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<article article-type="research-article" dtd-version="1.3" xmlns:mml="http://www.w3.org/1998/Math/MathML" xmlns:xlink="http://www.w3.org/1999/xlink" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" xml:lang="ru"><front><journal-meta><journal-id journal-id-type="publisher-id">docru</journal-id><journal-title-group><journal-title xml:lang="ru">Доктор.Ру</journal-title><trans-title-group xml:lang="en"><trans-title>Title</trans-title></trans-title-group></journal-title-group><issn pub-type="ppub">1727-2378</issn><issn pub-type="epub">2713-2994</issn><publisher><publisher-name>ООО "ГК "РУСМЕДИКАЛ"</publisher-name></publisher></journal-meta><article-meta><article-id pub-id-type="doi">10.31550/1727-2378-2023-22-6-60-66</article-id><article-id custom-type="elpub" pub-id-type="custom">docru-265</article-id><article-categories><subj-group subj-group-type="heading"><subject>Research Article</subject></subj-group><subj-group subj-group-type="section-heading" xml:lang="ru"><subject>НЕВРОЛОГИЯ</subject></subj-group><subj-group subj-group-type="section-heading" xml:lang="en"><subject>NEUROLOGY</subject></subj-group></article-categories><title-group><article-title>Неинвазивная нейромодуляция как метод обезболивания в комплексной терапии хронической боли в нижней части спины</article-title><trans-title-group xml:lang="en"><trans-title>Non-invasive Neuromodulation as a Pain Management Method in a Combined Therapy of Chronic Lower Back Pain</trans-title></trans-title-group></title-group><contrib-group><contrib contrib-type="author" corresp="yes"><contrib-id contrib-id-type="orcid">https://orcid.org/0000-0002-7498-1871</contrib-id><name-alternatives><name name-style="eastern" xml:lang="ru"><surname>Мельникова</surname><given-names>Е. А.</given-names></name><name name-style="western" xml:lang="en"><surname>Melnikova</surname><given-names>E. A.</given-names></name></name-alternatives><bio xml:lang="ru"><p>Мельникова Екатерина Александровна — д. м. н., профессор, руководитель отделения физиотерапии и реабилитации </p><p> 129110, г. Москва, ул. Щепкина, д. 61/2. </p></bio><bio xml:lang="en"><p> 61/2 Shchepkin St., Moscow, 129110 </p></bio><email xlink:type="simple">melkaterina3@yandex.ru</email><xref ref-type="aff" rid="aff-1"/></contrib><contrib contrib-type="author" corresp="yes"><contrib-id contrib-id-type="orcid">https://orcid.org/0000-0001-9371-5934</contrib-id><name-alternatives><name name-style="eastern" xml:lang="ru"><surname>Старкова</surname><given-names>Е. Ю.</given-names></name><name name-style="western" xml:lang="en"><surname>Starkova</surname><given-names>E. Yu.</given-names></name></name-alternatives><bio xml:lang="ru"><p>Старкова Елена Юрьевна  — научный сотрудник отделения физиотерапии и реабилитации </p><p> 129110, г. Москва, ул. Щепкина, д. 61/2 </p></bio><bio xml:lang="en"><p> 61/2 Shchepkin St., Moscow, 129110 </p></bio><email xlink:type="simple">elena.starkova@inbox.ru</email><xref ref-type="aff" rid="aff-1"/></contrib><contrib contrib-type="author" corresp="yes"><contrib-id contrib-id-type="orcid">https://orcid.org/0000-0002-1787-7015</contrib-id><name-alternatives><name name-style="eastern" xml:lang="ru"><surname>Макарова</surname><given-names>М. Р.</given-names></name><name name-style="western" xml:lang="en"><surname>Makarova</surname><given-names>M. R.