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Farmacoterapia Para El Control Del Dolor: Pautas De Uso (2008)

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Farmacoterapia Para El Control Del Dolor: Pautas De Uso (2008) FARMACOTERAPIA PARA EL CONTROL DEL DOLOR.qxd:MANEJO OPIOIDES.qxd 2/9/09 12:38 Página 1 FARMACOTERAPIA PARA EL CONTROL DEL DOLOR: PAUTAS DE USO REUNIÓN DE EXPERTOS Salamanca 29 y 30 de Septiembre de 2008 Cátedra Extraordinaria del Dolor FUNDACIÓN GRÜNENTHAL Universidad de Salamanca 1 FARMACOTERAPIA PARA EL CONTROL DEL DOLOR.qxd:MANEJO OPIOIDES.qxd 2/9/09 12:38 Página 2 FARMACOTERAPIA PARA EL CONTROL DEL DOLOR: PAUTAS DE USO. REUNIÓN DE EXPERTOS Copyright: FUNDACIÓN GRÜNENTHAL Depósito Legal: M-37522-2009 Reservados todos los derechos. 2 FARMACOTERAPIA PARA EL CONTROL DEL DOLOR.qxd:MANEJO OPIOIDES.qxd 2/9/09 12:38 Página 3 FARMACOTERAPIA PARA EL CONTROL DEL DOLOR: PAUTAS DE USO REUNIÓN DE EXPERTOS Entidades Colaboradoras: Escuela Andaluza de Salud Pública Sociedad Española de Anestesiología Reanimación y Terapéutica del Dolor Sociedad Española de Cirugía Ortopédica y Traumatología Sociedad Española de Cirugía Vascular Sociedad Española del Dolor Sociedad Española de Farmacología Sociedad Española de Geriatría y Gerontología Sociedad Española de Oncología Médica Sociedad Española de Pediatría Sociedad Española de Reumatología Universidad de Salamanca Complejo Hospitalario de Salamanca Cátedra Extraordinaria del Dolor FUNDACIÓN GRÜNENTHAL Universidad de Salamanca 3 FARMACOTERAPIA PARA EL CONTROL DEL DOLOR.qxd:MANEJO OPIOIDES.qxd 2/9/09 12:38 Página 4 FARMACOTERAPIA PARA EL CONTROL DEL DOLOR: PAUTAS DE USO. REUNIÓN DE EXPERTOS 4 FARMACOTERAPIA PARA EL CONTROL DEL DOLOR.qxd:MANEJO OPIOIDES.qxd 2/9/09 12:38 Página 5 DIRECTOR Y COORDINADOR DEL CURSO DIRECTOR Y COORDINADOR DEL CURSO Clemente Muriel Villoria Catedrático de Anestesiología, Reanimación y Terapéutica del Dolor Hospital Clínico Universitario, Universidad de Salamanca Director de la Cátedra Extraordinaria del Dolor “FUNDACIÓN GRÜNENTHAL” Universidad de Salamanca 5 FARMACOTERAPIA PARA EL CONTROL DEL DOLOR.qxd:MANEJO OPIOIDES.qxd 2/9/09 12:38 Página 6 FARMACOTERAPIA PARA EL CONTROL DEL DOLOR: PAUTAS DE USO. REUNIÓN DE EXPERTOS 6 FARMACOTERAPIA PARA EL CONTROL DEL DOLOR.qxd:MANEJO OPIOIDES.qxd 2/9/09 12:38 Página 7 PARTICIPANTES PARTICIPANTES Prof. C. Muriel Villoria Director Cátedra Extraordinaria del Dolor “Fundación Grünenthal” Universidad de Salamanca Jefe del Servicio de Anestesiología, Reanimación y Terapéutica del Dolor. Hospital Clínico Universitario de Salamanca Dra. I. Sánchez Magro Fundación Grünenthal Dr. J. M. Recalde CADIME. Escuela Andaluza de Salud Pública. Granada Prof. M. Puig Prof. Titular de Anestesiología. Director de la Cátedra Extraordinaria de Dolor Universitat Autònoma de Barcelona Servicio de Anestesiología. Hospital del Mar. Barcelona Prof. J. A. Micó Catedrático y Director de Departamento de Neurociencias (Farmacología y Psiquiatría). Universidad de Cádiz Dr. J. L. de la Calle Unidad para el Estudio y Tratamiento del Dolor Hospital Ramón y Cajal. Madrid Dra. J. Usón Sección Reumatología. Hospital Universitario de Móstoles. Madrid 7 FARMACOTERAPIA PARA EL CONTROL DEL DOLOR.qxd:MANEJO OPIOIDES.qxd 2/9/09 12:38 Página 8 FARMACOTERAPIA