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2019, Número 3

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Ortho-tips 2019; 15 (3)


Nuevas perspectivas del dolor en el paciente diabético

Fernández FM

Idioma: Español
Referencias bibliográficas: 49
Paginas: 171-184
Archivo PDF: 324.35 Kb.


RESUMEN

El dolor en el paciente diabético estaba clásicamente asignado a la polineuropatía periférica que estos pacientes desarrollan como parte de su enfermedad. Era un dolor innegablemente neuropático y a eso se ha ceñido su consideración durante mucho tiempo. Pero conforme se ha ido profundizando en el conocimiento fisiopatológico y clínico del dolor en general, el cuadro doloroso expresado en el diabético también ha experimentado ciertos cambios fundamentales. Al dolor típicamente neuropático de los pacientes diabéticos, con una doble base por la polineuropatía desmielinizante y la pérdida axonal, se suman las manifestaciones dolorosas secundarias a los fenómenos inflamatorios locales, a la isquemia, al dolor mixto de las artropatías concomitantes y a la neuropatía autonómica simpática distal. Hay que tener en cuenta la hiperactividad espontánea de los nociceptores, sus varios componentes periféricos y centrales, su cronicidad y su frecuente carácter inflamatorio. El comportamiento del dolor en los pacientes diabéticos es variable, ya que en muchas ocasiones se presenta sin componentes neuropáticos y siendo fundamentalmente articular y/o vascular en un alto porcentaje de casos, con una centralización secundaria. De hecho, hay autores que apuntan su carácter de dolor mixto en múltiples instancias. Enfocar el dolor, en el paciente diabético, en esa dirección diagnóstica y terapéutica puede mejorar la expectativa en cuanto a mejoría y calidad de vida de esos pacientes.


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