Uso de la terapia intratecal ante dolor neuropático refractario: a propósito de un caso clínico.
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| Title: | Uso de la terapia intratecal ante dolor neuropático refractario: a propósito de un caso clínico. |
|---|---|
| Alternate Title: | Use of intrathecal therapy for refractory neuropathic pain: a case report. |
| Authors: | Reina-Méndez, Laura1 (AUTHOR) laura.reina@salutsantjoan.cat |
| Source: | Dolor: Investigación, Clínica & Terapéutica. 2025, Vol. 40 Issue 4, p115-121. 7p. |
| Subjects: | PAIN medicine, PAIN management, NEURALGIA, CHRONIC pain, MORPHINE, INTERDISCIPLINARY research, SPINAL infusions |
| Abstract (English): | Neuropathic pain is a chronic condition that arises from injuries or diseases affecting the nervous system, both central and peripheral. Its complex management, impact on quality of life, and high healthcare costs make it a significant issue. The treatment of neuropathic pain follows a stepwise approach and is classified into first-line, second-line, and finally third-line pharmacological strategies. First-line treatments include tricyclic antidepressants, serotonin-norepinephrine reuptake inhibitors, and antiepileptics. If these are ineffective, topical agents or tramadol (second-line drugs) are used. When these also fail, third-line treatments are considered, including strong opioids like morphine or botulinum toxin type A. However, some patients develop refractory pain, necessitating intrathecal therapy. Intrathecal administration allows drugs to be delivered directly to their site of action, bypassing hepatic metabolism and improving analgesic efficacy. The drugs approved for this use are morphine and ziconotide. Morphine, due to its water solubility, offers greater spinal selectivity and prolonged diffusion. Ziconotide, on the other hand, blocks calcium channels and acts through a different mechanism than opioids, making it a suitable alternative in refractory cases. In the described clinical case, after all therapeutic strategies had failed, intrathecal therapy with morphine and bupivacaine was initiated. However, as satisfactory results were not achieved, ziconotide was added. Despite its high cost and the need for specialized resources, intrathecal therapy has proven effective in improving pain control and quality of life in selected patients, reducing hospital admissions, though never eliminating them entirely. Its implementation requires a multidisciplinary approach, with nursing playing a key role in patient follow-up and support. [ABSTRACT FROM AUTHOR] |
| Abstract (Spanish): | El dolor neuropático es una condición crónica que surge de lesiones o enfermedades del sistema nervioso, tanto central como periférico. El manejo complejo, impacto en la calidad de vida y alto coste sanitario lo convierten en un problema relevante. El tratamiento del dolor neuropático sigue un esquema escalonado y se clasifica en estrategias farmacológicas de primera, de segunda y finalmente de tercera línea. En la primera línea de tratamiento se emplean antidepresivos tricíclicos, inhibidores de la recaptación de serotonina y noradrenalina y antiepilépticos. Si estos no funcionan, se usan agentes tópicos o tramadol, que son los fármacos de segunda línea. Cuando estos tampoco son efectivos, se recurre a la tercera línea de tratamiento; opioides potentes como la morfina o la toxina botulínica tipo A. Sin embargo, algunos pacientes desarrollan dolor refractario, lo que hace necesario recurrir a la terapia intratecal. La administración intratecal permite depositar los fármacos directamente en su lugar de acción, evitando el metabolismo hepático y mejorando la eficacia analgésica. Los fármacos aprobados para este uso son la morfina y el ziconotide. La morfina, por su solubilidad en agua, tiene mayor selectividad espinal y difusión prolongada. Por otro lado, el ziconotide bloquea canales de calcio, actuando de manera distinta a los opioides y siendo una alternativa en casos refractarios. En el caso clínico descrito, después de fracasar toda estrategia terapéutica, se inició la terapia intratecal con morfina y bupivacaína, pero al no obtener resultados satisfactorios, se añadió ziconotide. A pesar de su elevado coste y la necesidad de recursos especializados, la terapia intratecal ha demostrado mejorar el control del dolor y la calidad de vida de los pacientes seleccionados, reduciendo ingresos hospitalarios, aunque nunca evitándose al 100%. Su implementación requiere un enfoque multidisciplinar, con un papel clave de enfermería en el seguimiento y apoyo al paciente. [ABSTRACT FROM AUTHOR] |
