Una mirada actualizada del enfoque y tratamiento del dolor neuropático crónico en el paciente con lesión medular
DOI:
https://doi.org/10.28957/rcmfr.v27n1a3Palabras clave:
trauma raquimedular, dolor neuropático, dolor neuropático central.Resumen
El dolor neuropático asociado a lesión medular se define como un dolor crónico secundario a una lesión o enfermedad que afecta el sistema somatosensorial; es una patología frecuente de origen central, que genera un impacto negativo en la calidad de vida, la función física, el ánimo y la rehabilitación. El enfoque y tratamiento del dolor neuropático crónico es un desafío para el médico fisiatra. La mayoría de los pacientes cursan con un dolor grave de difícil manejo. La elección del método farmacológico según el nivel de recomendación, el proceso interdisciplinario, el uso de terapias coadyuvantes y los procedimientos intervencionistas son herramientas determinantes para el éxito del tratamiento.Biografía del autor/a
Paula Andrea Yañez Diaz
Médica especialista en Medicina Física y Rehabilitación, Universidad de la Sabana, Chía, Colombia
María Catalina Gómez Guevara
Médica especialista en Medicina
Física y Rehabilitación.
Coordinadora de Especialización
de Medicina Física y
Rehabilitación de la Facultad de
Medicina de la Universidad de La
Sabana. Docente de la
Universidad de La Sabana,
Chía, Colombia
Juan Bernardo Hoyos Gutierrez
Médico especialista en Dolor y Cuidados Paliativos del Instituto Nacional de Cancerología. Médico especialista en Medicina Física y Rehabilitación. Hospital San Ignacio
Referencias bibliográficas
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10. Jongen JLM, Hans G, Benzon HT, Huygen F, Craig T. Neuropathic Pain and Pharmacological Treatment. Pain Practice. 2014; 14(3):283-95.
11. Hulsebosch CE, Hains BC, Crown ED, Carlton SM. Mechanisms of chronic central neuropathic pain after spinal cord injury. Brain Res Rev [Internet]. Elsevier B.V.; 2009 [consulta 16 oct 2016];60(1):202- 13. Disponible en: http://dx.doi.org/10.1016/j.brainresrev.2008.12.010
12. D’Angelo R, et al. Neuropathic pain following spinal cord injury: what we know about mechanisms assessment and Management. Eur Rev Med Pharmacol. 2013;23:3257-61.
13. Finnerup NB, Attal N, Haroutounian S, McNicol E, Baron R, Dworkin RH, et al. Pharmacotherapy for neuropathic pain in adults: A systematic review and metaanalysis. Lancet Neurol. 2015;14(2):162-73.
14. Boroujerdi A, Zeng J, Sharp K, Kim D, Steward O, Luo ZD. Calcium channel alpha-2-delta-1 protein upregulation in dorsal spinal cord mediates spinal cord injuryinduced neuropathic pain states. Pain [Internet]. International Association for the Study of Pain; 2011 [consulta 16 oct 2016];152(3):649–55. Disponible en: http://dx.doi.org/10.1016j.pain.2010.12.014
15. Gwak YS, Hulsebosch CE. GABA and central neuropathic pain following spinal cord injury. Neuropharmacology [Internet]. Elsevier Ltd; 2011 [consulta 17 oct 2016];60(5):799-808. Disponible en: http://dx.doi.org10.1016/j.neuropharm. 2010.12.030
16. Jutzeler CR, Freund P, Huber E, Curt A, Kramer JLK. Neuropathic pain and functional reorganization in the primary sensorimotor cortex after spinal cord injury. J Pain [Internet]. Elsevier Inc; 2015 [consulta 18 oct 2016];16(12):1256-67. Disponible en: http://linkinghub.elsevier.comretrieve/pii/S152659001500842117.
Yoon EJ, Kim YK, Shin HI, Lee Y, Kim SE. Cortical and white matter alterations in patients with neuropathic pain after spinal cord injury. Brain Res [Internet]. Elsevier; 2013 [consulta 20 oct 2016];1540(2013):64-73. Disponible en: http://dx.doi.org/10.1016/j.brainres.2013.10.007
18. Finnerup NB, Baastrup C, Jensen TS. Neuropathic pain following spinal cord injury pain: mechanisms and treatment. Scand J Pain [Internet]. Elsevier B.V.; 2009 [consulta 22 oct 2016];1:S3-11. Disponible en: http://www.sciencedirect.com/science/article/pii/S1877886009700035
19. Cardenas DD, Felix ER. Pain after spinal cord injury: a review of classification, treatment approaches, and treatment assessment. PM R [Internet]. Elsevier Inc.; 2009 [consulta 22 oct 2016];1(12):1077-90. Disponible en: http://dx.doi.org/10.1016/j.pmrj.2009.07.002
20. Calmels P, Mick G, Perrouin-Verbe B, Ventura M. Neuropathic pain in spinal cord injury: Identification, classification, evaluation. Ann Phys Rehabil Med. 2009;52(2):83-102.
