Neuropathic Pain

Neuropatska bol neugodan je osjetni i emocionalni doživljaj uzrokovan oštećenjem ili bolešću somatosenzornog dijela živčanog sustava. Procjenjuje se da 7 – 8% stanovnika Europe pati od neuropatske boli. Klasični primjeri takve boli jesu bolna dijabetička polineuropatija, postherpetička neuralgija, trigeminalna neuralgija, radikularna bol, bol nakon moždanog udara, bol zbog ozljede leđne moždine te postkirurška bol. Neuropatska bol odraz je patološkog zbivanja u živčanom sustavu, koje ima za posljedicu niz različitih patofizioloških mehanizama u nastanku boli. Bol se javlja spontano, osobito u mirovanju, a doživljava kao pečenje, žarenje, sijevajuća ili oštra ubodna bol. Neuropatska je bol evocirana dodirom (mehanička alodinija) ili promjenom temperature (termička alodinija). Bol remeti san, izaziva tjeskobu i potištenost te smanjuje kvalitetu života bolesnika. U liječenju bolesnika s neuropatskom boli postoje dva cilja. Prvi je postavljanje ispravne dijagnoze i liječenje osnovne bolesti. Drugi je cilj definirati bolni sindrom i provesti simptomatsko liječenje boli. U liječenju neuropatske boli smjernice EFNS-a preporučju antiepileptike (gabapentin, pregabalin), tricikličke antidepresive i SNRI (duloksetin, venlafaksin) kao lijekove prvog izbora. Druga linija liječenja uključuje opioide. Topički lidokain može biti lijek izbora kod bolesnika s mehaničkom alodinijom. Kombinirana terapija može se primijeniti u slučajevima kada se monoterapija pokaže neučinkovitom, a trebali bi se kombinirati lijekovi s međusobno dopunjujućim mehanizmima djelovanja. Transkutana električna živčana stimulacija (engl. transcutaneous electrical nerve stimulation – TENS) ima dokazani analgetski učinak i uz redovitu kineziterapiju znatno pridonosi poboljšanju funkcionalnog stanja bolesnika. Psihoterapijska potpora važna je u liječenju kronične boli. Dijagnostika i liječenje neuropatske boli zahtijevaju interdisciplinarni i multimodalni pristup.Neuropathic pain is an unpleasant sensory and emotional experience caused by a lesion or a disease of the somatosensory nervous system. It is estimated to affect as much as 7-8% of the general population in Europe. Classic examples include painful diabetic polyneuropathy, postherpetic neuralgia, trigeminal neuralgia, and central poststroke and spinal cord injury pain, although traumatic/postsurgical neuropathies and painful radiculopathies represent common conditions in the general population. Neuropathic pain is a reflection of a pathologic event in the nervous system that results in a series of pathophysiological mechanisms involved in the onset of pain. It occurs spontaneously, particularly at rest, and is experienced as a burning, shooting or sharp stabbing pain. It is provoked by touch (mechanical allodynia) or temperature change (thermal allodynia). The pain interferes with sleep and provokes anxiety and depression, reducing a patient’squality of life. There are two goals in neuropathic pain treatment: firstly, establish a correct diagnosis and treat primary disease, and secondly, define painful syndrome and treat pain symptomatically. The EFNS guidelines for the treatment of neuropathic pain recommend the use of antiepileptic drugs (gabapentin, pregabalin), tricyclic antidepressants and SNRIs (duloxetine, venlafaxine) as drugs of first choice. Second-line treatment includes opioids. Topical lidocaine may be a drug of choice in patients with mechanical allodynia. Combined therapy can be used if monotherapy proves unsuccessful, and drugs with mutually supplementary mechanisms of action should be used. Transcutaneous electrical nerve stimulation (TENS) has a proven analgesic effect and, along with regular kinesitherapy, significantly contributes to the improvement of a patient’s functional state. Psychotherapeutic support is important in the treatment of chronic pain. Diagnostics and treatment of neuropathic pain require an interdisciplinary and multimodal approach