{"id":19217,"date":"2026-10-13T16:13:41","date_gmt":"2026-10-13T14:13:41","guid":{"rendered":"https:\/\/jurmed.ro\/medici\/?p=19217"},"modified":"2026-10-13T16:49:03","modified_gmt":"2026-10-13T14:49:03","slug":"cum-abordam-durerea-mixta-din-afectiunile-musculoscheletale","status":"publish","type":"post","link":"https:\/\/jurmed.ro\/medici\/cum-abordam-durerea-mixta-din-afectiunile-musculoscheletale\/","title":{"rendered":"Cum abord\u0103m durerea mixt\u0103 din afec\u021biunile musculoscheletale"},"content":{"rendered":"<p style=\"text-align: center;\"><strong>Autor: Daiana Popa, Spitalul Clinic de recuperare Medical\u0103 B\u0103ile-Felix<\/strong><\/p>\n<p style=\"text-align: justify;\">Durerea mixt\u0103 \u00een afec\u021biunile musculoscheletale se refer\u0103 la prezen\u021ba concomitent\u0103 a cel pu\u021bin dou\u0103 forme de durere, nociceptiv\u0103, neuropatic\u0103 \u0219i\/sau nociplastic\u0103, care se manifesta simultan sau secven\u021bial \u00een aceea\u0219i regiune a corpului. Este una dintre cele mai frecvente manifest\u0103ri ale durerii \u00een patologia musculoscheletal\u0103, care r\u0103m\u00e2ne adesea subdiagnosticat\u0103 \u0219i gestionat\u0103 deficitar, \u00een mare parte deoarece nu este recunoscut\u0103 ca o categorie distinct\u0103 \u0219i nu dispune de criterii diagnostice bine definite. Cele trei categorii de durere se suprapun la pacien\u021bii individuali, ceea ce constituie baza conceptual\u0103 a durerii mixte. Experien\u021ba global\u0103 a durerii fiec\u0103rui individ poate include mai mult de unul dintre aceste tipuri de durere care sunt, de asemenea, modulate de factori psihologici, sociali \u0219i culturali.<\/p>\n<p style=\"text-align: justify;\"><strong>Defini\u021bie<\/strong>. Un consens interna\u021bional din 2026 (Freynhagen et al.) a definit durerea mixt\u0103 drept &#8222;durere asociat\u0103 cu o leziune, boal\u0103 sau tulburare care determin\u0103 o suprapunere a cel pu\u021bin dou\u0103 forme ale durerii (nociceptiv\u0103, neuropatic\u0103 sau nociplastic\u0103)&#8221;. Mul\u021bi exper\u021bi consider\u0103 aceste tipuri de durere ca elemente din cadru unui continuum, mai degrab\u0103 dec\u00e2t entit\u0103\u021bi distincte, ceea ce poate explica uneori r\u0103spunsurile terapeutice suprapuse (de exemplu, AINS pot ameliora ocazional durerea neuropatic\u0103, iar stabilizatorii membranari pot reduce durerea postchirurgical\u0103, care reprezint\u0103 unul dintre prototipurile durerii nociceptive).<\/p>\n<p style=\"text-align: justify;\">\u00cen ciuda recunoa\u0219terii clinice tot mai extinse, termenul &#8222;durere mixt\u0103&#8221; nu este inclus oficial ca o categorie taxonomic\u0103 de sine st\u0103t\u0103toare de c\u0103tre <strong>Asocia\u021bia Interna\u021bional\u0103 pentru Studiul Durerii (IASP)<\/strong><\/p>\n<p style=\"text-align: justify;\">Printre cele mai frecvente afec\u021biuni musculoscheletale \u00een care ne confrunt\u0103m cu durerea mixt\u0103<\/p>\n<p style=\"text-align: justify;\">se num\u0103r\u0103:<\/p>\n<ul style=\"text-align: justify;\">\n<li>Durerea lombar\u0103 cronic\u0103 cu radiculopatie\/sciatic\u0103: durere axial\u0103 mecanic\u0103 (nociceptiv\u0103) combinat\u0103 cu durere radicular\u0103 (neuropatic\u0103) la nivelul membrelor.