RESUMEN
El dolor crónico constituye un problema de salud pública a nivel mundial, se estima que afecta alrededor del 20% de la población. Cada vez hay más evidencia de que el modelo de atención a estos pacientes es a través de equipos interdisciplinarios, con énfasis en la comunicación entre las diferentes disciplinas, y la construcción de una mirada conjunta del paciente. La Unidad Interdisciplinaria de Dolor del Hospital Maciel - Banco de Seguros del Estado es la puesta en práctica de un modelo biopsicosocial de atención al dolor crónico, donde el objetivo terapéutico es la rehabilitación integral de la persona. En este artículo se describe la población asistida en los primeros siete meses de trabajo en el Banco de Seguros del Estado, la evaluación integral que realiza el equipo y los resultados más relevantes, así como la construcción del plan terapéutico individualizado. La lumbalgia crónica poscirugía fue el cuadro clínico más frecuente. De la evaluación integral se destaca la interferencia del dolor con las actividades básicas de la vida diaria en 90%, alteraciones del sueño en 60% y el diagnóstico de depresión en el 40% de la población asistida. Se detallan las intervenciones realizadas en los tres pilares terapéuticos: farmacológico, rehabilitación física y abordaje psicoterapéutico, con el objetivo definido de la rehabilitación de la persona y su reintegro al trabajo. (AU)
Chronic pain is a global public health problem, and according to estimations, it affects around 20% of the population. Evidence is telling us the best assistance model for this kind of patients is through multidisciplinary teams, focusing on communication among the different disciplines and building up a common approach to patients. The Pain Multidisciplinary Unit at Maciel Hospital - National Insurance Bank involves the implementation of a biopsychosocial assistance model for Chronic Pain, whose therapeutic goal is the comprehensive rehabilitation of the patient. This study describes the population assisted in the first seven months of operation at the National Insurance Bank, the comprehensive evaluation conducted by the team and the most relevant results, as well as the definition of a personalized therapeutic plan. Chronic low back pain was the most frequent clinical condition. Upon comprehensive assessment we point out how pain interfered with basic everyday life activities in 90% of patients, sleep alterations in 60% and depression diagnosed on 40% of the population assisted. The studies provides a detailed account of interventions around the three therapeutic pillars: pharmacologic, physical rehabilitation and psychotherapy, having the main objective been defined as the individual's rehabilitation and going back to work.
A Dor Crônica é um problema de Saúde Pública em todo o mundo; estima-se que afeta ao redor de 20 % da população. Cada vez mais há evidências de que o modelo de atenção para pacientes com Dor Crônica seja composto por equipes interdisciplinares, com ênfase na comunicação entre as diferentes disciplinas, e na construção de uma forma conjunta de ver o paciente. A "Unidad Interdisciplinaria de Dolor del Hospital Maciel - Banco de Seguros del Estado" é o resultado de colocar em prática um modelo biopsicossocial de atenção à Dor Crônica, no qual o objetivo terapêutico é a reabilitação integral da pessoa. Neste artigo descreve-se a população atendida nos primeiros 7 meses de trabalho no Banco de Seguros del Estado, a avaliação integral que a equipe realiza e os resultados mais relevantes, e também a construção do plano terapêutico individualizado. A Lombalgia Crônica pós-cirurgia foi o quadro clínico mais frequente. Destaca-se da avaliação integral a Interferência da Dor com as Atividades Básicas da Vida Diária em 90 %, alterações do sono em 60 % e o diagnóstico de Depressão em 40 % da população atendida. As intervenções realizadas nos três pilares terapêuticos: farmacológico, reabilitação física e abordagem psicoterapêutica são descritas detalhadamente com o objetivo definido de reabilitar a pessoa e possibilitar sua reintegração ao trabalho.
Asunto(s)
Dolor , Grupo de Atención al Paciente , Dimensión del DolorRESUMEN
Introducción: Se puede definir dolor como una experiencia sensorial o emocional desagradable asociada a un daño real o potencial en un tejido. El dolor agudo postoperatorio mal controlado aumenta la morbimortalidad al impactar sobre múltiples sistemas. Para abordar este problema se han creado unidades encargadas de manejar el dolor perioperatorio, conformadas por equipos multidisciplinarios. Objetivos: El objetivo general de esta revisión es presentar el funcionamiento y la experiencia a la fecha de la Unidad del Dolor Agudo Perioperatorio (UDAP) del Hospital Gustavo Fricke (HGF) a los distintos servicios. Desarrollo: La Unidad del Dolor Agudo Perioperatorio (UDAP) del HGF se gesta dentro de la unidad de anestesia y pabellones quirúrgicos en enero del año 2018.Son cerca de 30 pacientes mensuales los que se incluyen en la unidad, los que en promedio están 2 días con algún tipo de analgesia avanzada. Estos pacientes han sido sometidos a cirugías de distintas especialidades, siendo la cirugía digestiva la más frecuente, seguido de la ginecológica y traumatológica. Conclusión: La UDAP del HGF es una iniciativa que nace buscando garantizarla evaluación y seguimiento adecuado de los pacientes sometidos a intervenciones quirúrgicas. La experiencia a la fecha ha sido satisfactoria, no obstante, existen aspectos a mejorar y que constituyen los desafíos a mediano y largo plazo de la unidad.
