Guías para la prescripción de opioides en el dolor no oncológico en ancianos Guidance on opioids prescribing for the management of persistent non-cancer pain in older adults. Guerriero F1. World J Clin Cases. 2017 Mar 16;5(3):73-81. doi: 10.12998/wjcc.v5.i3.73. Abstract Many older adults suffer from persistent pain but prevalence studies consistently showed high levels of untreated or under-treated pain in old population. Both persistent pain and pain under-treatment adversely affect independence and quality of life in geriatric patients. Pain management is challenging in this age-group because of the declining organ function, the presence of concurrent diseases and polypharmacy. For all the above reasons, persistent pain in the elderly should be considered a geriatric syndrome per se and effective approaches are warranted. Current guidelines and consensus statements recommend opioid therapy for older adults with moderate-to-severe persistent pain or functional impairment and diminished quality of life due to pain. However clinicians and patients themselves have some concerns about opioids use. Age-related decline in organs functions and warnings about risk of addiction and drug misuse/abuse also in geriatric patients need particular attention for safe prescribing. On the basis of clinical evidence, these practical recommendations will help to improve the competence on opioid role in persistent pain management and the likelihood of a successful analgesic trial in older patients. KEYWORDS: Chronic pain; Elderly; Opioids; Pain management PDF Mecanismos del dolor óseo en la osteoporosis. Revisión narrativa Bone pain mechanism in osteoporosis: a narrative review. Mattia C1, Coluzzi F1, Celidonio L1, Vellucci R2. Clin Cases Miner Bone Metab. 2016 May-Aug;13(2):97-100. Epub 2016 Oct 5. Abstract Bone pain in elderly people dramatically affects their quality of life, with osteoporosis being the leading cause of skeletal related events. Peripheral and central mechanisms are involved in the pathogenesis of the nervous system sensitization. Osteoporosis in the elderly has been associated with increased density of bone sensory nerve fibers and their pathological modifications, together with an over-expression of nociceptors sensitized by the lowering pH due to the osteoclastic activity. The activation of N-methyl-D-aspartate (NMDA) receptors and the microglia, as a response to a range of pathological conditions, represent the leading cause of central sensitization. Unfortunately, osteoporosis is named the "silent thief" because it manifests with painful manifestation only when a fracture occurs. In the management of patients suffering from bone pain, both the nociceptive and the neuropathic component of chronic pain should be considered in the selection of the analgesic treatment. KEYWORDS: bone; opioids; osteoporosis; pain mechanism PDF Implicaciones del uso de analgésicos en el dolor por osteoporosis. Opioides Implications of analgesics use in osteoporotic-related pain treatment: focus on opioids. Vellucci R1, Mattia C2, Celidonio L2, Mediati RD1. Clin Cases Miner Bone Metab. 2016 May-Aug;13(2):89-92. Epub 2016 Oct 5. Abstract Bone loss is asymptomatic and will progress without pain and other symptoms until the occurrence of a fracture. The occurrence of a breaking bone induce acute pain determined and supported by a mechanical, inflammatory and neuropathic component. Very often the acute component evolves in a chronic musculoskeletal component. Overall objectives of the analgesic therapy can be summarized in pain relief, improving sleep, improve mobility, reduce anxiety, emotional component and depression. Osteoporosis is predominantly a condition of the elderly, more likely to have coexisting cardiovascular disease and age-related decline in renal function, receiving treatment for one or more comorbid conditions, taking multiple medications. Analgesic treatment with NSAIDs has negative effects on skeletal health and healing of the injured skeleton and increase risk of adverse events especially in older patients. Despite all opioids therapy represents a mainstay in the treatment of patients with moderate to severe pain, it can induce an endocrinopathy, which may affect bone metabolism. The negative effects of opioids on hormonal axis are not the same for all molecule and the choice of drug can be crucial in the treatment of patients with chronic pain. KEYWORDS: chronic pain; opioids; osteoporosis; osteoporosis fractures; osteoporotic pain; pain; pain treatment PDF 5to curso internacional Anestesiologia cardiotoracica_ vascular_ ecocardiografia y circulaci_n extracorporea. Curso sobre Anestesia en Trasplantes, Cirugía abdominal, Plástica, Oftalmología y Otorrinolaringología. Committee for European Education in Anaesthesiology (CEEA) y el Colegio de Anestesiólogos de León A.C. Abril 7-9, 2017, León Guanajuato, México Informes (477) 716 06 16, kikinhedz@gmail.com Like us on Facebook Follow us on Twitter Find us on Google+ View our videos on YouTube Anestesiología y Medicina del Dolor 52 664 6848905 vwhizar@anestesia-dolor.org anestesia-dolor.org Copyright © 2015

