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Боль в спине как частая причина обращения к специалисту в амбулаторных условиях
Боль в спине как частая причина обращения к специалисту в амбулаторных условиях
Пизова Н.В. Боль в спине как частая причина обращения к специалисту в амбулаторных условиях. Неврология и Ревматология (Прил. к журн. Consilium Medicum). 2018; 1: 5–9. DOI: 10.26442/2414-357X_2018.1.5-9
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Аннотация
В статье рассмотрены вопросы острых и хронических болей в спине, причины их возникновения, основные патогенетические механизмы их формирования. Представлены часто встречаемые причины болевого синдрома. Дана характеристика ноцицептивной, нейропатической и психогенной боли в спине. Описаны комплексы «красных и желтых флажков», требующих особого внимания со стороны практикующего врача. Представлены алгоритмы диагностики боли в спине. Описана тактика ведения пациента с острой и хронической болью в спине, основанная на принципах доказательной медицины. Отдельное внимание отведено месту препарата флупиртин в терапии болевого синдрома.
Ключевые слова: острая и хроническая боль в спине, диагностика, лечение, флупиртин.
Key words: acute and chronic back pain, diagnosis, treatment, flupirtine.
Ключевые слова: острая и хроническая боль в спине, диагностика, лечение, флупиртин.
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Key words: acute and chronic back pain, diagnosis, treatment, flupirtine.
Полный текст
Список литературы
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2. Dagenais S, Tricco AC, Haldeman S. Synthesis of recommendations for the assessment and management of low back pain from recent clinical practice guidelines. Spine J 2010; 10 (6): 514–29.
3. Shmagel A, Foley R, Ibrahim H. Epidemiology of Chronic Low Back Pain in US Adults: Data From the 2009-2010 National Health and Nutrition Examination Survey. Arthritis Care Res (Hoboken) 2016; 68 (11): 1688–94.
4. Smart KM, Blake C, Staines A et al. Mechanisms-based classifications of musculoskeletal pain: part 1 of 3: symptoms and signs of central sensitisation in patients with low back (± leg) pain. Man Ther 2012; 17 (4): 336–44.
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7. Морозова О.Г., Ярошевский А.А. Нейропатическая боль: взгляд невролога. Новости медицины и фармации. Неврология. 2010; 339. / Morozova O.G., Iaroshevskii A.A. Neiropaticheskaia bol': vzgliad nevrologa. Novosti meditsiny i farmatsii. Nevrologiia. 2010; 339. [in Russian]
8. Dubin AE, Patapoutian A. Nociceptors: the sensors of the pain pathway. J Clin Invest 2010; 120 (11): 3760–72.
9. Nijs J, Malfliet A, Ickmans K et al. Exp Opin Pharmacother 2014; 15 (12): 1671–83.
10. Подчуфарова Е. Боль в спине: механизмы развития и лечение. Совр. терапия в психиатрии и неврологии. 2012; 3: 47–53. / Podchufarova E. Bol' v spine: mekhanizmy razvitiia i lechenie. Sovr. terapiia v psikhiatrii i nevrologii. 2012; 3: 47–53. [in Russian]
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12. Парфенов В.А. Врачебная тактика при болях в нижней части спины. Мед. совет. 2016; 8: 76–80. / Parfenov V.A. Vrachebnaia taktika pri boliakh v nizhnei chasti spiny. Med. sovet. 2016; 8: 76–80. [in Russian]
13. Oren O, Ablin J. Precision medicine: the emerging approach to the chronic pain patient. Int J Clin Rheumtol 2013; 4: 491–9.
14. Боль: руководство для врачей и студентов. Под ред. акад. РАМН Н.Н.Яхно. М.: МЕДпресс-информ, 2009. / Bol': rukovodstvo dlia vrachei i studentov. Pod red. akad. RAMN N.N.Iakhno. M.: MEDpress-inform, 2009. [in Russian]
15. Waddell G, Burton AK. Occupational health guidelines for the management of low back pain at work: evidence review. Occup Med 2001; 51 (2): 124–35.
