ABSTRACT
El herpes zóster es una erupción cutánea dolorosa que resulta de la reactivación del virus varicela zóster latente en los ganglios de las raíces dorsales o pares craneales. En este artículo se hace una revisión actualizada del tratamiento farmacológico y la prevención del dolor secundario a la infección por el virus. La forma más efectiva para prevenir la neuralgia postherpética y sus consecuencias es la propia prevención del herpes. Desde hace varios años disponemos de una vacuna de virus vivos atenuados (cepa Oka virus varicela zóster) autorizada en adultos de 50 o más años de edad; esta vacuna ha demostrado su eficacia contra el herpes zóster y la neuralgia postherpética; sin embargo su eficacia decrece con la edad y está contraindicada en pacientes con algún tipo de inmunosupresión. Hoy en día existen vacunas recombinantes que son una alternativa y pueden administrarse a personas inmunocomprometidas (AU)
Shingles is a painful rash that results from reactivation of latent varicella-zoster virus in the dorsal root ganglia or cranial nerves. In this article an update is presented on the prevention and pharmacological treatment of the secondary pain from the virus infection. The most effective way to prevent post-herpetic neuralgia and its consequences is the prevention of herpes itself. A live attenuated vaccine (the Oka strain varicella zoster virus) has been available for several years, and is approved in adults aged 50 years old. Although this vaccine has shown to be effective against herpes zoster and post-herpetic neuralgia, its effectiveness decreases with age and is contraindicated in patients with some form of immunosuppression. Today the recombinant vaccines provide an alternative, and may be administered to immunocompromised persons (AU)
Subject(s)
Humans , Middle Aged , Herpes Zoster/prevention & control , Herpes Zoster/therapy , Pain Management , Chronic Pain/drug therapy , Neuralgia, Postherpetic/drug therapy , Herpes Zoster Vaccine/administration & dosage , Herpes Zoster/complications , Herpes Zoster/physiopathology , Immunocompetence , Antibodies, Viral/therapeutic use , Antiviral Agents/therapeutic use , Glucocorticoids/therapeutic use , Methadone/therapeutic useABSTRACT
Shingles is a painful rash that results from reactivation of latent varicella-zoster virus in the dorsal root ganglia or cranial nerves. In this article an update is presented on the prevention and pharmacological treatment of the secondary pain from the virus infection. The most effective way to prevent post-herpetic neuralgia and its consequences is the prevention of herpes itself. A live attenuated vaccine (the Oka strain varicella zoster virus) has been available for several years, and is approved in adults aged 50 years old. Although this vaccine has shown to be effective against herpes zoster and post-herpetic neuralgia, its effectiveness decreases with age and is contraindicated in patients with some form of immunosuppression. Today the recombinant vaccines provide an alternative, and may be administered to immunocompromised persons.
Subject(s)
Herpes Zoster Vaccine/administration & dosage , Herpes Zoster/complications , Neuralgia, Postherpetic/prevention & control , Age Factors , Herpes Zoster/prevention & control , Humans , Immunocompromised Host , Middle AgedABSTRACT
Back pain and/or gluteal region pain is a frequent complaint in primary care and often is difficult to determine their origin. When a patient consults us for this reason we tend to direct the focus to the study of bone and nerve structures, without considering that in a large number of cases the myofascial system is involved. In a study with 250 patients in order to determine the prevalence of tendinosis and tear of the gluteus medius or minimus muscles, was found by MRI that 14% of patients who went to the doctor for pain in the buttock, hip or groin had this type of injury in any of the muscles mentioned (1). In these cases a diagnosis and early treatment with injections is essential to prevent progression to persistent pain and decreased muscle function.
Subject(s)
Buttocks , Muscular Diseases/diagnosis , Muscular Diseases/therapy , Humans , SyndromeABSTRACT
El dolor de espalda y/o región glútea es un motivo de consulta frecuente en atención primaria y en muchas ocasiones resulta difícil precisar su origen. Cuando un paciente consulta por este motivo solemos dirigir el foco de atención hacia el estudio de las estructuras óseas y nerviosas, sin tener en cuenta que en un gran número de casos está implicado el sistema miofascial. En un estudio realizado en 250 pacientes con el objetivo de determinar la prevalencia de tendinosis y roturas del glúteo medio o menor, se comprobó por medio de RM que el 14% de los pacientes que acudían al médico por dolor en la nalga, cadera o ingle presentaban este tipo de lesión en alguno de los músculos mencionados. En estos casos un diagnóstico y tratamiento precoz con infiltraciones es fundamental para evitar la progresión a un dolor persistente y disminución de la función muscular (AU)
Back pain and/or gluteal region pain is a frequent complaint in primary care and often is difficult to determine their origin. When a patient consults us for this reason we tend to direct the focus to the study of bone and nerve structures, without considering that in a large number of cases the myofascial system is involved. In a study with 250 patients in order to determine the prevalence of tendinosis and tear of the gluteus medius or minimus muscles, was found by MRI that 14% of patients who went to the doctor for pain in the buttock, hip or groin had this type of injury in any of the muscles mentioned (1). In these cases a diagnosis and early treatment with injections is essential to prevent progression to persistent pain and decreased muscle function (AU)
Subject(s)
Humans , Female , Middle Aged , Low Back Pain/complications , Low Back Pain/diagnosis , Low Back Pain/therapy , Myofascial Pain Syndromes/complications , Myofascial Pain Syndromes/diagnosis , Anesthetics, Local/therapeutic use , Early Diagnosis , Myofascial Pain Syndromes/drug therapy , Pelvis/pathology , Pelvis , Diagnosis, Differential , Piriformis Muscle Syndrome/diagnosis , Piriformis Muscle Syndrome/drug therapy , Trigger Points/pathology , Trigger PointsABSTRACT
El ziconotide, péptido sintético análogo de la O-conotoxina de un caracol marino, ha sido introducido recientemente como un fármaco para el tratamiento del dolor rebelde a opioides. Consigue su efecto terapéutico a través de un bloqueo selectivo de los canales de calcio (Ca) tipo N dependientes de voltaje, por medio del cual reduce la liberación de neurotransmisores pronociceptivos en el asta posterior de la médula espinal, inhibiendo, de esta manera, la transmisión del impulso doloroso. Una de sus ventajas es la de no provocar tolerancia, e incluso en caso necesario, podría ser administrado conjuntamente con morfina, potenciándose la acción de ambos fármacos (AU)
The ziconotide is structurally the synthetic peptide analogue of the V-conotoxin Conus magus, a marine snail. It has recently been introduced as a drug for the treatment of pain unresponsive to opioids. Achieves its therapeutic effect via a potent selective blockade of voltage sensitive calcium channels, which in turn reduces the release of neurotransmitters pronociceptivos in the dorsal horn of the spinal cord by this action inhibits the transmission of painful stimulus.Among its advantages is to not cause tolerance. In addition, if necessary, could be co-administered with morphine, producing a synergistic effect on its action on pain (AU)
