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Abordaje del dolor en mayores

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Ponencia invitada en la V Jornada de Fisioterapia en Geriatría, Barcelona 2015.
"Pain management in the elderly". Invited speaker at V Jornada de Fisioterapia en Geriatría, Barcelona 2015.

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Abordaje del dolor en mayores

  1. 1. Eva Sierra Silvestre @esiesil
  2. 2. DOLOR
  3. 3. 73.5% Miró, J., Paredes, S., Rull, M., Queral, R., Miralles, R., Nieto, R., … & Baos, J. (2007). Pain in older adults: A prevalence study in the Mediterranean region of Catalonia. European Journal of Pain, 11: 83. doi: 10.1016/j.ejpain.2006.01.001 DOLOR CRÓNICO 94.5%
  4. 4. Bonifazi, W.L. (2000). Painful truths. Contemporary Long Term Care, 23(8), 1 No se diagnostica No se trata Se confunde con demencia o depresión Frecuentemente, el dolor…
  5. 5. ¿QUÉ TIENE DE ESPECIAL EL DOLOR EN LOS MAYORES?
  6. 6. Mielinizadas: 35% No mielinizadas: 50% [Neurotransmisores] Transporte axonal AFERENTES NOCICEPTIVAS PRIMARIAS Verdu E, Ceballos D, Vilches JJ, et al. Influence of aging on peripheral nerve function and regeneration. J Peripher Nerv Syst. 2000;5:191–208. Ochoa J, Mair WGP. The normal sural nerve in man. II. Changes in the axon and schwann cells due to ageing. Acta Neuropathol (Berl). 1969; 13:217–239. O’Sullivan DJ, Swallow M. The fibre size and content of the radial and sural nerves. J Neurol Neurosurg Psychiatry. 1968;31:464–470. Rafalowska J, Drac H, Roeinska K. Histological and electrophysiological changes of the lower motor neuron with aging. Polish Medical Science and Histology Bulletin. 1976;15:271–280
  7. 7. SISTEMA NERVIOSO CENTRAL Muerte neuronal Pérdida de las ramificaciones dendríticas Cambios neuroquímicos Pérdida de mielina Deterioro sistema inhibidor endógeno del dolor Prineas JW, Spencer PS. Pathology of the nerve cell body in disorders of the peripheral nervous system. In: Dyck PJ, Thomas PK, Lambert EH, eds. Peripheral Neuropathy. Philadelphia: W B Saunders; 1975:253–295. Ko ML, King MA, Gordon TL, et al. The effects of aging on spinal neurochemistry in the rat. Brain Res Bull. 1997;42:95–98. Hamm RJ, Knisely JS. Environmentally-induced analgesia: an agerelated decline in a neurally-mediated, nonopioid system. Psychol Aging. 1986;1:195–201. Bodnar RJ, Romero MT, Kramer E. Organismic variables and pain inhibition: roles of gender and aging. Brain Res Bull. 1988;21:947–953.
  8. 8. UMBRALES DE DOLOR Umbral estímulos térmicos Umbral dolor a la presión Lautenbacher, S., Kunz, M., Strate, P., Nielsen, J., & Arendt-Nielsen, L. (2005). Age effects on pain thresholds, temporal summation and spatial summation of heat and pressure pain. Pain, 115(3), 410–8. doi:10.1016/j.pain.2005.03.025 Tolerancia Al dolor
  9. 9. DETERIORO COGNITIVO Respuesta a estímulos limitada Expresividad facial Conductas de dolor Scherder E, Bouma A, Borkent M, Rahman O. Alzheimer patients report less pain intensity and pain affect than non-demented elderly. Psychiatry [Internet]. 1999;62(3):265–72 Scherder E J, Sergeant J A, Swaab D F et al. Pain processing in dementia and its relation to neuropathology. Lancet Neurology 2003; 2:677–686
  10. 10. ¿DE QUÉ TIPOS DE DOLOR HABLAMOS?
  11. 11. DOLOR AGUDO Gibson, S. J., & Helme, R. D. (2001). Age-related differences in pain perception and report. Clinics in Geriatric Medicine, 17(3), 433 456. Tresch, D. D. (1998). Management of the older patient with acute myocardial infarction: difference in clinical presentations between older and younger patients. Journal of the American Geriatrics Society, 46,1157 1162. Enfermedades que cursan con dolor Confusión Agitación Agresividad Anorexia Fatiga ¿Dolor?
