Chronická bolest představuje významný celospolečenský socio-ekonomický problém. Výraznou měrou se podílí na invalidizaci obyvatelstva vyspělých zemí světa a nepříznivě ovlivňuje kvalitu života. Strategie léčby chronické bolesti je multimodální; zahrnuje farmakoterapii, rehabilitační léčbu, psychoterapii, invazivní metody a některé další léčebné možnosti. Základní strategie léčby bolesti vychází z třístupňového analgetického žebříčku WHO. Základem léčby chronické bolesti jsou neopioidní analgetika, dle intenzity bolesti kombinovaná se slabými nebo silnými opioidy. Tato léčba může být doplňována adjuvantní analgetickou medikací. Opioidy v poslední době dělíme i na konvenční a atypické. Zástupcem atypických opioidů je především buprenorfin a tapentadol.
Chronic pain is a major society-wide socio-economic problem. It significantly contributes to the population disability rate in developed countries and adversely affects the quality of life. The strategy of chronic pain management is multimodal, involving pharmacotherapy, rehabilitation therapy, psychotherapy, invasive methods, and some other therapeutic options. The basic pain management strategy is based on the WHO three-step analgesic ladder. Non-opioid analgesics are the mainstay of chronic pain management, combined with weak or strong opioids depending on the intensity of pain. This treatment can be supplemented with adjuvant analgesic medication. Recently, opioids have also been classified into conventional and atypical ones. Buprenorphine and tapentadol are the main examples of atypical opioids.
- MeSH
- buprenorfin farmakologie terapeutické užití MeSH
- chronická bolest * diagnóza farmakoterapie MeSH
- kvalita života MeSH
- lidé MeSH
- management bolesti metody MeSH
- opioidní analgetika farmakologie klasifikace terapeutické užití MeSH
- tapentadol farmakologie terapeutické užití MeSH
- tramadol farmakologie terapeutické užití MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- přehledy MeSH
In the previous article, the author demonstrated the close relationship between bloodletting practices in medieval Europe and acupuncture in Traditional Chinese Medicine. This study aimed to explore how acupuncture-based treatment was applied in medieval Europe. The author hypothesizes that the physical stimulation of acupuncture points associated with bloodletting was one of the main methods of pain management at that time. The study examined the indications for phlebotomy as depicted in the original illustration from Practica Medicinalis written by the 15th-century Archbishop of Prague, Sigismundus Albicus, supplemented by two other European medieval medical manuscripts. A total of 76 distinct symptoms (corresponding to 25 bloodletting acupuncture points) from the Practica Medicinalis illustration were assembled into four groups: 1) Pain and inflammation symptoms; 2) Symptoms commonly associated with pain and inflammation; 3) General symptoms affecting various organs and functions; and 4) Conditions unrelated to pain or inflammation. Among the 76 symptoms and 25 acupuncture points, only nine symptoms and a single bloodletting point were not associated with the treatment of pain or inflammation. This suggests that acupuncture-based therapy was an effective method for managing pain and inflammation in the Middle Ages and that such treatment could still be valuable from a modern clinical perspective.
- MeSH
- akupunkturní body * MeSH
- akupunkturní terapie * dějiny MeSH
- bolest dějiny MeSH
- dějiny středověku MeSH
- lidé MeSH
- management bolesti * dějiny metody MeSH
- zánět * dějiny terapie MeSH
- Check Tag
- dějiny středověku MeSH
- lidé MeSH
- Publikační typ
- časopisecké články MeSH
- historické články MeSH
- Geografické názvy
- Evropa MeSH
BACKGROUND AND OBJECTIVES: Trigeminal neuralgia affects approximately 2% of patients with multiple sclerosis (MS) and often shows higher rates of pain recurrence after treatment. Previous studies on the effectiveness of stereotactic radiosurgery (SRS) for trigeminal neuralgia did not consider the different MS subtypes, including remitting relapsing (RRMS), primary progressive (PPMS), and secondary progressive (SPMS). Our objective was to investigate how MS subtypes are related to pain control (PC) rates after SRS. METHODS: We conducted a retrospective multicenter analysis of prospectively collected databases. Pain status was assessed using the Barrow National Institute Pain Intensity Scales. Time to recurrence was estimated through the Kaplan-Meier method and compared groups using log-rank tests. Logistic regression was used to calculate the odds ratio (OR). RESULTS: Two hundred and fifty-eight patients, 135 (52.4%) RRMS, 30 (11.6%) PPMS, and 93 (36%) SPMS, were included from 14 institutions. In total, 84.6% of patients achieved initial pain relief, with a median time of 1 month; 78.7% had some degree of pain recurrence with a median time of 10.2 months for RRMS, 8 months for PPMS, 8.1 months for SPMS ( P = .424). Achieving Barrow National Institute-I after SRS was a predictor for longer periods without recurrence ( P = .028). Analyzing PC at the last available follow-up and comparing with RRMS, PPMS was less likely to have PC (OR = 0.389; 95% CI 0.153-0.986; P = .047) and SPMS was more likely (OR = 2.0; 95% CI 0.967-4.136; P = .062). A subgroup of 149 patients did not have other procedures apart from SRS. The median times to recurrence in this group were 11.1, 9.8, and 19.6 months for RRMS, PPMS, and SPMS, respectively (log-rank, P = .045). CONCLUSION: This study is the first to investigate the relationship between MS subtypes and PC after SRS, and our results provide preliminary evidence that subtypes may influence pain outcomes, with PPMS posing the greatest challenge to pain management.
