Más de insensibilidad congénita al dolor/ More on congenital insensitivity to pain

Agosto 6, 2017. No. 2772

Indiferencia congénita al dolor Congenital Indifference to Pain Adelaida Álvarez C.*, Simón P. Aristizábal L.**, Luis E Rev. Col. Anest. Noviembre 2010 - enero 2011. Vol. 38 - No. 4: 528-535 Resumen Introducción. En la fase aguda, el dolor ejerce un mecanismo natural de protección. No obstante, existen dos trastornos congénitos cuya característica principal es una baja o nula reactividad al trauma: la insensibilidad congénita al dolor y la indiferencia congénita al dolor. Esta última es una condición poco común en la que a pesar de no existir anormalidades neurológicas en las vías del dolor, el individuo carece de una respuesta emocional a la lesión tisular. Objetivos. Presentar el caso de una niña con indiferencia congénita al dolor y hacer revisión de la fisiopatología y una aproximación diagnóstica. Metodología y resultados. Presentación de caso clínico. Conclusiones. El diagnóstico de indiferencia congénita al dolor es básicamente un diagnóstico de exclusión y dado que aún no se conoce cura para este trastorno, la prevención, la educación y el tratamiento interdisciplinario son lo primordial en estas entidades. PDF Las mutaciones NaV1.9 del canal de sodio asociadas con la insensibilidad al dolor disminuyen la excitabilidad neuronal. Sodium channel NaV1.9 mutations associated with insensitivity to pain dampen neuronal excitability. Huang J1, Vanoye CG2, Cutts A3, Goldberg YP3, Dib-Hajj SD1, Cohen CJ3, Waxman SG1, George AL Jr2. J Clin Invest. 2017 Jun 30;127(7):2805-2814. doi: 10.1172/JCI92373. Epub 2017 May 22.Abstract Voltage-gated sodium channel (NaV) mutations cause genetic pain disorders that range from severe paroxysmal pain to a congenital inability to sense pain. Previous studies on NaV1.7 and NaV1.8 established clear relationships between perturbations in channel function and divergent clinical phenotypes. By contrast, studies of NaV1.9 mutations have not revealed a clear relationship of channel dysfunction with the associated and contrasting clinical phenotypes. Here, we have elucidated the functional consequences of a NaV1.9 mutation (L1302F) that is associated with insensitivity to pain. We investigated the effects of L1302F and a previously reported mutation (L811P) on neuronal excitability. In transfected heterologous cells, the L1302F mutation caused a large hyperpolarizing shift in the voltage-dependence of activation, leading to substantially enhanced overlap between activation and steady-state inactivation relationships. In transfected small rat dorsal root ganglion neurons, expression of L1302F and L811P evoked large depolarizations of the resting membrane potential and impaired action potential generation. Therefore, our findings implicate a cellular loss of function as the basis for impaired pain sensation. We further demonstrated that a U-shaped relationship between the resting potential and the neuronal action potential threshold explains why NaV1.9 mutations that evoke small degrees of membrane depolarization cause hyperexcitability and familial episodic pain disorder or painful neuropathy, while mutations evoking larger membrane depolarizations cause hypoexcitability and insensitivity to pain. PDF ¿Podemos compartir un dolor que nunca sentimos? Correlaciones neuronales de empatía en pacientes con insensibilidad congénita al dolor. Can we share a pain we never felt? Neural correlates of empathy in patients with congenital insensitivity to pain. Danziger N1, Faillenot I, Peyron R. Neuron. 2009 Jan 29;61(2):203-12. doi: 10.1016/j.neuron.2008.11.023. Abstract Theories of empathy differ regarding the relative contributions of automatic resonance and perspective taking in understanding others' emotions. Patients with the rare syndrome of congenital insensitivity to pain cannot rely on "mirror matching" (i.e., resonance) mechanisms to understand the pain of others. Nevertheless, they showed normal fMRI responses to observed pain in anterior mid-cingulate cortex and anterior insula, two key regions of the so-called "shared circuits" for self and other pain. In these patients (but not in healthy controls), empathy trait predicted ventromedial prefrontal responses to somatosensory representations of others' pain and posterior cingulate responses to emotional representations of others' pain. These findings underline the major role of midline structures in emotional perspective taking and understanding someone else's feeling despite the lack of any previous personal experience of it--an empathic challenge frequently raised during human social interactions. PDF Dolor emocional sin dolor sensorial - ¿Sueño? Emotional pain without sensory pain--dream on? Borsook D, Becerra L. Neuron. 2009 Jan 29;61(2):153-5. doi: 10.1016/j.neuron.2009.01.003. Abstract The article by Danziger and colleagues in this issue of Neuron evaluates empathy in a unique population--individuals with congenital insensitivity to pain. As such, it provides insights into the brain's ability to evaluate others' feeling to observed pain without having a specific sensory experience of pain itself. PDF XIV Congreso Virtual Mexicano de Anestesiología 2017 Octubre 1-Diciembre 31, 2017 Información / Information California Society of Anesthesiologists Reuniones / Events Informacion / Information

