BOL – etiologija, patogeneza,...
Transcript of BOL – etiologija, patogeneza,...
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Strengthening Capacities for Higher Education of Pain Medicine in Western Balkan countries – HEPMPProject number: 585927-EPP-1-2017-1-RS-EPPKA2-CBHE-JP (2017 – 3109 / 001 – 001)
NEUROFIZIOLOGIJA AKUTNOG I HRONIČNOG BOLAProf. dr Dejan M. Nešić
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Strengthening Capacities for Higher Education of Pain Medicine in Western Balkan countries – HEPMPProject number: 585927-EPP-1-2017-1-RS-EPPKA2-CBHE-JP (2017 – 3109 / 001 – 001)
Gentika
Godine
Fiziologija
Stres Funkcije mozga i kičmene moždine
Neuroprotektivne supstance
Stil života,Sociokulturološki
aspekti
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Bol je shodno novoj definiciji, uznemirijućeiskustvo sa postojećim ili potencijalnimoštećenjem tkiva sa senzornom, emotivnom,kogtivinom i socijalnom komponentom.
Williams AC, Craig KD. Updating the definition of pain. Pain. 2016; 157(11): 2420-2423.
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Strengthening Capacities for Higher Education of Pain Medicine in Western Balkan countries – HEPMPProject number: 585927-EPP-1-2017-1-RS-EPPKA2-CBHE-JP (2017 – 3109 / 001 – 001)
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Strengthening Capacities for Higher Education of Pain Medicine in Western Balkan countries – HEPMPProject number: 585927-EPP-1-2017-1-RS-EPPKA2-CBHE-JP (2017 – 3109 / 001 – 001)
ŽIVOTNI STRESORI
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BOL – KOMPLESNI FENOMEN
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Strengthening Capacities for Higher Education of Pain Medicine in Western Balkan countries – HEPMPProject number: 585927-EPP-1-2017-1-RS-EPPKA2-CBHE-JP (2017 – 3109 / 001 – 001)
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Bol je svestan, neprijatansenzorni doživljaj.
Bol je neprijatan senzorni i emotivni doživljaj koji je povezan sa postojećim oštećenjem tkiva.
Bol je afektivni stimulus koji izaziva refleks izbegavanja.
Bol je posledica bolesti ili lezije somatosenzornog sistema.
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BOL je filogenetski najstariji
senzorni modalitet prisutan i
kod najnižih životinjskih vrsta.
Senzacija bola informiše mozak o štetnosti stimulusa i potrebiza uklanjanjem takve senzacije, a ne o kvalitetu stimulusa.
BOL - senzacija koja je karakteristična po grupi neprijatnih osećaja, aktivira autonomni, fiziološki,somatomotorni odgovor (Aδ i C).
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BOLNI SINDROMIpostoperativni bol, artritis, neuropatski bol, bol u leđima
MEHANIZMI ZA NASTANAK BOLA
BOL IZAZIVAInflamacija, oštećenje tkiva, lezije nerava
NASTANAK BOLA
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Strengthening Capacities for Higher Education of Pain Medicine in Western Balkan countries – HEPMPProject number: 585927-EPP-1-2017-1-RS-EPPKA2-CBHE-JP (2017 – 3109 / 001 – 001)KOŽA – POPREČNI PRESEK
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RECEPTORI U KOŽI
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Strengthening Capacities for Higher Education of Pain Medicine in Western Balkan countries – HEPMPProject number: 585927-EPP-1-2017-1-RS-EPPKA2-CBHE-JP (2017 – 3109 / 001 – 001)
1. TERMORECEPTORA(TOPLO, HLADNO)
2.HEMORECEPTORA
(UKUS, MIRIS, HEMIJSKI SASTAV KRVI) 3.
