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Identifier 000438634
Title Αναδρομική μελέτη αξιολόγησης, διαχείρισης και έκβασης ασθενών με χρόνιο νευροπαθητικό πόνο
Alternative Title Retrospective study of evaluation, management and outcome of patients with chronic neuropathic pain
Author Μαθιουδάκη, Αμαλία
Thesis advisor Παπαϊωάννου, Αλεξάνδρα
Reviewer Ηλία, Σταυρούλα
Μπριασούλης, Γεώργιος
Abstract Background: Neuropathic pain, which is a symptom and not a disease, is caused by a lesion or disease of the somatosensory system. There are two types of neuropathic pain, depending on the topography of the lesion, the central and the peripheral. It is estimated that it affects 7-10% of the global population and it is more common in people over the age of 50. It usually coexists with other types of pain, like nociceptive pain, and these cases are called mixed syndromes. Patients with neuropathic pain deal with sleep disorders, anxiety, depression and therefore the quality of their life is affected. Objective: The purpose of this master’s thesis is the retrospective study of cases with neuropathic pain and the comparison of patients with malignancy and non-malignancy, in terms of causes, treatment and final outcome. Methods: This is a retrospective and monocentric study, which took place at the Pain Centre of the Anesthesiology Clinic of the University General Hospital of Heraklion. The patients’ medical records were studied for the data collection and the data registration was made in an electronic database. The presence of neuropathic pain was defined as the inclusion criterion. The total sample consisted of 120 patients, 60 of whom had a malignancy and the remaining 60 did not. Pain was assessed using the Visual Analog Scale-VAS. Results: The mean age of patients was 64.0±15,1 years. Pain was classified into neuropathic pain (52, 43.3%) and mixed pain (68, 58.7%). The most common causes of pain for non-malignancy cases were Herpes Zoster (23%) and Spinal Cord injuries (14%), while for the group with malignancy were gynecological and breast cancers (12%) and lung cancer (12%). The groups did not differ in terms of the main symptoms while heartburn and allodynia were the most common (n=28, 46,7% and n=14, 23,3%, respectively). The anatomical distribution of pain did not differ between groups while overall it was mostly reported in the lower extremity area (46.7%) and the pelvis (32.5%). Pain affected patients’ sleep in a different way between the two groups, while the malignancy group was unable to sleep (36.7% vs 16.7%), reported waking up (45% vs 50%) and was only able to sleep with drugs (5% vs 1.7%) (p<0.017). In addition, 50.4% of patients had a moderate psychological state and 31.3% had a poor psychological state, without any differences between the two groups (p=0.229). NSAIDS were more common in patients without malignancy (58,3% vs 15,9%, p<0,001). On the contrary, antidepressant use was higher in patients with malignancy (61,7% vs 28,3%, p<0,001) as well as the anticonvulsant use (91,7% vs 70,0%, p=0,003). In the category of patients without malignancy, no one received strong opioids (p<0,001). A high median VAS score of 10 was observed in patients with malignancy compared with a median of 8 recorded in patients without a malignancy, before initiating treatment. The changes of VAS score after the 1st and the 2nd medication in the two groups were formed as following: median 7 (malignancy) and 6.5 (non-malignancy) after the 1st medication and 4 and 3 after the 2nd medication respectively. Conclusion: The characteristics of pain vary considerably but without significant difference between patients with or without malignancy. The main symptom seemed to be a burning sensation. In patients without malignancy, treatment starts with mild analgesic drugs and there is a chance of progressive escalation. In contrast to patients with malignancy, treatment is usually aggressive and stronger drugs are administered, as their aggravated state of health requires. Finally, neuropathic pain affects sleep, psychological status and subsequently the quality of life for these patients.
Language Greek
Subject Malignancy
Διαταραχές ύπνου
Issue date 2021-03-29
Collection   School/Department--School of Medicine--Department of Medicine--Post-graduate theses
  Type of Work--Post-graduate theses
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