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Inicio Gaceta Médica de Bilbao Antiinflamatorios no esteroideos y paracetamol en el tratamiento del dolor
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Vol. 104. Núm. 4.
Páginas 148-155 (Enero 2007)
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Vol. 104. Núm. 4.
Páginas 148-155 (Enero 2007)
Acceso a texto completo
Antiinflamatorios no esteroideos y paracetamol en el tratamiento del dolor
Nonsteroidal anti-inflamatory drugs and paracetamol in pain treatment
Antiinflamatorio ez- esteroideoak eta parazetamola minaren tratamenduan
Visitas
106508
Vicente Ortiz-Pereda1,
Autor para correspondencia
vortip@gmail.com

Correspondencia: Vicente Ortiz-Pereda. Servicio de Anestesia, Reanimación y tratamiento del Dolor. Hospital de Basurto. 48013 Bilbao. Bizkaia. España UE.
, Maite López1, Agustín Arroita1, Luciano Aguilera2, Jon Azkue3, F. Torre-Mollinedo4, A. Isla-Baranda5
1 Unidad del Dolor del Hospital de Basurto. Servicio de Anestesiología, Reanimación y Tratamiento del Dolor. Bilbao. Bizkaia. España. UE
2 Servicio de Anestesiología, Reanimación y Tratamiento del Dolor del Hospital de Basurto. Bilbao. Bizkaia. España. UE
3 Profesor adjunto al Departamento de Neurociencias, Escuela de Medicina y Odontología, Universidad del País Vasco. Leioa. Bizkaia. España. UE
4 Unidad del Dolor del Hospital de San Eloy. Servicio de Anestesiología, Reanimación y Tratamiento del Dolor. Barakaldo. Bizkaia. España. UE
5 Unidad del Dolor del Hospital de Galdakao-Usansolo. Servicio de Anestesiología, Reanimación y Tratamiento del Dolor. Galdakao. Bizkaia. España. UE
Este artículo ha recibido
Información del artículo
Resumen

Los antiinflamatorios no esteroideos (AINES) y el PARACETAMOL incluye un grupo de fármacos con estructuras químicas diferentes que forman junto a la medicación coadyuvante el primer escalón del tratamiento del dolor propuesto por la OMS o que complementa la analgesia en los demás escalones. Estos medicamentos poseen un mecanismo de acción periférico sobre el proceso inflamatorio y también central minorando la transmisión del impulso doloroso. Se estudia su eficacia en los diversos tipos de dolor. Se discutirá la posibilidad de obtener analgesia con estos fármacos valorando las distintas familias de los mismos y sus características farmacológicas específicas, incluyendo los nuevos inhibidores selectivos de la COX-2. Se revisan los efectos adversos de estos medicamentos en especial sus acciones en el sistema gastrointestinal, renal, cardiovascular, hepático y hematológico, sus reacciones de hipersensibilidad y posibles interferencias medicamentosas. Por ultimo se sugiere una guía para su uso correcto.

Palabras clave:
Antiinflamatorios no esteroideos
paracetamol
dolor agudo
dolor crónico
dolor oncológico
analgesia
efectos adversos
Summary

Nonsteroidal anti-inflammatory drugs (NSAIDS) and PARACETAMOL include a group of medications with different chemical structures which form, together with coadyuvant medication, the first step in pain treatment proposed by the OMS or which complements analgesia in other steps. These medications have a peripheral mechanism which acts on the inflammation and a central one which decreases pain transmission. A discussion will take place over the possibility of obtaining analgesia with these drugs valuing their different families and their pharmacological characteristics, including new selective COX-2 inhibitors. These medications' adverse effects are revised, especially their actions in the gastrointestinal, renal, cardiovascular, hepatic, and hematological systems, their hypersensibility reactions and possible medicinal interferences. Finally, a guideline of correct use is suggested.

