Terapias de Tratamiento Farmacológico en la Radiculopatía Cervical Secundarias a Hernias de Disco: Artículo de Revisión
Resumen
La radiculopatía cervical (RC) impone un gran impacto epidemiológico en el ámbito personal y socioeconómico. Es una de las 5 condiciones principales de dolor crónico (DC) en términos de prevalencia y años perdidos por discapacidad. Aunque la mayoría de los episodios agudos se resuelven espontáneamente, más de un tercio de los afectados tendrán síntomas leves y/o recurrentes por más de 1 año. Los antiinflamatorios no esteroideos (AINES) son eficaces para el dolor agudo, y la práctica clínica se guía principalmente por los resultados de estudios realizados para otras condiciones de DC. El objetivo de este trabajo es realizar una revisión detallada de las terapias farmacológicas actuales más eficaces para el tratamiento de la RC por hernia de disco, basándonos en diversas plataformas científicas y bases de datos especializadas internacionales y nacionales en inglés y español, incluyendo alrededor de 65 artículos actualizados que brindan esta información pertinente. Se observó que existen pocos artículos de investigación enfocados en el tratamiento farmacológico de la RC, sin embargo, la mayoría concluyen en que se debe de iniciar el manejo del dolor de manera personalizada, considerando los comórbidos de cada paciente; iniciando con paracetamol, AINES, AINES-selectivos, derivados débiles opioides y/o en combinación con fármacos neuromoduladores.
Descargas
Citas
Adams, M. A., Lama, P., Zehra, U., & Dolan, P. (2015). Why do some intervertebral discs degenerate, when others (in the same spine) do not? Clinical Anatomy, 28(2), 195–204.
https://doi.org/10.1002/ca.22404
Bednarik, J., Kadanka, Z., Dusek, L., Kerkovsky, M., Vohanka, S., Novotny, O., Urbanek, I., & Kratochvilova, D. (2008). Presymptomatic spondylotic cervical myelopathy: an updated predictive model. European Spine Journal, 17(3), 421–431. https://doi.org/10.1007/s00586-008-0585-1
Chang, V., Gonzalez, P., & Akuthota, V. (2008). Evidence-informed management of chronic low back pain with adjunctive analgesics. The Spine Journal, 8(1), 21–27.
https://doi.org/10.1016/j.spinee.2007.10.006
Chou, R. (2010). Pharmacological Management of Low Back Pain. Drugs, 70(4), 387–402. https://doi.org/10.2165/11318690-000000000-00000
Chou, R., & Huffman, L. H. (2007). Medications for Acute and Chronic Low Back Pain: A Review of the Evidence for an American Pain Society/American College of Physicians Clinical Practice Guideline. Annals of Internal Medicine, 147(7), 505. https://doi.org/10.7326/0003-4819-147-7-200710020-00008
Chronic pain: lifetime psychiatric diagnoses and family history. (1985). American Journal of Psychiatry, 142(10), 1156–1160. https://doi.org/10.1176/ajp.142.10.1156
Clark, M. R., & Cox, T. S. (2002). Refractory chronic pain. Psychiatric Clinics of North America, 25(1), 71–88. https://doi.org/10.1016/S0193-953X(03)00053-4
Cohen, S. P. (2015). Epidemiology, Diagnosis, and Treatment of Neck Pain. Mayo Clinic Proceedings, 90(2), 284–299. https://doi.org/10.1016/j.mayocp.2014.09.008
Cohen, S. P., Bicket, M. C., Jamison, D., Wilkinson, I., & Rathmell, J. P. (2013). Epidural Steroids. Regional Anesthesia and Pain Medicine, 38(3), 175–200.
