Univerzitet u Novom Sadu, Medicinski fakultet / University of Novi Sad, Faculty of Medicine
Published 2025 | Version v1
Conference proceeding Open

Menadžment bola nakon moždanog udara – iskustva iz kliničke prakse

Authors/Creators

  • 1. ROR icon University of Novi Sad
  • 2. Clinical Center of Vojvodina
  • 3. Univerziteta u Novom Sadu Medicinski Fakultet
  • 4. Clinical Centre of Vojvodina
  • 5. Specijalna bolnica za reumatske bolesti
  • 6. Clinical Centre of Vojvodina, Medical Rehabilitation Clinic

Abstract (Serbian)

Uvod: Bol nakon moždanog udara (PSP) je učestala, ali nedovoljno lečena komplikacija cerebrovaskularnog inzulta koja narušava oporavak i kvalitet života pacijenata . Obuhvata sindrome različite etiologije , uključujući centralni bol nakon moždanog udara (CPSP), kompleksni regionalni bolni sindrom (CRPS), bol povezan sa spasticitetom, bol u hemiplegičnom ramenu i glavobolju. Raznovrsna etiologija i prezentacija bola se pokazala kao izazov u diferencijalnoj dijagnozi i kliničkoj praksi, što često dovodi do neadekvatnog tretmana.Kliničko iskustvo i terapija: Lečenje PSP zahteva multidisciplinarni, individualizovani pristup zbog svoje raznovrsne etiologije i lošeg odgovora na konvencionalne analgetike. Praksa je pokazala da je multimodalni pristup, koji kombinuje farmakološke, fizikalne i psihološke intervencije, najefikasniji. Farmakološki agensi prve linije za neuropatski bol, kao što su triciklični antidepresivi (npr. amitriptilin) i antikonvulzivi (npr. gabapentin, pregabalin, lamotrigin), pokazuju terapeutske koristi, posebno u rešavanju neuronske hiperekscitabilnosti. Fizikalna terapija, uključujući vežbe za povećanje obima pokreta, pravilno pozicioniranje i elektroterapija (npr. TENS, FES), ključna je za upravljanje mišićno-skeletnim bolom i problemima povezanim sa spasticitet. Za slučajeve refraktornog bola, neinvazivne tehnike neuromodulacije , kao što je repetitivna transkranijalna magnetna stimulacija (rTMS), pokazuju obećavajuće rezultate , dok se invazivne opcije , uključujući duboku moždanu stimulaciju ili stimulaciju motornog korteksa, smatraju poslednjim sredstvom za refrakterni bol.Izazovi i ishodi: Ključni izazov u kliničkoj praksi je različit početak i subjektivni opis bola, što često dovodi do otežanog postavljanja dijagnoze. Mnogi pacijenti doživljavaju značajne neželjene efekte lekova, što zahteva česta prilagođavanja terapije. Iako je potpuno eliminisanje bola često nedostižno, primarni cilj lečenja se pomera ka značajnom smanjenju bola, poboljšanom snu i poboljšanoj funkcionalnoj nezavisnosti i ukupnom kvalitetu života.Zaključak: Efikasno upravljanje bolom nakon moždanog udara zahteva ranu identifikaciju, tačnu dijagnozu osnovnog mehanizma i tipa bola i integrisan, terapeutski pristup usmeren na pacijenta. Kontinuirano kliničko istraživanje i poboljšano aplikovanje smernica zasnovanih na dokazima su neophodni za optimizaciju ishoda lečenja pacijenata nakon moždanog udara koji imaju hronični bol.

Abstract (English)

Background: Post-stroke pain (PSP) is a common, yet often incompletely managed, consequence of stroke, significantly impairing patient recovery and quality of life. It encompasses various etiologies, including central post-stroke pain (CPSP), complex regional pain syndrome (CRPS), pain secondary to spasticity, shoulder subluxation, and headache. Practice highlights the diverse presentations and the challenges in differential diagnosis, which often lead to undertreatment and mismanagement. Clinical Experience and Management: The management of PSP requires a multidisciplinary, individualized approach due to its varied nature and often poor response to conventional analgesics. Our clinical experience suggests that a multimodal approach, combining pharmacological, physical, and psychological interventions, is most effective. First-line pharmacological agents for neuropathic pain, such as tricyclic antidepressants (e.g., amitriptyline) and anticonvulsants (e.g., gabapentin, pregabalin, lamotrigine), show therapeutic benefits, particularly in addressing neuronal hyperexcitability. Physical therapy, including range-of-motion exercises, proper positioning, and electrical stimulation (e.g., TENS, FES), is crucial for managing musculoskeletal pain and spasticity-related issues. For refractory cases, non-invasive neuromodulation techniques, such as repetitive transcranial magnetic stimulation (rTMS), show promise, while invasive options, including deep brain stimulation or motor cortex stimulation, are considered last resorts for intractable pain. Challenges and Outcomes: A key challenge in clinical practice is the varied onset and subjective description of pain, often leading to delayed diagnosis. Furthermore, many patients experience significant side effects from medication, necessitating frequent adjustments to treatment plans. While complete pain elimination is frequently elusive, the primary goal of management shifts towards meaningful pain reduction, improved sleep, and enhanced functional independence and overall quality of life. Conclusion: Effective management of post-stroke pain demands early identification, accurate diagnosis of the underlying pain type, and an integrated, patient-centered therapeutic approach. Continued clinical research and improved adherence to evidence-based guidelines are essential to optimize outcomes for stroke survivors suffering from this debilitating condition.

Files

Nacionalni kongres Bol 2025 Menadžment bola nakon moždanog uadara – iskustva iz kliničke prakse.pdf

Files (2.8 MB)

Additional details

Additional titles

Alternative title (English)
Pain management after stroke - experiences from clinical practice