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Medicina del dolor y cuidados paliativos

Permanent URI for this communityhttps://hdl.handle.net/20.500.14595/768

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    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-Liberato
    Objectives: 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.
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    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 Esteban
    Background: 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.
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    Nefopam, ¿Útil para él dolor neuropático?
    (Revista Chilena de Anestesia, 2024-06-04) Santiago Téllez Buitrago Ribero; Omar Fernando Gomezese; Andrea Gutiérrez
    Nefopam 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.
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    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 Suárez
    Introduction: 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.
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    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 Buitrago
    El 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?
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