Influencia de las comorbilidades en la intensidad del dolor en los pacientes con lumbalgia crónica / Influence of comorbidities on pain intensity in patients with chronic low back pain

ObjetivoEl dolor crónico es un proceso complejo que puede variar dependiendo de factores como el tiempo de evolución, estado de ánimo o incluso experiencias previas vividas. Nuestro objetivo es describir las características de los pacientes que acuden con diagnóstico de lumbalgia a una primera visita en la Unidad del Dolor (UD) y buscar aquellos factores que pueden interferir en la percepción del dolor.MétodosSe realiza un análisis inferencial de los pacientes que acuden por primera vez a la UD del Hospital de la Santa Creu y Sant Pau de Barcelona con diagnóstico de lumbalgia crónica durante el periodo de Noviembre 2012 a Noviembre 2018. La intensidad del dolor promedio en las últimas 24 horas se cuantifica utilizando datos del cuestionario Brief Pain Inventory (BPI). Utilizando regresión linear múltiple, se valoran los factores predictivos independientes de intensidad de dolor EVN24.ResultadosLa variable de mayor impacto fue el grado de depresión según HAD_D. Utilizando regresión logística binaria para el análisis multivariado, se obtuvo un modelo que se relaciona (r = 0,354, p < 0,001) de manera significativa con la intensidad del dolor (EVN24).ConclusionesEl tratamiento especializado de la lumbalgia en las UD debe tener en cuenta el perfil de paciente y en especial los trastornos afectivos y las comorbilidades asociadas ya que predicen una mayor intensidad del dolor. En consecuencia, la comorbilidad asociada no solo repercute en la mayor intensidad del dolor, sino que las características físicas que acompañan al paciente durante todo el proceso pueden influir o incluso comprometer el tratamiento. (AU)

ObjectivesChronic pain is a complex process that can vary depending on factors such as time evolution, mood, or even previous experiences. Our objective is to describe patient's characteristics from those who were referred with a diagnosis of low back pain in their first Pain Unit (PU) visit, and identify those factors that may interfere with their pain perception.MethodsInferential analysis was carried out from data recorded in the PU database of the Hospital de la Santa Creu y Sant Pau in Barcelona, from November 2012 to November 2018. The average pain intensity during the last 24 hours (EVN24) was quantified using data from the BPI (Brief Pain Inventory) questionnaire. Using multiple linear regression, the independent predictive factors related to pain intensity (EVN24) were assessed.ResultsMood disorders (Degree of depresión acording HAD_D level) was the variable with the highest impact in pain perception. Using binary logistic regression for multivariate analysis, a model of variables related to pain intensity (EVN24) was obtained (R = 0.354, P < 0.001).ConclusionsThe specialized treatment of low back pain in PUs must take into account the patient's profile and especially the affective disorders and associated comorbidities since they predict a greater intensity of pain. Consequently, the associated comorbidity not only affects the greater intensity of pain, but the physical characteristics that accompany the patient throughout the process can influence or even compromise treatment. (AU)

Influence of comorbidities on pain intensity in patients with chronic low back pain. / Influencia de las comorbilidades en la intensidad del dolor en los pacientes con lumbalgia crónica.

OBJECTIVES: Chronic pain is a complex process that can vary depending on factors such as time evolution, mood, or even previous experiences. Our objective is to describe patient's characteristics from those who were referred with a diagnosis of low back pain in their first Pain Unit (PU) visit, and identify those factors that may interfere with their pain perception. METHODS: Inferential analysis was carried out from data recorded in the PU database of the Hospital de la Santa Creu y Sant Pau in Barcelona, from November 2012 to November 2018. The average pain intensity during the last 24 hours (EVN24) was quantified using data from the BPI (Brief Pain Inventory) questionnaire. Using multiple linear regression, the independent predictive factors related to pain intensity (EVN24) were assessed. RESULTS: Mood disorders (Degree of depresión acording HAD_D level) was the variable with the highest impact in pain perception. Using binary logistic regression for multivariate analysis, a model of variables related to pain intensity (EVN24) was obtained (R = 0.354, P < 0.001). CONCLUSIONS: The specialized treatment of low back pain in PUs must take into account the patient's profile and especially the affective disorders and associated comorbidities since they predict a greater intensity of pain. Consequently, the associated comorbidity not only affects the greater intensity of pain, but the physical characteristics that accompany the patient throughout the process can influence or even compromise treatment.

