ORGANISATION OF SERVICE ORGANISATION OF SERVICE FOR THE TREATMENT OF FOR THE TREATMENT OF

CHRONIC PAIN IN THE CHRONIC PAIN IN THE REPUBLIC OF CROATIAREPUBLIC OF CROATIA

Vesna Golubović, MD PhDDepartment of Anaesthesiology, Reanimathology and

Intensive TherapyMedical Faculty Rijeka

University of Rijeka

The anaesthesiologists started with theThe anaesthesiologists started with the painpain management at the management at the ::Department of Neurosurgery in Clinical Department of Neurosurgery in Clinical Hospital Centre Zagreb in 1978. Hospital Centre Zagreb in 1978. The Clinic for Pain Management in The Clinic for Pain Management in General Hospital in Karlovac in 1979.,General Hospital in Karlovac in 1979.,The Clinic for Pain Management The Clinic for Pain Management TThe he ClinicalClinical Hospital Centre in RijHospital Centre in Rijekaeka in in 1986. 1986. The Clinic for Pain Management The Clinic for Pain Management TThe he General Hospital in Osijek in 198General Hospital in Osijek in 19899..

In 1994 the Croatian Society for In 1994 the Croatian Society for Anaesthesiology, Reanimation Anaesthesiology, Reanimation and Intensive Care (HDAIL) and Intensive Care (HDAIL) within the Croatian Medical within the Croatian Medical Association (CMA) starts with Association (CMA) starts with the organisation of the centres the organisation of the centres for the treatment of pain, but for the treatment of pain, but the activity ends with the the activity ends with the change of presidency. change of presidency.

In In 1994.1994. the Croatian Society for the Croatian Society for Hospicium/Palliative Care (HDH/PS) Hospicium/Palliative Care (HDH/PS) was founded at CMA (at that time was founded at CMA (at that time the President was Prof. the President was Prof. ddr. sc. Anica r. sc. Anica Jušić). Anaesthesiologists were Jušić). Anaesthesiologists were included in the activity of this included in the activity of this society from the very first day (Dr. society from the very first day (Dr. Marijana Persoli-Gudelj was the vice-Marijana Persoli-Gudelj was the vice-president of the Society).president of the Society).

On 31st March 2000 the Croatian On 31st March 2000 the Croatian Society for the Treatment of Pain Society for the Treatment of Pain (HDAIL) within the Croatian Medical (HDAIL) within the Croatian Medical Association - CMA was founded in Association - CMA was founded in Zagreb. The founders and actuators of Zagreb. The founders and actuators of the Society were the Clinic for the pain the Society were the Clinic for the pain management from General Hospital management from General Hospital Karlovac, the Croatian Society for Karlovac, the Croatian Society for Hospitium/Palliative care (HDH/PS) at Hospitium/Palliative care (HDH/PS) at CMA and the Department for CMA and the Department for Anaesthesiology of Medical Faculty Anaesthesiology of Medical Faculty Zagreb. The first President of the Zagreb. The first President of the Society was Prim. Dr. Marijana Persoli-Society was Prim. Dr. Marijana Persoli-GudeljGudelj..

OSNIVAČKA SKUPŠTINA OSNIVAČKA SKUPŠTINA HRVATSKOG DRUŠTVAHRVATSKOG DRUŠTVA ZA ZA

LIJEČENJE BOLILIJEČENJE BOLIPetak, 31.ožujka 2000. Petak, 31.ožujka 2000.

HLZ-Šubićeva 9, Zagreb HLZ-Šubićeva 9, Zagreb

Radno predsjedništvo:Radno predsjedništvo: Prim dr Marijana Persoli- Prim dr Marijana Persoli- GudeljGudelj Prof dr Višnja Majerić- KoglerProf dr Višnja Majerić- Kogler Prof dr Anica JušićProf dr Anica Jušić

