141 Terapia e dolore: EBM review
Benefici della magnetoterapia sono stati evi- denziati nella terapia del dolore di pazienti affetti da gonartrosi.
E’ risultata non efficace, invece, nella terapia del dolore in pazienti affetti da patologia cronica aspecifica della spalla (periartrite, tendinite della cuffia dei rotatori) (57-64). Per quanto riguarda altre terapie fisiche qua- li massoterapia, trazioni meccaniche, termo- terapia, onde d’urto extracorporee, laser-te- rapia, emg-biofeedback e altri trattamenti combinati non vi sono in letteratura studi clinici sufficienti per permettere di dare rac- comandazioni valide sulla loro efficacia in patologie dolorose croniche.
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Nel 2007 sono state apportate modifiche alla normativa riguardante la prescrizione dei farmaci stupefacenti per la terapia del dolore. In particolare sono attualmente prescrivibili i cosiddetti “derivati della cannabis”, già uti- lizzati in altri paesi europei, che si sono rive- lati utili, tra l’altro, nel trattamento di sindro- mi dolorose refrattarie, come il dolore neu- ropatico, e di importanti effetti collaterali della chemioterapia, come ad esempio il vo- mito non controllato da altri antiemetici. Un’ulteriore innovazione, che potrà facilitare il trattamento del dolore moderato/severo, è quella introdotta dal disegno di legge 1249/2007, già approvato al Senato e in di- scussione alla Camera, i cui punti di maggior impatto sulla pratica clinica quotidiana sono riportati qui sotto. Tra questi è da rimarcare la proposta di abolizione del ricettario speciale dei farmaci stupefacenti dell’Allegato IIIbis. DECRETO MINISTERIALE DEL 18 APRILE 2007 Tutti gli stupefacenti e le sostanze psicotrope sono suddivisi in due Tabelle:
Nella Tabella I sono comprese tutte le so- stanze con potere tossicomanigeno ed ogget- to di possibile abuso.
Nella Tabella II sono inserite le sostanze che hanno attività farmacologica e pertanto sono usate in terapia (farmaci). Alcune sostanze compaiono in entrambe le tabelle.
La Tabella II è suddivisa in cinque sezioni (A, B, C, D, E) in cui sono distribuiti i farma- ci in relazione al decrescere del loro poten- ziale d’abuso.
I farmaci dell’Allegato III bis, nel quale so- no elencate le sostanze per le quali è prevista la semplificazione delle modalità prescrittive per la terapia del dolore, sono contrassegnati nella Tabella II con due asterischi (**).
In tal caso rimangono valide le regole de- scritte di seguito:
•ciascuna ricetta può contenere fino a due preparazioni o dosaggi per un trattamento complessivo di 30 giorni;
• poiché il medico di medicina generale deve es- sere in grado di far fronte ad urgenze, può ricor-