Bolest v neurologii
| Title in English | Pain in neurological diseases |
|---|---|
| Authors | |
| Year of publication | 2020 |
| Type | Chapter of a book |
| MU Faculty or unit | |
| Citation | |
| Description | Chronic pain represents an important and serious symptom of many neurological diseases. Pain can develop anytime during the time course of most of the relevant clinical units. However, its prevalence significantly increases with the progression of the disease and its duration and also with the increase of disability. The highest pain prevalence is thus usually found in pronounced phases of these diseases, which are frequently managed by palliative care. Pain affects about 60 to 80% of patients with Parkinson´s disease, 15 to 85 % of patients suffering from amyotrophic lateral sclerosis, 29 to 86% of patients with multiple sclerosis, 8 to 55% stroke patients and almost a half of the patients with dementia. Particularly non-cooperating and/or non-communicating patient with dementia, after stroke or in other pronounced neurological diseases are in a high risk of insufficient pain diagnostics and treatment. The presence and intensity of the pain in these patients is assessed mainly from the patients behaviour and presence of autonomic symptoms and signs. In many neurological diseases, both the nociceptive and neuropathic pain may develop. Furthermore, both these two types of pain are frequently combined. The differential diagnostics of these types of pain is based on the clinical neurological examination and detailed medical history focused on the description of pain characteristics and pain relieving/worsening conditions. The therapy of nociceptive pain is mostly based on the use of antipyretic analgesics, nonsteroidal antiinflammatory drugs and both weak and strong opioids. Neuropathic pain can be treated with several antiepileptics (gabapentin, pregabalin) or antidepressants (amitriptyline, duloxetine). In both types of pain, psychotherapy and/some invasive pain management techniques may also apply. |