Avtor/Urednik		Zaletel, Marjan
Naslov		Zdravljenje bolečine v nosečnosti
Prevedeni naslov		Treatment of pain in pregnancy
Tip		članek
Vir		Med Razgl
Vol. in št.		Letnik 44, št. Suppl 3
Leto izdaje		2005
Obseg		str. 107-14
Jezik		slo
Abstrakt		Pregnant women may present with medical and surgical conditions that result in both acute or chronic pain. The publication Drugs in Pregnancy and Lactation is one of the few resources available to health care providers when questions arise about safety of drugs during pregnancy and lactation. The recognition of teratogenicity of aminopterin and thalidomide changed the perception and resulted in recommendation of extremely conservative drug use during pregnancy. Our knowledge about risk of birth defects from drug exposure is limited. The lack of information on the treatment of pain syndromes is compounded by complex physiological and pharmacological factors in pregnancy. The maternal-placental-fetal unit can be viewed as a three-compartment pharmacokinetic model with distinct properties of absorption, distribution, metabolism and elimination of drugs. The teratogenic potential of a drug varies with gestational age. The review of literature did not offer much information about use of nonopioid analgetic drugs in the treatment of pain in pregnancy. Further studies of new antiepileptics such as gabapentin and topiramate are required, as well as of cyclooxygenase-2 inhibitors. There are some well-documented cases supporting safety of use of opioid drugs in therapy ofacute and chronic pain. In migraine, nonpharmacologic treatment should be tried first. Analgesics such as paracetamol and opiods should be used with caution. Prophylactic treatment should be the last resort.
Izvleček		Pri nosečnicah se lahko pojavijo patološka stanja, ki jih spremlja akutna ali kronična bolečina. Publikacija Drugs in Pregnancy and Lactation je eden izmed virov, ki so na razpolago zdravnikom, če se pojavi vprašanje glede varnosti zdravil med nosečnostjo in dojenjem. Pojav teratogenosti ob uporabi aminopterina in talidomida je spremenilo prepričanje o varnosti zdravil med nosečnostjo. Posledica so bila priporočila, ki so poudarjala zelo omejeno uporabo zdravil med nosečnostjo, kar je vodilo k omejenemu znanju o učinkovanju analgetikov med nosečnostjo. Poleg pomanjkanja podatkov glede zdravljenja bolečinskih sindromov pa tudi same fiziološke in farmakološke spremembe med nosečnostjo še dodatno povečajo nepredvidljivost delovanja zdravil. Enota mati-posteljica-plod je namreč tridelni farmakokinetični model z določenimi lastnostmi glede absorbcije, porazdelitve, presnove in izločanja zdravila. Teratogeni potencial zdravila se spreminja s trajanjem nosečnosti. Pregled dosedanje literature ne nudi dovolj podatkov o uporabi neopiodnih analgetikov med nosečnostjo. Potrebne so dodatne raziskave in poročila o učinkih novejših protiepileptičnih zdravil, kot sta gabapentin in topiramat. Prav tako ni dovolj raziskav o učinkih zaviralcev ciklooksigenaze 2 v nosečnosti. Nekateri primeri kažejo, da so opioidi varna zdravila za zdravljenje akutne in kronične bolečine. Pri zdravljenju migrene najprej poskusimo z nefarmakološkimi ukrepi, analgetike, kot je paracetamol, opioide pa uporabljamo previdno. Preventivno zdravljenje predstavlja zadnji izbor za zdravljenje migrene.
Deskriptorji		PAIN ANALGESICS MIGRAINE PREGNANCY