INICIJATIVNI ODBOR ZA OSNIVANJE INICIJATIVNI ODBOR ZA OSNIVANJE DRUŠTVA ZA LIJEČENJE BOLI-HLZDRUŠTVA ZA LIJEČENJE BOLI-HLZPrim dr Marijana Persoli- GudeljPrim dr Marijana Persoli- GudeljPrim dr Egidio ČepulićPrim dr Egidio ČepulićProf dr Božidar VrhovacProf dr Božidar VrhovacProf dr Nikša ZuragProf dr Nikša ZuragDoc dr Vesna GolubovićDoc dr Vesna Golubovićdr sci Josip Žunićdr sci Josip ŽunićDoc dr Mladen HavelkaDoc dr Mladen HavelkaProf dr Višnja Majerić KoglerProf dr Višnja Majerić KoglerDoc dr Antun BačićDoc dr Antun BačićProf dr Anica JušićProf dr Anica Jušićdr Maja Grba-Bujevićdr Maja Grba-BujevićPrim dr Biserka ValjakPrim dr Biserka Valjakdr Ines Adanić Mdr Ines Adanić Miikloškakloškadr Mira Finglerdr Mira Finglerdr mr sci Tonko Vlakdr mr sci Tonko Vlakdr mr sci Biserka Štambukdr mr sci Biserka Štambukdr mr dr mr scisci Zlatko Houra Zlatko Houra

It was proclaimed in 1989. in the USA It was proclaimed in 1989. in the USA that the pain treatment is the fourth that the pain treatment is the fourth field of the anaesthesiologists practice, field of the anaesthesiologists practice, besides anaesthesia, intensive therapy besides anaesthesia, intensive therapy and reanimatology.and reanimatology.

The treatment of pain (algology) is The treatment of pain (algology) is today growing into a new clinical today growing into a new clinical discipline in most developing countries discipline in most developing countries of the world and our association is of the world and our association is promoting the promoting the guidelines according to guidelines according to EFIC.EFIC.

The Croatian Society for PainThe Croatian Society for Pain MManagement become the anagement become the member of the European member of the European Federation of IASP Chapters Federation of IASP Chapters (EFIC), and International (EFIC), and International Association for the Study of Pain Association for the Study of Pain (IASP) in 2002.(IASP) in 2002.

Since 2002. the Croatian Society Since 2002. the Croatian Society for the Pain Management (HDAIL) for the Pain Management (HDAIL) has been included in the global has been included in the global project Europe project Europe aagainst Pain (EAP) gainst Pain (EAP) in which take part World Health in which take part World Health Organisation (WHO), European Organisation (WHO), European Federation of IASP Chapters (EFIC), Federation of IASP Chapters (EFIC), and International Association for and International Association for the Study of Pain (IASP).the Study of Pain (IASP).

Each year during 1 week in Each year during 1 week in October in many Croatian cities October in many Croatian cities medical educational personal and medical educational personal and volvoluuntenteeers organize lectures about rs organize lectures about pain and treatement pain and treatement inducing inducing media attention (TV, radio, media attention (TV, radio, newspapers, etc.)newspapers, etc.) and animating and animating community to be aware that pain community to be aware that pain is a desease that can be treated.is a desease that can be treated.

IIn our country each year since 1997. in n our country each year since 1997. in Karlovac has been organized one day Karlovac has been organized one day symposium dedicated to the treatment of symposium dedicated to the treatment of pain and has been held in co-operation with pain and has been held in co-operation with many world known experts in this field many world known experts in this field ..The topics of the symposium included the The topics of the symposium included the following issues: following issues: Treatment of malignant pain - modern Treatment of malignant pain - modern approach; approach; Three step analgesic scale - WHO; Three step analgesic scale - WHO; AAnalgesics-opiates/neo-opiates; nalgesics-opiates/neo-opiates; EthicsEthics

Palliative medicine; Palliative medicine; Pain in elderly people;Pain in elderly people;Pain in children; Pain in children; Pain in women; Pain in women; Neuropathic pain.Neuropathic pain.

Since 27th November 2003. by Since 27th November 2003. by the decision of the Croatian the decision of the Croatian Insurance Health Organisation Insurance Health Organisation (HZZO) the (HZZO) the CClinics for the pain linics for the pain treatment have become specially treatment have become specially registered (coded) sub-services registered (coded) sub-services within the frame of within the frame of anaesthesiology.anaesthesiology.