PARA EL CONTROL DEL DOLOR: PAUTAS DE USO. REUNIÓN DE EXPERTOS Dra. M. V. Ribera Jefe de la Unidad de Dolor Hospital Universitario Vall d’Hebron. Barcelona Dr. C. Alegre de Miau Servicio Reumatología Hospital Universitario Vall d´Hebron. Barcelona. Institut Universitari Dexeus Dr. J. A. Virizuela Servicio Oncología Médica Hospital Virgen Macarena. Sevilla Dr. L. Sannorberto Hospital Universitario Salamanca Prof. Asociado Universidad de Salamanca Prof. F. Lozano Catedrático de Cirugía Vascular Universidad de Salamanca Dr. P. Gil Gregorio Jefe de Servicio de Geriatría Hospital Universitario San Carlos. Madrid Dr. F. Reinoso-Barbero Jefe Clínico de Anestesia Pediátrica Hospital Universitario La Paz. Madrid Dr. A. Camba Jefe de Servicio de Anestesiología Hospital El Ferrol. A Coruña Prof. R. González-Sarmiento Unidad de Medicina Molecular-Departamento de Medicina Universidad de Salamanca 8 FARMACOTERAPIA PARA EL CONTROL DEL DOLOR.qxd:MANEJO OPIOIDES.qxd 2/9/09 12:38 Página 9 SUMARIO SUMARIO SUMARIO................................................................................................................................. 9 PRÓLOGO................................................................................................................................ 11 EPIDEMIOLOGÍA DEL DOLOR ...................................................................................... 13 FARMACOLOGÍA DEL DOLOR: ANALGÉSICOS ....................................................... 19 FARMACOLOGÍA DEL DOLOR: COADYUVANTES ANALGÉSICOS .................... 27 SISTEMAS Y VÍAS PARA EL USO DE ANALGÉSICOS ............................................ 41 CONTROL FARMACOLÓGICO DEL DOLOR NOCICEPTIVO ................................ 51 CONTROL FARMACOLÓGICO DEL DOLOR NEUROPÁTICO .............................. 63 CONTROL FARMACOLÓGICO EN LA FIBROMIALGIA .......................................... 73 CONTROL FARMACOLÓGICO DEL DOLOR ONCOLÓGICO ................................. 77 CONTROL FARMACOLÓGICO DEL DOLOR POSTOPERATORIO ...................... 93 CONTROL FARMACOLÓGICO DEL DOLOR VASCULAR ....................................... 103 CONTROL FARMACOLÓGICO EN EL PACIENTE ANCIANO/PACIENTE CON PLURIPATOLOGÍA ......................................................... 109 CONTROL FARMACOLÓGICO EN LA EDAD PEDIÁTRICA .................................. 115 SITUACIÓN ACTUAL EN EL TRATAMIENTO DEL DOLOR SEGÚN LA ESCALERA DE LA OMS .............................................................................. 123 GENÉTICA Y FÁRMACOS ANALGÉSICOS .................................................................. 127 CONCLUSIONES .................................................................................................................. 135 9 FARMACOTERAPIA PARA EL CONTROL DEL DOLOR.qxd:MANEJO OPIOIDES.qxd 2/9/09 12:38 Página 10 FARMACOTERAPIA PARA EL CONTROL DEL DOLOR: PAUTAS DE USO. REUNIÓN DE EXPERTOS 10 FARMACOTERAPIA PARA EL CONTROL DEL DOLOR.qxd:MANEJO OPIOIDES.qxd 2/9/09 12:38 Página 11 PRÓLOGO PRÓLOGO Un aspecto que quisiera destacar es la gran oportunidad de trasladar a esta Monografía, un tema de tanto interés como es el de “FARMACOTERAPIA PARA EL CONTROL DEL DOLOR: PAUTAS DE USO en un momento en que están en primer plano diversos problemas referentes a la asistencia sanitaria