Reumatizam
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Osteoporosis is a systemic skeletal disease characterized by low bone mass and microarchitectural deterioration of bone tissue, with vertebral compressive fractures (VCFs) that may occur as a consequence. Vertebral compression fractures (VCFs) can lead to severe acute and chronic pain, impaired mobility, reduced quality of life and an increased risk of mortality due to decreased mobility and pulmonary dysfunction. When painful VCFs do come to clinical attention, they are typically treated with optimal pain management (OPM). ⋯ For peo- ple with painful osteoporotic VCFs refractory to analgesic treatment, PVP and BKP perform significantly better in unblinded trials than OPM in terms of improving quality of life and reducing pain and disability. It is possible that BKP and PVP may lead to reductions in mortality. In small subgroup of patients with neurological injury related to an osteoporotic fracture, different open surgical techniques were used to suit different fracture patterns, with good clinical and radiological results.
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Spine surgery is a matter of interest of several specialities. The development of new instrumentations brought a number of new operative techniques. Minimally invasive surgery, endoscopy, offers superior results, but first disapontiments appear as well. What to operate, when and how? A schematic presentation of pathology, operative procedures and indications are presented.
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Rheumatic diseases are the leading cause of chronic disability. Physical therapy and rehabilitation are an integral part of the strategy of treatment of rheumatic diseases in order to maintain the function of the musculoskeletal system. Early detection of disability provides a more efficient implementation of all measures of physiotherapy treatment. ⋯ Long-term effect of exercise is possible only if patients achieve adherence to the program. Questionnaires activities of daily living asses functional status of patients, can be a guide for planning the rehabilitation program and indicator of the effectiveness of therapeutic intervention as well. Methods of physical therapy and rehabilitation are part of all published guidelines for the management of rheumatoid arthritis, spondyloarthritides, osteoarthritis, osteoporosis, chronic back pain, chronic non-malignant pain and fibromyalgia.
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Chronic pain is defined as persistent pain, which can be either continuous or recurrent and of suficient duration and intensity to affect patient's well-being, level of function and quality of life. The assessment should include the use of structured instruments to determine the severity, the impact of psychosocial factors and function. Sensory, affective and cognitive factors contribute to the persistence of pain. ⋯ McGill Pain Questionnaire i Brief Pain Inventory are widely used multidimensional tools. Disease specific and generic questionnaires should be applicated to assess disability on personal level. Appropriate diagnosis of chronic pain is the first step to successful treatment.