СИНДРОМ ХРОНИЧЕСКОЙ БОЛИ-CHRONIC PAIN SYNDROME

Хронической болью, по данным Международной ассоциации по изучению боли, принято считать боль, которая продолжается сверх нормального периода заживления и длится не менее 3 мес . В настоящее время хроническую боль рассматривают как самостоятельное заболевание, в основе которого патологический процесс в соматической сфере и первичная или вторичная дисфункция периферической и центральной нервной систем. Неотъемлемым признаком хронической боли является формирование эмоционально-личностных расстройств, она может быть вызвана только дисфункцией в психической сфере, т.е. относиться к идиопатическим или психогенным болям . Психогенная хроническая боль наиболее распространена и наиболее сложна для диагностики и лечения. В соответствии с критериями DSM-IV понятие хронической боли используется для обозначения болевого синдрома, длящегося более 6 мес.

Хронический болевой синдром может наблюдаться в клинической картине любой депрессии. Симптомы депрессии при хроническом болевом синдроме могут быть очевидными или стертыми. Достаточно часто боль является «маской» депрессии и собственно депрессивные симптомы выступают в атипичной форме и скрыты за доминирующей в клинической картине болью. Среди синдромов маскированной депрессии некоторые авторы отдельно выделяют алгическо-сенестопатический синдром. Больные с типичными проявлениями депрессии достаточно быстро оказываются в поле зрения психиатров. Напротив, больные с атипично протекающими, маскированными депрессиями долго и подчас безрезультатно лечатся у врачей общей практики, так как распознать подобную депрессию достаточно сложно.

It may seem surprising to include the automobile as a source of indoor air pollution. Yet, not only does ambient (outdoor) air pollution enter the home, but the automobile itself has become part of the home in parts of the United States. Many houses have been built with the garage incorporated into their structures. This is particularly true in the case of ranch houses. Not uncommonly, the master bedroom is located directly above the garage and is saturated by fumes rising from it.

For the chemically susceptible, this development in modern living can be disastrous. Simply stated, garages should not be incorporated into the basements of homes unless elaborate precautions are taken to prevent fumes and odors from rising and fouling the air of the living quarters. To do this, however, is extremely difficult—in fact, nearly impossible. Even a passageway between a garage and home may allow sufficient fumes to enter the house to cause or perpetuate symptoms. Careless home construction often contributes to this problem.

A similar situation prevails in many apartment houses, where garage fumes get into the elevator shafts and contaminate the living quarters of the buildings. One partial solution to this problem is to let a car cool off completely before putting it into the garage. In this way, engine fumes will be less apt to accumulate and pollute the house.

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Eye allergies are allergic reactions of the eyes. They may affect the conjunctiva (the transparent covering over the whites of the eyes and the insides of the eyelids). They may also affect the skin on the eyelids and around the eyes.

Eye allergies are caused by a wide variety of substances carried to the eyes by the air or by the hands. Seasonal, airborne materials are pollens from trees, grass, weeds and other plants. Non-seasonal airborne materials include house dust, feathers, molds, and animal dander (tiny scales from the skin of an animal). Many irritants may be carried to the eyes by the hands, including nail polish, household cleaning products, materials from stuffed toys, and finger paints.

Signs and symptoms

The whites of the eyes become red and itchy. The eyes water, but no pus is formed. Occasionally, the whites become visibly swollen with clear jelly-like material. The eyelids become swollen and red. The skin of the eyelids may be smooth or rough and scaly. Pouches beneath the eyes may become swollen and bluish and resemble «shiners».

Certain clues can distinguish eye allergies from several other conditions that also cause reddened eyes (conditions such as conjunctivitis, viruses, foreign bodies in the eyes, sties, glaucoma). Eye allergies cause itching and tearing but never cause pain or pus. Swelling of the whites of the eyes is a key sign of an eye allergy.

Home care

Oral antihistamines usually help. With your doctor’s permission, use of eye drops containing phenylephrine or ephedrine brings temporary relief. Applying cold compresses to the eyes may also ease the discomfort. Whenever possible, identifying and avoiding the irritating substance is clearly the best solution.

Precautions

• If there is pus or pain in the eyes, the condition is probably not an allergy.

• If the pupils of the eyes are dilated (enlarged) and slow to respond to light, see your doctor.

• If home treatment is not effective in 24 hours, see your doctor.

• If vision is affected, see your doctor.

Medical treatment

Your doctor will examine the outsides and insides of your child’s eyes. Medicated eye drops are effective but are safe only after a doctor’s examination. Skin tests may be suggested to help identify the substances causing the allergic reaction. Desensitization shots over an extended period are rarely recommended.

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