Radiofrecuencia de los nervios geniculados para el tratamiento del dolor crónico en la osteoartrosis de rodilla / Genicular nerve radiofrequency in osteoarthritis-related chronic knee pain

Introducción: El uso de radiofrecuencia de los nervios geniculados para el tratamiento del dolor crónico de la rodilla secundario a osteoartrosis inició en 2011, y desde entonces se han realizado varios estudios con diferentes metodologías. Sin embargo, continúan generándose muchas dudas con respecto a las dianas anatómicas, los criterios de selección y la evidencia de su efectividad. Materiales y métodos: Se realizó una búsqueda electrónica desde enero de 2011 hasta abril de 2020 en las siguientes bases de datos: PubMed®, Embase ®, Google Académico y Web of Science (WoS). La búsqueda inicial encontró 106 artículos, de los cuales tomamos 33 para realizar la presente revisión. Resultados: Después de analizar cinco ensayos clínicos abiertos, un estudio de corte transversal, cuatro estudios prospectivos observacionales, ocho estudios de neuroanatomía, tres estudios retrospectivos, cuatro casos clínicos, dos series de casos, tres revisiones de la literatura y tres ensayos clínicos aleatorizados, controlados y doble ciegos; encontramos que la radiofrecuencia de los nervios geniculados disminuye el dolor asociado a la osteoartrosis de rodilla, consiguiendo una mejoría funcional con una duración variable del efecto analgésico entre tres y doce meses. A pesar del avance científico en esta área, aún no hay un consenso en cuanto a la neuroanatomía de la cápsula articular de la rodilla, la ubicación de las dianas, los parámetros empleados en radiofrecuencia y la utilidad de los bloqueos diagnósticos. Conclusiones: Se necesitan más ensayos clínicos que estandaricen los parámetros utilizados y confirmen los resultados positivos de los estudios realizados con radiofrecuencia de los nervios geniculados...(AU)

Introduction: The use of genicular nerve radiofrequency procedures to treat chronic knee pain due to osteoarthritis has surged in 2011, though many questions remain regarding anatomical targets, selection criteria, and evidence for effectiveness. Materials and methods: An electronic search was performed from January 2011 to April 2020. Databases searched included PubMed®, Embase®, Google Scholar and Web of Science (WoS). The initial search found 106 articles. Thirty-three articles were taken for this review. Results: After analyzing five open clinical trials, one cross-sectional study, four prospective observational studies, eight neuroanatomy studies, three retrospective studies, four clinical cases, two case series, three literature reviews and three randomized, double blind, controlled trials; we found genicular nerve radiofrequency achieves a pain reduction and functional improvement with a variable duration, between three and twelve months. There is no consensus regarding the neuroanatomy of the knee joint capsule, the location of the targets, the radiofrequency parameters used and the usefulness of diagnostic blocks. Conclusion: More clinical trials are needed to standardize the parameters used and confirm the positive results of genicular nerve radiofrequency. Although lonthere are few cases of adverse events associated with radiofrequency of the geniculate nerves, more studies are needed to support the safety of this technique and its long-term side effects in osteoarthritis knee pain management associated that do not respond to other previous medical treatments.(AU)

High-frequency spinal cord stimulation as rescue therapy for chronic pain patients with failure of conventional spinal cord stimulation.

BACKGROUND: This study aims to evaluate the efficacy of 10-kHz high-frequency (HF10) devices as a rescue treatment in patients with failure of conventional spinal cord stimulation (SCS) therapy for chronic pain without the need to change the spinal hardware. METHODS: In this real-world prospective study, patients with neuropathic pain treated with conventional tonic SCS in whom the therapy had failed, either during the trial phase or after a period of optimal functioning, were recruited throughout 2 years for HF10-SCS therapy. Data on analgesia, functionality, analgesics use and treatment safety were collected 12 months after treatment. RESULTS: Eleven of the 18 (61%) patients included in the study were successfully rescued with HF10-SCS. Of them, 5 out of 12 (45%) were in the trial phase and six out of six (100%) had previously functioning implants. A significant improvement in low-back and limb pain was obtained (p = 0.003 and p = 0.0001, respectively). Treatment success was significantly associated with gender (p = 0.037), weight (p = 0.014), body mass index (BMI) (p = 0.007) and time of rescue (p = 0.015). A linear regression test confirmed a significant association between treatment failure and BMI and gender (p = 0.004). CONCLUSIONS: Our results suggest that analgesic rescue with HF10-SCS is an effective therapeutic option for non-responders to conventional SCS, although obesity might be a limiting factor for treatment success. Nevertheless, more comprehensive studies are needed to corroborate our findings. SIGNIFICANCE: This study shows that high-frequency stimulation may be useful in patients with failure of conventional tonic stimulation for chronic pain, both in the trial phase and in previously implanted subjects. The novelty of this study lies in the use of the implanted epidural electrodes, which avoids the need for further surgery. The results in terms of pain control and recovery of functionality are satisfactory. In addition, variables such as male gender and high body mass index could be predictors of therapy failure.