del tratamiento del dolor visto como enfermedad. Se trata de una obra sacada de la VIII Reunión de Expertos donde se abordan prácticamente toda la temática más actual de esta parcela de la asistencia sanitaria. En los primeros capítulos se tratan una serie de temas conceptuales, básicos, que no suelen encontrarse en los tratados convencionales de medicina, ni siquiera en publicaciones más específicas de la temática que nos ocupa. Algo parecido puede decirse de la última parte de la obra, donde se exponen una serie de métodos tera- péuticos en función del agente causal, característicos de esta peculiar forma de ejer- cer la medicina en la asistencia diaria. Quiero insistir en estos aspectos, pues creo que van a constituir el sello de distinción de esta obra. Entre estos dos bloques se halla el grueso expositivo de las nuevas vías de admi- nistración, con especial énfasis en la vía transdérmica y espinal. Cada uno de los capí- tulos, está desarrollado con una gran sencillez, precisión y, al mismo tiempo, ampli- tud, para que ningún lector pueda sentir el desencanto de que algo falta. Hemos expuesto, también, numerosos esquemas y tablas de gran valor didáctico que pienso van a ayudar al estudioso a comprender mejor los temas. 11 FARMACOTERAPIA PARA EL CONTROL DEL DOLOR.qxd:MANEJO OPIOIDES.qxd 2/9/09 12:38 Página 12 FARMACOTERAPIA PARA EL CONTROL DEL DOLOR: PAUTAS DE USO. REUNIÓN DE EXPERTOS Finalmente debo expresar mi reconocimiento a los autores, amigos todos, muchos de ellos miembros destacados de la distintas Sociedades implicadas en el tratamien- to del Dolor, y de manera especial a la FUNDACIÓN GRÜNENTHAL, por el gran reto que mantienen de forma permanente hacia la formación en el estudio y tratamiento del dolor. Profesor Clemente Muriel Villoria Salamanca, 2009 12 FARMACOTERAPIA PARA EL CONTROL DEL DOLOR.qxd:MANEJO OPIOIDES.qxd 2/9/09 12:38 Página 13 EPIDEMIOLOGÍA DEL DOLOR EPIDEMIOLOGÍA DEL DOLOR Dr. José Mª Recalde Manrique CADIME. Escuela Andaluza de Salud Pública. Granada El dolor es un síntoma tan viejo como Entendiéndolo tanto como un proce- la propia humanidad y ha formado parte so sensorial, como emocional (es decir, inseparable de ésta, iniciándose la lucha fenómeno psíquico); situando al mismo contra él con la misma medicina. Es, por nivel las respuestas biológicas a los estí- tanto, una vivencia consustancial a la mulos nociceptivos, como el significado propia existencia del ser humano, inde- de estos estímulos para el individuo. pendiente de cualquier otro atributo o Esto supone entender el dolor como una condición de la persona: edad, sexo, experiencia de gran complejidad, subje- situación social o económica; incluso del tiva, individual e intransferible. momento histórico. Los estudios epidemiológicos permi- Sin embargo, es cuando intentamos ten establecer la dimensión de un pro- definirlo, cuando nos percibimos de la blema de salud y podrían ayudar al des- gran magnitud del fenómeno, de los arrollo de medidas específicas para su innumerables matices, connotaciones y solución. En los últimos veinte años aspectos que queremos transmitir con el diversos estudios han determinado la concepto de dolor. De esta dificultad en presencia de dolor en la población gene- encontrar
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