https://doi.org/10.1097/AAP.0b013e31828ea086
Cohen, S. P., Hayek, S., Semenov, Y., Pasquina, P. F., White, R. L., Veizi, E., Huang, J. H. Y., Kurihara, C., Zhao, Z., Guthmiller, K. B., Griffith, S. R., Verdun, A. V., Giampetro, D. M., & Vorobeychik, Y. (2014). Epidural Steroid Injections, Conservative Treatment, or Combination Treatment for Cervical Radicular Pain. Anesthesiology, 121(5), 1045–1055.
https://doi.org/10.1097/ALN.0000000000000409
Cook, C. E., Hegedus, E., Pietrobon, R., & Goode, A. (2007). A Pragmatic Neurological Screen for Patients With Suspected Cord Compressive Myelopathy. Physical Therapy, 87(9), 1233–1242. https://doi.org/10.2522/ptj.20060150
Côté, P., van der Velde, G., Cassidy, J. D., Carroll, L. J., Hogg-Johnson, S., Holm, L. W., Carragee, E. J., Haldeman, S., Nordin, M., Hurwitz, E. L., Guzman, J., & Peloso, P. M. (2009). The Burden and Determinants of Neck Pain in Workers. Journal of Manipulative and Physiological Therapeutics, 32(2), S70–S86. https://doi.org/10.1016/j.jmpt.2008.11.012
Croft, P. R., Lewis, M., Papageorgiou, A. C., Thomas, E., Jayson, M. I. V., Macfarlane, G. J., & Silman, A. J. (2001). Risk factors for neck pain: a longitudinal study in the general population. Pain, 93(3), 317–325. https://doi.org/10.1016/S0304-3959(01)00334-7
Cruccu, G., Anand, P., Attal, N., Garcia-Larrea, L., Haanpaa, M., Jorum, E., Serra, J., & Jensen, T. S. (2004). EFNS guidelines on neuropathic pain assessment. European Journal of Neurology, 11(3), 153–162. https://doi.org/10.1111/j.1468-1331.2004.00791.x
Deyo, R. A., & Weinstein, J. N. (2001). Low Back Pain. New England Journal of Medicine, 344(5), 363–370. https://doi.org/10.1056/NEJM200102013440508
Dreiser, R.-L., Le Parc, J. M., Vélicitat, P., & Lleu, P. L. (2001). Oral meloxicam is effective in acute sciatica: two randomised, double-blind trials versus placebo or diclofenac. Inflammation Research, 50(S1), 17–23. https://doi.org/10.1007/PL00022375
Dworkin, R. H., Backonja, M., Rowbotham, M. C., Allen, R. R., Argoff, C. R., Bennett, G. J., Bushnell, M. C., Farrar, J. T., Galer, B. S., Haythornthwaite, J. A., Hewitt, D. J., Loeser, J. D., Max, M. B., Saltarelli, M., Schmader, K. E., Stein, C., Thompson, D., Turk, D. C., Wallace, M. S., … Weinstein, S. M. (2003). Advances in Neuropathic Pain. Archives of Neurology, 60(11), 1524.
https://doi.org/10.1001/archneur.60.11.1524
Dworkin, R. H., O’Connor, A. B., Backonja, M., Farrar, J. T., Finnerup, N. B., Jensen, T. S., Kalso, E. A., Loeser, J. D., Miaskowski, C., Nurmikko, T. J., Portenoy, R. K., Rice, A. S. C., Stacey, B. R., Treede, R.-D., Turk, D. C., & Wallace, M. S. (2007). Pharmacologic management of neuropathic pain: Evidence-based recommendations. Pain, 132(3), 237–251.
https://doi.org/10.1016/j.pain.2007.08.033
Eisenberg, E., McNicol, E. D., & Carr, D. B. (2005). Efficacy and Safety of Opioid Agonists in the Treatment of Neuropathic Pain of Nonmalignant Origin. JAMA, 293(24), 3043.