  12. 12. DOLOR AGUDO Cole, L. J., Farrell, M. J., Gibson, S. J., & Egan, G. F. (2010). Age-related differences in pain sensitivity and regional brain activity evoked by noxious pressure. Neurobiology of Aging, 31(3), 494 503 Gibson S. J. In: Proceedings of the 10th World Congress on Pain, Progress in Pain Research and Management. Vol. 24. Dostrovsky J. O., Dolor bien localizado Localización atípica Intensidad dolor decreciente con la edad
  13. 13. Lynch D. Geriatric pain. In: Raj P. P., editor. Practical Management of Pain. 3rd ed. St. Louis, MO: Mosby; 2000. pp. 270–271 DOLOR CRÓNICO
  14. 14. Trombosis venosa profunda Fracturas Tromboembolismo pulmonar Rastogi, R., & Meek, B. D. (2013). Management of chronic pain in elderly, frail patients: finding a suitable, personalized method of control. Clinical Interventions in Aging, 8, 37–46 Baja calidad de vida COMORBILIDAD DOLOR CRÓNICO
  15. 15. Kaye, A. D., Baluch, A., & Scott, J. T. (2010). Pain management in the elderly population: a review. The Ochsner Journal, 10(3), 179–87.
  16. 16. Miró, J., Paredes, S., Rull, M., Queral, R., Miralles, R., Nieto, R., Huguet, A. and Baos, J. (2007), Pain in older adults: A prevalence study in the Mediterranean region of Catalonia. European Journal of Pain, 11: 83. doi: 10.1016/j.ejpain.2006.01.001 Fisioterapia TRATAMIENTO
  17. 17. ¿QUÉ HAY DE NUEVO EN FISIOTERAPIA?
  18. 18. ARTROSIS Fransen M, McConnell S, Harmer AR, Van der Esch M, Simic M, Bennell KL. Exercise for osteoarthritis of the knee. Cochrane Database of Systematic Reviews 2015, Issue 1. Art. No.: CD004376. DOI: 10.1002/14651858.CD004376.pub3 Lluch Girbés, E., Nijs, J., Torres-Cueco, R., & López Cubas, C. (2013). Pain treatment for patients with osteoarthritis and central sensitization. Physical Therapy, 93(6), 842–51
  19. 19. ARTROSIS Nijs, J., Paul van Wilgen, C., Van Oosterwijck, J., van Ittersum, M., & Meeus, M. (2011). How to explain central sensitization to patients with “unexplained” chronic musculoskeletal pain: practice guidelines. Manual Therapy, 16(5), 413–8. Lluch Girbés, E., Nijs, J., Torres-Cueco, R., & López Cubas, C. (2013). Pain treatment for patients with osteoarthritis and central sensitization. Physical Therapy, 93(6), 842–51
  20. 20. ARTROSIS Hurley MV, Walsh NE, Mitchell H, Nicholas J, Patel A. Longterm outcomes and costs of an integrated rehabilitation program for chronic knee pain: a pragmatic, cluster randomized, controlled trial. Arthritis Care Res 2012;64:238e47.
  21. 21. Waller, B., Ogonowska-Slodownik, A., Vitor, M., Lambeck, J., Daly, D., Kujala, U. M., & Heinonen, A. (2014). Effect of therapeutic aquatic exercise on symptoms and function associated with lower limb osteoarthritis: systematic review with meta-analysis. Physical Therapy, ARTROSIS
  22. 22. Avelar NC, Simao AP, Tossige-Gomes R, Neves CD, RochaVieira E, Coimbra CC, et al. The effect of adding whole-body vibration to squat training on the functional performance and self-report of disease status in elderly patients with knee osteoarthritis: a randomized, controlled clinical study. J Altern Complement Med 2011;17:1149e55 Fukuda TY, Alves da Cunha R, Fukuda VO, Rienzo FA, Cazarini Jr C, Carvalho Nde A, et al. Pulsed shortwave treatment in women with knee osteoarthritis: a multicenter, randomized, placebo-controlled clinical trial. Phys Ther 2011;91:1009e17. ARTROSIS
  23. 23. NEUROPATÍA DIABÉTICA Boyd, B. S., Wanek, L., Gray, A. T., & Topp, K. S. (2010). Mechanosensitivity during lower extremity neurodynamic testing is diminished in individuals with Type 2 Diabetes Mellitus and peripheral neuropathy: a cross sectional study. BMC Neurology, 10, 75. doi:10.1186/1471-2377-10-75 Kumar P.S., Adhikari P., Jeganathan P.S, D’Souza S.C. Immediate effects of nerve sliders and nerve massage on vibration and thermal perception thresholds in patients with
