A carregar...
Publicação
A dor neuropática em doentes oncológicos
| Nome: | Descrição: | Tamanho: | Formato: | |
|---|---|---|---|---|
| 352.75 KB | Adobe PDF |
Autores
Orientador(es)
Resumo(s)
A dor é um problema frequente entre a população oncológica, impondo-se, neste âmbito, como um verdadeiro desafio terapêutico. A dor neuropática, em particular, destaca-se pela sua não rara resistência à analgesia convencional. A miríade de factores promotores e moduladores que fundamentam a génese de uma dor neuropática parecem constituir a base da heterogeneidade verificada.
Embora a sua real prevalência seja desconhecida, estima-se que pelo menos 15-20% dos doentes venha a experienciar dor neuropática ao longo do curso da sua doença, com prevalências mais elevadas em estadios avançados.
Adicionalmente, é frequentemente identificada uma relação de causalidade bidireccional, surgindo a dor como consequência de determinadas terapêuticas anti-neoplásicas instituidas. É ainda importante sublinhar a provável subestimação dos números apresentados dada a ausência de uniformidade nos sistemas de caracterização usados na definição de dor neuropática.
As dificuldades inerentes ao seu reconhecimento e alívio são os motivos pelos quais se considera pertinente rever o papel do clínico e o nível de evidência associada aos algoritmos disponíveis para a caraterização e manejo da dor neuropática em Oncologia. O conhecimento da eficácia, segurança e tolerabilidade dos fármacos mais utilizados neste âmbito relevam-se determinantes numa população fragilizada e polimedicada. As terapêuticas de segunda e terceira linha constituem um recurso válido, reforçado não pela robustez quantitativa dos dados, mas pela marcada variação interpessoal nas respostas. A necessidade de alívio satisfatório da dor neuropática prende-se com o marcado impacto na qualidade de vida dos doentes, repercutindo-se, por acréscimo, na gestão psicológica de uma doença de base tendencialmente consumptiva.
Pain is a frequent problem among cancer patients, emerging, within this scope, as an utmost challenge. Neuropathic pain, in particular, stands out for its rather common resistance to conventional analgesic therapies. The observed heterogeneity is acceptably explained by the great array of promoters and modulating factors associated to its genesis. Although its real prevalence is unknown, it is predicted that 15-20% of patients are likely to suffer from neuropathic pain during the course of the disease, and an even higher proportion at advanced stages of the disease. Moreover, it is frequently identified a bi-directional causal relationship, as certain anti-cancer therapies are implicated in the origin of the pain. These numbers are considered underestimated as there is an acknowledged lack of standardization of methods applied when its identification is attempted. The relevance of reviewing the physician’s role and the current related algorithm’s evidence level is sustained by the difficulties associated to its recognition and relief. The knowledge of the efficacy, safety and tolerability profiles concerning the most applied therapies is especially import when taking into account a fragile population, frequently on multidrug regimens. Second and third-line therapies are a valid resource considering the variety of individual responses. The necessity of a satisfactory relief is related to the significance of a neuropathic pain’s impact in a patient’s quality of life which, in turn, reflects itself in the psychological management of a potentially consumptive disease.
Pain is a frequent problem among cancer patients, emerging, within this scope, as an utmost challenge. Neuropathic pain, in particular, stands out for its rather common resistance to conventional analgesic therapies. The observed heterogeneity is acceptably explained by the great array of promoters and modulating factors associated to its genesis. Although its real prevalence is unknown, it is predicted that 15-20% of patients are likely to suffer from neuropathic pain during the course of the disease, and an even higher proportion at advanced stages of the disease. Moreover, it is frequently identified a bi-directional causal relationship, as certain anti-cancer therapies are implicated in the origin of the pain. These numbers are considered underestimated as there is an acknowledged lack of standardization of methods applied when its identification is attempted. The relevance of reviewing the physician’s role and the current related algorithm’s evidence level is sustained by the difficulties associated to its recognition and relief. The knowledge of the efficacy, safety and tolerability profiles concerning the most applied therapies is especially import when taking into account a fragile population, frequently on multidrug regimens. Second and third-line therapies are a valid resource considering the variety of individual responses. The necessity of a satisfactory relief is related to the significance of a neuropathic pain’s impact in a patient’s quality of life which, in turn, reflects itself in the psychological management of a potentially consumptive disease.
Descrição
Trabalho Final do Curso de Mestrado Integrado em Medicina, Faculdade de Medicina, Universidade de Lisboa, 2015
Palavras-chave
Dor neuropática Cancro Alívio da dor Analgésicos