16. Hepguler S. Neuropathic component of low back pain. Minimally Invasive Spine Surgery: Current Aspects 2015; 8: 229–45.
17. Эрдес Ш.Ф. и др. Неспецифическая боль в нижней части спины. Клинические рекомендации для участковых терапевтов и врачей общей практики. М.: КомплектСервис, 2008. / Erdes Sh.F. i dr. Nespetsificheskaia bol' v nizhnei chasti spiny. Klinicheskie rekomendatsii dlia uchastkovykh terapevtov i vrachei obshchei praktiki. M.: KomplektServis, 2008. [in Russian]
18. Van Tulder M.Becker А, Bekkering T et al. European guidelines for the management of acute nonspecific low back pain in primary care. Eur Spine J 2006; 15 (2): 169–91.
19. Kinkade S. Evaluation and Treatment of Acute Low Back Pain. Am Fam Physician 2007; 75 (8): 1181–8.
20. Practice guidelines for chronic pain management: an updated report by the American Society of Anesthesiologists Task Force on Chronic Pain Management and the American Society of Regional Anesthesia and Pain Medicine. Anesthesiology 2010; 4: 810–33.
21. Worz R, Mueller-Schwefe G, Stroehmann I et al. Back pain: Guidelines for drug therapy. Fortschr Med 2000; 142 (5): 27–33.
22. http://instrukciya-otzyvy.ru/1432-nolodatak-po-primeneniyu-analogi-kapsuly-tabletki-golovnaya-bol-me...
23. Kornhuber J, Bleich S, Wiltfang J et al. Flupirtine shows functional NMDA receptor antagonism by enhancing Mg2+ block via activation of voltage independent potassium channels. J Neural Transm 1999; 106 (9–10): 857–67.
24. Szelenyi I, Nickel B, Borbe HO, Brune H. Mode of antinociceptive action on flupirtine in the rats. Br J Pharmacol 1989; 97: 835–42.
25. Bleyer H, Carlsson KH, Erkel HJ, Jurna I. Flupirtine depresses nociceptive activity evoked in rat thalamus. Eur J Pharmacol 1988; 151 (2): 259–65.
26. Carlsson KH, Jurna I. Depression by flupirtine, a novel analgesic agent, of motor and sensory responses of the nociceptive system in the rat spinal cord. Eur J Pharmacol 1987; 143 (1): 89–99.
27. Weiser T, Szelenyi I, Nickel B, Weinrich M. In vitro and in vivo findings about the muscle relaxing properties of flupirine. Naunyn-Schmiedeberg's Arch Pharmacol 1992; 246 (Suppl. 1): R22.
28. Jurna I, Nickel B, Lobisch M et al. Analgetisch und mioralaxierend: Flupirtine. Pharmazie 1992; 137 (35): 24–32.
29. Mueller-Schwefe G. Flupirtine in acute and chronic pain associated with muscle tenseness. Results of a postmarket surveillance study. Fortschr Med Orig 2003; 121 (1): 11–8.
30. Uberall MA, Mueller-Schwefe GH, Terhaag B. Efficacy and safety of flupirtine modified release for the management of moderate to severe chronic low back pain: results of SUPREME, a prospective randomized, double-blind, placebo- and active-controlled parallel-group phase IV study. Curr Med Res Opin 2012; 28 (10): 1617–34.
31. Wörz R. Longterm treatment of chronic pain patients with flupirtine on hepatotoxicity and persistent effectiveness from 7 months to 22 years. MMW Fortschr Med 2014; 156 (Suppl. 4): 127–34.
2. Dagenais S, Tricco AC, Haldeman S. Synthesis of recommendations for the assessment and management of low back pain from recent clinical practice guidelines. Spine J 2010; 10 (6): 514–29.
