Clase 2 - Dolor Crónico

7/23/2019 Clase 2 - Dolor Crnico

1/17

CLASE 2 DOLOR CRNICO

DRA. TRINIDAD MARIQUEO | FARMACOLOGA CLNICA 2015 | MEDICINA

FISIOPATOLOGA DEL DOLOR CRNICOLa defnicingenrica e! "!"r #eg$n !a a#"ciaci%n in&ernaci"na! 'ara e! e#&(i" e! "!"r)IA*+, e#- e'eriencia #en#"ria! / e"ci"na! e#agraa!e a#"ciaa a a3" &i#(!ar ei#&en&e "'"&encia! " e#cri&a en &rin"# e e#e a3".

E! "!"r &iene (n c"'"nen&e n"cice'&i4" (e e# objetivo e! c(a! #e '(ee e4a!(ar eian&e&cnica# e n"cie&r6a '(ien" e&erinar en can&ia c(7n&" "!"r #ien&e (na 'er#"na " (nania! e e'erien&aci%n e ac(er" a cier&a# re#'(e#&a# 8ren&e a (n e#&6(!" "!"r"#" / (nc"'"nen&e eocion!"(e e# #(9e&i4" / (/ re!aci"na" c"n !a# e'eriencia# e 4ia (e :a&eni" (n ini4i(" a !" !arg" e #( ei#&encia / c"n !a c(!&(ra en e! c(a! e#&7 in#er&".

Cmo sera una vida sin dolor? Ei#&en 'er#"na# (e &ienen (&aci"ne# en !"# cana!e# e

#"i" !a# c(a!e# #e :a "#er4a" (e 're#en&an i#&in&a# an"a!6a# en !a 'erce'ci%n e! "!"ren "ne e'enien" e !a (&aci%n &enre"# (n e8ec&" e&erina" '"r e9e'!"(&aci"ne# en !"# cana!e# e #"i" e &i'" 1.; !"# c(a!e# #"n i'"r&an&e# 'ara !a e'"!ari#i"!"g6a e! arc"re=e9" e#&e n"# 4a a 'eri&ir &ener (na re#'(e#&a 8ren&e a e#&6(!"# (e '(ie#en #er a3in"#'ara e! "rgani#" en "ne &"a e#a re#'(e#&a )e inte&%! ! nive" de "! *d'"! e)(in!" . Enic:" circ(i&" :a/ &re# ne(r"na# (e #"n i'"r&an&e#+ "! ne'%on! !,e%ente !a inte%ne'%on!/!a ne'%on! e,e%ente. La ne(r"na a8eren&e e# e! n"cice'&"r (e !"# '"e"# enc"n&rar en !a#('er>cie e !a 'ie! '"r e9e'!" &enien" !a ca'acia e cen#ar e! a3" en e! &e9i". ?#&ane(r"na &iene (n c(er'" ce!(!ar e! c(a! e#&7 a! in&eri"r e !"# gang!i"# e! a#&a "r#a! e! (e a #(4e< 'r"/ec&a :acia e! :a#&a "r#a! e !a (!a e#'ina! 'rinci'a!en&e a !a# !7ina# I / II en"ne :acen c"nei%n c"n in&erne(r"na# !a# c(a!e# #"n !a# (e !ieran !"# ne'%ot%!n)i)o%e)de ti(o in-ibito%io'rinci'a!en&e c"" GA@A / g!icina / a #( 4e< &iene c"nei%n c"n !a 'ar&e4en&ra! e !a e(!a e#'ina! !a c(a! e#&7 re!aci"naa c"n !a re#'(e#&a "&"ra.

+7gina .e ./


2/17



CLASIFICACINDELDOLOR

Do"o% C%nico- +er#i#&e '"r 7# e &re# e#e# / !a #(a&"ria e !"# c"'"nen&e# (e an"rigen a! "!"r cr%nic" #"n a!ree"r e 20 'er" #i n"# '"ne"# en !a #i&(aci%n e (e &""#&ene"# (na gen&ica i#&in&a / '"r ene ca'aciae# i#&in&a# e re#'"ner a! "!"r / n" &an

#"!" '"r e! c"'"nen&e gen&ic" #in" (e ae7# '"r c%" :e"# a'reni" a #en&ir e! "!"r'(ee (e &enga"# (n" e e#"# c"'"nen&e# (e e#& eacera" / :aga (e &enga"# (n"!"r e 7# e &re# e#e# #i&(aci%n en !a c(a! an" (n 87rac" #e '"r6a re4er&ir e! "!"r /a(n #ien" e 7# e &re# e#e# n" #er6a cr%nic". E# '"r !" c(a! en e#&"# "en&"# ei#&e (nae#'ecie e i#/(n&i4a en&r" e !a c"(nia cien&6>ca a! &ra&ar e en&ener '"r ( :a/'er#"na# (e 'a#an !a arrera e "!"r ag(" a "!"r cr%nic".

