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2018, vol. 68, br. 6, str. 1009-1020
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Opioidni i adjuvantni analgetici u savremenom lečenju bola
Opioids and adjuvant analgesics in current treating of pain
Univerzitet u Beogradu, Farmaceutski fakultet, Institut za farmakologiju, Srbija
e-adresa: racabbr@eunet.rs
Projekat: Ispitivanje mehanizma dejstva, interakcija i toksičnih efekata adjuvantnih analgetika (MPNTR - 175045)
Sažetak
Morfin, kao primer opioida se smatra 'zlatnim standardom' u lečenju jakih bolova, sa kojim se svi drugi lekovi porede. Međutim, potencijal opioida da izazovu zavisnost/adikciju i depresiju disanja stvorilo je tzv. 'opiofobe' među zdravstvenim radnicima, zbog kojih se opioidi nedovoljno koriste u lečenju jakih bolova. Ali, adikcija i izrazita depresija disanja gotovo nikada ne mogu da se jave u terminalnih pacijenata. Zato strah od zavisnosti i respiratorne depresije ne treba da spreči povećanje doze opioida kada pacijent i dalje pati od bola. Opioidi su slabo efikasni u lečenju neuropatskih bolova. Za lečenje neuropatskih bolova koriste se antiepileptici (karbamazepin, pregabalin, gabapentin) i antidepresivi (amitriptilin, duloksetin).
Abstract
Morphine, as a paradigm of opioids, is 'gold standard' in treating severe pain, to which all other drugs are compared. However, abuse and respiratory depression potentials have resulted in 'opiophobia' among health professionals, and underutilization of opioids as analgesics. But, addiction and respiratory depression are almost never present in pain management in palliative care. So, fear of addiction and respiratory depression should not prevent increasing of opioid dose in those patients in paliative care who still suffer of severe pain. Opioids are ineffective in treating neuropathic pain. Antiepileptics (carbamazepine, pregabalin, gabapentin) and antidepressants (amitriptyline, duloxetine) are used for neuropathic pain.
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