RESUMEN
PURPOSE OF REVIEW: Targeted intrathecal drug delivery systems (IDDS) are an option in algorithms for the treatment of patients with moderate-to-severe chronic refractory pain. This article is intended to review the literature regarding IDDS published over the last year, with special attention to the Polyanalgesic Consensus Conference 2012. RECENT FINDINGS: The recommendations made by the Polyanalgesic Consensus Conference 2012 are reviewed. Separate considerations of intrathecal drug therapy for neuropathic and nociceptive pain syndromes and the new concept of 'microdosing' are discussed in this article. SUMMARY: This review includes the recommendations for the use of IDDS, trialing, and recent reports of complications (especially, the occurrence of granulomas). In addition, the latest documents on cerebrospinal fluid and potential lines of future development are discussed.
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Dolor Crónico/tratamiento farmacológico , Sistemas de Liberación de Medicamentos , Inyecciones Espinales , Neuralgia/tratamiento farmacológico , Dolor Intratable/tratamiento farmacológico , Humanos , Inyecciones Espinales/efectos adversos , Neoplasias/fisiopatologíaRESUMEN
OBJECTIVE: Botulinum toxin is a neurotoxin that has been widely used in chronic pain for the treatment of multiple conditions with a component of localized muscle spasm. Recent studies suggest that botulinum toxin is effective in the treatment of neuropathic pain syndromes such as post-herpetic neuralgia. CASE REPORT: We report the case of a 67-year-old man who underwent atypical segmentectomy of a right lower lobe lung nodule. The patient was referred to our pain management department with a of 2-year history persistent pain along the thoracotomy scar having a predominantly neuropathic component, refractory to standard treatments. He was successfully treated with subcutaneous botulinum toxin type A. DISCUSSION: On the basics of our own experience and on the analysis of the reports published in the literature, fractioned subcutaneous injections of botulinum toxin may be useful for the treatment of various chronic localized pain conditions including chronic post-thoracotomy pain.
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Toxinas Botulínicas Tipo A/administración & dosificación , Fármacos Neuromusculares/administración & dosificación , Dolor Postoperatorio/tratamiento farmacológico , Toracotomía/efectos adversos , Anciano , Carcinoma de Células Escamosas/cirugía , Humanos , Inyecciones Subcutáneas , Neoplasias Pulmonares/cirugía , Masculino , Neuralgia/tratamiento farmacológico , Neuralgia/etiología , Dolor Postoperatorio/etiologíaRESUMEN
Supraorbital neuralgia has been identified as an infrequent cause of headache that may prove very difficult to control pharmacologically. Peripheral nerve stimulation using electrodes to stimulate the nerve segmentally responsible for the zone of pain may constitute a management alternative in such cases. We present the case of a patient with headache because of posttraumatic supraorbital neuralgia, refractory to medical treatment, with good analgesic control after peripheral nerve stimulation. Peripheral nerve stimulation may be considered a safe, reversible treatment for patients with headache secondary to supraorbital neuralgia who respond poorly to pharmacological treatment, thus avoiding irreversible alternatives such as surgery.
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Terapia por Estimulación Eléctrica/métodos , Neuralgia/terapia , Nervios Periféricos/efectos de la radiación , Adulto , Humanos , Masculino , Dimensión del Dolor/métodos , Nervios Periféricos/fisiologíaRESUMEN
OBJECTIVE: Botulinum toxin is a neurotoxin that has been widely used in chronic pain for the treatment of multiple conditions with a component of localized muscle spasm. Recent studies suggest that botulinum toxin is effective in the treatment of neuropathic pain syndromes such as postherpetic neuralgia or painful scars. METHODS: We searched the PubMed and OvidSP databases. We also included cross-referencing bibliographies from primary and review articles. DISCUSSION: In this descriptive review, we evaluate the usefulness, safety, and potential pathophysiological mechanism of botulinum toxin type A for treatment of painful disorders with neuropathic component such as postherpetic neuralgia, diabetic neuropathy, or trigeminal neuralgia. CONCLUSIONS: On the basis of the analysis of the reports published in the literature, it would seem that fractioned peripheral subcutaneous and perineural injections of botulinum toxin type A may be useful for the treatment of various chronic pain conditions with neuropathic component.
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Toxinas Botulínicas Tipo A/uso terapéutico , Neuralgia/tratamiento farmacológico , Toxinas Botulínicas Tipo A/administración & dosificación , Bases de Datos Factuales/estadística & datos numéricos , Humanos , Inyecciones SubcutáneasAsunto(s)
Analgésicos no Narcóticos/uso terapéutico , Mielitis Transversa/fisiopatología , Dolor/tratamiento farmacológico , omega-Conotoxinas/uso terapéutico , Anciano , Analgésicos Opioides/uso terapéutico , Femenino , Humanos , Meperidina/uso terapéutico , Mielitis Transversa/tratamiento farmacológicoRESUMEN
No disponible
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Humanos , Neuralgia Posherpética/terapia , Estimulación Eléctrica/métodos , Herpes Zóster/complicacionesRESUMEN
No disponible