Publication: Reconocimiento de la sensibilización central en el paciente con dolor crónico y alternativas de tratamiento en fisioterapia.
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2019-06
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Abstract
El dolor crónico está asociado a un cuidado intensivo de la salud y altos índices de discapacidad a nivel mundial. Ya que esta patología cursa con hiperexcitabilidad del sistema nervioso central y un funcionamiento erróneo de las vías inhibitorias de la nocicepción, parece tener beneficios limitados a la hora de establecer un diagnóstico y seguir un tratamiento. Actualmente, la población que presenta patología musculoesquelética crónica está en aumento, y, por consiguiente, supone un gran problema socioeconómico, pues implica un gasto excesivamente alto en el presupuesto sanitario. Para evitar el incremento del número de personas con esta afectación, además de prevenir los factores agravantes (como el abuso de opioides, la inactividad física, los pensamientos catastrofistas, etc…), se debe llevar a cabo un abordaje multidisciplinar de esta patología.
Hoy en día, el diagnóstico de la sensibilización central en una patología crónica, es un reto debido a la falta de un método estandarizado que regule los pasos a seguir para lograrlo, sin embargo, se puede emplear información proveniente del diagnóstico médico, combinado con los datos obtenidos de la historia clínica y el examen individual que se realizará en cada paciente. Es indispensable el establecimiento de las pautas adecuadas para que el fisioterapeuta pueda intervenir a través de una valoración clínica óptima. Pese a presentar un panorama bastante negativo, la evidencia sugiere que si se realiza un diagnóstico específico y un tratamiento acorde a la patología, los cambios en el sistema nervioso podrían ser reversibles
Chronic pain is associated with intensive health care and high rates of disability worldwide. Since this pathology presents hyperexcitability of the central nervous system and a malfunctioning of the inhibitory pathways of nociception, it seems to have limited benefits when establishing a diagnosis and follow a treatment. Currently, the population presenting with chronic musculoskeletal pathology is increasing, and therefore poses a major socioeconomic problem, because it implies an excessively high spending on the health budget. In order to avoid the increase in the number of people with this affectation, in addition to preventing aggravating factors (such as the abuse of opioids, physical inactivity, catastrophic thoughts, etc...), a multidisciplinary approach must be carried out of this pathology. Nowadays, the diagnosis of central sensitization in a chronic pathology, is a challenge due to the lack of a standardized method that regulates the steps to follow to achieve it, however, it can be use information from the medical diagnosis, combined with the data obtained from the clinical history and the individual examination that will be carried out in each patient. It is essential to establish the appropriate guidelines so that the physiotherapist can intervene through an optimal clinical assessment. Despite presenting a rather negative picture, evidence suggests that changes in the nervous system could be reversible if a specific diagnosis and treatment according to pathology are performed.
Chronic pain is associated with intensive health care and high rates of disability worldwide. Since this pathology presents hyperexcitability of the central nervous system and a malfunctioning of the inhibitory pathways of nociception, it seems to have limited benefits when establishing a diagnosis and follow a treatment. Currently, the population presenting with chronic musculoskeletal pathology is increasing, and therefore poses a major socioeconomic problem, because it implies an excessively high spending on the health budget. In order to avoid the increase in the number of people with this affectation, in addition to preventing aggravating factors (such as the abuse of opioids, physical inactivity, catastrophic thoughts, etc...), a multidisciplinary approach must be carried out of this pathology. Nowadays, the diagnosis of central sensitization in a chronic pathology, is a challenge due to the lack of a standardized method that regulates the steps to follow to achieve it, however, it can be use information from the medical diagnosis, combined with the data obtained from the clinical history and the individual examination that will be carried out in each patient. It is essential to establish the appropriate guidelines so that the physiotherapist can intervene through an optimal clinical assessment. Despite presenting a rather negative picture, evidence suggests that changes in the nervous system could be reversible if a specific diagnosis and treatment according to pathology are performed.