PPain treatment as entirely new ain treatment as entirely new medical branch lay on particular medical branch lay on particular education.education.

Curriculum for subspecialisation Curriculum for subspecialisation in pain medicine in Croatia was in pain medicine in Croatia was made 4 years ago, and still it has made 4 years ago, and still it has not been approved by Ministry of not been approved by Ministry of Health and Social Welfer.Health and Social Welfer.

““Pain medicine as a speciality, a sub-Pain medicine as a speciality, a sub-speciality or supraspeciality, has speciality or supraspeciality, has been realised in some countries as been realised in some countries as Turkey, Finland and Sweden. This is a Turkey, Finland and Sweden. This is a very important political topic that very important political topic that EFIC need to have focus on, and EFIC need to have focus on, and helping other national societies in helping other national societies in their efforts to establish pain their efforts to establish pain medicine as a recognised sub-medicine as a recognised sub-speciality” (Harald Brevik, President speciality” (Harald Brevik, President of EFIC, President's Message in EFIC of EFIC, President's Message in EFIC NewsletterNewsletter, , January 16th, 2003.).January 16th, 2003.).

Since 2000. postgraduate courses of first Since 2000. postgraduate courses of first category have been held and organized category have been held and organized by the Department of Anaesthesiology of by the Department of Anaesthesiology of Medical Faculty University of Zagreb and Medical Faculty University of Zagreb and Osijek.Osijek.Until nowadays the topics were: Until nowadays the topics were: Chronic pain – diagnosis and treatment – Chronic pain – diagnosis and treatment – general part; general part; CChronic pain – diagnosis and treatment – hronic pain – diagnosis and treatment – special part; special part; Pain in children – diagnosis and Pain in children – diagnosis and treatment; treatment; Pain treatment in cancer patients; Pain treatment in cancer patients; Acute pain - diagnosis and treatment; Acute pain - diagnosis and treatment; Neuropatic pain- diagnosis and treatmentNeuropatic pain- diagnosis and treatment..

The 1st Congress of the Croatian The 1st Congress of the Croatian Society for Pain Management Society for Pain Management with international participation with international participation was held was held at at the Lakes of Plitvice the Lakes of Plitvice from 12 – 14th October 2006. from 12 – 14th October 2006. The goal of that Congress was to The goal of that Congress was to promote multidisciplinary promote multidisciplinary approach for the treatment of approach for the treatment of acute and chronic pain and to acute and chronic pain and to inform and discuss with the inform and discuss with the audience on the contemporary audience on the contemporary model for the treatment of pain model for the treatment of pain in Croatiain Croatia. .

Members of the Croatian Society Members of the Croatian Society for Pain Management regularly for Pain Management regularly participate in numerous other participate in numerous other symposiums and congresses symposiums and congresses (oncology, physiatrics, neurology, (oncology, physiatrics, neurology, surgery, or maxillofacial surgery, surgery, or maxillofacial surgery, plastic and reconstructive plastic and reconstructive surgery, primary care medicine surgery, primary care medicine etc.)etc.) promoting multidisciplinary promoting multidisciplinary approach in pain treatement.approach in pain treatement.

The Society has been very active The Society has been very active inin education of population education of population (gerontology public lectures, (gerontology public lectures, symposium for 100% war invalids, symposium for 100% war invalids, symposium for paraplegic symposium for paraplegic patients, education for employees patients, education for employees in the old people homes, public in the old people homes, public lectures etc.).lectures etc.).

The members of the The members of the Croatian Society for Pain Croatian Society for Pain Management have issued Management have issued many papers: many papers: bbookooks, ss, scriptcripts,s, ssupplementupplements, bs, brochurerochures, s, ddeclarationeclarations,s, translation translationss of of IASP and EFIC materialsIASP and EFIC materials etc. etc.

The Society for Pain The Society for Pain Management advocated and Management advocated and supported registration of many supported registration of many drugs in our country (Kapanol, drugs in our country (Kapanol, Durogestic , MST Continus, Durogestic , MST Continus, Sevredol, Transtec , Fentanyl M, Sevredol, Transtec , Fentanyl M, Oxycontin, Zaldiar, Oxycontin, Zaldiar, PalladonPalladon,Versatis,etc,Versatis,etc).).

