Medicina del dolor y cuidados paliativos
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Item Prevention and treatment of cisplatin-induced ototoxicity in adults: A systematic review(2023-09-23) Juan Esteban Correa-Morales; Sara Giraldo-Moreno; Nidia Mantilla-Manosalva; Laura Cuellar-Valencia; Oscar Felipe Borja-Montes; Lennis Jazmin Bedoya-Muñoz; María Fernanda Iriarte-Aristizábal; Elias Quintero-Muñoz; Andrea Marcela Zuluaga-LiberatoObjectives: Ototoxicity is a common disabling side effect of platinum-based chemotherapy. This study aimed to assess the evidence on the management of platinum-induced ototoxicity in adult cancer patients. Methods: Four databases were searched up to 1 November 2022. Original studies were included if they reported on a pharmacologic or non-pharmacologic intervention to prevent or treat platinum ototoxicity in adults. The articles' quality was assessed via two grading scales. Results: Nineteen randomised controlled trials and five quasi-experimental studies with 1673 patients were analysed. Eleven interventions were identified, nine pharmacological and two non-pharmacological. Six of the interventions (sodium thiosulphate, corticoids, sertraline, statins, multivitamins and D-methionine) showed mild benefits in preventing cisplatin-induced ototoxicity. Only one trial assessed corticoids as a potential treatment. Overall, only six trials were deemed with a low risk of bias. The majority of studies inadequately documented intervention-related adverse effects, thereby limiting safety conclusions. Conclusions: Current interventions have mild benefits in preventing cisplatin-induced ototoxicity in adult cancer patients. Sodium thiosulphate is the most promising intervention as a preventive strategy. Rigorous, high-quality research is warranted, encompassing an evaluation of all potential symptoms and innovative treatment modalities. Keywords: chemotherapy-related adverse events; cisplatin-induced ototoxicity; hearing loss; otoprotection; platinum chemotherapy.Item Subcutaneous Levetiracetam Administration in Latino Patients on Home Care(Sage Journals, American Journal of Hospice and Palliative Medicine, 2023-10-31) Cuellar-Valencia, Laura; Claros-Hulbert, Angelica; Ortegon, Adriana; Pino, Juliana; Velandia, Laura; Correa-Morales, Juan EstebanBackground: Levetiracetam has a favorable pharmacology profile to be used subcutaneously. However, its subcutaneous use is still considered off-label as this is beyond its license. The evidence base for its safety, tolerability, and efficacy is limited to observational studies. Objectives: To report the safety and efficacy of subcutaneous levetiracetam in Latino patients on home care. Design: Observational retrospective case series study. Subjects: Consecutive sample of Latino adults with life-limiting illnesses. Methods: A case series framework with 4 domains (selection, ascertainment, causality, and reporting) to ensure reporting quality was used. Additionally, 8 relevant outcomes established in a previous comprehensive review, were collected and reported. Adverse reactions were documented using the Common Terminology Criteria for Adverse Events. Results: Fifteen Latino patients with oncological and non-oncological diagnoses received subcutaneous levetiracetam for a mean of 21 days on home care. Levetiracetam was most frequently initiated subcutaneously due to loss of the oral route. The average dosage of subcutaneous levetiracetam was 1200 mg. Only 1 patient required a dose adjustment, and only 2 patients experienced a total of 5 seizures during the therapy trial. No adverse reactions were reported. Conclusions: Subcutaneous levetiracetam appears to be effective and safe. This case series of Latino patients in home care expands the evidence of its use in the home care setting. The preliminary data reported by now on multiple case series warrants robust trials.Item Nefopam, ¿Útil para él dolor neuropático?(Revista Chilena de Anestesia, 2024-06-04) Santiago Téllez Buitrago Ribero; Omar Fernando Gomezese; Andrea GutiérrezNefopam is a drug with very interesting pharmacological characteristics for the treatment of acute postoperative pain, but even more, as an understudied analgesic strategy for neuropathic pain. The present review article was proposed to perform a search with the MeSH terms in (PubMed) with the formula terms (nefopam [MeSH Terms]) AND (neuropathic pain [MeSH Terms]). In this way, a great void of medical literature on a molecule with a great potential for research was evidenced since the sixties in European countries, doctors like Basset and collaborators in 1969 as a potential antidepressant which owes its action in relation to its interaction with the inhibition of monoamine reuptake, suppressive effect on sodium voltage channels and an inhibitory activity on voltage-dependent calcium channels; so, it is a drug with a high likelihood to the antineuropathic ones. At present there are no recommendations or guidelines that support the use of Nefopam for the treatment of neuropathic pain and so it is interesting to make a review article that can examine the little literature found and allow to awaken the interest of clinical researchers to add an intravenous analgesic strategy for neuropathic pain.Item Guided imagery for symptom management of patients with life-limiting illnesses: A systematic review of randomized controlled trials.