3. Shmagel A, Foley R, Ibrahim H. Epidemiology of Chronic Low Back Pain in US Adults: Data From the 2009-2010 National Health and Nutrition Examination Survey. Arthritis Care Res (Hoboken) 2016; 68 (11): 1688–94.
4. Smart KM, Blake C, Staines A et al. Mechanisms-based classifications of musculoskeletal pain: part 1 of 3: symptoms and signs of central sensitisation in patients with low back (± leg) pain. Man Ther 2012; 17 (4): 336–44.
5. Shtok V.P., Levin O.S. Spravochnik po formulirovaniiu klinicheskogo diagnoza boleznei nervnoi sistemy. M.: MIA, 2006. [in Russian]
6. Kaplan W, Wirtz V, Mantel-Teeuwisse A et al. Priority medicines for Europe and the World: 2013 upd ate. World Health Organization: Geneva, Switzerland, 2013. http://www.who.int/medicines/areas/priority_medicines/Master DocJune28_FINAL_Web.pdf.
7. Morozova O.G., Iaroshevskii A.A. Neiropaticheskaia bol': vzgliad nevrologa. Novosti meditsiny i farmatsii. Nevrologiia. 2010; 339. [in Russian]
8. Dubin AE, Patapoutian A. Nociceptors: the sensors of the pain pathway. J Clin Invest 2010; 120 (11): 3760–72.
9. Nijs J, Malfliet A, Ickmans K et al. Exp Opin Pharmacother 2014; 15 (12): 1671–83.
10. Podchufarova E. Bol' v spine: mekhanizmy razvitiia i lechenie. Sovr. terapiia v psikhiatrii i nevrologii. 2012; 3: 47–53. [in Russian]
11. Itz CJ, Geurts JW, van Kleef M, Nelemans P. Clinical course of non-specific low back pain: A systematic review of prospective cohort studies se t in primary care. Eur J Pain 2013; 17: 5–15.
12. Parfenov V.A. Vrachebnaia taktika pri boliakh v nizhnei chasti spiny. Med. sovet. 2016; 8: 76–80. [in Russian]
13. Oren O, Ablin J. Precision medicine: the emerging approach to the chronic pain patient. Int J Clin Rheumtol 2013; 4: 491–9.
14. Bol': rukovodstvo dlia vrachei i studentov. Pod red. akad. RAMN N.N.Iakhno. M.: MEDpress-inform, 2009. [in Russian]
15. Waddell G, Burton AK. Occupational health guidelines for the management of low back pain at work: evidence review. Occup Med 2001; 51 (2): 124–35.
16. Hepguler S. Neuropathic component of low back pain. Minimally Invasive Spine Surgery: Current Aspects 2015; 8: 229–45.
17. Erdes Sh.F. i dr. Nespetsificheskaia bol' v nizhnei chasti spiny. Klinicheskie rekomendatsii dlia uchastkovykh terapevtov i vrachei obshchei praktiki. M.: KomplektServis, 2008. [in Russian]
18. Van Tulder M.Becker А, Bekkering T et al. European guidelines for the management of acute nonspecific low back pain in primary care. Eur Spine J 2006; 15 (2): 169–91.
19. Kinkade S. Evaluation and Treatment of Acute Low Back Pain. Am Fam Physician 2007; 75 (8): 1181–8.
20. Practice guidelines for chronic pain management: an updated report by the American Society of Anesthesiologists Task Force on Chronic Pain Management and the American Society of Regional Anesthesia and Pain Medicine. Anesthesiology 2010; 4: 810–33.
21. Worz R, Mueller-Schwefe G, Stroehmann I et al. Back pain: Guidelines for drug therapy. Fortschr Med 2000; 142 (5): 27–33.
22. http://instrukciya-otzyvy.ru/1432-nolodatak-po-primeneniyu-analogi-kapsuly-tabletki-golovnaya-bol-me...