E# c"n e! arg(en&" an&eri"r (e 'ara !a 'r"8e#"ra !a e>nici%n (e ice (e e! "!"r cr%nic" e#e! (e 'eranece '"r 7# e &re# e#e# #e (ea c"r&a / e# (/ 7#ica #in aarcar c(a!e# #"n!"# ecani#"# (e e#&7n re!aci"na"# c"n e! 'a#" e "!"r ag(" a cr%nic".

Ei#&en 4aria# e>nici"ne# (e e'enen e ( &i'" e e#'ecia!ia &iene e! 'r"8e#i"na! (ien!a a 'er" en genera! e! "!"r n"cice'&i4" (e n" e# 'a&"!%gic" !" i4ien en "!"r in=aa&"ri" /"!"r ne(r"'7&ic".

Do"o% Nocice(tivo- N" 'a&"!%gic". *e a en re#'(e#&a a! a3". Do"o% In0!to%io- E're#i%n e ci&"(ina# 'r"in=aa&"ria# !a# (e an&ienen e#&a

in=aaci%n / !a 4(e!4en 'er#i#&en&e. Do"o% Ne'%o(1tico- Da3" e! ner4i" " e! *NC. E# (n "!"r an"ra!en&e an&eni" en e!

&ie'".

+7gina 2e ./


3/17


DRA. TRINIDAD MARIQUEO | FARMACOLOGA CLNICA 2015 | MEDICINAE# i'"r&an&e &ener en c(en&a (e a 'e#are (e #e c!a#i>(en en i8eren&e# &i'"# e"!"r e#&"# n" #e #e'aran '(e#&" (e !"#e4en&"# "c(rren c"n9(n&aen&e. T""#e#&"# ecani#"# !ct!n !" i)o

tie(o.

An&e (n e#&6(!" e a3" #e generanci&"(ina# 'r"in=aa&"ria# (e ac&i4an !"#n"cice'&"re# (e 'r"(ce (na "ibe%!cin!ntid%ic! '"r 'ar&e e! i#"n"cice'&"r e# ecir !a i#a ne(r"na!iera ''&i"# (e #"n 'r"in=aa&"ri"#.En&"nce#-

P%ie% Evento- Ac&i4aci%n e !a# c!(!a# 'r"in=aa&"ria# (e re#'"nen an&e e! a3".

Se&'ndo Evento- Ac&i4aci%n e !a# Fira# C )'rinci'a!e# ne(r"na# c"n(c&"ra# e! "!"r,(e c"ien


4/17


DRA. TRINIDAD MARIQUEO | FARMACOLOGA CLNICA 2015 | MEDICINAi#in(/en !a re#'(e#&a in:ii&"ria 4"!4ien" :i'ereci&a!e a &"" e! #i#&ea. A#6e e#&a 8"ra e#a #"ree#&i(!aci%n 'r"(ce e! 'a#" e "!"r ag(" a "!"r cr%nic".

La !ieraci%n e 8ac&"re# 'r"in=aa&"ri"# e#e e! n"cice'&"r #e en"ina in0!!cinne'%o&*nic!8

SENSI9ILI:ACIN

Tene"# (na gran can&ia e rece'&"re# (e e#&7n #ien" ac&i4a"# '"r 8ac&"re# 'r"in=aa&"ri"# !iera"# en re#'(e#&a a (na3" 'eri8ric" a e#&" #e !e !!aa)en)ibi"i;!cin (e%i,*%ic! 'er" &ainei#&e (na )en)ibi"i;!cin #i"!%gic",.

