GRACE Sindrome de dolor complejo regional.pptx

sindrome de dolor complejo regiones, causalgia

1. Sindrome de Dolor Complejo Regional TRAUMATOLOGIA Y ORTOPEDIA DOCENTE: DR. FRANCISCO OTALORA MR. GRACE TICONA ANDRADE

2. 01 Historia sobre terminologia OBJETIVOS Conocer 02 Definir Definicion 03 Conocer que situaciones implican Etiologia 04 D escribir las bases Fisiopatologia 05 Diagnostico 06 Tratamiento

3. TERMINOLOGIA CONDICIÓN DOLOROSA: MÚLTIPLES NOMBRES DESDE SU APARCIÓN CAUSALGIA SÍNDROME DE H O MB R O - M ANO DISTROFIA SI M P Á T I C O R E F L E J A 1º TÉRMINO EN APARECER D I S T R O FIA R E F L E J A NEUROVASCULAR

4. Dolor regional (MMSS MMII fundamentalmente) Continúo NO distribución nerviosa o metamérica Normalmente traumatológica DESPROPORCIONADO al evento que lo causó Manifestaciones vegetativas Edema Cambios tróficos Cambios de temperatura y color Alteraciones sudoración. Curso variable en el tiempo Mejor pronóstico cuando se trata inicialmente DEFINICION

5. Incidencia: 7% de pacientes tras trauma, incision o cirugia Pico incidencia: 35 a 60 años (90% tras traumatismo, 10% espontaneo ) Predominio en mujeres: 4:1 Extremidades superiores: mas frecuente Unilateral Niños y ancianos Duracion media: 15 años Cronificacion >12 meses 15% Dolor incontrolable: 15% EPIDEMIOLOGIA

6. ETIOLOGIA

7. F . de s e n c a de n a n t e s F . P r ed i s p o n e n t e s Genéticos M e t a b ó li c os Psicológicos Inmovilizaciones Trauma Cirugía Rehabilitación mal realizada Fármacos (yodo, TBC) Ninguno… CRONIFICACIÓN

8. FISIOPATOLOGIA 1. Respuesta inflamatoria 2. Sensibilizacion central y periferica

9. CRITERIOS DE BUDAPEST D I A G NÓ S T I C O 1. PURAMENTE CLÍNICO S I G N OS S Í N T O M AS 2. DIAGNÓSTICO DE EXCLUSIÓN 3. EXPLORACIONES COMPLEMENTARIAS ( Confirman y apoyan diagnóstico ) 4. NO PRECISA DE ESTUDIOS DE LABORATORIO

10. V . DI A G N Ó S TI C O Radiología simple Gammagrafía ósea con Tc99 . RNM Termografía . Estudios en el sist. nervioso autónomo/ EMG Estudios electrodiagnósticos . Determinacion Bioquímica

11. GA MM A GRA F Í A ÓSEA HIPERVASCULARIZACIÓN ÓSEA HIPERCAPTACIÓN ÓSEA TEST DE F E N T OL A M I NA DISMINUCIÓN DEL DOLOR Y LA HIPERALGESIA SUPERIOR AL 50% DURANTE CASI 12 HORAS R AD I O G R A F Í A SIMPLE IMÁGENES INCIPIENTES DE OSTEOPOROSIS MOTEADA REABSORCIÓN ÓSEA SUBPERIÓSTICA T E RMO G R A F Í A DIFERENCIA EN LA MEDICIÓN DE TEMPERATURA ENTRE LA EXTREMIDAD AFECTADA Y LA SANA

12. . D i s f unc i ó n Motora Debilidad Amplitud de movimiento reducida Temblor Distonía Mioclonus Disminución de la fuerza muscular, s/t la fuerza de prensió n Distrofia > o < crecimiento de uñas y cabello Ca m bi o s e n pi el : pal i de z, f ib r o s i s, hiperqueratosis, piel brillante y fina

13. Sensoriales Dolo r in t en s o . Hiperestesia Hiperalgesia Alodinia Deficiencias sensoriales como trastorno hemisensorial Hipoestesia trigeminal Autónomos Tumefacción Cambios de color y temperatura Anomalías de sudoración

