Глава 8. Болевой синдром при травме и шоке (доц. М.А. Кацадзе, доц. О.Ю. Кузнецова, проф. В.А. Михайлович) ........... 266

Особенности ноцицептивной импульсации при травме . ..... 267

Влияние болевого фактора на тяжесть шока ......... 269

Роль ведущего повреждения в проявлениях болевого синдрома . .271

Лечение болевого синдрома при травме . . . ....... 289

Роль методов местной анестезии .............. 287

Глава 9. Трудно купируемые боли у онкологических больных (проф. И. А. Фрид, д-р мед. Наук в. Г. Беляев) . . .......... 295

Особенности проблемы и обезболивания в онкологии ...... 293

Патогенез и клиническая картина хронического болевого синдрома

V онкологических больных . . . . ............ 295

Лечение хронического болевого синдрома у онкологических больных 299

Лекарственная терапия ................ 300

Нейрохирургические операции . . . .......... 312

Дополнительные методы . . . . . .......... 313

Заключение ...................... 316

Список литературы ..................... 320

CONTENTS

Introduction . . . . . . . ............... 3

Chapter 1. Neurophysiological mechanisms of pain (Yu. D. Ignatov, A. A. Zaifseu) . .................... 7

The receptor system and afferent conductors of pain sensitivity . . . 7

Segmentary mechanisms of the formation of pain flow and ascending pathways of pain sensitivity . . . . . ......... 12

Suprasegrnentary structures and mechanisms of integration of pain 30

Morphofunctional organisation of the brain analgetic systems ... 38 Neurophysiological mechanisms of the formation of hcmodynamic nociceptive reactions . . . . . . . ........... 44

Chapter 2. Neuropnarmacology of opiates and opioids (A. A. Zaifseu, Yu. D. Ignatov) . . . . . . .............. 65

Pharmacodynamics and pharmacokinetics of analgetics . .... 65

Opioid peptidcs . . . . . . . ........... 73

Antagonists of opiates and opioids ............ 75

Opiate regional analgesia . . . . . . ........ 76

Neuronal mechanisms of analgetic action of narcotic analgetics and opioid peptides . . . . . . . ............ 80

The influence of opiates and opioids on the brain analgetic systems 87 Neurochemical bases of the analgetic effect of analgetics and opioid peptides . . . . . . ................ 92

Scrotoninergic mechanisms of the analgetic effect of opiates and opioids . . . . . . .............. .92

Adrencrgic mechanisms of the analgetic effect of opiates and opioids . . . . . . . ...........:.. 95

GABAcrgic mechanisms of the analgetic effect of opiates and opioids . . . . . . .............. 98

Psychopharmacological mechanisms of the analgetic effect of opiates and opioids . . . . . . ............... 102

Neuropharmacological correction of hemodynamic pain reactions . 108

Chapter 3. Side effects of narcotic analgetics {E. E. Zwartao) . . . .118

Opiate tolerance . . . . . . ............. 118

Opiate dependence . . . . . ............. 124

The influence of narcotic analgetics on respiration ....... 129

The influence on intestinal motility . . . . ........ 132

Chapter 4. Pathophysiological aspects of pain (N. N. Petrishchev} . .134

The influence of pain on hemostasis . . . . ........ 134

The influence of pain on respiration ............. 145

Chapter 5. Nonmedicamentous methods of treatment of the pain syndrome(A. T. Kachan, V. P. Lebedev, V. S. Lobzin, V. S. Lobzin) . . . . .151

Acupuncture analgesia . . . . . . . .......... 151

Mechanisms of acupuncture analgesia ........... 153

Methods of the acupuncture action ...... . . . . 155

Transcranial electroanalgesia . . . . . . ......... 162

Physioitierapy in arresting the pain . . .......... 180

Chapter 6. The pain syndrome in ischemic heart disease (O. Yu. Kuznetsova, V. A. Mikhailouich, V. V. Ruksin) . . . . ....... 189

Morphofunctional bases of nociception in IHD ......... 189

Clinical characteristics of pain ........ . . . . .193

Analgesia in IHD . . . ................ 205

Chapter 7. The pain syndrome in diseases of the nervous system . . . 233 Systematization of pain syndromes in clinical neurology (V.S. Lobzin) . . . . . .................. 233

Pathogenesis and clinical course of pain syndromes in neuropathology 236

Syndromes of central origin . . . . . ........ 236

Syndromes of peripheral origin ............. 242

Principles and methods of pathogenetic therapy of pain syndromes . 255

The effectiveness of complex therapy and choice of leading direc­tions in arresting pain in clinical neurology . . . .... 255

Chapter 8. The pain syndrome in trauma and shock (M. A. Katsadze, O.Yu. Kuznetsova, V. A. Mikhailovich) ............. 266

Specific features of nociccptive impulsation in trauma ...... 267

The influence of pain factor on the degree of shock ....... 269

The role of the leading injury in manifestations of the pain syndrome 271 Treatment of the pain syndrome in trauma .......... 279

The role of methods of local anesthesia .......... 287

Chapter 9 Hard-arrested pains in oncological, patients (I. A. Frid, V.O. Belyaev) . . . . . ............... 293

Specificitv of the problem and analgesia in oncology ...... 293

Pathogenesis and clinical picture of the chronic pain syndrome in on­cological patients . . . . . . ............ 295

Treatment of the chronic pain syndrome in oncological patients . . 299 Medicamentous therapy ................ 300

Neurosurgical operations ............... 312

Additional methods ................. 313

Conclusion . . . . . . ................. 316

List of literature ...................... 320

БОЛЕВОЙ СИНДРОМ

Зав. редакцией В.Л. Ларин

Редактор В.Л. Ларин

Переплет художника В.Н. Нечаева

Художественный редактор Т.Г. Кашицкая

Технический редактор Э.П. Выборнова

Корректор Т. Н. Шлёнская

ИБ № 5422. Монография

Сдано в набор 11.04.90. Подписано в печать 30.10.90. Формат бумаги 60X88¹/₁₆ Бумага офсет.№1 Гарнитура литературная. Печать офсетная. Усл. печ. л. 2058. Уел кр-отт 20,58. Уч.-изд. л. 22,57. Тираж 20000 экз. Заказ № 631. Цена 1 р. 70 к.

Ленинград, ордена Трудового Красного Знамени издательство «Медицина», Ленинградское отделение. 191104, Ленинград, ул. Некрасова, д. 10. Ленинградская типография № 4 ордена Трудового Красного Знамени Ленинградского объединения «Техническая книга» им. Евгении Соколовой Государственного комитета СССР по печати. 191126, Ленинград. Социалистическая ул., 14.