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Применение витаминов группы В в практике врача-невролога
Применение витаминов группы В в практике врача-невролога
Пилипович А.А. Применение витаминов группы В в практике врача-невролога. Consilium Medicum. 2020; 22 (9): 82–86.DOI: 10.26442/20751753.2020.9.200438
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Аннотация
Витамины – это группа органических соединений, которые необходимы для нормального физиологического функционирования, но не синтезируются организмом эндогенно и поэтому должны в небольших количествах поступать из окружающей среды. Роль витаминов группы В в функционировании клеток чрезвычайно важна: они действуют как коферменты в широком спектре катаболических и анаболических ферментативных реакций. Их эффекты тесно взаимосвязаны и особенно значимы для функционирования нервной системы, включая производство энергии, синтез и восстановление ДНК или РНК, геномное и негеномное метилирование, синтез многочисленных медиаторов и прочих нейрохимических и сигнальных молекул. Данные эпидемиологических исследований показывают, что значительная часть населения развитых стран страдает от дефицита одного или нескольких витаминов группы В и что в отсутствие оптимальной диеты введение в рацион питания комплекса витаминов группы В в адекватных дозах является рациональным подходом к сохранению здоровья мозга и организма в целом. Генетические дефекты метаболизма витаминов и витаминодефицитные состояния являются безусловными показаниями к терапии витаминами группы В. Однако наиболее распространенной причиной их назначения служит ряд неврологических заболеваний, при которых дефицит витаминов группы В отсутствует. Так, одним из самых частых показаний к назначению витаминов группы В является болевой синдром при заболеваниях опорно-двигательного аппарата и при невропатиях. Считается, что витамины группы В способны влиять на ноцицептивные и нейропатические боли, обладают собственным анальгетическим и противовоспалительным действием. Комбинированное применение витаминов В1 + В6 + В12 в большинстве случаев более предпочтительно, чем монотерапия, поскольку эти витамины выполняют синергичные биохимические роли в нервной системе, т.е. действуют сообща, и ни один из них не может заменить другой. Экспериментальные и клинические данные свидетельствуют об эффективности комплексной терапии витаминами группы В ряда заболеваний периферической и центральной нервной системы. Относительно терапии болевых синдромов можно сделать следующие выводы: витамины группы В обладают анальгетической активностью, их совместное применение более эффективно, чем монотерапия В1, В6 и В12, в лечении острых болей, комбинация витаминов В с нестероидными противовоспалительными препаратами более эффективна и безопасна, чем монотерапия последними. В будущем, скорее всего, показания к применению витаминов группы В будут только расширяться.
Ключевые слова: болевой синдром, боль в спине, дорсалгия, невропатия, витамины группы В, Нейромультивит.
B-vitamins. As an example, one of the most common indications for the prescription of B-vitamins is pain syndrome in musculoskeletal disorders and neuropathies. It is believed that B-vitamins are able to affect nociceptive and neuropathic pain, have their own analgesic and anti-inflammatory effects. In most cases, the combined use of B1 + B6 + B12 vitamins is more preferable than monotherapy, since these vitamins perform synergistic biochemical roles in the nervous system, i.e. act together, and none of them can replace the other. Experimental and clinical data showed the effectiveness of complex therapy with B-vitamins in a number of peripheral and central nervous system disorders. The following conclusions can be drawn on the treatment of pain syndromes: B-vitamins have analgesic effect, their combined use is more effective than B1, B6 or B12 monotherapy for the treatment of acute pain, the combination of B-vitamins with non-steroidal anti-inflammatory drugs (NSAIDs) is more effective and safe than monotherapy with NSAIDs. In the future, most likely, the indications for the use of B-vitamins will be expanded.
Key words: pain syndrome, back pain, dorsalgia, neuropathy, B-vitamins, Neuromultivit.
Ключевые слова: болевой синдром, боль в спине, дорсалгия, невропатия, витамины группы В, Нейромультивит.
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B-vitamins. As an example, one of the most common indications for the prescription of B-vitamins is pain syndrome in musculoskeletal disorders and neuropathies. It is believed that B-vitamins are able to affect nociceptive and neuropathic pain, have their own analgesic and anti-inflammatory effects. In most cases, the combined use of B1 + B6 + B12 vitamins is more preferable than monotherapy, since these vitamins perform synergistic biochemical roles in the nervous system, i.e. act together, and none of them can replace the other. Experimental and clinical data showed the effectiveness of complex therapy with B-vitamins in a number of peripheral and central nervous system disorders. The following conclusions can be drawn on the treatment of pain syndromes: B-vitamins have analgesic effect, their combined use is more effective than B1, B6 or B12 monotherapy for the treatment of acute pain, the combination of B-vitamins with non-steroidal anti-inflammatory drugs (NSAIDs) is more effective and safe than monotherapy with NSAIDs. In the future, most likely, the indications for the use of B-vitamins will be expanded.