MEHANORECEPTORA(DODIR, PRITISAK, VIBRACIJA)
4. NOCIOCEPTORA
(BOL - MEŠAVINA MEHANO, TERMO I HEMORECEPTORA)
5. ELEKTROMAGNETSKI
(FOTORECEPTORI)
Modaliteti somatskog senzibiliteta se ostvaruje preko:
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NIVOI TRANSMISIJE BOLA1. Mesto povrede
2. Kičmena moždina
3. Retikularna formacija moždanog stabla
4. Talamus
5. Somatosenzorni koteks
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1. Galer BS, Dworkin RH. A Clinical Guide to Neuropathic Pain. Minneapolis, MN: McGraw-Hill; 2000.2. Irving GA, Wallace MS. Pain Management for the Practicing Physician. New York, NY: Churchill Livingstone; 1997.3. Woolf CJ, et al. Ann Intern Med. 2004;140:441-451.
Injury
PeripheralNerve
Brain
DescendingPathway
AscendingPathway
SpinalCord
DorsalHorn
DorsalRoot
Ganglion
C-Fiberα-β Fiber
α-δ Fiber
Conduction
Transduction
Transmission/Modulation
Perception
NIVOI PERCEPCIJE BOLA
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ZAŠTITNI REFLEKS KAO POSLEDICA AKTIVIRANJA RECEPTORA ZA BOL
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Strengthening Capacities for Higher Education of Pain Medicine in Western Balkan countries – HEPMPProject number: 585927-EPP-1-2017-1-RS-EPPKA2-CBHE-JP (2017 – 3109 / 001 – 001)SOMATSKI BOL
(Somatska inervacija senzitivnim vlaknima spinalnih i kranijalnih nerava) I prema lokalizaciji:- Površni (iz kože i sluzokože)- Duboki (iz ligamenata, mišića, zglobnih kapsula, tetiva, periosta)II kvalitetu (karakteru):- Akutna bol : (Brz, oštar, dobro lokalizovan i sa istovremenom stimulacijom receptora za dodir)- Hronična bol: (Spor, žareći, obično povezan sa masivnim oštećenjem tkiva i slabom lokalizacijom)III Mehanizmu nastanka:
- PRAVI (NOCICEPTIVNI) - INFLAMACIJSKI- NEUROPATSKI
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HRONIČAN BOL (perzistentan, spori, bol pečenja, žareći, potmuli, tup)
- počinje sekundu ili kasnije nakon bolnog nadražaja
- vremenom se njegov intenzitet pojačava (u toku minuta, sati ili dana)
- broj nadraženih receptora se tokom vremena pojačava
- bol se javlja mnogo lakše, jer se prag za aktivacijureceptora smanjuje
Hroničan bol je specifičan zdravstveni problem i bolest per se sa pravom na lečenje (EFIC’s Declaration, D. Niv, M. Devor 2001).
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HRONIČNI BOL JE POSEBNI ETITET“Bol može biti upozoravajući signal koji spašavaživote mnogih ljudi.... ali i signal koji uništavaživote mnogih drugih ljudi. Hronični bol, nijeupozorenje koje sprečava povredu ili bolest.Hronični bol je bolest, rezultat poremećaja uneuronu koji je pošao "naopako"“.
MELZAK, 2005
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AKUTNI BOL HRONIČNI BOL
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NOCICEPTIVNI BOL
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PERIFERNI NEUROPATSKI BOL
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To brain
Dorsal horn
Substance P, aspartate, neurotensin, glutamate
Spinal cord
Dorsal root ganglion
Tissue injury
Bradykinin
Leukotrienes
Ion fluxes (H+/ K+)
Prostaglandins
Transmission via spinothalamic tract
to brain
Substance P
Histamine Sensitized nociceptor
MEHANIZAM NASTANKA HRONIČNOG BOLA
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SENZITIZACIJA
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Visceralni nocioceptori su lokalizovani u organima i unutrašnjim šupljinama.
Slabo lokalizovan, neprijatan i povezan sa mučninom, gađenjem....
Širi se u druge regije.
Uključuju se visceralna, vegetativna vlakna.
VISCERALNI BOL
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STRAH BESPOMOĆNOST
PREDKIDANJE SNA NERVOZA
BOL
BOL
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BOLNAPETOST U
MIŠIĆIMAPRITISAK NA
NERVE
REDUKOVANA CIRKULACIJA
SKRAĆENJE MIŠIĆA
OGRANIČENI POKRETI
AKTIVIRANJE RECEPTORA
ZA BOL
STRES
POSLEDICE BOLA
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Neuromatrix