Dor aguda ou dor crônica: o que seu paciente sente?

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Seu paciente sente dor aguda, ou dor crônica?

Hoje o assunto são as diferenças entre a dor aguda e a dor crônica e como identificar qual o seu paciente sente.

Por exemplo: chega um paciente em seu consultório com uma semana apresentando dor cervical ou 1 ano e meio de dor lombar irradiada para as pernas. Esses casos devem ser tratados da mesma forma? Qual a diferença?

Sem falar de diagnóstico ou de tratamento específico, a diferença entre uma dor aguda e uma dor crônica é relativamente simples: existe um conceito mais antigo de que a dor aguda é aquela que dura 2 a 3 meses e um conceito mais moderno, baseado na fisiopatologia que se refere à dor aguda como aquela dor que dura o tanto esperado para a resolução do quadro que conduziu à mesma. Já a dor crônica é justamente o oposto: é uma dor com duração superior a 3 meses ou que se estende para além do tempo esperado para a resolução de uma lesão qualquer. Para ilustrar: a dor aguda tem uma função evolutiva. Se você sofre uma lesão aguda, você vai tirar aquela parte do corpo que está em contato com o objeto que te causou a lesão e isso é um reflexo protetor que nós fomos adquirindo com a evolução. Já a dor crônica, acredita-se que ela não tenha uma função protetora como tem a dor aguda. Mecanismos de retroalimentação da dor fazem com que ocorra um ciclo vicioso de cada vez que você sente um estímulo doloroso você vai aumentar a capacidade de sentir um novo estímulo e isso hoje em dia é tratado de forma muito diferente da dor aguda.

Então, pra dor aguda geralmente se usa mais analgésicos, enquanto para dor crônica existe uma tendência muito grande de indicar cada vez mais o tratamento de adjuvantes não opioides. É por isso que é extremamente importante o trabalho de classificação de dor aguda e crônica, considerando que os tratamentos são bem diferentes.

Dr. Felipe Chiodini

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