<\/li>\n<li>Sindromul de chirurgie lombar\u0103 e\u0219uat\u0103; durere lombar\u0103 mecanic\u0103 (nociceptiv\u0103) plus durere radicular\u0103 la nivelul membrelor inferioare (cu caracter neuropat).<\/li>\n<li>Osteoartrita (\u00een special a genunchiului\/\u0219oldului); durere articular\u0103 nociceptiv\u0103 cu elemente de tip neuropatic \u0219i fenomene de sensibilizare central\u0103; (literatura raporteaz\u0103 componente de tip neuropatic la &gt; \u2153 dintre pacien\u021bii cu artroza a genunchiului sau \u0219oldului).<\/li>\n<li>Boli reumatismale \u00een care durerea nociceptiv\u0103 inflamatorie coexist\u0103 frecvent cu mecanisme nociplastice (10\u201348% din pacien\u021bii cu fibromialgie).<\/li>\n<\/ul>\n<p style=\"text-align: justify;\"><strong>Epidemiologie: <\/strong>Prevalen\u021ba variaz\u0103 considerabil (~7% p\u00e2n\u0103 la 59%) \u00een func\u021bie de popula\u021bie, context \u0219i defini\u021bia opera\u021bional\u0103. Un studiu amplu din asisten\u021ba medical\u0103 primar\u0103\/ortopedie a estimat durerea mixt\u0103 la &gt;50% dintre pacien\u021bii cu durere cronic\u0103.<\/p>\n<p style=\"text-align: justify;\">\u00centr-un studiu ortopedic multicentric condus \u00een Mexic \u00een 2026 (n=6895), durerea mixt\u0103 a fost al doilea cel mai frecvent fenotip (39%), dup\u0103 durerea pur nociceptiv\u0103 (54%). Dintre cazurile mixte, combina\u021bia dominant\u0103 a fost nociceptiv\u0103\u2013neuropatic\u0103 (69%), urmat\u0103 de nociceptiv\u0103\u2013nociplastic\u0103 (12%), toate trei (8%) \u0219i neuropatic\u0103\u2013nociplastic\u0103 (0.9%).<\/p>\n<p style=\"text-align: justify;\">Durerea mixt\u0103 este asociat\u0103 \u00een mod constant cu simptome mai severe, durat\u0103 mai lung\u0103, afectare func\u021bional\u0103 mai mare, calitate a vie\u021bii redus\u0103 \u0219i utilizare mai mare a serviciilor medicale comparativ cu durerea cu un singur mecanism.<\/p>\n<p style=\"text-align: justify;\"><strong>Evaluare<\/strong>. Diagnosticul este \u00een principal clinic, bazat pe anamnez\u0103 detaliat\u0103 \u0219i examinare fizic\u0103 am\u0103nun\u021bit\u0103, mai degrab\u0103 dec\u00e2t pe un instrument diagnostic standardizat. Freynhagen et al. au propus nou\u0103 \u00eentreb\u0103ri-cheie de screening pentru identificarea mecanismelor predominante.<\/p>\n<p style=\"text-align: justify;\"><strong>Management. <\/strong>Terapia are la baz\u0103 abordarea mecanismelor fiziopatologice care stau la baza manifest\u0103rilor clinice \u0219i presupune o interven\u021bie multimodal\u0103 \u0219i interdisciplinar\u0103, viz\u00e2nd fiecare component\u0103 care contribuie la producerea durerii<strong>.<\/strong><\/p>\n<p style=\"text-align: justify;\">Pentru a aborda componenta nociceptiv\u0103, standardul de aur \u00eel reprezint\u0103 AINS, alte antiinflamatoare, opioide \u00een cazuri selectate \u0219i abord\u0103ri interven\u021bionale, precum \u0219i mijloace non-farmacologice din sfera medicinei fizice.