Author/Editor     Lahajnar, Slavica
Title     Farmakološko zdravljenje kronične bolečine
Translated title     Pharmacologic treatment of chronic pain
Type     članek
Source     Rehabilitacija
Vol. and No.     Letnik 5, št. 1-2
Publication year     2006
Volume     str. 77-80
Language     slo
Abstract     Chronic pain often causes suffering and loss of energy and enthusiasm for any activity of the patients and thereby also higher health care costs. The treatment is effective if it is multimodal, or, to be more precise, if it involves several treatment approaches, such as pharmacologic treatment, physical therapy and psycho-social management of a patient. The treatment choice depends on the cause and nature of pain and particularities of each patient. The principal purpose of pain treatrnent is to relieve the pain so that it is bearable and thereby also to improve the functioning of the patient or at least his comfort. Standard analgesics are developed from aspirin extracted from willow tree bark and morphine extracted from opium which is an exudative frorn unripe capsules of poppy. In the last century, plenty synthetic agents with a similar effect, yet stronger and with higher safety benefits, have been developed. The chronic pain not caused by cancer is treated by non-steroid anti-rheumatics (NSAR); they are the most freguently indicated analgesics. If the agents from the group of non-opioids are not sufficient and also nonpharmacologic treatment approaches are ineffective in pain-relieving, the patient is prescribed opioids. The Work Group of Slovenian Association for Pain Management elaborated the guidelines and recommendations for an effective and safe application of strong opioids in the treatment of chronic non-malignant pain. Neuropathic pain is treated by antidepressants and antiepileptics. Opioids are considered to be the drugs of tertiary choice. In the majority of patients, the neuropathic pain is caused by several mechanisms. A concurrent application of two or even three different agents from among the group of analgesics can effectively relieve the neuropathic pain and has significantly less toxic effects. (Abstract truncated at 2000 characters)
Summary     Kronična bolečina je pogosto vzrok za trpljenje in izgubo delovne sposobnosti bolnika in večje stroške v zdravstvu. Zdravljenje je uspešno, če je multimodalno, kar pomeni, da vključuje več pristopov. Mednje sodijo zdravljenje z zdravili, fizikalno zdravljenje in psiho-socialna obravnava bolnika. Izbira je odvisna od vzroka za bolečino, vrste bolečine in posebnosti bolnika, ki ga zdravimo. Cilja zdravljenja sta zmanjšati jakost bolečine do blage in izboljšati funkcioniranje ali vsaj udobje bolnika. Klasični analgetiki imajo svoj izvor v aspirinu iz lubja vrbe in morfinu, ki je aktivni izvleček opija dobljenega iz glavice maka. Zadnjih 100 let je bilo narejenih veliko sintetičnih učinkovin s podobnim delovanjem, le da so bolj učinkovite in varne. Za zdravljenje kronične bolečine, ki ni posledica raka, so nesteroidni antirevmatiki (NSAR) najbolj pogosto predpisani analgetiki. Če zdravila iz skupine neopioidov ne zadoščajo in so neučinkovite tudi nefarmakološke metode, uvedemo opioide. Delovna skupina Slovenskega združenja za zdravljenje bolečine (SZZB) je v letu 2005 izdelala smernice in priporočila za učinkovito in varno uporabo močnih opioidov za zdravljenje kronične ne-maligne bolečine. Nevropatsko bolečino zdravimo z antidepresivi in antiepileptiki. Zdravila tretjega izbora so opioidi. Pri večini bolnikov je v nastanek nevropatske bolečine vpletenih več mehanizmov. Sočasna uporaba dveh ali celo treh zdravil iz različnih skupin analgetikov za zdravljenje nevropatske bolečine pripomore k boljšemu obvladovanju bolečine in ima manj neželenih učinkov. Katero zdravilo ali kombinacijo bomo izbrali za bolnika je odvisno tudi od zdravstvenega stanja bolnika in možnih neželenih učinkov posameznega zdravila. Pri izbiri zdravila za zdravljenje bolečine tehtamo med koristjo in škodo za posameznega bolnika.
Descriptors     PAIN
CHRONIC DISEASE
ANALGESICS, NON-NARCOTIC
ANALGESICS, OPIOID
NEURALGIA
ANTIDEPRESSIVE AGENTS
ANTICONVULSANTS
ANESTHETICS, LOCAL