21. Celik EC, Erhan B, Lakse E. The clinical characteristics of neuropathic pain in patients with spinal cord injury. Spinal Cord [Internet]. Nature Publishing Group; 2012 [consulta 24 oct 2016];50(8):585-9. Disponible en: http://www.ncbi.nlm.nih.gov/pubmed/22430511
22. Finnerup NB. Pain in patients with spinal cord injury. Pain [Internet]. International Association for the Study of Pain; 2013 [consulta26 oct 2016];154:S71-6. Disponible en: http://dx.doi.org/10.1016j.pain.2012.12.007
23. Mehta S, McIntyre A, Janzen S, Loh E, Teasell R. Systematic Review of Pharmacologic Treatments of Pain After Spinal Cord Injury: An Update. Arch Phys Med Rehabil. 2016; 97(8):1381-1391.
24. Cardenas DD, Emir B, Parsons B. Examining the Time to Therapeutic Effect of Pregabalin in Spinal Cord Injury Patients With Neuropathic Pain. Clin Ther [Internet]. Elsevier; 2015 [consulta 26 oct 2016];37(5):1081–90. Disponible en: http://dx.doi.org/10.1016/j.clinthera.2015.02.028
25. Attal N, Mazaltarine G, Perrouin-Verbe B, Albert T. Chronic neuropathic pain management in spinal cord injury patients. What is the efficacy of pharmacological treatments with a general mode of administration? (oral, transdermal, intravenous). Ann Phys Rehabil Med. 2009;52(2):124-41.
26. Guy S, Mehta S, Leff L, Teasell R, Loh E. Anticonvulsant medication use for the management of pain following spinal cord injury: systematic review and effectiveness analysis. Nature Publishing Group; 2013 [consulta 2 nov 2016];52(2):89-96. Disponibleen: http://dx.doi.org/10.1038/sc.2013.146
27. Mehta S, McIntyre A, Dijkers M, Loh E, Teasell RW. Gabapentinoids ar effective in decreasing neuropathic pain and other secondary outcomes after spinal cord injury: A meta-analysis. Arch Phys Med Rehabil [Internet]. Elsevier Ltd; 2014 [consulta 3 nov 2016];95(11):2180-6. Disponible en: http://dx.doi.org/10.1016/j.apmr.2014.06.010
28. Cardenas DD, Nieshoff EC, Suda K, Goto S, Sanin L, Kaneko T et al. A randomized trial of pregabalin in patients with neuropathic pain due to spinal cord injury. Neurology [Internet]. 2013 [consulta 5 nov 2016];80(6):533.9. Disponible en: http://ovidsp.ovid.comovidweb.cgi?T=JS&PAGE=
reference&D=emed11&NEWS=N&AN=2013103213
29. Rintala DH, Holmes SA, Courtade D, Fiess RN, Tastard LV, Loubser PG. Comparison of the Effectiveness of Amitriptyline and Gabapentin on Chronic Neuropathic Pain in Persons With Spinal Cord Injury. Arch Phys Med Rehabil. 2007;88(12):1547.60.
30. Salinas FA, Lugo LH, García HI. Efficacy of Early Treatment with Carbamazepine in Prevention of Neuropathic Pain in Patients with Spinal Cord Injury. Am J Phys Med Rehabil. 2012;91(12):1020-7.
31. Vranken JH, Hollmann MW, Van Der Vegt MH, Kruis MR, Heesen M, Vos K, et al. Duloxetine in patients with central neuro
2. Guy SD, Mehta S, Casalino A, Côté I, Moulin DE, Parrent AG, et al. The CanPain SCI Clinical Practice Guidelines for Rehabilitation Management of Neuropathic Pain after Spinal Cord: Recommendations for treatment. Spinal Cord 2016; 54:S14-S23.
3. Bryce TN, Biering-Sørensen F, Finnerup NB, Cardenas DD, Defrin R, Lundeberg T, et al. International Spinal Cord Injury Pain Classification: part I. Background and description. Spinal Cord. 2012;50(6):413-7.