- MeSH
- bolest etiologie chirurgie MeSH
- lidé MeSH
- lokální recidiva nádoru chirurgie MeSH
- management bolesti metody MeSH
- neuralgie trigeminu * radioterapie chirurgie MeSH
- radiochirurgie * metody MeSH
- retrospektivní studie MeSH
- roztroušená skleróza * chirurgie MeSH
- výsledek terapie MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- časopisecké články MeSH
- multicentrická studie MeSH
The use of virtual reality (VR) in medicine is rapidly expanding, particularly in areas like pain management, surgical training, and mental health therapy. This study examines the implementation and effects of the Cold River VR application, a fully immersive tool designed to help manage pain and anxiety during dressing changes for burn trauma patients in a Czech hospital. The Cold River application immerses patients in a peaceful, interactive virtual environment, utilizing eye-tracking technology to engage them without the need for physical controllers, which could interfere with wound care. The study included 67 participants and found that Cold River effectively distracted patients, making the often painful and anxiety-provoking dressing changes more bearable. While stakeholder interviews indicated that the VR application was generally well-received and seen as a valuable tool in reducing patient discomfort, challenges such as lengthy calibration and occasional issues with nausea and headset discomfort were noted. Importantly, the Cold River application increased patient engagement and reduced the psychological burden associated with burn care, though it also highlighted the need for customization based on individual patient preferences and conditions. Overall, the experience with Cold River suggests that immersive VR holds significant potential for improving patient care during burn treatment, particularly when tailored to specific patient needs and contexts.
- Klíčová slova
- Cold River,
- MeSH
- dospělí MeSH
- lidé středního věku MeSH
- lidé MeSH
- management bolesti metody MeSH
- mladý dospělý MeSH
- pacienti psychologie MeSH
- popálení * ošetřování psychologie terapie MeSH
- postoj zdravotnického personálu MeSH
- senioři MeSH
- terapie pomocí virtuální reality * metody přístrojové vybavení MeSH
- Check Tag
- dospělí MeSH
- lidé středního věku MeSH
- lidé MeSH
- mladý dospělý MeSH
- mužské pohlaví MeSH
- senioři MeSH
- ženské pohlaví MeSH
- Publikační typ
- klinická studie MeSH
- práce podpořená grantem MeSH
- MeSH
- lidé MeSH
- management bolesti ekonomika metody MeSH
- popálení * ošetřování terapie MeSH
- terapie pomocí virtuální reality * ekonomika metody MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- dopisy MeSH
Virtuálna realita (VR) predstavuje zlom v pediatrickej starostlivosti o popáleniny, poskytujúc inovatívne riešenia nielen v akútnej liečbe, ale aj v rehabilitácii. Distrakčná terapia, osvedčený psychologický fenomén, tvorí základ účinnosti VR. Vedecké štúdie neustále potvrdzujú, že pohlcujúce zážitky VR dokážu odvrátiť pozornosť dieťaťa od bolestivých procedúr, čím sa znižuje vnímaná intenzita bolesti. VR je tiež dôležitým nefarmakologickým doplnkom, ktorý je v súlade s prístupmi založenými na dôkazoch a poskytuje vedecky podloženú alternatívu a doplnkovú liečbu k farmakologickým stratégiám zvládania bolesti. Vedecké štúdie u detí podstupujúcich rehabilitáciu popálenín ukazujú, že cvičenia s podporou VR prispievajú k zlepšeniu rozsahu pohybu, koordinácie a funkčných výsledkov. Prispôsobivosť aplikácií VR umožňuje vytváranie personalizovaných rehabilitačných plánov, ktoré sú prispôsobené individuálnym potrebám každého dieťaťa. Našim cieľom bolo primárne predstaviť recentné práce týkajúce sa využitia VR v starostlivosti o popálených pacientov a to najmä pri starostlivosti o rany a v rehabilitácii po popáleninách a poukázať na to, čo z nich vyplýva v kontexte vplyvu VR ako doplnku farmakologickej liečby na zníženie bolesti.
