Manejo del dolor crónico posquirúrgico y oncológico tras cirugía cáncer de mama y posterior recidiva ósea.
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| Title: | Manejo del dolor crónico posquirúrgico y oncológico tras cirugía cáncer de mama y posterior recidiva ósea. |
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| Alternate Title: | Management of chronic postsurgical and oncological pain after breast cancer surgery and metachronous bone metastasis. |
| Authors: | Morales-Viveros, Camila1 (AUTHOR) camila.morales.viveros@hmar.cat, Moltó-García, Luis1 (AUTHOR), Bande-Julián, David1 (AUTHOR), Rodríguez-Rivas, Uxia1 (AUTHOR), Comps-Vicente, Olga1 (AUTHOR) |
| Source: | Dolor: Investigación, Clínica & Terapéutica. 2025, Vol. 40 Issue 4, p130-132. 3p. |
| Subjects: | CHRONIC pain, BREAST cancer, PAIN management, NEURALGIA, METASTASIS, DRUG administration, SPINAL infusions, ANALGESICS |
| Abstract (English): | The intrathecal therapy has been used further than 40 years and offers several benefits in selected cases when compared with systemic opioids therapy for chronic cancer pain and non-oncologic pain. These include the direct delivery of the drug to its site of action –the dorsal horn of the spinal cord–, bypassing first-pass metabolism and the blood-brain barrier. These mechanisms allow the use of a lower necessary dosage to obtain the desired analgesic effect and, in turn, less interaction of the administered drug with other systemic receptors, reducing its adverse or undesirable effects. Morphine and Ziconotide are the only agents approved by the FDA (Food and Drug Administration) for intrathecal therapy in chronic pain. We present the case of a patient with neuropathic pain after breast cancer surgery, initially treated with oral and transdermal opioids, adjuvants and spinal cord stimulation (SCS). After several years of clinical stability, she presented a significant increase in the level of pain in the context of metachronous bone and mediastinal metastases. Therefore, we proposed a new analgesic approach including nociceptive and neuropathic pain treatment in a systemic strategy. [ABSTRACT FROM AUTHOR] |
| Abstract (Spanish): | La terapia intratecal, en uso hace más de 40 años, ofrece varios beneficios en casos bien seleccionados, con respecto a la administración sistémica de opioides en pacientes que padecen dolor crónico refractario oncológico y no oncológico. Entre ellos cabe mencionar la entrega directa del fármaco en su sitio de acción –asta dorsal de la médula espinal–, saltando el metabolismo de primer paso y la barrera hematoencefálica. Estos mecanismos permiten el uso de una menor dosificación necesaria para obtener el efecto analgésico deseado y a su vez menor interacción del fármaco administrado con los demás receptores sistémicos, lo que disminuye los efectos adversos o indeseados de este. Morfina y ziconotida son los únicos agentes aprobados por la FDA (Food and Drug Administration) para terapia intratecal en dolor crónico. Presentamos el caso de una paciente con dolor neuropático tras cirugía oncológica de mama, inicialmente tratada con opioides vía oral y transdérmica, coadyuvantes y terapia de electroestimulación (EEM) de cordones posteriores. Con lo anterior, se logra estabilidad clínica durante años hasta la aparición de metástasis óseas y mediastínicas asociadas a un incremento considerable del nivel de dolor. En este contexto, fue necesario plantear una nueva estrategia de abordaje analgésico con enfoque sistémico que incluye el tratamiento del dolor nociceptivo y neuropático. [ABSTRACT FROM AUTHOR] |
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| Database: | MedicLatina |
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| Abstract: | The intrathecal therapy has been used further than 40 years and offers several benefits in selected cases when compared with systemic opioids therapy for chronic cancer pain and non-oncologic pain. These include the direct delivery of the drug to its site of action –the dorsal horn of the spinal cord–, bypassing first-pass metabolism and the blood-brain barrier. These mechanisms allow the use of a lower necessary dosage to obtain the desired analgesic effect and, in turn, less interaction of the administered drug with other systemic receptors, reducing its adverse or undesirable effects. Morphine and Ziconotide are the only agents approved by the FDA (Food and Drug Administration) for intrathecal therapy in chronic pain. We present the case of a patient with neuropathic pain after breast cancer surgery, initially treated with oral and transdermal opioids, adjuvants and spinal cord stimulation (SCS). After several years of clinical stability, she presented a significant increase in the level of pain in the context of metachronous bone and mediastinal metastases. Therefore, we proposed a new analgesic approach including nociceptive and neuropathic pain treatment in a systemic strategy. [ABSTRACT FROM AUTHOR] |
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| ISSN: | 02140659 |
| DOI: | 10.24875/DOL.M25000033 |
