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2000, Número 1

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Salud Mental 2000; 23 (1)


Papel del sistema mesolímbico dopaminérgico en el componente afectivo del dolor crónico

Sotres-Bayon F, Pellicer F

Idioma: Español
Referencias bibliográficas: 77
Paginas: 23-29
Archivo PDF: 136.84 Kb.


RESUMEN

El dolor es un evento reconocible, localizable topológicamente, de duración definible, y de contenido emocional aversivo. La Asociación Internacional para el Estudio del Dolor lo ha definido como una experiencia sensorial y emocional desagradable relacionada con un daño real o potencial del tejido, que incluye una serie de conductas relacionadas con el dolor, visibles o audibles, que pueden ser modificadas por el aprendizaje.
Por su duración se ha propuesto clasificarlo en: dolor agudo o fásico y dolor crónico o tónico. El dolor agudo conducido por el sistema espinotalámico lateral es breve y dismuye rápidamente en intensidad. El dolor crónico es persistente y se conduce por el sistema espinotalámico medial.
Se han desarrollado modelos animales de dolor crónico con los que se intenta esclarecer la forma de operar de un fenómeno complejo que requiere de alternativas terapéuticas más racionales. Hay tres modelos básicos al respecto: el foco central irritativo, la deaferentación y la hiperestimulación. Nuestro grupo desarrolló un modelo de hiperestimulación, inyectando carragenina (CAR) intraplantar, por medio de la cual se dispara una conducta de auto lesión (CAL) asociada con la entrada de información dolorosa, persistente y desagradable. Esta misma conducta anormal se presenta en los síndromes humanos como: el de Lesh-Nyhan, Gilles de la Tourette, analgesia congénita, y los trastornos psiquiátricos como el obsesivo compulsivo, depresión y esquizofrenia. En los animales, esta conducta anormal se ha relacionado con los dolores disestésicos, dolores espontáneos, con la hiperalgesia y la alodinia, que al igual que el dolor crónico, son muy variables de uno a otro individuo, y en las que intervienen factores genéticos, cognoscitivos y afectivos no muy bien identificados hasta el momento.
Se ha relacionado al sistema límbico con los procesos afectivos y cognoscitivos. Una de las áreas cerebrales vinculadas al sistema límbico es la corteza anterior del cíngulo (CAC), cuya ablación (cingulotomía) disminuye la sensación dolorosa desagradable en algunos pacientes con dolor crónico.
Por otro lado, una de las estructuras estrechamente relacionadas con el sistema límbico, y más específicamente con la CAC, es el área tegmental ventral (ATV). Diversos trabajos postulan la acción dopaminérgica de este núcleo sobre la CAC. Esta recibe proyecciones neurales, principalmente dopaminérgicas, del ATV por medio del haz medial del cerebro anterior. Se ha indicado que la estimulación eléctrica del ATV aumenta el umbral de la respuesta conductual a la estimulación nociceptiva en la rata. Más aún, hay evidencia electrofisiológica de la actividad de las neuronas nociceptivas en la CAC, susceptibles de inhibirse por la estimulación eléctrica del ATV. En las ratas neurectomizadas se ha observado que la autoestimulación del ATV disminuye la conducta de autotomía; por el contrario, la lesión de este núcleo induce un incremento en la conducta antes mencionada.
En esta revisión se destaca la importancia del sistema mesolímbico dopaminérgico en la compleja experiencia afectiva del dolor.


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