Virtual reality (VR) represents a breakthrough in pediatric burn care, providing in- novative solutions not only in acute treatment, but also in rehabilitation. Distractive therapy, a proven psychological phenomenon, underlies the effectiveness of VR. Scientific studies have consistently confirmed that immersive VR experiences can divert a child's attention from painful procedures, thus reducing the perceived intensity of pain. VR also serves as an important non-pharmacological adjunct that is aligned with evidence-based approaches and provides sci- entifically-based alternative and complementary treatment to pharmacological pain management strategies. Scientific studies in children undergoing burn rehabilitation demonstrate that VR-supported exercises contribute to improving range of motion, coordination, and functional outcomes. The adaptability of VR applications allows the creation of personalized rehabilitation plans tailored to the individual needs of each child. Our goal was primarily to introduce recent works regarding the use of VR in the care of patients with burns, particularly in wound care and rehabilitation after burns, and to highlight their implications in the context of the impact of VR as an adjunct to pharmacological treatment for pain reduction.
- MeSH
- akutní bolest etiologie klasifikace psychologie terapie MeSH
- bolest klasifikace psychologie MeSH
- dítě MeSH
- klinická studie jako téma MeSH
- lidé MeSH
- management bolesti metody MeSH
- pediatrie metody MeSH
- popálení * diagnóza klasifikace psychologie terapie MeSH
- rány a poranění klasifikace psychologie terapie MeSH
- rehabilitace metody psychologie MeSH
- virtuální realita * MeSH
- Check Tag
- dítě MeSH
- lidé MeSH
- Publikační typ
- přehledy MeSH
Cieľ: Zistiť priemernú intenzitu aktuálne pociťovanej bolesti, jej vplyv na behaviorálnu a funkčnú oblasť života podľa Medical Outcomes Study (MOS) Pain Effects Scale (PES) a aktuálne pociťovanú celkovú kvalitu života podľa Multiple Sclerosis Quality of Life 54 (MSQoL-54). Súbor a metodika: V kvantitatívnej observačnej štúdii participovalo 108 pacientov s RS. Dotazník obsahoval Vizuálnu analógovú škálu bolesti (VAS) na posúdenie intenzity aktuálnej bolesti, MOS PES na zistenie vplyvu bolesti na vybrané funkčné a behaviorálne oblasti kvality života, subjektívne vnímanie celkovej kvality života položkou nástroja MSQoL-54. Opisnou štatistikou boli vyhodnotené priemery a vzťahy Spearmanovým korelačným koeficientom. Výsledky: Pacienti uvádzali priemernú stredne silnú intenzitu bolesti podľa VAS (M = 3,8). Farmakoterapiu užívalo 66,7 % pacientov s efektom občasnej a častej minimalizácie bolesti; najčastejšie nesteroidné antiflogistiká (n = 55). Nefarmakologické metódy využívalo 36 pacientov s občasnou a častou minimalizáciou bolesti; najviac cvičenie. MOS PES ukázal mierny vplyv bolesti na funkčné a behaviorálne oblasti kvality života. Podľa MSQoL-54 bola celková kvalita života hodnotená ako uspokojivá (M = 5,8) a so stúpajúcou intenzitou bolesti sa znižovala. Zvyšujúca intenzita bolesti podľa MOS PES negatívne ovplyvňovala náladu, schopnosť chodiť, spánok, bežné činnosti a rekreačné aktivity. Záver: Objektivizácia bolesti a identifikácia jej vplyvu na kvalitu života pomôže zefektívniť individualizovanú liečbu RS.
Aim: To determine the mean intensity of currently experienced pain, its impact on behavioral and functional domains of life according to the The Medical Outcomes Study (MOS) Pain Effects Scale (PES) and currently experienced overall quality of life according to the Multiple Sclerosis Quality of Life 54 (MSQoL-54) in MS. Patients and methods: The quantitative observational study had 108 MS patients. The questionnaire included the Visual Analogue Scale (VAS) to assess the intensity of current pain, MOS PES to determine the impact of pain on selected functional and behavioral areas of the quality of life, and subjective perception of the overall quality of life using the item of the MSQoL-54. Descriptive statistics was used to evaluate averages and Spearman’s correlation coefficient to detect any relationship. Results: Patients reported a mean moderate pain intensity according to the VAS (M = 3.8). Pharmacotherapy was used by 66.7% of patients with the effect of occasional and frequent pain minimization; most commonly used drugs were nonsteroidal antiphlogistics (N = 55). Non-pharmacological methods were used by 36 patients with intermittent and frequent pain minimization; most used method was exercise. MOS PES showed a moderate effect of pain on functional and behavioral quality of life domains. According to the MSQoL-54, overall quality of life was rated as satisfactory (M = 5.8), and was rated lower with increasing pain intensity. Increasing pain intensity according to the MOS PES negatively affected mood, walking ability, sleep, activities of daily living, and recreational activities. Conclusion: Objectification of pain and identification of its impact on quality of life will help to improve individualized MS treatment.
- MeSH
- analgetika terapeutické užití MeSH
- antikonvulziva terapeutické užití MeSH
- bolest * etiologie MeSH
- cvičení MeSH
- hodnotící studie jako téma MeSH
- kvalita života * psychologie MeSH
- lidé MeSH
- management bolesti metody MeSH
- měření bolesti metody MeSH
- průzkumy a dotazníky MeSH
- roztroušená skleróza * komplikace psychologie terapie MeSH
- Check Tag
- lidé MeSH
