1 / 82

NEURALGIA POSHERPÉTICA

NEURALGIA POSHERPÉTICA. ERWIN ASPRILLA RI ANESTESIOLOGIA UMNG – HOMIC 2010. NPH: 3ra causa de dolor neuropatico. The impact of varicella zoster virus: Chronic pain. Journal of Clinical Virology 48 (2010) S1, S8–S13. Problema de Salud Publica ???. NEURALGIA POSTHERPETICA.

flint
Download Presentation

NEURALGIA POSHERPÉTICA

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. NEURALGIA POSHERPÉTICA ERWIN ASPRILLA RI ANESTESIOLOGIA UMNG – HOMIC 2010

  2. NPH: 3ra causa de dolor neuropatico The impact of varicella zoster virus: Chronic pain Journal of Clinical Virology 48 (2010) S1, S8–S13

  3. Problema de Salud Publica ???

  4. NEURALGIA POSTHERPETICA • Dolor luego de la finalización del exantema (90 a 120 días). Herpes Zoster and Postherpetic Neuralgia in Older Adults Kenneth Schmader, .Clin Geriatr Med 23 (2007) 615–632

  5. EPIDEMIOLOGIA Herpes Zoster and Postherpetic Neuralgia in Older Adults Kenneth Schmader, .Clin Geriatr Med 23 (2007) 615–632

  6. EPIDEMIOLOGIA Herpes Zoster and Postherpetic Neuralgia in Older Adults Kenneth Schmader, .Clin Geriatr Med 23 (2007) 615–632

  7. EPIDEMIOLOGIA Herpes Zoster and Postherpetic Neuralgia in Older Adults Kenneth Schmader, .Clin Geriatr Med 23 (2007) 615–632

  8. EPIDEMIOLOGIA Herpes Zoster and Postherpetic Neuralgia in Older Adults Kenneth Schmader, .Clin Geriatr Med 23 (2007) 615–632

  9. ETIOLOGIA DNA VIRUS AlfaherpesviridaeVaricellovirus

  10. ETIOLOGIA Diámetro de 150 a 200 nm, 125000 pares de bases, 2 cadenas DNA isomericas que codifica 70 productos génicos.

  11. ETIOLOGIA Advances in the understanding of the pathogenesis and epidemiology of herpes zoster Journal of Clinical Virology 48 (2010) S1, S2–S7

  12. ETIOLOGIA

  13. Complicaciones de la Infeccion HZ

  14. PRINCIPAL FACTOR DE RIESGO Herpes Zoster and Postherpetic Neuralgia in Older Adults Kenneth Schmader, .Clin Geriatr Med 23 (2007) 615–632

  15. FACTORES DE RIESGO Herpes Zoster and Postherpetic Neuralgia in Older Adults Kenneth Schmader, .Clin Geriatr Med 23 (2007) 615–632

  16. POBLACIONES SUCEPTIBLES Herpes Zoster and Postherpetic Neuralgia in Older Adults Kenneth Schmader, .Clin Geriatr Med 23 (2007) 615–632

  17. F.R. NEURALGIA POST HERPETICA Herpes Zoster and Postherpetic Neuralgia in Older Adults Kenneth Schmader, .Clin Geriatr Med 23 (2007) 615–632

  18. CARACTERISTICAS CLINICAS • Reactivación del VVZ • Diseminación al ganglio sensorial y al nervio periférico . • Activación de la R// inmune. • Inflamación y destrucción neuronal Herpes Zoster and Postherpetic Neuralgia in Older Adults Kenneth Schmader, .Clin Geriatr Med 23 (2007) 615–632

  19. FISIOPATOLOGIA

  20. HISTORIA NATURAL Herpes Zoster and Postherpetic Neuralgia in Older Adults Kenneth Schmader, .Clin Geriatr Med 23 (2007) 615–632

  21. FASES DEL DOLOR Herpes Zoster and Postherpetic Neuralgia in Older Adults Kenneth Schmader, .Clin Geriatr Med 23 (2007) 615–632

