Определение выраженности и клинической структуры когнитивных нарушений у пациентов с хроническим болевым синдромом различной локализации, а также факторов, влияющих на их развитие.

Цель исследования

Целью настоящего исследования являлось определение выражен-ности и клинической структуры КН у пациентов с хроническим болевым синдромом различной локализации, а также факторов, влияющих на их развитие.

Задачи исследования

1. Сравнить клинические, социо-демографические характеристики, тру-доспособность и наличие феномена ЦС у пациентов с острой болью в спине (ОБС) и  ХБС.

2. Изучить выраженность и клиническую структуру КН при ХБС по сравнению с популяционными нормативами.

3. Определить выраженность КН в зависимости от длительности болево-го синдрома и выраженности ЦС у пациентов с болью в спине.

4. Изучить выраженность и клиническую структуру КН при хрониче-ской мигрени (ХМ).  

5. Оценить влияние жалоб на нарушения памяти, наличие депрессии и тревоги, а также признаков ЦС на выраженность объективных КН у пациентов с ХБС и ХМ

6. Сравнить выраженность и структуру КН и факторов на них влияю-щих при ХБС, ХМ. 

Научная новизна и практическая значимость 

   В нашей работе впервые в России проведен анализ выраженности, клинической структуры КН при болевых синдромах различной локали-зации, также впервые был оценен вклад различных факторов, оказыва-ющих влияние на эти нарушения. Было выявлено снижение показателей нейропсихологических тестов при ХБС и ХМ по сравнению с популяци-онными нормативами, что говорит о нарушении различных аспектов ко-гнитивных функций у пациентов с ХБ.

Получены новые факты о том, что у пациентов с хроническими бо-левыми синдромами имеется когнитивная дисфункция в виде нарушения скорости обработки информации, концентрации и поддержание внима-ния, нарушения исполнительной функции и памяти.

СОДЕРЖАНИЕ

Введе-ние…………………………………………………………………………..4

Глава 1. Обзор литерату-ры……………………………………………………12

1.1 Эпидемиология и бремя хронической бо-ли………………………………..12

1.2 Хроническая боль и когнитивные наруше-ния……………………………...13

1.3 Влияние эмоциональных и когнитивных факторов на выраженность и хронизацию боли ………………………………………………………..….16

1.4 Влияние боли на когнитивные функ-ции……………………………………23

1.5 Особенности когнитивных нарушений при различных болевых син-дромых…………………………………………………………………... 25

1.6 Хроническая боль и болезнь Альцгейме-ра…………………………………31

1.7 Механизмы коморбидности хронической боли и когнитивных наруше-ний……………………………………………………………………33  

1.8 Заключение…….……………………………………………………..……...42

Глава 2. Материалы и методы………………………………………………..44

2.1 Материал исследова-ния……………………………………………………..44

2.2 Методы исследова-ния……………………………………………………….46

2.3 Статистическая обработка материа-ла………………………………………52

2.4 Дизайн исследова-ния………………………………………………………...53

Глава 3. Результаты исследова-ния…………………………………………..54

3.I Клинико-демографические характеристики пациентов с болями в спине и особенности центральной сенситиза-ции……………………………………….54

3.1.1 Демографические и клинические характеристики пациен-тов………….54

3.1.2 Причины неспецифической боли в спине и их представленность в группе с ХБС и ОБС……………………………………………………………………...56

3.1.3 Результаты анкетирования пациентов с болью в спине…………………59

3.1.4 ЦС у пациентов с болью в спине………………………………………….60

3.1.5 Альгомет-рия………………………………………………………………..63 

3.2 Выраженность и клиническая структура КН при ХБС и факторы, вли-яющие на них…….………………………………………………………..…65

3.2.1 Выраженность и клиническая структура КН при ХБС………………….65

3.2.2 Анализ факторов, влияющих на КН при ХБС……………………………68

3.2.3 Сравнение клинико-демографических показателей и результатов ко-гнитивного тестирования у пациентов с ХБС и ХМ…………………………………………………………………………….…..73

3.2.4 Сравнение результатов когнитивных тестов у пациентов с ХБС и ХМ..75 

3.2.5 Анализ факторов, влияющих на выраженность КН при ХМ и сравне-ние с ХБС……………………………………………………………………………..78

3.2.6 Корреляционный анализ факторов, влияющих на выраженность КН у пациентов с ХБС и ХМ………………………………………………………….82

Глава 4. Обсуждение полученных результа-тов……………………………..86

Выво-ды………………………………………………………………….………102

Практические рекоменда-ции…………………………………………………..103

Список условных сокраще-ний…………………………………………………104

Список литерату-ры………………………………………………………...…...106

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