NON-PHARMACOLOGICAL PAIN MANAGEMENT OF RHEUMATIC DISEASES

Reumatske bolesti jedan su od vodećih uzroka kroničnih bolnih stanja, koja, ako se ne prepoznaju i pravodobno ne liječe, uzrokuju nesposobnost te posljedično smanjuju kvalitetu života pojedinca. Kronična bol kod reumatskih bolesnika ima multifaktorsku podlogu. Zbog toga je često praćena poremećajem spavanja i raspoloženja, umorom te smanjenjem funkcionalnog kapaciteta i zglobova i kralježnice. Novija istraživanja upućuju na činjenicu da reumatska bol nije samo nociceptivna, već kod velikog broja bolesnika može imati karakteristike i neuropatske i centralne boli. Upravo zbog navedenoga dosadašnji je pristup liječenju reumatske boli često davao vrlo skromne rezultate. Zato se reumatska bol više ne smije liječiti samo kao simptom, već kao zasebna bolest. Učinkovito liječenje reumatske boli zahtijeva multidisciplinarni, biopsihosocijalni pristup, uzimajući u obzir uzrok i karakter boli, obilježja bolesti, stil života te psihološku sposobnost pojedinca za nošenje s bolnim stanjima. Pažljiv odabir različitih modali teta nefarmakološkog liječenja trebao bi zato biti prvi korak u liječenju reumatske boli, uz primjenu dostupnih nam farmakoloških intervencija. Malen broj sustavnih pregleda, koji su obuhvatili samo manji broj uzroka i načina liječenja reumatske boli, uz upitnu kvalitetu dokaza, upućuje na potrebu izrade novih visokokvalitetnih randomiziranih kontroliranih studija, koje bi omogućile stvaran uvid u djelotvornost brojnih nefarmakoloških postupaka u liječenju reumatske boli.Rheumatic diseases are a leading cause of chronic painful conditions, which, if not recognized and treated in a timely manner, cause inability and consequently reduce the quality of life of individuals. Chronic pain in rheumatic patients has a multifactorial background. Th erefore, it is oft en accompanied by sleep and mood disturbances, fatigue, and reduced functional capacity of joints and the spine. Recent studies suggest that rheumatic pain is not exclusively nociceptive, and that in a large number of patients it may have the characteristics of neuropathic and central pain. Th us, the current approach to the treatment of rheumatic pain oft en had very modest results. For these reasons, rheumatic pain can no longer be treated only as a symptom, but should rather be viewed as a separate disease. Eff ective treatment of rheumatic pain requires a multidisciplinary, biopsychosocial approach taking into account the cause and nature of the pain, the disease characteristics, lifestyle, and psychological ability of an individual to deal with painful conditions. Careful selection of diff erent modes of non-pharmacological treatment should be the fi rst step in the treatment of rheumatic pain with the use of available pharmacological interventions. A small number of systematic reviews, which included only a small number of causes and treatments for rheumatic pain with questionable quality of evidence, indicates the need to develop new high-quality randomized controlled trials, in order to enable real insight into the eff ectiveness of non-pharmacological methods for the treatment of rheumatic pain