B grupės vitaminų svarba malšinant skausmą

B grupės vitaminų svarba malšinant skausmą

Įvadas

Dažnai į šeimos gydytoją kreipiasi pacientai, kurie skundžiasi bendru silpnumu, nuovargiu, mieguistumu, galvos, kojų ir nugaros skausmais. Surinkus išsamią anamnezę, išsiaiškinama, kad dažniausios tokių simptomų priežastys yra netinkama mityba ir gyvenimo būdas. Valgant netinkamą maistą, mūsų organizme ima trūkti reikalingų medžiagų ir vitaminų. Neretai galime įtarti B grupės vitaminų stoką. Jų organizmas paprastai nekaupia, todėl jų būtina reguliariai gauti. B grupės vitaminus sudaro 8 vitaminai: B1 – tiaminas, B2 – riboflavinas, B3 – niacinas (nikotino rūgštis), B5 – pantoteno rūgštis, B6 – piridoksinas, B7 – biotinas, B9 – folio rūgštis, B12 – kobalaminas. Kiekvienas B grupės vitaminas yra svarbus mūsų organizmo biologiniams procesams. Jie užtikrina normalų nervinės sistemos funkcionavimą, dalyvauja medžiagų apykaitos procesuose, palaiko normalią virškinimo trakto funkciją, reguliuoja cukraus kiekį kraujyje ir didina atsparumą stresui. Dėl pastarosios funkcijos daugumai žmonių rekomenduotina kasdien vartoti šių vitaminų, o sportuojantiesiems yra būtini. B grupės vitaminai nepakeičiami gydant mažakraujystę. Jie užtikrina ir tinkamą imuninės sistemos funkcionavimą ir augimo procesą.

Visų B grupės vitaminų šaltiniai, poveikis ir rekomenduojamas dozavimas pateikti 1 lentelėje.

1 lentelė. B grupės vitaminų poveikis, dozavimas ir pagrindiniai šaltiniai 

 

B grupės vitaminų nauda

B grupės vitaminai svarbūs medžiagų apykaitai, kai yra skaidomi su maistu gaunami baltymai, riebalai ir angliavandeniai, gaminantis raudoniesiems kraujo kūneliams, vystantis ir funkcionuojant nervų sistemai. Trūkstant šios grupės vitaminų, dažnas pradeda skųstis prasta nuotaika, greitu nuovargiu, nemiga ar įvairaus pobūdžio lėtiniu skausmu, padidėjusiu dirglumu, gali nemaloniai tvinkčioti ar trūkčioti raumenys, varginti tirpimai, lūžinėti nagai, slinkti plaukai. Tokiais atvejais žmonės bando ieškoti sunkių ligų, tačiau tokių negalavimų priežastis gali būti paprasčiausias B grupės vitaminų trūkumas.

B grupės vitaminai (B1, B6 ir B12) pasižymi neurotropiniu ir skausmą mažinančiu veikimu, ypač vartojami kartu. Jie dalyvauja daugelyje centrinėje nervų sistemoje ir periferiniuose nervuose vykstančių biocheminių reakcijų. Vitaminas B1 (tiaminas) dalyvauja sintetinant aksonų baltymus ir acetilcholiną, metabolizuojant angliavandenius. Vitaminas B6 (piridoksinas) dalyvauja aminorūgščių, baltymų, angliavandenių ir lipidų metabolizme, taip pat neuromediatorių, kurie yra svarbūs skausmo jutimui, sintezėje. Vitaminas B12 (cianokobalaminas) tiesiogiai malšina skausmą, yra reikalingas mielino sintezei. Nacionalinių sveikatos institutų išvados nurodo, kad vitaminas B3 (niacinas ar niacinamidas) sustiprina judesio spektrą ir mažina skausmą bei uždegimą. Manoma, kad vitaminas B3 gali būti naudingas siekiant užkirsti kelią osteoartritui, stiprinant gliukokortikoidų gamybą (natūralų steroidų), todėl sumažėtų uždegimas. Nustatyta, kad didelei populiacijos daliai trūksta B grupės vitaminų. Dėl šios priežasties nervinis audinys tampa imlesnis pažeidimams, ūminis skausmas dažniau tampa lėtiniu.

 

B grupės vitaminai ir įvairaus pobūdžio skausmas

Įvairios etiologijos skausmui gydyti dažniausiai skiriami nesteroidiniai ir steroidiniai vaistai nuo uždegimo, tačiau tyrimų duomenys rodo, kad papildomos naudos galima pasiekti ir skiriant B grupės vitaminų preparatus.

