Bolest je komplikovaná subjektivní entita, kterou je obtížné kvantifikovat a léčit. Jednotlivci se prostřednictvím svých životních zkušeností učí pojmu bolesti a koncepce vnímání bolesti se u člověka mění. Přestože bolest obvykle plní adaptivní roli, může mít nepříznivé účinky na kvalitu života – na funkční, sociální a psychologickou rovnováhu. Proto je třeba respektovat sdělení jednotlivce o tom, že prožívá a cítí bolest, či sledovat různé symptomy bolesti. Perioperační léčba bolesti je dnes součástí komplexní péče o pacienty, kteří se podrobují operačním zákrokům, a je spojena s četnými benefity pro pacienta i společnost. V současnosti je k dispozici dostatek léků, lékových forem, modalit léčby i dostatek literárních údajů, vč. poznatků o organizaci léčby pooperační bolesti. Komplexní péče začíná již před operačním výkonem na specializovaných ambulancích správnou přípravou pacienta na anestezii a operační výkon. Samotná léčba pooperační bolesti je podobně jako péče o pacienta po chirurgickém výkonu multidisciplinárním týmovým úkolem, na němž se podílejí zejména ošetřující lékař, operatér, anesteziolog a sestry pooperačního oddělení. Součástí této rozsáhlé spolupráce jsou specializované týmy na léčbu akutní pooperační bolesti, které mají úlohu především konziliární, vzdělávací a organizační a pomáhají zajišťovat specializované léčebné postupy tišení bolesti. Je nutné, aby všechny specialisty spojovaly základní znalosti a jejich uplatňování v praxi.
Pain is a complicated subjective entity that is difficult to quantify and treat. Individuals learn the concept of pain through their life experience, and a person’s concept of pain perception changes. Although pain usually fulfills an adaptive role, it can have adverse effects on quality of life – functional, social and psychological balance. Therefore, it is necessary to respect the communication of the individual experiencing and feeling pain, or to monitor the various symptoms of pain. Today, perioperative pain management is part of the comprehensive care of patients undergoing surgery, and is associated with numerous benefits for the patient and society. Currently, there are enough drugs, dosage forms, treatment modalities available, as well as enough literary data, incl. knowledge about the organization of postoperative pain treatment. Comprehensive care begins even before surgery in specialized outpatient clinics with the proper preparation of the patient for anesthesia and surgery. The treatment of postoperative pain itself is similar to the care of a patient after a surgical procedure, a multidisciplinary team task, in which the attending physician, surgeon, anesthetist and nurses of the postoperative department participate in particular. Part of this extensive collaboration are specialized teams for the treatment of acute postoperative pain, which primarily have a conciliatory, educational and organizational role, and help to provide specialized treatment procedures for pain relief. It is necessary for all specialists to combine basic knowledge and their application in practice.
- MeSH
- Analgesics administration & dosage pharmacology classification MeSH
- Analgesia methods MeSH
- Anti-Inflammatory Agents, Non-Steroidal administration & dosage pharmacology classification adverse effects MeSH
- Surgical Procedures, Operative adverse effects MeSH
- Adrenal Cortex Hormones administration & dosage MeSH
- Humans MeSH
- Dipyrone administration & dosage MeSH
- Morphine administration & dosage MeSH
- Analgesics, Opioid administration & dosage classification MeSH
- Acetaminophen administration & dosage MeSH
- Perioperative Care methods MeSH
- Pain, Postoperative * drug therapy therapy MeSH
- Postoperative Care * methods MeSH
- Enhanced Recovery After Surgery MeSH
- Check Tag
- Humans MeSH
- Publication type
- Review MeSH
- MeSH
- Pain * drug therapy MeSH
- Child MeSH
- Fentanyl administration & dosage adverse effects MeSH
- Humans MeSH
