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Dolor crónico después de mastectomía: conocimiento actual y lagunas de conocimiento

Savera Khan1, Abby P Chiu1, Cathryn Payne2

  • 1Department of Anesthesiology and Pain Medicine, University of Washington School of Medicine, Seattle, WA, USA.

Minerva anestesiologica
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Resumen

El síndrome de dolor posmastectomía (SDPM) afecta hasta el 52% de los pacientes, lo que impacta la calidad de vida. Esta revisión sintetiza el conocimiento actual sobre la prevención y el tratamiento del SDPM, identificando factores de riesgo clave y lagunas de conocimiento para futuras investigaciones.

Palabras clave:
dolor posmastectomíasíndrome de dolor posmastectomíacáncer de mamadolor neuropáticocalidad de vidafactores de riesgoprevencióntratamientoinvestigación

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Área de la Ciencia:

  • Oncología; Medicina del Dolor; Complicaciones Quirúrgicas

Sus antecedentes:

  • El síndrome de dolor posmastectomía (SDPM) es una complicación común y debilitante después de la cirugía de cáncer de mama. A menudo se presenta como dolor neuropático persistente, lo que reduce significativamente la calidad de vida y el funcionamiento de los pacientes.

Objetivo del estudio:

  • Revisar y sintetizar el conocimiento actual sobre la epidemiología, prevención y tratamiento del SDPM. Identificar lagunas de conocimiento e informar futuras direcciones de investigación para el manejo del SDPM.

Principales métodos:

  • Revisión sistemática de la literatura existente sobre el SDPM. Análisis de datos epidemiológicos, factores de riesgo, estrategias preventivas y opciones de tratamiento.

Principales resultados:

  • La incidencia del SDPM varía del 28% al 52%, y se asocia con edad más joven, cirugía axilar extensa y dolor preexistente. Las estrategias preventivas prometedoras incluyen la crema EMLA, la pregabalina y el bloqueo PECS II. Los tratamientos efectivos pueden implicar capsaicina tópica, amitriptilina, venlafaxina y terapia cognitiva basada en mindfulness.

Conclusiones:

  • La evidencia para las intervenciones del SDPM es limitada por la heterogeneidad de los estudios y los tamaños de muestra pequeños. La investigación adicional sobre los mecanismos moleculares y los ensayos clínicos a gran escala son cruciales para un manejo efectivo. La identificación de biomarcadores para enfoques de medicina personalizada es esencial para el tratamiento futuro del SDPM.