Anestesiología y Medicina del Dolor 52 664 6848905 vwhizar@anestesia-dolor.org anestesia-dolor.org

Grupos de Trabecula del fémur proximal

http://www.reemplazoprotesico.com.mx/academia/grupos-de-trabecula-del-femur-proximal/

Trabecula groups of proximal femur

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Courtesy: Harry Benjamin Laing MRCS, Ortho M8, FRCS(Tr and Orth) Tutorials

Trabecula groups of the proximal femur, Frcs orth revision

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Buprenorfina / Buprenorphine

Agosto 7, 2017. No. 2773

Buprenorfina para el dolor crónico. Una revisión de su efectividad Buprenorphine for Chronic Pain: A Review of the Clinical Effectiveness [Internet]. Source Ottawa (ON): Canadian Agency for Drugs and Technologies in Health; 2017 Jan. CADTH Rapid Response Reports. Excerpt Buprenorphine is an opioid analgesic available in Canada as transdermal patches and sublingual tablets (tablets also contain naloxone).1,2Buprenorphine/naloxone is indicated for substitution treatment in opioid drug dependence in adults whereas transdermal buprenorphine is indicated for the management of pain severe enough to require daily, continuous, long-term opioid treatment. Buprenorphine produces typical opioid agonist effects and in higher doses its agonist effects reach a ceiling and it can act as an antagonist. This property distinguishes it from morphine. It has high affinity for mu opioid receptors but only weakly activates them.3 For this reason, buprenorphine may be less likely to cause respiratory depression than full opioid agonists such as fentanyl or morphine.4 When buprenorphine is given concomitantly with other opioids, it antagonizes the effects of the other opioids by displacing them from the mu receptors. This can lead to withdrawal syndrome if buprenorphine is added to another opioid. If buprenorphine is withdrawn while the dose of the other opioid is being increased, it can increase the risk of overdose.3 The role of opioids in chronic cancer pain has been well established but their role and the relative effectiveness of opioids such as buprenorphine in the context of chronic non-cancer pain is unclear. PDF Uso y mal uso de agonistas opioides en la adicción a los opioides. Use and misuse of opioid agonists in opioid addiction. Modesto-Lowe V1,2,3, Swiezbin K2, Chaplin M3,4, Hoefer G5. Cleve Clin J Med. 2017 May;84(5):377-384. doi: 10.3949/ccjm.84a.16091. Abstract Although methadone (an opioid agonist) and buprenorphine (a partial opioid agonist) have evidence to support their use in treating opioid use disorder, they remain misunderstood and underutilized. In this article, we outline the risks and benefits of using these drugs as maintenance therapy in opioid-dependent patients. PDF Nuevos desarrollos en el manejo de la adicción a opioides. Impacto del implante subdérmico de buprenorfina New developments in managing opioid addiction: impact of a subdermal buprenorphine implant. Itzoe M1, Guarnieri M1. Drug Des Devel Ther. 2017 May 10;11:1429-1437. doi: 10.2147/DDDT.S109331. eCollection 2017. Abstract Opioid addiction to prescription and illicit drugs is a serious and growing problem. In the US alone, >2.4 million people suffer from opioid use disorder. Government and pharmaceutical agencies have begun to address this crisis with recently released and revised task forces and medication-assisted therapies (MAT). For decades, oral or intravenous (IV) MATs have helped patients in their recovery by administration of opioid agonists (methadone, buprenorphine, oxycodone), antagonists (naltrexone, naloxone), and