<\/p>\n<p style=\"text-align: justify;\">Pentru componenta neuropatic\u0103, de prim\u0103 inten\u021bie r\u0103m\u00e2n gabapentinoide (pregabalin, gabapentin), antidepresivele triciclice \u0219i inhibitorii selectivi ai recapt\u0103rii serotoninei \u0219i noradrenalinei (SNRI) ca de ex., duloxetina, precum \u0219i op\u021biuni interven\u021bionale cum sunt blocurile nervoase \u0219i tehnicile invazive de neuromodulare.<\/p>\n<p style=\"text-align: justify;\">Tratamentul componentei nociplastice are \u00een vedere o abordare multimodal\u0103 care include terapia cognitiv-comportamental\u0103, psihoterapia, exerci\u021biile fizice \u0219i agen\u021bii farmacologici cu ac\u021biune central\u0103.<\/p>\n<p style=\"text-align: justify;\">Managementul acestei manifest\u0103ri complexe trebuie s\u0103 abordeze simultan dimensiunile biologice, psihologice \u0219i func\u021bionale ale bolii.<\/p>\n<p style=\"text-align: justify;\">Colegiul Medical American (American College of Physicians) recomand\u0103 ca terapia farmacologic\u0103 s\u0103 fie rezervat\u0103 pacien\u021bilor cu durere lombar\u0103 cronic\u0103 care au avut un r\u0103spuns inadecvat la tratamentul non-farmacologic \u0219i s\u0103 urmeze o abordare etapizat\u0103, cu urm\u0103toarea succesiune:<\/p>\n<ul style=\"text-align: justify;\">\n<li>AINS, ca tratament de prim\u0103 linie, care au un efect slab p\u00e2n\u0103 la moderat asupra durerii \u0219i efecte discutabile asupra func\u021biei (dovezi de calitate moderat\u0103). Niciun AINS nu este superior altuia. Din cauza efectelor adverse gastrointestinale \u0219i renale, factorii de risc renovasculari \u0219i gastrointestinali trebuie evalua\u021bi \u00een mod prioritar, recomand\u00e2ndu-se cea mai mic\u0103 doz\u0103 eficient\u0103 pe durat\u0103 minim\u0103.<\/li>\n<li>A doua linie o reprezint\u0103 tramadolul sau duloxetina (dovezi de calitate moderat\u0103). Tramadolul are un efect moderat asupra durerii \u0219i un efect mic asupra func\u021biei pe termen scurt, dar prezint\u0103 risc de abuz asociat opioidelor, \u00een timp ce duloxetina are un efect mic asupra durerii \u0219i func\u021biei.<\/li>\n<li>Opioidele se recomand\u0103 ca ultim\u0103 solu\u021bie, numai dup\u0103 e\u0219ecul celor de mai sus \u0219i numai atunci c\u00e2nd beneficiile dep\u0103\u0219esc riscurile \u00een urma unei argument\u0103ri documentate privind raportul beneficiu\u2013risc. Opioidele (morfina, oximorfona, hidromorfona, tapentadolul) au avut doar un efect slab, pe termen scurt, asupra durerii \u0219i func\u021biei.<\/li>\n<\/ul>\n<p style=\"text-align: justify;\">Observ\u0103m c\u0103 ghidul ACP abordeaz\u0103 durerea lombar\u0103 cronic\u0103 \u00een sens larg \u0219i nu precizeaz\u0103 op\u021biuni farmacologice specifice pentru fiecare dintre componente; nociceptiva \u0219i neuropat\u0103\/radicular\u0103 a durerii mixte.