Uso de medicações por via subaracnóidea no tratamento da dor crônica

Abstract

Several advances were achieved in controlling pain with intrathecal administration of the above-mentioned drugs. Certainly some will be used, thus enriching therapeutic armamentarium, and others will be temporarily or permanently abandoned. However, several clinical and experimental studies will still be needed for knew knowledge to be incorporated and safely used by professionals dealing with chronic pain.

Quercetin action on pain modulation/ Ação da quercetina sobre a modulação da dor

“…In this study, due to the fact that the groups threshold (figure 6) was lower when compared to the same groups when they passed the baseline test (figure 2), the possibility of NO production from L-arginine, consequently causing a painful condition and as the group results Q50 and PC in figure 5 were similar, it is believed that quercetin does not act in this way. It was verified also the possible influence on cholinergic system, specifically in muscarinic receptors, due to studies showing high density of this receptor type in dorsal spine surface areas, having an antinociceptive effect triggered by direct agonists responsible for cholinesterase inhibition 23 .…”

O papel dos bloqueios anestésicos no tratamento da dor de origem cancerosa

“…Não há dúvidas de que estes pacientes são altamente beneficiados com o uso de pequenas doses de morfina injetada no espaço peridural ou no subaracnóideo, possivelmente associada com anestésico local ou com drogas adjuvantes como cetamina 22 e a clonidina 23 , quando há dores neuropáticas, aumentando os efeitos antinociceptivos e reduzindo a amplificação e prolongamento do estímulo doloroso na medula espinhal e da excitabilidade neuronal, pois atuam com diferentes mecanismos. Outras drogas como neostigmina, amitriptilina, benzodiazepínicos são propostas na literatura como adjuvantes para serem empregadas por estas vias 24 . Aassociação de morfina com a bupivacaína em baixas doses nas vias citadas tem sido proposta como o 4º passo da escada analgésica da OMS.…”

“…It is clear that those patients are highly benefited with the use of low epidural or spinal morphine doses, possibly associated to local anesthetics or adjuvant drugs such as ketamine 22 and clonidine 23 , when there is neuropathic pain, increasing anti-noxious effects and decreasing painful stimulation amplification and duration in the spinal cord and neuronal excitability, because they act through different mechanisms. Other drugs, such as neostigmine, amitriptiline and benzodiazepines are proposed by the literature as adjuvants to be administered through these routes 24 . The association of low dose bupivacaine and morphine by the above-mentioned routes has been proposed as the 4 th step in the WHO analgesic stair.…”