| Abstract | Međunarodna udruga za proučavanje boli (engl. IASP, International Association for the Study of Pain) definira neuropatsku bol kao kroničnu bol koja nastaje kao posljedica oštećenja ili disfunkcije središnjeg ili perifernog živčanog sustava bez aktivacije nociceptora. Incidencija neuropatske boli je u neprekidnom porastu te se procjenjuje da od nje pati 7-8 % stanovnika Europe i prema svojoj pojavnosti se ona nalazi na trećem mjestu učestalosti među različitim oblicima kronične boli u Europi. S obzirom na to koji dio živčanog sustava je zahvaćen, dijeli se na središnju i perifernu neuropatsku bol. Uzroci mogu biti razni, međutim u ordinacijama obiteljske medicine liječnici su najčešće uključeni u skrb i liječenje pacijenata koji boluju od dijabetičke polineuropatije te lumbalne i cervikalne radikulopatije. Patofiziologija nastanka neuropatske boli je kompleksna i danas postoji nekoliko različitih teorijskih modela mehanizma njenog nastanka pri čemu svi u podlozi imaju neku patološku promjenu u strukturama koje su odgovorne za prijenos i obradu informacija o boli. Pacijenti se mogu, uz oštru bol, prezentirati različitim senzacijama kao što su parestezije, alodinija, hiperalgezija itd., a postavljanje dijagnoze temelji se, uz anamnezu i klinički pregled, na elektromioneurografiji (EMNG-u). U liječenju neuropatske boli farmakoterapija je „zlatni standard“ pri čemu su, prema smjernicama EFNS-a (engl. European Federation of Neurological Societies), lijekovi prvog izbora duloksetin i pregabalin, a drugog izbora opioidi. Treća linija liječenja odnosi se na nefarmakološke metode i postupke. |
| Abstract (english) | The International Association for the Study of Pain (IASP) defines neuropathic pain as chronic pain that occurs as a result of damage or dysfunction of the central or peripheral nervous system without activation of nociceptors. The incidence of neuropathic pain is continuously increasing, and it is estimated that 7-8% of the population of Europe suffers from it, and according to its incidence, it ranks third among chronic pain in Europe. Depending on which part of the nervous system is affected, it is divided into central and peripheral neuropathic pain. The causes can be various, however, in family medicine offices, doctors are most often responsible for the care and treatment of patients suffering from diabetic polyneuropathy and lumbar and cervical radiculopathy. The pathophysiology of the occurrence of neuropathic pain is complex and today there are several different theoretical models of the mechanism of its occurrence, all of which are based on some pathological change in the structures that are responsible for the transmission and processing of information about pain. Patients may present, in addition to sharp pain, with various sensations such as paresthesia, allodynia, hyperalgesia etc., and the diagnosis is based, along with anamnesis and clinical examination, on electromyoneurography (EMNG). In the treatment of neuropathic pain, pharmacotherapy is the „gold standard“, whereby, according to EFNS (European Federation of Neurological Societies) guidelines, the drugs of first choice are duloxetine and pregabalin, and the second choice are opioids. The third line of treatment refers to non-pharmacological methods and procedures. |