23. Kornhuber J, Bleich S, Wiltfang J et al. Flupirtine shows functional NMDA receptor antagonism by enhancing Mg2+ block via activation of voltage independent potassium channels. J Neural Transm 1999; 106 (9–10): 857–67.
24. Szelenyi I, Nickel B, Borbe HO, Brune H. Mode of antinociceptive action on flupirtine in the rats. Br J Pharmacol 1989; 97: 835–42.
25. Bleyer H, Carlsson KH, Erkel HJ, Jurna I. Flupirtine depresses nociceptive activity evoked in rat thalamus. Eur J Pharmacol 1988; 151 (2): 259–65.
26. Carlsson KH, Jurna I. Depression by flupirtine, a novel analgesic agent, of motor and sensory responses of the nociceptive system in the rat spinal cord. Eur J Pharmacol 1987; 143 (1): 89–99.
27. Weiser T, Szelenyi I, Nickel B, Weinrich M. In vitro and in vivo findings about the muscle relaxing properties of flupirine. Naunyn-Schmiedeberg's Arch Pharmacol 1992; 246 (Suppl. 1): R22.
28. Jurna I, Nickel B, Lobisch M et al. Analgetisch und mioralaxierend: Flupirtine. Pharmazie 1992; 137 (35): 24–32.
29. Mueller-Schwefe G. Flupirtine in acute and chronic pain associated with muscle tenseness. Results of a postmarket surveillance study. Fortschr Med Orig 2003; 121 (1): 11–8.
30. Uberall MA, Mueller-Schwefe GH, Terhaag B. Efficacy and safety of flupirtine modified release for the management of moderate to severe chronic low back pain: results of SUPREME, a prospective randomized, double-blind, placebo- and active-controlled parallel-group phase IV study. Curr Med Res Opin 2012; 28 (10): 1617–34.
31. Wörz R. Longterm treatment of chronic pain patients with flupirtine on hepatotoxicity and persistent effectiveness from 7 months to 22 years. MMW Fortschr Med 2014; 156 (Suppl. 4): 127–34.
2. Dagenais S, Tricco AC, Haldeman S. Synthesis of recommendations for the assessment and management of low back pain from recent clinical practice guidelines. Spine J 2010; 10 (6): 514–29.
3. Shmagel A, Foley R, Ibrahim H. Epidemiology of Chronic Low Back Pain in US Adults: Data From the 2009-2010 National Health and Nutrition Examination Survey. Arthritis Care Res (Hoboken) 2016; 68 (11): 1688–94.
4. Smart KM, Blake C, Staines A et al. Mechanisms-based classifications of musculoskeletal pain: part 1 of 3: symptoms and signs of central sensitisation in patients with low back (± leg) pain. Man Ther 2012; 17 (4): 336–44.
5. Шток В.П., Левин О.С. Справочник по формулированию клинического диагноза болезней нервной системы. М.: МИА, 2006. / Shtok V.P., Levin O.S. Spravochnik po formulirovaniiu klinicheskogo diagnoza boleznei nervnoi sistemy. M.: MIA, 2006. [in Russian]
6. Kaplan W, Wirtz V, Mantel-Teeuwisse A et al. Priority medicines for Europe and the World: 2013 upd ate. World Health Organization: Geneva, Switzerland, 2013. http://www.who.int/medicines/areas/priority_medicines/Master DocJune28_FINAL_Web.pdf.
