Abordaje del estreñimiento inducido por opioides en pacientes con cáncer: una revisión narrativa
DOI:
https://doi.org/10.35509/01239015.1116Palabras clave:
analgésicos opioides, estreñimiento, estreñimiento inducido por opioides, laxativos, dolor, neoplasiasResumen
El estreñimiento inducido por opioides (EIO) constituye una de las complicaciones gastrointestinales más frecuentes y limitantes en pacientes oncológicos bajo analgesia prolongada. Su fisiopatología multifactorial, ausencia de tolerancia farmacológica y elevado impacto funcional lo convierten en un desafío clínico que exige estrategias proactivas de prevención, diagnóstico y tratamiento. Esta revisión narrativa, sustentada en evidencia reciente y en un consenso interdisciplinario, sintetiza las principales recomendaciones para el abordaje integral del EIO en pacientes oncológicos. Se destaca la identificación de opioides con mayor riesgo de constipación, los criterios clínicos estandarizados para su diagnóstico, las indicaciones para el uso escalonado de laxantes osmóticos, estimulantes y secretagogos, y el papel de los antagonistas periféricos del receptor opioide mu (PAMORA, según sus siglas en inglés) en casos refractarios. Asimismo, se propone un algoritmo clínico estructurado, aplicable en escenarios de alta complejidad, que facilita la toma de decisiones, mejora la adherencia terapéutica y contribuye al control sintomático efectivo, sin comprometer la eficacia analgésica. Esta herramienta resulta especialmente útil en el manejo multidisciplinario del paciente oncológico con EIO.
Biografía del autor/a
Jorge Andrés Sánchez-Duque, Especialista en entrenamiento de la Especialización en Medicina del Dolor y Cuidados Paliativos, convenio Universidad Militar Nueva Granada - Instituto Nacional de Cancerología, Bogotá D. C., Colombia.
1 Especialista en entrenamiento de la Especialización en Medicina del Dolor y Cuidados Paliativos, convenio Universidad Militar Nueva Granada - Instituto Nacional de Cancerología, Bogotá D. C., Colombia.
Eliana Katherine Manrique-Hernández, Unidad de Medicina Familiar, Facultad de Ciencias de la Salud, Universidad del Cauca, Popayán, Colombia.
2 Unidad de Medicina Familiar, Facultad de Ciencias de la Salud, Universidad del Cauca, Popayán, Colombia.
Adalberto David Pantoja-Molina, Unidad de Medicina Familiar, Facultad de Ciencias de la Salud, Universidad del Cauca, Popayán, Colombia.
2 Unidad de Medicina Familiar, Facultad de Ciencias de la Salud, Universidad del Cauca, Popayán, Colombia.
Lizeth Xiomara Morales-Ceballos, Unidad de Epidemiología, Facultad de Ciencias de la Salud, Universidad Tecnológica de Pereira, Pereira, Colombia.
3 Unidad de Epidemiología, Facultad de Ciencias de la Salud, Universidad Tecnológica de Pereira, Pereira, Colombia.
Karol Tatiana Manrique-Hernández, Estudiante del pregrado en Medicina, Universidad Cooperativa de Colombia, Villavicencio, Colombia.
4 Estudiante del pregrado en Medicina, Universidad Cooperativa de Colombia, Villavicencio, Colombia.
Eduardo Alfonso Acosta-Quevedo (†), Grupo Cuidado Paliativo, Instituto Nacional de Cancerología, Bogotá D. C., Colombia.
5 Grupo Cuidado Paliativo, Instituto Nacional de Cancerología, Bogotá D. C., Colombia.
(†) Reconocimiento póstumo a la participación del doctor Eduardo Alfonso Acosta Quevedo (Q. E. P. D.)
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