<\/p>\n<p style=\"text-align: justify;\">Dac\u0103 \u00eens\u0103 c\u0103ut\u0103m o abordare bazat\u0103 pe mecanismele subiacente pentru durerea lombar\u0103 cronic\u0103 cu radiculopatie care reprezint\u0103 prototipul sindromului de \u201edurere mixt\u0103\u201d, combin\u00e2nd o component\u0103 nociceptiv\u0103 (mecanic\u0103\/inflamatorie) axial\u0103 cu o component\u0103 neuropat\u0103 radicular\u0103, strategia recomandat\u0103 trebuie s\u0103 vizeze fiecare mecanism, de\u0219i dovezile pentru componenta neuropat\u0103 \u00een durerea spinal\u0103 radicular\u0103 sunt considerabil mai slabe \u0219i mai controversate dec\u00e2t pentru neuropatiile periferice, precum neuropatia diabetic\u0103 sau nevralgia postherpetic\u0103.<\/p>\n<p style=\"text-align: justify;\">Pentru componenta nociceptiv\u0103, AINS r\u0103m\u00e2n tratamentul de prim\u0103 linie. O analiz\u0103 JAMA din 2026 confirm\u0103 AINS ca tratament de prim\u0103 linie pentru durerea lombar\u0103 nespecific\u0103, cu precizarea c\u0103 exist\u0103 un risc semnificativ crescut de evenimente adverse gastrointestinale, ceea ce necesit\u0103 o selec\u021bie atent\u0103 a pacien\u021bilor. Ini\u021biativa Global Spine Care din 2018 enumer\u0103, de asemenea, AINS (\u00eempreun\u0103 cu exerci\u021biile fizice sau manipularea spinal\u0103) ca tratament de prim\u0103 linie, \u00een mod specific, pentru durerea spinal\u0103 cu radiculopatie.<\/p>\n<p style=\"text-align: justify;\">Duloxetina este medicamentul de linia a doua cel mai bine sus\u021binut pentru componenta axial\u0103. De remarcat c\u0103 exist\u0103 un dezacord real \u00eentre diferitele ghiduri; astfel c\u0103 ghidurile NICE \u0219i OMS nu recomand\u0103 antidepresivele deoarece micile beneficii sunt dep\u0103\u0219ite de evenimentele adverse sup\u0103r\u0103toare (grea\u021b\u0103, somnolen\u021b\u0103).<\/p>\n<p style=\"text-align: justify;\">Pentru componenta neuropat\u0103 (manifestat\u0103 prin durerea radicular\u0103) se reg\u0103sesc gabapentinoidele, care \u00eens\u0103 nu sunt suficient sus\u021binute de studii pentru durerea spinal\u0103 radicular\u0103, \u00een ciuda rolului lor consacrat \u00een alte afec\u021biuni neuropate. O analiz\u0103 sistematic\u0103 nu a g\u0103sit dovezi solide pentru gabapentin\/pregabalin \u00een durerea lombar\u0103 cronic\u0103 cu sau f\u0103r\u0103 durere radicular\u0103. \u0218i aici ne lovim de controverse; astfel, o analiz\u0103 AAFP (American Association of Family Physicians) din 2025 recomand\u0103 explicit evitarea antiepilepticelor\/gabapentinoidelor pentru durerea lombar\u0103 cronic\u0103 din cauza lipsei beneficiului \u0219i a efectelor nocive asociate (ame\u021beli, sedare), sus\u021bin\u00e2nd \u00een acela\u0219i timp utilizarea lor pentru durerea neuropat\u0103 definit\u0103 (nevralgie postherpetic\u0103, neuropatie diabetic\u0103). \u00cen analiza JAMA din 2026 se precizeaz\u0103, de asemenea, c\u0103 nu se recomand\u0103 pregabalinul\/gabapentinul pentru durerea lombar\u0103 cronic\u0103 nespecific\u0103. Dovezile privind duloxetina \u00een radiculopatia