Acute disseminated encephalomyelitis (AEM) and acute transverse myelitis (OPM) are autoimmune demyelinating diseases of the central nervous system. Two clinical observations of AEM and OPM developed after suffering acute coronavirus infection (SARS-CoV-2) are presented. Differential diagnosis was carried out with multiple sclerosis, encephalitis of an infectious nature, compressive myelopathy, and opticomyelitis. Both observations show an almost complete recovery of lost functions. The pathogenetic mechanisms of the development of AEM and OPM in patients with coronavirus infection are discussed. The onset of central nervous system dysimmune lesion in the context of coronavirus infection makes it necessary to monitor the clinical situation with the involvement of a neurologist for timely diagnosis and determination of therapeutic tactics that can reduce the degree of disability of patients.
Fibromyalgia (FM) often occurs under the mask of non-specific low back pain (NLBP).Objective: to compare the combined disorders and treatment efficacy in FM and chronic NLBP (chNLBP).Patients and methods. We examined 33 patients with chNLBP (27 women and 6 men, mean age 51.5±16.7 years) and 53 patients with FM (47 women and 6 men, mean age 46.8±14.6 years). Pain intensity was assessed using a numerical rating scale (NRS), using the Hospital Anxiety and Depression Scale (HADS), the Screening for Somatoform Symptoms-2 (SOMS-2), the Epworth Sleepiness Scale (ESS), Insomnia Severity Index (ISI), updated Fibromyalgia Impact Questionnaire (FIQR; disability in patients with FM), Oswestry Index (IO; disability in patients with chNLBP). Comprehensive treatment of patients included educational conversations, cognitive behavioral therapy, kinesitherapy, among drugs antidepressants, and in patients with FM anticonvulsants.Results and discussion. Previously, the diagnosis of FM was established only in 15% of patients, the diagnosis of chNLBP – in 82% of patients. The intensity of pain in FM was 7.1±1.9 points according to the NRS and was higher than in chNLBP (5.6±2.4 points; p=0.002). In the group of patients with FM compared to patients with chNLBP, significantly higher values of anxiety according to HADS (10.9±4.5 and 6.9±4.0 points; p<0.001), sleepiness according to ESS (8.2±4.6 and 6.2±4.6 points; p=0.014), somatization according to SOMS-2 (28.0 and 20.0 points; p<0.001) were detected. Possible anatomical causes of pain have been identified in all patients with chNLBP and only in 13% of patients with FM. 6 months after thestart of treatment in the FM group, pain intensity significantly (p<0.001) decreased to 3.7±2.6 points according to the NRS, anxiety to 6.7±3.5 points according to HADS, depression to 4.7±2 .6 points according to HADS, disability from 54.9±18.4 to 34.0±20.2 points according to FIQR; in chNLBP group pain intensity significantly (p<0.05) decreased to 2.6±2.1 points according to the NRS, anxiety decreased to 4.2±2.5 points according to HADS, depression to 6.5±3.3 points according to HADS, disability from 37.8±17.4 to 14.5±14.2 points according to IO.Conclusion. FM is less frequently diagnosed in comparison with chNLBP, accompanied by a higher pain intensity, anxiety, sleepiness and somatization. Complex therapy leads to a stable positive effect both in chNLBP and in FM.
Chronic low back pain (CLBP) is the most common chronic pain syndrome that causes deterioration of the quality of life and disability. Anxiety and depressive disorders are significantly more common in patients with CLBP. The negative impact of CLBP on cognitive abilities and sleep was revealed. Treatment of patients with CLBP should be started with non-pharmacological methods, including an educational program, kinesiotherapy, and cognitive behavioral therapy. Antidepressants are prescribed for CLBP to reduce the severity of associated anxiety and depressive disorders, improve sleep and relieve pain. The efficacy and safety of sertraline (Serenatа) in CLBP, its additional neurochemical mechanisms of action due to its effect on dopamine reuptake, interaction with sigma receptors, low incidence of side effects, and high adherence of patients to therapy are discussed.
Background. Fibromyalgia (FM) is manifested by chronic widespread pain syndrome, sleep disorders, fatigue and subjective cognitive impairment. There is a late diagnosis of FM in different countries; there is no data on the typical medical practice of managing patients with FM in our country. Aim. To analyse the previous typical practice of managing patients with FM. Materials and methods. Fifty three patients with FM (47 women and 6 men) were under observation; the average age was 46.814.6 years. The duration of FM symptoms (years), the intensity of pain syndrome according to a Numerical Rating Scale (NRS), quality of life using The Revised Fibromyalgia Impact Questionnaire (FIQR), emotional state according to the Hospital Anxiety and Depression Scale (HADS), and treatment were evaluated. Results. The duration of symptoms before the diagnosis of FM was 7.0 (2.015.0) years. The intensity of pain during the initial examination in patients with FM according to NRS 7.11.9 points, the effect on the quality of life of patients with FM according to FIQR 54.918.4 points. The majority of patients (85%) were not diagnosed with FM before hospitalization. There were no statistically significant differences in the intensity of pain (p=0.478), the level of quality of life (p=0.611), the level of anxiety (0.159) and depression (0.347) in the groups of patients who had or did not have a diagnosis of FM. Conclusion. FM is rarely diagnosed in our country, even in cases of diagnosis, patients in many cases do not receive effective treatment, which reflects the low awareness of doctors about modern methods of diagnosis and treatment of FM.
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