Rev. Soc. Esp. Dolor. 2020; 27(4): 273-277 / DOI: 10.20986/resed.2020.3818/2020
Iván H. Salazar, Rocha Romero, Juan Pablo Revelo, Andrés E. Mora
RESUMEN
El dolor abdominal crónico de origen benigno puede ser incapacitante y disminuye significativamente la calidad de vida de algunos pacientes. Para su tratamiento es usual el uso crónico de opioides que se han asociado a originar otras fuentes de dolor, por lo que deberían sopesar tratamientos farmacológicos alternativos.
Sin embargo, cuando estos no son efectivos, insuficientes u ocasionan efectos adversos intolerables, el manejo intervencionista del dolor debería considerarse. En este campo la inhibición de los nervios esplácnicos que es una técnica que puede ser empleada para el control del dolor oncológico, podría jugar un papel importante a pesar de que aún no cuenta con evidencia sólida de su aplicabilidad en tratar el dolor crónico de origen benigno.
Hasta donde sabemos, en el Ecuador es la primera vez que se realiza este procedimiento y el presente informe sugiere que puede ofrecer buenos resultados, incluso después de terminado el efecto de los fármacos utilizados.
ABSTRACT
Chronic abdominal pain of benign origin can be disabling and significantly reduces the quality of life of some patients. Common treatment includes the chronic use of opioids that have also been linked with causing different sources of pain, so alternative pharmacological treatments should be considered instead.
However, when these are not effective, insufficient, or cause intolerable adverse effects, interventional pain management should be considered. In this field, the inhibition of splanchnic nerves, which is a technique that can be used to control cancer pain, could play an important role in the treatment of chronic pain of benign origin, despite the lack of solid evidence in its applicability.
As far as we know, it is the first time that this procedure has been performed in Ecuador and this report suggests that it can offer positive results even after the effect of the drugs used has ended.
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Bibliografía
1. Loukas M, Klaassen Z, Merbs W, Tubbs RS, Gielecki J, Zurada A. A review of the thoracic splanchnic nerves and celiac ganglia. Clin Anat. 2010;23(5):512-22. DOI: 10.1002/ca.20964.
2. Plancarte-Sánchez R, Máyer-Rivera F, Guillén Núñez MR, Guajardo-Rosas J, Acosta-Quiroz CO. Abordaje transdiscal de los nervios esplácnicos Cir Ciruj. 2003;71(3):192-203.
3. Kapural L, Lee N, Badhey H, McRoberts WP, Jolly S. Splanchnic block at T11 provides a longer relief than celiac plexus block from nonmalignant, chronic abdominal pain. Pain Manag. 2019;9(2):115-21.
4. Celebi N, Sahin A, Canbay O, Uzümcügil F, Aypar U. Abdominal pain related to mitochondrial neurogastrointestinal encephalomyopathy syndrome may benefit from splanchnic nerve blockade. Paediatr Anaesth. 2006;16(10):1073-6. doi: 10.1111/j.1460-9592.2006.01918.x
5. Moeschler SM, Hoelzer BC, Eldrige JS. A patient with loin hematuria syndrome and chronic flank pain treated with pulsed radiofrequency of the splanchnic nerves. Clin J Pain. 2013;29(11):e26-e29. DOI: 10.1097/AJP.0b013e31828c8922.
6. Fernández López MT, López Otero MJ, Bardasco Alonso ML, Álvarez Vázquez P, Rivero Luis MT, López Barros G. Síndrome de Wilkie: a propósito de un caso. Nutr Hosp. 2011;26(3):646-9. DOI: 10.3305/nh.2011.26.3.5215.
7. Szigethy E, Knisely M, Drossman D. Opioid misuse in gastroenterology and non-opioid management of abdominal pain. Nat Rev Gastroenterol Hepatol. 2018;15(3):168-80. DOI: 10.1038/nrgastro.2017.141.
8. Cook SF, Lanza L, Zhou X, Sweeney CT, Goss D, Hollis K, et al. Gastrointestinal side effects in chronic opioid users: results from a population-based survey. Aliment Pharmacol Ther. 2008;27(12):1224-32. DOI: 10.1111/j.1365-2036.2008.03689.x.