lombosacrat\u0103 \u00een mod specific sunt, de asemenea, neconcludente, chiar dac\u0103 aceasta este aprobat\u0103 de FDA pentru durerea musculoscheletal\u0103\/lombar\u0103. O analiz\u0103 sistematic\u0103 din 2024 a 11 ghiduri de practic\u0103 clinic\u0103 pentru radiculopatia lombosacrat\u0103 a constatat c\u0103 exist\u0103 foarte pu\u021bin acord \u00eentre ghiduri; \u00a0antidepresivele au reprezentat clasa recomandat\u0103 cel mai frecvent, niciun ghid nu a recomandat acetaminofen, benzodiazepine sau relaxante musculare, iar fiecare clas\u0103 de medicamente a avut cel pu\u021bin un ghid care a avut recomand\u0103ri \u00eempotriva utiliz\u0103rii sale. Trei ghiduri nu au recomandat deloc medicamente, favoriz\u00e2nd \u00eengrijirea nefarmacologic\u0103 bazat\u0103 pe terapii fizicale, educa\u021bie \u0219i tehnici cognitiv-comportamentale.<\/p>\n<p style=\"text-align: justify;\">\u00centre medicamentele nerecomandate \u00een general se num\u0103r\u0103 Acetaminofenul, relaxantele musculaturii scheletice, benzodiazepinele \u0219i corticosteroizii orali, care nu au dovezi de eficacitate pentru durerea lombar\u0103 cronic\u0103 (cu sau f\u0103r\u0103 radiculopatie) \u0219i prezint\u0103 risc de efecte nocive. Corticosteroizii orali nu s-au dovedit eficien\u021bi pentru durerea radicular\u0103, iar injec\u021biile epidurale cu corticosteroizi pot oferi doar o ameliorare modest\u0103, pe termen scurt, a durerii radiculare. De asemenea, opioidele ofer\u0103 doar o ameliorare modest\u0103 pe termen scurt, cu riscuri substan\u021biale, \u0219i ar trebui rezervate cazurilor refractare.<\/p>\n<p style=\"text-align: justify;\">Centrele pentru Controlul \u0219i Prevenirea Bolilor din Statele Unite (CDC) recomand\u0103 abord\u0103rile noninvazive, nonfarmacologice ca terapie de baz\u0103 pentru durerea mixt\u0103 subacut\u0103 \u0219i cronic\u0103, men\u021bion\u00e2nd c\u0103 acestea pot ameliora durerea \u0219i func\u021bia f\u0103r\u0103 risc de efecte nocive grave.<\/p>\n<p style=\"text-align: justify;\">\u00centre acestea:<\/p>\n<ul style=\"text-align: justify;\">\n<li>Terapia prin exerci\u021bii fizice (dovezi de \u00eenalt\u0103 calitate): exerci\u021biile aerobice, acvatice sau de rezisten\u021b\u0103 reduc durerea \u0219i \u00eembun\u0103t\u0103\u021besc func\u021bia \u00een cazul durerilor de spate, fibromialgiei \u0219i osteoartritei \u0219oldului\/genunchiului, beneficiile men\u021bin\u00e2ndu-se timp de 2\u20136 luni dup\u0103 tratament. Exerci\u021biile fizice \u00eembun\u0103t\u0103\u021besc \u00een primul r\u00e2nd func\u021bionarea, dar \u0219i intensitatea durerii.<\/li>\n<li>Terapii comportamentale\/psihologice: terapia cognitiv-comportamental\u0103 \u0219i reducerea stresului bazat\u0103 pe mindfulness \u00eembun\u0103t\u0103\u021besc durerea \u0219i func\u021bia. TCC ofer\u0103 beneficii mici p\u00e2n\u0103 la moderate pe termen scurt \u0219i lung \u0219i este cea mai eficient\u0103 atunci c\u00e2nd este combinat\u0103 cu exerci\u021bii fizice\/fizioterapie, mai degrab\u0103 dec\u00e2t administrat\u0103 singur\u0103.