MEDIX, God. 20 Br. 111  •  Pregledni članak  •  Neurologija HR ENG

Dijagnostika i liječenje boli u bolesnika s multiplom sklerozomDiagnosis and treatment of pain in patients with multiple sclerosis

Ivan Bielen

Premda se bol ne ubraja u vodeće simptome za postavljanje dijagnoze multiple skleroze (MS), kad se pojavi, može postati i najveći problem za bolesnika, a presudno utječe na kvalitetu života. Iako se epidemiološki podatci razlikuju, procjenjuje se da neku vrstu boli ima više od 50% oboljelih. Kod MS-a bol se može prema patogenezi podijeliti na neuropatsku i nociceptivnu, a neki autori tu pripisuju i disfunkcionalni tip boli koji je izraz patološkog procesuiranja bolnih impulsa bez anatomske lezije živčanih struktura, odnosno podražaja nociceptora. Smatra se da postoji više patoloških mehanizama koji se u istoga bolesnika vjerojatno isprepleću, no smatra se da je vjerojatno najvažnija centralna senzitizacija, do koje dolazi zbog patološke reorganizacije somatosenzornih puteva, što je izazvano procesima deaferentacije. Liječenje neuropatske boli kod MS-a nije specifično, već proizlazi iz temeljnih načela neuropatske boli. Lijekovi prvog izbora su pregabalin, gabapentin i triciklički antidepresivi, no u novije vrijeme ima sve više dokaza i o učinkovitosti egzogenih kanabinoida. Bolni spazmi mogu se liječiti medikamentima kao što su: diazepam, baklofen, dantrolen ili tizanidin, no sve više ima izvještaja o uspješnom liječenju spastičnosti s pomoću infiltracija botulinskog toksina, osobito u slučajevima gdje je spastičnost praćena bolju. 

Ključne riječi:
neuropatska bol; nociceptivna bol; liječenje; multipla skleroza

Članak u cijelosti pročitajte u tiskanom izdanju MEDIX, God. 20 Br. 111

Pain is not one of the leading symptoms for the diagnosis of multiple sclerosis (MS), however when it appears it can become a big problem for patients due to its decisive influence on the quality of life. Although epidemiological data vary, it is estimated that more than 50% of patients with MS suffer from some kind of pain. In MS, the pain can be divided according to the pathogenesis in neuropathic and nociceptive. Some authors would add the dysfunctional type of pain that is an expression of the pathological processing of pain impulses without anatomical lesions of nerve structure and nociceptors stimuli. It is considered that there are several pathophysiological mechanisms working in the same patient, but the most important would be pathological central sensitization as a result of the pathological reorganization of the somatosensory pathways which is caused by the processes of deafferentation. Therapy for neuropathic pain in multiple sclerosis is not specific, and it is based on the fundamental principles of the neuropathic pain treatment. The favored drugs for treatment are pregabalin, gabapentin and tricyclic antidepressants, but there are many reports on exogenous cannabinoids being an efficient alternative in treating neuropathic pain in MS. Painful spasms can be treated by the drugs such as diazepam, baclofen and tizanidine. Botulin toxin is reported to be very successful in treating painful spasticity. 

Key words:
multiple sclerosis; neuropathic pain; nociceptive pain; therapy