| Copyright of Dolor: Investigación, Clínica & Terapéutica is the property of Publicidad Permanyer SLU and its content may not be copied or emailed to multiple sites without the copyright holder's express written permission. Additionally, content may not be used with any artificial intelligence tools or machine learning technologies. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.) | |
| Database: | MedicLatina |
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| Header | DbId: lth DbLabel: MedicLatina An: 188931252 AccessLevel: 6 PubType: Academic Journal PubTypeId: academicJournal PreciseRelevancyScore: 0 |
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| Items | – Name: Title Label: Title Group: Ti Data: Uso de la terapia intratecal ante dolor neuropático refractario: a propósito de un caso clínico. – Name: TitleAlt Label: Alternate Title Group: TiAlt Data: Use of intrathecal therapy for refractory neuropathic pain: a case report. – Name: Author Label: Authors Group: Au Data: <searchLink fieldCode="AR" term="%22Reina-Méndez%2C+Laura%22">Reina-Méndez, Laura</searchLink><relatesTo>1</relatesTo> (AUTHOR)<i> laura.reina@salutsantjoan.cat</i> – Name: TitleSource Label: Source Group: Src Data: <searchLink fieldCode="JN" term="%22Dolor%3A+Investigación%2C+Clínica+%26+Terapéutica%22">Dolor: Investigación, Clínica & Terapéutica</searchLink>. 2025, Vol. 40 Issue 4, p115-121. 7p. – Name: Subject Label: Subjects Group: Su Data: <searchLink fieldCode="DE" term="%22PAIN+medicine%22">PAIN medicine</searchLink><br /><searchLink fieldCode="DE" term="%22PAIN+management%22">PAIN management</searchLink><br /><searchLink fieldCode="DE" term="%22NEURALGIA%22">NEURALGIA</searchLink><br /><searchLink fieldCode="DE" term="%22CHRONIC+pain%22">CHRONIC pain</searchLink><br /><searchLink fieldCode="DE" term="%22MORPHINE%22">MORPHINE</searchLink><br /><searchLink fieldCode="DE" term="%22INTERDISCIPLINARY+research%22">INTERDISCIPLINARY research</searchLink><br /><searchLink fieldCode="DE" term="%22SPINAL+infusions%22">SPINAL infusions</searchLink> – Name: Abstract Label: Abstract (English) Group: Ab Data: Neuropathic pain is a chronic condition that arises from injuries or diseases affecting the nervous system, both central and peripheral. Its complex management, impact on quality of life, and high healthcare costs make it a significant issue. The treatment of neuropathic pain follows a stepwise approach and is classified into first-line, second-line, and finally third-line pharmacological strategies. First-line treatments include tricyclic antidepressants, serotonin-norepinephrine reuptake inhibitors, and antiepileptics. If these are ineffective, topical agents or tramadol (second-line drugs) are used. When these also fail, third-line treatments are considered, including strong opioids like morphine or botulinum toxin type A. However, some patients develop refractory pain, necessitating intrathecal therapy. Intrathecal administration allows drugs to be delivered directly to their site of action, bypassing hepatic metabolism and improving analgesic efficacy. The drugs approved for this use are morphine and ziconotide. Morphine, due to its water solubility, offers greater spinal selectivity and prolonged diffusion. Ziconotide, on the other hand, blocks calcium channels and acts through a different mechanism than opioids, making it a suitable alternative in refractory cases. In the described clinical case, after all therapeutic strategies had failed, intrathecal therapy with morphine and bupivacaine was initiated. However, as