+7gina >e ./


5/17


DRA. TRINIDAD MARIQUEO | FARMACOLOGA CLNICA 2015 | MEDICINAA ni4e! e !a e(!a e#'ina! !a re"e!aci%n #een"ina in('. De! i#" "" e! @DN+in&eracci"na c"n #(# rece'&"re# (e a &ra4# e(na #erie e ca#caa# 'r"(cen !a !ieraci%n eca!ci" in&race!(!ar / 46a# e #e3a!i


6/17



En !a iagen #e "#er4a (na c"rrien&e e&i'" eci&a&"ri" / #e e4iencia (e c(an":a/ (n a(en&" en !a !ieraci%n ene(r"&ran#i#"re# e &i'" eci&a&"ri" !ac"rrien&e #(e 7# e! "!e / e#&"e"#&rar6a :i'ereci&ai!ia eiaa '"ra(en&" en !a !ieraci%n e g!(&aa&" '"re9e'!".

+7gina e ./


7/17


DRA. TRINIDAD MARIQUEO | FARMACOLOGA CLNICA 2015 | MEDICINA !" i#" "c(rre c"n !a# c"rrien&e#c(an" #"n e &i'" in:ii&"ria#. A:"ra :a/en"# in:iici%n '"r(e i#in(/e e! 'a#" ec"rrien&e a &ra4# e e#&"# rece'&"re# '"r'ria e! e8ec&" e !"# NT in:ii&"ri"#. +"r

e9e'!" a &ra4# e 'r"#&ag!anina# #e in:ien!"# cana!e# e g!icina e# ecir 'a#an 7#&ie'" cerra"# / !a c"rrien&e (e 'a#a e# '"ca.

DOLORCRNICO

E! "!"r cr%nic" e# a(e! (e (ra 1) de 7 e)e) / (e /a n" c('!e c"n (na 8(nci%n ea!er&a #in" (e c"n#&i&(/e (na 'a&"!"g6a '"r #6 i#". E! 'araiga ac&(a! #e a '"r(e :a/'acien&e# re8rac&ari"# a! &ra&aien&" 8arac"!%gic" ac&(a! " #ea e# c"'!e9" '"r(e c"n ei#" &ra&aien&" :a/ 'er#"na# (e re#'"nen (/ ien / '(een #eg(ir c"n #( 4ia iaria /"&ra# (e n" re#'"nen a! i#" &ra&aien&".

@IPTESISDELDOLORCRNICO

Una e !a# :i'%&e#i# e '"r( #e 'r"(ce "!"r cr%nic" e#&7 re!aci"naa c"n !a ac&i4aci%n e!a# &"!) e :ec:" en !a (!a e#'ina! cerca e! 0H e !a# c!(!a# #"n g!6a# / e! re#&"ne(r"na# en&"nce# c('!en (n r"! (/ i'"r&an&e en i4er#a# 'a&"!"g6a#. La ac&i4aci%n e !a#g!6a# 'a#a '"r !a !ieraci%n e (ii"(ina# c"" !a CCL2 !a c(a! in:ie !"# rece'&"re# eg!icina. a #( 4e< !ieran TNF (e e# (na ci&"(ina 'r"in8!aa&"ria (e ac&i4a a#&r"ci&"# / &""e#&e circ(i&" #e ac&i4a.

+7gina /e ./


8/17



En e! e#(ea #e 4e (na in(n"=("re#cencia e a#&r"ci&"# e (!a e#'ina! (e e#&7n ene#&a" (ie#cen&e# en "!"r ag(" / (e c(an" #e ac&i4an caian #( "r8"!"g6a. &"a# e#a#46a# e#&7n re!aci"naa# c"n e! 'a#" e "!"r ag(" a "!"r cr%nic" / "c(rren 'ara!e!aen&e )en!a ia'" a'arece (n e#(ea r(&a! n" :a/ (e a'renr#e!" #"!" &ener en c(en&a (e #"n'ara!e!"#,.

DOLORNE$ROPTICO

D"!"r (e "c(rre e anera e)(ont1ne! "ne !are#'(e#&a a e#&6(!"# in"c("# / n"cice'&i4"# #eenc(en&ra (!to"&ic!ente !("ifc!d!)e# ecir:i'er#en#ii!ia,. E#&" #e ee a (na a!&eraci%n e8(nci%n / e#&r(c&(ra e! #i#&ea #"a&"#en#"ria!8E#&e &i'" e "!"r re#(!&a e (na '!a#&iciaa!aa'&a&i4a e! #i#&ea e re#'(e#&a a! "!"r (na#erie e cai"# (e c"n#&i&(/en (n e#&a" een8erea ne(r"!%gica. Ca(#a" '"r an"ra!iae#8(nci"na!e# )a3" e&a%!ic", " e#&r(c&(ra!e# )a3"86#ic", e! #i#&ea ner4i"#" 'eri8ric" " cen&ra! / (e '(ee "c(rrir #in e#&i(!aci%n e

n"cice'&"re#.

