Niefarmakologiczne metody leczenia bólu

Międzynarodowe Stowarzyszenie Badania Bólu (IASP, International Association for the Study of Pain) zaleca wielokierunkowe leczenie chorych z bólem przewlekłym, także z uwzględnieniem metod niefarmakologicznych: technik anestezjologicznych, leczenia chirurgicznego, programów rehabilitacyjnych, terapii poznawczej i behawioralnej czy technik wspomagających — głównie neuromodulacji, w celu uzyskania większej sprawności, nawet mimo utrzymywania się doznań bólowych. W pracy omówiono powyższe metody oraz ich ocenę na podstawie badań kontrolowanych. Skojarzona terapia bólu z zastosowaniem metod niefarmakologicznych jest rekomendowana między innymi u pacjentów z bólami narządu ruchu, a w szczególności dolnego odcinka kręgosłupa

Niefarmakologiczne metody leczenia bólu

Międzynarodowe Stowarzyszenie Badania Bólu (IASP, International Association for the Study of Pain) zaleca wielokierunkowe leczenie chorych z bólem przewlekłym, także z uwzględnieniem metod niefarmakologicznych: technik anestezjologicznych, leczenia chirurgicznego, programów rehabilitacyjnych, terapii poznawczej i behawioralnej czy technik wspomagających - głównie neuromodulacji, w celu uzyskania większej sprawności, nawet mimo utrzymywania się doznań bólowych. W pracy omówiono powyższe metody oraz ich ocenę na podstawie badań kontrolowanych. Skojarzona terapia bólu z zastosowaniem metod niefarmakologicznych jest rekomendowana między innymi u pacjentów z bólami narządu ruchu, a w szczególności dolnego odcinka kręgosłup

A comparison of the usefulness of selected neuropathic pain scales in patients with chronic pain syndromes: a short communication

The aim of the study was to compare the usefulness of selected neuropathic pain scales in the diagnosis and monitoring of pain in patients with cancer and non-cancer pain syndromes. 62 patients with symptoms of chronic pain were enrolled in to the study. Following a routine medical examination (interview and physical examination) the patients together with the investigators completed four (DN4, PainDETECT, LANSS, MPQ). In addition, all the patients were examined using von Frey filaments to confirm the presence or absence of allodynia. Neuropathic pain was diagnosed using the scales in a total of 39 patients (62.9%). In addition, examination with von Frey filaments revealed hyperalgesia in 50%, hypoaesthesia in 30.95% and allodynia in 27% of the patients. The DN4 scale turned out to be the most sensitive (confirming neuropathic pain in 78.5% of all the study patients) and the LANSS scale turned out to be the least sensitive (confirming neuropathic pain in 48.49% of all the study patients). Adv. Pall. Med. 2010; 9, 4: 117–122The aim of the study was to compare the usefulness of selected neuropathic pain scales in the diagnosis and monitoring of pain in patients with cancer and non-cancer pain syndromes. 62 patients with symptoms of chronic pain were enrolled in to the study. Following a routine medical examination (interview and physical examination) the patients together with the investigators completed four (DN4, PainDETECT, LANSS, MPQ). In addition, all the patients were examined using von Frey filaments to confirm the presence or absence of allodynia. Neuropathic pain was diagnosed using the scales in a total of 39 patients (62.9%). In addition, examination with von Frey filaments revealed hyperalgesia in 50%, hypoaesthesia in 30.95% and allodynia in 27% of the patients. The DN4 scale turned out to be the most sensitive (confirming neuropathic pain in 78.5% of all the study patients) and the LANSS scale turned out to be the least sensitive (confirming neuropathic pain in 48.49% of all the study patients). Adv. Pall. Med. 2010; 9, 4: 117–12

Identification of epidural space in the sacral spine by means of a thermolesion needle and an radiofrequency (RF) generator - a preliminary report

Caudal epidural injections are one of the commonly used interventions in managing chronic low back pain. The caudal approach to epidural space was first reported by Sicard in 1901. Injection of steroids to treat low back pain was introduced in 1952. Corticosteroids delivered into epidural space demonstrate higher local concentrations over an inflamed nerve root and will be more effective than a steroid administered either orally or by intramuscular injection. The clinical effectiveness evaluations fill the literature with various types of reports including randomised clinical trials, prospective trials, retrospective studies, case reports, and meta-analyses. Evidence from all types of evaluations with regard to clinical outcomes and cost-effectiveness of caudal epidural injections is encouraging. Reports of the effectiveness of all types of epidural steroids vary from 18% to 90%. One of the reasons for this discrepancy is the difficulty in accurate identification of caudal epidural space and inaccurate needle placement when performed without imaging guidance in a substantial number of patients. Caudal epidural injection is a safe, effective technique when performed with due care. In many centres this procedure is performed under fluoroscopic or ultrasound guidance. In our study we used stimulation with a radiofreqency needle to identify caudal epidural space for low back pain treatment (30 patients).Caudal epidural injections are one of the commonly used interventions in managing chronic low back pain. The caudal approach to epidural space was first reported by Sicard in 1901. Injection of steroids to treat low back pain was introduced in 1952. Corticosteroids delivered into epidural space demonstrate higher local concentrations over an inflamed nerve root and will be more effective than a steroid administered either orally or by intramuscular injection. The clinical effectiveness evaluations fill the literature with various types of reports including randomised clinical trials, prospective trials, retrospective studies, case reports, and meta-analyses. Evidence from all types of evaluations with regard to clinical outcomes and cost-effectiveness of caudal epidural injections is encouraging. Reports of the effectiveness of all types of epidural steroids vary from 18% to 90%. One of the reasons for this discrepancy is the difficulty in accurate identification of caudal epidural space and inaccurate needle placement when performed without imaging guidance in a substantial number of patients. Caudal epidural injection is a safe, effective technique when performed with due care. In many centres this procedure is performed under fluoroscopic or ultrasound guidance. In our study we used stimulation with a radiofreqency needle to identify caudal epidural space for low back pain treatment (30 patients)

Anatomical aspects of epidural and spinal analgesia

Regional anaesthesia seems to be the future of the anaesthesia in this century. The knowledge of the anatomy of the epidural and other spinal spaces seems to play the crucial role in success of regional anaesthesia. It's important in perioperative medicine and cancer pain treatment. Up to date there is not too many datas considering anatomy of these compartments. Many of the results obtained by researchers in the past are still not mentioned in the clinical textbooks. This article is an attempt to resolve this problem.Regional anaesthesia seems to be the future of the anaesthesia in this century. The knowledge of the anatomy of the epidural and other spinal spaces seems to play the crucial role in success of regional anaesthesia. It's important in perioperative medicine and cancer pain treatment. Up to date there is not too many datas considering anatomy of these compartments. Many of the results obtained by researchers in the past are still not mentioned in the clinical textbooks. This article is an attempt to resolve this problem