14. Objetivo : Mejorar la función: evitar secuelas óseas y articulares Aliviar el dolor y la rigidez Conseguir remisión de síntomas  restauración funcional Tratamiento multidisciplinar  3 elementos clave: Tratamiento del dolor. Rehabilitación. Terapia psicológica . Fundamental : C o n s e nso g e n e r al i z a d o : lo s pa c i e n t e s qu e n o r e s po n d e n a un nivel de tratamiento aceptable tras 12–16 semanas Medidas intervencionistas TRATAMIENT0

15. . BIFOSFONATOS / CALCITONINA OPIOIDES / AINES KETAMINA SUBANESTÉSICA IV AN T I D E P R E SI V O S / AN T I C O NVU L SI V O S ANESTÉSICOS TÓPICOS BLOQUEO DE NERVIO SIMPÁTICO BLOQUEO REGIONAL IV BLOQUEO DE NERVIO SOMÁTICO BLOQUEO DE CATÉTER EPIDURAL Y DE PLEXO NEUROESTIMULACIÓN VÍA INTRATECAL ( BACLOFENO ) SIMPATECTOMÍA ESTIMULACIÓN CORTEZA MOTRIZ TRATAMIENTOS NO INVASIVOS TRATAMIENTOS INVASIVOS

16. . DOLOR NEUROPÁTICO + Analgésicos periféricos no opioides + Opioides débiles + Analgésicos periféricos NO opioides + Analgésicos opioides potentes + Analgésicos periféricos NO opioides

17. AMITRIPTILINA VENLAFAXINA 10-75 mg/día 7 5 -150m g / d ía ANTIDEPRESIVOS OXCARBACEPINA GABAPENTINA TOPIRAMATO PREGABALINA 600-2400 mg/día 900-3200 mg/día 150-400 mg/día 150-600 mg/día ( 3 tomas ) ( 3 tomas ) ( 2 tomas ) ( 2 tomas ) ANTICONVULSIVOS TR A T A M I E N T OS TÓPICOS C AP S A IC INA 4-5 apli/día LIDOCAINA 1. TRATAMIENTO NO INVASIVO

18. DOSIS ALTERNAS ( 60-80 mg/día) 2 semanas. CORTICOESTEROIDES EFCTIVIDAD A CORTO PLAZO ( < 6 meses ) PRAZOSINA/TERAZOSINA MAL TOLERADOS ( HIPTENSIÓN ORTOSTÁTICA Y DEPRESIÓN ) S I M P A T I C O L Í T I C O S INGERIBLES CLONIDINA TRANSDÉRMICA/GEL DISMINUCIÓN DE ALODINIA DONDE SE APLICA

19. Únicos fármacos que aportan al tratamiento del SDRC. B I F OS F O N A T OS 1º Linea para control del dolor en fase aguda Inbidores de la reabsorción ósea CALCITONINA Elección en estadios avanzados (corto plazo) OPIOIDES NO EFICACIA PROBADA

20. NO ESTA CLARA SU EFICACIA BLOQUEADORES CANALES CALCIO ÚTIL EN PACIENTES RESISTENTES AL TRATAMIENTO GRAN CANTIDAD DE EFECTOS ADVERSOS ANTAGONISTAS NMDA (KETAMINA ) V I T A MINA C PREVENTIVO ( FRACTURAS DE COLLES )

21. 2. TRATAMIENTO INVASIVO Bloqueo simpatico

22. Bloqueo Nerviosos

23. Estimulación medular La evidencia para la estimulación medular es fuerte a corto plazo y moderada a largo plazo (B-C).

24. La administración de medicación por vía intratecal ha demostrado su efectividad en los pacientes con SDRC que no responden a la EME, con distonía asociada al SDRC Infusión espinal de fármaco

25. CONCLUSIONES E x t re m ar l o s cu i da d os dura n te l a c i rug í a, l i m i ta nd o el t i e m p o quirúrgico y de la isquemia. Buen control del dolor postoperatorio Su diagnóstico en puramente clínico li m i t a l a ac titud Tratamiento precoz y multidisciplinar E l n o - c o n o c i m i e nt o d e l a f i s i o p a t o l o g ía terapéutica 5. Es una enfermedad real y claramente invalidante

