Manejo del dolor en demencia: bases neurobiológicas, evaluación y estrategias terapéuticas multimodales

Juan José  Valero; Ismael Contreras

Autores/as

Juan José Valero https://orcid.org/0009-0008-2907-0623
Ismael Contreras https://orcid.org/0009-0008-2307-6020

Palabras clave:

Demencia , Dolor, Evaluación del Dolor , Analgesia, Alzheimer, Cuidados Paliativos , Escalas Conductuales

Resumen

Objetivo: Realizar una revisión crítica y actualizada sobre el manejo del dolor en pacientes con demencia, abarcando fundamentos neurobiológicos, herramientas de evaluación, estrategias farmacológicas y no farmacológicas, y consideraciones éticas. Método: Revisión narrativa exhaustiva (2015–2026) en PubMed/MEDLINE, Cochrane Library, EMBASE y Scopus, con términos MeSH: "dementia", "pain management", "pain assessment", "Alzheimer disease", "opioids", "behavioral pain scales". Se incluyeron ensayos clínicos aleatorizados, revisiones sistemáticas, metaanálisis y guías de práctica clínica de organizaciones internacionales. Resultados: El dolor es altamente prevalente en la demencia (60–80%), con frecuente infradiagnóstico debido a las limitaciones comunicativas. Los fundamentos neurobiológicos revelan una alteración paradójica del procesamiento nociceptivo. Las escalas conductuales observacionales (PAINAD, DOLOPLUS-2, ABBEY) constituyen los instrumentos más válidos para la evaluación. El manejo farmacológico multiescalón siguiendo la OMS, adaptado al perfil geriátrico y combinado con intervenciones no farmacológicas, representa la estrategia óptima. Conclusiones: El dolor en demencia exige un enfoque individualizado, multimodal y éticamente responsable. La implementación de protocolos estandarizados es imperativa para mejorar la calidad de vida de esta población.

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