dolor rehabilitacion

7/24/2019 Dolor Rehabilitacion

1/56

DOLORALEJANDRO HERNANDEZHARRISON HERRERALICETH FERNANDEZ

MERCY GUERRERO MUOZANAMARIA GOMEZ AROCAWILLIAM ANDRES FLOREZ


2/56

DEFINICIN UNA SENSACIN DESAGRADABLE Y UNA EXPERIENCIA

EMOCIONAL ASOCIADAS CON UN DAO TISULAR REAL O

POTENCIAL, O DESCRITA EN TRMINOS DE TAL DAO. ASOCIACIN INTERNACIONAL PARA EL ESTUDIO DEL

DOLOR IASP!


3/56

INVOLUCRA

C"#$%&%'"

M"&%'()%*$ C"+"-&(+%$&" A/)&%'" E0%-%&1(2

CLASIFICACION

AGUDO Y CRONICONOCICEPTIVOS

NEUROPTICOS

INDIVIDUALYSUBJETIVO


4/56

PROCESOS DEL DOLOR

Proceso final en que los 3 primeros interactan, con una seriede fenmenos individuales, crean la experiencia subjetiva y

emocional denominada dolor.

PEREP!"#$

%"&'()!"#$

apacidad que tienen los sistemas anal*+sicos end*enosde modificar la transmisin del impulso nervioso inibiendo

las astas posteriores.

-R)#%!!"#$

Propa*acin del estimulo nervioso asta los nerviossensoriales del #.

-R)#&'!"#$

Proceso por el cual el estimulo nocivo perif+rico se convierteen estimulo el+ctrico.


5/56

NOCICEPTORES

Fibras Nociceptivas Tipo Velocidad Dimetro

Fibras A- Miel/nicas 4-30m./sg 1-5mm

Fibras C Amiel/nicas 0,4-2m/sg 0,3-1,5mm

FIBRAS A G-($ #-"0"- 3 4 '2")%5(5 5

)"$51))%*$. A67 (-&%)%( $ 2( &-(0+%0%*$ 52

5"2"- A87 ()&%'($ ($& 0&9+12"0

&:)&%20 01('0 S"+:&%)" 01-;)%(2 3 -"/1$5". L(+%$(0 I


6/56

NOCICEPTORES


7/56

L(0 $1-"$(0 $")%)&%'(0

0)1$5(-%(0 0 $)1$&-($5%0&-%>1%5(0 $ 2( 010&($)%(#-%0 0%$(2. Dolor Rpido: 0

2")(2%?($ $ 2 $@)2"+(-#%$(2 2(+%$( I! (2#1$(00 $)1$&-($ 2")(2%?(5(0-"/1$5(+$& 2 $@)2"0$0"-%(2 -"%" 2(+%$(0

I= 3 =!.

Dolor Lento:0 2")(2%?($ 2( 2(+%$( =. P-" 2(

+(3"- 5 2( $1-"$(0$")%)&%'(0 22#($ ( 2(0

ASTA POSTERIOR


8/56

ASCENDENT

ES DELDOLOR

L(0 0#1$5(0$1-"$(0 5($ "-%#$ (&-0 H()0(0)$5$&0)"$&-(2(&-(20 1)"$/"-+($ 2( VaEspinotali!a

ElNeoespinotali!o

ElPaleoespinotali!o

" El

Va Dolor Lento

Va Dolor Rpido


9/56

FASC$C%LO NEOESPINOTAL&'ICO IMPORTANTE PARA LA INTENSIDAD Y AGUDEZA DEL DOLOR Y SU UBICACIN

TOPOGRFICA.

FASC$C%LO PALEOESPINOTAL&'ICO (

ESPINORRETIC%LOTAL)'ICO FOR'ACIN RETIC%LAR DEL B%LBO RA*%$DEOSISTEMA RETICULOTALMICO

MULTISINPTICO!7 PROYECTA IMPULSOS NOCICEPTI=OS HASTA TLAMO N+CLEOS TAL)'ICOSPOST"Y N+CLEOS INTRALA'INARES! Y A ESTRUCTURAS ASOCIADAS AL SISTE'A L$'BICORESPONSABLE DE LAS RESPUESTAS AFECTI=AS DEL DOLOR ANGUSTIA, DEPRESIN!