- Morphine administration & dosage pharmacology adverse effects MeSH
- Analgesics, Opioid * administration & dosage classification adverse effects MeSH
- Oxycodone administration & dosage pharmacology MeSH
- Tramadol administration & dosage pharmacology adverse effects MeSH
- Check Tag
- Child MeSH
- Humans MeSH
- Publication type
- Review MeSH
- MeSH
- Adenosine Monophosphate administration & dosage MeSH
- Alanine administration & dosage MeSH
- Antipyretics administration & dosage MeSH
- Antiviral Agents administration & dosage MeSH
- Bronchodilator Agents administration & dosage MeSH
- Medical Records MeSH
- COVID-19 * diagnosis complications therapy MeSH
- Dexamethasone administration & dosage MeSH
- Expectorants administration & dosage MeSH
- Hospitalization MeSH
- Immunosuppressive Agents therapeutic use MeSH
- Janus Kinase Inhibitors administration & dosage MeSH
- Quarantine MeSH
- Frailty classification MeSH
- Ascorbic Acid administration & dosage MeSH
- Humans MeSH
- Morphine administration & dosage MeSH
- Neurocognitive Disorders drug therapy MeSH
- Nutrition Therapy MeSH
- Oxygen Inhalation Therapy methods MeSH
- Drinking MeSH
- Relative Value Scales MeSH
- Risk Factors MeSH
- Aged MeSH
- Severity of Illness Index MeSH
- Death Certificates MeSH
- Vitamin D administration & dosage MeSH
- Check Tag
- Humans MeSH
- Aged MeSH
- Publication type
- Practice Guideline MeSH
- Keywords
- neinvazivní plicní ventilace, paliativní sedace, pseudobulbární afekt,
- MeSH
- Amyotrophic Lateral Sclerosis * diagnosis drug therapy classification complications pathology psychology therapy MeSH
- Diagnosis, Differential MeSH
- Living Wills MeSH
- Fatal Outcome MeSH
- Frontotemporal Lobar Degeneration drug therapy MeSH
- Humans MeSH
- Morphine administration & dosage MeSH
- Nutritional Support MeSH
- Palliative Care MeSH
- Respiratory Insufficiency etiology drug therapy therapy MeSH
- Check Tag
- Humans MeSH
- Publication type
- Review MeSH
Morphine is considered a gold standard in pain treatment. Nevertheless, its use could be associated with severe side effects, including drug addiction. Thus, it is very important to understand the molecular mechanism of morphine action in order to develop new methods of pain therapy, or at least to attenuate the side effects of opioids usage. Proteomics allows for the indication of proteins involved in certain biological processes, but the number of items identified in a single study is usually overwhelming. Thus, researchers face the difficult problem of choosing the proteins which are really important for the investigated processes and worth further studies. Therefore, based on the 29 published articles, we created a database of proteins regulated by morphine administration - The Morphinome Database (addiction-proteomics.org). This web tool allows for indicating proteins that were identified during different proteomics studies. Moreover, the collection and organization of such a vast amount of data allows us to find the same proteins that were identified in various studies and to create their ranking, based on the frequency of their identification. STRING and KEGG databases indicated metabolic pathways which those molecules are involved in. This means that those molecular pathways seem to be strongly affected by morphine administration and could be important targets for further investigations. SIGNIFICANCE: The data about proteins identified by different proteomics studies of molecular changes caused by morphine administration (29 published articles) were gathered in the Morphinome Database. Unification of those data allowed for the identification of proteins that were indicated several times by distinct proteomics studies, which means that they seem to be very well verified and important for the entire process. Those proteins might be now considered promising aims for more detailed studies of their role in the molecular mechanism of morphine action.