https://doi.org/10.1001/jama.293.24.3043
Fejer, R., Kyvik, K. O., & Hartvigsen, J. (2006). The prevalence of neck pain in the world population: a systematic critical review of the literature. European Spine Journal, 15(6), 834–848. https://doi.org/10.1007/s00586-004-0864-4
Fishbain, D. A., Cole, B., Lewis, J. E., & Gao, J. (2014). What Is the Evidence that Neuropathic Pain Is Present in Chronic Low Back Pain and Soft Tissue Syndromes? An Evidence-Based Structured Review. Pain Medicine, 15(1), 4–15. https://doi.org/10.1111/pme.12229
FitzGerald, G. A., & Patrono, C. (2001). The Coxibs, Selective Inhibitors of Cyclooxygenase-2. New England Journal of Medicine, 345(6), 433–442. https://doi.org/10.1056/NEJM200108093450607
Fouyas, I., Statham, P., Sandercock, P., & Lynch, C. (2001). Surgery for cervical radiculomyelopathy. In I. Fouyas (Ed.), The Cochrane Database of Systematic Reviews. John Wiley & Sons, Ltd. https://doi.org/10.1002/14651858.CD001466
Ghasemi, M., Golabchi, K., Mousavi, S. A., Asadi, B., Rezvani, M., Shaygannejad, V., & Salari, M. (2013). The value of provocative tests in diagnosis of cervical radiculopathy. Journal of Research in Medical Sciences: The Official Journal of Isfahan University of Medical Sciences, 18(Suppl 1), S35-8.
Hamza, M. S., Anderson, D. G., Snyder, J. W., Deschner, S., & Cifu, D. X. (2009). Effectiveness of Levetiracetam in the Treatment of Lumbar Radiculopathy: An Open‐Label Prospective Cohort Study. PM&R, 1(4), 335–339. https://doi.org/10.1016/j.pmrj.2008.12.004
Hartman, J. (2014a). Anatomy and clinical significance of the uncinate process and uncovertebral joint: A comprehensive review. Clinical Anatomy, 27(3), 431–440. https://doi.org/10.1002/ca.22317
Hogg-Johnson, S., van der Velde, G., Carroll, L. J., Holm, L. W., Cassidy, J. D., Guzman, J., Côté, P., Haldeman, S., Ammendolia, C., Carragee, E., Hurwitz, E., Nordin, M., & Peloso, P. (2008). The Burden and Determinants of Neck Pain in the General Population. Spine, 33(Supplement), S39–S51. https://doi.org/10.1097/BRS.0b013e31816454c8
Iencean, St. M. (2000). Lumbar Intervertebral Disc Herniation Following Experimental Intradiscal Pressure Increase. Acta Neurochirurgica, 142(6), 669–676.
https://doi.org/10.1007/s007010070111
Jensen, M. P., Chodroff, M. J., & Dworkin, R. H. (2007). The impact of neuropathic pain on health-related quality of life: Review and implications. Neurology, 68(15), 1178–1182. https://doi.org/10.1212/01.wnl.0000259085.61898.9e
Kääriä, S., Laaksonen, M., Rahkonen, O., Lahelma, E., & Leino-Arjas, P. (2012). Risk factors of chronic neck pain: A prospective study among middle-aged employees. European Journal of Pain, 16(6), 911–920. https://doi.org/10.1002/j.1532-2149.2011.00065.x
Kang, J. D., Georgescu, H. I., McIntyre-Larkin, L., Stefanovic-Racic, M., & Evans, C. H. (1995). Herniated Cervical Intervertebral Discs Spontaneously Produce Matrix Metalloproteinases, Nitric Oxide, Interleukin-6, and Prostaglandin E2. Spine, 20(Supplement), 2373–2378.
https://doi.org/10.1097/00007632-199511001-00001
Khoromi, S., Patsalides, A., Parada, S., Salehi, V., Meegan, J. M., & Max, M. B. (2005). Topiramate in Chronic Lumbar Radicular Pain. The Journal of Pain, 6(12), 829–836.