26. BIBLIOGRAFÍA

27. Identifying information It’s the closest planet to the Sun and the smallest in the Solar System Mercury Venus has a beautiful name and is the second planet from the Sun Venus Despite being red, Mars is actually a cold place. It’s full of iron oxide dust Mars

28. About the patient Age: 70 Gender: Male Allergies: None Observations Earth is the third planet from the Sun and the only one that harbors life in the Solar System. This is where we all live Mercury Mercury is the closest planet to the Sun 2005 Mars Despite being red, Mars is a cold place 2010 Venus Venus is the second planet from the Sun 2015

29. A picture is worth a thousand words

30. Physical examination Mercury Mercury is the closest planet to the Sun Venus Venus is the second planet from the Sun Mars Mars is actually a very cold place Jupiter Jupiter is the biggest planet of them all Saturn It’s composed of hydrogen and helium Neptune It’s the farthest planet from the Sun

31. Mercury is the closest planet to the Sun and the smallest one in the Solar System. This planet's name has nothing to do with the liquid metal, since Mercury was named after the Roman messenger god Discussion summary

32. Findings Follow the link in the graph to modify its data and then paste the new one here. For more info, click here Evolution Jupiter Jupiter is the biggest planet of them all Neptune It’s the farthest planet from the Sun Saturn It’s a gas giant and has several rings 125,000 Big number

33. Awesome words

34. Prevalence Mercury It’s the closest planet to the Sun 70% Mars Mars is actually a very cold place 30% 50,000,363 Total cases

35. Review of the system “Mercury is the closest planet to the Sun and the smallest of them all” Dr. Jenna Doe “Venus has a beautiful name and is the second planet from the Sun” Dr. Louis Smith “Despite being red, Mars is actually a cold place. It’s full of iron oxide dust” Dr. Lisa Jones “Neptune is the farthest planet from the Sun. It's also the fourth-largest” Dr. John Lewis

36. Mercury is the closest planet to the Sun Mercury Venus is the second planet from the Sun Venus Mars is actually a very cold place Mars Jupiter is the biggest planet of them all Jupiter It’s composed of hydrogen and helium Saturn It’s the farthest planet from the Sun Neptune Diagnosis

37. Treatment It’s the closest planet to the Sun and the smallest in the Solar System Mercury Venus has a beautiful name and is the second planet from the Sun Venus 2 1

38. Comparison Venus Mars Jupiter Venus is the second planet from the Sun Yes Yes No Saturn is composed of hydrogen and helium Yes No Yes Jupiter is the biggest planet of them all No No Yes

39. 140,000 Big numbers catch your audience’s attention

40. Patient monitoring Week 1 Mercury is the closest planet to the Sun 10% Mercury 30% Venus 60% Mars Week 2 Despite being red, Mars is a cold place 70% Jupiter 10% Saturn 20% Neptune Week 3 Neptune is the farthest planet from the Sun 40% Saturn 30% Ceres 30% Earth

41. 10% Mercury is the closest planet to the Sun Mercury Post-prevention 20% Despite being red, Mars is a cold place Mars 30% It’s the second planet from the Sun Venus 40% It’s the farthest planet from the Sun Neptune

42. Contraindications and indications You should You shouldn’t Describe the things patients should do here Describe the things patients should do here Describe the things patients should do here Describe the things patients should do here Describe the things patients shouldn't do here Describe the things patients shouldn't do here Describe the things patients shouldn't do here Describe the things patients shouldn't do here

43. Case timeline Day 1 Mercury is the closest planet to the Sun Day 2 Venus is the second planet from the Sun Day 3 Mars is actually a very cold place Day 4 Neptune is very far from the Sun

44. Conclusions Do you know what helps you make your point clear? Lists like this one: They’re simple You can organize your ideas clearly You’ll never forget to buy milk! And the most important thing: the audience won’t miss the point of your presentation ever again

45. References AUTHOR (YEAR). Title of the publication . Publisher AUTHOR (YEAR). Title of the publication . Publisher AUTHOR (YEAR). Title of the publication . Publisher AUTHOR (YEAR). Title of the publication . Publisher AUTHOR (YEAR). Title of the publication . Publisher AUTHOR (YEAR). Title of the publication . Publisher AUTHOR (YEAR). Title of the publication . Publisher

46. Our team You can speak a bit about this person here Peter Doe You can speak a bit about this person here Anna Johnson

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