REVIEW OF NON - PHARMACOLOGICAL THERAPY PROCEDURES IN CANCER PAIN MANAGEMENT

Karcinomska bol za bolesnika, njegovu obitelj i multidisciplinarni tim stručnjaka predstavlja veliki problem. U liječenju boli multidisciplinarni tim treba obuhvatiti koncept liječenja totalne boli, odnosno fizički, psihološki, socijalni i duhovni aspekt bolesnika, uzimajući u obzir sve stupnjeve u ekspresiji karcinomske boli. Učinkovito liječenje karcinomske boli može se postići multimodalnim pristupom, tj. kombinacijom farmakoloških postupaka i nefarmakoloških postupaka (fizikalnih tehnika, komplementarnih metoda, psihoterapijskih tehnika) za liječenje karcinomske boli. Fizikalna tehnika, TENS se pokazala učinkovitom u smanjenju intenziteta kronične karcinomske boli, a palijativna radioterapija u smanjenju intenziteta boli uzrokovane koštanim metastazama i metastazama na mozgu. Komplementarna metoda u liječenju karcinomske boli, akupunktura, koristi se u kombinaciji s opioidima za liječenje specifičnih karcinomskih bolnih stanja, ili za smanjivanje/otklanjanje nuspojava opioida kao što su opstipacija, povraćanje i svrbež. Od psihoterapijskih tehnika, tehnika biološke povratne sprege korisna je u smanjenju karcinomske boli uzrokovane mišićnom tenzijom; klinička hipnoza koristi se za smanjenje tjeskobe kojoj je u podlozi bol i kod organske boli moguće je smanjiti osjetljivost na bol; KBT je djelotvorna u kontroliranju boli u žena s metastatskim karcinomom dojke te u odraslih oboljelih od karcinoma koji su bili podvrgnuti terapiji presađivanja koštane moždine. Medicinska sestra kao član multidisciplinarnog tima za liječenje karcinomske boli provodi najviše vremena s bolesnikom i njegovom obitelji stoga ima veoma važnu ulogu u prepoznavanju i kontroliranju karcinomske boli. Da bi medicinska sestra uspješno sudjelovala u liječenju karcinomske boli mora biti educirana, iskusna i dobro poznavati proces zdravstvene njege jer jedino na taj način može napraviti odgovarajući plan i izabrati najprikladnije individualizirane intervencije. Intervencije medicinske sestre moraju biti usmjerene svim komponentama karcinomske boli, odnosno fizičkoj psihosocijalnoj, i duhovnoj komponenti totalne karcinomske boli.Cancer pain is a significant problem for the patient, his family and multidisciplinary team. Multidisciplinary team for pain management should treat total cancer pain including all components of cancer pain: the physical, psychological, social and spiritual. Effective cancer pain management will be achieved only by a multimodal approach, i.e. a combination of pharmacological procedures and non-pharmacological procedures (physical techniques, complementary methods, psychotherapeutic techniques) in cancer pain management. Useful physical techniques for cancer pain management are TENS (transcutaneous electrical nerve stimulation) and palliative radiotherapy. TENS proved to be effective in reducing intensity of chronic cancer pain, while palliative radiotherapy is effective in reducing intensity of cancer pain caused by bone metastases and brain metastases. A complementary method, acupuncture, is used with opioid therapy for treatment of specific cancer pain conditions, or for reducing / eliminating opioid therapy side effects such as constipation, vomiting and pruritus. Useful psychotherapeutic techniques in cancer pain management are biofeedback, clinical hypnosis and KBT. Biofeedback is useful in reducing intensity of pain caused by muscular tension; clinical hypnosis is used to reduce anxiety, and in organic pain it is possible to reduce the sensitivity to pain; KBT is effective for controlling pain in women with metastatic breast cancer, also in adult cancer patients after bone marrow transplantation. As a member of multidisciplinary team for cancer pain management nurse spends most of her time with patient and his family, and plays very important role in recognizing and controlling cancer pain. For successful participation in cancer pain management, nurse must be educated and informed . Only educated and informed nurse can make appropriate nursing plan and choose the most suitable individualized nursing intervention in health care process.Nursing interventions must be directed to all components of total cancer pain: physical, psychosocial, spiritual