Pharmacological and Non-pharmacological Approaches for the Management of Neuropathic Pain in Multiple Sclerosis.

Multiple sclerosis is a chronic inflammatory disease that affects the central nervous system and can cause various types of pain including ongoing extremity pain, Lhermitte's phenomenon, trigeminal neuralgia, and mixed pain. Neuropathic pain is a major concern for individuals with multiple sclerosis as it is directly linked to myelin damage in the central nervous system and the management of neuropathic pain in multiple sclerosis is challenging as the options available have limited efficacy and can cause unpleasant side effects. The literature search was conducted across two databases, PubMed, and Google Scholar. Eligible studies included clinical trials, observational studies, meta-analyses, systematic reviews, and narrative reviews. The objective of this article is to provide an overview of literature on pharmacological and non-pharmacological strategies employed in the management of neuropathic pain in multiple sclerosis. Pharmacological options include cannabinoids, muscle relaxants (tizanidine, baclofen, dantrolene), anticonvulsants (benzodiazepines, gabapentin, phenytoin, carbamazepine, lamotrigine), antidepressants (duloxetine, venlafaxine, tricyclic antidepressants), opioids (naltrexone), and botulinum toxin variants, which have evidence from various clinical trials. Non-pharmacological approaches for trigeminal neuralgia may include neurosurgical methods. Non-invasive methods, physical therapy, and psychotherapy (cognitive behavioral therapy, acceptance and commitment therapy and mindfulness-based stress reduction) may be recommended for patients with neuropathic pain in multiple sclerosis. The choice of treatment depends on the severity and type of pain as well as other factors, such as patient preferences and comorbidities. There is a pressing need for healthcare professionals and researchers to prioritize the development of better strategies for managing multiple sclerosis-induced neuropathic pain.

[Signifuing resident of the city poltava at the expense of signs stroke, risk factors and urgent measures (according to medico-social survey)].

OBJECTIVE: Introduction: The problem of cerebrovascular diseases and their most severe form - cerebral stroke is one of the most pressing problems in modern medicine due to the high level of lethality, significant disability of patients. The aim: To assess and increase the sign of residents of the city Poltava at the expense of signs of stroke, its risk factors for emergence and emergency measures for stroke. PATIENTS AND METHODS: Materials and methods: During the annual social event dedicated to the World Stroke Day, on October 27, 2017, a survey of 981 people in Poltava city was conducted by volunteer students and staff of the Department of Nervous Diseases with Neurosurgery and Medical Genetics of "Ukrainian Medical Stomatological Academy". RESULTS: Results: About the signs of a stroke were known only by 750 (76.5%) residents of the city Poltava. Only 557 people (56.8%) can provide first aid. The most well-known were women of the middle age category. An increase in arterial pressure was observed in 392 subjects (39.9%). About the presence of diabetes reported 167 (17.2%) of the respondents; the influence of stress - 659 (67.4%); tobacco-smoking - 230 (23,5%); 451 (45.8%) of the respondents had an increased body mass. CONCLUSION: Conclusions: As a result of the study, it was found that awareness among Poltava residents about a stroke at a low level, one in four people do not know the main signs of a stroke. The most common risk factors for stroke were stress, body weight and high blood pressure. Every second questionnaire will not be able to provide urgent measures for stroke.