<\/li>\n<\/ul>\n<p style=\"text-align: justify;\">Exerci\u021biile fizice \u0219i psihoterapia sunt interven\u021biile cu cel mai mare randament \u0219i cu cea mai larg\u0103 aplicabilitate.<\/p>\n<p style=\"text-align: justify;\">Categoriile suplimentare de interven\u021bii nonfarmacologice bazate pe dovezi includ:<\/p>\n<ul style=\"text-align: justify;\">\n<li>Modalit\u0103\u021bi fizice: TENS, termoterapie\/crioterapie, masaj, ultrasunete, terapie cu laser de intensitate redus\u0103.<\/li>\n<li>Terapii complementare\/alternative: acupunctur\u0103, yoga, tai chi, qigong.<\/li>\n<li>Reabilitare specific\u0103 pentru durerea neuropatic\u0103: terapia cu oglind\u0103, imagistica motorie.<\/li>\n<\/ul>\n<p style=\"text-align: justify;\">Ca s\u0103 exemplific\u0103m cu cea mai frecvent\u0103 entitate nosologic\u0103 \u00een care se manifest\u0103 durerea mixt\u0103, \u00a0managementul durerii lombare asociate cu o component\u0103 radicular\u0103, ar trebui s\u0103 fie <strong>multimodal, <\/strong>bazat \u00een primul r\u00e2nd pe mijloace non-farmacologice din arsenalul medicinei fizice, \u00een timp ce terapia farmacologic\u0103 se indic\u0103 doar ca adjuvant\u0103. Recomandarea este s\u0103 se \u00eenceap\u0103 cu AINS, s\u0103 se adauge duloxetin\u0103 pentru o component\u0103 persistent\u0103\/neuropat\u0103 \u0219i s\u0103 se rezerve tramadolul\/opioidele \u0219i steroizii epidurali interven\u021bionali pentru cazurile refractare, recunosc\u00e2nd \u00een acela\u0219i timp c\u0103 dovezile de \u00eenalt\u0103 calitate pentru componenta neuropat\u0103 \u00een radiculopatie r\u0103m\u00e2n limitate, iar ghidurile sunt contradictorii.<\/p>\n<p style=\"text-align: justify;\">Un plan multimodal, centrat pe pacient, este principiul unificator. Nicio terapie individual\u0103 nu are beneficii consistente, astfel \u00eenc\u00e2t combinarea modalit\u0103\u021bilor \u00een func\u021bie de preferin\u021bele \u0219i motiva\u021bia pacientului, av\u00e2nd ca baz\u0103 autogestionarea \u0219i educa\u021bia, duce la cele mai bune rezultate.<\/p>\n<p style=\"text-align: justify;\"><strong>Bibliografie:<\/strong><\/p>\n<ol style=\"text-align: justify;\">\n<li><a href=\"https:\/\/pubmed.ncbi.nlm.nih.gov\/42559696\">Mixed Pain: Toward a Consensus Definition and a Mechanism-Based Framework<\/a>. Freynhagen R, Morlion B, Alc\u00e1ntara Montero A, et al. European Journal of Pain (London, England). 2026;30(7):e70356.<\/li>\n<li><a href=\"https:\/\/pubmed.ncbi.nlm.nih.gov\/41158466\">Mixed Pain: Clinical Practice Recommendations<\/a>. Varrassi G, Far\u00ec G, Narvaez Tamayo MA, et al. Frontiers in Medicine. 2025;12:1659490.<\/li>\n<li><a href=\"https:\/\/pubmed.ncbi.nlm.nih.gov\/33012210\">When to Consider &#8222;Mixed Pain&#8221;? The Right Questions Can Make a Difference!<\/a>. Freynhagen R, Rey R, Argoff C. Current Medical Research and Opinion. 2020;36(12):2037-2046.