Dolor. Dolor nociceptivo. Dolor neuropático. Neuroestimulación. Perfusor implantable R. Galvez Mateoscoordinador Abordaje actual del dolor neuropático. El dolor neuropático puede empeorar en ausencia de tratamiento. Se denomina ‘dolor nociceptivo’ al dolor que todos conocemos producto. La presentación a través de los estados del dolor varía Dolor neuropático Dolor iniciado 3 Dolor nociceptivo El dolor nociceptivo es una respuesta fisiológica.
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Los botones se encuentran debajo. The key talking points on this slide are as follows: Due to the prevalence and characteristics of PHN and DPN, these states may be considered representative of peripheral neuropathic pain. Nociceptive pain is an appropriate physiologic response that occurs when specific peripheral sensory neurons nociceptors respond to noxious stimuli.
Nociceptive pain has a protective role because it elicits reflex and behavioral responses that keep tissue damage to a minimum.
Acute pain, such as that seen with tissue inflammation and chronic pain, such that accompanying osteoarthritis, are examples of nociceptive pain. There are cases in which an individual experiences pain sensations that are a blend of pain having a nociceptive and a neuropathic origin.
For example, in carpal tunnel syndrome, it is common experience to have nociceptive pain, felt around the wrist, and neuropathic pain, felt in the distribution territory of the median nerve fingers. References International Association for the Study of Pain. Harcourt Publishers Limited ; Additional key words: International Association for the Study of Pain. The receptor of peripheral nociceptors may be activated by noxious mechanical, thermal heat and cold or chemical stimuli.
Pain impulses are then transmitted along sensory axons, contained in peripheral nerves and dorsal roots, to the dorsal horn. In the superficial layers of the dorsal horn they make synaptic connection with second-order neurons that transmit the impulses through the spinal cord to the brain ascending transmission pathway.
In the brain, the thalamus and certain specific cortical areas are critical for the sensory and emotional experience of pain. Transmission and processing of pain impulses is also modulated by descending inhibitory and segmental controls. Principles of Anatomy and Physiology. Patients with neuropathic pain have chronic pain, which is typically considered to be pain that persists beyond the normal time of healing or for more than months.
This slide lists some of the most commonly encountered peripheral and central causes of neuropathic pain. The key points on this slide are as follows: Any type of peripheral nerve or root injury may lead to neuropathic pain: Metabolic disturbances may also cause neuropathies associated with neuropathic pain, most notably diabetes mellitus but also uremia and hypothyroidism.
Infections such as HIV may also result in peripheral nerve damage. Toxins implicated in peripheral nerve injury include chemotherapeutic agents, lead, organophosphorates and alcohol.
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Glue sniffing has also been associated with neuropathic pain from peripheral neuropathy. Vascular disorders polyarteritis nodosa, lupus erythematosusnutritional deficiencies niacin, thiamine, pyridoxineand direct effects of cancer due to metastases and infiltration may also cause peripheral neuropathies leading to neuropathic pain.
Spinal cord lesions and tumors are also known, common causes of central neuropathic pain. A clinical guide to neuropathic pain. Woolf CJ et al.
One part of the nocideptivo included random digit dialing to 14, people who were asked a series of questions about pain and medical diagnoses they had received. Any person who did not have a formal diagnosis of neuropathic pain, but who had features consistent with neuropathic pain, was reviewed by an expert to confirm the presence of absence of neuropathic pain. This suggests that approximately 1 in 15 adults are experiencing neuropathic pain of some description at any given time.
Neuropagico results of the Neuropathic Pain Patient Flow Survey suggest that the global prevalence of neuropathic pain may be under-estimated in the literature. References Data on file, Pfizer Inc. J Pain Symptom Manage. Neuropathic Pain Patient Flow Survey.
Neuropathic pain neuropstico prevalent among patients with diabetes and following herpes zoster infection shingles.
Am J Hosp Palliat Care. S Additional key words: Spontaneous pain is the most frequent symptom in all painful neuropathies and presents with a burning quality, localized superficially, or electric shock-like pain for several seconds.
Paresthesias are abnormal nociceptvio that are not unpleasant, such as tingling.
Symptoms of stimulus-evoked pain can be described according to the nature of the provoking stimulus, i. Allodynia is a painful response to a stimulus that is not normally painful. Hyperalgesia is a heightened response to a stimulus that would normally evoke pain. Hyperpathia is a painful syndrome characterized by an abnormally delayed painful reaction to a stimulus, especially a repetitive stimulus.
