RESUMO
RESUMEN El dolor oncológico no controlado es uno de los síntomas que afectan de forma negativa la salud física y psicológica de los pacientes con diagnóstico de cáncer. Sin dudas, representa una situación especialmente dramática. Existe evidencia sobre los beneficios del control del dolor en estos pacientes; para lograrlos, es preciso valorar las causas, localización, intensidad y duración del dolor antes y durante el tratamiento. Se plantean diferentes formas de medir la intensidad del dolor, y la escala visual analógica es una de las más comunes, además de ser la más utilizada internacionalmente respecto al resto de las escalas unidimensionales. La Organización Mundial de la Salud propone el uso de la escalera analgésica de forma pautada, con la correspondiente titulación de la necesidad de analgésicos, así como de los tratamientos coadyuvantes necesarios. Estandarizar correctamente los tratamientos y evaluar su respuesta, es imprescindible para el control del dolor. La presente revisión bibliográfica se propone un acercamiento a las directrices internacionales en el abordaje terapéutico de esta entidad, y con ello, ofrecer una actualización del tema.
ABSTRACT Uncontrolled oncological pain is one of the symptoms that negatively affect the physical and psychological health of patients diagnosed with cancer. Undoubtedly, it represents a particularly dramatic situation. There is evidence about pain control benefits of in these patients; to achieve them, it is necessary to assess the causes, location, intensity and duration of pain before and during treatment. Different ways of measuring pain intensity are proposed, and the analog visual scale is one of the most common, in addition to being the most used internationally with respect to the rest of the single-dimensional scales. The World Health Organization proposes the use of the analgesic ladder in a prescribed manner, with the corresponding titration of the analgesic need, as well as the necessary coadjutant treatments. Standardizing treatments correctly and evaluating their response, is essential for pain control. The present bibliographic review proposes an overlook to the international guidelines in the therapeutic approach of this condition, and with it, it offers an update on the topic.
RESUMO
JUSTIFICATIVA E OBJETIVOS: A dor é um sintoma frequente nas neoplasias malignas, porém na maioria das vezes o farmacêutico da farmácia hospitalar diante da enorme tarefa burocrática que o afastam do paciente, não tem contribuído significativamente na assistência ao paciente com dor oncológica. O objetivo deste estudo foi propor a inserção o profissional farmacêutico no controle da dor de origem oncológica visando o uso racional e o monitoramento das reações adversas a medicamentos. CONTEÚDO: Para o controle efetivo do quadro álgico, implementação de medidas analgésicas e avaliação da eficácia terapêutica da dor faz-se essencial o uso correto da "Guia para Tratamento da Dor no Câncer" da Organização Mundial de Saúde (OMS), o qual proporciona diretrizes para o controle da dor na maioria dos pacientes com câncer avançado, e ainda, é fundamental o relato da experiência dolorosa do paciente aos profissionais da saúde. CONCLUSÃO: As escalas de mensuração da dor aliadas ao protocolo preconizado pela OMS tem-se mostrado um instrumento essencial para o uso racional de medicamentos. O profissional farmacêutico, além de cumprir com sua atividade corrente, está capacitado para interagir nas equipes multidisciplinares, auxiliando no tratamento álgico de pacientes oncológicos, avaliando o comprimento desse protocolo estabelecido pela OMS no controle da dor.
BACKGROUND AND OBJECTIVES: Pain is a frequent cancer symptom, however most of the times pharmacists of the hospital pharmacy, due to the huge bureaucratic tasks that depart them from patients, have not significantly contributed in assisting cancer pain patients. This study aimed at proposing the insertion of pharmacists in the cancer pain control team aiming at the rational use of drugs at and monitoring patients' adverse reactions. CONTENTS: For effective pain control, implementation of analgesic measures and assessment of therapeutic efficacy, it is critical to adequately use the "Guide to Cancer Pain Management" of the World Health Organization (WHO), which establishes guidelines for controlling pain of most advanced cancer patients; it is also fundamental to report patients' painful experience to health professionals. CONCLUSION: Pain measurement scales added to WHO's recommended protocol have been shown to be a critical tool for the rational use of drugs. Pharmacists, in addition to performing their daily activities, are qualified to interact in multidisciplinary teams helping controlling cancer patients' pain, by evaluating the compliance with this WHO protocol to control pain.
Assuntos
Oncologia , Dor , Cuidados Paliativos , FarmacêuticosRESUMO
Nuestro trabajo tiene como objetivo general el evaluar la calidad de la atención a los pacientes con dolor en etapa terminal. Específicamente, se busca determinar la intensidad del dolor aplicando La Escala Análoga Visual del Dolor; evaluar el grado de incapacidad funcional aplicando la Escala de Prolo modificada; correlacionar la intensidad dolorosa con la potencia analgésica de los fármacos utilizados, teniendo en cuenta la Escalera Analgésica de la Organización Mundial de la Salud; así como la capacidad para participar en la toma de decisiones a la hora de realizar un proceder y el real conocimiento de su enfermedad. Para ello seleccionamos 50 pacientes de un universo de 100. Los pacientes incluidos venían remitidos de las consultas de las diferentes especialidades médicas y de oncología con diagnostico de dolor por cáncer. Se les aplico una entrevista individual realizada por el especialista de la Clínica del Dolor Crónico. Se cuantificó la intensidad dolorosa, se determinó el grado de incapacidad funcional, tratamientos farmacológicos previos, información médica sobre la enfermedad, posibilidades terapéuticas, complicaciones y el uso de morfínicos. Como resultado de nuestro estudio pudimos apreciar que el 56 por ciento de los pacientes padecían dolor moderado e intenso, que el grado de incapacidad funcional era malo, que desde el punto de vista farmacológico habían sido inadecuadamente tratados y que la mayoría desconocían la causa de su dolor.
Our work has as general objective to evaluate the quality from the attention to the patients with pain in terminal stage and specifically to determine the intensity of the pain applying the similar visual scale of the pain, to evaluate the grade of functional inability applying the scale of modified PROLO, to correlate the painful intensity with the analgesic power of the used medications keeping in mind the Analgesic Stairway of OMS, as well as the capacity to participate in the taking of decisions when carrying out a to proceed and the real knowledge of its illness. For we select it 50 patients, of an universe of 100 patients, the included patients came remitted of the consultations of the medical different Specialties and of Oncology with I Diagnose of pain for cancer, he/she is applied an individual interview carried out by the specialist of the Clinic of the Chronic pain. You quantify the painful intensity, you determines the grade of functional inability, pharmacological previous treatments, Information prescribes on the illness, therapeutic possibilities, complications and the morphine use. As a result of our study we could appreciate that 56 percent of the patients suffered moderate and intense pain that the grade of functional inability was bad that you/they had been treated improperly from the pharmacological point of view, and that most ignored the cause of its pain.