- MeSH
- Databases, Factual * MeSH
- Databases as Topic MeSH
- Internet MeSH
- Humans MeSH
- Metabolic Networks and Pathways MeSH
- Morphine administration & dosage MeSH
- Proteins drug effects MeSH
- Proteomics methods MeSH
- Check Tag
- Humans MeSH
- Publication type
- Journal Article MeSH
- Research Support, Non-U.S. Gov't MeSH
- MeSH
- Surgical Oncology MeSH
- Gynecologic Surgical Procedures MeSH
- Clinical Studies as Topic MeSH
- Humans MeSH
- Morphine administration & dosage therapeutic use MeSH
- Perioperative Care methods MeSH
- Pain, Postoperative * drug therapy MeSH
- Check Tag
- Humans MeSH
- Female MeSH
- Publication type
- Research Support, Non-U.S. Gov't MeSH
Neuromodulačné techniky predstavujú paletu terapeutických postupov s rozličnými možnosťami ovplyvňovania dráh bolesti. Jedná sa buď o aplikáciu vybraného liečiva, alebo pôsobenie elektrického signálu v blízkosti periférneho (PNS) alebo centrálneho nervového systému (CNS), ktorým sa moduluje vnímanie bolesti. Aplikácia farmák do epidurálneho alebo subarachnoidálneho priestoru sa využíva ako súčasť katetrizačných techník s kontinuálnym podávaním liečiva. Druhú skupinu tvoria vyspelé neurostimulačné systémy, pri ktorých elektrický signál na úrovni PNS alebo CNS zložitým účinkom ovplyvňuje vedenie a percepciu bolesti. Napriek mnohým teóriám založeným na experimentálnych výsledkoch, ich patofyziologický mechanizmus účinku nie je doteraz jednoznačne vysvetlený. Dominantné postavenie medzi neurostimulačnými technikami v liečbe chronickej bolesti predstavujú techniky založené na stimulácii miechových štruktúr, dorzálnych ganglií a periférnych nervov založených na aplikácii elektród do zadného alebo aj predného epidurálneho priestoru. Táto terapeutická metóda je určená pre rezistentné chronické bolestivé stavy, ako napríklad komplexný regionálny bolestivý syndróm (KRBS), syndróm zlyhanej operácie chrbtice (failed back surgery syndrome, FBSS) a iné, po vyčerpaní ostatných liečebných možností. Typy miechových stimulátorov sa líšia hlavne v použití rozličných frekvencií v rámci nastavenia stimulačných parametrov a v použitom type generátora elektrických impulzov. Dnes je rozlišovacím parametrom aj kompatibilita systémov s magnetickou rezonanciou. Neuromodulačné techniky predstavujú dôležitý nástroj liečby refraktérnej chronickej bolesti. U správne indikovaných pacientov s dobre fungujúcou miechovou stimuláciou dochádza k výraznému zlepšeniu kvality života a redukcii vedľajších účinkov farmakoterapie. Cieľom práce je opísať problematiku neuromodulačnej liečby a jej súčasných výsledkov.
Neuromodulation techniques represent a spectrum of therapeutic approaches with various options to influence the pain pathways. It can be either the application of the chosen medication or the action of electrical signals in the vicinity of the peripheral (PNS) or central nervous system (CNS), by which the perception of pain is modulated. The application of medications into the epidural or subdural space is commonly used as a part of catheterisation techniques with a continuous administration of the chosen medication. The second group is made up of modern neurostimulation systems, during which electrical signals at the level of the PNS or CNS affect the conduction and perception of pain in a complex manner. Despite numerous theories based on experimental results, their pathophysiological mechanism of action has not yet been fully explained. The dominant role among neurostimulation techniques in the management of chronic pain, for example in the cases of complex regional pain syndrome (CRPS), failed back surgery syndrome (FBSS) and others, belongs to the techniques based on the stimulation of spinal structures, dorsal ganglia and peripheral nerves, with the application of electrodes to the posterior and anterior epidural space. The types of spinal stimulators differ mainly in the application of different frequencies within the stimulation parameters settings and the electrical impulse generator type used. Nowadays, a distinguishing parameter is also the compatibility of the systems with magnetic resonance. Neuromodulation techniques are important part of chronic refractory pain treatment. Correct indications of patients with a functional spinal cord stimulation lead to improvement of quality of life and reduction of pharmacological side effects. The goal of this article is to cover current neuromodulation treatment modalities and to inform about actual clinical outcomes of various methods.
