| Avances recientes en el tratamiento del dolor |
Recent advances in the treatment of pain.
Davis MP.
F1000 Med Rep. 2010 Aug 19;2:63.
Abstract
Cancer pain and chronic non-malignant pain can be difficult to manage and may not respond satisfactorily to standard analgesics. Sequential empiric analgesic trials are usually done to manage individual patients. Experimental human pain models have helped to clarify mechanisms of opioid and adjuvant analgesic actions. Combinations of opioids and adjuvant analgesics better relieve pain than either opioids or adjuvant analgesics alone, as demonstrated in randomized controlled trials. The analgesic activity of antidepressants is largely dependent upon norepinephrine reuptake and activation of alpha 2 adrenergic receptors. Corticosteroids reduce postoperative orthopedic incident pain, which may allow patients to ambulate earlier and with less pain. Spinal corticosteroids reduce lower hemibody pain. Gabapentinoids as single high doses reduce postoperative pain and certain acute pain syndromes. Individuals who experience flares of pain while on spinal opioids benefit from intrathecal boluses of levobupivicaine or sublingual ketamine. Interventional approaches to pain management are often necessary due to the limitations of systemic analgesics. Electronics stimulators (peripheral, spinal and motor cortex) improve difficult to manage chronic pain syndromes. Pulsed radiofrequency reduces pain without tissue damage, which could be an advantage over chemical or radiofrequency neurotomy. Botulinum toxin A reduces focal neuropathic pain that is durable. Interventional related successes in relieving pain are operator dependent. Most reported benefits of systemic and regional analgesics and interventional approaches to pain relief are not based on randomized trials and are subject to selection bias, sampling error, and placebo responses, which may over-inflate reported benefits. Randomized controlled trials are needed to confirm reported benefits.
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2990447/pdf/medrep-02-63.pdf
|
| Farmacología de analgésicos opioides y no opioides en dolor crónico |
Pharmacology of opioid and nonopioid analgesics in chronic pain states.
Martin TJ, Eisenach JC.
Department of Physiology, Wake Forest University School of Medicine, Winston-Salem, North Carolina 27157, USA. tjmartin@wfubmc.edu
J Pharmacol Exp Ther. 2001 Dec;299(3):811-7.
Abstract
Chronic pain represents a mixture of pathophysiologic mechanisms, a complex assortment of spontaneous and elicited pain states, and a somewhat unpredictable response to analgesics. Opioids remain the mainstay of treatment of moderate to severe chronic pain, although there is little systematic examination to guide drug selection. Cyclooxygenase inhibitors play primarily an adjunctive role in chronic pain treatment. Agents with little activity in the treatment of acute pain, such as antidepressants, antiepileptics, and i.v. administered local anesthetics, are initiated in many patients and have significant long-term efficacy in some patients with chronic pain. The N-methyl-D-aspartate antagonist ketamine and the alpha(2)-adrenergic agonist clonidine exhibit activity in patients with acute or chronic pain and reduce opioid consumption, but are often poorly tolerated due to side effects. Topical treatment with capsaicin or lidocaine exhibits efficacy in a subset of patients, and invasive intrathecal treatment with opioids as well as clonidine, neostigmine, and adenosine may have advantages in some patients. Several laboratory models have been developed to mimic chronic pain states found in humans. Nerve injury has been induced in rats by a variety of means, resulting in mechanical allodynia and thermal hyperalgesia. A number of arthritic states have also been produced by means of chronic joint inflammation in rats. The pharmacology of these neuropathic and arthritic pain models generally resembles that found in the respective human conditions. Additional models of chronic pain, particularly visceral pain, have been developed; however, the pharmacology of these models is not well established at this time.
http://jpet.aspetjournals.org/content/299/3/811.full.pdf |
|
No hay comentarios:
Publicar un comentario