Laser correction procedure for pain syndrome

FIELD: medicine.

SUBSTANCE: correction of pain syndrome accompanying severe psoriasis is ensured with skin irradiation within affected region or above inflammatory tissue using low intensity IR rays of CO2 laser. Laser wavelength is 10.6 mcm. Radiation power density in pulse-periodic regime is 0.015-1 Wt/cm2, radiation pulse duration is 0.5-10 mc, pulse window is 10-100 mc, and highly directional IR radiation divergence is 10-2 radians. While radiation, laser beam is moved on skin within affected region during 5-10 minutes, herewith zone exposure duration determined by laser beam diameter is 1-2 sec. Skin is preliminary coated with adenosine triphosphate with daily exposure within course of 10-15 days.

EFFECT: evident reparative analgesic effect, reduced time of hospital stay, prevention of complications.

1 ex

 

The invention relates to medicine, in particular to a method of laser correction of pain syndrome in severe forms of psoriasis.

Characteristic radiation of CO2laser having a wavelength of 10.6 μm, is its strong absorption by biological tissues, which is caused by the absorption of the contained water molecules. At a wavelength of 10.6 µm water absorption ratio μand=856,7 cm-1. The characteristic penetration depth of the radiation CO2laser in water L=1/μandon which the radiation intensity decreases 2.73 times, is ˜12 μm. With strong absorption and low scattering of radiation CO2laser in biological tissues is associated its use primarily in surgery as a "light scalpel".

Informed use of laser radiation to reduce (edema) pain became possible after it was found that peripheral nerves and neurons sensitive to light. In 1971 there was a message about the change in the activity of cells isolated abdominal ganglion Aplysia when exposed to radiation of an argon laser (Folk R.J. Laser stimulation of nerve cell Aplysia // Science. 1971. V.I 71. P.907-908).

When comparing the responses of a neuron to the action of radiation of the near and middle infrared bands, it was found that the threshold density is here the power of radiation, calling the response of the neuron is reduced by seven orders of magnitude, from 0.45 to 2×10-8W/cm2when the transition from the spectral range of 0.8-3 μm to a wavelength of CO2laser (10.6 μm). This fact is testified to the existence of the mechanism of high spectral selectivity of the membrane of a neuron (Pavlenko and others, Thermoreceptors function of the receptor of the crayfish stretch // Physiological journal of the USSR. I.M. Sechenov. LXI. 1975. No. 6. S-932).

The influence of low-intensity infrared radiation on neurons warm-blooded animals was studied by using the method of local fixation potential (patch - clamp method), studied the influence of infrared radiation spectral range 1-56 μm on slow sodium channels in cultured dissociated neurons in spinal ganglia of the rat (Plakhova V.B. have been and other Possible mechanisms of action of infrared radiation on the membrane of the sensory neuron // Sensory systems. 2003. V.17. N 1. P.24-31).

The methodology used allowed us to obtain quantitative data about the response of the neuron's membrane by the action of radiation by measuring a threshold of potentialcustomers activation of the portal system of slow sodium channels. The results of these studies have attested to the fact that the infrared radiation reduces the value of the threshold potentiometricdetermination portal device slow sodium channels (Na v1.8). The effect of radiation was removed by ouabain, a specific blocker of Na,K-ATPase, which confirmed its participation in the "reception" of IR radiation. Na,K-ATPase is a membrane structure of a neuron that performs the function of the ion pump and transducer signal, regulating the activation of the portal system of slow sodium channels responsible for the coding of the pain signal (Krylov BV and other Morphine reduces sensitivity to potential slow sodium channels // Russian Fiziol. the log them. I.M. Sechenov. 1999. T, No. 2. S-236).

Exposure to nerve cells by radiation of CO2laser leads to a range of consecutive physical and physiological processes. Primary among them is the absorption of radiation by molecules of ATP, due to their vibrational absorption bands in the middle infrared (IR) region of the spectrum. Energy is released in the enzymatic hydrolysis of ATP

ATP+H2About→ADP+H2O+RO3.

