La Evidencia para el Tratamiento Farmacológico del Dolor Neuropático
Publicado Originalmente en Revista Pain 150 (2010) 573–581
DOI:
https://doi.org/10.47924/neurotarget2011325Palabras clave:
dolor neuropático, tratamiento farmacológico, evidencia, número necesario a tratarResumen
Los ensayos randomizados, doble ciegos, controlados con placebo sobre el dolor neuropático son cada vez más comunes y por ende se necesita una revisión actualizada de la evidencia disponible. Los estudios fueron identificados por medio de búsquedas en MEDLINE y EMBASE. Los valores del número necesario a tratar (NNT) y número necesario a dañar (NND) se utilizaron para comparar la eficacia y seguridad de los diferentes tratamientos para un número de condiciones dolorosas neuropáticas. Se incluyeron ciento setenta y cuatro estudios, lo que representa un 66% de incremento en los ensayos randomizados, controlados con placebo publicados en los últimos 5 años. Se examinó la polineuropatía dolorosa (más comúnmente debida a diabetes) en 69 estudios, neuralgia post-herpética en 23, mientras que la injuria nerviosa periférica, dolor central, neuropatía por HIV, y neuralgia de trigémino fueron estudiados con menor frecuencia. Los antidepresivos tricíclicos, los inhibidores de la recaptación de serotonina y noradrenalina, los anticonvulsivantes gabapentina y pregabalina, y los opioides son las clases de drogas para las cuales existe la mejor evidencia de un efecto clínico relevante. A pesar del 66% de incremento en los ensayos publicados, sólo se obtuvo una limitada mejoría en el tratamiento del dolor neuropático. Una amplia proporción de pacientes con dolor neuropático permanece con un insuficiente alivio del dolor. Este hecho exige otras opciones de tratamiento para abordar el dolor neuropático crónico. Para evaluar la hipótesis de que una clasificación basada en el mecanismo puede ayudar a mejorar el tratamiento de pacientes individuales, se necesitan ensayos farmacológicos de gran escala que apunten a identificar los posibles subgrupos de pacientes que tengan probabilidades de responder a drogas específicas.
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Derechos de autor 2011 Nanna Brix Finnerup, Søren Hein Sindrup, Troels Staehelin Jensen
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