Key words: pain syndrome, back pain, dorsalgia, neuropathy, B-vitamins, Neuromultivit.
Полный текст
Список литературы
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[Pilipovich A.A. Back pain: selection of therapy in terms of safety and efficacy. Consilium Medicum. 2017; 19 (2.3. Neurology and rheumatology): 56–62 (in Russian).]
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[Khabirov F.A., Khaibullint T.I., Granatov E.V. Effektivnost' i bezopasnost' neiromul'tivita pri vertebrogennykh radikulopatiiakh. Zhurnal nevrologii i psikhiatrii. 2017; 10: 38–43 (in Russian).]
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[Starchina Iu.A. Vitaminy gruppy V v lechenii zabolevanii nervnoi sistemy. Nevrologiia, neiropsikhiatriia, psikhosomatika. 2009; 2: 84–7 (in Russian).]
29. Calderon-Ospina CA, Nava-Mesa MO, Arbelaez Ariza CE. Effect of Combined Diclofenac and B Vitamins (Thiamine, Pyridoxine, and Cyanocobalamin) for Low Back Pain. Management: Systematic Review and Meta-analysis. Pain Med 2020; 21 (4): 766–81.
30. Vetter G, Bruggemann G, Lettko M et al. Shortening diclofenac therapy by B vitamins. Results of a randomized double-blind study, diclofenac 50 mg versus diclofenac 50 mg plus B vitamins, in painful spinal diseases with degenerative changes. Z Rheumatol 1988; 47 (5): 351–62.
31. Kuhlwein A, Meyer HJ, Koehler CO. Reduced diclofenac administration by B vitamins: Results of a randomized double-blind study with reduced daily doses of diclofenac (75 mg diclofenac versus 75 mg diclofenac plus B vitamins) in acute lumbar vertebral syndromes. Klin Wochenschr 1990; 68 (2): 107–15.
32. Bruggemann G, Koehler CO, Koch EM. Results of a double-blind study of diclofenac vitamin B1, B6, B12 versus diclofenac in patients with acute pain of the lumbar vertebrae. A multicenter study. Klin Wochenschr 1990; 68 (2): 116–20.
33. Levin OS, Moseikin I. Vitamin B complex (milgamma) in the treatment of vertebrogenic lumbosacral radiculopathy. Zh Nevrol Psikhiatr im SS Korsakova. 2009; 109 (10): 30–5.
34. Mibielli M, Geller M, Cohen J et al. Diclofenac plus B vitamins versus diclofenac monotherapy in lumbago: The DOLOR study. Curr Med Res Opin 2009; 25 (11): 2589–99.
35. Ковальчук В.В., Аманова Э.О., Галкин А.С. и др. Комбинированные препараты: возможность повышения эффективности и безопасности традиционной терапии боли в спине. Эффективная фармакотерапия. Неврология и психиатрия. 2017; 19: 80–8.
[Koval'chuk V.V., Amanova E.O., Galkin A.S. et al. Kombinirovannye preparaty: vozmozhnost' povysheniia effektivnosti i bezopasnosti traditsionnoi terapii boli v spine. Effektivnaia farmakoterapiia. Nevrologiia i psikhiatriia. 2017; 19: 80–8 (in Russian).]
2. Kennedy DO. B Vitamins and the Brain: Mechanisms, Dose and Efficacy. Nutrients 2016; 8 (2): 68.
3. Strokov I.A., Akhmedzhanova L.T., Solokha O.A. Vitaminy gruppy V v lechenii nevrologicheskikh zabolevanii. RMZh. Nevrologiia. Psikhiatriia. 2009; 11: 776–84 (in Russian).
4. Nardin RA, Amic AN, Raynor EM. Vitamin B(12) and methylmalonic acid levels in patients presenting with polyneuropathy. Muscle Nerve 2007; 36 (4): 532–5.