(Journal of Palliative Medicine, 2024-06-22) Juan Esteban Correa-Morales; Nidia Mantilla-Manosalva; Ximena Rodríguez-Cardona; Lennis Jazmin Bedoya-Muñoz; Bibiana Florez-Vargas; Marta Ximena León; Sara Giraldo-Moreno; Omar Fernando Gomezese; Natalia Salamanca-BalenBackground: Patients with life-limiting illnesses receiving palliative care have a high symptom burden that can be challenging to manage. Guided imagery, an alternative therapy in which patients are induced to picture mental images with sensory components, has proven in quasi-experimental studies to be effective as a complementary therapy for symptom management. Objective: To systematically review randomized controlled trials that report evidence of guided imagery for symptom management in patients with life-limiting illnesses. Methods: The Preferred Reporting Items for Systematic Reviews and Meta-Analyses guideline was followed for this review and the search strategy was applied in Medline, CINHAL, and Web of Science. The quality of the articles was evaluated using the Cochrane Collaboration’s Risk-of-Bias Tool 2 (RoB 2). The results are presented using the Guidance on the Conduct of Narrative Synthesis in Systematic Reviews. Results: A total of 8822 studies were initially identified through the search strategy, but after applying exclusion criteria, 24 randomized controlled trials were included in this review. The quality assessment revealed that 11 studies had a high risk of bias, 11 had some concerns, and 2 had a low risk of bias. Out of the 24 included studies, 14 evaluated oncological diagnosis, while the remaining 9 focused on non-oncological diagnoses across 6 different diseases. Guided imagery was found to be effective in managing symptoms in 20 out of the 24 studies. Regardless of the disease stage, patients who received guided imagery experienced relief from anxiety, depression, pain, nausea, vomiting, sleep disturbances, and fatigue. Conclusion: Guided imagery therapy has shown promising results regarding symptom management in palliative care patients with life-limiting illnesses.Item Guided imagery for symptom management of patients with life-limiting illnesses: A systematic review of randomized controlled trials.(Journal of Palliative Medicine, 2024-06-22) Juan Esteban Correa-Morales; Nidia Mantilla-Manosalva; Ximena Rodriguez-Cardona; Lennis Jazmin Bedoya-Muñoz; Bibiana Florez-Vargas; Martha Ximena Leon; Sara Giraldo-Moreno; Omar Fernando Gomezese; Natalia Salamanca-BallenPatients with life-limiting illnesses receiving palliative care have a high symptom burden that can be challenging to manage. Guided imagery, an alternative therapy in which patients are induced to picture mental images with sensory components, has proven in quasi-experimental studies to be effective as a complementary therapy for symptom management. Objective: To systematically review randomized controlled trials that report evidence of guided imagery for symptom management in patients with life-limiting illnesses. Methods: The Preferred Reporting Items for Systematic Reviews and Meta-Analyses guideline was followed for this review and the search strategy was applied in Medline, CINHAL, and Web of Science. The quality of the articles was evaluated using the Cochrane Collaboration’s Risk-of-Bias Tool 2 (RoB 2). The results are presented using the Guidance on the Conduct of Narrative Synthesis in Systematic Reviews. Results: A total of 8822 studies were initially identified through the search strategy, but after applying exclusion criteria, 24 randomized controlled trials were included in this review. The quality assessment revealed that 11 studies had a high risk of bias, 11 had some concerns, and 2 had a low risk of bias. Out of the 24 included studies, 14 evaluated oncological diagnosis, while the remaining 9 focused on non-oncological diagnoses across 6 different diseases. Guided imagery was found to be effective in managing symptoms in 20 out of the 24 studies. Regardless of the disease stage, patients who received guided imagery experienced relief from anxiety, depression, pain, nausea, vomiting, sleep disturbances, and fatigue. Conclusion: Guided imagery therapy has shown promising results regarding symptom management in palliative care patients with life-limiting illnesses.Item Evaluation of loneliness and its associated factors in caregivers of patients with dementia: a cross-sectional study(Colombia Médica, 2024-09-30) Hernandez Rico Angie Nathalia; Flórez Vargas Bibiana; Guadarrama Vega Santiago; Pino Pinzón Carmen Juliana; Agamez Insignares Claudia PatriciaObjective: To identify the levels of loneliness and the factors associated with the prevalence of loneliness in caregivers of patients with dementia. Methods: An observational cross-sectional