Bol je potrebno liječiti prema prihvaćenim smjernicama, a cilj je našeg istraživanja bio utvrđivanje učestalosti i osobitosti intervencija u izvanbolničkoj hitnoj medicini (HMP) zbog liječenja maligne boli. Učinili smo retrospektivnu analizu prospektivne baze podataka Nastavnog zavoda za hitnu medicinu Grada Zagreba u razdoblju od 1. siječnja do 31. prosinca 2014.godine. U ispitivanje su uključeni bolesnici oboljeli od maligne bolesti, a razlog intervencija tima hitne medicinske pomoći bila je maligna bol. Analizirani su: demografski podatci (dob, spol), struktura ispitanika prema vrsti maligne bolesti (Međunarodna klasifikacija bolesti), vrijeme intervencije (noć/dan), vrijeme intervencije prema danu u tjednu, vrsta primijenjenog analgetika (neopioid, opioid, adjuvantni analgetik) i načinu unosa analgetika u organizam. Podatci su prikazani u tablicama, kategorijske i nominalne vrijednosti prikazane su odgovarajućim frekvencijama i udjelima. U promatranom razdoblju HMP Zagreb imao je 70 155 intervencija, a zbog maligne boli ih je bilo 516 (0,74 %): 265 (51 %) bolesnica 251 (49 %) bolesnika. Povećan udio starije dobne skupine uzrok je sve većeg broja novootkrivenih bolesnika s malignim bolestima. Tako distribucija bolesnika prema dobnim skupinama pokazuje da je najveći broj bolesnika bio između 60. i 80. godine života (335 ili 64,91 %). Između 50. i 60. godine života pomoć je zatražio dvostruko manji broj bolesnika - 85 (16,47 %). Prema MBK klasifi kaciji bolesti najčešći uzrok bolova zbog kojih su bolesnici zatražili pomoć HMP-a bile su zloćudne novotvorine probavnih organa (138, 26,74%), respiratornih i intratorakalnih organa (10,5, 20,34 %). Tijekom dana ekipa HMP-a obavila je 288 (55,81 %) intervencija, tijekom noći 228 (44,19 %) .Tijekom vikenda obavljeno je 178 (34,36 %) intervencija, a radnim danom 340 (65,64 %). Ove intervencije posljedica su specifične organizacije rada izvanbolničkih zdravstvenih djelatnosti. Neopioidni su analgetici kao prva stepenica u liječenju maligne boli primijenjeni su puta 303 (58,72 %), slabi opioidi 205 puta (39,74 %), a jaki opioidi 8 puta (1,55 %). Glavna prepreka za optimalno liječenje boli je neadekvatna procjena boli. Najčešća je bila intramuskularna primjena analgetika (483, 93,24 %), a potom intravenska (21, 4,05 %) i supkutana (10, 1,93 %). Zaključujemo da je neophodno potrebno educirati timove HMP-a s naglaskom na procjenu jačine boli ljestvicama za bol uz propisivanje analgetske terapije sukladno preporukama.It is necessary to treat pain according to accepted guidelines and the goal of our research was to determine the frequency and characteristics of interventions in outpatient emergency medical services (EMS) for the treatment of malignant pain. We performed retrospective analysis of the prospective database of the Zagreb Municipal Teaching Institute of Emergency Medicine in the period from January 1 to December 31, 2014. The study included patients suffering from malignant diseases and malignant pain as the reason for the EMS team intervention. We analyzed demographic data (age, gender), structure of patients by type of malignant disease (International Classifi cation of Diseases, ICD), time of intervention (night/day), time of intervention according to day of the week, type of analgesics applied (non-opioid, opioid analgesic or adjuvant), and the route of painkiller administration. Data are presented in tables, categorical and nominal values are shown as appropriate frequencies and shares. Zagreb EMS had 70,155 interventions in the period observed, of which 516 (0.74%) patients with malignant pain, including 265 (51%) female and 251 (49%) male patients. The increased proportion of elderly population caused a growing number of newly diagnosed patients with malignant diseases. Therefore, distribution of patients according to age groups showed that the highest number of patients were in the 60-80 age group (n=335; 64.91%). Eighty-five (16.47%) patients aged 50-60 requested help from EMS. According to the ICD, the most common cause of pain for which patients sought help from EMS were malignant neoplasms of digestive organs (n=138; 26.4%), respiratory and intrathoracic organs (10.5% and 20.34%, respectively). The EMS team had 288 (55.81%) interventions during the day and 228 (44.19%) interventions during the night. They had 178 (34.36%) interventions over weekend and 340 (65.64%) interventions on work days. These interventions are the result of the specifi c work organization of outpatient hospital health services. Non-opioid analgesics as the fi rst step in the treatment of malignant pain were administered 303 (58.72%) times, weak opioids 205 (39.74) times, and strong opioids 8 (1.55%) times. The main obstacle to optimal pain management is inadequate assessment of pain. Intramuscular administration of analgesics (n=483; 93.24%) was most frequent, followed by intravenous (n=21; 4.05%) and subcutaneous (n=10; 1.93%) route. We conclude that it is necessary to educate EMS teams, especially focusing on the assessment of the degree of pain using scales for pain with prescription of analgesic therapy in accordance with recommendations
