Therapy of Cancer Pain

Na ljestvici vodećih uzroka smrti maligne bolesti zauzimaju drugo mjesto. Napredak u medicini doveo je do duljeg preživljenja bolesnika s malignim bolestima pa se karcinom smatra kroničnom bolesti. Jedan od najtežih simptoma maligne bolesti je bol. Ovisno o patofiziološkome mehanizmu maligna se bol može podijeliti na nociceptivnu, neuropatsku i inflamatornu bol. S obzirom na to da je bol subjektivan osjećaj, veliku pozornost treba posvetiti adekvatnoj procjeni boli jer je ona temelj kvalitetnog liječenja maligne boli. U liječenju se koristimo farmakološkim i nefarmakološkim metodama. Farmakološki se pristup provodi prema modelu „trostupanjske analgoljestvice“, odnosno prema njezinoj modifikaciji „modelu lifta“. Nefarmakološko liječenje uključuje psihosocijalne intervencije, fizikalnu terapiju, radioterapiju, rjeđe kemoterapiju, anesteziološke, neurokirurške i kirurške postupke. Istraživanja dokazuju da unatoč novim saznanjima o patofiziologiji boli, dostupnosti lijekova i postojanju smjernica o liječenju boli ono i dalje nije adekvatno te 50 – 70% ljudi s malignom bolesti trpi određeni stupanj boli. Cilj našega svakodnevnog rada jest promijeniti taj uznemiravajući postotak i tako u praksu uvesti načela potporne i palijativne skrbi koja osiguravaju pravo svakog bolesnika na liječenje boli.Malignant diseases are the second most common cause of death. Progress in medicine led to a longer survival of patients with malignant diseases, thereby considering cancer a chronic disease. One of the most distressing symptoms reported by patients with malignant diseases is pain. Depending on pathophysiological mechanisms, malignant pain is divided into nociceptive, neuropathic and inflammatory pain. Since pain is a subjective feeling, great attention should be paid to its adequate assessment because this is the basis for a quality treatment of malignant pain. In treatment, pharmacological and non-pharmacological methods are used. The pharmacological approach follows a “three-step ladder” model, or its modification known as “lift model”. Non-pharmacological treatment includes psychosocial interventions, physical therapy, radiation therapy, and less often chemotherapy, anesthesiology, and surgical and neurosurgical procedures. Researches show that despite the new knowledge about the pathophysiology of pain, the availability of drugs and the existence of guidelines for the treatment of pain, this treatment is still not adequate, and 50-70 % of people with malignant diseases suffer from some degree of pain. The goal of our daily work is to change this alarming rate and to implement in the principles of supportive and palliative care which ensure the right to pain treatment to each and every patient