Geriausių skausmo gydymo rezultatų pasiekiama tuomet, kai gydymas parenkamas individualiai, derinant nefarmakologines ir farmakologines priemones. Nefarmakologinės priemonės apima sveikos gyvensenos mokymą, tinkamą fizinį aktyvumą, optimalų miego ir poilsio režimą, streso valdymo priemones. Farmakologinis gydymas – tai pirmiausia skubioji pagalba, o paskui tęsiamas profilaktinis gydymas. Pirmojo pasirinkimo vaistai ūminiam skausmui malšinti – nesteroidiniai vaistai nuo uždegimo (NVNU), steroidai. Gydant lėtinį skausmą, skiriami vaistai nuo traukulių, antidepresantai, miorelaksantai ir kitų grupių vaistai. Trečioji gydymo medikamentų grupė – pagalbiniai ir alternatyvūs preparatai. Dažniausiai ir plačiausiai naudojami yra magnis, B grupės vitaminai, kofermentas Q10 ir žuvų taukai. Geresnis efektas pasiekiamas tuomet, kai derinami keli pagalbiniai ir alternatyvūs preparatai, bei tuomet, kai į kiekvieną tokį derinį įeina ir B grupės vitaminų preparatas.

Pirmą kartą apie B grupės vitaminų naudojimą skausmui gydyti pradėta kalbėti 1950 metais, kai šie vitaminai imti skirti kaip analgetikai. Tada plačiai paplito aiški žinutė apie šių vitaminų neurotropinį poveikį ir tiesioginį poveikį nervinei sistemai. Iki šiol ypač populiarios yra tiek atskirų B grupės vitaminų (B1, B6, B12), tiek jų derinių injekcijos bei geriamosios formos. Klinikinė patirtis rodo, kad parenteralinis tiamino (B1), piridoksino (B6) ir cianokobalamino (B12) naudojimas puikiai malšina skausmą, normalizuoja padidėjusio dirglumo reakcijas, mažina jutimų sutrikimus. Gydytojai, siekdami mažinti skausmo sindromą, greta kitų vaistų, pacientui dažnai skiria ir B grupės vitaminus [9].           

Pastaraisiais metais publikuota apie 100 mokslinių tyrimų, kuriuose įrodytas B grupės vitaminų teigiamas poveikis skausmui. 2000 metais atliktas pirmasis atsitiktinių imčių, placebu kontroliuojamas tyrimas, kuriame analizuotas B12 vitamino poveikis gydant lėtinį nugaros skausmą. Dauguma tyrimo dalyvių teigė pajutę sumažėjusį skausmo lygį ir pagerėjusią sąnarių funkciją, judesių amplitudę. Kitas tyrimas atliktas su 100 pacientų, kuriems diagnozuota diabetinė neuropatija. Viena grupė tiriamųjų buvo gydyta vitaminu B12, o antroji vartojo antidepresantą nortriptiliną. Vitamino B12 grupėje skausmas sumažėjo 3,66 balo, notriptilino grupėje – 0,86 balo [9].

B6 grupės vitaminas dažnai skiriamas tunelinio riešo sindromui gydyti. Tinkama terapinė tiamino dozė gydant šį skausmo sindromą yra 200 mg/p. Didesnės jo dozės gali sukelti toksinį poveikį. Įprastas gydymo kursas – 3 mėnesiai.

Tyrimų duomenimis, riboflavinas (B12) sumažina migrenos dažnį ir trukmę 68 proc. suaugusių pacientų [2].

Daugelyje tyrimų pabrėžiama, kad B grupės vitaminų kompleksas yra efektyvesnis gydant skausmą, palyginti su pavieniais B grupės vitaminais. Buvo atliktas atsitiktinių imčių, dvigubai aklas tyrimas su preparatu, kurio sudėtyje buvo vitamino B1 (100 mg), B6 (200 mg) ir B12 (200 mg). Tyrime dalyvavo pacientai, kuriuos vargino lėtinis nugaros skausmas. Minėtas preparatas buvo skiriamas po 1 tabletę 3 k./d. Pagal numatytą protokolą, pacientams po ūminio periodo gydymo (trukusio maždaug 3 savaites), buvo tęsiamas profilaktinis 6 mėnesių trukmės gydymas. Kontrolinė grupė vartojo placebą. Šio tyrimo rezultatai parodė, kad pacientai, vartoję vitaminus, lengviau toleravo skausmą, be to, jis gerokai atlėgo.

Kitas tyrimas buvo atliktas su 1 082 pacientais, kuriems buvo skirtas parenterinis gydymas B grupės vitaminų kompleksu (B– 200 mg, B– 200 mg, B12 – 1 mg). 86 proc. tiriamųjų nurodė polineuropatijos simptomų sumažėjimą, 45 proc. asmenų, kuriuos vargino nugaros skausmas, teigė, kad šis nemalonus pojūtis tapo ne toks intensyvus arba net visai dingo. Gydytojai palankiai atsiliepė apie šio vitaminų komplekso toleravimą ir vertino jį kaip puikų arba labai puikų. Įrodyta, kad rekomenduotina terapinė dozė nepageidaujamų reiškinių nesukėlė arba jie buvo minimalūs. Tyrimo autoriai rekomendavo skirti šį preparatą ūminiam skausmui gydyti po 1 ampulę kasdien, o esant silpnesnio pobūdžio skausmui ar tęsiant reabilitacinį gydymą – leisti po 1 ampulę kas 2–3 dienas [9]. Tyrimo išvadose pabrėžiama, kad šiuo metu B grupės vitaminų naudojimas gali būti laikomas sėkmingu daugelio neuropatijų ir nugaros skausmo gydymo metodu.