Introduction: Pain may be defined as an unpleasant sensory or emotional experience associated with real or potential tissue damage. Poorly managed acute post-operatory pain affects multiple systems and increases mortality and morbidity. To address this issue, pain management units have been created for the management of perioperative pain by multidisciplinary teams. Objectives: The general objective of this review is to describe the functioning and experience to date of the Acute Perioperative Pain Unit (UDAP) in Gustavo Fricke Hospital (HGF). Development: Gustavo Fricke Hospital´s Acute Perioperative Pain Unit has been administered by the operating theatre and anaesthesia unit since January 2018. Around 30 patients are seen per month. They receive step 3 pain relief and the average length of stay is 2 days. The patients undergo surgeries from the various specialties, gastrointestinal surgery being the most frequent, followed by gynecological and traumatological. Conclusion: The Gustavo Fricke Hospital Acute Perioperative Pain Unit arose from the need to guarantee adequate evaluation and follow-up of surgical patients. To date the experience has been satisfactory, however some aspects could be improved and these constitute medium and long term challenges for the unit.
RESUMEN
Introducción: Se puede definir dolor como una experiencia sensorial o emocional desagradable asociada a un daño real o potencial en un tejido. El dolor agudo postoperatorio mal controlado aumenta la morbimortalidad al impactar sobre múltiples sistemas. Para abordar este problema se han creado unidades encargadas de manejar el dolor perioperatorio, conformadas por equipos multidisciplinarios. Objetivos: El objetivo general de esta revisión es presentar el funcionamiento y la experiencia a la fecha de la Unidad del Dolor Agudo Perioperatorio (UDAP) del Hospital Gustavo Fricke (HGF) a los distintos servicios. Desarrollo: La Unidad del Dolor Agudo Perioperatorio (UDAP) del HGF se gesta dentro de la unidad de anestesia y pabellones quirúrgicos en enero del año 2018. Son cerca de 30 pacientes mensuales los que se incluyen en la unidad, los que en promedio están 2 días con algún tipo de analgesia avanzada. Estos pacientes han sido sometidos a cirugías de distintas especialidades, siendo la cirugía digestiva la más frecuente, seguido de la ginecológica y traumatológica. Conclusión: La UDAP del HGF es una iniciativa que nace buscando garantizar la evaluación y seguimiento adecuado de los pacientes sometidos a intervenciones quirúrgicas. La experiencia a la fecha ha sido satisfactoria, no obstante, existen aspectos a mejorar y que constituyen los desafíos a mediano y largo plazo de la unidad.
Introduction: Pain may be defined as an unpleasant sensory or emotional experience associated with real or potential tissue damage. Poorly managed acute post-operatory pain affects multiple systems and increases mortality and morbidity. To address this issue, pain management units have been created for the management of perioperative pain by multidisciplinary teams. Objectives: The general objective of this review is to describe the functioning and experience to date of the Acute Perioperative Pain Unit (UDAP) in Gustavo Fricke Hospital (HGF). Development: Gustavo Fricke Hospital´s Acute Perioperative Pain Unit has been administered by the operating theatre and anaesthesia unit since January 2018. Around 30 patients are seen per month. They receive step 3 pain relief and the average length of stay is 2 days. The patients undergo surgeries from the various specialties, gastrointestinal surgery being the most frequent, followed by gynecological and traumatological. Conclusion: The Gustavo Fricke Hospital Acute Perioperative Pain Unit arose from the need to guarantee adequate evaluation and follow-up of surgical patients. To date the experience has been satisfactory, however some aspects could be improved and these constitute medium and long term challenges for the unit.
RESUMEN
BACKGROUND: One of the most frequent problems caused by diabetes is the so called painful diabetic neuropathy. This condition can be treated through numerous types of therapy. The purpose of this study was to analyze, as a meta-analysis, different treatments used to alleviate painful diabetic neuropathy, with the aim of generating results that help making decisions when applying such treatments to tackle this pathology. METHODS: A search was conducted in the main databases for Health Sciences, such as PUBMED, Web of Science (WOS), and IME biomedicina (Spanish Medical Reports in Biomedicine), to gather randomized controlled trials about treatments used for painful diabetic neuropathy. The analyzed studies were required to meet the inclusion criteria selected, especially those results related to pain intensity. RESULTS: Nine randomized controlled trials were chosen. The meta-analysis shows significant positive effects for those treatments based on tapentadol [g: −1.333, 95% CI (−1.594; −1.072), P < 0.05], duloxetine [g: −1.622, 95 % CI (−1.650; −1.594), P < 0.05], pregabalin [g: −0.607, 95% CI (−0.980; −0.325), P < 0.05], and clonidine [g: −0.242, 95 % CI (−0.543; −0.058), P < 0.05]. CONCLUSIONS: This meta-analysis indicates the effectiveness of the treatments based on duloxetine, gabapentin and pregabalin, as well as other drugs, such as tapentadol and topic clonidine, whose use is better prescribed in more specific situations. The results provided can help increase the knowledge about the treatment of painful diabetic neuropathy and also in the making of clinical practice guidelines for healthcare professionals.