study was conducted, including unpaid caregivers of patients with dementia who were receiving home care in Bogotá, Colombia. The prevalence of loneliness was estimated using the UCLA Loneliness Scale. Participants were also assessed regarding their satisfaction with providing care and whether they felt they received the necessary emotional support from family and friends. The association between loneliness and the patient's clinical variables, as well as the sociodemographic characteristics of the caregiver, was evaluated by calculating the odds ratio (OR) between the groups. Results: A total of 52 caregivers of patients with dementia were included. Severe loneliness was present in 5.77% of caregivers, while 26.92% experienced moderate loneliness. All caregivers reported feeling satisfied with providing care to their relatives, and 71% felt that their family or friends provided the emotional support they required. Loneliness was more common among caregivers of patients with total functional dependence (OR 4.061, P = 0.0278). Conversely, the perception of receiving emotional support from family and friends was identified as a potential protective factor against loneliness (OR 0.184, P = 0.0104). Conclusions: The prevalence of loneliness in this study is lower than that reported in previous studies. All caregivers reported satisfaction in providing care; most perceived adequate emotional support from family and friends. These factors could be contributing to the lower prevalence of loneliness observed.Item Prevalence of pain in pediatric patients undergoing cancer treatment at the Colombian National Cancer Institute - INC.(2024-12-16) Bilena Molina Arteta; Lennis Jazmín Bedoya Muñoz; Angélica Claros Hulbert D; Ricardo Sánchez Pedraza; Amaranto SuárezIntroduction: Hospitalized children continue to experience pain ranging in intensity from moderate to severe in 25-64% of the cases during hospital admission. Nevertheless, this symptom remains underdiagnosed and undertreated in the pediatric population. Objective: To characterize the presence of pain within the first 24 hours of hospital admissions in patients aged 3 to 17 undergoing cancer treatment, hospitalized at the Colombian National Cancer Institute (INC) in the city of Bogota. Methods: Descriptive, observational and retrospective study. The frequency of pain in patients under 18 years of age undergoing oncologic treatment was obtained by reviewing medical records to assess the presence of pain during the first 24 hours of hospital admission. Results: A total of 193 pediatric patients were included. The prevalence of pain in the pediatric population during the first 24 hours of hospitalization was 40.4% (95% CI: 33.4% to 47.7%). The most common pain scale used was the numeric pain rating scale in 67.9% of the children with a median age of 13 years (IQR=5). Most of the children showed mild pain (63.6%). Among the causes of pain reported in the patients the most common were causes related to the underlying disease (58 patients, 74.36%), followed by surgical procedures (21.7%). Conclusion: Pain in children with cancer is more prevalent. Therefore, it is crucial to make an early and in-depth assessment of pain while under medical care, as this symptom has been underdiagnosed for years, and therefore undertreated. Keywords: pain, pediatrics, prevalence.Item Uterine phantom pain syndrome(2024-12-16) Sandra Marisel Botía PinzónPhantom uterus pain is an uncommon phenomenon observed in women following a hysterectomy, where painful sensations resembling menstrual cramps or uterine contractions persist despite the removal of the uterus. This report presents the case of a 34-year-old woman from Bogotá, Colombia, diagnosed with advanced endometrial adenocarcinoma who underwent a radical hysterectomy. The patient developed progressive pelvic pain associated with dyspareunia, suggestive of phantom uterus syndrome. Management included neuromodulators and pelvic nerve blockade. This case highlights the complexity of phantom uterus pain, where neuronal plasticity and neuroinflammatory responses may play crucial roles in the generation and persistence of post-surgical pain symptoms. It underscores the need for individualized therapeutic approaches and a deeper understanding of underlying mechanisms to enhance the quality of life of affected patients.Item Prevalencia de síndrome doloroso post mastectomía y factores asociados en centro de referencia en Colombia para el control integral del cáncer(Revista chilena Anestesia, 2025) Alejandrina Martinez Orjuela, Bilena MolinaObjetivo: establecer la prevalencia del síndrome doloroso post mastectomía y caracterizar algunas condiciones clínicas y sociales de las pacientes sometidas a manejo quirúrgico por cáncer de mama en el centro de referencia en Colombia para el control integral del cáncer, y buscar posibles asociaciones de éstas con la aparición de síndrome doloroso post mastectomía. Metodología: estudio observacional descriptivo de corte transversal con componente analítico en pacientes con diagnóstico de cáncer