5. Zhang P, Tsuchiya K, Kinoshita T et al. Vitamin B6 prevents IL-1β production by inhibiting NLRP3 inflammasome activation. JBC Papers in Press. Published on October 12, 2016 as Manuscript M116.743815. http://www.jbc.org/cgi/doi/10.1074/jbc.M116.743815
6. Danilov A.B., Danilov Al.B. Control the pain. Biopsychosocial approach. Мoscow, 2012; p. 582 (in Russian).
7. Duan-Duan He, Yu Gao, Shan Wang et al. Systematic Administration of B Vitamins Alleviates Diabetic Pain and Inhibits Associated Expression of P2X3 and TRPV1 in Dorsal Root Ganglion Neurons and Proinflammatory Cytokines in Spinal Cord in Rats. Pain Res Management 2020; 2020: 11.
8. Zaringhalam J, Akbari A, Zali AR et al. Long-term treatment by vitamin B1 and reduction of serum proinflammatory cytokines, hyperalgesia, and paw edema in adjuvant-induced arthritis. Basic Clin Neurosci 2016; 7 (4): 331–40.
9. Gibson GE, Blass JP. Thiamine-dependent processes and treatment strategies in neurodegeneration. Antioxid Redox Signal 2007; 9: 1605–10.
10. Ang CD, Al viar MJ, Dans AL et al. Vitamin B for treating peripheral neuropathy. Cochrane Database Syst Rev 2008; 3: CD004573.
11. Kasdan M, Janes C. Carpal tunnel syndrome and vitamin B6. Plast Reconstr Surg 1987; 79: 456–8.
12. Aufiero E, Stitik T, Foye M et al. Piridoxine hydrochloride treatment of carpal tunnel syndrome: a review. Nutr Rev 2004; 3: 96–104.
13. Katan MB. How much vitamin B6 is toxic? Ned Tijdschr Geneeskd 2005; 46: 2545–6.
14. Scott K, Zeris S, Kothari MJ. Elevated B 6 levels and peripheral neuropathies. Electromyogr Clin Neurophysiol 2008; 5: 219–23.
15. Talaei A, Siavash M, Majidi H et al. Vitamin B12 may be more effective than nortriptyline in improving painful diabetic neuropathy. Int J Food Sci Nutr 2009; 60 (Suppl. 5): 71–6.
16. Al-Saaeed SM, Al-Khalisy MH. The Regenerative Role of Vitamins B1, B6, B12 in Treatment of Peripheral Neuropathy. Int J Sci Res 2015: 2411–5.
17. Mauro GL, Martorana U, Cataldo P et al. Vitamin B12 in low back pain: a randomised, double-blind, placebo-controlled study. Eur Rev Med Pharmacol Sci 2000; 4 (3): 53–8.
18. Chiu CK, Low TH, Tey YS et al. The efficacy and safety of intramuscular injections of methylcobalamin in patients with chronic nonspecific low back pain: a randomised controlled trial. Singapore Med J 2011; 52 (12): 868–73.
19. Walker BF. The prevalence of low back pain: a systematic review of the literature from 1966 to 1998. J Spinal Disord 2000; 13: 205–17.
20. Van Tulder M, Becker A, Bekkering T et al. Chapter 3. European guidelines for the management of acute nonspecific low back pain in primary care. Eur Spine J 2006; 15 (Suppl. 2): 169–91.
21. Koes BW, van Tulder MW, Thomas S. Diagnosis and treatment of low back pain BMJ 2006; 332: 1430–4.
22. Lewis J, O’Sullivan P. Is it time to reframe how we care for people with non-traumatic musculoskeletal pain? Br J Sports Med 2018; 52 (24): 1543–4.
23. Danilov A.B. Neuropathic pain. In: Golubev V.L. Selected Lectures on Neurology. 2006; p. 203–23 (in Russian).
24. Pilipovich A.A. Back pain: selection of therapy in terms of safety and efficacy. Consilium Medicum. 2017; 19 (2.3. Neurology and rheumatology): 56–62 (in Russian).
25. Calderon-Ospina CA, Nava-Mesa MO. B Vitamins in the nervous system: Current knowledge of the biochemical modes of action and synergies of thiamine, pyridoxine, and cobalamin. CNS Neurosci Ther 2020; 26: 5–13.
26. Jolivalt CG, Mizisin LM, Nelson A et al. B vitamins alleviate indices of neuropathic pain in diabetic rats. Eur J Pharmacol 2009; 612: 41–7.
