title: [Pain management in patients with liver cirrhosis].
abstract: Pain management in patients with liver cirrhosis is a real challenge and is often inadequate due to a lack of therapeutic efficacy or the high incidence of adverse effects. The focus of treatment differs depending on whether the pain is acute or chronic and involves understanding the causative pathophysiological mechanism. Analgesics should be started with the minimum effective dose and should be titrated slowly with avoidance of polypharmacy. Adverse effects must be monitored, especially sedation and constipation, which predispose the patient to the development of hepatic encephalopathy. The first-line drug is paracetamol, which is safe at doses of 2-3g/day. Non-steroidal anti-inflammatory agents are contraindicated because they can cause acute renal failure and/or gastrointestinal bleeding. Tramadol is a safe option for moderate-severe pain. The opioids with the best safety profile are fentanyl and hydromorphone, with methadone as an alternative. Topical treatment can reduce oral drug consumption. In neuropathic pain the first-line therapeutic option is gabapentin. The use of antidepressants such as amitriptyline can be considered in some patients. Interventional techniques are a valuable tool in moderate to severe pain, since they allow a reduction in drug therapy and consequently its adverse effects. Psychological treatment, physical therapy and rehabilitation should be considered as part of multimodality therapy in the management of chronic pain.
authors.affiliation: Servicio de Anestesiología y Reanimación, Hospital Clínic de Barcelona, Barcelona, España; Unidad del Dolor, Servicio de Anestesiología y Reanimación, Hospital Clínic de Barcelona, Barcelona, España. Electronic address: ojeda@clinic.ub.es.
authors.forename: Antonio
authors.initials: A
authors.lastname: Ojeda
authors.affiliation: Servicio de Anestesiología y Reanimación, Hospital Clínic de Barcelona, Barcelona, España; Unidad del Dolor, Servicio de Anestesiología y Reanimación, Hospital Clínic de Barcelona, Barcelona, España.
authors.forename: Luis A
authors.initials: LA
authors.lastname: Moreno
mesh_terms: D000082:Acetaminophen / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use; D000588:Amines / Q000008:administration & dosage / Q000627:therapeutic use; D000700:Analgesics / Q000008:administration & dosage / Q000009:adverse effects / Q000493:pharmacokinetics / Q000627:therapeutic use*; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use; D003131:Combined Modality Therapy; D003509:Cyclohexanecarboxylic Acids / Q000008:administration & dosage / Q000627:therapeutic use; D004359:Drug Therapy, Combination; D000077206:Gabapentin; D005767:Gastrointestinal Diseases / Q000139:chemically induced; D006530:Hepatorenal Syndrome / Q000378:metabolism; D006801:Humans; D008658:Inactivation, Metabolic; D008099:Liver / Q000378:metabolism; D008103:Liver Cirrhosis / Q000150:complications*; D009294:Narcotics / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use; D009407:Nerve Block; D059408:Pain Management / Q000379:methods*; D026741:Physical Therapy Modalities; D017410:Practice Guidelines as Topic; D000069583:Pregabalin; D005680:gamma-Aminobutyric Acid / Q000008:administration & dosage / Q000031:analogs & derivatives / Q000627:therapeutic use
chemical_list: D000588:Amines; D000700:Analgesics; D000894:Anti-Inflammatory Agents, Non-Steroidal; D003509:Cyclohexanecarboxylic Acids; D009294:Narcotics; D000082:Acetaminophen; D000069583:Pregabalin; D005680:gamma-Aminobutyric Acid; D000077206:Gabapentin
keywords: Adverse drug events; Cirrosis hepática; Hepatic cirrhosis; Manejo del dolor; Pain management; Reacciones adversas farmacológicas