Remiantis keletu klinikinių tyrimų, stuburo skausminių sindromų gydymo trukmė gali būti sumažinta vartojant vitaminų B1, B6, B12 ir diklofenako derinį vietoj monoterapijos vien diklofenaku. Be to, vartojant šį derinį, gali būti pasiektas ryškesnis analgetinis poveikis. 1990 metais atliktas daugiacentris atsitiktinių imčių, dvigubai aklas tyrimas, siekiant palyginti klinikinį diklofenako (25 mg) ir kombinuoto preparato, į kurio sudėtį buvo įtrauktas diklofenakas (25 mg), vitaminas B1 (50 mg), B6 (50 mg) ir B12 (0,25 mg), poveikį. Jame dalyvavo 418 pacientų. Tyrimo rezultatai atskleidė, kad gydymas diklofenaku ir B grupės vitaminais buvo kur kas efektyvesnis, palyginti su diklofenako monoterapija [9].

Apibendrinimas

Esant sveikai ir įvairiapusei mitybai, organizmas yra aprūpinamas reikiamais vitaminais ir jam tikrai negresia avitaminozė. Tačiau išskiriamos 2 galimų vitaminų stokos grupės. Pirmoji siejama su vitaminų stoka dėl ligų (beriberis, alkoholizmas, cistinė fibrozė) ar dėl prastos mitybos. Antrajai grupei priskiriami genetiniai sindromai, sietini su metaboliniais sutrikimais. B grupės vitaminų stoka sudaro palankias sąlygas nervų sistemos pažeidimams, nes sumažina nervinio audinio atsparumą mechaniniams, toksiniams, infekciniams veiksniams, sukelia ir palaiko jau esančius pažeidimus, skatina jų progresavimą. B grupės vitaminų trūkumas gali išsivystyti ar padidėti dėl ligos – uždegimo, infekcijos, nes tuomet vitaminai greičiau suyra, jų apykaita yra greitesnė, ląstelės juos blogiau pasisavina.

Toliau atliekami tyrimai, siekiant įrodyti B grupės vitaminų naudą gydant skausmą. Jau dabar galime teigti, kad vitaminų kompleksas, ypač B1, B6, B12, turi ryškesnį analgetinį poveikį, nei gydant pavieniais B grupės vitaminais. Gydant ūminį skausmą, B grupės vitaminų kompleksas drauge su NVNU yra gerokai efektyvesnis, palyginti vien tik su monoterapija vaistais nuo skausmo.

Literatūra:

  1. Jo M. Wilmshurst, MD. Diagnosis and Management of Pediatric Peripheral Neuropathies in Resource-Poor Settings. 2014 Febr [cited 2014 febr 28]: www.medscape.org/viewarticle/779794.

2.Ginny Tyler Meadows, et al. Pharm BCPS, FASHP, FPPAG. Treatment Considerations for Headache in Pediatric Patients. US Pharmacist. 2016;41(5):23-27 www.medscape.com/viewarticle/866899.

  1. Anne Becker. Vitamin B for Back Pain. 2016 www.psychologytoday.com/intl/articles/200305/vitamin-b-back-pain.
  2. Myung K. Park, MD, FAAP, FACC. Parks’ the pediatric cardiology handbook 5th edition; 2017. p. 321-331.
  3. Thull-Freedman J. Evaluation of chest paini n the pediatric patients, Med Clin N Am 94:327-347, 2010.
  4. National institute of neurological Disorders and stroke. Low back pain fact sheet. www.ninds.nih.gov/Disorders/Patient-Caregiver-Education/Fact-Sheets/Low-Back-Pain-Fact-Sheet.
  5. Divakara Kedlaya, MBBS; Chief Editor: Dean H Hommer, MD. Mononeuritis Multiplex Workup. 2017 febr 06. http://emedicine.medscape.com/article/316024-workup.
  6. Tarakad S Ramachandran. Acute Inflammatory Demyelinating Polyradiculoneuropathy. 2017 Jun 08. http://emedicine.medscape.com/article/1169959-overview.
  7. Ан. Б. Данилов. Витамины группы В в лечении боли. 2017.https://www.lvrach.ru/2009/09/10638532/.

 


469 mintys apie “B grupės vitaminų svarba malšinant skausmą

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