r-n-jРоссийский неврологический журналRussian neurological journal2658-79472686-7192МИА10.30629/2658-7947-2023-28-6-11-18r-n-j-499Research ArticleОБЗОРЫREVIEWSМетоды лечения фантомной боли с позиций доказательной медициныPhantom limb pain: actual concepts of pathophysiology and treatment methods from the standpoint of evidence-based medicinehttps://orcid.org/0000-0002-7826-5135МокиенкоА. О.MokienkoO. A.

Москва

Olesya А. Mokienko

Moscow

Lesya.md@yandex.ruhttps://orcid.org/0000-0001-5261-3552ИвкинаМ. В.IvkinaM. V.

Москва

Moscow

erekhova_m@mail.ruМосковский медицинский университет «Реавиз»; Институт высшей нервной деятельности и нейрофизиологии РАН; Научный центр неврологииРоссияMoscow Medical University “Reaviz”; Institute of Higher Nervous Activity and Neurophysiology of Russian Academy of Sciences; Research Center of NeurologyRussian FederationМосковский медицинский университет «Реавиз»; Московский государственный медико-стоматологический университет имени А.И. ЕвдокимоваРоссияMoscow Medical University “Reaviz”; Moscow State University of Medicine and Dentistry named after A.I. EvdokimovRussian Federation2023080120242861118Copyright © Мокиенко А.О., Ивкина М.В., 20242024Мокиенко А.О., Ивкина М.В.Mokienko O.A., Ivkina M.V.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.r-n-j.com/jour/article/view/499

Несмотря на большое количество исследований, посвященных эффективности различных лекарственных и нелекарственных методов терапии, до сих пор не разработана тактика лечения ФБ, что во многом обусловлено сложным механизмом ее формирования. Хотя ФБ относят к невропатической боли, стандартные методы терапии невропатической боли не всегда оказываются эффективными при данном синдроме. Для оптимизации схем существующих методов лечения ФБ, а также поиска и клинических исследований новых терапевтических подходов необходимо учитывать имеющуюся на сегодняшний день доказательную базу.

Материал и методы

Материал и методы. Проведен анализ публикаций с высоким уровнем доказательности (рандомизированных контролируемых исследований, систематических обзоров и метаанализов), посвященных методам лечения фантомной боли. Поиск литературы производился в системах Medline PubMed и eLIBRARY.

Результаты

Результаты. В обзоре приведена доказательная база для методов фармакотерапии (опиоиды, антагонисты NMDA-рецепторов, трициклические антидепрессанты, антиконвульсанты, локальные анестетики), для методов, основанных на иллюзии фантома (зеркальная терапия, представление движения, виртуальная реальность), для методов неинвазивной (чрескожная электронейростимуляция, транскраниальная магнитная стимуляция, траскраниальная электрическая стимуляция головного мозга) и инвазивной (глубокая стимуляция мозга, стимуляция моторной коры головного мозга, стимуляция спинного мозга, стимуляция ганглия дорсального корешка) нейромодуляции. Представлены данные о наиболее изученных режимах дозирования разных методов лекарственной и нелекарственной терапии.

Rationale

Rationale. Despite a large number of studies on the effectiveness of various pharmacological and non- pharmacological therapies, PLP treatment tactics have not yet been developed, which is largely due to the complex mechanism of the formation of this pathology. Although PLP is classified as neuropathic pain, standard methods of neuropathic pain therapy are not always effective for this syndrome. To optimize the regimens of existing methods of PLP treatment, as well as the search and clinical trials of new therapeutic approaches, it is necessary to take into account the currently available evidence base.

Material and methods

Material and methods. Our analysis included publications on phantom pain treatment methods with a high level of evidence (randomized controlled trials, systematic reviews and meta-analyses). Literature search was performed in Medline PubMed and eLIBRARY systems.

Results

Results. The review provides an evidence base for pharmacotherapy methods (opioids, NMDA-receptor antagonists, tricyclic antidepressants, anticonvulsants, local anesthetics), for methods based on the phantom illusion (mirror therapy, motion representation, virtual reality), for non-invasive (transcutaneous electrical neurostimulation, transcranial magnetic stimulation, transcranial electrical stimulation) and invasive (deep brain stimulation, motor cortex stimulation, spinal cord stimulation, dorsal root ganglion stimulation) neuromodulation. Data on the most studied dosing regimens of different methods of pharmacological and non-pharmacological therapy are presented.

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The authors declare that there are no conflicts of interest present.