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Dor em cuidados paliativos pediátricos : uma revisão da literatura
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Advisor(s)
Abstract(s)
A dor é um sintoma frequente em cuidados paliativos pediátricos, podendo ser profundamente incapacitante a vários níveis e causador de grande sofrimento para a criança e família. Surge no contexto de várias doenças, relacionada com a própria doença ou com as intervenções médicas ou terapêuticas. É essencial o diagnóstico precoce de modo a que não seja subtratada ou subestimada, sendo de elevada importância a história clínica, o exame objetivo e o recurso a ferramentas de avaliação da intensidade da dor, exploradas nesta revisão da literatura. Relativamente ao tratamento da dor em contexto de CPP, este deve ser multimodal, individualizado e reavaliado periodicamente. A terapêutica farmacológica depende da intensidade da dor, estando reservados os opioides para a dor moderada a grave, apesar de nem todas as formulações estarem disponíveis em Pediatria. Apesar de a morfina ser a opção de primeira linha, pela sua segurança e eficácia, existem algumas situações que beneficiam da utilização de outras alternativas terapêuticas, como é o caso da dor irruptiva, para a qual têm surgido novas opções terapêuticas. Não obstante o facto de nos últimos anos terem existido grandes avanços na investigação nesta área, o controlo da dor em cuidados paliativos pediátricos permanece limitado por diversas barreiras mencionadas na literatura, como a dificuldade de realização de estudos nesta área, os estigmas associados e a utilização off-label de muitos fármacos e doses extrapolados a partir dos adultos, sendo bastante importante o investimento nesta área. Nesta revisão são ainda abordadas as várias modalidades terapêuticas não farmacológicas, como por exemplo a hipnose, tal como algumas opções para os casos mais graves.
Pain is a frequent symptom in pediatric palliative care, it can be profoundly disabling at various levels and cause great suffering for the child and family. It arises in the context of several diseases, related to the disease itself or to the medical or therapeutic interventions. Early diagnosis is crucial so that it is not undertreated or underestimated, with critical relevance of clinical history, physical examination, and the use of tools for assessing pain intensity, that are explored in this literature review. Regarding the treatment of pain in the context of pediatric palliative care, it must be multimodal, individualized and periodically reassessed. Pharmacological therapy depends on the intensity of the pain, opioids being reserved for moderate to severe pain, although not all formulations are available in Pediatrics. Though morphine is the first line option, due to its safety and efficacy, there are some situations that benefit from the use of other therapeutic alternatives, such as irruptive pain, for which new therapies have emerged. Despite the fact that in recent years there have been great advances in research in this area, pain control in pediatric palliative care remains limited by several barriers mentioned in the literature, such as the difficulty of carrying out studies in this area, the associated stigmas, and the off-label use of many drugs and doses extrapolated from adults, which reinforce the importance of investment in this area. This review also addresses the various non-pharmacological therapeutic modalities, such as hypnosis, as well as some options for the most severe cases.
Pain is a frequent symptom in pediatric palliative care, it can be profoundly disabling at various levels and cause great suffering for the child and family. It arises in the context of several diseases, related to the disease itself or to the medical or therapeutic interventions. Early diagnosis is crucial so that it is not undertreated or underestimated, with critical relevance of clinical history, physical examination, and the use of tools for assessing pain intensity, that are explored in this literature review. Regarding the treatment of pain in the context of pediatric palliative care, it must be multimodal, individualized and periodically reassessed. Pharmacological therapy depends on the intensity of the pain, opioids being reserved for moderate to severe pain, although not all formulations are available in Pediatrics. Though morphine is the first line option, due to its safety and efficacy, there are some situations that benefit from the use of other therapeutic alternatives, such as irruptive pain, for which new therapies have emerged. Despite the fact that in recent years there have been great advances in research in this area, pain control in pediatric palliative care remains limited by several barriers mentioned in the literature, such as the difficulty of carrying out studies in this area, the associated stigmas, and the off-label use of many drugs and doses extrapolated from adults, which reinforce the importance of investment in this area. This review also addresses the various non-pharmacological therapeutic modalities, such as hypnosis, as well as some options for the most severe cases.
Description
Trabalho Final do Curso de Mestrado Integrado em Medicina, Faculdade de Medicina, Universidade de Lisboa, 2020
Keywords
Abordagem da dor Cuidados paliativos pediátricos Analgesia Opioides Tratamento Pediatria