10/56

V$AS DESCENDENTES

SISTE'A 'OD%LADOR10&($)%( G-%0 P-%0%2'%($(-( P-%'$&-%)12(- M0$)/(2"(-& 01-%"- 5 2( -"&1>-($)%(

&-+%$(5(0 (-&0 5 3 '$&-9)12"

N@)2" M(#$" 52 R(/N@)2" R&%)12(-

C"+2" %$%>%5"- 52 5"2"- -)&"-0 +"-/9$%)"0!(0&( "0&-%"- 5 2( +512( 0%$(2!

S >2"1( 2 5"2"- ($&0 1 22#1 (2 )->-"


11/56

(as interneuronas que

forman la sustancia

*elatinosa l0mina !!4 y

las l0minas mas

ventrales !!!, !5, 54 del

asta dorsal.

6)1) y la 6licina

iniben el efectoexcitador de la fibras.

'OD%LACIN ( CONTROL DEDOLOR


12/56

CONTROLE,-ENO DELDOLOR(as *ruesas fibras

nerviosas aferentes que

conducen el impulso de la

sensibilidad t0ctil se

conectan con la sustancia*elatinosa y otras neuronas

del asta dorsal.

Tcnica TENSestimulacin

transcut7nea4


13/56

ONTROL END-ENO DEL DOLOE0&%+12()%*$ 2)&-%)( "&%5"0 "%"50

$5*#$"0 POE!.N1-"$(0 5 2( 010&($)%(#-%0 -%()151)&(2 3S10&($)%( #-%0 -"51)$

($(2#0%(, N@)2" M(#$"52 R(/ 3 "&-(0 $1-"$(05 2( F"-+()%*$ R&%)12(-.L"0 ("$0 50)%$5$(0&( 2( 010&($)%(#2(&%$"0( %$%>$0&%+12" 5"2"-!

POE /(+%2%(07 $)/(2%$(0,

>&($5"-;$(0, 5%$"-;$(0,$5"+"-;$(0 3


14/56

=IAS ASCENDENTES Y MODULADORAS DEL DOLOR


15/56

TIPOS DE DOLOR

DOLOR AGUDO7 )"$0)1$)%( %$+5%(&( 5 2(()&%'()%*$ 5 2"0 0%0&+(0 $")%)&%'"0 "- 1$0&%+12". T%$ /1$)%*$ 5 -"&))%*$ >%"2*#%)(. )"$09$&"+(0 0%)"2*#%)"0 0)(0"0 3 2%+%&(5"0 ( 1$(

($0%5(5 2'.

DOLOR CRONICO7 $" "0 1$( /1$)%*$ -"&)&"-(, 3+:0 1 1$ 09$&"+( 0 )"$0%5-( )"+" 1$($/-+5(5, 1$ 5"2"- -0%0&$& 1 15

(1&"-&1(-0 "- 1$ &%+" -"2"$#(5" 5010 51$( 20%*$, %$)210", $ (10$)%( 5 22(. S12 0--/-()&(-%" ( 2"0 &-(&(+%$&"0 3 0 (0")%( (%+"-&($&0 09$&"+(0 0%)"2*#%)"0.


16/56

TIPOS DE DOLOR CLASIFICACIN FISIOPATOLGICA7

DOLOR SO'&TICO:

DESENCADENADO POR TRAUMATISMOSPINCHAZO, CORTE, GOLPE,PINZAMIENTO, TORSIN

NOCICEPTORES MECONOCEPTORES,POLIMODALES, KUMICOS!, CONACCIN NEUROEFECTORA FLA,BRADIKUINIDAS, SUSTANCIA P,

SEROTONINA, E HISTAMINA!

AMPLIFICACIN DE LA REACCINTISULAR, AUMENTO DE LA PERCEPCINDOLOROSA .IPERAL-ESIA"

DOLOR VISCERAL: COMPLEJO Y MENOS CONOCIDO LOS TRES PRINCIPALES DESENCADENANTES SON

LA DISTENSIN, LA ISKUEMIA Y LA INFLAMACIN

S+%"2"#9( M5%)( A-#$& A2'(-?


17/56

S+%"2"#9( M5%)( A-#$& A2'(-?


18/56

TIPOS DE DOLOR

N1-":&%)"7 E0&: -"51)%5" "- 0&%+12" 5%-)&"52 0%0&+( $-'%"0" )$&-(2 " "- 20%*$ 5 '%(0$-'%"0(0 -%/-%)(0.

S 50)-%> )"+" 1$?($& ,1+($&,()"+(Q(5" 5 (-0&0%(0, 5%00&0%(0 ,%-(2#0%( ,%-0&0%( 3 (2"5%$%(.

