ABSTRACT
La prescripción de opioides para el dolor crónico se ha incrementado en las últimas décadas. Sin embargo, las dudas sobre su seguridad a largo plazo, un uso inadecuado y el desarrollo de conductas aberrantes asociadas a opioides (CAAO) dificultan la toma de decisiones clínicas, provocando un tratamiento insuficiente del dolor crónico. Diversas guías prácticas han establecido recomendaciones para el control de los pacientes que reciben opioides a largo plazo. Cualquier médico debe conocer las herramientas disponibles para identificar a aquellos pacientes que presenten un riesgo elevado de mal uso de los opioides. Debe, además, saber cómo detectarlo y abordarlo sin comprometer el tratamiento óptimo del dolor en aquellos pacientes que sí pueden beneficiarse de un uso correcto de los opioides. En el presente trabajo se revisan las principales guías de práctica clínica, revisiones sistemáticas, recomendaciones y estrategias para minimizar los riesgos de los opioides en el tratamiento del dolor crónico no oncológico (AU)
Prescription of opioids for chronic pain has increased in recent decades. However, issues arise about their long-term safety, abuse and opioid-associated aberrant behaviors that hinder clinical decision-making, thereby contributing to insufficient treatment of chronic pain. Several clinical practice guidelines have established different recommendations for monitoring patients receiving long-term opioid therapies, and screening tools have been recommended to identify those at high risk. Every physician should be aware of the tools available to identify those patients requiring opioid treatment and having a high risk of addictive behaviors, knowing how to detect and treat it without compromising the optimal management of pain in those patients who can benefit from correct use of opioids. We hereby review the main clinical practice guidelines, systematic reviews, recommendations and strategies to minimize the risks of opioids in the treatment of chronic non-cancer pain (AU)
Subject(s)
Humans , Chronic Pain/drug therapy , Analgesics, Opioid/therapeutic use , Opioid-Related Disorders/prevention & control , Patient Safety , Practice Patterns, Physicians' , Behavior, Addictive/prevention & control , Prescription Drug Misuse/prevention & control , Risk FactorsABSTRACT
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Subject(s)
Female , Humans , Male , Pain Clinics/organization & administration , Pain Clinics/standards , Pain Management/methods , Pain Management/standards , Health Education/methods , Health Education/organization & administration , Health Education/standards , Fentanyl/therapeutic use , Polygalacturonase/therapeutic use , Societies, Medical/legislation & jurisprudence , Societies, Medical/standards , Opioid-Related Disorders/complicationsABSTRACT
No disponible
Subject(s)
Humans , Female , Child , Smith-Lemli-Opitz Syndrome/chemically induced , Smith-Lemli-Opitz Syndrome/diagnosis , Fentanyl/therapeutic use , Bronchoscopy , Albuterol/therapeutic use , Adrenal Cortex Hormones/therapeutic use , Electrocardiography , Aminophylline/therapeutic use , Dipyrone/therapeutic useABSTRACT
INTRODUCTION: The interindividual variability in cardiorespiratory function during liver transplantation (OLT) has been attributed to various factors, including polymorphisms in immunity genes known to affect the circulation levels of cytokines. AIM: To evaluate polymorphisms of genes encoding for interleukin-6 (IL6) and tumor necrosis factor (TNF) in association with cardiorespiratory function in OLT. DESIGN: Prospective observational study. PATIENTS AND METHODS: We studied 62 consecutive patients who had OLT performed in our hospital between 2004 and 2005. Polymorphisms at positions -308 and -409 of TNF gene, as well as those at -174 and -574 of IL6 gene were determined in all patients by means of PCR-RFLPs. Associations were carried out using chi-square tests and analysis of variance. A bilateral P < .05 was accepted as significant. RESULTS: No statistically significant associations were observed. CONCLUSIONS: A relationship between the polymorphisms studied and respiratory function in OLT was lacking. These results must be interpreted with caution due to the limited sample size.