  24. 24. DOLOR POR CÁNCER Bernabei R, Gambassi G, Lapane K, et al. Management of Pain in Elderly Patients With Cancer. JAMA. 1998;279(23):1877-1882. McNeely ML, Campbell K, Ospina M, Rowe BH, Dabbs K, Klassen TP, Mackey J, Courneya K. Exercise interventions for upper-limb dysfunction due to breast cancer treatment. Cochrane Database of Systematic Reviews 2010, Issue 6. Art. No.: CD005211. Fong Daniel Y T, Ho Judy W C, Hui Bryant P H, LeeAntoinette M, Macfarlane Duncan J, Leung Sharron S K et al. Physical activity for cancer survivors: meta-analysis of randomised controlled trials BMJ2012; 344 :e70
  25. 25. RESUMIENDO… Makris, U. E., Abrams, R. C., Gurland, B., & Reid, M. C. (2014). Management of persistent pain in the older patient: a clinical review. JAMA, 312(8), 825–36. doi:10.1001/jama.2014.9405
  26. 26. ¡Envejezcamos juntos! Lo mejor está por llegar -Robert Browning-
  27. 27. Eva Sierra Silvestre eva.sierra.silvestre@gmail.com @esiesil
  28. 28. Imágenes • Portada: http://images.wisegeek.com/elderly-womans-hands.jpg • Nº2: http://www.haddenham.net/med/elderly-man-M80903.jpg • http://downtownlalaw.com/wp-content/uploads/2012/08/Elderly-Nursing-Home-Abuse-Laws- California.jpg • http://www.thoughtpursuits.com/wp-content/uploads/2014/05/an-old-woman4.jpg • http://media3.popsugar- assets.com/files/2014/02/28/037/n/1922441/e92047784e279033_thumb_temp_image14898002 1393627278.jpg.xlarge/i/45-Life-Lessons-Written-90-Year-Old-Woman.jpg • http://www.neon.org.nz/images/Aged%20care%20Inquiry/_43Y9482-cropped.jpg • Nº3: http://s.icons8.com/wp-content/uploads/2014/11/old_woman.png • http://s.icons8.com/wp-content/uploads/2014/11/old_man.png • Nº4: http://www.innovage.group.shef.ac.uk/assets/files/Innovage%20News%201%20(web).pdf • Nº5: http://safetyfirstfinancialplanners.com/wp-content/uploads/2014/02/oldmanMedium.jpg • Nº6:http://comps.canstockphoto.es/can-stock-photo_csp3855629.jpg • Nº7:http://funderstanding.com/wp-content/uploads/2011/04/brain-based-learning.png • Nº8: https://lh3.googleusercontent.com/3e_3aQtfwwRnN4m- ZRi5ntSUbvUvVth0TShbUQAl_HxeKSus2oI5CNi2zICfxDU9MD3pbf4=s121 • Nº9:http://www.centropsicologicocpc.es/wp-content/uploads/2014/12/deterioro-cognitivo1.jpg • Nº11: http://www.geneticportraits.ca/ • Nº13: http://blogs.discovermagazine.com/d-brief/files/2013/03/shutterstock_89553295.jpg
  29. 29. Imágenes • Nº15:http://bottomlessmimosa.com/wp-content/uploads/homeless-man1.png • Nº16: http://img.freepik.com/fotos-gratis/personagens-de-desenhos-animados-medicos_23- 2147498614.jpg?size=318cf&ext=jpg • https://s-media-cache-ak0.pinimg.com/236x/23/39/df/2339df6df8eefaf5f2cf55b15cfd3f80.jpg • http://www.freepik.es/vector-gratis/ejercita-tu-cerebro_771734.htm • Nº17: http://4.bp.blogspot.com/_WiqMAWNl9Js/TI4QwPMra4I/AAAAAAAAIdM/2bjDjmd5Qk8/s320/fisio terapia+cl%C3%A1sica+marcha+paralelas.jpg • Nº18:http://ys.fh21.com.cn/uploads/allimg/150127/12_150127133629_1.jpg • Nº19:http://whatwillmatter.com/wp-content/uploads/2012/06/Education-brain-as-a- muscle_68644981.jpg • Nº20: https://ufhealth.org/sites/default/files/media/News/COM/LIFE%20Study_JSJ_IMG_1477.jpg • Nº21: http://mediad.publicbroadcasting.net/p/shared/npr/styles/x_large/nprshared/201307/205474633. jpg • Nº22:http://www.diariohoracero.com/images/familia_45_03.jpg • https://www.fisiomarket.com/2067-home_default/Onda-Corta-INTELECT-SHORTWAVE-400.jpg • Nº23:http://free-stock-illustration.com/abdominal+exercises+for+seniors?image=37495902 • Nº24:http://i.telegraph.co.uk/multimedia/archive/02432/elderly-cancer_2432803k.jpg • Nº25:http://3.bp.blogspot.com/-4JcV8HpSQBg/TqDXmq3qHzI/AAAAAAAAUAs/y- 6hgac2zEI/s400/vejez%252Btomados%2Bde%2Bla%2Bmano.jpg • Nº26: http://stevemccurry.com/blog/stronger-weakness • Nº27:https://farm8.staticflickr.com/7360/13379246975_a0168daf45_b.jpg

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