S"$ +2"0 2( 2"(&9( >-(1%(2 " 21+>"


19/56

S+%"2"#9( M5%)( A-#$& A2'(-?


20/56

S+%"2"#9( M5%)( A-#$& A2'(-?


21/56

DERMATOMAS Y

MIOTOMAS

DERMATOMAS


22/56

DER'ATO'A P%NTO DE EST%DIOC Prot#/eran!ia O!!ipitalC Fosa S#pra!la0i!#lar 1Tr2ono S#pra!la0i!#lar3C En el '#45n del .o/ro 1Arti!#la!i5n A!roio!la0i!#lar3

C Lado lateral de la Fosa C#/ital 1Delante del Plie2#e del !odolateral3C P#l2arC Dedo 'a6orC Dedo 'e4i7#e

T Lado edial de la Fosa C#/ital 1Delante del Plie2#e del !odo'edial3

T V8rti!e de la A9ilaT,T


23/56

ERMATOMAS

DERMATOMAS


24/56

DERMATOMAS

MIOTOMAS


25/56

MIOTOMASRAZ MIOTOMA FUNCIN

A EXAMINAR

REFLEJO INERVACIN

C5 M.Biceps Brachii Flei!" #el C$#$ Bicipi%al M&sc&l$c&%a"e$

C' M. E%e"s$r carpira#ialis L$"(&s ) Bre*is

E%e"si!" #e la M&+eca Ra#ial

C, M.Triceps Brachii E%e"si!" #el c$#$ Tricipi%al Ra#ial

C- M.Fle$r i(i%$r&/

0r$1&"#&s

Flei!" #e la 1ala"(e #is%al #el

#e#$ /e#i$

Me#ia"$

T2 M.A3#&c%$r i(i%i /i"i/i A3#&cci!" #el #e#$ /e+i4&e Ul"ar

L M.ili$ps$as Flei$" #e la Ca#era Fe/$ral

L6 M.4&a#riceps Fe/$ris E%e"si!" #e la r$#illa 0a%ellar

7r$%&lia"$8

Fe/$ral

L9 M.%i3ialis A"%eri$r E%e"si!" #el T$3ill$ 0er$"e$ 0r$1&"#$

L5 M. e%e"s$r hall&cisl$"(&s

E%e"si!" #e la 1ala"(e #is%al#el #e#$ :$r#$

0er$"e$ 0r$1&"#$

;2 M.%riceps ;&rae Flei!" #el T$3ill$ A4&ile$

7calc


26/56

C


27/56

= '"TRICEPS BRAC.II

MIOTOMASC@= '"Fle9or Di2itor#

Pro;#nd#s

MIOTOMAS


28/56

T='"ABD%CTORDI-ITI 'INI'I

MIOTOMASL='" Iliopsoas

MIOTOMAS


29/56

L='" *%ADRICEPSFE'ORIS L= '" Ti/ialis Anterior

MIOTOMAS


30/56

DIAGNSTICO Y E=ALUACIN CLNICA

H%0&"-%( C2%$%)(7 C(-()&-90&%)(0 52

5"2"-. A L I C I A!T%+" 5

'"21)%*$. G$-( 2%+%&()%*$V R012&(5"0 5

&-(&(+%$&"0-'%"0.

E(+$ /90%)"7 D(&"0 ">&%'"0

(-( -(;-+(- 2(

HC. I$)21%- 0%+-70%0&+( +10)12"012&%)",)"21+$( '-&>-(2

3 '(21()%*$$1-"2*#%)(.

AA$&%#5(5 L7 L")(2%?()%*$ I7 I--(5%()%*$ " -"(#()%*$ C7C(-:)&-I7 I$&$0%5(5 A7 A&$1()%*$ " A#-('(+%$&"


31/56


32/56


33/56

TRATA'IENTO NOFAR'ACOLO-ICO

DEL DOLOR


34/56

TERAPIA LASER


35/56

EFECTOS DE LA TERAPIAL&SER

EFECTOS BIOL-ICOS DEL L&SER:

A$(2#0%( $ (2 ?"$( %--(5%(5(

A$&% %$(+(&"-%"

A$&% 5+(&"0"C%)(&-%?( 2(0 -%5(0 3 &-(1+(&%0+"0 $

5%'-0"0 &%5"0.