7. Морозова О.Г., Ярошевский А.А. Нейропатическая боль: взгляд невролога. Новости медицины и фармации. Неврология. 2010; 339. / Morozova O.G., Iaroshevskii A.A. Neiropaticheskaia bol': vzgliad nevrologa. Novosti meditsiny i farmatsii. Nevrologiia. 2010; 339. [in Russian]
8. Dubin AE, Patapoutian A. Nociceptors: the sensors of the pain pathway. J Clin Invest 2010; 120 (11): 3760–72.
9. Nijs J, Malfliet A, Ickmans K et al. Exp Opin Pharmacother 2014; 15 (12): 1671–83.
10. Подчуфарова Е. Боль в спине: механизмы развития и лечение. Совр. терапия в психиатрии и неврологии. 2012; 3: 47–53. / Podchufarova E. Bol' v spine: mekhanizmy razvitiia i lechenie. Sovr. terapiia v psikhiatrii i nevrologii. 2012; 3: 47–53. [in Russian]
11. Itz CJ, Geurts JW, van Kleef M, Nelemans P. Clinical course of non-specific low back pain: A systematic review of prospective cohort studies se t in primary care. Eur J Pain 2013; 17: 5–15.
12. Парфенов В.А. Врачебная тактика при болях в нижней части спины. Мед. совет. 2016; 8: 76–80. / Parfenov V.A. Vrachebnaia taktika pri boliakh v nizhnei chasti spiny. Med. sovet. 2016; 8: 76–80. [in Russian]
13. Oren O, Ablin J. Precision medicine: the emerging approach to the chronic pain patient. Int J Clin Rheumtol 2013; 4: 491–9.
14. Боль: руководство для врачей и студентов. Под ред. акад. РАМН Н.Н.Яхно. М.: МЕДпресс-информ, 2009. / Bol': rukovodstvo dlia vrachei i studentov. Pod red. akad. RAMN N.N.Iakhno. M.: MEDpress-inform, 2009. [in Russian]
15. Waddell G, Burton AK. Occupational health guidelines for the management of low back pain at work: evidence review. Occup Med 2001; 51 (2): 124–35.
16. Hepguler S. Neuropathic component of low back pain. Minimally Invasive Spine Surgery: Current Aspects 2015; 8: 229–45.
17. Эрдес Ш.Ф. и др. Неспецифическая боль в нижней части спины. Клинические рекомендации для участковых терапевтов и врачей общей практики. М.: КомплектСервис, 2008. / Erdes Sh.F. i dr. Nespetsificheskaia bol' v nizhnei chasti spiny. Klinicheskie rekomendatsii dlia uchastkovykh terapevtov i vrachei obshchei praktiki. M.: KomplektServis, 2008. [in Russian]
18. Van Tulder M.Becker А, Bekkering T et al. European guidelines for the management of acute nonspecific low back pain in primary care. Eur Spine J 2006; 15 (2): 169–91.
19. Kinkade S. Evaluation and Treatment of Acute Low Back Pain. Am Fam Physician 2007; 75 (8): 1181–8.
20. Practice guidelines for chronic pain management: an updated report by the American Society of Anesthesiologists Task Force on Chronic Pain Management and the American Society of Regional Anesthesia and Pain Medicine. Anesthesiology 2010; 4: 810–33.
21. Worz R, Mueller-Schwefe G, Stroehmann I et al. Back pain: Guidelines for drug therapy. Fortschr Med 2000; 142 (5): 27–33.
22. http://instrukciya-otzyvy.ru/1432-nolodatak-po-primeneniyu-analogi-kapsuly-tabletki-golovnaya-bol-me...
23. Kornhuber J, Bleich S, Wiltfang J et al. Flupirtine shows functional NMDA receptor antagonism by enhancing Mg2+ block via activation of voltage independent potassium channels. J Neural Transm 1999; 106 (9–10): 857–67.
24. Szelenyi I, Nickel B, Borbe HO, Brune H. Mode of antinociceptive action on flupirtine in the rats. Br J Pharmacol 1989; 97: 835–42.
25. Bleyer H, Carlsson KH, Erkel HJ, Jurna I. Flupirtine depresses nociceptive activity evoked in rat thalamus. Eur J Pharmacol 1988; 151 (2): 259–65.
