Author/Editor		Pražnikar, Aleš
Title		Osnove zaznavanja in zdravljenja bolečine
Type		članek
Source		Rehabilitacija
Vol. and No.		Letnik 2, št. 3-4
Publication year		2003
Volume		str. 3-10
Language		slo
Abstract		Pain is an unpleasant experience in its very nature. Its most important physiological role is preservation of somatic integrity - it represents clear evolutionary advantage. Attributes of a stimulus, environmental circumstances and personal characteristics of an individual determine whether a noxious stimulus will be perceived as painful. Important difference exists between nociception and pereeption of pain. Nociception describes mechanisms of detection and propagation of a possible painful stimulus. All the "levels" of neuraxis are involved in nociception: nerves, spinal cord, brainstem and brain. Perception of pain is a conscious experience and as such a result of continuous elimination and processing of sensory input to the brain. Pain perception is a result of the on-going relation between faeilitatory and inhibitory nociceptive mechanisms. Tissue damage or/and outbursts of nociceptor activity can significantly influence nociceptor direct vicinity (primary sensitisation), as well as facilitate long-term modulation of the synapse activity in higher neural centres (secondary sensitisation); both mechanisms may be involved in pain that persists after the healing has completed (persistent pain). Different neural inhibitory mechanisms and systems exist to lessen the perception of pain: the gate theory, descendent inhibitory system of brainstem and brain and endogenous opioide system. Various therapies of persistent pain are based on the listed mechanisms of nociception and perception of pain. Electrical stimulation or kinesitherapy are used to actuate the sensory input through larger neural fibres (Ab) and so to increase the inhibitory influence according to gate theory. Pharmacological therapeutics may inhibit prostaglandin synthesis and so decrease the excitability of nociceptors (NSAID). (Abstract truncated at 2000 characters).
Summary		Bolečina, kot nujno neprijetna izkušnja, pomembno pripomore k varovanju telesne integritete, zato jo moramo razumeti kot evolucijsko prednost. Posameznik lahko določen škodljiv dražljaj zazna kot boleč glede na značilnosti dražljaja, svoje značilnosti in trenutne okoliščine. Razlikujemo med nocicepcijo in percepcijo - zaznavo bolečine. Nocicepcija je detekcija in prevajanje potencialno bolečega dražljaja. V nocicepcijo so vpleteni vsi nivoji živčevja: živci, hrbtenjača, možgansko deblo in možgani. Zaznava bolečine je izkušnja zavesti oziroma rezultat možganskega izločevanja in obdelovanja senzoričnega dotoka. Zaznava bolečine temelji na trenutnem razmerju med facilitatornimi in inhibitornimi nociceptivnimi mehanizmi. Poškodba in/ali izbruhi dejavnosti nociceptorjev lahko pomembno vplivajo na svoje neposredno okolje (primarna senzitizacija) in dolgoročno preoblikujejo sinapse višjih živčnih središč (sekundarna senzitizacija), oba mehanizma facilitirata in lahko vzdržujeta bolečino dolgo po končanem celjenju. Živčevje inhibitorno vpliva na obdelovanje nociceptivnega dotoka in s tem na manjšo zaznavo bolečine preko različnih sistemov ali mehanizmov: teorije vrat, descendentnih vplivov osrednjega živčevja in endogenega opioidnega sistema. Poznane fiziološke in patofiziološke mehanizme nocicepcije in percepcije skušamo izkoristiti v zdravljenju persistentne bolečine. Z električno stimulacijo ali kinezoterapijo povečamo senzorični dotok po debelejših živčnih vlaknih in tako povečamo inhibitorni vpliv po teoriji vrat. Z različnimi farmakološkimi učinkovinami inhibiramo tvorbo prostaglandinov in tako vplivamo na vzdražnost nociceptorjev (nesteroidni antirevmatiki). (Izvleček skrajšan pri 2000 znakih).
Descriptors		NOCICEPTORS PAIN MEASUREMENT PAIN THRESHOLD PAIN ANTI-INFLAMMATORY AGENTS, NON-STEROIDAL ELECTRIC STIMULATION THERAPY KINESIOLOGY, APPLIED ANTICONVULSANTS ANTI-ARRHYTHMIA AGENTS ANTI-INFLAMMATORY AGENTS, STEROIDAL ANALGESICS, OPIOID ANTERIOR HORN CELLS SPINOTHALAMIC TRACTS