Ei#&en i#&in&a# 8!)e) de" do"o% ne'%o(1tico. En !a iagen #e enci"nan !"# i#&in&"# &i'"# e"!"r ne(r"'7&ic" '"r e9e'!" #i &ene"# (n "!"r 'eri8ric" / e#&e (ra '"r 7# e &re#e#e# '"r6a"# &ener '"r e9e'!" ne(ra!gia e#'ina! en&re "&ra# / &"" e#&e &i'" e'a&"!"g6a# e#&7n a#"ciaa# a a3" 'eri8ric". Tain &ene"# "!"r ne(r"'7&ic" a#"cia" aa3" cen&ra!.

3ECANIS3OSDELDOLORNE$ROPTICO

+7gina e ./


9/17


DRA. TRINIDAD MARIQUEO | FARMACOLOGA CLNICA 2015 | MEDICINADen&r" e !"# 'rinci'a!e# ecani#"# re!aci"na"# c"n e! 'a#" e "!"r ag(" acr%nic" / 'rinci'a!en&e "!"r e &i'" ne(r"'7&ic" #e :a 'r"'(e#&" (e e#&7 re!aci"na" c"n!"te%!cione) de "!) v!) in-ibito%i!) en rece'&"re# e g!icina / GA@A a ni4e! e !a PAGH)')t!nci! &%i) (e%i!c'ed'ct!"J ? de" "oc') coe%'"e') a ni4e! #('rae#'ina!. A(n(e !"##i#&ea# e !"# gang!i"# cen&ra!e# e#&7n &"a46a 8(nci"nan" #(# e8ec&"# '"r6an ei!i&ar#e en

(n 'acien&e c"n "!"r ne(r"'7&ic". Tene"# a!&eraci"ne# e &i'" GA@Argica# / &ainG!icenrgica# en e! a#&a "r#a! )&ain :a/ GA@Argica# 'er" e# 'rinci'a!en&e e g!icina,.

Tain &ene"# e! #i#&ea e "'i"ie# en%gen"# (e c"n&ri(/e a !a #en#ii!ia an"ra!.

En e! e#(ea #e (e#&ra !" (e "c(rrec(an" :a/ a!&eraci"ne# a ni4e! e ne(r"na#e &i'" GA@Argica#. La# ne(r"na# in:ii&"ria#)GA@Argica, #e 4an 'erien" en e! 'a#" e"!"r ag(" a cr%nic" " #ea &ene"# (n#i#&ea (e e#&7 eci&an" a !a# ne(r"na##ec(naria# / n" e#&7 !a in:iici%n n"

#"!aen&e en !"# rece'&"re# #in" (e en !a#ne(r"na# (e :acen e rece'&"re#. Una e !a#&e"r6a# (e #e '!an&ea #"re '"r ( #e'r"(ce e#&e "!"r cr%nic" a#"cia" a !a# 46a#in:ii&"ria# e# "o) c!bio) en e" (otenci!de" c"o%'%o '"r(e ei#&e (n cana! (e e# eKCC2(e e# e! (e an&iene e! '"&encia! "

graien&e e c!"r(r" 'er" c(an" ei#&e !ieraci%n e @DNF '"r 'ar&e e !"# a#&r"ci&"# /icr"g!6a# e#&e re(ce !a e're#i%n e e#&"# cana!e#. En&"nce# (n rece'&"r e g!icina " eGA@A (e era (n rece'&"r (e 'eri&6a !a en&raa e c!"(r" /a n" 4a a &ener c!"r(r" '"r(e n"

4a a &ener e! &ran#'"r&a"r (e 'eri&e e#e graien&e " e#&7 (/ '"c" e're#a" en&"nce# !"(e 4a a #(ceer e# (e e! c!"r(r" 4a a #a!ir. Rec"re"# (e e! c!"r(r" e# :i'er'"!ari


10/17


DRA. TRINIDAD MARIQUEO | FARMACOLOGA CLNICA 2015 | MEDICINA F!%!cote%!(i!+Ei#&en 87rac"# n" "'i"ie# )'"r e9e'!" AINE*, "'i"ie# /

a!g(n"# ana!g#ic"# (e #"n a/(4an&e# c"" an&ie're#i4"# / an&ie'i!'&ic"# (e n" #e(#an c"" &a! en 'acien&e# c"n "!"r #in" (e #e (#an '"r(e #e :a 'r"a" (e e#&a#r"ga# :an '"i" re(cir " c"n&r"!ar e! "!"r cr%nic" 'er" n" #e (#an 'ara !" (e 8(er"ncrea"#. (Adyuvantes: Posible pregunta de prueba). L"# 'rinci'a!e# 87rac"# (e #e

