapy allowed to significant decrease the depressive symptoms, the severity of autonomic dysfunction and pain.

Conclusion.The results of study confirm the fact that the prevalence of depression and autonomic disorders among patients with exacerbations of chronic lowback pain and its negative impact on the course of pain. High efficacy of trazodone hydrochloride (tryttiko) associated with the treatment of chronic low back pain and depression, autonomic dysfunction is covered in this article.


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