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smanjenje bola sa minimalnom toksičnošću (P < 0,001) . farmakološka terepija nije efikasna i podrazumijeva fizičku
17
Iako nema dovoljno dokaza iz randomizovanih studija, to- aktivnost, akupunkturu, elektrostimulaciju kože, stimulaciju
pikalna primjena mentola je preporučena zbog male cije- kičmene moždine, EEG-bazirani neurofidbek i dr. Tu spada-
ne lijeka i minimalnih neželjenih efekata. Gel sa sadržajem ju i različite suportivne mjere i tehnike u cilju prilagođavanja
baklofen/amitriptilin/ketamin je pokazao nesignifikantno životnog i radnog okruženja pacijentovim potrebama, što
poboljšanje senzorne neuropatije u randomizovanoj studiji podrazumijeva i različite vrste asistencije kod svakodnevnih
na 208 pacijenata . Signifikantno poboljšanje je bilo samo aktivnosti, u zavisnosti da li je dominantno motorno ili sen-
18
u motornoj subskali, te se korišćenje ovog gela može uzeti zorno oštećenje (tabela 2) .
12
u obzir. Kapsaicin 8% flasteri se najčešće koriste za liječenje
neuropatskog bola, ali se mogu koristiti i za bol CIPN-gene-
ze, iako još nema dovoljno dokaza u literaturi.

Nefarmakološki tretman se koristi kao dodatak far-
makološkoj terapiji ili samostalna metoda liječenja kada

Zaključak

Iako su na raspolaganju brojne farmakološke supstance za liječenje neuropatskog bola, još uvijek
nema jasnih preporuka, koja je medikamentozna terapija najdjelotvornija. Često se koristi trostruka
kombinacija lijekova i to triciklički antidepresivi, antikonvulzivi i lokalni anestetici, a ima i pacijenata

kojima je potrebna hronična terapija opioidima uz navedenu kombinaciju lijekova. Kancerski bol
se može otkloniti ili držati pod kontrolom kod najvećeg broja pacijenata, u oko 90% slučajeva.
Neophodni su veliko znanje i posvećenost ljekara i medicinskog osoblja, uz podršku porodice i drugih
bliskih osoba, kako bi liječenje kancerskog bola bilo uspješnije.

Abstract

Cancer pain is often the first sign of a malignant disease. At the time of the diagnosis of a malignant disease, about 30-
40% of patients have pain, and at an advanced stage around 70-80%, which leads to a bad physical and emotional state of
the patient. Improved survival leads to an increase in prevalence, either with life-prolonging or curative treatment, which
leads to an increased number of patients who experience the pain. For successful pain treatment, it is important to have a
good and detailed pain assessment. Neuropathic pain is defined as ‘pain caused by a primary lesion or dysfunction of the
nervous system’. A special form of neuropathic pain is neuropathic pain of cancer origin. CIPN is a chemotherapy-induced
peripheral neuropathy, it is a type of neuropathic pain, it has a recognizable symptomatology, an uncertain prognosis
and there is no prevention. Patients complain of pain in the distal to more proximal parts of the extremities, distributed in
the form of socks and gloves, tingling, burning, electric shocks, numbness, insensitivity or excessive sensitivity to touch.
In general, neuropathic pain, apart from the painful physical component of the chronic course, affects the emotional
experience and causes a generalized anxiety disorder, and can also lead to depression.

Keywords: cancer pain, neuropathic pain, neuropathic pain of cancer origin, chemotherapy-induced peripheral neuropathy

Literatura 3. Jovanović D. Treatment of pain caused by carcinoma “Strengthening
Capacities for Higher Education of Pain Medicine in Western Balkan
countries - HEPMP” (Project number: 585927-EPP-1-2017-1-RS-EPPKA2-
1. National Comprehensive Cancer Network. NCCN clinical practice CBHE-JP (2017 – 3109/001 – 001)).
guidelines in oncology. In: Adult cancer pain (version 2. 2019), 4. NHS. Scottish palliative care guidelines – pain management 2019.
[09/05/19], 2019. Available online: www.nccn.org/professionals/ Available online: www.palliativecareguidelines.scot.nhs.uk/guidelines/
physician_gls/pdf/pain.pdf pain/pain-management.aspx
2. Chapman EJ, Edwards Z, Boland JW, Maddocks M, Fettes L, Malia C, et 5. Snijders RAH, Brom L, Theunissen M, van den Beuken-van Everdingen
al. Practice review: Evidence-based and effective management of pain MHJ. Update on Prevalence of Pain in Patients with Cancer 2022: A
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REVIJALNI RADOVI Galenika Medical Journal, 2024; 3(10):54-60. 59