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Efectividad y seguridad de los sistemas de administración de medicamentos intratecales para dolor crónico no oncológico: revisión sistemática

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dc.contributor.advisorOspina Medina, María Cristina
dc.creatorArenas Lewis, Felipe Andrés
dc.creatorEnciso Prieto, Valeria Alexandra
dc.creatorMahecha Rivera, Lina María
dc.creator.degreeMagíster en Epidemiología
dc.creator.degreeLevelMaestría
dc.date.accessioned2024-12-09T12:50:52Z
dc.date.available2024-12-09T12:50:52Z
dc.date.created2024-12-02
dc.descriptionIntroducción: el dolor crónico no oncológico es una enfermedad multinivel que afecta al paciente y su familia en diferentes aspectos de la vida diaria, con consecuencias a largo plazo en la funcionalidad. Se considera una patología de difícil manejo y su abordaje terapéutico debe ser por un grupo multidisciplinario. En Estados Unidos se han descrito una prevalencia que pude variar de 11 hasta 40%, al igual en Inglaterra la prevalencia puede llegar hasta el 43% de la población. En la actualidad se reconoce que en países con ingresos medio-bajo puede ser mayor. Debido al difícil manejo de estos pacientes, se han empezado a considerar terapias analgésicas con diferentes rutas de administración de medicamentos, que permitan dar un mejor control del dolor y contribuir a la funcionalidad del paciente. Entre estas se ha descrito el uso de dispositivos de administración vía intratecal, sin embargo, actualmente no hay una clara recomendación acerca de sus indicaciones, eficacia y seguridad. Objetivo: Evaluar la eficacia y seguridad de los sistemas de administración de medicamentos intratecal, como estrategia terapéutica en pacientes que cursen con dolor crónico de etiología no oncológica. Metodología: Se realizó una revisión sistemática de la literatura disponible sobre el uso de dispositivos de administración intratecal para el manejo del dolor crónico no oncológico en las siguientes bases de datos Pubmed, Embase, Cochrane Library, BVS y Preprints. Se incluyeron ensayos clínicos y estudios observacionales, la evaluación de riesgo se hizo con la herramienta de Cochrane. Finalmente se realizó prueba de heterogeneidad con I2 y análisis por subgrupos. Resultados: En total se incluyeron 18 estudios de los cuales 10 fueron observacionales y 8 ensayos clínicos aleatorizados. En total de incluyeron 987 pacientes con una edad media de 58.5 años. Todos los estudios evaluaron el efecto el uso de los sistemas de administración de medicamento por vía intratecal en el control del dolor, sin embargo, solo 8 estudios se incluyeron en el metaanálisis debido a disponibilidad de los datos. Se encontró que el uso de la terapia a estudio mejoro el dolor, con una DMS -1.94 (IC 95% -4.12;0.24) y una heterogeneidad del 97%, lo cual indica una alta variabilidad entre los estudios incluidos (p<0.01). Solo 10 estudios evaluaron de alguna manera la calidad de vida y solo 3 estudios evaluaron el impacto en la funcionalidad con diferentes instrumentos de medición con datos faltantes, por lo que no fue posible realizar un análisis de los desenlaces deseados. Conclusión: El uso de sistemas de administración de medicamentos por vía intratecal puede ser una opción terapéutica en el manejo de pacientes con dolor crónico no oncológico, aunque la alta heterogeneidad y falencias en la metodología entre los estudios incluidos limitan la generalización de los datos. Es necesario el desarrollo de investigaciones clínicas con alta calidad metodológica para fortalecer las recomendaciones del uso de sistemas de administración de medicamentos por vía intratecal en el manejo del dolor crónico.
dc.description.abstractIntroduction: Chronic non-cancer pain is a multilevel disease that affects the patient and his/her family in different aspects of daily life, with long-term consequences on functionality. It is considered a difficult-to-manage pathology and its therapeutic approach must be by a multidisciplinary group. In the United States, the prevalence of this condition vary from 11 to 40%, while in England the prevalence can reach up to 43% of the population. It is currently recognized that in countries with low-middle incomes it can be higher. Due to the difficult management of these patients, analgesic therapies with different routes of administration of medications have begun to be considered, which allow for better pain control and contribute to the functionality of the patient. Among these, the use of intrathecal administration devices has been described, however, there is currently no clear recommendation regarding their indications, efficacy and safety. Objective: To evaluate the efficacy and safety of intrathecal drug administration systems as a therapeutic strategy in patients with non- cancer chronic pain. Methodology: A systematic review of the available literature on the use of intrathecal administration devices for the management of chronic non-cancer pain was performed in the following databases: Pubmed, Embase, Cochrane Library, VHL and Preprints. Clinical trials and observational studies were included, and risk assessment was performed using the Cochrane tool. Finally, a heterogeneity test was performed with I2 and subgroup analysis. Results: A total of 18 studies were included, of which 10 were observational and 8 were randomized clinical trials. In total 987 patients were included with a medium aged of 58.5 years. All studies evaluated the effect of the use of intrathecal drug administration systems on pain control, however, only 8 studies were included in the meta-analysis due to data availability. The use of the study therapy was found to improve pain, with a DMS of -1.94 (95% CI -4.12;0.24) and a heterogeneity of 97%, indicating a high variability between the included studies (p<0.01). Only 10 studies somehow evaluated the quality of life and only 3 studies evaluated the impact on functionality with different measurement tools and with some missing data, so it was not possible to do an analysis of the desired outcomes. Conclusion: The use of intrathecal drug delivery systems may be a therapeutic option in the management of patients with chronic non-cancer pain, although the high heterogeneity and flaws in the methodology between the included studies limit the generalization of the data. The development of clinical research with high methodological quality is necessary to strengthen the recommendations for the use of intrathecal drug delivery systems in the management of chronic pain.
dc.format.extent109 PP
dc.format.mimetypeapplication/pdf
dc.identifier.doihttps://doi.org/10.48713/10336_44481
dc.identifier.urihttps://repository.urosario.edu.co/handle/10336/44481
dc.language.isospa
dc.publisherUniversidad del Rosariospa
dc.publisherUniversidad CES. Facultad de Medicina
dc.publisher.departmentEscuela de Medicina y Ciencias de la Saludspa
dc.publisher.programMaestría en Epidemiologíaspa
dc.rightsAttribution-NonCommercial-NoDerivatives 4.0 International*
dc.rights.accesRightsinfo:eu-repo/semantics/openAccess
dc.rights.accesoAbierto (Texto Completo)
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dc.source.instnameinstname:Universidad del Rosario
dc.source.reponamereponame:Repositorio Institucional EdocUR
dc.subjectDolor crónico no oncológico
dc.subjectsistemas de administración de medicamentos intratecal
dc.subjectrevisión sistemática
dc.subjectIDDS
dc.subject.keywordChronic non-cancer pain
dc.subject.keywordintrathecal drug delivery systems
dc.subject.keywordsystematic review
dc.subject.keywordIDDS
dc.titleEfectividad y seguridad de los sistemas de administración de medicamentos intratecales para dolor crónico no oncológico: revisión sistemática
dc.title.TranslatedTitleEffectiveness and safety of intrathecal drug delivery systems for the management of non-cancer chronic pain: a systematic review.
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dc.type.hasVersioninfo:eu-repo/semantics/acceptedVersion
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local.department.reportEscuela de Medicina y Ciencias de la Salud
local.regionesBogotá
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