Prirodne tvari u liječenju neuropatske boli

professional thesis

• Author: Iva Vučemilo
• Mentor: Marija Kindl (mentor)
• Committee member: Lidija Bach-Rojecky (predsjednik povjerenstva)
• Committee member: Marija Kindl (član povjerenstva)
• Committee member: Zdenka Kalođera (član povjerenstva)
• Granter: University of Zagreb; Faculty of Pharmacy and Biochemistry; (Department of pharmacognosy); Zagreb
• Defense date and country: 2023-01-12, Croatia
• Scientific / art field, discipline and subdiscipline: BIOMEDICINE AND HEALTHCARE; Pharmacy; Pharmacy

Abstract

Cilj istraživanja
Neuropatska bol zahvaća 7-10 % opće populacije, a standardna farmakoterapija je učinkovita u manje od 50 % pacijenata i uzrokuje mnogo nuspojava koje ograničavaju njihovo korištenje. Cilj ovog specijalističkog rada je pretražiti kliničke znanstvene spoznaje o učinkovitosti i sigurnosti primjene odabranih prirodnih tvari u liječenju neuropatske boli kako bi se istražile nove učinkovite terapijske mogućnosti kod ove vrste boli.
Materijali i metode
Istraživanja u okviru ovoga specijalističkog rada teorijskog su karaktera i uključuju pregled dostupne literature o dosadašnjim suvremenim znanstvenim spoznajama o odabranim prirodnim tvarima u liječenju neuropatske boli. U pretraživanju radova relevantnih za temu ovoga rada korištene su elektronske bibliografske baze podataka PubMed (Medline), Science Direct, Scopus i Cochrane Library. Važan izvor informacija bile su i monografije i izvješća o ocjeni biljnih droga koje donosi Europska agencija za lijekove.
Rezultati
Potencijal u liječenju neuropatske boli, temeljem utvrđenih mehanizama djelovanja i pretkliničkih istraživanja, pokazale su sljedeće biljne tvari i vrste: kapsaicin, kanabinoidi, kurkumin, noćurak, šafran i gospina trava. Najviše kliničkih dokaza ima lokalna primjena kapsaicina u obliku flastera (8 %) kod liječenja postherpetične i dijabetičke neuropatije te neuropatije povezane s HIV-om. Kvaliteta dokaza je bila umjerena ili vrlo niska, uglavnom zbog malog broja istraživanja i nedovoljno ispitanika. Iako su provedena brojna istraživanja s pripravcima na bazi kanabinoida, dokazi o njihovoj učinkovitosti su nedostatni. Oromukozni sprej na bazi kanabinoida (2,7 mg THC/2,5 mg CBD) smanjuje bol i olakšava spavanje kod pacijenata s perifernom neuropatskom boli i centralnom neuropatijom kod multiple skleroze. Dvije studije su ukazale na povoljan učinak različitih formulacija kurkumina kod perifernih neuropatija. Također, kliničke studije koje bi potvrdile povoljan učinak noćurka, šafrana i gospine trave u liječenju neuropatske boli nedostaju (jedna do dvije relevantne studije).
Zaključak
Za navedene biljne tvari i vrste potrebno je provesti velike, dobro dizajnirane i kontrolirane studije kako bi se osigurali čvrsti dokazi o njihovoj mogućoj učinkovitosti i sigurnosti u liječenju neuropatske boli. Poticanje primjene prirodnih tvari u liječenju ove vrste boli može smanjiti upotrebu i nuspojave konvencionalnih lijekova te povećati kvalitetu života pacijenata.

Abstract (english)

Objectives
The prevalence of neuropathic pain is estimated between 7 and 10 % in the general population and standard pharmacological treatments are effective in less than 50 % of patients and often are associated with undesirable side-effects that limit their use. The aim of this specialistic work is to research clinical scientific knowledge about efficacy and safety of selected natural products in the treatment of neuropathic pain in order to examine new therapeutic options for this type of pain.
Material and Methods
Research in this work is of theoretical character and includes an overview of the available literature on the up-to-date scientific knowledge about selected natural products in the treatment of neuropathic pain. Electronic bibliographic databases such as PubMed (Medline), Science Direct, Scopus and Cochrane Library were searched for relevant literature for this work. European Union herbal monographs and assessment reports were also an important source of information.
Results
Based on established mechanisms of action and preclinical research, these are natural products and plant species that have potential in treating neuropathic pain: capsaicin, cannabinoids, curcumin, evening primrose, saffron and St John's wort. Best evidence has local use of the capsaicin patch (8 %) in the treatment of postherpetic, diabetic neuropathy and neuropathy associated with HIV. Quality of the evidence was moderate or very low, mainly due to the small number of studies and insufficient number of participants. Despite a large number of studies with cannabinoids, evidence of efficacy is still lacking. Oromucosal spray with cannabinoids (2.7 mg THC/2.5 mg CBD) reduces the pain and sleep disorders in patients with peripheral neuropathic pain and central neuropathic pain in multiple sclerosis. Two studies have shown beneficial effects of different formulations of curcumin on peripheral neuropathies. Likewise, clinical studies that prove beneficial effects for evening primrose, saffron and St John's wort in treating neuropathic pain are lacking (one or two relevant studies).
Conclusion
Large, well-designed and controlled studies are needed for these herbal substances and species to provide strong evidence of their possible efficacy and safety in the treatment of neuropathic pain. Encouraging the use of natural products in the treatment of this type of pain can reduce the use and side effects of conventional drugs and increase the quality of life of patients.

• Keywords: neuropatska bol; prirodne tvari; biljne droge; kapsaicin; kanabinoidi; kurkumin; noćurak; šafran; gospina trava
• Keywords (english): neuropathic pain; natural products; plant extracts; capsaicin; cannabinoids; curcumin; evening primrose; saffron; St John's wort
• Language: croatian
• URN:NBN: urn:nbn:hr:163:698317
• Study programme: Title: Phytopharmacy with dietotherapy; Study programme type: university; Study level: postgraduate specialist; Academic / professional title: sveučilišni magistar/sveučilišna magistra fitofarmacije s dijetoterapijom (sveučilišni magistar/sveučilišna magistra fitofarmacije s dijetoterapijom)
• Type of resource: Text
• File origin: Born digital
• Access conditions: Embargoed access; Embargo expiration date: 2025-12-01
• Created on: 2023-02-16 14:50:55