Key words:
nonsteroidal anti-inflamatory drugs
paracetamol
acute pain
chronic pain
cancer pain
analgesia
adverse effects
Laburpena

Antiinflamatorio ez esteroideoek (AIEE) eta parazetamolak egitura kimiko ezberdineko farmako talde bat osatzen dute. MOEk proposatutako minaren tratamendu-eskeileraren lehenengo maila osaten dute, sendagai osagarriekin batera, eta eskailararen gainontzeko mailetan ere analgesia osatxeko erabiltzen dira. Sendagaion eragina periferian gauzatzen da, inflamazioan bertan, baina eragina dute baita erdiko nerbio sisteman ere, minaren garraio sinaptikoa eragotziz. Lan honetan min mota ezberdinetan duen eragina aztertzen da. Analgesia lostzeko duten ahalmena izango da hizpide, familia ezberdinen farmakologi ezaugarri bereziak aintzat hartuz, eta COX-2ren berariazko eragozleak ere aztertuz. Sandagai hauen albo eraginak aztertzen dira, batez ere digestio-aparatuan, gernu aparatuan, bihotz eta hodi aparatuan, gibelean eta odolean dituen eraginak, eta baita sortzen dituzten hipersentsibilitate erreakzioak eta beste farmakoekiko elkarreraginak ere. Azkenik, sendagaiok egoki erabiltzeko jarraibideak proposatzen dira.

