Dolor crónico de origen neoplásico

Última actualización el 22/08/2016

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Introducción

Definición

Conceptos Generales

Es el DOLOR CRÓNICO  de origen  neoplásico .

Epidemiología

Etiopatogenia

-Las causas del dolor oncológico incluyen:

A) Efecto directo del tumor y de sus metástasis (es lo más frecuente).

B) Tratamientos antineoplásicos.

C) Secundario a exploraciones diagnósticas.

D) Síndromes paraneoplásicos.

E)  Dolor no asociado al cáncer.

 

Factores Precipitantes

-

Clínica

El dolor oncológico puede ser :

1)  DOLOR DE TIPO  NOCICEPTIVO

DOLOR SOMÁTICO  : 

  • Sordo, continuo , profundo  ,  bien localizado 
  • Ejm  :  dolor  que  acompaña  a las metástasis  óseas ,  afectación pleural

DOLOR VISCERAL

  • Continuo, mal localizado  ,  descrito  como una presión profunda o compresiva con frecuencia  irradiado a la piel,
  • Ejm :  Metástasis  hepáticas  , distensión intestinal proximal a la  obstrucción , etc

2) DOLOR NEUROPÁTICO

  • Urente , quemante  , paroxístico , punzante
  • Ejm :  sdme  postoracotomía, plexopatía  lumbar  y  braquial  ( sdme  de Pancoast )

( Estos  dos  tipos  de dolor  pueden  acompañarse    de dolor  tipo  simpático  )

(Pueden  coexistir  distintos  tipos de dolr  en un mismo paciente  :  nociceptivo , neuropático ,  simpático )

 

En los pacientes con dolor oncológico  de moderado a intenso  generalmente se encuentran  2 componentes : el dolor de base , por proceso canceroso , de carácter continuo  o perisitente , con una duración  superior a 12 horas al día  , y el denominado dolor irruptivo , que es una exacerbación de este dolor  de base , de mayor intensidad , cuya aparición no está relacionada  con el control analgésico del mismo. Este último tipo de dolor aparece 85 % de todos los dolores por cáncer. Generalmente se presenta de forma súbita, con un pico a los pocos minutos y una duración aproximada de 30 minutos. Puede aparecer varias veces  al día . 

 

 

Complicaciones

-

Diagnóstico

Anamnesis

-

Exploración Física

-

Exploraciones Complementarias

-

Diagnóstico Diferencial

-

Pronóstico

-

Prevención

-

Tratamiento

Estrategias terapéuticas
Tratamiento conservador
Fármacológico

-

No farmacológico

-

Tratamiento intervencionista

-

Cirugía

-

Algoritmo de actuación

-

Última actualización el 22/08/2016

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Comentarios

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