EFECTO FOTOTR'ICO DEL L&SER

C"$0&%&13 1$( /"-+( 5 +$0( " $-#9(1&%2%?(>2 +W! "- 2( -"%( )212( (-( 2($"-+(2%?()%*$ 5 2(0 /1$)%"$0 (2&-(5(0.

S &-(&( 5 1$ /)&" /"&"$-#&%)" "

>%"$-#&%)"

EFECTO FOTO*%$'ICO DEL L&SER

S -"51) 2( 2%>-()%*$ 5 010&($)%(0 )"+" 2(%0&(+%$(, 0-"&"$%$( 3 >-(5%)%$%$(.

A1+$&" 5 -"51))%*$ 5 ATP %$&-()212(-.

E0&9+12" 5 2( 09$&0%0 5 ADN, 09$&0%0 -"&%)(3 $?%+:&%)(.

EFECTO FOTOELCTRICO DEL L&SER

N"-+(2%?()%*$ 52 "&$)%(2 5 ++>-($(()&1($5" 5%-)&(+$& 0">- 2( +"'%2%5(5%*$%)( %$5%-)&(+$& (2 %$)-+$&(- 2ATP -"51)%5" "- 2( )212( 3 $)0(-%"(-( ()- /1$)%"$(2 2( >"+>( 5 0"5%" 3"&(0%"


36/56

DOSIS TERAP%TICADEL L&SER: L( 5"0%0

-)"+$5(>2 (-( 2((2%)()%*$ 00&(>2) $&-7 ( J12%"0 )+

D$5-: 5 1$(0-% 5 (-:+&-"01 5> 0&(>2)- 2;0%"&-(1&( .

P(-( %$1%- 0">- 2($-#9( 0"2")"$&-"2(+"0 2 &%+"

5 2( (2%)()%*$.

'TODOS DEAPLICACIN DELL&SER:

P#nt#al: $ 1$1$&" " 1$&"0-5&-+%$(5"0,1$&"0 5 ()11$&1-(

&). S (2%)($ )"$ 20):$- $/")(5" $1$ 1$&" ;". Barrido de p#ntos:

0 (2%)( 505 2"00%0&+(0 5 )(Q*$ )"$0"0. Barrido total de #naona: +5%($&0%0&+(0 5 )(Q*$1 )"$&-"2($ 0"0,5%>1($5" 1$ '(%'$52 (? .

INDICACIONES DE LATERAPIA L&SER

P-")0"0 12)-"0"0.

P-")0"0 '(-%)"0"0.

T$"0%$"'%&%0.

C(012%&%0 3 >1-0%&%0.F%>-"+%(2#%(.

F(0)%&%0.

F%>-"0%0.

C212%&%0.

D0#(--"0 &%012(-0,5--(+0 3

+(&"+(0.

CONTRAINDICACIONES

N" 0&:$ )2(-(+$&0&(>2)%5(0 $%5;$%5(0.

E$ -")0"0 +(2%#$"05> ">0-'(-0 2(

-010&(.E2 +(3"- 2%#-" 0(22( $ 2( "0%)%*$5%-)&(.

E2 ;0%"&-(1&( 5>()&1(- $ &"5"+"+$&" )"$-15$)%( 3 $

)"$&9$1( 0-( 5$1'(0 )"$)210%"$0 3('($)0.


37/56

ESTI'%LACIN

ELCTRICATRANSC%T&NEA

1TENS3"


38/56

KUE ES VE0 1$( /"-+( 5 2)&-"&-(%( 5 >((/-)1$)%( 1 -+%& 0&%+12(- 2(0 ;>-(0 $-'%"0(0

#-10(0 A < (2/( +%29$%)(0 5 )"$51))%*$ -:%5(.D0$)(5$( ( $%'2 )$&-(2 2( 10&( $ +(-)( 5 2"00%0&+(0 ($(2#0%)"0 50)$5$&0 5 )(-:)&- %$%>%&"-%"

TENS Con0en!ional:

E0 2 TENS 5 (2&( /-)1$)%( 3 (+2%&15 >((. S 1&%2%?(0">-&"5" (-( 2( 5%0+%$1)%*$ 52 5"2"-, $ -">2+(0 5 (2&(()&1(2%5(5, -""-)%"$($5" ($(2#0%( 5 )"-&( 51-()%*$, S-)"+%$5( )"+" /-)1$)%( 5 (-&%5( H?, 0%&1:$5"0$&- 3 H? 2(0 /-)1$)%(0 +:0 /)&%'(0. L( (+2%&155> (10&(-0 (0&( -%+$&(- (-0&0%(0 (#-(5(>20

