Pain management in oncological patient

Onkološka bolest jedna je od najtežih kroničnih bolesti te vodeći uzrok smrti u svijetu. Uvelike narušava kvalitetu života, a jedan od najtežih simptoma koji nosi sa sobom je bol. Bol je u onkoloških bolesnika rezultat rasta tumora i njegovih metastaza, njihova pritiska na okolne strukture i infiltracije neuralnih struktura. Razvoju boli pridonose i liječničke intervencije, kako dijagnostičke poput biopsija, tako i kurativne poput kemoterapije. Uzrokovana je raznim mehanizmima pa je stoga i način njenog liječenja kompleksan. Uobičajeno je korištenje farmakološke terapije ovisno o intenzitetu boli te je stoga važno i dobro evaluirati bol. Subjektivna narav boli otežava razvoj dijagnostičkih pomagala za procjenu boli i jasnog vrednovanja učinka pojedinih metoda. Unatoč tome dugogodišnja istraživanja dovela su do razvoja tehnika koje dokazano pomažu u procjeni boli i njenom liječenju. Provjerene farmakološke metode poput uporabe opioida danas se dopunjuju modernim lijekovima kao što je denosumab te lijekovima na bazi kanabionida koji su proizašli iz uporabe kanabisa u mnogim kulturama. Za bol koja ne odgovara na farmakološku terapiju i dalje su dostupne neurokirurške metode, a razvijaju se i nove integrativne metode liječenja. U suradnji s bolesnikom treba odabrati odgovarajuću metodu liječenja i redovito pratiti odgovor na terapiju kako bi se postigao najbolji mogući ishod.Oncological disease is one of te most severe chronic diseases and the leading cause of death in the world. It greatly impairs quality of life and one of the most difficult symptoms it brings with it is pain. Pain in oncology patients is the result of tumor growth and its metastases, their pressure on surrounding structures and infiltration of neural structures. Medical interventions, both diagnostic, such as biopsies, and curative, such as chemotherapy, also contribute to the development of pain. It is caused by various mechanisms, so its treatment is also complex. Usually pharmacological therapy is used depending on the intensity of the pain, and therefore it is important to evaluate the pain well. The subjective nature of pain makes it difficult to develop diagnostic tools for pain assessment and to clearly evaluate the effect of some of the methods. Despite this, long-term research has led to the development of techniques that are proven to help in the assessment of pain and its treatment. Proven pharmacological methods such as the use of opioids are now being supplemented by modern drugs such as denosumab and cannabinoid-based drugs that have emerged from the use of cannabis in many cultures. Neurosurgical methods are still available for pain that does not respond to pharmacological therapy, and new integrative treatment methods are being developed. In cooperation with the patient, an appropriate method of treatment should be chosen and the response to therapy should be monitored regularly in order to achieve the best possible outcome