Запущенные страдания разрушают мозг
Интервью: Лара Петрова
Она бывает острой — возникающей из-за травмы, воспаления или инфекции. Такая боль предупреждает об опасности, сообщая о неполадках в организме. Обычно проходит по мере заживления, но в случае неполного излечения может стать хронической.
...А кому не знакома эмоциональная боль?! Психические расстройства вызывают мучения, которые мы чувствуем так же сильно, как и физические. Они приводят к ночным кошмарам и пагубным пристрастиям, например к выпивке или наркотикам.
Физическая и психическая боли тесно связаны. Первая может давать душевные расстройства, вторая приводит к соматическим заболеваниям (гипертония, инфаркт).
Душу и тело невозможно лечить как отдельные объекты. Их следует рассматривать только как единое целое. К тому же изменения, происходящие в нервной системе, неразрывно связаны с психологией пациента. А его болевое поведение, в свою очередь, затрагивает все аспекты жизни — семью, финансовые траты, то, как он работает или как учится... Именно так считает Людмила Качко, инструктор по анестезиологии Тель-Авивского университета и заведующая клиникой хронической боли детского медицинского центра «Шнайдер» (Петах-Тиква, Израиль) — единственного в своем роде специализированного учреждения на Ближнем Востоке. В Одессу она приехала, чтобы дать мастер-класс врачам областной детской клинической больницы.
— Еще двадцать лет назад считалось, что боль — такой же симптом, как повышение давления и температуры, — поясняет Людмила. — Мол, раз нет лекарей температуры или давления, то не может быть и специалиста по боли. Но позднее доказали: такой симптом, как боль, особенно хроническая, продолжающаяся больше трех месяцев, вызывает в организме независимые от самого недуга изменения. Именно в связи с данными проблемами появилась специальность «альголог» (от греческого слова «альгос» — «боль»).
Всегда настоящая...
— Человек впадает в депрессию, — продолжает Людмила Качко. — Плюс есть особые формы недугов, сопровождающиеся болью отнюдь не в месте поражения, а это приводит к так называемым защитным движениям. Некомпетентный психиатр таким пациентам запросто ставит диагноз «психологическая боль», чего на самом деле не существует, потому что боль всегда настоящая. И не имеет значения, есть у страданий физическая база или происходит то, чего не видно. Процессы — в мозгу, в психике, реальны и одинаковы.
— Почему же появляются «вторичные» боли?
— Существует сложная группа недугов, при которых боль возникает из-за не совсем ясных процессов в центральной нервной системе. То есть из-за включения «посторонних» нервов мозг «рисует» неправильную проекционную картину. Не потому, что человек психически болен, и не потому, что он лжет, — просто мозг неправильно воспринимает информацию. Один из примеров — флекторная дистрофия (атрофия Зудека). Ее очень сложно диагностировать. Больные «бродят» между невропатологом, ортопедом, травматологом и хирургом. Эта хворь — большой хамелеон. И людей, мучающихся от невероятно тяжелых, жгущих болей, часто обвиняют в симуляции...
Другой пример — постгерпетическая невралгия. У пациента был герпес, на его фоне — межреберная невралгия. Все прошло, кожа чистая, а человек продолжает жаловаться на невероятные боли. Из-за них невозможно выдержать даже прикосновение ткани! Дома приходится ходить голышом! Ко мне обращалась женщина, которая из-за мучений от такой невралгии за две недели потеряла 15 килограммов! Об этой напасти знают дерматологи и невропатологи. Но не все... И только компетентные специалисты направляют к альгологам.
От хронической боли страдают более 30 % взрослого населения, около 25 % детей. В развитых странах боль — наиболее частая причина обращения к врачу. В числе медицинских проблем она на третьем месте, после онкологии и сердечно-сосудистых заболеваний. 90 % болезней сопровождаются болью. Если она длится долго, в мозгу на уровне биохимических реакций происходят изменения, начинаются психические нарушения.
— Каковы методы лечения боли?
— Очень разнообразны, как и сама боль. С одной стороны, надо лечить процесс (конечно, если удалось установить диагноз, а это получается не всегда, особенно у детей), с другой — отдельные симптомы: нарушение сна, деятельности кишечника. Необходимо лечить и проблемы в семье — для этого нужны психологи и физиотерапевты. То есть нужно бить по всем «точкам». Плюс лекарственная терапия, физиотерапия и так далее.
— Есть ли надежда, что при излечении первопричины боль уйдет?
— Смотря в какой ситуации. Приведу пример из другой области. У человека повышенное давление. Пока он принимает таблетки, он чувствует себя хорошо. Это значит, что, в определенном плане, его вылечили. Но если прием медпрепаратов прекратить, повысится давление, велика вероятность инфаркта и инсульта. То есть один из аспектов боли — ожидания больного и его семьи: они должны быть реальными. Есть болезни, которые мы вылечиваем совместно с ортопедами, невропатологами, хирургами. Существуют недуги, когда может наступить ремиссия — улучшение самочувствия. Но проблема не только в этом. Хроническому больному нужно объяснить: с «этим» он ДОЛЖЕН ЖИТЬ — выработать психологические методы защиты и не впадать в депрессию.
— Можете привести пример, когда безнадежные, казалось бы, больные после лечения у альголога становились на ноги?
— Та же атрофия Зудека вылечивается: больной, пришедший на костылях, может уже через месяц играть в футбол. Среди моих пациентов была 10-летняя девочка, которая не могла двигать рукой. Через год этот ребенок занял третье место в Израиле по дзюдо в своей возрастной группе.
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バーバリー (Burberry)は、 バーバリー ベルト1856年にロンドンの バーバリー マフラーベイジングストークにてトーマス・ バーバリー が開業した洋服店で生まれたファッションブランドです。 バーバリーの名前の由来はスペイン語の バーバリー コート「ガバルディナ」（巡礼者の バーバリー マフラー着る上っ張り）といわれています。 バーバリー サングラス」は、1856年創業の、バーバリー ワンピースイギリスを代表するファッションブランド バーバリー マフラー .創業者であるトーマス・バーバリー(Thomas Burberry)は、1835年イギリス・サリー州ブロッカムグリーンで誕生しました。 バーバリー コー 1924年有名な" バーバリー バッグ・チェック"が誕生。 バーバリー 財布コートの裏地としてデザインされたのが起源で、 バーバリー コートいつの時代にも定番の柄として愛されています。 バーバリー コート人気の一流ブランド特集の第６弾は、「 バーバリー」のバッグ・財布などいろいろ御紹介します！ バーバリー ベルト ( Burberry)は、 バーバリー マフラーブラックレーベル1856年にロンドンのベイジングストークにてトーマス・ バーバリー 財布が開業した洋服店で生まれたファッションブランドです。 バーバリー マフラーはジョージ五世からコート・ジャケット部門のロイヤルワラントを受け、 バーバリー バッグコーチ バッグ英国王室で愛され続けることになります。 バーバリー英国王室から授与されたものです バーバリー コート.
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