4. Perrouin-Verbe B, Ventura M, Albert T, Souan P, Fattal C, Revel M. Clinical practice guidelines for chronic neuropathic pain in the spinal cord injury patient: Introduction and methodology. Ann Phys Rehabil Med. 2009;52(2):77-82.
5. Werhagen L, Budh CN, Hultling C, Molander C. Neuropathic pain after traumatic spinal cord injury – relations to gender, spinal level, completeness, and age at the time of injury. Spinal Cord [Internet]. 2004 [consulta 13 oct 2016];42(12):665-673. Disponible en: http://www. n c b i . n l m . n i h . g ov/pubmed/15289801%5Cnhttp://www.nature.com/doifinder/10.1038/sj.sc.3101641
6. Siddall P. Pain Management of Neuropathic Pain. Spinal Cord. 2009;47:352-359.
7. Margot-Duclot A, Tournebise H, Ventura M, Fattal C. What are the risk factors of occurence and chronicity of neuropathic pain in spinal cord injury patients? Ann Phys Rehabil Med. 2009;52(2):111-23.
8. Treede RD, Jensen TS, Campbell JN, et al. Neuropathic pain Redefinition and a grading system for clinical and research. Neurology 2008;70;1630-1636.
9. Felix ER. Chronic neuropathic pain in SCI. Evaluation and treatment. Phys Med Rehabil Clin N Am [Internet]. Elsevier Inc; 2014 [consulta 15 oct 2016];25(3):545-71. Disponibleen: http://dx.doi.org/10.1016/j.pmr.2014.04.007
10. Jongen JLM, Hans G, Benzon HT, Huygen F, Craig T. Neuropathic Pain and Pharmacological Treatment. Pain Practice. 2014; 14(3):283-95.
11. Hulsebosch CE, Hains BC, Crown ED, Carlton SM. Mechanisms of chronic central neuropathic pain after spinal cord injury. Brain Res Rev [Internet]. Elsevier B.V.; 2009 [consulta 16 oct 2016];60(1):202- 13. Disponible en: http://dx.doi.org/10.1016/j.brainresrev.2008.12.010
12. D’Angelo R, et al. Neuropathic pain following spinal cord injury: what we know about mechanisms assessment and Management. Eur Rev Med Pharmacol. 2013;23:3257-61.
13. Finnerup NB, Attal N, Haroutounian S, McNicol E, Baron R, Dworkin RH, et al. Pharmacotherapy for neuropathic pain in adults: A systematic review and metaanalysis. Lancet Neurol. 2015;14(2):162-73.
14. Boroujerdi A, Zeng J, Sharp K, Kim D, Steward O, Luo ZD. Calcium channel alpha-2-delta-1 protein upregulation in dorsal spinal cord mediates spinal cord injuryinduced neuropathic pain states. Pain [Internet]. International Association for the Study of Pain; 2011 [consulta 16 oct 2016];152(3):649–55. Disponible en: http://dx.doi.org/10.1016j.pain.2010.12.014
15. Gwak YS, Hulsebosch CE. GABA and central neuropathic pain following spinal cord injury. Neuropharmacology [Internet]. Elsevier Ltd; 2011 [consulta 17 oct 2016];60(5):799-808. Disponible en: http://dx.doi.org10.1016/j.neuropharm. 2010.12.030
16. Jutzeler CR, Freund P, Huber E, Curt A, Kramer JLK. Neuropathic pain and functional reorganization in the primary sensorimotor cortex after spinal cord injury. J Pain [Internet]. Elsevier Inc; 2015 [consulta 18 oct 2016];16(12):1256-67. Disponible en: http://linkinghub.elsevier.comretrieve/pii/S152659001500842117.
Yoon EJ, Kim YK, Shin HI, Lee Y, Kim SE. Cortical and white matter alterations in patients with neuropathic pain after spinal cord injury. Brain Res [Internet]. Elsevier; 2013 [consulta 20 oct 2016];1540(2013):64-73. Disponible en: http://dx.doi.org/10.1016/j.brainres.2013.10.007
18. Finnerup NB, Baastrup C, Jensen TS. Neuropathic pain following spinal cord injury pain: mechanisms and treatment. Scand J Pain [Internet]. Elsevier B.V.; 2009 [consulta 22 oct 2016];1:S3-11. Disponible en: http://www.sciencedirect.com/science/article/pii/S1877886009700035
19. Cardenas DD, Felix ER. Pain after spinal cord injury: a review of classification, treatment approaches, and treatment assessment. PM R [Internet]. Elsevier Inc.; 2009 [consulta 22 oct 2016];1(12):1077-90. Disponible en: http://dx.doi.org/10.1016/j.pmrj.2009.07.002
20. Calmels P, Mick G, Perrouin-Verbe B, Ventura M. Neuropathic pain in spinal cord injury: Identification, classification, evaluation. Ann Phys Rehabil Med. 2009;52(2):83-102.