Nuevas tendencias en el tratamiento del dolor postoperatorio en cirugía general y digestiva / New trends in the treatment of post-operative pain in general and gastrointestinal surgery

Una correcta aplicación de la analgesia multimodal que resulte adecuada a la intensidad del dolor, a las características de la cirugía y al régimen de hospitalización planteado aportará la clave para mejorar el manejo del dolor postoperatorio, actualmente infratratado. En las cirugías de alta complejidad el mejor beneficio se obtiene al asociar los analgésicos a las técnicas de anestesia locorregional. La analgesia epidural no sólo proporciona una excelente calidad analgésica, sino que puede prevenir complicaciones y reducir la morbimortalidad postoperatoria. Últimamente, los bloqueos periféricos y las técnicas de infiltración, parietal con o sin catéter, han adquirido mayor protagonismo en la analgesia postoperatoria de cirugías como hemorroides o herniorrafias. Todas estas técnicas analgésicas se integran en el concepto de rehabilitación postoperatoria precoz y persiguen como objetivo minimizar los efectos secundarios asociados al tratamiento y facilitar la recuperación funcional del paciente. Además, el correcto manejo del dolor postoperatorio no sólo aumenta la calidad asistencial intrahospitalaria, sino que es un factor que se debe considerar en el desarrollo del dolor crónico posquirúgico, cuya incidencia es significativa y deteriora la calidad de vida de los pacientes (AU)

The correct application of multimodal analgesia appropriate to the pain intensity, the characteristics of the surgery and the hospitalisation scheme provide the key to improving the management of postoperative pain, which is currently still under treated. In highly complex surgeries the best benefit is obtained by combining systemic analgesic drugs with regional analgesia techniques.Epidural analgesia, not only provides an excellent quality of analgesia, but can prevent complications and reduce postoperative morbidity. Recently, peripheral blocks and parietal infiltration techniques, with or without catheter, have gained prominence in the postoperative analgesia of haemorrhoids and hernia repair. All these analgesic techniques are integrated into the concept of early postoperative rehabilitation and pursue the objective of minimising the side effects associated with the treatment and facilitate the functional recovery of the patient. In addition, proper postoperative pain management, not only increases the quality of in-patient care but is also a factor to consider in the development of chronic post-surgical pain, where the impact is significant and impairs the quality of life of the patients (AU)

[New trends in the treatment of post-operative pain in general and gastrointestinal surgery]. / Nuevas tendencias en el tratamiento del dolor postoperatorio en cirugía general y digestiva.

The correct application of multimodal analgesia appropriate to the pain intensity, the characteristics of the surgery and the hospitalisation scheme provide the key to improving the management of postoperative pain, which is currently still under treated. In highly complex surgeries the best benefit is obtained by combining systemic analgesic drugs with regional analgesia techniques. Epidural analgesia, not only provides an excellent quality of analgesia, but can prevent complications and reduce postoperative morbidity. Recently, peripheral blocks and parietal infiltration techniques, with or without catheter, have gained prominence in the postoperative analgesia of haemorrhoids and hernia repair. All these analgesic techniques are integrated into the concept of early postoperative rehabilitation and pursue the objective of minimising the side effects associated with the treatment and facilitate the functional recovery of the patient. In addition, proper postoperative pain management, not only increases the quality of in-patient care but is also a factor to consider in the development of chronic post-surgical pain, where the impact is significant and impairs the quality of life of the patients.