El dolor neuropático de tipo dolor central es un dolor por desaferenciación secundario a una lesión del sistema nervioso central: cerebro, tronco cerebral y. Durante muchos años, los fármacos antidepresivos se han utilizado para controlar el dolor neuropático y suelen ser el tratamiento de primera elección. manejo farmacológico del dolor neuropático. Pharmacological management of neuropathic Pain. Sandra Flórez MD*, Marta León MD**, Marcela Torres MSc.
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Recommendations for the treatment of neuropathic pain. Camba cA.
TRATAMIENTO FARMACOLOGICO DEL DOLOR NEUROPATICO
The introduction and development of new products with demonstrated efficacy in neuropathic pain has generated a clear need for an evidence based algorithm to treat nneuropatico different types of neuropathic pain. The present article aims to provide recommendations on the treatment of neuropathic pain supported by the scientific evidence and agreed on by consensus by a multidisciplinary group of experts in methodology and pain management.
The evidence was obtained from meta-analyses including the greatest amount of information available for each type of neuropathic pain. The literature search was performed by 5 reviewers, who focussed individually on the distinct forms of presentation of neuropathic pain.
Meta-analyses and randomized, controlled clinical trials were selected. Finally, retrieved articles were evaluated and clinical recommendations for the treatment of neuropathic pain were designed by the pain specialists. For some types of neuropathic pain, there is insufficient information. In these types of pain, recommendations based on scientific publications without evidence were included to provide the greatest possible amount of information on their treatment.
Studies of safety and efficacy in postherpetic neuralgia PHNpainful diabetic neuropathy PDNand trigeminal neuralgia TN were reviewed as paradigms of peripheral neuropathic pain. The scarce available information on central neuropathic pain CNP and sympathetic pain SP was also gathered. Based on the results obtained with this literature review and the evidence extracted, a decision algorithm was designed with the drugs currently available in the Spanish pharmacopeia for PHN and PDN, and separate decision algorithms were designed for TN and finally for CNP and SP.
These recommendations take into account the treatments that should be used initially – first line treatments – and subsequently the alternatives are outlined in order of preference, based on daily clinical practice according to the consensus of the pain specialists. Peripheral neuropathic pain; Central neuropathic pain; Diabetic neuropathy; Postherpetic neuralgia; Trigeminal neuralgia; Central pain; Therapeutic algorithm; Meta-analysis. Es por ello que hay una clara necesidad de tener un algoritmo basado en la evidencia para tratar las diferentes condiciones del DN.
Estudios de eficacia y seguridad. El dolor en la NDD se percibe como el resultado de la suma de 2 percepciones: La NT se puede dividir a su vez en: La NT presenta una incidencia anual de 4,5 por cada La NT se puede dividir a su vez, en: La tabla 7 muestra los resultados de los estudios seleccionados. La oxcarbacepina tiene un menor nivel de evidencia que la carbamacepina. El baclofen y la lamotrigina tienen un nivel de evidencia C. Para ello, es conveniente que estos pacientes sean derivados a centros especializados en este tipo de tratamiento unidades de tratamiento del dolor.
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