<\/li>\n<li><a href=\"https:\/\/onlinelibrary.wiley.com\/doi\/10.1155\/prm\/5554084\">Musculoskeletal Pain Phenotypes in Private Orthopedic Clinics in Mexico, Including Mixed Pain: A Multicenter Study<\/a>. Guti\u00e9rrez-Mendoza I, D E GZ, L LA, et al. Pain Research &amp; Management. 2026;2026(1):e5554084.<\/li>\n<li><a href=\"https:\/\/pubmed.ncbi.nlm.nih.gov\/34062143\">Chronic Pain: An Update on Burden, Best Practices, and New Advances<\/a>. Cohen SP, Vase L, Hooten WM. Lancet (London, England). 2021;397(10289):2082-2097.<\/li>\n<li><a href=\"https:\/\/onlinelibrary.wiley.com\/doi\/10.1002\/acr.25104\">Identifying and Managing Nociplastic Pain in Individuals With Rheumatic Diseases: A Narrative Review<\/a>. Murphy AE, Minhas D, Clauw DJ, Lee YC. Arthritis Care &amp; Research. 2023;75(10):2215-2222.<\/li>\n<li><a href=\"https:\/\/pubmed.ncbi.nlm.nih.gov\/34062144\">Nociplastic Pain: Towards an Understanding of Prevalent Pain Conditions<\/a>. Fitzcharles MA, Cohen SP, Clauw DJ, et al. Lancet (London, England). 2021;397(10289):2098-2110.<\/li>\n<li><a href=\"https:\/\/doi.org\/10.1007\/s40122-021-00235-2\">Management of Musculoskeletal Pain: An Update with Emphasis on Chronic Musculoskeletal Pain<\/a>. El-Tallawy SN, Nalamasu R, Salem GI, et al. Pain and Therapy. 2021;10(1):181-209.<\/li>\n<li><a href=\"https:\/\/pubmed.ncbi.nlm.nih.gov\/32852923\">Systematic Review and Synthesis of Mechanism-Based Classification Systems for Pain Experienced in the Musculoskeletal System<\/a>. Shraim MA, Mass\u00e9-Alarie H, Hall LM, Hodges PW. The Clinical Journal of Pain. 2020;36(10):793-812.<\/li>\n<li><a href=\"https:\/\/www.aafp.org\/link_out?pmid=33064421\">Chronic Musculoskeletal Pain: Nonpharmacologic, Noninvasive Treatments.<\/a>Am Fam Physician (2020).Used under license from the American Academy of Family Physicians.<\/li>\n<li><a href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC9639433\/\">CDC Clinical Practice Guideline for Prescribing Opioids for Pain &#8211; United States, 2022.<\/a><\/li>\n<li><u>Pain Management Best Practices<\/u> Inter-Agency Task Force Report: Updates, Gaps, Inconsistencies, and Recommendations. U.S. Department of Health and Human Services (2019, May).<\/li>\n<\/ol>\n<p style=\"text-align: justify;\">\n","protected":false},"excerpt":{"rendered":"<p>Autor: Daiana Popa, Spitalul Clinic de recuperare Medical\u0103 B\u0103ile-Felix Durerea mixt\u0103 \u00een afec\u021biunile musculoscheletale se refer\u0103 la prezen\u021ba concomitent\u0103 a cel pu\u021bin dou\u0103 forme de durere, nociceptiv\u0103, neuropatic\u0103 \u0219i\/sau nociplastic\u0103, [&hellip;]<\/p>\n","protected":false},"author":1,"featured_media":9437,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_exactmetrics_skip_tracking":false,"_exactmetrics_sitenote_active":false,"_exactmetrics_sitenote_note":"","_exactmetrics_sitenote_category":0,"footnotes":""},"categories":[363],"tags":[],"class_list":["post-19217","post","type-post","status-publish","format-standard","has-post-thumbnail","category-reabilitare-medicala"],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v27.0 - 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