The enzyme reaction is Na,K-ATPase is a transmembrane protein that performs a "pumping" function and that is especially important in our consideration, transductor function. Its inclusion is due to the hydrolysis reaction of "active" molecules of ATP with after exposure to IR radiation some excess energy - activation energy (Ea). The conditions under which which the activation energy is determined energies only translational motion of the molecules, the rate constant of hydrolysis is determined by the expression (NR. Kondrat'ev, 1974)

k=al1/2exp(-Eand/RT)

in which A - pre-exponential factor, T is the temperature, R is the universal gas constant.

Absorbing the radiation of the ATP molecule acquires additional energy and goes into an excited vibrational state. The hydrolysis rate of the excited molecules increases. This is because if the molecules internal (vibrational and rotational) energy exceeding the energy of the translational motion, the dependence of the rate constant on temperature is more strong

k=ATnexp(-Ea/RT), n>1.

Transductor function of Na,K-ATPase in this case is to strengthen incident on the membrane of a nerve cell signal, emitted low-intensity radiation in the IR range. In addition, the Na,K-ATPase as transducer transmits a signal next to the membrane ion channels that regulate their excitability. The action of radiation, increasing the rate of ATP hydrolysis and, consequently, increasing energy input Na,K-ATPase in a unit of time, accompanied by a decrease in excitability it is slow sodium channels responsible for the coding of the pain signal (Krylov BV and other Morphine reduces sensitivity to potential slow Natrii the x channels // Russian Fiziol. the log them. I.M. Sechenov. 1999. T, No. 2. S-236).

The closest prototype of the adopted method of laser correction of pain syndrome in patent RU No. 2296596, including local irradiation of the skin in the affected area of low-intensity Visakhapatnam infrared CO2laser at a wavelength of 10.6 microns in the pulse-periodic mode. However, the prototype does not allow you to adjust pain syndrome, in particular, psoriatic arthritis and several other syndromes with impaired cellular process of oxidative phosphorylation.

The inventive method of treatment of patients with severe forms of psoriasis, including irradiation of the skin in the affected area of low-intensity Visakhapatnam infrared CO2laser at a wavelength of 10.6 microns in the pulse-periodic mode, implement the irradiation from 5 to 10 minutes daily, moving the beam of laser radiation on the skin in the affected area by 1-2 stops, with the following parameters: beam divergence of 10-2glad pulse duration of the radiation of 0.5 to 10 MS and the duration of pauses between 10-100 MS, the power density of 0.015-1 W/cm2and before irradiation is applied to the skin of ATP, performing a course of 10-15 sessions. The ATP content in the grease from 0.09% to 30% depending on severity.

This set of essential features of the claimed act which provides both the technical result - possible non-drug, non-invasive correction of the pain syndrome in severe forms of psoriasis, comparable in strength to act "big" analgesics. The proposed method does not violate the physiological status and the integrity of the body and has no negative side effects (addiction, the need for a gradual increase in dose, the reactions of the autonomic nervous system and higher emotional centers), reflected in the constant use of "big" analgesics. Pain is eliminated much faster than when using classical tools of pharmacology.

This technical result is determined not previously known laser irradiation with the original parameters, exogenous introduction of ATP through the skin in the affected area (by electrophoresis or by percutaneous introduction ATP-containing ointments). The authors described the mechanism of interaction of radiation WITH2laser with the membrane of nerve cells and an explanation of the achieved effect.

Example

Treatment with IR laser was performed in patients with severe forms of psoriasis in age from 21 to 65 years. Duration of illness ranged on average from 3 to 20 years. Provoking factors of the disease were: nervous stress, colds, exacerbation of hronicheskoj the gastritis, diseases of the hepatobiliary system, the intake of alcohol. Seasonal psoriasis was diagnosed in 72% of patients, the off-season at 28%. Family nature of psoriasis is set at 19.2% of all patients. The vast majority of patients were male (75%), and persons of working age was 83%. Skin lesion in all patients had widespread in the form of large plaques or diffuse lesions, often with a partial erythroderma. In 85% of patients the disease was in an advanced stage, and 15% in stationary. 40% of the observed patients were observed phenomena asthenia, complaints of itching of the skin in the area of lesions. All patients with psoriasis the process on the skin was characterized by resistance to traditional therapies (vitamins, sedatives and hyposensitizing means CRF). The drugs, steroid and immunotropic drugs previously taken with a temporary effect 67% of patients, photochemotherapy - 15%. In 23% of patients had no remission for 3 years. The duration of relapse over 12 months detected in 47% of patients.