</given-names></name></name-alternatives><bio xml:lang="ru"><p>Макарова Марина Ростиславовна — к. м. н., доцент, ведущий научный сотрудник отдела медицинской реабилитации </p><p>105120, г. Москва, ул. Земляной Вал, д. 53 </p></bio><bio xml:lang="en"><p> 53 Zemlyanoy Val St., Moscow, 105120 </p></bio><email xlink:type="simple">makarovamr@mail.ru</email><xref ref-type="aff" rid="aff-2"/></contrib><contrib contrib-type="author" corresp="yes"><contrib-id contrib-id-type="orcid">https://orcid.org/0000-0002-3245-167X</contrib-id><name-alternatives><name name-style="eastern" xml:lang="ru"><surname>Сомов</surname><given-names>Д. А.</given-names></name><name name-style="western" xml:lang="en"><surname>Somov</surname><given-names>D. A.</given-names></name></name-alternatives><bio xml:lang="ru"><p>Сомов Дмитрий Алексеевич — к. м. н., старший научный сотрудник отдела медицинской реабилитации </p><p>105120, г. Москва, ул. Земляной Вал, д. 53 </p></bio><bio xml:lang="en"><p> 53 Zemlyanoy Val St., Moscow, 105120 </p></bio><email xlink:type="simple">docsomov@bk.ru</email><xref ref-type="aff" rid="aff-2"/></contrib></contrib-group><aff-alternatives id="aff-1"><aff xml:lang="ru"><institution>ГБУЗ МО «Московский областной научно-исследовательский клинический институт имени М.Ф. Владимирского»</institution><country>Россия</country></aff><aff xml:lang="en"><institution>M.F. Vladimirsky Moscow Regional Clinical Research Institute</institution><country>Russian Federation</country></aff></aff-alternatives><aff-alternatives id="aff-2"><aff xml:lang="ru"><institution>ГАУЗ «Московский научно-практический центр медицинской реабилитации, восстановительной и спортивной медицины Департамента здравоохранения города Москвы»</institution><country>Россия</country></aff><aff xml:lang="en"><institution>Moscow Research and Practice Center for Medical Rehabilitation, Restorative and Sports Medicine</institution><country>Russian Federation</country></aff></aff-alternatives><pub-date pub-type="collection"><year>2023</year></pub-date><pub-date pub-type="epub"><day>19</day><month>02</month><year>2025</year></pub-date><volume>22</volume><issue>6</issue><issue-title>НЕВРОЛОГИЯ ПСИХИАТРИЯ</issue-title><fpage>60</fpage><lpage>66</lpage><permissions><copyright-statement>Copyright &amp;#x00A9; Мельникова Е.А., Старкова Е.Ю., Макарова М.Р., Сомов Д.А., 2025</copyright-statement><copyright-year>2025</copyright-year><copyright-holder xml:lang="ru">Мельникова Е.А., Старкова Е.Ю., Макарова М.Р., Сомов Д.А.</copyright-holder><copyright-holder xml:lang="en">Melnikova E.A., Starkova E.Y., Makarova M.R., Somov D.A.</copyright-holder><license xml:lang="ru" license-type="creative-commons-attribution" xlink:href="https://creativecommons.org/licenses/by/4.0/" xlink:type="simple"><license-p>Данная работа распространяется под лицензией Creative Commons Attribution 4.0.</license-p></license><license xml:lang="en" license-type="creative-commons-attribution" xlink:href="https://creativecommons.org/licenses/by/4.0/" xlink:type="simple"><license-p>This work is licensed under a Creative Commons Attribution 4.0 License.</license-p></license></permissions><self-uri xlink:href="https://docru.elpub.ru/jour/article/view/265">https://docru.elpub.ru/jour/article/view/265</self-uri><abstract><p>Цель обзора: освещение российского и зарубежного опыта применения неинвазивной нейромодуляции с целью обезболивания у пациентов с хронической болью в нижней части спины (БНС); представление различных методов нейромодуляции, а также других реабилитационных технологий, которые могут применяться в сочетании с ней у лиц с БНС; описание параметров и программ нейромодуляции для оптимального проявления анальгезирующего эффекта. Основные положения. БНС — широко распространенное (встречается у 7,5% мирового населения) и социально значимое заболевание (одна из ведущих причин утраты трудоспособности в мире). Эффективность медикаментозного купирования хронической БНС составляет около 40%, в связи с этим