Abril 1, 2017. No. 2646

Guías para la prescripción de opioides en el dolor no oncológico en ancianos Guidance on opioids prescribing for the management of persistent non-cancer pain in older adults. Guerriero F1. World J Clin Cases. 2017 Mar 16;5(3):73-81. doi: 10.12998/wjcc.v5.i3.73. Abstract Many older adults suffer from persistent pain but prevalence studies consistently showed high levels of untreated or under-treated pain in old population. Both persistent pain and pain under-treatment adversely affect independence and quality of life in geriatric patients. Pain management is challenging in this age-group because of the declining organ function, the presence of concurrent diseases and polypharmacy. For all the above reasons, persistent pain in the elderly should be considered a geriatric syndrome per se and effective approaches are warranted. Current guidelines and consensus statements recommend opioid therapy for older adults with moderate-to-severe persistent pain or functional impairment and diminished quality of life due to pain. However clinicians and patients themselves have some concerns about opioids use. Age-related decline in organs functions and warnings about risk of addiction and drug misuse/abuse also in geriatric patients need particular attention for safe prescribing. On the basis of clinical evidence, these practical recommendations will help to improve the competence on opioid role in persistent pain management and the likelihood of a successful analgesic trial in older patients. KEYWORDS: Chronic pain; Elderly; Opioids; Pain management PDF Mecanismos del dolor óseo en la osteoporosis. Revisión narrativa Bone pain mechanism in osteoporosis: a narrative review. Mattia C1, Coluzzi F1, Celidonio L1, Vellucci R2. Clin Cases Miner Bone Metab. 2016 May-Aug;13(2):97-100. Epub 2016 Oct 5. Abstract Bone pain in elderly people dramatically affects their quality of life, with osteoporosis being the leading cause of skeletal related events. Peripheral and central mechanisms are involved in the pathogenesis of the nervous system sensitization. Osteoporosis in the elderly has been associated with increased density of bone sensory nerve fibers and their pathological modifications, together with an over-expression of nociceptors sensitized by the lowering pH due to the osteoclastic activity. The activation of N-methyl-D-aspartate (NMDA) receptors and the microglia, as a response to a range of pathological conditions, represent the leading cause of central sensitization. Unfortunately, osteoporosis is named the "silent thief" because it manifests with painful manifestation only when a fracture occurs. In the management of patients suffering from bone pain, both the nociceptive and the neuropathic component of chronic pain should be considered in the selection of the analgesic treatment. KEYWORDS: bone; opioids; osteoporosis; pain mechanism PDF Implicaciones del uso de analgésicos en el dolor por osteoporosis. Opioides Implications of analgesics use in osteoporotic-related pain treatment: focus on opioids. Vellucci R1, Mattia C2, Celidonio L2, Mediati RD1. Clin Cases Miner Bone Metab. 2016 May-Aug;13(2):89-92. Epub 2016 Oct 5. Abstract Bone loss is asymptomatic and will progress without pain and other symptoms until the occurrence of a fracture. The occurrence of a breaking bone induce acute pain determined and supported by a mechanical, inflammatory and neuropathic component. Very often the acute component evolves in a chronic musculoskeletal component. Overall objectives of the analgesic therapy can be summarized in pain relief, improving sleep, improve mobility, reduce anxiety, emotional component and depression. Osteoporosis is predominantly a condition of the elderly, more likely to have coexisting cardiovascular disease and age-related decline in renal function, receiving treatment for one or more comorbid conditions, taking multiple medications. Analgesic treatment with NSAIDs has negative effects on skeletal health and healing of the injured skeleton and increase risk of adverse events especially in older patients. Despite all opioids therapy represents a mainstay in the treatment of patients with moderate to severe pain, it can induce an endocrinopathy, which may affect bone metabolism. The negative effects of opioids on hormonal axis are not the same for all molecule and the choice of drug can be crucial in the treatment of patients with chronic pain. KEYWORDS: chronic pain; opioids; osteoporosis; osteoporosis fractures; osteoporotic pain; pain; pain treatment PDF Curso sobre Anestesia en Trasplantes, Cirugía abdominal, Plástica, Oftalmología y Otorrinolaringología. Committee for European Education in Anaesthesiology (CEEA)  y el Colegio de Anestesiólogos de León A.C. Abril 7-9, 2017, León Guanajuato, México Informes  (477) 716 06 16, kikinhedz@gmail.com

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