Un mundo de dolor

BALTIMORE – El dolor en la vida es ubicuo. Inexorablemente ligado a la conciencia, es una experiencia que todos los seres vivos con sistemas nerviosos avanzados comparten. Para nuestros ancestros, cuyas vidas estaban en constante peligro, el dolor ofrecía una ventaja evolutiva, que indicaba la necesidad de alejarse de la fuente de dolor. Sin embargo, la evolución no ha logrado ir a la par de los avances biomédicos y tecnológicos, tanto que el dolor crónico (dolor que va más allá de una herida o mal grave) se ha convertido en sí mismo en una enfermedad.

No se puede subestimar el impacto social del dolor crónico. De acuerdo con el Instituto estadounidense de Medicina, una de cada tres personas padece dolor crónico –más que las que sufren enfermedades cardiacas, cáncer y diabetes, combinadas. El dolor es la causa principal de incapacidad, en especial el dolor de espalda entre las personas menores de 45 años y dolor articular en individuos más grandes. Tan solo en los Estados Unidos, se estima que el dolor crónico genera un costo de alrededor de 600 mil millones de dólares anuales. 

Se puede clasificar el dolor a partir de varios factores, como la duración o parte del cuerpo. Sin embargo, la clasificación más útil se basa en el mecanismo. El dolor nociceptivo, que es provocado por una lesión a tejido no nervioso, sucede por ejemplo, cuando una persona se tuerce el tobillo. Un ejemplo de dolor nociceptivo es el que se produce con la artritis. En contraste, el dolor neuropático, surge por una lesión o enfermedad y afecta el sistema nervioso. La lesión a los nervios derivada de la diabetes (neuropatía diabética) y dolor persistente después de haber padecido herpes (neuralgia posherpética) son de las causas más comunes.

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