https://doi.org/10.1016/j.jpain.2005.08.002
Khot, A., Bowditch, M., Powell, J., & Sharp, D. (2004). The Use of Intradiscal Steroid Therapy for Lumbar Spinal Discogenic Pain. Spine, 29(8), 833–836. https://doi.org/10.1097/00007632-200404150-00002
Koes, B. W., Scholten, R. J. P. M., Mens, J. M. A., & Bouter, L. M. (1997). Efficacy of non-steroidal anti-inflammatory drugs for low back pain: a systematic review of randomised clinical trials. Annals of the Rheumatic Diseases, 56(4), 214–223. https://doi.org/10.1136/ard.56.4.214
Liu, R., Kurihara, C., Tsai, H., Silvestri, P. J., Bennett, M. I., Pasquina, P. F., & Cohen, S. P. (2017a). Classification and Treatment of Chronic Neck Pain. Regional Anesthesia and Pain Medicine, 42(1), 52–61. https://doi.org/10.1097/AAP.0000000000000505
Maher, D. P., Chen, L., & Mao, J. (2017). Intravenous Ketamine Infusions for Neuropathic Pain Management: A Promising Therapy in Need of Optimization. Anesthesia & Analgesia, 124(2), 661–674. https://doi.org/10.1213/ANE.0000000000001787
Manchikanti, L., Cash, K. A., Pampati, V., & Malla, Y. (2014). Two-Year Follow-Up Results of Fluoroscopic Cervical Epidural Injections in Chronic Axial or Discogenic Neck Pain: A Randomized, Double-Blind, Controlled Trial. International Journal of Medical Sciences, 11(4), 309–320. https://doi.org/10.7150/ijms.8069
Matsumoto, M., Fujimura, Y., Suzuki, N., Nishi, Y., Nakamura, M., Yabe, Y., & Shiga, H. (1998). MRI of cervical intervertebral discs in asymptomatic subjects. The Journal of Bone and Joint Surgery, 80(1), 19–24. https://doi.org/10.1302/0301-620X.80B1.7929
Montgomery, S. A., Tobias, K., Zornberg, G. L., Kasper, S., & Pande, A. C. (2006). Efficacy and Safety of Pregabalin in the Treatment of Generalized Anxiety Disorder. The Journal of Clinical Psychiatry, 67(05), 771–782. https://doi.org/10.4088/JCP.v67n0511
Murray, C. J. L. (2013). The State of US Health, 1990-2010. JAMA, 310(6), 591.
https://doi.org/10.1001/jama.2013.13805
Nguyen, C., Boutron, I., Baron, G., Sanchez, K., Palazzo, C., Benchimol, R., Paris, G., James-Belin, É., Lefèvre-Colau, M.-M., Beaudreuil, J., Laredo, J.-D., Béra-Louville, A., Cotten, A., Drapé, J.-L., Feydy, A., Ravaud, P., Rannou, F., & Poiraudeau, S. (2017). Intradiscal Glucocorticoid Injection for Patients With Chronic Low Back Pain Associated With Active Discopathy. Annals of Internal Medicine, 166(8), 547. https://doi.org/10.7326/M16-1700
Nilsen, T. I. L., Holtermann, A., & Mork, P. J. (2011). Physical Exercise, Body Mass Index, and Risk of Chronic Pain in the Low Back and Neck/Shoulders: Longitudinal Data From the Nord-Trondelag Health Study. American Journal of Epidemiology, 174(3), 267–273.
https://doi.org/10.1093/aje/kwr087
Okada, E., Matsumoto, M., Ichihara, D., Chiba, K., Toyama, Y., Fujiwara, H., Momoshima, S., Nishiwaki, Y., Hashimoto, T., Ogawa, J., Watanabe, M., & Takahata, T. (2009). Aging of the Cervical Spine in Healthy Volunteers. Spine, 34(7), 706–712.
https://doi.org/10.1097/BRS.0b013e31819c2003
Radhakrishnan, K., Litchy, W. J., O’Fallon, W. M., & Kurland, L. T. (1994). Epidemiology of cervical radiculopathy. Brain, 117(2), 325–335. https://doi.org/10.1093/brain/117.2.325
Rao, R. (2003). Neck pain, cervical radiculopathy, and cervical myelopathy: pathophysiology, natural history, and clinical evaluation. Instructional Course Lectures, 52, 479–488.