TENS por r;a2as:T(+>%$ 0 2 )"$") )"+" &$0 "- &-$0 5 %+120". E0 2TENS 5 /-)1$)%( >(( 3 (+2%&15 (2&( " TENS "- -:/(#(0.N" -"'")( 1$( 5%0+%$1)%*$ %$+5%(&( 52 5"2"-, -" 50105 +%$1&"0 5 (2%)()%*$ (3 1$ -9"5" 5 ( "-(0 5(2%'%". S +2( 0% TENS )"$'$)%"$(2 $" 01-# /)&".L( /-)1$)%( >:0%)( 5 )(5( &-$ 0 5 H?.


39/56

ELCTRICA

TRANSC%T&NEA1TENS3"Indi!a!iones -enerales del TENS< L0%"$0 ('120%'(0 52 2" >-(1%(2,20%"$0 5 2"0 $-'%"0 -%/-%)"0

$1-"+( 5"2"-"0"!.< L0%"$0 5 )"+-0%*$ $-'%"0( 35%0&-";( 0%+:&%)( -( 09$5-"+ 52&@$2 )(-%($"!.

< D"2"- 52 +1Q*$ 3" 5"2"- /($&(0+( 5+%+>-"0.

< N1-(2#%( "0& -&%)(.< D"2"- 5 0(25( 3 )122" (0")%(5" )"$5"2"- 5 %-$( " >-(?" -0)&%'(+$&.< N1-(2#%( 52 &-%#+%$".

< D"2"- $ $/-+"0 &-+%$(20.

< D"2"- ">0&&-%)".

Contraindi!a!iones del TENS

< P-0$)%( 5 +(-)((0"0.

< E$/-+5(5 )(-59()( " (--%&+%(0. S(2'"-)"+$5()%*$ 52 )(-5%*2"#"!.< D"2"- 0%$ 5%(#$"0&%)(-.

< E%20%(, 0%$ )"$012&(- 2"0 )1%5(5"0 3)"$0"0 $)0(-%"0 )"$ 2 +5%)".< D1-($& 2"0 &-0 -%+-"0 +00 52+>(-(?".

< N" (2%)(- $ 2( >")(.

< N" 1&%2%?(- $ 2 &-(3)&" 5 2( (-&-%()(-*&%5(.

< N" +2(- 0">- %2 20%"$(5(.

< N" (2%)(- 0">- %2 ($0&0%(5(.

< N" 1&%2%?(- 0">- 2 (>5"+$ 51-($& 2+>(-(?"


40/56

CRIOTERAPIA


41/56

CRIOTERAPIA

G*#e esH

E0 1$ )"$1$&" 5 -")5%+%$&"0 1 1&%2%?($ 2( &+-(&1-( /-9( $ 2(&-(1&%)( +5%)(. S 5%/-$)%( 5 2( %"&-+%( "- 1 0&( 5%0+%$13 2( &+-(&1-( )$&-(2 52

"-#($%0+", +%$&-(0 1 2( )-%"&-(%( 5%0+%$13 2( &+-(&1-( -%/-%)( 3#$-(2+$& 0 1$&1(2.

FACTORES

L( %$&$0%5(5 5 0& $/-%(+%$&" 5$5 5 !#atro ;a!tores-%$)%(2+$&7 D%/-$)%( 5 &+-(&1-( $&- 2 (#$& /-9" 3 2"0 &%5"0T%+" 5 "0%)%*$ L( )"$51)&%'%5(5 &-+%)( 52 :-( &-(&(5(T%" 5 (#$& /-9" 1&%2%?(5".

EFECTOSFISIOLOGIC

OS

D%0+%$1)%*$ 5 2( &+-(&1-(

D%0+%$1)%*$ 52 +&(>"2%0+" &%012(- D%0+%$1)%*$ 52 1" 0($#19$" D%0+%$1)%*$ 5 2( %$(+()%*$ D%0+%$1)%*$ 52 5+( A$(2#0%( "- ())%*$ 5%-)&( 0">- 2(0 &-+%$()%"$0 $-'%"0(0 %$5%-)&( 2