¿Tratamos bien el dolor irruptivo? / Do we treat breakthrough pain well?

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Oral pregabalin for postoperative pain relief after third molar extraction: a randomized controlled clinical trial.

OBJECTIVES: The aim of this randomized controlled clinical trial was to evaluate the efficacy and safety of pregabalin administered pre- and postoperatively in patients with pain and swelling due to the surgical removal of impacted lower third molars. MATERIALS AND METHODS: The final study sample comprised 60 volunteers (23 males and 37 females). Group 1 (n = 30) received 75 mg oral pregabalin 1 h before surgery and 1 h after surgery. Group 2 (n = 30) served as a control group and received no pregabalin. Both groups were administered with 650 mg paracetamol every 8 h for 2 days. Postoperative pain intensity and swelling were measured using a visual analog scale (VAS); pain relief experienced was reported using a four-point verbal rating scale (VRS); the rescue medication requirement, adverse effects, and global impression of the medication were also recorded. RESULTS: No significant difference in pain intensity (VAS) was observed between the groups. However, fewer rescue medication tablets were needed by pregabalin-treated patients than by controls (p = 0.021). The frequency and intensity of adverse effects were significantly higher in pregabalin-treated patients (p < 0.001), although no serious adverse events occurred. No significant difference in the degree of swelling was observed in any measurement except that from mandibular angle to lip junction, which showed lesser inflammation in the pregabalin group at 24 h post-surgery (p = 0.011). The global opinion on the medication received was more positive in the pregabalin group (p = 0.042). CONCLUSIONS: The administration of pregabalin reduces the requirement for rescue medication after third molar surgery and results in a more constant pain level, with fewer peaks of pain intensity. CLINICAL RELEVANCE: These findings suggest that pregabalin may be useful to control acute postoperative pain. Adverse effects are known to be reduced at the low pregabalin dose used in our study.

Diagnóstico y tratamiento del dolor irruptivo oncológico: recomendaciones de consenso / Diagnosis and treatment of break-through cancer pain: Consensus recommendations

INTRODUCCIÓN Y OBJETIVOS: El dolor irruptivo oncológico (DIO) es una exacerbación aguda del dolor que presenta diferentes criterios diagnósticos y de tratamiento por parte de los diferentes especialistas implicados en su manejo. Para facilitar la toma de decisiones en la práctica clínica habitual, ocho especialistas de referencia de 4 sociedades científicas implicadas en el manejo del paciente oncológico, han diseñado este documento de consenso. MÉTODOS: Tras una búsqueda bibliográfica en las publicaciones más relevantes sobre DIO, se establecieron las recomendaciones preliminares. El grupo de expertos realizó una reunión de trabajo siguiendo la metodología Metaplan(R), donde se debatieron las recomendaciones a incorporar al documento. Cada una de las afirmaciones y recomendaciones fueron clasificadas según su grado de recomendación, atendiendo a las categorías del sistema SIGN (Scottish Intercollegiate Guidelines Network). RESULTADOS: El manejo del DIO requiere de una anamnesis completa, tanto del DIO como del dolor basal, y una exploración física del paciente asociada a pruebas complementarias cuando sean precisas. Los fármacos de elección para el tratamiento del DIO deben ser aquellos que muestren una analgesia potente, con rápido inicio de acción, efectos secundarios mínimos y de fácil administración. El fentanilo administrado por vía transmucosa es actualmente el principio activo más adecuado a las necesidades analgésicas del dolor irruptivo, con independencia del opioide mayor utilizado para el control del dolor basal. CONCLUSIÓN: Este consenso puede ser una herramienta útil para la mejora de la calidad de vida del paciente con cáncer, ya que permite un mejor diagnóstico y tratamiento del DIO