Rasmussen, P. V., Sindrup, S. H., Jensen, T. S., & Bach, F. W. (2004). Symptoms and signs in patients with suspected neuropathic pain. Pain, 110(1), 461–469.
https://doi.org/10.1016/j.pain.2004.04.034
Roth, D., Mukai, A., Thomas, P., Hudgins, T. H., & Alleva, J. T. (2009). Cervical Radiculopathy. Disease-a-Month, 55(12), 737–756. https://doi.org/10.1016/j.disamonth.2009.06.004
Rothman, S. M., & Winkelstein, B. A. (2010). Cytokine Antagonism Reduces Pain and Modulates Spinal Astrocytic Reactivity After Cervical Nerve Root Compression. Annals of Biomedical Engineering, 38(8), 2563–2576. https://doi.org/10.1007/s10439-010-0012-8
Rubinstein, S. M., Pool, J. J. M., van Tulder, M. W., Riphagen, I. I., & de Vet, H. C. W. (2007). A systematic review of the diagnostic accuracy of provocative tests of the neck for diagnosing cervical radiculopathy. European Spine Journal, 16(3), 307–319. https://doi.org/10.1007/s00586-006-0225-6
Saldaña, M. T., Navarro, A., Pérez, C., MasramÃ3n, X., & Rejas, J. (2010). A Cost-Consequences Analysis of the Effect of Pregabalin in the Treatment of Painful Radiculopathy under Medical Practice Conditions in Primary Care Settings. Pain Practice, 10(1), 31–41.
https://doi.org/10.1111/j.1533-2500.2009.00312.x
Sampath, P., Bendebba, M., Davis, J. D., & Ducker, T. (1999). Outcome in Patients With Cervical Radiculopathy. Spine, 24(6), 591–597. https://doi.org/10.1097/00007632-199903150-00021
Schoenfeld, A. J., George, A. A., Bader, J. O., & Caram, P. M. (2012). Incidence and Epidemiology of Cervical Radiculopathy in the United States Military. Journal of Spinal Disorders & Techniques, 25(1), 17–22. https://doi.org/10.1097/BSD.0b013e31820d77ea
Stillman, M. (2006). Clinical approach to patients with neuropathic pain. Cleveland Clinic Journal of Medicine, 73(8), 726–728. https://doi.org/10.3949/ccjm.73.8.726
Vasseljen, O., Woodhouse, A., Bjrngaard, J. H., & Leivseth, L. (2013). Natural course of acute neck and low back pain in the general population: The HUNT study. Pain, 154(8), 1237–1244. https://doi.org/10.1016/j.pain.2013.03.032
Visco, C. J., Cheng, D. S., & Kennedy, D. J. (2011). Pharmaceutical Therapy for Radiculopathy. Physical Medicine and Rehabilitation Clinics of North America, 22(1), 127–137.
https://doi.org/10.1016/j.pmr.2010.11.003
Wei, G., Liang, J., Chen, B., Zhou, C., Ru, N., Chen, J., & Zhang, F. (2016a). Comparison of transforaminal verse interlaminar epidural steroid injection in low back pain with lumbosacral radicular pain: a meta-analysis of the literature. International Orthopaedics, 40(12), 2533–2545. https://doi.org/10.1007/s00264-016-3220-5
Derechos de autor 2023 Carlos Eduardo Fuentes Baez , José Ángel Elí Sandoval Gutiérrez, Graciela Tovar Sanchez, Moisés Santiago González
Esta obra está bajo licencia internacional Creative Commons Reconocimiento 4.0.