neurojourНеврологический журнал имени Л.О. БадалянаL.O. Badalyan Neurological Journal2686-89972712-794XФГАУ «НМИЦ здоровья детей» Минздрава России10.46563/2686-8997-2026-7-1-210neurojour-239Research ArticleОБЗОРЫ ЛИТЕРАТУРЫLITERATURE REVIEWSПатофизиологическая основа и клиническая значимость нейропластических изменений спинного мозга в формировании фантомного болевого синдромаPathophysiological Basis and Clinical Significance of Neuroplastic Changes of the Spinal Cord in the Formation of Phantom Pain Syndromehttps://orcid.org/0000-0002-7659-9756СамарцевИ. Н.SamartsevI. N.

Самарцев Игорь Николаевич - доктор мед. наук, профессор кафедры нервных болезней ФГБВОУ ВО «ВМедА им. С.М. Кирова» Минобороны России.

Санкт-Петербург

Igor N. Samartsev - MD, Dr. Sci. (Medicine), Associate Professor of the Department of Nervous Diseases, S.M. Kirov Military Medical Academy.

St. Petersburg

alpinaigor@mail.ruhttps://orcid.org/0009-0002-1673-4044ДенисоваЮ. В.DenisovaYu. V.

Денисова Юлия Владимировна - врач-невролог, врач-функциональной диагностики, ЦМР Санкт-Петербургского ГБУЗ «Клиническая больница Святителя Луки».

194044, Санкт-Петербург

Yulia V. Denisova - neurologist, Functional Diagnostics Physician, St. Petersburg State Medical University St. Luke’s Clinical Hospital.

194044, St. Petersburg

velikiy_chelovek@mail.ruhttps://orcid.org/0000-0003-0363-102XЖиволуповС. А.ZhivolupovS. A.

Живолупов Сергей Анатольевич - доктор мед. наук, профессор кафедры нервных болезней ФГБВОУ ВО «ВМедА им. С.М. Кирова» Минобороны России.

Санкт-Петербург

Sergey A. Zhivolupov - MD, Dr. Sci. (Medicine), Professor of the Department of Nervous Diseases, S.M. Kirov Military Medical Academy.

St. Petersburg

peroslava@yandex.ruhttps://orcid.org/0000-0001-6348-0759ЗабировС. Ш.ZabirovS. Sh.

Забиров Сергей Шамилевич - канд. мед. наук; заведующий ЦМР Санкт-Петербургского ГБУЗ «Клиническая больница Святителя Луки».

Санкт-Петербург

Sergey Sh. Zabirov - MD, Cand. Sci. (Medicine), Head of the Medical Rehabilitation Center, St Luke Clinical Hospital.

St. Petersburg

zabirus@mail.ruhttps://orcid.org/0000-0001-9724-6899НажмудиновР. З.NazhmudinovR. Z.

Нажмудинов Рамазан Загиргаджиевич - канд. мед. наук, заведующий отделением медицинской реабилитации взрослых с нарушением функции ПНС и КМС Санкт-Петербургского ГБУЗ «Клиническая больница Святителя Луки».

Санкт-Петербург

Ramazan Z. Nazhmudinov - MD, Cand. Sci. (Medicine), Neurologist, Head of the Department of Medical Rehabilitation of Adults with Impaired Function of the Central Nervous System and CMS, St Luke Clinical Hospital.

St. Petersburg

nazhmudinov003@mail.ruhttps://orcid.org/0009-0006-7781-7459БогинскийВ. С.BoginskyV. S.

Богинский Валентин Сергеевич - курсант 2-го факультета ФГБВОУ ВО «ВМедА им. С.М. Кирова» Минобороны России.

Санкт-Петербург

Valentin S. Boginsky - MD, cadet of the 2nd Faculty, S.M. Kirov Military Medical Academy.

St. Petersburg

bvs120203@gmail.comФГБВОУ ВО «Военно-медицинская академия имени С.М. Кирова» Министерства обороны Российской ФедерацииРоссияKirov Military Medical AcademyRussian FederationЦентр медицинской реабилитации Санкт-Петербургского ГБУЗ «Клиническая больница Святителя Луки»РоссияSaints Luke’s Clinical Hospital, Center for Medical RehabilitationRussian Federation20260507202672111118Copyright © Самарцев И.Н., Денисова Ю.В., Живолупов С.А., Забиров С.Ш., Нажмудинов Р.З., Богинский В.С., 20262026Самарцев И.Н., Денисова Ю.В., Живолупов С.А., Забиров С.Ш., Нажмудинов Р.З., Богинский В.С.Samartsev I.N., Denisova Y.V., Zhivolupov S.A., Zabirov S.S., Nazhmudinov R.Z., Boginsky V.S.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.neuro-journal.ru/jour/article/view/239

Фантомный болевой синдром, возникающий у значительной части пациентов после ампутации конечности, представляет собой сложный по своей патофизиологической основе болевой феномен, существенно снижающий качество жизни пациентов. Накопленные в последнее время данные убедительно доказывают, что нейропластические изменения в спинном мозге являются критически важным ранним звеном в патогенезе развития данной патологии.

В настоящим обзоре дан анализ современных представлений о патофизиологической основе спинальной нейропластичности при фантомном болевом синдроме после травматической ампутации. Обсуждается вклад центральной сенситизации, структурной реорганизации и нейровоспаления в формирование специфических симптомов заболевания (спонтанной и стимулиндуцированной боли, соматотопической реорганизации и проч.). Особое внимание уделяется анализу клинической значимости обсуждаемых патофизиологических процессов: от объяснения эффективности существующих методов лечения до перспектив разработки новых таргетных стратегий, направленных на модуляцию спинальной нейропластичности для профилактики развития и терапии сформировавшегося фантомного болевого синдрома.

Phantom pain syndrome, which occurs in a significant proportion of patients after limb amputation, is a pathophysiologically complex pain phenomenon that significantly reduces the quality of life of patients. Recent data have convincingly proved that neuroplastic changes in the spinal cord are a critically important early link in the pathogenesis of this pathology.

This review presents an analysis of current understanding of the pathophysiological basis of spinal neuroplasticity in phantom pain syndrome after traumatic amputation. The contribution of central sensitization, structural reorganization and neuroinflammation to the formation of specific symptoms of the disease (spontaneous and stimulus-induced pain, somatotopic reorganization, etc.) is discussed. Special attention is paid to the analysis of the clinical significance of the discussed pathophysiological processes: from explaining the effectiveness of existing treatment methods to the prospects for the development of new targeted strategies aimed at modulating spinal neuroplasticity for the prevention of the development and therapy of the formed phantom pain syndrome.

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The authors declare that there are no conflicts of interest present.