satisfactory results were not achieved, ziconotide was added. Despite its high cost and the need for specialized resources, intrathecal therapy has proven effective in improving pain control and quality of life in selected patients, reducing hospital admissions, though never eliminating them entirely. Its implementation requires a multidisciplinary approach, with nursing playing a key role in patient follow-up and support. [ABSTRACT FROM AUTHOR] – Name: Abstract Label: Abstract (Spanish) Group: Ab Data: El dolor neuropático es una condición crónica que surge de lesiones o enfermedades del sistema nervioso, tanto central como periférico. El manejo complejo, impacto en la calidad de vida y alto coste sanitario lo convierten en un problema relevante. El tratamiento del dolor neuropático sigue un esquema escalonado y se clasifica en estrategias farmacológicas de primera, de segunda y finalmente de tercera línea. En la primera línea de tratamiento se emplean antidepresivos tricíclicos, inhibidores de la recaptación de serotonina y noradrenalina y antiepilépticos. Si estos no funcionan, se usan agentes tópicos o tramadol, que son los fármacos de segunda línea. Cuando estos tampoco son efectivos, se recurre a la tercera línea de tratamiento; opioides potentes como la morfina o la toxina botulínica tipo A. Sin embargo, algunos pacientes desarrollan dolor refractario, lo que hace necesario recurrir a la terapia intratecal. La administración intratecal permite depositar los fármacos directamente en su lugar de acción, evitando el metabolismo hepático y mejorando la eficacia analgésica. Los fármacos aprobados para este uso son la morfina y el ziconotide. La morfina, por su solubilidad en agua, tiene mayor selectividad espinal y difusión prolongada. Por otro lado, el ziconotide bloquea canales de calcio, actuando de manera distinta a los opioides y siendo una alternativa en casos refractarios. En el caso clínico descrito, después de fracasar toda estrategia terapéutica, se inició la terapia intratecal con morfina y bupivacaína, pero al no obtener resultados satisfactorios, se añadió ziconotide. A pesar de su elevado coste y la necesidad de recursos especializados, la terapia intratecal ha demostrado mejorar el control del dolor y la calidad de vida de los pacientes seleccionados, reduciendo ingresos hospitalarios, aunque nunca evitándose al 100%. Su implementación requiere un enfoque multidisciplinar, con un papel clave de enfermería en el seguimiento y apoyo al paciente. [ABSTRACT FROM AUTHOR] – Name: AbstractSuppliedCopyright Label: Group: Ab Data: <i>Copyright of Dolor: Investigación, Clínica & Terapéutica is the property of Publicidad Permanyer SLU and its content may not be copied or emailed to multiple sites without the copyright holder's express written permission. Additionally, content may not be used with any artificial intelligence tools or machine learning technologies. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract.</i> (Copyright applies to all Abstracts.) |
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| RecordInfo | BibRecord: BibEntity: Identifiers: – Type: doi Value: 10.24875/DOL.M25000030 Languages: – Code: spa Text: Spanish PhysicalDescription: Pagination: PageCount: 7 StartPage: 115 Subjects: – SubjectFull: PAIN medicine Type: general – SubjectFull: PAIN management Type: general – SubjectFull: NEURALGIA Type: general – SubjectFull: CHRONIC pain Type: general – SubjectFull: MORPHINE Type: general – SubjectFull: INTERDISCIPLINARY research Type: general – SubjectFull: SPINAL infusions Type: general Titles: – TitleFull: Uso de la terapia intratecal ante dolor neuropático refractario: a propósito de un caso clínico. Type: main BibRelationships: HasContributorRelationships: – PersonEntity: Name: NameFull: Reina-Méndez, Laura IsPartOfRelationships: – BibEntity: Dates: – D: 01 M: 10 Text: 2025 Type: published Y: 2025 Identifiers: – Type: issn-print Value: 02140659 Numbering: – Type: volume Value: 40 – Type: issue Value: 4 Titles: – TitleFull: Dolor: Investigación, Clínica & Terapéutica Type: main |
| ResultId | 1 |