combinations of the two (buprenorphine/naloxone). While shown to be successful, particularly when combined with psychological counseling, oral and IV forms of treatment come with constraints and challenges. Patients can become addicted to the agonists themselves, and there is increased risk for diversion, abuse, or missed dosages. Consequently, long-acting implants have begun to be developed as a potentially preferable method of agonist delivery. To date, the newest implant approved by the US Food and Drug Administration (May 2016) is Probuphine®, which delivers steady-state levels of buprenorphine over the course of 6 months. Numerous studies have demonstrated its efficacy and safety. Yet, implants come with their own risks such as surgical site irritation, possible movement, and protrusion of implant out of skin. This review introduces the opioid abuse epidemic, examines existing medications used for therapy, and highlights Probuphine as a new treatment option. Costs associated with MATs are also discussed. KEYWORDS: Probuphine®; addiction; buprenorphine; long-acting implant; medication-assisted therapy; opioids PDF Probufina® (implante de buprenorfina). Un candidato prometedor en la dependencia oipioide Probuphine® (buprenorphine implant): a promising candidate in opioid dependence. Barnwal P1, Das S2, Mondal S3, Ramasamy A4, Maiti T5, Saha A6. Ther Adv Psychopharmacol. 2017 Mar;7(3):119-134. doi: 10.1177/2045125316681984. Epub 2016 Dec 19. Abstract Opioid dependence leads to physical dependence and addiction which finally results in profound medical, psychological and social dysfunction. One of the useful medications for opioid dependence is buprenorphine, the partial opioid agonist, which is used alone or in combination with naloxone. However, buprenorphine is the victim of its own success due to its illicit use and accidental poisoning in children. Also, buprenorphine typically requires daily self-administration and its effectiveness heavily depends on patient adherence. So, poor treatment adherence results in ineffective treatment manifesting as craving and withdrawal symptoms. Short-term use of buprenorphine in opioid dependence is also often followed by relapse. Buprenorphine when used sublingually often results in inadequate or fluctuating blood concentrations and poorer treatment retention compared with methadone. All of these led to the development of Probuphine®, a polymeric matrix composed of ethylene vinyl acetate and buprenorphine in the form of implants, that are implanted subdermally in office practice and deliver the active drug over 6 months. Buprenorphine release from such implant is fairly consistent, avoiding plasma peaks and troughs, and the implant is also reported to be safe. In this review article, we have highlighted these aspects of treatment of opioid addiction, stressing on the pharmacology of buprenorphine and Probuphine®, and relevant clinical trials addressing the efficacy and safety of Probuphine®. This sustained-release implantable formulation of buprenorphine has the potential to be a suitable alternative to daily or alternate day sublingual buprenorphine which can thereby eliminate the need for daily supervision, minimizing fluctuations in plasma concentrations, and allowing these patients to reduce clinic or pharmacy visits. KEYWORDS: Probuphine®; addiction; buprenorphine; implant; opioid dependence PDF XIV Congreso Virtual Mexicano de Anestesiología 2017 Octubre 1-Diciembre 31, 2017 Información / Information

Anestesiología y Medicina del Dolor 52 664 6848905 vwhizar@anestesia-dolor.org anestesia-dolor.org