The data of the Croatian Insurance Health The data of the Croatian Insurance Health Organisation (HZZO) for 2008. are following: Organisation (HZZO) for 2008. are following: Centre for Pain Management - Clinical Centre for Pain Management - Clinical Hospital Zagreb, Hospital Zagreb, Department for Pain Management and Department for Pain Management and Palliative Medicine - General Hospital Palliative Medicine - General Hospital Karlovac,Karlovac,Department for Pain Management and Department for Pain Management and Hyperbaric Medicine - Clinical Hospital Hyperbaric Medicine - Clinical Hospital Osijek, Osijek, 2255 Pain Management Pain Management ClinicsClinics – as a part of – as a part of DDepartments of anaesthesiology epartments of anaesthesiology

The EFIC - Grunenthal scholarship The EFIC - Grunenthal scholarship (EEG scholarship) for 2008. won the (EEG scholarship) for 2008. won the member of the Society member of the Society Dr.scDr.sc. . Marijana Braš from Clinical Hospital Marijana Braš from Clinical Hospital Centre in Zagreb on topic: Connection Centre in Zagreb on topic: Connection of COMT polymorphism with chronic of COMT polymorphism with chronic lumbar pain syndrome of PTSP linked lumbar pain syndrome of PTSP linked with war.with war.

The members of the Society took The members of the Society took active part as invited lecturers, active part as invited lecturers, oral or poster presenters and oral or poster presenters and participants in numerous participants in numerous domestic anddomestic and iinternational nternational congresses and seminars congresses and seminars ..

COMPARATION OF POSTOPERATIVE COMPARATION OF POSTOPERATIVE PAIN MANAGEMENT TECHIQUES OF PAIN MANAGEMENT TECHIQUES OF

EXPRESSION OF CYTOLITIC EXPRESSION OF CYTOLITIC MOLECULE PERFORINMOLECULE PERFORIN

V. Golubovic,V. Golubovic, SS. . GGolubovicolubovic, V. Sotosek , V. Sotosek Tokmadzic, M. Petkovic , Tokmadzic, M. Petkovic , I. Mrakovcic-I. Mrakovcic-Sutic, Sutic,

EPIDURAL ANALGESIA-INDUCED EPIDURAL ANALGESIA-INDUCED IMMUNOMODULATION OF CELL-IMMUNOMODULATION OF CELL-

MADIATED CITOTOXICITY IN MADIATED CITOTOXICITY IN PATIENTS WITH COLORECTAL PATIENTS WITH COLORECTAL

CARCINOMACARCINOMA

SS. . GGolubovicolubovic,, V. Golubovic,V. Golubovic, V. Sotosek V. Sotosek Tokmadzic, M. Petkovic, Tokmadzic, M. Petkovic, I. Mrakovcic-I. Mrakovcic-SuticSutic

Department of Anesthesiology, Department of Anesthesiology, Reanimatology and Intensive Care, Reanimatology and Intensive Care, Medical Faculty,Medical Faculty, University of Rijeka, Croatia, University of Rijeka, Croatia, Department of Department of Physiology andPhysiology and Immunology, Immunology, Medical Faculty,Medical Faculty, University of Rijeka, University of Rijeka, CroatiaCroatia

THE INFLUENCE OF EARLY CONTINOUS THE INFLUENCE OF EARLY CONTINOUS EPIDURAL ANALGESIA ON EPIDURAL ANALGESIA ON

HEMODYINAMIC CHANGES IN ELDERLY HEMODYINAMIC CHANGES IN ELDERLY TRAUMA PATIENTS WITH SEVERAL TRAUMA PATIENTS WITH SEVERAL