27. Khabirov F.A., Khaibullint T.I., Granatov E.V. Effektivnost' i bezopasnost' neiromul'tivita pri vertebrogennykh radikulopatiiakh. Zhurnal nevrologii i psikhiatrii. 2017; 10: 38–43 (in Russian).
28. Starchina Iu.A. Vitaminy gruppy V v lechenii zabolevanii nervnoi sistemy. Nevrologiia, neiropsikhiatriia, psikhosomatika. 2009; 2: 84–7 (in Russian).
29. Calderon-Ospina CA, Nava-Mesa MO, Arbelaez Ariza CE. Effect of Combined Diclofenac and B Vitamins (Thiamine, Pyridoxine, and Cyanocobalamin) for Low Back Pain. Management: Systematic Review and Meta-analysis. Pain Med 2020; 21 (4): 766–81.
30. Vetter G, Bruggemann G, Lettko M et al. Shortening diclofenac therapy by B vitamins. Results of a randomized double-blind study, diclofenac 50 mg versus diclofenac 50 mg plus B vitamins, in painful spinal diseases with degenerative changes. Z Rheumatol 1988; 47 (5): 351–62.
31. Kuhlwein A, Meyer HJ, Koehler CO. Reduced diclofenac administration by B vitamins: Results of a randomized double-blind study with reduced daily doses of diclofenac (75 mg diclofenac versus 75 mg diclofenac plus B vitamins) in acute lumbar vertebral syndromes. Klin Wochenschr 1990; 68 (2): 107–15.
32. Bruggemann G, Koehler CO, Koch EM. Results of a double-blind study of diclofenac vitamin B1, B6, B12 versus diclofenac in patients with acute pain of the lumbar vertebrae. A multicenter study. Klin Wochenschr 1990; 68 (2): 116–20.
33. Levin OS, Moseikin I. Vitamin B complex (milgamma) in the treatment of vertebrogenic lumbosacral radiculopathy. Zh Nevrol Psikhiatr im SS Korsakova. 2009; 109 (10): 30–5.
34. Mibielli M, Geller M, Cohen J et al. Diclofenac plus B vitamins versus diclofenac monotherapy in lumbago: The DOLOR study. Curr Med Res Opin 2009; 25 (11): 2589–99.
35. Koval'chuk V.V., Amanova E.O., Galkin A.S. et al. Kombinirovannye preparaty: vozmozhnost' povysheniia effektivnosti i bezopasnosti traditsionnoi terapii boli v spine. Effektivnaia farmakoterapiia. Nevrologiia i psikhiatriia. 2017; 19: 80–8 (in Russian).
2. Kennedy DO. B Vitamins and the Brain: Mechanisms, Dose and Efficacy. Nutrients 2016; 8 (2): 68.
3. Строков И.А., Ахмеджанова Л.Т., Солоха О.А. Витамины группы В в лечении неврологических заболеваний. РМЖ. Неврология. Психиатрия. 2009; 11: 776–84.
[Strokov I.A., Akhmedzhanova L.T., Solokha O.A. Vitaminy gruppy V v lechenii nevrologicheskikh zabolevanii. RMZh. Nevrologiia. Psikhiatriia. 2009; 11: 776–84 (in Russian).]
4. Nardin RA, Amic AN, Raynor EM. Vitamin B(12) and methylmalonic acid levels in patients presenting with polyneuropathy. Muscle Nerve 2007; 36 (4): 532–5.
5. Zhang P, Tsuchiya K, Kinoshita T et al. Vitamin B6 prevents IL-1β production by inhibiting NLRP3 inflammasome activation. JBC Papers in Press. Published on October 12, 2016 as Manuscript M116.743815. http://www.jbc.org/cgi/doi/10.1074/jbc.M116.743815
6. Данилов А.Б., Данилов Ал.Б. Управляй болью. Биопсихосоциальный подход. М., 2012; с. 582.
[Danilov A.B., Danilov Al.B. Control the pain. Biopsychosocial approach. Мoscow, 2012; p. 582 (in Russian).]
7. Duan-Duan He, Yu Gao, Shan Wang et al. Systematic Administration of B Vitamins Alleviates Diabetic Pain and Inhibits Associated Expression of P2X3 and TRPV1 in Dorsal Root Ganglion Neurons and Proinflammatory Cytokines in Spinal Cord in Rats. Pain Res Management 2020; 2020: 11.