- MeSH
- Back Pain * surgery therapy MeSH
- Chronic Pain therapy MeSH
- Clonidine administration & dosage adverse effects therapeutic use MeSH
- Electric Stimulation methods MeSH
- Electrodes, Implanted MeSH
- Humans MeSH
- Spinal Cord surgery drug effects MeSH
- Spinal Cord Stimulation methods MeSH
- Morphine administration & dosage adverse effects therapeutic use MeSH
- Neurosurgical Procedures methods MeSH
- omega-Conotoxins adverse effects therapeutic use MeSH
- Analgesics, Opioid administration & dosage adverse effects therapeutic use MeSH
- Injections, Spinal * methods MeSH
- Check Tag
- Humans MeSH
- MeSH
- Fentanyl administration & dosage MeSH
- Drug Therapy, Combination MeSH
- Humans MeSH
- Morphine administration & dosage MeSH
- Cancer Pain * drug therapy MeSH
- Lung Neoplasms MeSH
- Analgesics, Opioid administration & dosage pharmacology adverse effects MeSH
- Oxycodone administration & dosage MeSH
- Palliative Care MeSH
- Breakthrough Pain drug therapy MeSH
- Drug Administration Routes MeSH
- Check Tag
- Humans MeSH
- Female MeSH
- Publication type
- Case Reports MeSH
Bolest je subjektivní vjem a úspěšnou léčbou bolesti se zabývají lidé již po mnoho staletí. Chronická bolest je v algeziologické praxi popisovaná podle patofyziologických mechanizmů vzniku bolesti a rozdělována na dva základní druhy – nociceptivní bolest a neuropatická. Tyto dva druhy se objevují samostatně nebo se mohou vzájemně kombinovat. Světová zdravotnická organizace (WHO) vytvořila třístupňový analgetický žebříček s doporučením užití opioidů v léčbě onkologické bolesti a tato doporučení jsou dnes široce aplikována při užití opioidní terapie v léčbě chronické nenádorové bolesti. Základním představitelem silných opioidů i nadále zůstává morfin, který je zvláště využíván v léčbě bolesti v paliativní medicíně. V ambulantní algeziologické praxi je dávána přednost novějším molekulám opioidům s nižším výskytem nežádoucích účinků. V současné době jsou k dispozici v náplasťové formě – fentanyl a buprenorfin. U perorální léčby bolesti se využívá široká nabídka opioidních analgetik – oxycodon a hydromorfon. V posledních letech se pro své působení prosadil nový opioid tapentadol se svým prokázaným duálním efektem spočívajícím jak ve schopnosti aktivovat opioidní μ-receptory, tak zároveň blokovat zpětnou resorpci noradrenalinu. Svým působením je dnes řazen do nové tzv. MOR-NRI třídy analgetik.
Pain is subjective perception a and the effective management of chronic pain is fundamental goal for the people , who treat thepain. Chronic pain is describe like two basic kinds of pain – nociceptive and neuropathic pain., wich appears separatly or in combination.The World Health Organisation (WHO) developer outlines the tree-step analgesic lader these opioids in the managementof cancer pain, and these are widely accepted and extensively validated guidelines heve been influential in the aplplication ofopioidy therapy for treatment of chronic, non-malignant pain.The morfin is the main representative such potent opioids and plays an important role in management of pain in patients withchronic pain in paliative care. The newer- generation agents –fentanyl, buprenorfin, oxycodon, hydromorfon and tapentadolplays important role in chronic, non malignant pan.New opioid tapentadol is the first compoud of new pharmacological class MOR-NRI, that combines mi-opioid-agonist and noradrenalinre-uptake inhibitor activities in one molecule.
- Keywords
- koanalgetika, gabapentinoidy,
- MeSH
- Antidepressive Agents, Tricyclic adverse effects therapeutic use MeSH
- Administration, Cutaneous MeSH
- Buprenorphine administration & dosage therapeutic use MeSH
- Chronic Pain * drug therapy classification MeSH
- Adult MeSH
- Duloxetine Hydrochloride therapeutic use MeSH
- Fentanyl administration & dosage therapeutic use MeSH
- Gabapentin MeSH
- Hyperalgesia MeSH
- Drug Therapy, Combination MeSH
- Humans MeSH
- Pain Management MeSH
- Pain Measurement MeSH
- Morphine administration & dosage therapeutic use MeSH
- Naloxone therapeutic use MeSH
- Neuralgia * diagnosis drug therapy MeSH
- Nociceptive Pain * diagnosis drug therapy MeSH
- Analgesics, Opioid therapeutic use MeSH
- Oxycodone therapeutic use MeSH
- Paresthesia MeSH
- Pregabalin administration & dosage therapeutic use MeSH
- Aged MeSH
- Tapentadol MeSH
- Tramadol therapeutic use MeSH
- Venlafaxine Hydrochloride therapeutic use MeSH
- Constipation chemically induced MeSH
- Check Tag
- Adult MeSH
- Humans MeSH
- Aged MeSH
- Publication type
- Review MeSH
