Mecanismos del dolor por cáncer

Mecanismos del dolor por cáncer Mechanism of cancer pain. Schmidt BL, Hamamoto DT, Simone DA, Wilcox GL. Department of Oral and Maxillofacial Surgery, School of Dentistry, University of California San Francisco, USA. Brian.Schmidt@ucsf.edu Mol Interv. 2010 Jun;10(3):164-78. Abstract Ongoing and breakthrough pain is a primary concern for the cancer patient. Although the etiology of cancer pain remains unclear, animal models of cancer pain have allowed investigators to unravel some of the cancer-induced neuropathologic processes that occur in the region of tumor growth and in the dorsal horn of the spinal cord. Within the cancer microenvironment, cancer and immune cells produce and secrete mediators that activate and sensitize primary afferent nociceptors. Pursuant to these peripheral changes, nociceptive secondary neurons in spinal cord exhibit increased spontaneous activity and enhanced responsiveness to three modes of noxious stimulation: heat, cold, and mechanical stimuli. As our understanding of the peripheral and central mechanisms that underlie cancer pain improves, targeted analgesics for the cancer patient will likely follow http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2895277/pdf/0100164.pdf   Terapia génica: un abordaje potencial para el dolor por cáncer Gene therapy: a potential approach for cancer pain. Handy CR, Krudy C, Boulis N. Department of Neurosurgery, Emory University, 101 Woodruff Circle, Rm 6339, Atlanta, GA 30322, USA. Pain Res Treat. 2011;2011:987597. Epub 2011 Jun 9. Abstract Chronic pain is experienced by as many as 90% of cancer patients at some point during the disease. This pain can be directly cancer related or arise from a sensory neuropathy related to chemotherapy. Major pharmacological agents used to treat cancer pain often lack anatomical specificity and can have off-target effects that create new sources of suffering. These concerns establish a need for improved cancer pain management. Gene therapy is emerging as an exciting prospect. This paper discusses the potential for viral vector-based treatment of cancer pain. It describes studies involving vector delivery of transgenes to laboratory pain models to modulate the nociceptive cascade. It also discusses clinical investigations aimed at regulating pain in cancer patients. Considering the prevalence of pain among cancer patients and the growing potential of gene therapy, these studies could set the stage for a new class of medicines that selectively disrupt nociceptive signaling with limited off-target effects. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3196247/pdf/PRT2011-987597.pdf   Factor de conversión oral-parenteral para la morfina en cuidado paliativo: estudio piloto prospectivo, randomizado y cruzado Oral-parenteral conversion factor for morphine in palliative cancer care: a prospective randomized crossover pilot study. Starlander J, Melin-Johansson C, Jonsson H, Axelsson B. Department of Internal Medicine, Östersund Hospital, 831 83 Östersund, Sweden. Pain Res Treat. 2011;2011:504034. Epub 2011 Feb 15. Abstract Objective. This pilot study clinically tests whether a conversion factor of 2 to 1 is appropriate when changing from oral to parenteral morphine administration in the treatment of cancer-related nociceptive pain and calculates the size of an adequately powered future study. Methods. Eleven outpatients with incurable cancer and well-controlled nociceptive pain were randomly assigned to either intravenous or subcutaneous morphine using half the previous oral 24-hour dose. Each group crossed over after the first three-day period. Serum concentrations of morphine and its metabolites were monitored as well as intensity of pain. Results. Oral to subcutaneous and oral to intravenous quotas of morphine concentrations were approximately 0.9. Subcutaneous to intravenous morphine quotas were 1. Conclusions. The conversion factor of 2 to 1 seems to be a reasonable average but with an obvious need for individual adjustments. Concurrent medications and substantially higher doses of morphine could potentially affect the appropriate conversion factor. An adequately powered study to validate these findings would need at least 121 patients. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3197012/pdf/PRT2011-504034.pdf  Radiología intervencional y el cuidado de paciente oncológico Interventional radiology and the care of the oncology patient. O'Neill SB, O'Connor OJ, Ryan MF, Maher MM. Department of Radiology, University College Cork, Cork, Ireland. Radiol Res Pract. 2011;2011:160867. Epub 2011 Mar 29. Abstract Interventional Radiology (IR) is occupying an increasingly prominent role in the care of patients with cancer, with involvement from initial diagnosis, right through to minimally invasive treatment of the malignancy and its complications. Adequate diagnostic samples can be obtained under image guidance by percutaneous biopsy and needle aspiration in an accurate and minimally invasive manner. IR techniques may be used to place central venous access devices with well-established safety and efficacy. Therapeutic applications of IR in the oncology patient include local tumour treatments such as transarterial chemo-embolisation and radiofrequency ablation, as well as management of complications of malignancy such as pain, organ obstruction, and venous thrombosis. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3196980/pdf/RRP2011-160867.pdf

Atentamente Anestesiología y Medicina del Dolor www.anestesia-dolor.org