Merskey H et al. Classification of Chronic Pain: The survey used both qualitative research in-depth interviews with patients and physicians and focus groups and quantitative research interviews and case reviews with pain clinicians and patient questionnaires to assess issues relating to the management of neuropathic pain.
Patients with neuropathic pain were asked how they would describe their pain. Patients with neuropathic pain described their pain in a wide variety of ways. References Data on file.
As part of the survey, patients with neuropathic pain provided responses about what type of doctor they first visited for their pain and what type of doctor was responsible for managing their pain at the time of the survey.
GPs play a key role in the diagnosis and management of neuropathic pain. GPs admit to neurpoatico it difficult to recognize neuropathic pain. There is a clear need for enhanced education of GPs and other non-pain specialists to improve the recognition and diagnosis of neuropathic pain. Neuropathic Pain Patient Flow Survey 2. The survey was conducted in subjects with painful neuropathic conditions recruited by general practitioners and non-pain specialists in 6 European countries France, Germany, Italy, The Netherlands, Spain and the UK.
In total, patients provided responses on the duration of their neuropathic pain. Physicians recruited patients as they presented for a doolor clinic scheduled visit. Patients must have experienced neuropathic pain due to one of 10 study-defined neuropathic pain conditions in the previous 7 days. Patients with low back pain were excluded from the survey to ensure nlciceptivo only those patients with clearly defined neuropathic pain were included. Equal numbers of men and women were recruited.
This survey confirmed that individuals with neuropathic pain often suffer for long periods of time. Reference Data neuropatuco file. The inter-relationship between these three factors, as dolorr on this slide, is complex, but must be considered carefully if treatment for neuropathic pain is to be satisfactory. Although most pain disorders begin with injury or disease, their course and outcome are affected by emotional, behavioral and social factors.
Chronic pain significantly interferes with sleep, with most studies showing a positive correlation between pain intensity and degree of sleep disturbance. Many chronic pain patients have signs and symptoms of depression and anxiety; sleep nkciceptivo can lead to anxiety, and depression can be both the cause and result of sleep deprivation. Physicians must evaluate all aspects of pain, sleep and mood in patients with chronic pain.
Management and treatment should address both the pain and the comorbidities, to improve nociceptiv functioning, and enhance quality of life. Reference Nicholson and Verma. S9-S27 Additional key words: Patients were recruited from 2 multidisciplinary pain clinics in Sweden.
This slide shows the proportions of patients who rated their discomfort as 4 moderate to 7 very severe. Data on 7 of the 10 most frequently reported comorbid symptoms are shown on the slide. A lack of energy, drowsiness, and difficulty in concentrating, were also troubling for many individuals.
Reference Meyer-Rosberg et al. In the study by Fishbain et al,1 chronic pain patients who were admitted consecutively to a pain center were evaluated using DSM-III criteria. Both anxiety and depression are common comorbidities in patients with chronic pain. Schedule for affective disorders and schizophrenia — Lifetime version References Fishbain et al. Fishbain DA et al. Krishnan KR et al. Response categories ranged from 0 did not interfere nocicepgivo 10 completely interfered.
This slide reflects domains for which interference in function was substantial i. In this survey, the average age of respondents was 63 years; first onset of neuropathic pain was at the mean age of 57 years.
Over half the patients reported substantial impairment in social and recreational activities, enjoyment of life, mobility and being able to work normally. The results of this survey demonstrate that DPN has a definite and measurable negative impact on patient quality of life. Reference Galer et al. Diabetes Res Clin Pract. Diabetes Res Clin Prac ; Patients with low back pain were excluded from the survey to ensure that only those patients with clearly defined pain were included.
As part of this survey, employed individuals were asked if they had reduced productivity at work during the previous 4 weeks. In addition to reporting reduced productivity at work, participants had also missed an average of 5. This survey has confirmed that the indirect costs associated with neuropathic pain in terms of lost work productivity are substantial.
European Survey in Painful Neuropathic Disorders. In summary, neuropathic pain represents a healthcare challenge. Its complex etiology and variable symptomatology make neuropathic pain difficult to diagnose, especially for GPs. The pain associated with the condition is often severe, and many patients experience debilitating pain despite receiving treatment.
The severity and chronic nature of neuropathic pain have an important impact on the well-being of sufferers; many patients experience sleep disturbances and functional impairments, and many have comorbid anxiety and depression.