9. Tuteja AK, Biskupiak J, Stoddard GJ, Lipman AG. Opioid-induced bowel disorders and narcotic bowel syndrome in patients with chronic non-cancer pain. Neurogastroenterol Motil. 2010;22(4):424-e96. DOI: 10.1111/j.1365-2982.2009.01458.x.
10. Bistritz L, Bain VG. Sphincter of Oddi dysfunction: Managing the patient with chronic biliary pain. World J Gastroenterol. 2006;12(24):3793-802. DOI: 10.3748/wjg.v12.i24.3793.
11. Wu SD, Zhang ZH, Jin JZ, Kong J, Wang W, Zhang Q, et al. Effects of narcotic analgesic drugs on human Oddi’s sphincter motility. World J Gastroenterol. 2004;10(19):2901-4. DOI: 10.3748/wjg.v10.i19.2901.
12. Afghani E, Lo SK, Covington PS, Cash BD, Pandol SJ. Sphincter of Oddi Function and Risk Factors for Dysfunction. Front Nutr. 2017;4:1. DOI: 10.3389/fnut.2017.00001.
13. Gurusamy KS, Lusuku C, Davidson BR. Pregabalin for decreasing pancreatic pain in chronic pancreatitis. Cochrane Database Syst. Rev 2016;2:CD011522. DOI: 10.1002/14651858.CD011522.pub2.
14. Xie C, Tang Y, Wang Y, Yu T, Wang Y, Jiang L et al. Efficacy and safety of antidepressants for the treatment of Irritable Bowel Syndrome: a meta-analysis. PLoS ONE. 2015;10(8);e0127815. DOI: 10.1371/journal.pone.0127815.
15. Daghaghzadeh H, Naji F, Afshar H, Sharbafchi MR, Feizi A, Maroufi M, et al. Efficacy of duloxetine add on in treatment of inflammatory bowel disease patients: a double-blind controlled study. J Res Med Sci. 2015;20(6):595-601. DOI: 10.4103/1735-1995.165969.
16. Plancarte Sánchez R, Guajardo Rosas J, Guillen Nuñez R. Manejo Integral del Dolor. Cancerología. 2006;1:273-81.
17. Herrero Trujillano M, Mendiola de la Osa A, Insausti Valdivia J, Pérez-Cajaraville J. Revisión de los procedimientos intervencionistas neurolíticos en el dolor asociado al cáncer de páncreas. Propuesta de algoritmo. Rev Soc Esp Dolor. 2019;26(6):342-58. DOI: 1020986/resed20193715/2018.
18. Kapural L, Jolly S. Interventional Pain Management Approaches for Control of Chronic Pancreatic Pain. Curr Treat Options Gastroenterol. 2016;14(3):360-70. DOI: 10.1007/s11938-016-0100-4.
19. Radiofrequency thermocoagulation of the thoracic splanchnic nerve in functional abdominal pain syndrome -A case report. Korean J Anesthesiol. 2011;61(1):79-82. DOI: 10.4097/kjae.2011.61.1.79.
20. Olesen SS, Frøkjær JB, Lelic D, Valeriani M, Drewes AM. Pain-associated adaptive cortical reorganisation in chronic pancreatitis. Pancreatology. 2010;10(6):742-51. DOI: 10.1159/000321644.
21. Woolf CJ. Central sensitization: implications for the diagnosis and treatment of pain. Pain. 2011;152(3 Suppl):S2-S15. DOI: 10.1016/j.pain.2010.09.030.
22. Zhao X, Xu M, Jorgenson K, Kong J. Neurochemical changes in patients with chronic low back pain detected by proton magnetic resonance spectroscopy: A systematic review. Neuroimage Clin. 2016;13:33-8. DOI: 10.1016/j.nicl.2016.11.006.
23. Garcea G, Thomasset S, Berry DP, Tordoff S. Percutaneous splanchnic nerve radiofrequency ablation for chronic abdominal pain. ANZ J Surg. 2005;75(8):640-4. DOI: 10.1111/j.1445-2197.2005.03486.x.
24. Choi JW, Joo EY, Lee SH, Lee CJ, Kim TH, Sim WS. Radiofrequency thermocoagulation of the thoracic splanchnic nerve in functional abdominal pain syndrome -A case report-. Korean J Anesthesiol. 2011;61(1):79-82. DOI: 10.4097/kjae.2011.61.1.79.