de mama que fueron llevadas a procedimiento quirúrgico para tratamiento de este en las instalaciones del Instituto Nacional de Cancerología, entre enero de 2019 y julio de 2020. Resultados: Se analizaron los resultados de 149 pacientes, obteniendo una prevalencia de 38.9 %; encontrando como factores de asociación con la aparición de síndrome doloroso post mastectomía tener edad menor de 45 años, recibir manejo con cirugía de mama no conservadora, y antecedente personal de depresión. Conclusiones: La prevalencia del síndrome doloroso post mastectomía en el Instituto Nacional de Cancerología, se encuentra entre los valores establecidos de la literatura a nivel mundial, por lo cual se hace necesario, aplicar estrategias que permitan impactar en la prevención del mismo sobre todo en pacientes jóvenes y con algunos aspectos como desempleo y trastornos de la esfera mental, que podrían predisponer a la aparición del síndrome, además de hacer búsqueda activa de síntomas sugestivos de dolor crónico en los postoperatorios, para establecer estrategias óptimas de manejo y evitar impacto negativo en las pacientes sobrevivientes de cáncer.Item Validación de la escala PPS-v2 en pacientes con diagnóstico de cáncer en un hospital de cuarto nivel en Colombia(2025) Angie Natalia Hernandéz RicoObjective: To validate the Palliative Performance Scale version 2 (PPSv2) in Colombian patients diagnosed with cancer. Methodology: A cross-sectional observational study evaluated 270 patients diagnosed with cancerand treated at the [details omitted for double-anonymized peer review]. The PPSv2 scale, Karnofsky Performance Scale (KPS), and the Eastern Cooperative Oncology Group (ECOG) scale were administered to assess the validity and reliability of the PPSv2. Results: 172 patients (63.7%) were female, with a median age of 59 (interquartile range ± 18 years). The Cronbach's alpha coefficient was 0.903 (95% CI: 0.88–0.92). Concurrent validity was assessed by comparing the PPSv2 scale with the KPS and ECOG scales, yielding Spearman correlation coefficients of 0.973 for KPS and -0.915 for ECOG. An intraclass correlation coefficient (ICC) of 0.99 was found, indicating high inter-rater reliability. To determine test-retest reliability, the ICC was calculated, yielding a result of 0.81 (95% CI: 0.58–0.92). Conclusions: The PPSv2 scale demonstrates adequate internal consistency, concurrent validity, and inter-rater and test-retest reliability in patients diagnosed with cancer.Item “Caracterización de pacientes con síndrome doloroso postmastectomia y su prevalencia en el Instituto Nacional de Cancerología”(2025) Alejandrina Martinez Orjuela; Bilena MolinaObjective: to determine the prevalence of post-mastectomy pain syndrome (PMPS) and to characterize certain clinical and social conditions in patients who underwent surgical management for breast cancer at the national referral center in Colombia for comprehensive cancer care. Additionally, to identify potential associations between these factors and the development of PMPS. Methodology: A cross-sectional descriptive observational study with an analytical component was conducted in patients diagnosed with breast cancer who underwent surgical treatment at the Instituto Nacional de Cancerología between January 2019 and July 2020. Results: data from 149 patients were analyzed, yielding a prevalence of 38.9%. Factors found to be associated with the development of PMPS included being under 45 years of age, undergoing non-conservative breast surgery, and having a personal history of depression. Conclusions: The prevalence of PMPS at the Instituto Nacional de Cancerología is consistent with global literature reports. These findings highlight the need to implement strategies aimed at preventing PMPS, especially in younger patients and those with risk factors such as unemployment and mental health disorders, which may predispose them to the syndrome. Furthermore, active screening for symptoms suggestive of chronic pain in the postoperative period is essential to establish optimal management strategies and to prevent a negative impact on breast cancer survivors.Item Percepción de los médicos acerca de extubación paliativa en las unidades de cuidado intensivo(2025) Alejandrina Martinez Orjuela; Melissa Reyes Rueda; Nelson Francisco Castañeda AlarcónIntroducción: Durante la estancia de los pacientes en la Unidad de Cuidado Intensivo (UCI), los médicos encargados de su cuidado se pueden enfrentar a la necesidad de retiro de soportes vitales, como lo es el soporte ventilatorio. Objetivo: evaluar la percepción de los médicos que trabajan en UCI en Colombia sobre la extubación paliativa y los factores que influyen en su toma de decisiones. Metodología: La aplicación de una encuesta autoaplicada, realizada a 36 médicos de diversas especialidades, se analizaron aspectos sociodemográficos, percepciones éticas y legales, y la influencia de la espiritualidad en la suspensión de la ventilación mecánica. Resultados: La mayoría de los encuestados son médicos intensivistas, hombres, con menos de cinco años de