Hitz gakoak:
Antiinflamatorio ez- esteroideoak
Parazetamola
Min akutua
Min kronikoa
Min tumorala
Analgesia
Eragin desiragaitzak
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Bibliografía
[1.]
Practice Guidelines for Cancer Pain Management A Report by the American Society of Anesthesiologists Task Force on Pain Management, Cancer Pain Section.
Anesthesiology, 84 (1996), pp. 1243-1257
[2.]
Levy, Michael H..
Drug Therapy: Pharmacologic Treatment of Cancer Pain.
New England Journal of Medicine, 335 (1996), pp. 1124-1132
[3.]
World Health Organization. Cancer pain relief. Geneva: World Health Organization, 1986.
[4.]
Jenkins CA, Bruera E. Nonsteroidal antiinflammatory drugs as adjuvant analgesics in cancer patients.
[5.]
Vane J.R..
Inhibition of prostaglandin synthesis as a mechanism of action from aspirin-like drugs.
Nature New Biology, 231 (1971), pp. 232-239
[6.]
Vane J.R., Botting R.M..
Mechanism of action of nonsteroidal antiinflammatory drugs.
Am J Med., 104 (1998), pp. 2S-8S
[7.]
Jurna I., Brune K..
Central effect of the nonsteroidal antiinflammatory agents, indomethacin, ibuprofen and diclofenac, determined in C fibre-evoked activity in single neurones of the rat thalamus.
Pain, 41 (1990), pp. 71-80
[8.]
Bjorkman R..
Central antinociceptive effects of Nonsteroidal antiinflammatory drugs and paracetamol.
Acta Anaesthesiol Scand Supl., 103 (1995), pp. 1-44
[9.]
Fu J.Y., Masferrer J.L., Seibert K., et al.
The induction and supresion of prostaglandin H2 synthasa (cyclooxygenasa) in human monocytes.
J Biol Chem, 265 (1990), pp. 16737-16740
[10.]
Chan C.C., Boyce S., Briedeau C., et al.
Rofecoxib [Vioxx, MK-0966;4-(4'-methylsulfonylphenyl)-3-phenyl-2-(5H)-furanona]: a potent and orally active cyclooxigenase-2 inhibitor: pharmacological and bioquimical profiles.
J PharmacolExp Ther., 290 (1999), pp. 551-560
[11.]
Cryer B., Feldman M..
Cyclooxygenasa-1 and Cyclooxygenasa-2 selectivity of widely used nonsteroidal anti-inflamatory drugs.
Am J Med., 104 (1998), pp. 421-423
[12.]
Gierse J.K., Koboldt C.M., Walker M.C., Seibert K., Isakson P.C..
Kinetics basis for selective inhibition of cyclo-oxigenases.
Biochem J., 44 (1999), pp. 293A
[13.]
Gebhart G.F., McCormack K.J..
Neuronal plasticity. Implication for pain therapy.
Drugs, 47 (1994), pp. 1-47
[14.]
Bonnefont J., Courade J.P., Alloui A., Eschalier A..
Antinociceptive mechanism of action of paracetamol.
Drugs, 63 (2003), pp. 1-4
[15.]
Yask T.L., Dirig D.M., Malmberg A.B..
Mechanism of action of nonsteroidal anti-inflammatory drugs.
Cancer Invest, 16 (1998), pp. 509-527
[16.]
Millan M.J..
Descending control of pain.
Prog Neurobiol., 66 (2002), pp. 355-474
[17.]
Libert F., Bonnefont J., Bourinet E., Doucet E., Alloui A., Hamon M., Nargeot J., Eschalier A..
Acetaminophen: A Central Analgesic Drug That Involves a Spinal Tropisetron-Sensitive, Non–5-HT3 Receptor-Mediated Effect.
Mol Pharmacol, 66 (2004), pp. 728-734
[18.]
Flower R.J., Vane J.R..
Inhibition of prostaglandin syntetase in brain explains the antipyretic activity of paracetamol (4-acetaminophenol).
Nature, 240 (1972), pp. 410-411
[19.]
Eisenberg E., Berkey C.S., Carr D.B., Mosteller F., Chalmers T.C..
Efficacy and safety of Nonsteroidal anti-inflammatory drugs for cancer pain: a meta-analysis.
J Clin Oncol, 12 (1994), pp. 2756-2765
[20.]
Schug S.A., Dunlop R., Zech D..
Pharmacological management of cancer pain.
Drugs, 43 (1992), pp. 44-53
[21.]
Inturrisi C.E..
Management of cancer pain. Pharmacology and principles of management.
Cancer, 63 (1989), pp. 2308-2320
[22.]
Tulder M van, Scholten RJ, Koes BW, Deyo RA. Nonsteroidal antiinflamatory drugs for low back pain. A systematic review within the framework of cochrane collaboration back review group. Spine; 25:2501-2513.
[23.]
World Health Organitation.
Cancer Pain Relief: with a guide to opioid availability, World Health Organization, (1966),
[24.]
Americam College of Rheumatology Subcomittee on osteoarthritis of the hip and knee: 2000 update..
Americam College of Rheumatology Subcomittee on osteoarthritis Guidelines.
[25.]
Lipton R.B., Baggish J.S., Stewart W.F., Codispoti J.R., Fu M..
Efficacy and safety of acetaminophen in the treatment of migraine: results of a randodomized, double-blind, placebo-controlled, population-based study.
Archives of internal medicine, 160 (2000), pp. 3486-3492
[26.]
Miranda H.F., Puig M.J., Prieto J.C., Pinardi G..
Synergism betwen paracetamol and nonsteroidal anti-inflamatory drugs in experimental acute pain.
[27.]
Simon L.S. MD.
Biologic and clinical effects of the COX-2-specific inhibitors compared with traditional NSAIDs.
Current Opinion in Rheumatology, 12 (2000), pp. 163-170
[28.]
Feldman M., McMahon A.T..
Do cyclooxygenase-2 Inhibitors provide benefits similar to those of traditional nonsteroidal anti-inflamatory drugs, with less gastrointstinal toxicity?.
Annals Internal Medicine, 132 (2000), pp. 134-143
[29.]
Cryer B., Kimmey M.B..
Gastrointestinal Side Effects of Nonsteroidal Anti-inflamatory Drugs.