(&i!i


11/17


DRA. TRINIDAD MARIQUEO | FARMACOLOGA CLNICA 2015 | MEDICINA Rece'&"re# ac"'!a"# a 'r"&e6na G

3ec!ni)o de Accin- Ac&$an 'rinci'a!en&e a ni4e! (%e )in1(ticoeian&e -i(e%(o"!%i;!cin edi!d! (o% c!n!"e) de K8 Ae7# )e&agaa, e# ca'a< e (nir#e a !"# c!n!"e) de C! (%e )in1(tico)

/ "(!ar!"# nega&i4aen&e e anera (e e#&"# cana!e# n" #e aran&an&" 'r"4"can" (e !a# 4e#6c(!a# (e &ienen '"&encia! e &i'" eci&a&"ri"e in:ii&"ri" n" #e !ieren &an 87ci!en&e e e#a 8"ra "c(rre (nain:iici%n. +"r !" &an&" :a/ 2 c"'"nen&e# en e! ecani#" e acci%n (n"re!aci"na" c"n !"# cana!e# e B / e! "&r" c"n !"# cana!e# e CaBB.

Tain :a/ (n c"'"nen&e (e &iene (e 4er c"n !a# 46a# e #e3a!inia '"r rece'&"re# MOR

Ana!ge#ia genera! en "!"re# e gran in&en#ia ag("# c""cr%nic"#

Carac&er6#&ica# 8arac"cin&ica#-

@a9a @D )150H,

Uni%n a 'r"&e6na# e J5H

Me&a"!i


12/17



E,ecto) !dve%)o)-

Re#'iraci%n- M"r>na ca(#a e're#i%n re#'ira&"ria a! re(cir #en#ii!ia e! cen&r"re#'ira&"ri" a! CO2.

C"n#&i'aci%n )'"r c"n#(" 'r"!"nga" e "r>na,.

Re=e9" e !a &"#- M"r>na / c"e6na &ienen 'r"'ieae# an&i&(#i4a#. De'rien re=e9" e !a &"#.

Mi"#i#- La '('i!a '(n&i8"re e# carac&er6#&ica e !"# (#(ari"# e "r>na. E#&e 87rac"e#&i(!a e! n$c!e" e eingere#&':a! (e ca(#a e#&i(!aci%n 'ara#i'7&ica.

Ee#i#- M"r>na e#&i(!a irec&aen&e !a


13/17



De#&acar (e !a "r>na e# (/ 4er#7&i! &iene 4aria# 46a# e aini#&raci%n. E! &raa"! / e!8en&ani!" &ain #"n a#&an&e (&i!i


14/17



En e! re#(en #e e#&aca !a F"'oetin!c"" e! 7# (&i!i


15/17



ANTIEPILQPTICOS

D"ne caa &i'" e e'i!e'#ia &iene (na8arac"!"g6a i#&in&a. Ei#&en do) ti(o)&%!nde) de !t!ca#. Ae7# '(ee :aer e#&6(!"# c"" !"# cai"# e!(ce# in&en#"# / r7'i"# en !a carre&era (e '(een generar en 'er#"na# (n a&a(e e'i!'&ic" "#ea e#&6(!"# 4i#(a!e# (e '(een ga&i!!ar !a #incr"ni


16/17


DRA. TRINIDAD MARIQUEO | FARMACOLOGA CLNICA 2015 | MEDICINA Nive" (%e)in1(tico+ Cana!e# e NaB / !"#

cana!e# e CaB2

Nive" (o)t)in1(tico+ Rece'&"re# e AM+A /NMDA

Caa !anc" &iene #( 87rac". +"r e9e'!" !a!a"&rigina ac&$a 'rinci'a!en&e a ni4e! '"#in7'&ic" / #e (&i!i


17/17


DRA. TRINIDAD MARIQUEO | FARMACOLOGA CLNICA 2015 | MEDICINAG!b!(entin!- @a9a a#"rci%n "ra! n" #e (ne a 'r"&e6na# a!&" 4"!(en ei#&ri(ci%n #in e&a"!i

Documents

Clase 2 - Dolor Crónico