INTRODUCTION OBJECTIVES: Breakthrough cancer pain (BTcP) is an acute exacerbation of baseline pain. The clinicians involved in its management have different diagnostic and therapeutic criteria. In order to facilitate decision making in usual clinical practice, 8 reference experts from 4 scientific associations involved in the management of patients with cancer pain have developed this Consensus Document. METHODS: After an initial search on the most relevant publications in BTcP literature, a set of preliminary recommendations were established. A working meeting was subsequently held with the experts, following the Metaplan(R) methodology -a structured brainstorming technique- that produced a first version of the Consensus Document which, after several review rounds, was validated by all the participants. Every statement and recommendation was sorted according to its degree of recommendation, following the categories in the SIGN (Scottish Intercollegiate Guidelines Network) system. OUTCOMES: The management of BTcP requires a full anamnesis, both of BTcP itself and of baseline pain, a physical examination and the supplementary tests that are deemed necessary. The drugs of choice for the treatment of BTcP must be those with a potent and rapid analgesic effect a short duration, minimal side effects and easy administration. Transmucosal fentanyl is currently the active ingredient most fitting to the analgesic needs of BTcP, regardless of the major opioid used for control of the baseline pain. CONCLUSION: This Consensus can be a very useful tool to improve the quality of life in cancer patients, because it guides the clinician towards a better diagnose and treatment of BTcP

El manejo de la información en cuidados paliativos / No disponible

Según la Ley de Autonomía del paciente (Ley 41/2002, del 14 de Noviembre), es el paciente quien tiene derecho a ser informado y el titular de la información que reciba. Se ha elaborado una entrevista estructurada que se ha administrado de forma aleatoria a los familiares de los pacientes incluidos en el proceso asistencial Unidad de Cuidados Paliativos (UCP) del Hospital Virgen de las Nieves de Granada, para evaluar el grado de conocimiento sobre esta ley. Además de evaluar el nivel de conocimiento que el paciente dispone sobre su diagnóstico/pronóstico. Los datos obtenidos en este estudio contrastan con esta ley, donde menos de la mitad de los pacientes, según sus familiares, conocen su enfermedad y una cifra inferior la cuarta parte está informado su pronóstico. Asimismo, la mayoría de los familiares de pacientes avanzados se muestran en contra de la ley de Autonomía del Paciente. Este hecho obliga a que los profesionales nos esforcemos más en lograr un proceso comunicativo que acerque al paciente a su realidad y acompañamiento en su última fase de la vida (AU)

According to the patient’s autonomy law (Law 41/2002, of November 14), is the patient who has the right to be informed and the owner of the information it receives. It has developed a structured interview was administered randomly to the relatives of the patients in the care process Palliative Care Unit (PCU) of the Virgen de las Nieves Hospital of Granada, to assess the level of awareness about this law. In addition to assessing the level of knowledge that the patient has about their diagnosis / prognosis. The data obtained in this study contrast with the Act, where less than half of patients, according to their families, know their disease and a lower figure is reported fourth of its forecast. Also, most advanced patient relatives are against the law of patient autonomy. This requires that more professionals we strive to achieve a communicative process that brings the patient to his reality and support in their last phase of life (AU)

Effectiveness of pregabalin as monotherapy or combination therapy for neuropathic pain in patients unresponsive to previous treatments in a Spanish primary care setting.

