Topiramato: una alternativa para los pacientes con dolor neuropático de baja respuesta a los opioides y otros anticonvulsivantes

• Autores: J. Cevas, M. Somovilla, C. Rodríguez, J. L. García-Llano
• Localización: Revista de la Sociedad Española del Dolor (SED), ISSN 1134-8046, Vol. 12, Nº. 2, 2005, págs. 93-97
• Idioma: español
• Títulos paralelos:
  • Topiramate: an alternative for patients with neuropathic pain refractory to treament with opiates and other anticonvulsants
• Enlaces
  • Texto completo (pdf)
• Resumen
  • español

    El dolor neuropático en los pacientes oncológicos representa un reto difícil, con tratamientos poco exitosos, que representan un desafío terapéutico para los clínicos dedicados al cuidado de estos pacientes. Recientes estudios han vuelto a demostrar la utilidad de los tratamientos con opiáceos en este tipo de dolor. La introducción de la gabapentina ha representado una esperanza para los pacientes y los sanitarios, pero presenta fracasos terapéuticos de difícil rescate. Se presenta una casuística de 16 pacientes afectos de cáncer avanzado, con dolor neuropático resistente a los tratamientos empleados, inclusive la gabapentina, introduciendo en ellos el topiramato a dosis bajas como forma de tratamiento de rescate. De los 16 pacientes tratados, 7 logran un control satisfactorio del dolor, rebajando la escala de intensidad del dolor más de un 50%. Se reflejan las características de los pacientes, las escalas de valoración empleadas y los efectos secundarios registrados. Tres de los pacientes abandonaron la medicación antes de tiempo por efectos psicológicos.

  • English

    Neuropathic pain in cancer patients is a difficult problem, given the limited effectiveness of treatments that raise a therapeutic challenge for health professionals providing care to these patients. Recent studies have shown again the effectiveness of opiates for the management of this type of pain. The introduction of gabapentin has given hope to patients and health professionals, but it has therapeutic failures with a difficult rescue. We present a series of 16 patients with advanced cancer and neuropathic pain refractory to prior treatments, including gabapentin, that received low doses of topiramate as rescue therapy. Pain relief was satisfactory in 7 of the 16 patients treated and pain severity score improved more than 50%. We describe the patient characteristics, the assessment scales that were used and the side effects that were reported. Three patients discontinued the study medication before the end of the study because of psychological effects.

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