NEFARMAKOLOŠKO LIJEČENJE BOLNOG RAMENA – KOMPARATIVNO ISTRAŽIVANJE

Ivan Vlak, Ana Poljičanin, Tonko Vlak

Non-pharmacological treatment is undeniably a significant part of painful shoulder syndrome treatment. Medical exercises are its most important segment, according to the results of evidence-based medicine. Due to the fact that exercises are rarely used as monotherapy, we were particularly interested in the data regarding other non-pharmacological methods of treatment found in the Cochrane library and PEDro database (Physiotherapy Evidence Database). Simultaneously, we conducted a research study of painful shoulder syndrome treatment with conventional methods of physical therapy. The study included 157 patients, which allowed us to compare our preliminary results with data found in the previously mentioned databases. The majority of quality studies that can be found in the literature database involve the use of modern technology, such as extracorporeal shock wave therapy and high-intensity laser therapy, because they have proven to be very effective in the reduction of pain intensity and the increase of functional capacity of the painful shoulder. These methods of treatment have shown to be effective even in patients with calcific tendinitis, a more severe form of the disease, as well as in patients who had no calcifications. Conventional methods of treatment, often referred to as standard physical therapy (low-level laser therapy, electrotherapy, therapeutic ultrasound) have proven to be effective, but less effective compared to the aforementioned methods. The results of our research also corroborate the previously mentioned fact, thus confirming that the use of conventional methods of physical medicine (therapeutic ultrasound, diclofenac sonophoresis, interferential current therapy, low-level laser therapy, cryotherapy) has been successful in reducing pain intensity and increasing the functional capacity of the painful shoulder. Among the conventional methods of treatment, electrotherapy (interferential
current therapy) turned out to be the most efficient one. Non-pharmacological treatment have to be an integral part of all painful shoulder syndrome treatment protocols, and in the future, the use of modern technology in addition to conventional methods of treatment should be encouraged.

Nedvojbeno je da u procesu liječenja sindroma bolnog ramena važnu ulogu ima nefarmakološko liječenje (NFL) Pritom, sukladno rezultatima medicine utemeljene na dokazima (EBM), najveću ulogu imaju medicinske vježbe. One se, pak, rijetko rabe samostalno, kao monoterapija, pa nas je zbog toga zanimalo kakve ćemo podatke pronaći u Cochraneovoj bazi i Fizioterapijskoj bazi podataka (engl. Physiotherapy Evidence Database – PEDro) za ostale oblike NFL-a. Istodobno, proveli smo istraživanje o liječenju sindroma bolnog ramena konvencionalnom terapijom, uključivši u istraživanje 157 bolesnika, kako bismo svoje preliminarne rezultate mogli usporediti s podatcima nađenima u rečenim bazama podataka. Najveći broj kvalitetnih studija, pronađenih u literaturi, vezan je za primjenu modernih tehnologija, primjerice, udarnog vala i lasera visokog intenziteta, koji su pokazali znatan učinak na smanjenje boli i povećanje funkcionalnog kapaciteta bolnog ramena. Ove metode liječenja pokazale su se uspješnima i u bolesnika s kalcificirajućim tendinitisom, kao težim oblikom bolesti, ali i kod onih bez te otegotne činjenice. Konvencionalne metode liječenja, često nazivane klasičnom fizikalnom terapijom (elektroterapija, laser niskog intenziteta i ultrazvuk) pokazale su svoju učinkovitost, iako su uvijek bile inferiorne prije navedenim metodama. Rezultati našeg istraživanja bili su u skladu sa spomenutom činjenicom, tako da se primjena konvencionalne fizikalne terapije (ultrazvuk, sonoforeza, interferentne struje, laser niskog intenziteta, krioterapija) pokazala učinkovitom u smanjenju boli i povećanju funkcionalnog kapaciteta bolnog ramena, pri čemu je primjena interferentnih struja bila nešto uspješnija od drugih metoda. NFL mora i nadalje ostati sastavni dio svih protokola liječenja sindroma bolnog ramena, pri čemu modernim tehnologijama treba ustupati sve više mjesta u odnosu prema konvencionalnim metodama liječenja.