BACKGROUND AND OBJECTIVE: Patients from a previous study of neuropathic pain (NP) in the Spanish primary care setting still had symptoms despite treatment. Subsequently, patients were treated as prescribed by their physician and followed up for 3 months. Since pregabalin has been shown to be effective in NP, including refractory cases, the objective of this study was to assess the effectiveness of pregabalin therapy in patients with NP refractory to previous treatments. METHODS: This was a post hoc analysis of pregabalin-naïve NP patients treated with pregabalin in a 3-month follow-up observational multicenter study to assess symptoms and satisfaction with treatment. Patients were evaluated with the Douleur Neuropathique en 4 questions (DN4), the Brief Pain Inventory (BPI) and the Treatment Satisfaction for Medication Questionnaire (SATMED-Q) overall satisfaction domain. RESULTS: 1,670 patients (mean age 58 years, 59 % women), previously untreated or treated with ≥1 drug other than pregabalin, were treated with pregabalin (37 % on monotherapy). At 3 months, pain intensity and its interference with activities decreased by half (p < 0.0001), while the number of days with no or mild pain increased by a mean of 4.5 days (p < 0.0001). Treatment satisfaction increased twofold (p < 0.0001). Patients with a shorter history of pain and those with neuralgia and peripheral nerve compression syndrome (PCS) as etiologies had the highest proportion on monotherapy and showed the greatest improvements in pain-related parameters in their respective group categories. CONCLUSION: Treatment with pregabalin (as monotherapy or combination therapy) provides benefits in pain and treatment satisfaction in patients with NP, including refractory cases. Shorter disease progression and neuralgia and PCS etiologies are favorable factors for pregabalin treatment response.

Caso clínico. Escritura expresiva y emocional vía e-mail para el seguimiento de duelo / Case report. Expressive and emotional writing via e-mail for monitoring of mourning

El duelo es la respuesta natural a la pérdida de cualquier persona con la que se ha construido un vínculo afectivo. En el asesoramiento del duelo se pretende facilitar su elaboración y la adaptación a la nueva situación. Dentro de las diferentes técnicas para poder llevar acabo los objetivos en el duelo hay que saber adaptarse a cada persona valorando las estrategias individualizadas. Caso clínico: familiar de 18 años que hace 3 meses perdió a su padre, el cual fue atendido en la Unidad de Cuidados Paliativos (UCP), acude por no encontrarse bien, con llanto, ansiedad y pesadillas. El uso de la escritura emocional fue la técnica utilizada que ayudó a relatar sus comportamientos, emociones y pensamientos de manera secuencial y narrativa. Todo ello contribuyó a mejorar su nivel emocional y a acompañar en las tareas de duelo. Este tipo de terapia de escritura emocional unida al uso de nuevas tecnologías puede ser útil en el seguimiento del duelo de pacientes jóvenes o adolescentes (AU)

Griefis a natural response to the loss of anyone who has built a bond. Grief advice is to help in the development and adaptation to the new situation. Among the different techniques to accomplish the aims in the grief, one has to learn to adapt to each individual, assessing individual strategies. This case report concerns an 18 year-old female whose father died while in the Palliative Care Unit (PCU), who complained of being unwell, crying, anxiety and nightmares. The use of emotional writing was the technique used, both helped to relate (..) (AU)

Diagnóstico y tratamiento del dolor neuropático / Diagnosis and treatment of the neuropathic pain

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Relación de las variables del paciente y de la intervención con el dolor y la inflamación postoperatorios en la exodoncia de los terceros molares / Relation of patient and surgical variables to postoperative pain and inflammation in the extraction of third molars

Objetivos: El objetivo del presente trabajo es analizar la influencia de las variables del paciente y de la intervención con el dolor y la inflamación que normalmente acompañan a toda exodoncia de terceros molares. Diseño del estudio: Para lo cual se ha recogido una muestra de 150 pacientes a los que se realizó una extracción de un tercer molar. Se han tenido en cuenta como variables del paciente: el sexo, la edad y las dimensiones de la personalidad, como el grado de neuroticismo y de extroversión (cuestionario EPI) y como variables de la intervención: el tiempo, el grado de ostectomía, la odontosección y el número de suturas. El dolor se ha objetivado por medio de una escala visualanalógica (VAS) a las 0, 8, 24, 43 y 48 horas, mientras que la inflamación se ha medido por medio de una escala verbal (VRS) a las 48 horas de la intervención. Resultados: A partir de un análisis estadístico multivariante hemos visto que el dolor post extracción se relaciona sobre todo con la edad del paciente y el número de puntos de sutura durante el día de la intervención y con la inflamaciónen los días subsiguientes, y con una menor intensidad con el sexo y las dimensiones de la personalidad, como el grado de neuroticismo y de extroversión. Conclusiones: Los pacientes de más edad y los que son sometidos a intervenciones con un mayor número de puntos de sutura experimentarán un dolor más intenso. Y a su vez, los sujetos que tienen un dolor más intenso sufrirán también una inflamación superior (AU)