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• W2076164431 abstract "El tratamiento del dolor en el paciente con cirrosis hepática es un verdadero reto, siendo muchas veces inadecuado por falta de eficacia terapéutica o por la gran incidencia de efectos adversos. El enfoque del tratamiento es diferente si el dolor es agudo o crónico e implica conocer el mecanismo fisiopatológico responsable del mismo. El tratamiento farmacológico se ha de iniciar con la dosis mínima efectiva y titular lentamente, evitando la polifarmacia. Se enfatiza el control de los efectos adversos, especialmente la sedación y el estreñimiento que predisponen el desarrollo de la encefalopatía hepática. El paracetamol es el primer eslabón terapéutico siendo seguro a dosis 2-3 g/día. Los antiinflamatorios no esteroideos están contraindicados ya que pueden inducir insuficiencia renal aguda y/o sangrado gastrointestinal. El tramadol es una opción segura en el tratamiento del dolor moderado a severo. Los opioides con mayor seguridad terapéutica son el fentanilo, la hidromorfona y la metadona como segunda opción. El tratamiento tópico puede disminuir el consumo de fármacos por vía oral. En el tratamiento del dolor neuropático la gabapentina es la primera opción terapéutica, mientras que los antidepresivos tricíclicos pueden estar indicados en cierto grupo de pacientes. Las técnicas intervencionistas son una herramienta valiosa a utilizar en el dolor moderado a severo ya que permiten disminuir el tratamiento farmacológico y con ello los efectos adversos. Las intervenciones psicológicas, la terapia física y la rehabilitación deben ser consideradas como parte de la terapia multimodal en el abordaje del dolor crónico. Pain management in patients with liver cirrhosis is a real challenge and is often inadequate due to a lack of therapeutic efficacy or the high incidence of adverse effects. The focus of treatment differs depending on whether the pain is acute or chronic and involves understanding the causative pathophysiological mechanism. Analgesics should be started with the minimum effective dose and should be titrated slowly with avoidance of polypharmacy. Adverse effects must be monitored, especially sedation and constipation, which predispose the patient to the development of hepatic encephalopathy. The first-line drug is paracetamol, which is safe at doses of 2-3 g/day. Non-steroidal anti-inflammatory agents are contraindicated because they can cause acute renal failure and/or gastrointestinal bleeding. Tramadol is a safe option for moderate-severe pain. The opioids with the best safety profile are fentanyl and hydromorphone, with methadone as an alternative. Topical treatment can reduce oral drug consumption. In neuropathic pain the first-line therapeutic option is gabapentin. The use of antidepressants such as amitriptyline can be considered in some patients. Interventional techniques are a valuable tool in moderate to severe pain, since they allow a reduction in drug therapy and consequently its adverse effects. Psychological treatment, physical therapy and rehabilitation should be considered as part of multimodality therapy in the management of chronic pain." @default.
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• W2076164431 date "2014-01-01" @default.
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• W2076164431 title "Tratamiento del dolor en el paciente con cirrosis hepática" @default.
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• W2076164431 doi "https://doi.org/10.1016/j.gastrohep.2013.05.007" @default.
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