8. Zaringhalam J, Akbari A, Zali AR et al. Long-term treatment by vitamin B1 and reduction of serum proinflammatory cytokines, hyperalgesia, and paw edema in adjuvant-induced arthritis. Basic Clin Neurosci 2016; 7 (4): 331–40.
9. Gibson GE, Blass JP. Thiamine-dependent processes and treatment strategies in neurodegeneration. Antioxid Redox Signal 2007; 9: 1605–10.
10. Ang CD, Al viar MJ, Dans AL et al. Vitamin B for treating peripheral neuropathy. Cochrane Database Syst Rev 2008; 3: CD004573.
11. Kasdan M, Janes C. Carpal tunnel syndrome and vitamin B6. Plast Reconstr Surg 1987; 79: 456–8.
12. Aufiero E, Stitik T, Foye M et al. Piridoxine hydrochloride treatment of carpal tunnel syndrome: a review. Nutr Rev 2004; 3: 96–104.
13. Katan MB. How much vitamin B6 is toxic? Ned Tijdschr Geneeskd 2005; 46: 2545–6.
14. Scott K, Zeris S, Kothari MJ. Elevated B 6 levels and peripheral neuropathies. Electromyogr Clin Neurophysiol 2008; 5: 219–23.
15. Talaei A, Siavash M, Majidi H et al. Vitamin B12 may be more effective than nortriptyline in improving painful diabetic neuropathy. Int J Food Sci Nutr 2009; 60 (Suppl. 5): 71–6.
16. Al-Saaeed SM, Al-Khalisy MH. The Regenerative Role of Vitamins B1, B6, B12 in Treatment of Peripheral Neuropathy. Int J Sci Res 2015: 2411–5.
17. Mauro GL, Martorana U, Cataldo P et al. Vitamin B12 in low back pain: a randomised, double-blind, placebo-controlled study. Eur Rev Med Pharmacol Sci 2000; 4 (3): 53–8.
18. Chiu CK, Low TH, Tey YS et al. The efficacy and safety of intramuscular injections of methylcobalamin in patients with chronic nonspecific low back pain: a randomised controlled trial. Singapore Med J 2011; 52 (12): 868–73.
19. Walker BF. The prevalence of low back pain: a systematic review of the literature from 1966 to 1998. J Spinal Disord 2000; 13: 205–17.
20. Van Tulder M, Becker A, Bekkering T et al. Chapter 3. European guidelines for the management of acute nonspecific low back pain in primary care. Eur Spine J 2006; 15 (Suppl. 2): 169–91.
21. Koes BW, van Tulder MW, Thomas S. Diagnosis and treatment of low back pain BMJ 2006; 332: 1430–4.
22. Lewis J, O’Sullivan P. Is it time to reframe how we care for people with non-traumatic musculoskeletal pain? Br J Sports Med 2018; 52 (24): 1543–4.
23. Данилов А.Б. Нейропатическая боль. В кн.: Голубев В.Л. Избранные лекции по неврологии. 2006; c. 203–23.
[Danilov A.B. Neuropathic pain. In: Golubev V.L. Selected Lectures on Neurology. 2006; p. 203–23 (in Russian).]
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[Pilipovich A.A. Back pain: selection of therapy in terms of safety and efficacy. Consilium Medicum. 2017; 19 (2.3. Neurology and rheumatology): 56–62 (in Russian).]
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[Khabirov F.A., Khaibullint T.I., Granatov E.V. Effektivnost' i bezopasnost' neiromul'tivita pri vertebrogennykh radikulopatiiakh. Zhurnal nevrologii i psikhiatrii. 2017; 10: 38–43 (in Russian).]
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30. Vetter G, Bruggemann G, Lettko M et al. Shortening diclofenac therapy by B vitamins. Results of a randomized double-blind study, diclofenac 50 mg versus diclofenac 50 mg plus B vitamins, in painful spinal diseases with degenerative changes. Z Rheumatol 1988; 47 (5): 351–62.
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32. Bruggemann G, Koehler CO, Koch EM. Results of a double-blind study of diclofenac vitamin B1, B6, B12 versus diclofenac in patients with acute pain of the lumbar vertebrae. A multicenter study. Klin Wochenschr 1990; 68 (2): 116–20.
33. Levin OS, Moseikin I. Vitamin B complex (milgamma) in the treatment of vertebrogenic lumbosacral radiculopathy. Zh Nevrol Psikhiatr im SS Korsakova. 2009; 109 (10): 30–5.