  22. CARACTERÍSTICAS DEL DOLOR

  23. Dolor preherpetico Alodinia - Hiperalgesia MECANISMOS DEL DOLOR

  24. DOLOR CRONICO

  25. SUBTIPOS

  26. SUBTIPOS

  27. Herpes Zoster and Postherpetic Neuralgia in Older Adults Kenneth Schmader, .Clin Geriatr Med 23 (2007) 615–632

  28. COMPROMISO OCULAR • VHZ: Rama oftálmica del trigémino 10 – 15% • Complicaciones oculares > si lesión nasociliar • Compromiso corneal y de la uvea: • Anestesia, ulceración corneal, glaucoma, neuritis óptica, ceguera. Herpes Zoster and Postherpetic Neuralgia in Older Adults Kenneth Schmader, .Clin Geriatr Med 23 (2007) 615–632

  29. OTRAS COMPLICACIONES VHZ • ACV 2ria a Arteritis granulomatosa de la Carótida interna. • Paresia focal motora • Parálisis facial • Síndrome de RamsayHunt (hipoacusia vértigo y parálisis facial) • Meningoencefalitis • Mielitis • Infección bacteriana 2ria. Herpes Zoster and Postherpetic Neuralgia in Older Adults Kenneth Schmader, .Clin Geriatr Med 23 (2007) 615–632

  30. Valoracion • The presence of prodromal pain • can be assessed by asking, “Did you have any pain before • the rash appeared in the area where you now have your • shingles rash?” The presence of herpes zoster pain can be • assessed by asking, “Do you have any pain in the area • where you now have your shingles rash?” And the presence • of pain after rash healing can be assessed by asking, • “Do you have any pain in the area where you had your • shingles rash?” Although such assessments of the presence • of any pain are a necessary first step in evaluating • herpes zoster pain and PHN, they must be supplemented • by assessments of pain intensity, as discussed below. Diagnosis and Assessment of Pain Associated With Herpes Zoster and Postherpetic Neuralgia. The Journal of Pain, Vol 9, No 1 (January), Supplement 1, 2008: pp S37-S44

  31. DIAGNOSTICO • CLINICA • ≠ de la infección por Herpes simple. • Otras condiciones: • Dermatitis de contacto, quemaduras, lesiones fúngicas. • Presentaciones atípicas • Cultivo viral, IFI, PCR, Serología. Herpes Zoster and Postherpetic Neuralgia in Older Adults Kenneth Schmader, .Clin Geriatr Med 23 (2007) 615–632

  32. Tratamiento www.thelancet.com Vol 367 January 21, 2006

  33. TRATAMIENTO INFECCIÓN AGUDA Herpes Zoster and Postherpetic Neuralgia in Older Adults Kenneth Schmader, .Clin Geriatr Med 23 (2007) 615–632

  34. Herpes Zoster and Postherpetic Neuralgia in OlderAdults Kenneth Schmader, .Clin Geriatr Med 23 (2007) 615–632 TERAPIA ANTIVIRAL

  35. No hay diferencias en la incidencia de NPH • Famciclovir

  36. NEURITIS POR HERPES ZOSTER CORTICOESTEROIDES • Poca evidencia que combinados con antivirales aceleren la tasa de cicatrización • No protegen contra la NPH • Única indicación la NHZ oftálmica ANALGESICOS • AINES (proceso inflamatorio) • OPIOIDES • Tramadol e Hidrocodona • Rotar con Morfina u Oxicodona

  37. TERAPIA ADYUVANTE Ninguno ha demostrado prevenir la incidencia de neuralgia posherpetica, pero pueden ser útiles para ↓ el dolor agudo Herpes Zoster and Postherpetic Neuralgia in Older Adults Kenneth Schmader, .Clin Geriatr Med 23 (2007) 615–632

  38. NEURALGIA POST HERPETICA • Evaluación y manejo multidisciplinario • Iniciar con terapias poco invasivas para pasar a tratamientos mas agresivos. • TRATAMIENTO EN FUNCION DE • Intensidad del Dolor • Edad del paciente • Patologías Asociadas • Resultados de tratamientos previos

  39. NEURALGIA POSHERPÉTICA Terapias de primera línea ↓ el dolor en 30 a 60% de los pacientes

  40. OPIOIDES

  41. OPIOIDES • OXICODONA: • NNT: 2,5, DISMINUCION VAS DE UN 50% • NNH: 38 • MORFINA • NO MORFINA EPIDURAL / CLASE IV • TRAMADOL • REDUCCION > 50% DEL DOLOR NNT: 4.7

  42. ANTIDEPRESIVOS TRICICLICOS

  43. ANTICONVULSIVANTES

More Related