Evaluación de la calidad de la atención del paciente con dolor en fase terminal: estudio descriptivo transversal / Quality of care for patients with end-stage pain: descriptive, cross-sectional study

Nuestro trabajo tiene como objetivo general el evaluar la calidad de la atención a los pacientes con dolor en etapa terminal. Específicamente, se busca determinar la intensidad del dolor aplicando La Escala Análoga Visual del Dolor; evaluar el grado de incapacidad funcional aplicando la Escala de Prolo modificada; correlacionar la intensidad dolorosa con la potencia analgésica de los fármacos utilizados, teniendo en cuenta la Escalera Analgésica de la Organización Mundial de la Salud; así como la capacidad para participar en la toma de decisiones a la hora de realizar un proceder y el real conocimiento de su enfermedad. Para ello seleccionamos 50 pacientes de un universo de 100. Los pacientes incluidos venían remitidos de las consultas de las diferentes especialidades médicas y de oncología con diagnostico de dolor por cáncer. Se les aplico una entrevista individual realizada por el especialista de la Clínica del Dolor Crónico. Se cuantificó la intensidad dolorosa, se determinó el grado de incapacidad funcional, tratamientos farmacológicos previos, información médica sobre la enfermedad, posibilidades terapéuticas, complicaciones y el uso de morfínicos. Como resultado de nuestro estudio pudimos apreciar que el 56 por ciento de los pacientes padecían dolor moderado e intenso, que el grado de incapacidad funcional era malo, que desde el punto de vista farmacológico habían sido inadecuadamente tratados y que la mayoría desconocían la causa de su dolor.

Our work has as general objective to evaluate the quality from the attention to the patients with pain in terminal stage and specifically to determine the intensity of the pain applying the similar visual scale of the pain, to evaluate the grade of functional inability applying the scale of modified PROLO, to correlate the painful intensity with the analgesic power of the used medications keeping in mind the Analgesic Stairway of OMS, as well as the capacity to participate in the taking of decisions when carrying out a to proceed and the real knowledge of its illness. For we select it 50 patients, of an universe of 100 patients, the included patients came remitted of the consultations of the medical different Specialties and of Oncology with I Diagnose of pain for cancer, he/she is applied an individual interview carried out by the specialist of the Clinic of the Chronic pain. You quantify the painful intensity, you determines the grade of functional inability, pharmacological previous treatments, Information prescribes on the illness, therapeutic possibilities, complications and the morphine use. As a result of our study we could appreciate that 56 percent of the patients suffered moderate and intense pain that the grade of functional inability was bad that you/they had been treated improperly from the pharmacological point of view, and that most ignored the cause of its pain.

Management of pain in leukemic children using the WHO analgesic ladder.

Objective. To ascertain the effectiveness of WHO analgesic ladder in pain management in children with leukemia. Methods. Children with leukemia who were referred to a pain and palliative care clinic attached to the Department of Pediatrics of a medical teaching hospital during a period of 6 months, were included in the study. Results. Thirty nine (39) children, who constituted 64% of children on treatment for leukemia, required referral to pain and palliative care services during the study period. Of these 92% had Acute Lymphocytic Leukemia (ALL) and 8% had Acute Non Lymphocytic Leukemia (ANLL). 95% of children had nociceptive pain and 5% had neuropathic pain. Step – 1 analgesia was effective in 12 (31%) children and 21 (54%) could be managed with Step – 2 analgesia. Step – 3 analgesia was required in only 6 (15%) children. Step 3 analgesia was required in children with neuropathic pain and bone pain. Conclusions. WHO analgesic ladder is effective in managing pain in children with leukemia. Majority of cases of cancer pain in children could be managed by the treating physician using non-opioids, weak opioids and adjuvants as per the WHO guidelines. Children with bone pain and neuropathic pain may require referral to specialist services and use of strong opioids like morphine. The study emphasizes the need for establishing specialist pain management services in all centres where children with cancer are treated.