Professional paper - Review paper
Pathophysiology and treatment of oncologic pain

Dobrila-Dintinjana, Renata; Vukelić, Jelena; Dintinjana, Marijan; Vanis, Nenad; Ružić, Alen; Brkljačić-Žagrović, Morana; Pleština, Sanja; Kolić, Zlatko (2012)
Metadata
Language Croatian
Title (Croatian)Patofiziologija i liječenje onkološkog bola
Title (English)Pathophysiology and treatment of oncologic pain
AuthorDobrila-Dintinjana, Renata
Vukelić, Jelena
Dintinjana, Marijan
Vanis, Nenad
Ružić, Alen
Brkljačić-Žagrović, Morana
Pleština, Sanja
Kolić, Zlatko
Abstract (Croatian)
Prema definiciji Međunarodnog udruženja za proučavanje bola (IASP), bol je neugodno osjetno i emocionalno iskustvo, udruženo s aktualnim ili potencijalnim oštećenjem tkiva, ili opisano u vrijeme takvog oštećenja. Ovisno o patofiziološkom mehanizmu koji dovodi do nastanka bola, bol možemo podijeliti na nociceptivnu, neuropatsku i inflamatornu. Karcinomski bol objedinjuje sva tri mehanizma. Nociceptivni bol nastaje podraživanjem nociceptora (slobodnih živčanih završetaka koji predstavljaju periferne receptore za bol). Neuropatski bol nastaje kao posljedica oštećenja perifernog ili središnjeg živčanog sustava, bez istodobnog podražaja nociceptora. Djelovanje analgezijskog sustava posredovano je putem endogenih opijata (encefalini, endorfini i dinorfini). Oni djeluju kao neurotransmiteri i neuromodulatori te vezivanjem za mi, kapa i delta opioidne receptore uzrokuju analgeziju. Maligni bol liječi se prema osnovnim načelima palijativne medicine, a to su brzo i djelotvorno uklanjanje bola, liječenje “totalnog” bola i plansko liječenje bola. Liječenje malignog bola uključuje farmakoterapijske pripravke, invazivne postupke i kognitivno-biheviorističke metode. Zlatni standard u liječenju malignog bola su opioidi. Morfij i njegovi agonisti široko se koriste u liječenju karcinomskog bola. Opstipacija, emeza, sedacija, konfuzija, halucinacije, retencija urina i vrtoglavica češće su nuspojave tijekom upotrebe opioida, dok je respiratorna depresija izuzetno rijetka nuspojava. Farmakoterapijskim pristupom, poštujući smjernice “trostupanjske ljestvice” ili “modela lifta” može se u preko 90 % bolesnika zadovoljavajuće liječiti bol. Liječenje intraktabilnog bola, liječenje bola u starijih bolesnika i male djece, opioidna rotacija, upotreba kortikosteroida, placebo u liječenju bola i brojna etička pitanja za sada još uvijek predstavljaju pravi izazov kako za istraživače, tako i za kliničare, doktore primarne zdravstvene zaštite i etičare.
Abstract (English)
According to the definition of the International Association for the Study of Pain (IASP), pain is a noticeably uncomfortable and emotional experience associated with actual or potential tissue damage or described at the time of such damage. Pain can be divided into nociceptive, neuropathic and inflammatory. Cancer pain includes all three mechanisms. Nociceptive pain causes stimulation of nociceptors (free nerve endings that are peripheral pain receptors). Neuropathic pain occurs as a result of damage to the peripheral or central nervous system, without simultaneous stimulation of nociceptors. Effect of analgesic system is mediated through endogenous opiates (enkefalins, endorphins and dinorfins). They act as neurotransmitters and neuromodulators, causing analgesia trough mu, kappa and delta opioid receptors. Malignant pain is treated according to basic principles of palliative medicine, and they are fast and effective pain management, treatment of “total” pain and pain treatment planning. Pharmacotherapeutic approach, respecting the Guidelines’ “three stage ladder” or “model lift” in over 90% of patients may be sufficient to treat pain. The gold standard in the treatment of malignant pain are opioids. Morphine and its agonists are widely used in the treatment of cancer pain. Constipation, vomiting, sedation, confusion, hallucinations, urinary retention, dizziness and respiratory depression are side effects. Treatment of intractable pain, pain in the elderly and small children, opioid rotation, use of corticosteroids, placebo in the treatment of pain and a number of ethical questions for now is still a real challenge for researchers and for clinicians, primary care doctors and ethicists.
Keywords (Croatian)farmakoterapija liječenje maligni bol
Keywords (English)cancer pain pharmacology treatment
Publication typeprofessional paper - review paper
Publication statuspublished
Peer reviewpeer review
Journal titleMedicina Fluminensis : Medicina Fluminensis
Numbering2012, Vol. 48, No. 3, pp 278-284
ISSN0025-7729
Datepublication: 03.09.2012.
Article URLhttp://hrcak.srce.hr/86939
Scientific fieldBIOMEDICINE AND HEALTHCARE
Clinical Medical Sciences
Oncology
InstitutionUniversity of Rijeka, Faculty of Medicine
(Department of Oncology and Radiotherapy)
URN:NBNhttps://urn.nsk.hr/urn:nbn:hr:184:937829