5%0+%$1%- 2 0(0+" 3 2( &1+/())%*$ E/)&" ($&%0(0+*5%)" A1+$&" 52 +&(>"2%0+" ( $0(0 5 2(0 #-(0(0 A))%*$ 5%1-&%)(


42/56

P"0&-(1+( (#15"C-%")%$&%)(

E0(0&%)%5(5

K1+(51-(0 2'0 301-;)%(20A/))%"$0 )"$ 5"2"- 3-1-%&"

P-")0"0 %$(+(&"-%"0E5+(0

A/))%"$0 )1&:$(0 30&&%)(0

F(0 +"--:#%)(

C"$&-()&1-(0 30(0+"0 +10)12(-0

F%>-7 E$ 0&"0 )(0"00 10($ (2%)()%"$0#$-(2%?(5(0 3( 0("- )(10( %$/))%"0(,1%-@-#%)(,$1-"#$%)(,50%5-(&()%*$ " "-5-"#(0

INDICACIONES H%-&$0"0

R%#%5? (-&%)12(-

H-%5(0

D%0+%$1)%*$ " -5%5(5 2( 0$0%>%2%5(5

=(0"0(0+"0

A-&-%"0)2-"0%0I$&"2-($)%( (2 /-9"

T-"+>"($#%&%0O>2%&-($&

Contraind

i!a!iones6pre!a#!io

nes


43/56

EERCICIO TERAP%TICO

C1(21%- -0"$( 0 15>$;)%(- 52 -)%)%"&-(1&%)". E2 -)%)%" (1+$&(2( /1-?(, +"-( 2 1%2%>-%" 3 2()""-5%$()%*$, +"-( 2 01Q",

%$)-+$&( 2( %>%2%5(5,0&%+12( 2 0%0&+()(-5%"'(0)12(-, &"$%;)( 2"0+@0)12"0 3 (2%'%( 2( -%#%5?+10)12"012&%)(, 2( /(&%#( 3 25"2"-.

E2 &-(1&( /90%)" 5%0Q(-: 1$-"#-(+( 1 0(&%0/(#( 2(0$)0%5(50 %$5%'%51(20 5 )(5(()%$&.A$&0 52 -)%)%" &-(1&%)" 0

(5+%$%0&-( 1$( +"5(2%5(5 (0%'(,


44/56

EERCICIO TERAPE%TICO

U$" 5 2"0 -%+-"0 &-(&(+%$&"0)"$&-( 2 5"2"- )-*$%)" 15 0- 1$-)%)%" /90%)" 2%#-", "- +2")(+%$(-.

E2 -)%)%" 0&%+12( 2( 2%>-()%*$ 52"0 ($(2#0%)"0 $(&1-(20 52"-#($%0+", $5"-;$(0!. F('"-) 2(%>%2%5(5, /"-&(2?( 3 -0%0&$)%( 3-51) 2 0&-0.

E2 -)%)%" &(+>%$ 15 /"-&(2)-+@0)12"0 ")" 10(5"0 " 5>%2%&(5"0 3(315(- ( 010&%&1%- 2 &-(>(" 5 1$+@0)12" 0">-1&%2%?(5" 3 )(10($& 525"2"-.


45/56

.IDROTERAPIA ( EERCICIO

L"0 ()%$&0 )"$ "0&"(-&-%&%0, (-&-%&%0-1+(&"%5, )($(2 '-&>-(2 0&-)" 35"2"- 5 0(25( " )122" 3 "&-(0$/-+5(50 5 2( )"21+$( 015$ >$;)%(- 5 2( &-(%(()1:&%)( %5-"&-(%(!.

C"$ /-)1$)%( 2 &-(&(+%$&" 0 22'(( )(>" $ 1$ &($1 " %0)%$( )"$(#1( )(2%$&. L( %5-"&-(%( 0&:%$5%)(5( (-( 2"0 )(0"0 5 5&-%"-"5 2( +"'%2%5(5, 5>%2%5(5, (-(

%$)-+$&(- 2( &"2-($)%( 52 ("3" (2)(+%$(-!, (09 )"+" (-( 2 5"2"-, 2(%>%2%5(5 3 2( )""-5%$()%*$.

E2 (#1( &%>%( -2(( 2"0 +@0)12"0. L("&(>%2%5(5 5-%'(5( 52 (#1(

/('"-) 2( +"'%2%?()%*$ 5 2(0(-&%)12()%"$0 0%$ 1$ 0/1-?"


