Medicina del dolor y cuidados paliativos
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Item Bilateral Sphenopalatine Ganglion Block in the Management of Headache Associated with Subarachnoid Hemorrhage: Case Report(Pain Medicine Case Reports, 2025) Acosta Gutiérrez, Harold Anderson; Molina Arteta, Bilena Margarita; Jaramillo, Natalia BoteroItem Características demográficas, clínicas y necesidades paliativas en pacientes indígenas con cáncer atendidos en el INC, 2012-2022(Revista Facultad Nacional de Salud Pública (En proceso de publicación), 2025-01-01) Claudia Agamez Insignares, Marta Ximena León, Natalia Botero Jaramillo, Lina Ospina Chaparro, Miguel Zamir TorresResumen Objetivo Describir los factores demográficos y clínicos relacionados con las necesidades paliativas en población indígena con cáncer atendida en el Instituto Nacional de Cancerología (INC) entre 2012 y 2022. Métodos Estudio descriptivo de corte transversal que incluyó pacientes indígenas mayores de 18 años con diagnóstico oncológico que consultaron al Instituto Nacional de Cancerología entre enero de 2012 y diciembre de 2022. Se revisaron historias clínicas electrónicas y se recolectaron variables demográficas, clínicas y de necesidades paliativas. La información fue sistematizada en REDCap y verificada por un monitor de investigación. Se realizó análisis univariado y bivariado con correlación de Spearman, V de Cramer, chi-cuadrado y razones de prevalencia con IC95%. Resultados Se analizaron 208 pacientes, 131 (62,98%) mujeres, mediana de edad 56 años. La mayoría procedía de Bogotá (37,5%), pertenecía a estratos bajos (98%) y al régimen subsidiado (66,35%). Los cánceres más frecuentes fueron mama (12,98%) y cérvix (12,5%). El 37,02% recibió tratamiento con intención paliativa. El 46,63% presentó dolor, el 25,48% usó opioides y el 29,33% fue valorado por cuidados paliativos. Variables clínicas como estadio, intención paliativa y dolor se asociaron con mayor necesidad de atención paliativa. Procedencia fuera de Bogotá y mayor escolaridad disminuyeron la probabilidad de recibir valoración por cuidados paliativos y analgesia. Conclusiones La población indígena con cáncer atendida en el INC presenta necesidades paliativas, sin embargo, presentando vulnerabilidad social y de acceso dadas por las características socioculturales. Las variables clínicas, especialmente estadio del cáncer, la intención paliativa en los tratamientos y dolor, fueron determinantes en la demanda de atención.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 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 Delirium en los diferentes escenarios de cuidados paliativos(Revista Chilena de Anestesia, 2024-03-11) Lennis J. Bedoya Muñoz, Natalia Botero Jaramillo, Lina Ortiz, María Ximena de la Ossa DuránPatients in palliative care are a high-risk group from delirium, with prevalences as high and variable as 13% to 42%. Which is associated with significant distress for patients, families, and health professionals. Furthermore, delirium is associated with accelerated functional and cognitive deterioration, prolonged hospital stays, and increased risk of institutionalization and death. The following article aims to carry out a non-systematic review of the literature and expose the presentation of delirium in different palliative care scenarios.Item Early Palliative Care Integration in End-Stage Liver Disease: A Narrative Review of Clinical Strategies for Symptom Control and Quality of Life(Journal of Pain & Palliative Care Pharmacotherapy, 2026-01-12) Sarria-Gómez, Daniela; Cristhian Camilo Martínez Torres; Diana Estrada Bermúdez; Liliana SaavedraEnd-stage liver disease (ESLD) is associated with a high symptom burden, poor prognosis, and limited access to curative disease. Despite growing evidence supporting the role of palliative care (PC), its integration into the routine management of ESLD remains limited and inconsistent. To synthesize the current evidence on the role of palliative care in ESLD, emphasizing its impact on quality of life and including strategies for symptom control and effective clinical integration. A narrative review with a systematic approach was conducted. PubMed, Scopus, Embase, and SciELO were searched for English- and Spanish-language studies published between 2015 and 2025. Studies were selected based on methodological rigor and relevance to PC interventions in ESLD. Key barriers to PC implementation include misconceptions about its use being limited to terminal phases, lack of referral criteria, and insufficient coordination between specialties. Evidence shows that early PC involvement improves symptom control (pain, dyspnea, pruritus, encephalopathy), decreases avoidable hospitalizations, and facilitates shared decision-making. Early and structured integration of palliative care into ESLD management is essential. Health systems should prioritize interdisciplinary care models, establish clear referral criteria, and promote a care approach focused on patient well-being, autonomy, and dignity.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 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 FelicianoItem 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 Exploring psilocybin’s role in mental health and palliative medicine: a path to improved well-being(Expert Opinion on Emerging Drugs, 2025-04-25) Maria-Alejandra Umbacia, Marta Ximena Leon, Jose-Manuel Quintero, LinaMaria Castro, Veronica Paez, Seetal Dodd & Rosa-Helena BustosABSTRACT Introduction: Although long known for their psychoactive effects, psychedelic drugs have only recently been investigated for medicinal use. Psilocybin has attracted the greatest interest with studies suggesting that it may be a useful agent in psychiatry and in palliative care. Areas covered: Clinical trials that included psilocybin were searched in PubMed, Embase, and ClinicalTrials.gov, demonstrating that adult psychiatry and palliative care are the medical fields that show the greatest interest in psilocybin treatment. Expert opinion: Psilocybin is a powerful drug that needs to be used with caution but may benefit some patients, including when other options have failed. It is best evidenced in treatment resistant depression and in palliative care, where patients are usually treated in specialist care centers. It has a novel mechanism of action, targeting the 5HT2A receptor, and can show rapid onset of action. There are many questions regarding its use that remain to be clarified, including its efficacy for other indications and its role as adjunctive treatment in psychotherapy. The psychoactive, or psychedelic effects are well documented, but their clinical importance is disputed.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 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 Neuralgia del nervio glosofaríngeo en pacientes oncológicos: serie de casos tratados con neurolisis del nervio glosofaríngeo en el Instituto Nacional de Cancerología y revisión de la literatura(2025-10-17) Acosta Gutiérrez, Harold Anderson; Molina Arteta, Bilena MargaritaItem 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 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 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 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.