26. Carlsson KH, Jurna I. Depression by flupirtine, a novel analgesic agent, of motor and sensory responses of the nociceptive system in the rat spinal cord. Eur J Pharmacol 1987; 143 (1): 89–99.
27. Weiser T, Szelenyi I, Nickel B, Weinrich M. In vitro and in vivo findings about the muscle relaxing properties of flupirine. Naunyn-Schmiedeberg's Arch Pharmacol 1992; 246 (Suppl. 1): R22.
28. Jurna I, Nickel B, Lobisch M et al. Analgetisch und mioralaxierend: Flupirtine. Pharmazie 1992; 137 (35): 24–32.
29. Mueller-Schwefe G. Flupirtine in acute and chronic pain associated with muscle tenseness. Results of a postmarket surveillance study. Fortschr Med Orig 2003; 121 (1): 11–8.
30. Uberall MA, Mueller-Schwefe GH, Terhaag B. Efficacy and safety of flupirtine modified release for the management of moderate to severe chronic low back pain: results of SUPREME, a prospective randomized, double-blind, placebo- and active-controlled parallel-group phase IV study. Curr Med Res Opin 2012; 28 (10): 1617–34.
31. Wörz R. Longterm treatment of chronic pain patients with flupirtine on hepatotoxicity and persistent effectiveness from 7 months to 22 years. MMW Fortschr Med 2014; 156 (Suppl. 4): 127–34.
________________________________________________
2. Dagenais S, Tricco AC, Haldeman S. Synthesis of recommendations for the assessment and management of low back pain from recent clinical practice guidelines. Spine J 2010; 10 (6): 514–29.
3. Shmagel A, Foley R, Ibrahim H. Epidemiology of Chronic Low Back Pain in US Adults: Data From the 2009-2010 National Health and Nutrition Examination Survey. Arthritis Care Res (Hoboken) 2016; 68 (11): 1688–94.
4. Smart KM, Blake C, Staines A et al. Mechanisms-based classifications of musculoskeletal pain: part 1 of 3: symptoms and signs of central sensitisation in patients with low back (± leg) pain. Man Ther 2012; 17 (4): 336–44.
5. Shtok V.P., Levin O.S. Spravochnik po formulirovaniiu klinicheskogo diagnoza boleznei nervnoi sistemy. M.: MIA, 2006. [in Russian]
6. Kaplan W, Wirtz V, Mantel-Teeuwisse A et al. Priority medicines for Europe and the World: 2013 upd ate. World Health Organization: Geneva, Switzerland, 2013. http://www.who.int/medicines/areas/priority_medicines/Master DocJune28_FINAL_Web.pdf.
7. Morozova O.G., Iaroshevskii A.A. Neiropaticheskaia bol': vzgliad nevrologa. Novosti meditsiny i farmatsii. Nevrologiia. 2010; 339. [in Russian]
8. Dubin AE, Patapoutian A. Nociceptors: the sensors of the pain pathway. J Clin Invest 2010; 120 (11): 3760–72.
9. Nijs J, Malfliet A, Ickmans K et al. Exp Opin Pharmacother 2014; 15 (12): 1671–83.
10. Podchufarova E. Bol' v spine: mekhanizmy razvitiia i lechenie. Sovr. terapiia v psikhiatrii i nevrologii. 2012; 3: 47–53. [in Russian]
11. Itz CJ, Geurts JW, van Kleef M, Nelemans P. Clinical course of non-specific low back pain: A systematic review of prospective cohort studies se t in primary care. Eur J Pain 2013; 17: 5–15.
12. Parfenov V.A. Vrachebnaia taktika pri boliakh v nizhnei chasti spiny. Med. sovet. 2016; 8: 76–80. [in Russian]
13. Oren O, Ablin J. Precision medicine: the emerging approach to the chronic pain patient. Int J Clin Rheumtol 2013; 4: 491–9.
