Abordaje inicial del paciente y criterios para remitirlo a la clínica del dolor

31 páginasTabla de contenido : Escalera analgésica de la OMS -- Escalas unidimensionales para valorar la intensidad del dolor -- Escalas multidimensionales para valoración del dolor -- Un nuevo enfoque del tratamiento del dolor basado en la evidencia científica: analgesia multimodal en dolor posquirúrgico -- Recomendaciones basadas en protocolos para la recuperación optimizada después de la cirugía (eras) -- Recomendaciones para el manejo del dolor quirúrgico en cirugía de tórax basadas en la evidencia -- Usos de gabapentinoides en el control y prevención del dolor -- Conductas y acciones que se deben evitar -- Conductas y acciones que se deben fomentar ¿cuándo solicitar interconsulta a clínica del dolor? -- Criterios para remitir un paciente desde primer nivel de atención a la clínica del dolor -- Posibles escenarios -- Titulación con morfina para dolor moderado a severo (eva > 4-10) en paciente adulto no oncológico -- Titulación con morfina en paciente oncológico -- Ratios de conversión de opioides -- Mecanismo de acción, indicaciones y contraindicaciones de los principales medicamentos usados en el tratamiento del dolor

Pain Management Strategies in Rheumatoid Arthritis: A Narrative Review

9 páginasRheumatoid Arthritis (RA) is a systemic autoimmune disease characterized by chronic inflammation and progressive deterioration of the joints, which generates pain and stiffness. The origin of this pain is multifactorial, with inflammation, secondary osteoarthritis, as well as central and peripheral sensitization playing important roles in the development. Up to 90.4% of RA patients visit a health professional for severe pain, and despite new therapies and sophisticated treatments, there are a limited number of options for analgesic management. We conducted a narrative review using the Medline and Pubmed search engines for articles in English and Spanish between 2000 and 2021, with the keywords “pain,” “rheumatoid arthritis,” “non-steroidal anti-inflammatory drugs” (NSAIDs), “opioids,” “glucocorticoids,” “disease modifying antirheumatic drugs” (DMARDs), “neuromodulators,” “antidepressants,” and “cannabinoids.” The articles describing epidemiology, pathophysiological considerations and current treatments were selected after a screening process carried out by the authors. It was found that DMARDs are the fundamental basis of treatment, since the main mechanism of pain in this entity is inflammation. Nonetheless, a significant number of patients continue to have pain despite optimal treatment. The available evidence for pain management in RA is scarce, however, medications such as NSAIDs, topical capsaicin, weak opioids, and treatments such as joint infiltrations or surgical management, play an important role in its management. We believe more research efforts are needed to optimize analgesic treatment recommendations, however, based on the current existing evidence, we propose a stepwise algorithm in order to properly approach these cases