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TRATAMIENTO FARMACOLOGICO DEL DOLOR NEUROPATICO

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Si bien existen muy pocas drogas aprobadas para el tratamiento del dolor neuropático, diversos agentes poseen actividad analgésica y pueden resultar útiles en este trastorno.
mcclane9.jpg Autor:
Gary Mccleane
Columnista Experto de SIIC

Institución:
Consultant in Pain Management Rampark Pain Center

Artículos publicados por Gary Mccleane
Recepción del artículo
8 de Abril, 2005 		Aprobación
26 de Abril, 2005
Primera edición
3 de Noviembre, 2005 		Segunda edición, ampliada y corregida
7 de Junio, 2021

TRATAMIENTO FARMACOLOGICO DEL DOLOR NEUROPATICO

Resumen
En condiciones normales, en el sistema nervioso existe equilibrio entre los estímulos inhibitorios y excitatorios. Este equilibrio puede verse afectado si el tejido nervioso se daña o irrita, lo que puede originar dolor neuropático. Dicho dolor no responde consecuentemente a los analgésicos opioides o a los antiinflamatorios no esteroides y puede ser necesario el empleo de otros agentes terapéuticos con actividad conocida sobre las vías inhibitorias y excitatorias del dolor. Estos otros agentes se consideran, tradicionalmente, en referencia a su empleo original. Con respecto a los opioides, el creciente número de datos apunta a un efecto analgésico en el dolor neuropático, aunque las preocupaciones acerca de su tolerancia y dependencia aún impiden su uso más extendido. Los anticonvulsivos comprenden un grupo de compuestos que poseen propiedades analgésicas y anticonvulsivas, pero cada uno posee mecanismos de acción diferentes y por ello diversos miembros de esta clase deberían probarse antes de arribar a la conclusión de que, en conjunto, no resultan efectivos. Los antidepresivos tricíclicos también pueden desempeñar un papel en el tratamiento de este tipo de dolor. Los miembros de este grupo que se aplican por vía tópica pueden también tener un papel para la terapéutica cuando el área dolorosa es pequeña. Otras opciones, como los inhibidores selectivos de la recaptación de serotonina, estabilizadores de membranas, capsaicina, baclofeno y clonidina pueden tener potencial para el tratamiento del dolor de origen neuropático.

Palabras clave
Dolor neuropático, drogas antiepilépticas, antidepresivos tricíclicos, opioides


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PHARMACOLOGICAL MANAGEMENT OF NEUROPATHIC PAIN

Abstract
In health, the nervous system exists in a balance between inhibitory and excitatory influences. This balance may be upset if neural tissue is damaged or irritated and may give rise to neuropathic pain. Such neuropathic pain does not respond consistently to opioid analgesics or NSAIDs and it may be necessary to utilize other therapeutic agents with known activity on either the excitatory or inhibitory components of the pain pathway. These other agents are traditionally considered with reference to their original uses. With respect to the opioids, increasing evidence points to an analgesic effect in neuropathic pain, although concerns regarding tolerance and dependence still prevent more widespread use. The anticonvulsants comprise a group of compounds possessing anticonvulsant and analgesic properties, but each possesses differing modes of action and so several members of the class should be tried before a conclusion is reached that they, as a whole, are ineffective. TCAs may also have a role in the treatment of neuropathic pain. Topical TCAs may also have a role where the area of neuropathic pain is small. Other options, such as SSRIs, membrane stabilizers, capsaicin, baclofen and clonidine may have potential in treating neuropathic pain.

Key words
Neuropathic pain, antiepileptic drugs, tricyclic antidepressants, opioids


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Especialidades
Principal: Neurología
Relacionadas: Anestesiología, Farmacología, Medicina Farmacéutica, Medicina Interna



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