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2012, Número 5

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Salud Mental 2012; 35 (5)


Procesamiento central del dolor neuropático: una aproximación integrativa

Coffeen U, Simón K, Mercado F, Almanza A, Magis L, Jaimes O, Contreras B, Pellicer F

Idioma: Español
Referencias bibliográficas: 66
Paginas: 367-374
Archivo PDF: 133.09 Kb.


RESUMEN

El término “matriz del dolor” se refiriere a todas las estructuras y vías del Sistema Nervioso Central relacionadas con la integración del dolor. Nuestro grupo estudia desde hace varios años los principales mecanismos involucrados en el desarrollo del dolor a largo plazo. Nos hemos enfocado en el estudio de diferentes núcleos y vías cortico- límbicas que están relacionadas con la parte afectiva-cognitiva, así como en la memoria de los procesos dolorosos. Dentro de estos núcleos se encuentra el área tegmental ventral (ATV), la corteza anterior del cíngulo (CAC) y la corteza insular. El ATV es una estructura principalmente dopaminérgica con proyecciones a la CAC y a la corteza insular. Como se verá más adelante, estimular este núcleo disminuye la nocicepción, mientras que el lesionarlo, la aumenta. En la CAC se ha estudiado cómo aminoácidos excitadores como el glutamato aumentan la nocicepción y cómo, por el contrario, los aminoácidos inhibitorios como la taurina, la disminuyen. Además esta corteza está relacionada con mecanismos de memoria dolorosa. Hemos visto que el bloqueo de receptores colinérgicos disminuye la adquisición de la memoria relacionada al dolor. Además, un estímulo nociceptivo aumenta la expresión de los receptores muscarínicos inhibitorios M2. En el caso de la corteza insular, se ha estudiado principalmente el papel del sistema dopaminérgico. Hemos encontrado que el bloqueo de receptores dopaminérgicos D2 disminuye de manera significativa la nocicepción neuropática. Encontramos también que los niveles extracelulares de dopamina en esta región disminuyen a consecuencia de un proceso inflamatorio, además de que disminuye la expresión del RNAm de los receptores excitadores D1 y aumenta la de los receptores inhibidores D2. A pesar del avance que se ha obtenido en esta área de investigación, se necesitan más estudios para integrar la relación entre los diferentes sistemas de neurotransmisión y poder proponer alternativas a los tratamientos convencionales para las diferentes patologías que cursan con una experiencia dolorosa.


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