Capsaicina tópica en el tratamiento del dolor neuropático
2004; Q106299148; Volume: 11; Issue: 5 Linguagem: Espanhol
ISSN
2254-6189
AutoresM. A. Vidal, Enrique J. Calderón, Daniel San Román, F. J. Pérez-Bustamante, L. M. Torres,
Tópico(s)Respiratory and Cough-Related Research
ResumoespanolEl dolor neuropatico es uno de los sindromes dolorosos mas complejos y de mas dificil tratamiento. Se denomina asi al sintoma resultante del dano neurologico (periferico, central o ambos) en una parte del sistema de transmision nerviosa del dolor. Se han utilizado diversos farmacos, pero ninguno ha resultado suficientemente efectivo y los efectos secundarios a menudo impiden su continuacion. Puede darse en distintas situaciones, todas ellas mas frecuentes en pacientes anosos. Se busca un analgesico potente con el menor numero de efectos secundarios posibles. Este articulo es una revision bibliografica, mediante la base de datos del Medline, del tratamiento con capsaicina topica en distintos casos de dolor neuropatico: neuralgia postherpetica, neuropatia diabetica, dolor neuropatico asociado al sida, neuralgia del trigemino, sindrome doloroso postmastectomia y dolor complejo regional. La aplicacion topica de capsaicina al 0,075%, ha demostrado ser eficaz en el tratamiento del dolor disestesico, por lo que constituye una alternativa terapeutica en este tipo de dolor. Su mecanismo de accion parece que se basa en la estimulacion selectiva de las neuronas de las fibras amielinicas C, provocando la liberacion de sustancia P y posiblemente otros neurotransmisores; y finalmente una deplecion de sustancia P, con lo que se produciria una alteracion de la transmision del dolor a los sistemas centrales produciendose un fenomeno de desensibilizacion. A pesar de que algunos estudios demuestran una mayor efectividad de la capsaicina frente a placebo, son pocos los pacientes que refieren una respuesta importante cuando se utiliza como unica terapia del dolor neuropatico. En ocasiones es imposible realizar estudios de doble ciego debido a la sensacion quemante de la que hemos hablado. Carece de efectos secundarios sistemicos importantes, no obstante en la primera semana de tratamiento puede aparecer prurito o sensacion de quemazon en la zona de aplicacion, que tiende a desaparecer despues de la primera semana. Esta sensacion de quemazon constituye, junto con la limitada efectividad clinica, la principal limitacion de la aplicacion topica de capsaicina. La principal indicacion del uso de la capsaicina topica es la de coadyuvante de los antidepresivos y anticonvulsivantes en el tratamiento de los diversos cuadros de dolor neuropatico, ya que como terapia unica parece ser insuficiente. Es una opcion a tener en cuenta en los pacientes anosos afectos de dolor neuropatico, con lo que disminuiremos la incidencia de efectos secundarios sistemicos y de interacciones medicamentosas. EnglishNeuropathic pain is one of the most complex painful syndromes and one of the most difficult to treat. It is a symptom resulting from neurological damage (peripheral, central or both) affecting the pain nervous transmission system. Several drugs have been used, but none of them has resulted effective enough and their side effects frequently deter the continuation of the treatment. It can show up in different situations, all of which are more frequent in aged patients. A powerful analgesic with as little number ofside effects as possible is needed. This paper is a bibliographic review performed through the Medline data base of the treatment with topical capsaicin in different cases of neuropathic pain: postherpetic neuralgia, diabetic neuropathy, neuropathic pain associated to AIDS, trigeminal neuralgia, post-mastectomy painful syndromes and regional complex pain. The topical administration of capsaicin 0.075%, has shown to be effective for the management of dysesthesic pain and hence it is a therapeutic alternative for this type of pain. Its mechanism of action appears to be based on the selective stimulation of the neurons of amyelinic fibers C, causing the release of substance P and perhaps of other neurotransmitters; and finally, a depletion of substance P, which would disturb pain transmission to central systems, causing a desensitization phenomenon. While some studies have shown a greater effectiveness of capsaicin versus placebo, few patients have reported a significant response when it is used as monotherapy for neuropathic pain. Sometimes double-blind studies cannot be conducted due to the burning sensation referred to above. Its lacks significant systemic side effects, but during the first week of therapy an itching or burning sensation can appear in the application area that tends to disappear after the first week. This burning sensation is, together with the limited clinical effectiveness, the major limitation of the topical administration of capsaicin. The main indication of topical capsaicin is as co-adjuvant of antidepressants and anticonvulsants for the management of several neuropathic pain conditions, since as monotherapy it seems to be insufficient. It is an option that has to be considered in aged patients with neuropathic pain, since it presents a lower incidence of systemic side effects and drug interactions.
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