PELVIC FRACTURESPELVIC FRACTURES

D. Bartolek, K. Sakić-Zdravčević, A. D. Bartolek, K. Sakić-Zdravčević, A. JokićJokićAnaesthesiology nad ICU, University Clinic of Anaesthesiology nad ICU, University Clinic of Traumatology, Zagreb, Croatia, Anesthesiology, Traumatology, Zagreb, Croatia, Anesthesiology, Clinic Hospital Center Zagreb, Zagreb, Croatia, Clinic Hospital Center Zagreb, Zagreb, Croatia, Anesthesiology, General Hospital “Sveti Duh”, Anesthesiology, General Hospital “Sveti Duh”, Zagreb, CroatiaZagreb, Croatia

CONTINIOUS WOUND INFUSION OF CONTINIOUS WOUND INFUSION OF LEVOBUPIVACINE PROVIDES EFFECTIVE LEVOBUPIVACINE PROVIDES EFFECTIVE

ANALGESIA AFTER COLORECTAL ANALGESIA AFTER COLORECTAL SURGERYSURGERY

S. Marić, L. Stefancic, D. Krleža S. Marić, L. Stefancic, D. Krleža Šupić, D. Vrdoljak, K. Zdravcevic Šupić, D. Vrdoljak, K. Zdravcevic Sakic Sakic Anesthesiology and Intensive Care, Anesthesiology and Intensive Care, University Hospital for Tumors, Zagreb University Hospital for Tumors, Zagreb Croatia, Anesthesiology and Intensive Care, Croatia, Anesthesiology and Intensive Care, University Hospital Center Zagreb, Zagreb, University Hospital Center Zagreb, Zagreb, CroatiaCroatia

A TREATMENT AND OUTCOMES ANALYSIS A TREATMENT AND OUTCOMES ANALYSIS

OF PATIENTS WITH COCCYDYNIAOF PATIENTS WITH COCCYDYNIA

N. Elezović, S. Ljubičić, M. Carev, B. DuplančićN. Elezović, S. Ljubičić, M. Carev, B. Duplančić

Anestheziology and Intensive Care, Clinical Hospital Split, CroatiaAnestheziology and Intensive Care, Clinical Hospital Split, Croatia

POSTTRAUMATIC STRESS DISORDER AND CHRONIC PAINPOSTTRAUMATIC STRESS DISORDER AND CHRONIC PAIN

M. Braš, Z. Lončar, M. BobanM. Braš, Z. Lončar, M. Boban

Clinic for Psichological Medicine, University Hospital Centre Zagreb, Clinic for Psichological Medicine, University Hospital Centre Zagreb, Zagreb Croatia, Pain Clinic, University Hospital of Traumatology, Zagreb, Zagreb Croatia, Pain Clinic, University Hospital of Traumatology, Zagreb, Croatia, Psychiatric Clinic, Clinical Hospital “Sestre Milosrdnice” Zagreb, Croatia, Psychiatric Clinic, Clinical Hospital “Sestre Milosrdnice” Zagreb, Croatia Croatia

EFFICACY OF PAIN COPING STRATEGIES IN ACUTE AND CHRONIC PAIN EFFICACY OF PAIN COPING STRATEGIES IN ACUTE AND CHRONIC PAIN PATIENTSPATIENTS

M. Havelka, A. Havelka Meštrović, M. BilićM. Havelka, A. Havelka Meštrović, M. Bilić

Department of Helath Psychology, Universitiy of Applied Health Studies, Department of Helath Psychology, Universitiy of Applied Health Studies, Zagreb, Croatia, Psychiatry Clinic, Dubrava Clinical Hospital, ZagrebZagreb, Croatia, Psychiatry Clinic, Dubrava Clinical Hospital, Zagreb

Our Society for Pain Our Society for Pain Management has been working Management has been working intensively on educational intensively on educational programs for health care programs for health care professions, patients, and professions, patients, and common people and on common people and on recognition of the society in recognition of the society in Croatia, Europe and world wide.Croatia, Europe and world wide.

The The 2nd2nd Congress of the Congress of the Croatian Society for Pain Croatian Society for Pain

7. - 9. 7. - 9. octoberoctober 2010. 2010. HOTEL OSIJEK HOTEL OSIJEK OSIJEKOSIJEK

Predsident HDLB 2009Predsident HDLB 2009

Prim.dr. Mira FinglerPrim.dr. Mira Fingler