21. Celik EC, Erhan B, Lakse E. The clinical characteristics of neuropathic pain in patients with spinal cord injury. Spinal Cord [Internet]. Nature Publishing Group; 2012 [consulta 24 oct 2016];50(8):585-9. Disponible en: http://www.ncbi.nlm.nih.gov/pubmed/22430511
22. Finnerup NB. Pain in patients with spinal cord injury. Pain [Internet]. International Association for the Study of Pain; 2013 [consulta26 oct 2016];154:S71-6. Disponible en: http://dx.doi.org/10.1016j.pain.2012.12.007
23. Mehta S, McIntyre A, Janzen S, Loh E, Teasell R. Systematic Review of Pharmacologic Treatments of Pain After Spinal Cord Injury: An Update. Arch Phys Med Rehabil. 2016; 97(8):1381-1391.
24. Cardenas DD, Emir B, Parsons B. Examining the Time to Therapeutic Effect of Pregabalin in Spinal Cord Injury Patients With Neuropathic Pain. Clin Ther [Internet]. Elsevier; 2015 [consulta 26 oct 2016];37(5):1081–90. Disponible en: http://dx.doi.org/10.1016/j.clinthera.2015.02.028
25. Attal N, Mazaltarine G, Perrouin-Verbe B, Albert T. Chronic neuropathic pain management in spinal cord injury patients. What is the efficacy of pharmacological treatments with a general mode of administration? (oral, transdermal, intravenous). Ann Phys Rehabil Med. 2009;52(2):124-41.
26. Guy S, Mehta S, Leff L, Teasell R, Loh E. Anticonvulsant medication use for the management of pain following spinal cord injury: systematic review and effectiveness analysis. Nature Publishing Group; 2013 [consulta 2 nov 2016];52(2):89-96. Disponibleen: http://dx.doi.org/10.1038/sc.2013.146
27. Mehta S, McIntyre A, Dijkers M, Loh E, Teasell RW. Gabapentinoids ar effective in decreasing neuropathic pain and other secondary outcomes after spinal cord injury: A meta-analysis. Arch Phys Med Rehabil [Internet]. Elsevier Ltd; 2014 [consulta 3 nov 2016];95(11):2180-6. Disponible en: http://dx.doi.org/10.1016/j.apmr.2014.06.010
28. Cardenas DD, Nieshoff EC, Suda K, Goto S, Sanin L, Kaneko T et al. A randomized trial of pregabalin in patients with neuropathic pain due to spinal cord injury. Neurology [Internet]. 2013 [consulta 5 nov 2016];80(6):533.9. Disponible en: http://ovidsp.ovid.comovidweb.cgi?T=JS&PAGE=
reference&D=emed11&NEWS=N&AN=2013103213
29. Rintala DH, Holmes SA, Courtade D, Fiess RN, Tastard LV, Loubser PG. Comparison of the Effectiveness of Amitriptyline and Gabapentin on Chronic Neuropathic Pain in Persons With Spinal Cord Injury. Arch Phys Med Rehabil. 2007;88(12):1547.60.
30. Salinas FA, Lugo LH, García HI. Efficacy of Early Treatment with Carbamazepine in Prevention of Neuropathic Pain in Patients with Spinal Cord Injury. Am J Phys Med Rehabil. 2012;91(12):1020-7.
31. Vranken JH, Hollmann MW, Van Der Vegt MH, Kruis MR, Heesen M, Vos K, et al. Duloxetine in patients with central neuro
Cómo citar
1.
Yañez Diaz PA, Gómez Guevara MC, Hoyos Gutierrez JB. Una mirada actualizada del enfoque y tratamiento del dolor neuropático crónico en el paciente con lesión medular. Rev. Colomb. Med. Fis. Rehabil. [Internet]. 28 de noviembre de 2017 [citado 20 de abril de 2024];27(1):68-82. Disponible en: https://revistacmfr.org/index.php/rcmfr/article/view/176
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2017-11-28
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