Author/Editor		Gregorič, Milan Roman; Bošnjak, Roman
Title		Zdravljenje hude bolečine z dovajanjem učinkovin v hrbtenični kanal in električnim draženjem hrbtenjače
Type		članek
Source		Rehabilitacija
Vol. and No.		Letnik 2, št. 3-4
Publication year		2003
Volume		str. 69-74
Language		slo
Abstract		Intrathecal infusion of analgetics; in particular morphin, may alleviate chronic intractable pain, also in cases when all other conservative treatment methods fail. The drugs are delivered intrathecally by means of an implanted pump and a catheter. Since the drugs are close to the receptors in the spinal cord, the doses needed for therapeutic effects are much smaller than at the oral therapy while systemic side effects are weaker or absent. There are two kinds of pumps: gas pump with constant flow and programmable electronic pump, which is controlled by telemetry and the daily dose as well as the mode of infusion (constant rate or periodic) can be selected by a programmer. The reservoir of the pump is refilled transcutaneously mostly at a few months time intervals. For the effacasy of the intrathecal treatment proper selection of the patients is most important. They need interdisciplinary team approach, including psychological testing. The pump is implanted only when a screening trial with a short lasting intrathecal drug application is performed before and if the result of this test is positive (pain relief of 50% or more). Similar effects and procedures are engaged in treatment of severe chronic pain by electrical epidural spinal cord stimulation by means of implanted neurostimulator, especially in treatment of neuropathic, ischemic pain and chronic pain syndromes following »failed back surgery«.
Summary		Ko odpovedo vsi konzervativni postopki zdravljenja, lahko hudo, nevzdržno kronično bolečino učinkovito olajšamo z dovajanjem protibolečinskih zdravil, predvsem morfina, v hrbtenični kanal. Zdravila dovajamo intratekalno s pomočjo vsajene črpalke in katetra. Ker tako zdravila približamo receptorjem v hrbtenjači, zadoščajo veliko nižji odmerki kot skozi usta, sistemski stranski učinki pa so slabotni, ali jih ni. Obstajajo plinske črpalke s stalnim pretokom in računalniško krmiljene elektronske črpalke. Slednje telemetrično krmilimo in določamo način dovajanja zdravila (stalno ali v posameznih odmerkih). Rezervoar polnimo skozi kožo, večinoma v nekajmesečnih presledkih. Za uspešnost take terapije je pomemben skrben izbor bolnikov, ki morajo biti medpanožno timsko obravnavani, tudi psihološko. Črpalko kirurško vsadimo le, če je ugoden izid poskusa kratkotrajne intratekalne terapije (zmanjšanje bolečine za 50% ali več). Podobni so postopki in učinki zdravljenja hude bolečine, predvsem nevropatske in ishemične ter bolečine po neuspelih ter ponavljanih operacijah na hrbtenici z epiduralo električno stimulacijo hrbtenjače, ki jo omogoča vsajeni nevrostimulator.
Descriptors		PAIN ELECTRIC STIMULATION THERAPY SPINAL CANAL SPINAL CORD MORPHINE INFUSION PUMPS