необходим поиск немедикаментозных методов лечения. Нейропатический компонент хронической БНС связан с перестройкой корковых структур головного мозга. Поэтому нейростимуляция представляется наиболее перспективным подходом к лечению хронической БНС, а транскраниальная электростимуляция постоянным током (ТЭпТ) и ритмическая транскраниальная магнитная стимуляция (рТМС) лидируют среди методов нейростимуляции по эффективности и безопасности. Метод рТМС — эффективный и безопасный способ борьбы как с ноцицептивной болью, так и с нейропатической болью, являющейся частым компонентом хронических заболеваний, в частности БНС. Основную зону воздействия представляют участки моторной коры (М1). В сравнении с ТЭпТ рТМС лучше переносится пациентами и демонстрирует лучшие результаты в отношении купирования боли. Заключение. Болевой синдром серьезно ограничивает возможность проведения реабилитационных мероприятий пациентам с БНС, при этом медикаментозные средства купирования боли обладают относительно низкой эффективностью. Мы предлагаем включить обезболивающую нейромодуляцию в комплексную терапию у таких больных. Наиболее популярными и эффективными методами нейростимуляции являются ТЭпТ и рТМС.</p></abstract><trans-abstract xml:lang="en"><sec><title>Aim</title><p>Aim: To describe the Russian and foreign experience in the use of non-invasive neuromodulation for pain management in patients with chronic lower back pain (LBP); to present various neuromodulation techniques and other rehabilitation methods which can be used in combination with neuromodulation in patients with LBP; to describe neuromodulation parameters and programs for an optimal analgesic effect.</p></sec><sec><title>Key points</title><p>Key points. LBP is a common (affecting 7.5 % of the world population) and socially significant condition (one of the leading causes of disability worldwide). The efficiency of drug pain management in chronic LBP is approximately 40 %, therefore, non-drug treatment options are required.</p><p>The neuropathic component of chronic LBP is associated with reorganization in cortex brain structures Hence, neural stimulation is a most promising approach to chronic LBP management, while transcranial direct current electrotherapy stimulation (TEdC) and rhythmic transcranial magnetic stimulation (rTMS) are the most efficient and safest neural stimulation methods. rTMS is an efficient and safe approach to the management both of nociceptive and neuropathic pain, which is a common component of chronic conditions, in particular of LBP. The main area of exposure is motor cortex areas (М1). As compared to TEdC, rTMS is better tolerated by patients and demonstrates better pain management results.</p></sec><sec><title>Conclusion</title><p>Conclusion. Pain syndrome is a significant limitation to rehabilitation in patients with LBP, and drug pain management is inefficient. We suggest that anaesthetic neuromodulation be included into a complex therapy of such patients. The most widely used and efficient neuromodulation techniques are TEdC and rTMS.</p></sec></trans-abstract><kwd-group xml:lang="ru"><kwd>боль в нижней части спины</kwd><kwd>реабилитация</kwd><kwd>транскраниальная магнитная стимуляция</kwd><kwd>нейропатическая боль</kwd></kwd-group><kwd-group xml:lang="en"><kwd>lower back pain</kwd><kwd>rehabilitation</kwd><kwd>transcranial magnetic stimulation</kwd><kwd>neuropathic pain</kwd></kwd-group></article-meta></front><back><ref-list><title>References</title><ref id="cit1"><label>1</label><citation-alternatives><mixed-citation xml:lang="ru">Fullen B., Morlion B., Linton S.J., Roomes D. et al. 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