34. Mibielli M, Geller M, Cohen J et al. Diclofenac plus B vitamins versus diclofenac monotherapy in lumbago: The DOLOR study. Curr Med Res Opin 2009; 25 (11): 2589–99.
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[Koval'chuk V.V., Amanova E.O., Galkin A.S. et al. Kombinirovannye preparaty: vozmozhnost' povysheniia effektivnosti i bezopasnosti traditsionnoi terapii boli v spine. Effektivnaia farmakoterapiia. Nevrologiia i psikhiatriia. 2017; 19: 80–8 (in Russian).]
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23. Danilov A.B. Neuropathic pain. In: Golubev V.L. Selected Lectures on Neurology. 2006; p. 203–23 (in Russian).
24. Pilipovich A.A. Back pain: selection of therapy in terms of safety and efficacy. Consilium Medicum. 2017; 19 (2.3. Neurology and rheumatology): 56–62 (in Russian).
25. Calderon-Ospina CA, Nava-Mesa MO. B Vitamins in the nervous system: Current knowledge of the biochemical modes of action and synergies of thiamine, pyridoxine, and cobalamin. CNS Neurosci Ther 2020; 26: 5–13.
26. Jolivalt CG, Mizisin LM, Nelson A et al. B vitamins alleviate indices of neuropathic pain in diabetic rats. Eur J Pharmacol 2009; 612: 41–7.
27. Khabirov F.A., Khaibullint T.I., Granatov E.V. Effektivnost' i bezopasnost' neiromul'tivita pri vertebrogennykh radikulopatiiakh. Zhurnal nevrologii i psikhiatrii. 2017; 10: 38–43 (in Russian).
28. Starchina Iu.A. Vitaminy gruppy V v lechenii zabolevanii nervnoi sistemy. Nevrologiia, neiropsikhiatriia, psikhosomatika. 2009; 2: 84–7 (in Russian).
29. Calderon-Ospina CA, Nava-Mesa MO, Arbelaez Ariza CE. Effect of Combined Diclofenac and B Vitamins (Thiamine, Pyridoxine, and Cyanocobalamin) for Low Back Pain. Management: Systematic Review and Meta-analysis. Pain Med 2020; 21 (4): 766–81.
30. Vetter G, Bruggemann G, Lettko M et al. Shortening diclofenac therapy by B vitamins. Results of a randomized double-blind study, diclofenac 50 mg versus diclofenac 50 mg plus B vitamins, in painful spinal diseases with degenerative changes. Z Rheumatol 1988; 47 (5): 351–62.
31. Kuhlwein A, Meyer HJ, Koehler CO. Reduced diclofenac administration by B vitamins: Results of a randomized double-blind study with reduced daily doses of diclofenac (75 mg diclofenac versus 75 mg diclofenac plus B vitamins) in acute lumbar vertebral syndromes. Klin Wochenschr 1990; 68 (2): 107–15.
32. Bruggemann G, Koehler CO, Koch EM. Results of a double-blind study of diclofenac vitamin B1, B6, B12 versus diclofenac in patients with acute pain of the lumbar vertebrae. A multicenter study. Klin Wochenschr 1990; 68 (2): 116–20.
33. Levin OS, Moseikin I. Vitamin B complex (milgamma) in the treatment of vertebrogenic lumbosacral radiculopathy. Zh Nevrol Psikhiatr im SS Korsakova. 2009; 109 (10): 30–5.
34. Mibielli M, Geller M, Cohen J et al. Diclofenac plus B vitamins versus diclofenac monotherapy in lumbago: The DOLOR study. Curr Med Res Opin 2009; 25 (11): 2589–99.
35. Koval'chuk V.V., Amanova E.O., Galkin A.S. et al. Kombinirovannye preparaty: vozmozhnost' povysheniia effektivnosti i bezopasnosti traditsionnoi terapii boli v spine. Effektivnaia farmakoterapiia. Nevrologiia i psikhiatriia. 2017; 19: 80–8 (in Russian).
Авторы
А.А. Пилипович*
ФГАОУ ВО «Первый Московский государственный медицинский университет им. И.М. Сеченова» Минздрава России (Сеченовский Университет), Москва, Россия
*aapilipovich@mail.ru
Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia
*aapilipovich@mail.ru
ФГАОУ ВО «Первый Московский государственный медицинский университет им. И.М. Сеченова» Минздрава России (Сеченовский Университет), Москва, Россия
*aapilipovich@mail.ru
________________________________________________
Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia
*aapilipovich@mail.ru
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