Osnovni principi liječenja kronične boli lijekovima

master's thesis

• Title (english): Basic principles of drug treatment of chronic pain
• Author: Višnja Majić
• Mentor: Mladen Perić (mentor)
• Committee member: Ante Sekulić (predsjednik povjerenstva)
• Committee member: DINKO TONKOVIĆ (član povjerenstva)
• Committee member: Mladen Perić (član povjerenstva)
• Granter: University of Zagreb; School of Medicine; (Department of Anaesthesiology, Resuscitation and Intensive Care in Surgical Specialities); Zagreb
• Defense date and country: 2014-07-15, Croatia
• Scientific / art field, discipline and subdiscipline: BIOMEDICINE AND HEALTHCARE; Clinical Medical Sciences; Anesthesiology and Reanimatology

Abstract

Bol se definira kao neugodan emocionalni i osjetni doživljaj povezan sa stvarnim ili potencijalnim oštećenjem tkiva ili je opisana u vrijeme takvog oštećenja. Kronična bol je ona koja traje dulje od 3 do 6 mjeseci. Danas zahvaća znatan broj populacije i predstavlja velik zdravstveni problem. Sama patogeneza kronične boli nije do kraja razjašnjena. Smatra se da je posljedica različitih neuroplastičnih procesa, posebice centralne senzitacije, fenomena hiperekscitacije centralnih neurona zbog repetitivnog podražaja od strane aferentnih neurona. Kronična bol se javlja u raznim stanjima te može biti maligne i nemaligne etiologije. Za liječenje kronične boli danas se u najvećoj mjeri koriste lijekovi. Liječenje se najčešće planira prema trostupanjskoj ljestvici Svjetske zdravstvene organizacije. U prvom stupnju indicirana je primjena neopioidnih analgetika (paracetamol, NSAIL, acetilsalicilna kiselina) no ako bol ne popušta, prelazi se na sljedeći stupanj koji uključuje slabe opioide (kodein, tramadol, pentazocin...) u kombinaciji sa ili bez neopioidnih analgetika. Završni, treći stupanj, uključuje primjenu jakih opioida (morfin, fentanil, buprenorfin...) također u mogućoj kombinaciji sa neopioidnim analgeticima. Kroz cijelu shemu terapije mogu se uključivati adjuvantni lijekovi iz skupina antikonvulziva, antidepresiva, lokalnih anestetika i kortikosteroida.

Abstract (english)

Pain is defined as an unpleasant sensory and emotional experience associated with actual or potential tissue damage, or described in terms of such damage. Pain that persists longer than 3 to 6 months is considered chronic pain. Chronic pain affects a large amount of the world population and it is an extensive public health problem. Pathogenesis of chronic pain is still not completely clarified. It is considered to be the result of different neuroplastic processes, especially central senzitation, a phenomenon of hyperexcitation of central neurons caused by a repetitive stimulus from afferent neurons. Chronic pain occurs in various conditions, and can be of malignan or non malignan etiology. Drugs are largely used for chronic pain treatment. The treatment is usually planned according to the WHO’s three step ladder. In the first stage nonopioid analgesics are indicated (paracetamol, NSAID, acetylsalicylic acid) but if the pain persists the therapy proceeds to the second stage involving weak opioids (codeine, tramadol, pentazocine...) in combination with or without non opioid analgesics. The last, third stage, involves usage of strong opioids (morphine, fentanyl, buprenorphine...) in combination with non opioid analgesics. Through the whole therapy scheme adjuvant drugs may be used, such as anticonvulsants, antidepressants, local anesthetics and corticosteroids.

• Keywords: kronična bol; neuroplastičnost; ljestvica SZO; opiodi
• Keywords (english): chronic pain; neuroplasticity; WHO pain ladder; opioids
• Language: croatian
• URN:NBN: urn:nbn:hr:105:887166
• Study programme: Title: Medicine; Study programme type: university; Study level: integrated undergraduate and graduate; Academic / professional title: doktor/doktorica medicine (doktor/doktorica medicine)
• Type of resource: Text
• File origin: Born digital
• Access conditions: Open access
• Created on: 2015-10-13 12:26:13