Pain Management

Ivet B Koleva, MD, PhD, DMedSc is a Medical Doctor (1986; Medical University of Sofia, Bulgaria), a Specialist in Physical and Rehabilitation Medicine /PRM/ (1990) and in Neurology (1995), with  ropean Certification in PRM (2008). She has completed three scientific theses: PhD in PRM (2004), PhD in Pedagogics (2013), Doctor of Medical Sciences in PRM (2009). She has worked as Associated Professor (from 2006) and as Professor in PRM (from 2010). She is Professor at the Medical University of Sofia, Bulgaria. She has published more than 100 papers in Bulgarian and international scientific journals, author of a lot of monographs and manuals in the field of Physical Medicine and ehabilitation, Neurorehabilitation, Neuro-ergotherapy, Grasp and Gait rehabilitation, Functional evaluation, Painmanagement. She is the Co-author of the Bulgarian National PRM Standard (2004). During the period 2007-2015 she was a Member of the PRM Section -European Union of Medical Specialist.

The Declaration of Montréal of IASP recognizes chronic pain as a serious health problem. Access to pain management is a fundamental human right. The goal of current work is to prove and evaluate the efficacy of application of different modalities and methods of the physical and rehabilitation medicine (PRM) on independence and quality of life of neurological patients. We effectuate a composition, clinical application and approbation series of complex neurorehabilitation algorithms for functional recovery and amelioration of independence in activities of daily living (ADL) of 1029 patients with neurological diseases, and 516 patients with neurosurgical conditions. The total of 1545 patients was divided into a lot of groups and subgroups, in each one we applied a different neurorehabilitation complex, composed by a synergic combination of natural and pre-formed physical modalities (electrical currents, laser; cryo/thermoagents, hydro-/balneo-/peloido-therapy; physiotherapy and occupational therapy). Patients were controlled before, during and at the end of the neurorehabilitation course and one month after its end - using a battery of traditional and contemporaneous objective methods (including for pain assessment): tests and scales for motor deficiency, balance and coordination; tests of functional grip of the upper limb; tests of gait and independent motion; complex functional scales for independence in ADL (self service, family, professional & social life); scales for depression and anxiety; visual analogue scale of pain; vibroesthesiometry; thermosensibility; laser Doppler flowmetry; ICF asessment. Based on detailed qualitative and quantitative evaluation we proved the efficacy of application of different PhThReh complexes and programs – on different types and levels of sensory, motor and functional deficiency in patients with diseases and conditions of the nervous systems. Mechanisms of physical analgesia are discussed. In conclusion we must say that physical modalities improve significantly the quality of life of patients with diseases and conditions of the nervous systems.