Irradiation with a laser was performed according to the type of the local impact of lesions, pain points. All these sites were initially subjected to percutaneous introduction of ATP using iontophoresis or through the use of ATP-containing ointments. The ATP content is ointment - from 0.09% to 30% depending on the severity of the pathological area. Initial exposure time ranged from 5 min to 10 min, depending on the initial condition of the patient, the activity of the process (with greater severity of the inflammatory process initial exposure time was less). The total exposure per procedure depended on the number and size of lesions. The total time of the session of physical therapy is standard for these types of procedures. The course of treatment was 10-15 days. Physiotherapeutic procedure was performed every day.

When performing method is the improvement of the General condition 2-3 days after the start of treatment. First of all, no feeling of weakness, malaise, decreased the intensity of itching, especially at the exudative forms of psoriasis, there was a General emotional lift. 4-5 procedure continued emergence of fresh papules, was a decrease in infiltration, scaling, intensity of colour of psoriatic lesions disappeared signs of inflammation on the joints, decreased arthralgia. To 10 days of therapy was noted marked regression of psoriatic items disappeared arthralgia. In patients with psoriatic arthritis (inflammatory and degenerative radiographic pattern of joint damage) by the 15th session noted the recovery of the amount of motion is in the affected joint.

Reduced length of stay of patients in hospital on average 7-10 days. Clinical improvement was noted in 58%, clinical improvement in 43% of patients. Complications and side effects of therapy were observed. Tolerability was good. Therapy has virtually no age restrictions. It is advisable to apply it to patients other treatments are contraindicated or had no effect.

The study was conducted action of pulsed low-intensity CO2laser in patients with psoriatic arthritis and trophic ulcers of the lower extremities. The study included 15 patients with psoriatic arthritis distal and proximal interphalangeal joints of the hands and feet, as well as the elbow and knee joints. The vast majority were women. Disease duration ranged from 6 months to 10 years. Source all patients underwent laboratory examination to exclude diseases with high inflammatory and immune activity of joint damage, clinical examination with assessment of pain by visual analogue scale (VAS) in millimeters at rest and during exercise, x-rays of the affected joints was carried out only during the initial visit. Patients with trophic ulcers of the lower legs were three women over the age of 60 years, with disease duration from 10 to 3 years. Everything aziende suffered from varicose disease. Laser irradiation was carried out according to the type of the local impact of lesions, pain points. Irradiation duration of one field ranged from 1 to 4 minutes, total time of exposure per procedure did not exceed 15 minutes. Laser therapy was performed daily. The average number of procedures in the course of treatment is 12-15. Results: before treatment, the clinical symptoms of psoriatic arthritis is characterized by joint pain, morning stiffness, increase the circumference of the joints, limited movement in the joint. Pain at rest on the scale of YOUR totaled 38.2 mm, the motion - 59,0 mm, palpation - 41,3 mm After the first 4-5 procedures all patients reported a significant decrease in pain, which was quite apparent in the first 2 -3 hours after a session, but gradually increased to the beginning of the next session, although, in General, pain intensity was below its initial level, there has been a decrease in feelings of tightness, swelling of the joints. On the scale of YOUR pain alone amounted to 28.2 mm, the motion - 44 mm, palpation 36,3 mm

Clinical improvement after a course of laser therapy was achieved in all patients. Notable reparative and analgesic effect was observed in patients with trophic ulcers, which allowed for a course to reduce 3-4 times square ulcers, to achieve four is investing a good granulation, to reduce the swelling of the affected limb.

A method for the treatment of patients with severe forms of psoriasis, including irradiation of the skin in the affected area of low-intensity Visakhapatnam infrared CO2laser at a wavelength of 10.6 microns in the pulse-periodic mode, characterized in that

irradiated daily for 5 to 10 minutes, moving the beam of radiation on the skin in the affected area with stops at 1-2 s, and:

the divergence vysokonapornogo radiation 10-2glad,

the pulse duration of the radiation of 0.5 to 10 MS, and the duration between pulses of 10-100 MS,

the power density of 0.015-1 W/cm2,

before irradiation is applied to the skin of ATP, and

the course of treatment is 10-15 days.



 

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