Dolor y cannabis
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Transcript of Dolor y cannabis
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S E S I Ó N B I B L I O G R Á F I C A
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1 4 . 1 0 . 2 0 1 4Durango, Durango, Hospital de Salud Mental "Dr. Miguel Vallebueno"
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PONENTE:Dr. Luis Fernando Molina Espinoza, R4 Psiquiatría
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CONTENIDO DE PRESENTACIÓN
M o t i v o d e p r e s e n t a c i ó n
O b j e t i v o s
I n t r o d u c c i ó n
A r t í c u l o
R e v i s i ó n b i b l i o g r á f i c a
C o m e n t a r i o s
C o n c l u s i o n e s
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DOLOR Y CANNABIS
ASESOR: Dra. Edurne Merced Austrich Senosiain, Psiquiatría de Enlace, INCMNSZ COORDINADOR: Dr. Alfonso Grageda Foyo, R5 Psiquiatría de Enlace, INCMNSZ
Dr. Leopoldo Alejandro López Jiménez, R4 Psiquiatría, INPRF Dr. Daniel Sierra Palacios, R4 Psiquiatría, HPRS
Dr. Luis Fernando Molina Espinoza, R4 Psiquiatría, HSMD
Ciudad de México, DF, INCMNSZ, 28 de abril de 2014
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MOTIVO DE PRESENTACIÓN
p e r s o n a lINTERÉSacadémico
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OBJETIVOS
VALOR ANALGÉSICO
¿PSIQUIATRÍA?
CALIDAD ANALGÉSICA
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I N T R O D U C C I Ó N
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DOLOR
1. m. Sensación molesta y aflictiva de una parte del cuerpo por causa interior ó exterior.
2. m. Sentimiento de pena y congoja.
(Del lat. Dolor, -ōris)
Real Academia Española
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International Association for the Study of Pain
La experiencia sensorial ó EMOCIONAL desagradable, asociada a daño titular real ó POTENCIAL, ó bien descrita en
términos de tal daño.
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DOLOR
Are cannabinoids an effective and safe treatment option in the management of pain? A qualitative systematic review. Campbell F, et al. BMJ, volume 323, 2001
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Are cannabinoids an effective and safe treatment option in the management of pain? A qualitative systematic review. Campbell F, et al. BMJ, volume 323, 2001
30%
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Are cannabinoids an effective and safe treatment option in the management of pain? A qualitative systematic review. Campbell F, et al. BMJ, volume 323, 2001
42.6%
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Are cannabinoids an effective and safe treatment option in the management of pain? A qualitative systematic review. Campbell F, et al. BMJ, volume 323, 2001
1 - 2 %
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Are cannabinoids an effective and safe treatment option in the management of pain? A qualitative systematic review. Campbell F, et al. BMJ, volume 323, 2001
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Are cannabinoids an effective and safe treatment option in the management of pain? A qualitative systematic review. Campbell F, et al. BMJ, volume 323, 2001
61.7%
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Are cannabinoids an effective and safe treatment option in the management of pain? A qualitative systematic review. Campbell F, et al. BMJ, volume 323, 2001
29 %AUTOMEDICACIÓN
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Are cannabinoids an effective and safe treatment option in the management of pain? A qualitative systematic review. Campbell F, et al. BMJ, volume 323, 2001
10 - 15 %
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(Cannabis sativa)
Cannabinoids in pain and palliative care medicine - hope or dope?. Kraft B, et al. MEMO, 2009
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Cannabionoids in pain and inflammation. Mbvundula EC, et al. Inflammopharmacology, Vol 12, No. 2, pp 99 - 114 (2004)
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Cannabionoids in pain and inflammation. Mbvundula EC, et al. Inflammopharmacology, Vol 12, No. 2, pp 99 - 114 (2004)
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A R T Í C U L O
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SMOKED CANNABIS FOR CHRONIC PAIN: A RANDOMIZED CONTROLLED
TRIAL
CMAJ
Mark A. Ware, Tongtong Wang, Stan Shapiro
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6.5
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Extracto
Dronabinol
Nabinol
Marihuana
Adverse effects of medical cannabinoids: A systematic Review. Tongtong WMS, et al. CMAJ, 2008
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Adultos
Dolor crónico
Trauma/Cirugía
Alodinia/hiperalgesia
Sin cannabis
CRITERIOS DE INCLUSIÓN
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Dolor por cáncer
Enfermedad cardiaca/pulmonar
Dependencia a sustancias
Antecedente psicótico
Ideación suicida
Embarazo
CRITERIOS DE EXCLUSIÓN
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Aleatorizado
Doble ciego
Placebo
Transversal (4 periodos)
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5 días
Cannabis Washout
9 días
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0%
2.5%
6%
9.4%
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Dolor
Sueño
Ánimo
Calidad de vida
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DOLOR
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SUEÑO
0% 2.5% 6% 9.4%
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CALIDAD DE VIDA
0% 2.5% 6% 9.4%
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ÁNIMO
0% 2.5% 6% 9.4%
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248
6efectos adversos leves
efectos adversos moderados
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R E V I S I Ó N
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Amygdala activity contributes to the dissociative effect of cannabis on pain
perceptionPain 154 (2013) 124-134
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Smoked cannabis spasticity in multiple sclerosis: a randomized, placebo-
controlled trialCMAJ, july 10, 2012, 184(10)
reducción de espasticidad (p<0.001)
reducción de dolor (p<0.008)
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The therapeutic potential of cannabis and cannabinoids
Dtsch Arztebl Int 2012; 109(29-30): 495-501
poco efectivos con el dolor agudo
efectivos con el dolor crónico
mejoría de hasta 34%
de múltiple etiología
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Therapeutic aspects of cannabis and cannabinoids
BJP 2001, 178:197-115
analgesia a dosis respuesta en 〜~5 h
efectivos en modelos animales sin uso de opiodes
efectos secundarios dosis-dependiente
considerados en dolor neuropático
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Cannabinoid-opioid interaction in chronic pain
Clinical Pharmacological & therapeutics, vol. 90, num. 6, December 2011
Mejoría del dolor significativa, 27%
sinergismo cannabis vaporizado + morfina/oxicodona
sin alteración de niveles plasmáticos de opioides
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Is there any clinically relevant cannabinoid-induced analgesia?
Pharmacology 2012;89:237-246
alivio del dolor, 30%
en dolor agudo, difícil predicción de beneficio
superioridad dudosa ante opiodes «débiles»
analgésicos leves-moderados
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Medicinal cannabis and painful sensory neuropathy
American Medical Association Journal of Ethics. May 2013, Vol. 15, Num. 5: 466-9
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Multicenter, double-blind, randomized, placebo-controlled, parallel-group study of the efficacy, safety, and tolerability of THC:CBD
extract and THC in patients with intractable cancer-related painJournal of Pain and Symptom management, vol.39, no. 2, February 2010.
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C O M E N T A R I O S
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C O N C L U S I O N E S
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¿Especificidad clínica?
Tiene eficacia analgésica
identificación de agentes activos
analgésicos leves-moderados
combinación con opiodes
¿Individualidad?
Participación por Psiquiatría
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!M U C H A S G R A C I A S¡
«Debo estar creciendo, tengo la cabeza más lejos del ombligo»
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RESIDENCIAPSIQUIATRÍADURANGO