American Journal of Medicine, 105 (1998), pp. 20S-30S
[30.]
Gabriel S.E., Jaakkimainen L., Bombardier C..
Risk for serious gastrointestinal complications related to use of nonsteroidal anti-inflammatory drugs. A meta-analysis.
Ann Intern Med., 115 (1991), pp. 787-796
[31.]
Singh G..
Recent consideratins in nonsteroidal antiinflamatory Drug gastropathy.
American Journal of Medicine, 105 (1998), pp. 31S-38S
[32.]
Silverstein F.E., Graham D.Y., Senior J.R., Davies H.W., Struthers B.J., Bittman R.M., et al.
Misoprostol reduces serious gastrointestinal complications in patients with rheumatoid arthritis receiving nonsteroidal antiinflammatory drugs. A randomized, double-blind, placebo-controlled trial.
Ann Intern Med., 123 (1995), pp. 241-249
[33.]
French P.C., Darekar B.S., Mills J.G., Wood J.R..
Ranitidine in the prevention of non-steroidal antiinflammatory drug-associated gastric and duodenal ulceration in arthritic patients.
Eur J Gastroenterol Hepatol, 6 (1994), pp. 1.141-1.147
[34.]
Taha A.S., Hudson N., Hawkey C.J., Swannell A.J., Trye P.N., Cottrell J., et al.
Famotidine for the prevention of gastric and duodenal ulcers caused by nonstroidal antiinflammatory drugs.
N Engl J Med., 334 (1996), pp. 1.435-1.439
[35.]
Becker J.C., Domschke, Thorsten W..
Current approaches to prevent NSAID-induced gastropathy – COX selectivity and beyond.
Br J Clin Pharmacol., 58 (2004), pp. 587-600
[36.]
Hawkey C.J., Karrassch J.A., Szcepañski L., Walker D., Burkun A., Swannell A.J., et al.
for the Omeprazole versus Misoprostol for NSAID-Induced Ulcer Management (OMNIUM) Study Group Omeprazol compared with misoprostol for ulcers associated with nonsteroidal antiinflammatory drugs.
N Engl J Med., 338 (1998), pp. 727-734
[37.]
Yeomans N.D., Tulassay Z., Juhász L., Rácz I., Howard J.M., Van Rensburg J., et al.
for the Acid Supression Trial Ranitidine versus Omeprazole for NSAID-Associated Ulcer Treatment (ASTRONAUT) Study Group.
N Engl J Med., (1998), pp. 719-772
[38.]
Whelton A..
Nephrotoxicity of nonsteroidal antiinflamatory drugs: Phisiologic foundations and clinical implications.
Am J Med., 106 (1999), pp. 13S-24S
[39.]
Swan S.K., Rudy D.W., Lasseter K.C., et al.
Effet of cyclooxygenasa-2 inhibition on Renal Funtion in Elderly Persons receiving a Low – Salt Diet: A Randomized Trial.
Ann Inter Med., 133 (2000), pp. 1-9
[40.]
Walshe Venuto R.C..
Acute oliguric renal failure induced by indomethacin: possible mechanisms.
Ann Intern Med., 91 (1979), pp. 47-49
[41.]
Whelton A., Stout R.L., Spilman P.S., Klassen D.K..
Renal effects of ibuprofen, piroxicam, and sulindac in patients with asyntomatic renal faliure. A prospective, randomized, crossover comparation.
Ann Intern Med., 112 (1990), pp. 568-576
[42.]
Abraham P.A., Keane W.F..
Glomerular and interstitial disease induced by nonsteroidal anti-inflamatory drugs.
Am J Nephrol., 4 (1984), pp. 1-6
[43.]
Pope J.E., Anderson J.J., Felson D.T..
A meta-analysis of the effects of nonsteroidal anti-inflamatory drugs on blood pressure.
Arch Intern Med., 153 (1993), pp. 477-484
[44.]
Tolman K.G..
Hepatotoxicity of non-narcotic analgesics.
Americam Journal of Medicine, 105 (1998), pp. 13S-19S
[45.]
Rumack B.H., Peterson R.C., Koch G.G., Amara I.A..
Acetaminophen overdose. 662 cases with evaluation of oral acetylcysteine treatment.
Arch. Intern. Med., 141 (1981), pp. 380-385
[46.]
Schafer A.I..
Effects of nonsteroidal antiinflamatory therapy on platelets.
Am J Med., 106 (1999), pp. 25S-36S
[47.]
Rybak M.E.M..
Hematologic effects of nonsteroidal anti-inflammatory drugs.
NSAIDs: a profile of adverse effects, pp. 113-132
[48.]
Szczeklik A Analgesics, allergy and asthma. In: Lasagna L, Prescott L F (eds) Non-narcotic analgesics today: benefits and risks.Drugs 1986 32 (suppl 4):148-163.
[49.]
US Food and Drug Administration. FDA Talk Paper: FDA issues public health advisory recommending limited use of Cox-2 inhibitors. Available at: http://www.fda.gov/bbs/topics/ANSWERS/2004/ANS01336.html.
[50.]
McGettigan P., Henry D..
Cardiovascular risk and inhibition of cyclooxygenase. A systematic review of the observational studies of selective and no selective inhibitors of cyclooxigenase 2.
[51.]
Gunnar H.G., Søren J., et al.
Risk of Death or Reinfarction Associated With the Use of Selective Cyclooxygenase-2 Inhibitors and Nonselective Nonsteroidal Antiinflammatory Drugs After Acute Myocardial Infarction.
Circulation, 113 (2006), pp. 2906-2913
[52.]
Grosser T., Fries S., FitzGerald G.A..
Biological basis for the cardiovascular consequences of COX-2 inhibition: therapeutic challenges and opportunities.
J. Clin Invest., 116 (2006), pp. 4-15
[53.]
US Food and Drug Administration. Science Paper. Concomitant use of ibuprofen and aspirin: Potential for attenuation of the anti-platelet effect of aspirin. September 2006. Available at: http://www.fda.gov/cder/drug/infopage/ibuprofen/science_paper.htm.
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