46/56

TERAPIA DE CALOR


47/56

CLASIFICACION

s#perJ!ial)1($5" 2($&-()%*$ 0>(( )"+" )"$ 210" 5 %$/-(--""0" $ ())%"$0&-(1&%)(0 "-+)($%0+"0-"0! "pro;#nda)1($5"0 5($ /)&"0>%"2*#%)"0 #-()%(0

(2 )(2$&(+%$&"5%-)&" 5 &%5"0-"/1$5"0 )"+"01)5 $ 2 10"5 (2#1$(0)"--%$&0

2&-%)(0!

M)($%0+"0 5

&-+"&-(%(7 C"$51))%*$7

P-"(#()%*$0)1$5(-%( (2)0 5 $-#9()%$&%)( 5 2(0

+"2)12(0 ()9(2( 01-;)% /-9((53()$&.

C"$'$)%*$ R(5%()%*$7

A2entest8ri!os

'edios!ond#!ti0oss5lidos

'edios!ond#!ti0os

sei s5lidos 6l7#idos 'edios

!on0e!ti0os Radia!ion


48/56

E;e!tos de la teroterapia

U$ (1+$&" )"$&-"2(5" 5 2(&+-(&1-( -"51)7 M"-(+%$&" 5 2( $1&-%)%*$

3 5 2( "%#$()%*$ )212(- M"-( 2(0 5/$0(0 (2

(1+$&(- 2( )($&%5(5 5 2"02+$&"0 5 5/$0(. A))%*$ >()&-%)%5( A))%*$ ($&%%$(+(&"-%(

)"+>(& %$(+()%"$0 $0&(5%" )-*$%)"! A))%*$ ($(2#0%)( A))%*$ ($&%0(0+*5%)(

M"-( 2( -0&(1-()%*$)212(- A1+$&( 2 5-$( 2%$/:&%)" F('"-) -")0"0 5

-(-()%*$ &%012(-

Indi!a!iones:

E$/-+5(50 -1+:&%)(0D0#(--"0 +10)12(-0

C"$&-()&1-(0 +10)12(-0

E0(0+"0

D"2"-0 +$0&-1(20

D"2"-0 #:0&-%)"0

P-")0"0 %$(+(&"-%"0)-*$%)"0 3 01> (#15"0

T$5%$%&%0

D%0&-";( 0%+:&%)( -(F$*+$" 5 R(3$(15

B1-0%&%0

T-(0&"-$"0 5 2( )%-)12()%*$

-%/-%)(R51)()%"$ /1$)%"$(2

F%>-"+%(2#%(

H%-&"$9(

Contraindi!a!iones:C(-5%"(&9(0

P()%$&0 ($&%)"(#12(5"0

P-")0"0 %$/))%"0"0

N"2(0%(0

G2(1)"+(

H%"&$0%*$ #-('H+"--(#%( ()&%'(

I$01;)%$)%( :&%)(

I$(+()%*$ (#15(

P-">2+(0 -$(20

T-(0&"-$"0 5-+%)"0 ()&%'"0"$#"0 "- +2"!

C"2(#$"(&%(0 ()&%'(0A2&-()%"$0 5 2( 0$0%>%2%5(5

INTERVENCIONES


49/56

INTERVENCIONESFAR'ACOLO-ICAS

ESCALA 7 D"2"- 2' AINES COADYU=ANTES

ESCALA 7 D"2"- +"5-(5" OPIOIDES DEBILES COADYU=ANTES ESCALON

AINES!ESCALA 7 D"2"- 0'-" OPIOIDES POTENTES COADYU=ANTES ESCALON

AINES!

ESCALA 7 D"2"- +13 0'-"

ESCALA ANALGESICA OMS


50/56

NORMAS DE USO DE LA ESCALA ANALGSICA7

. L( )1($&%;)()%*$ 5 2( %$&$0%5(5 52 5"2"- 0 0$)%(2$ 2 +($" 3 0#1%+%$&" 52 5"2"-. . L( 01>%5( 5 0)(2*$ 5$5 52 /(22" (2 0)(2*$ ($&-%"-.

. S% (3 /(22" $ 1$ 0)(2*$ 2 %$&-)(+>%" $&- /:-+()"052 +%0+" 0)(2*$ 15 $" +"-(- 2( ($(2#0%( )&"

$ 2 0)(2*$ !. . S% 2 0#1$5" 0)(2*$ $" 0 ;)(?, $" 5+"-(- 2( 01>%5( (2 &-)-

0)(2*$.. L( -0)-%)%*$ 5 )"(531'($&0 0 >(0( $ 2( )(10( 525"2"- 3 0 5>$ +($&$- )1($5" 0 01> 5 0)(2*$. . N" +?)2(- 2"0 "%"%50 5>%20 )"$ 2"0 "&$&0.

