Ispitivanje neuropatske komponente bola kod hroničnog lumbalnog bolnog sindroma
Sažetak
Uvod/Cilj. Hronični lumbalni bolni sindrom (HLBS) je najčešći uzrok funkcionalne onesposobljenosti i gubitka radne sposobnosti u razvijenim zemljama. Neka istraživanja pokazuju da je neuropatski bol (NB) prisutan u gotovo 50% bolesnika sa HLBS. Cilj rada bilo je određivanje karakteristika NB i njegovog uticaja na kvalitet života (KŽ) kod bolesnika sa HLBS. Metode. Bolesnici sa HLBS bili su testirani pomoću tri upitnika za procenu NB (Pain Detect Questionnaire, Leeds Assessment of Neuropathic Symptoms and Signs i Douleur Neuropathique 4 questions). Trideset dva bolesnika koja su imala kliničku dijagnozu NB prema važećim kriterijuma i koji su imali pozitivne rezultate na sva tri upitnika za procenu NB svrstani su u eksperimentalna grupu, a 32 bolesnika sa HLBS koji nisu ispunili kliničke kriterijume za NP i bili negativni i prema kliničkim kriterijumima i prema korišćenim upitnicima činili su kontrolnu grupu. Takođe, u ispitivanju su korišćene Hamiltonove skale za procenu depresije i anksioznosti (Ham-D i Ham-A), kao i Short Form (SF)-36 upitnik za procenu KŽ. Rezultati. Prema rezultatima magnetne rezonance, diskus hernija je bila češće prisutna kod bolesnika u eksperimentalnoj grupi, dok su u kontrolnoj grupi najčešće zabeležene degenerativne promene. Bolesnici iz eksperimentalne grupe su imali znatno veći intenzitet bola, bol sa propagacijom u nogama, koji se obično javljao u obliku epizoda iznenadnih jakih napada sa blagim bolom između epizoda. Najspecifičnije karakteristike NB bile su alodinija, senzacija nalik električnom udaru i hipestezije pri bockanju. Ovi bolesnici su imali znatno veće skorove depresije i anksioznosti, kao i lošiji KŽ u odnosu na bolesnike iz kontrolne grupe. Prediktori lošijeg KŽ kod bolesnika sa HLBS su bili veći stepen anksioznosti i depresije. Zaključak. Prisustvo alodinije, osećaja strujnih udara i hipestezija na bockanje ukazuju na HLBS. Bolesnici sa HLBS i NB imaju lošiji KŽ u odnosu na bolesnike sa HLBS bez NB.
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