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    Fármacos adyuvantes en el control del dolor en el Paciente con Cáncer

    Los fármacos adyuvantes son valiosos durante todas las fases de control del dolor para mejorar la eficacia analgésica, tratar los síntomas concurrentes y proporcionar analgesia independiente para tipos específicos de dolor. Los adyuvantes incluyen las siguientes substancias:

    • Los CORTICOSTEROIDES: proporcionan una variedad de efectos incluso levantar el ánimo temporalmente, actividad antiinflamatoria, actividad antiemética y estímulo del apetito, y pueden ser beneficiosos en el control de la caquexia y la anorexia. También reducen el edema cerebral y de la médula espinal y son esenciales en el control urgente de la presión intracraneal elevada y de la compresión epidural de la médula espinal. Los corticosteroides pueden ser utiles durante una crisis de dolor. La administración crónica aumenta el riesgo de depresión, agitación, hemorragia, diabetes, pérdida de músculo, infección y síndrome de Cushing. A pesar de que la terapia con esteroides es ampliamente aceptada, los datos resultan inadecuados para llegar a una conclusión definitiva sobre su eficacia y pautas de dosificación.[104-107]
    • Los ANTICONVULSIVOS: se usan para controlar el dolor neuropático, especialmente el dolor lancinante o ardiente. Algunos agentes deben ser usados con cuidado en los pacientes con cáncer sometidos a terapias supresoras de la médula ósea, tales como la quimioterapia y la radioterapia.
    • Los ANTIDEPRESIVOS: especialmente los tricíclicos, son útiles en el control del dolor neuropático. Estos fármacos tienen propiedades analgésicas innatas y pueden aumentar la potencia de los efectos analgésicos de los opioides. La experiencia de la que se ha informado más ampliamente ha sido con la amitriptilina; por lo tanto debe ser vista como el agente tricíclico de elección. Estas drogas tienen efectos secundarios anticolinérgicos que podrían añadirse a los efectos secundarios de los opioides.
    • Los NEUROLEPTICOS: particularmente la metotrimepracina, se han usado para tratar síndromes de dolor crónico. La metotrimepracina carece de los efectos inhibidores de los opioides sobre la motilidad del intestino y puede ser útil para tratar el estreñimiento obstinado inducido por los opioides u otros efectos secundarios que limitan las dosis. También tiene efectos antieméticos y ansiolíticos. La metotrimepracina es sedante y puede causar hipotensión si se administra por medio de una inyección intravenosa rápida.
    • Los ANESTESICOS LOCALES: se han usado para tratar el dolor neuropático. Los efectos secundarios incluyen trastorno gastrointestinal; requiere una evaluación cardiaca cuidadosa.
    • La HIDROXICINA: un agente ansiolítico ligero con propiedades sedantes típicas de los agentes antihistamínicos (H1) que es útil para tratar al paciente ansioso que tiene dolor. Esta antihistamina también tiene propiedades antieméticas y antipruríticas.
    • Los PSICOESTIMULANTES: pueden ser útiles para reducir la sedación inducida por los opioides cuando un ajuste de la dosis del opioide (o sea, reducción de dosis y aumento de la frecuencia de las dosis) no es eficaz.

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