experiencia en UCI. En términos de decisión clínica, el 92% de los participantes considera que la limitación o suspensión de tratamientos es una parte fundamental del ejercicio médico en UCI y que debe aplicarse sin importar la patología subyacente. En cuanto a la técnica de retiro de la ventilación mecánica, la mayoría (50%) opta por el destete terminal, mientras que un menor porcentaje (5.6%) percibe la extubación terminal como una práctica ilegal. El estudio también reveló que la religiosidad y la espiritualidad desempeñan un papel relevante en la toma de decisiones médicas. Conclusiones: Los resultados cuantitativos mostraron una considerable variabilidad en la percepción médica sobre la extubación paliativa, particularmente en función de la especialidad y las creencias religiosas.Item Eficacia de Ketamina en monoterapia como terapia analgésica para dolor neuropático de difícil manejo versus opioides en pacientes con cáncer avanzado, Una revisión sistemática con Metaanálisis.(Revista Chilena De Anestesia, 2025-01-17) Bilena Molina Arteta; Santiago Tellez BuitragoEl dolor neuropático oncológico ocasionalmente es refractario a terapias de primera línea como los antidepresivos tricíclicos, antidepresivos atípicos, anticonvulsivantes, gabapentinoides u opioides, convirtiéndose en un escenario desafiante y difícil de controlar. La carga sintomática, deterioro de la calidad de vida y la morbilidad hacen de este síntoma un reto significativo para el personal de salud. En la búsqueda de mejorar las terapias dirigidas a tratar este tipo de dolor, se ha postulado a la ketamina como una medicación prometedora. Este medicamento es altamente lipofílico y a dosis subanestésicas, es también utilizado en el tratamiento del dolor agudo postoperatorio y postraumático. Esto a raíz de su actividad como antagonista del receptor NMDA, inductor de síntesis y liberación de óxido nítrico y unión con receptores opioides tipo Mu que incrementa la efectividad de la señalización inducida por opioides. Aunque la ketamina usualmente se encuentra descrita como un analgésico adyuvante de los opioides para el tratamiento del dolor agudo posoperatorio y del crónico por cáncer, existen pocos estudios clínicos que demuestren claramente la eficacia de la Ketamina en monoterapia comparada con opioides en el dolor neuropático por cáncer. De modo que la presente revisión sistemática pretende responder la siguiente pregunta de investigación: ¿Cuál es la eficacia analgésica de la ketamina en monoterapia comparada con opioides en pacientes oncológicos con dolor neuropático de difícil manejo?Item Prevalencia de baja vitalidad en pacientes con neoplasias hematológicas recaídos/refractarios a 2 o más líneas de tratamiento.(2025-01-22) Humberto-Martínez Cordero, Laura-Cuellar.Item Clinical applications of artificial intelligence in symptom management and decision making in oncologic palliative care: a systematic review(Medicine Palliative in Practice (Early publication accepted 09.06.2025), 2025-06-09) Sandra Marisel Botía PinzónAbstract Introduction: Artificial intelligence (AI) is increasingly being integrated into healthcare, offering innovative tools to improve symptom management and support clinical decisionmaking in patients with advanced cancer receiving palliative care (PC). The study aimed to systematically evaluate recent evidence (2021–2024) on the clinical use of AI-based tools for symptom management, prognosis prediction, and clinical decision support in adult oncology patients in PC settings. Methods: A systematic review was conducted following the PRISMA-P 2015 guidelines. Databases searched included PubMed, Scopus, Cochrane Library, BVS, Scielo, and ScienceDirect, using MeSH terms related to AI, cancer, pain, and palliative care. Studies were included if they involved adult oncology patients using AI tools in PC and reported outcomes related to symptom control, clinical decisions, or mortality estimation. Two independent reviewers conducted the selection and methodological quality assessment using STROBE, PRISMA, and CONSORT guidelines. Only studies rated as medium or high quality were included. Results: From an initial pool of 3,018 records, 20 studies were selected. AI applications were grouped into prognosis and mortality prediction (n = 9), symptom identification and monitoring (n = 5), clinical decision support (n = 4), and communication tools (n = 2). Models included neural networks, eXtreme Gradient Boosting (XGBoost), decision trees, natural language processing (NLP), and chatbots. Most studies demonstrated high accuracy in retrospective or real-world clinical settings. Conclusions: AI has shown potential in the early identification of palliative needs, symptom control, and care planning. Prospective validation and implementation studies are needed to ensure ethical and safe integration into palliative care.Item Estrategias para la identificación y valoración inicial para el paciente con cáncer en final de vida, revisión panorámica(2025-07) Santiago Guadarrama Vega; Bibiana Florez V; Bilena Margarita Molina; John Feliciano