14. Bol': rukovodstvo dlia vrachei i studentov. Pod red. akad. RAMN N.N.Iakhno. M.: MEDpress-inform, 2009. [in Russian]
15. Waddell G, Burton AK. Occupational health guidelines for the management of low back pain at work: evidence review. Occup Med 2001; 51 (2): 124–35.
16. Hepguler S. Neuropathic component of low back pain. Minimally Invasive Spine Surgery: Current Aspects 2015; 8: 229–45.
17. Erdes Sh.F. i dr. Nespetsificheskaia bol' v nizhnei chasti spiny. Klinicheskie rekomendatsii dlia uchastkovykh terapevtov i vrachei obshchei praktiki. M.: KomplektServis, 2008. [in Russian]
18. Van Tulder M.Becker А, Bekkering T et al. European guidelines for the management of acute nonspecific low back pain in primary care. Eur Spine J 2006; 15 (2): 169–91.
19. Kinkade S. Evaluation and Treatment of Acute Low Back Pain. Am Fam Physician 2007; 75 (8): 1181–8.
20. Practice guidelines for chronic pain management: an updated report by the American Society of Anesthesiologists Task Force on Chronic Pain Management and the American Society of Regional Anesthesia and Pain Medicine. Anesthesiology 2010; 4: 810–33.
21. Worz R, Mueller-Schwefe G, Stroehmann I et al. Back pain: Guidelines for drug therapy. Fortschr Med 2000; 142 (5): 27–33.
22. http://instrukciya-otzyvy.ru/1432-nolodatak-po-primeneniyu-analogi-kapsuly-tabletki-golovnaya-bol-me...
23. Kornhuber J, Bleich S, Wiltfang J et al. Flupirtine shows functional NMDA receptor antagonism by enhancing Mg2+ block via activation of voltage independent potassium channels. J Neural Transm 1999; 106 (9–10): 857–67.
24. Szelenyi I, Nickel B, Borbe HO, Brune H. Mode of antinociceptive action on flupirtine in the rats. Br J Pharmacol 1989; 97: 835–42.
25. Bleyer H, Carlsson KH, Erkel HJ, Jurna I. Flupirtine depresses nociceptive activity evoked in rat thalamus. Eur J Pharmacol 1988; 151 (2): 259–65.
26. Carlsson KH, Jurna I. Depression by flupirtine, a novel analgesic agent, of motor and sensory responses of the nociceptive system in the rat spinal cord. Eur J Pharmacol 1987; 143 (1): 89–99.
27. Weiser T, Szelenyi I, Nickel B, Weinrich M. In vitro and in vivo findings about the muscle relaxing properties of flupirine. Naunyn-Schmiedeberg's Arch Pharmacol 1992; 246 (Suppl. 1): R22.
28. Jurna I, Nickel B, Lobisch M et al. Analgetisch und mioralaxierend: Flupirtine. Pharmazie 1992; 137 (35): 24–32.
29. Mueller-Schwefe G. Flupirtine in acute and chronic pain associated with muscle tenseness. Results of a postmarket surveillance study. Fortschr Med Orig 2003; 121 (1): 11–8.
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Авторы
Н.В.Пизова*
ФГБОУ ВО «Ярославский государственный медицинский университет» Минздрава России. 150000, Россия, Ярославль, ул. Революционная, д. 5
*pizova@yandex.ru
Yaroslavl State Medical University of the Ministry of Health of the Russian Federation. 150000, Russian Federation, Yaroslavl, ul. Revoliutsionnaia, d. 5
*pizova@yandex.ru
ФГБОУ ВО «Ярославский государственный медицинский университет» Минздрава России. 150000, Россия, Ярославль, ул. Революционная, д. 5
*pizova@yandex.ru
________________________________________________
Yaroslavl State Medical University of the Ministry of Health of the Russian Federation. 150000, Russian Federation, Yaroslavl, ul. Revoliutsionnaia, d. 5
*pizova@yandex.ru
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