. P-0)-%>%- )">-&1-( ($(2#0%)( 52 5"2"- %--1&%'".

I>1-"/$" 5%)2"/$()" $(-"$" +2"%)(+ )2)"%>


51/56

AINES

I>1-"/$", 5%)2"/$()", $(-"$", +2"%)(+, )2)"%>,()&(+%$"/$.

T)" &-(1&%)"7 U$( '? (2)($?(5( 2( 5"0%0 +:%+(-)"+$5(5(, 2 %$)-+$&" 5 2( 5"0%0 $" -"51) +(3"-($(2#0%(.

L( (5+%$%0&-()%*$ 5 '(-%"0 +5%)(+$&"0 ( 2( '? $" +"-(;)()%( ($(2#0%)(.

OPIOIDES

MODERADO7 O%"%50 5>%20 &-(+(5"2, "%)"5"$(, )"59$(! SE=ERO7 O%"%50 "&$&0 +-%5%$(, "%)"5"$( 2%>-()%*$

-&(-5(5(, +"-;$(, +(&(5"$(, /$&($%2"!

TECNICAS DEANESTESIAREGIONAL

C1($5" $" 0 ">&%$ 1$( ($(2#0%( (5)1(5( )"$ "%"%50

"&$&0, 5> )"$0%5-(-0 -")5%+%$&"0 )"+" 2( ($(2#0%()"$&%$1( 0%$(2 " %51-(2, >2"1" 5 $-'%"0 -%/-%)"0,>2"1" 0%+:&%)".


52/56

AUMENTAN LA EFICACIA ANALGSICA.

SE UTILIZAN EN EL MANEJO DE SNTOMAS CONCURRENTES KUEEXACERBAN EL DOLOR Y PARA TIPOS ESPECFICOS DE DOLOR COMO EL

NEUROPTICO.

SE INDICAN EN CUALKUIER ESCALN SI EL TIPO DE DOLOR LO PRECISA.

U&%2%?(5"0 )"+" &-(%((531'($& "- 01 /)&"05(&%'". P-%$)%(2+$&$ 5"2"- $1-":&%)",$1-"#$%)".

Antidepresi

0ostri!!li!os:

COADYU=ANTES7


53/56

U&%2%?(5"0 -%$)%(2+$& $ 5"2"-$1-":&%)", $1-"#$%)".

Anti!on0#lsi0antes:

D>%5" ( 01 /)&" 05($& 3-2(($& +10)12(-, 0%-'$ (-( 2

&-(&(+%$&" 5 2( ($0%5(5 3 5 2"00(0+"0 +10)12(-0 )(10($&0 55"2"-0 (#15"0.

P")( 1&%2%?()%*$ $ 2 5"2"- )-*$%)""- 01 &$5$)%( ( -"51)%-5$5$)%( /90%)( 3 091%)(.

Benodia!epinas:

U&%2%?(5"0 -%$)%(2+$& $ 5"2"-$1-":&%)", $1-"#$%)", 0"+:&%)".

Corti!oesteroides:


54/56

D"2"-0"+:&%)"

AINES7 A)&(+%$"/$, %>1-"/$",

$(-"$". OPIOIDES7 T-(+(5"2, )"59$(. C"-&%)"0&-"%50 3 ($0&0%)"0 &*%)"0. E0&%+12()%*$ &:)&%2 3 )"+-0(0 /-9(0.

D"2"-=%0)-(2

OPIOIDES7 T-(+(5"2, )"59$(. AINES7 A)&(+%$"/$, %>1-"/$",

$(-"$". A$0&0%( 0%$(27 L%5")(9$(,

>1%'()(9$(.


55/56

D"2"-N

.1-",:

&%)"

3

N

.1-"#H$%)"

ANTIDEPRESI=OSTRICICLICOS7A+%&-%&%2%$(, %+%-(+%$(

ANTICON=ULSI=ANTES7C(->(+(?%$(, :)%5"'(2-"%)", #(>($&%$(.

[BLOKUEO NER=IOPERIFERICO7 L%5")(9$(,

>1%'()(9$([CORTICOESTEROIDES7

D(+&(0"$(, -5$%0"2"$(.


56/56

dolor rehabilitacion

Documents