domingo, 26 de junio de 2016

Más sobre dolor episódico en cáncer / More on breakthrough cancer pain

Junio 26, 2016. No. 2369




Recomendaciones Canadienses para el manejo del dolor episódico por cáncer
Canadian recommendations for the management of breakthrough cancer pain.
Curr Oncol. 2016 Apr;23(2):96-108. doi: 10.3747/co.23.2865. Epub 2016 Apr 13.
Abstract
Breakthrough cancer pain (btcp) represents an important element in the spectrum of cancer pain management. Because most btcp episodes peak in intensity within a few minutes, speed of medication onset is crucial for proper control. In Canada, several current provincial guidelines for the management of cancer pain include a brief discussion about the treatment of btcp; however, there are no uniform national recommendations for the management of btcp. That lack, accompanied by unequal access to pain medication across the country, contributes to both regional and provincial variability in the management of btcp. Currently, immediate-release oral opioids are the treatment of choice for btcp. This approach might not always offer optimal speed for onset of action and duration to match the rapid nature of an episode of btcp. Novel transmucosal fentanyl formulations might be more appropriate for some types of btcp, but limited access to such drugs hinders their use. In addition, the recognition of btcp and its proper assessment, which are crucial steps toward appropriate treatment selection, remain challenging for many health care professionals. To facilitate appropriate management of btcp, a group of prominent Canadian specialists in palliative care, oncology, and anesthesiology convened to develop a set of recommendations and suggestions to assist Canadian health care providers in the treatment of btcp and the alleviation of the suffering and discomfort experienced by adult cancer patients.
KEYWORDS: Breakthrough cancer pain
Dolor episódico: definición, etiología y epidemiología
M. Nabal y F. Madrid
R e v. Soc. Esp. Dolor 9: 88-93, 200
R E S U M E N
El dolor episódico (D.E.) se define como la pres e n t a c i ó n de un dolor agudo transitorio en un paciente (con cáncer)cuyo dolor basal está controlado. Bajo este apelativo se incluyen el dolor incidental, el dolor de final de dosis y el dolor irruptivo. Las características epidemiológicas de este tipo de dolor son difíciles de precisar ya que no existe un consenso en la nomenclatura anglosajona sobre el tema, pe r o su prevalencia oscila entre el 19 y el 93% según las distintas series. El número medio de episodios descrito es de 4 (1-3600). La mitad de los dolores episódicos tienen un inicio brusco y una duración media inferior a 30 minutos. En todos los casos se describe la intensidad de los episodios de dolor como severa o muy severa. Los  mecanismos implicados en la aparición de este tipo de dolor son en propo r ciones similares: viscerales, somáticos, neuropáticos o mixtos. Hasta la fecha no disponemos de sistemas específicos para evaluar este tipo de dolor; y contamos con escasas herramientas terapéuticas específicas lo cual puede contribuir al desconocimiento sobre el tema. El presente trabajo pr etende profundizar en este tipo de dolor a partir de una revisión de la bibliografía disponible. © 2002 Sociedad Española del Dolor. Publicado por Arán Ediciones, S.L.
Palabras clave: Dolor episódico. Dolor incidental. Dolor irruptivo. Cuidados paliativos.
Que hacer y que no hacer cuando se diagnostica y trata en dolor episódico por cáncer. Opiniones de expertos
What to Do, and What Not to Do, When Diagnosing and Treating Breakthrough Cancer Pain (BTcP): Expert Opinion.
Drugs. 2016 Mar;76(3):315-30. doi: 10.1007/s40265-015-0519-2.
Abstract
Clinical management of breakthrough cancer pain (BTcP) is still not satisfactory despite the availability of effective pharmacological agents. This is in part linked to the lack of clarity regarding certain essential aspects of BTcP, including terminology, definition, epidemiology and assessment. Other barriers to effective management include a widespread prejudice among doctors and patients concerning the use of opioids, and inadequate assessment of pain severity, resulting in the prescription of ineffective drugs or doses. This review presents an overview of the appropriate and inappropriate actions to take in the diagnosis and treatment of BTcP, as determined by a panel of experts in the field. The ultimate aim is to provide a practical contribution to the unresolved issues in the management of BTcP. Five 'things to do' and five 'things not to do' in the diagnosis and treatment of BTcP are proposed, and evidence supporting said recommendations are described. It is the duty of all healthcare workers involved in managing cancer patients to be mindful of the possibility of BTcP occurrence and not to underestimate its severity. It is vital that all the necessary steps are carried out to establish an accurate and timely diagnosis, principally by establishing effective communication with the patient, the main information source. It is crucial that BTcP is treated with an effective pharmacological regimen and drug(s), dose and administration route prescribed are designed to suit the particular type of pain and importantly the individual needs of the patient.

Comité Europeo de Enseñanza en Anestesiología
Curso de Actualización en Anestesiología
Anestesia por Especialidades y Simposio Anestesia y Cirugía Plástica Seguras
Agosto 5-7, 2016. Tijuana BC, México
Información Dr. Sergio Granados Tinajero granadosts@gmail.com 

16th World Congress of Anaesthesiologists

28 August - 2 September 2016 
Hong Kong Convention and Exhibition Centre
World Federation of Societies of Anaesthesiologists
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