Sexo y dolor: la satisfacción sexual y la función sexual en una muestra de pacientes con dolor crónico benigno no pélvico / Sex and pain: sexual satisfaction and sexual function in a sample of patients with non-pelvic benign chronic pain

Introducción: La mayoría de los estudios son concluyentes al trazar la relación entre dolor crónico y disminución significativa de la calidad de vida. No obstante, no suele analizarse el factor sexual de una forma específica. Material y método: El objetivo de este estudio consiste en realizar una revisión bibliográfica pormenorizada por grupos analgésicos para determinar de modo concreto la influencia del fármaco sobre la respuesta sexual y, en segundo lugar, describir la asociación entre dolor y respuesta sexual en pacientes con dolor crónico no oncológico. Resultados: Los resultados reflejan que hay una alta prevalencia de dificultades sexuales en pacientes de las Unidades de Dolor. Estas dificultades están relacionadas con alteraciones psicológicas, con la tipología del dolor, con la edad y con el sexo de los pacientes. Conclusiones: Estos resultados sugieren que desde las Unidades de Dolor se podría realizar una intervención multidisciplinar centrada en la valoración exhaustiva de esta problemática, educación sanitaria y asesoramiento en materia sexual, que contribuyese a la mejora de la calidad de vida de nuestros pacientes

Introduction: Most of research are conclusive when stating chronic pain and decreased life's quality relationship. However, sexual factor is not usually analysed in a specific path. Desing and methods: The aim of this study is to undertake a bibliographic review divided by analgesic groups in order to determine in a certain way the painkiller influence over the sexual response, and in a second place, to describe the connection between pain and sexual response in not-oncological chronic pain patients. Results: Results show that there is a high prevalence of sexual difficulties in patients of the Pain Units. These difficulties are related to psychological alterations, patients' type of pain and age. Conclusions: These results suggest that a multidisciplinary intervention, centred on the exhaustive evaluation of this problem, health education and sexual counselling, could contribute to the improvement of the quality of life of our patients

Toxina botulínica A (Dysport ®) asociada a rehabilitación, en pacientes con dolor miofascial cervical o dorsal primario: un estudio piloto multicéntrico aleatorizado / Botulinum toxin type A associated to rehabilitation in patients with primary myofascial pain of cervical or dorsal localization: a randomized multicenter pilot study

Introducción. Se postula que la toxina botulínica A (TBA) es eficaz en el tratamiento del síndrome de dolor miofascial (SDM), pero estudios previos muestran resultados contradictorios. Nuestro objetivo es evaluar la eficacia y la seguridad de una dosis única de TBA (Dysport®) en el SDM primario de localización cervicodorsal. Material y métodos. Estudio piloto multicéntrico, aleatorizado, a doble ciego, paralelo y controlado con placebo. Se aleatorizó a los participantes (n=24, pauta 1:1) para recibir una dosis intramuscular de Dysport® (dosis máxima, 500 U) o de placebo, con seguimiento durante 12 semanas. Se midieron la intensidad del dolor mediante escala visual analógica (EVA) y los umbrales de dolor a la presión mediante algometría. A todos ellos se les indicó estiramientos musculares. Resultados. Los pacientes tratados con placebo mostraron una disminución inicial de la intensidad del dolor seguida de un aumento gradual, mientras que los que recibieron Dysport® mostraron una mejoría más lenta, pero más continua. Después de 12 semanas, las reducciones medias de las puntuaciones EVA fueron del 26 y el 44,6% respectivamente; la reducción en los pacientes a quienes se trataba con Dysport® fue clínicamente relevante, aunque la diferencia entre grupos no fue estadísticamente significativa. A las 12 semanas, el umbral de dolor a la presión había aumentado en ambos grupos (el 36% con placebo y el 58% con Dysport®; p = 0,748 entre tratamientos). Se apreciaron tendencias similares en todos los puntos gatillo. El tratamiento con Dysport® se toleró bien. Conclusiones. Estos resultados indican que Dysport® es beneficioso en el tratamiento del SDM cervicodorsal(AU)

Introduction. It is postulated that botulinum toxin type A (BTA) is effective in the treatment of the myofascial pain syndrome (MPS). However, previous studies have shown contradictory results. Our objective has been to evaluate the efficacy and safety of a single dose of BTA (Dysport®) in primary MPS of cervical-dorsal localization. Material and methods. A multicenter, randomized, double blind, parallel and placebo-controlled pilot study was performed. The participants (n=24, 1:1 regime) were randomized to receive an intramuscular dose of Dysport® (maximum dose: 500 U) or placebo, with follow-up for 12 weeks. Pain intensity using the visual analogue scale (VAS) and pressure pain threshold with the algometry were measured. All of the participants were told to perform muscle stretchings. Results. The patients treated with placebo showed an initial decrease in pain intensity followed by a gradual increase of it while those who received Dysport® show a slower, but more continued improvement. After 12 weeks, the mean reductions on the VAS were 26% and 44.6%, respectively. The reduction in the patients who were treated with Dysport® was clinically relevant, although the difference between groups was not statistically significant. At 12 weeks, the pressure pain threshold had increased in both groups (36% placebo and 58% Dysport®; P=.748 between treatments). Similar tendencies were seen in all the trigger points. Treatment with Dysport® was well tolerated. Conclusions. These results suggest that Dysport® is beneficial in the treatment of cervical-dorsal MPS(AU)

Calidad del sueño, dolor y depresión en fibromialgia / Sleep quality, pain and depression in fibromyalgia

Objetivo:El objetivo de este trabajo fue valorar la relación entre eltrastorno depresivo, las alteraciones del sueño y su influenciacon el dolor en pacientes con fibromialgia.Material y métodos:Se ha estudiado una muestra de 31 pacientes diagnosticadosde fibromialgia según los criterios del Colegio Americanode Reumatología y 29 controles con características demográficas semejantes. Ambos grupos cumplimentaronla subescala del sueño del Multiphasic Personality Inventory(MMPI), el cuestionario para depresión de Beck (BDI),y se les realizó una valoración del umbral doloroso mediantealgómetro manual tanto en puntos que definen la enfermedadcomo en puntos control. Los resultados obtenidosfueron procesados mediante el programa SPSS V8. Se estimaronlas medias y las medidas de dispersión para ambosgrupos. La significación estadística de las diferencias fueestimada mediante tests paramétricos, dada la normalidadde las poblaciones; utilizándose como medida de asociaciónla regresión lineal y la regresión múltiple ajustada paralas variables continuas del estudio. La linealidad de las determinacionesvinculadas al tiempo de evolución se estimaronmediante el test de Levene.Resultados:Destacan como resultados más importantes las diferenciasen las alteraciones del sueño total (p < 0,001), y sus escalas,con excepción del sonambulismo y ciclo. La sintomatologíadepresiva valorada mediante el test BDI mostródiferencias entre casos y controles (p < 0,001), constatándoseen los pacientes un crecimiento lineal de las mediasasociadas al tiempo de evolución. El umbral doloroso resultóigualmente desproporcionado a favor de los casos frentea los controles (p < 0,001) en todos los puntos explorados.El análisis de regresión múltiple ajustada de estas variablesevidencia un efecto sinérgico entre dolor, alteracionesdel sueño y escala BDI mostrando un r2 ajustado de 0,834(p < 0,001) lo que establece según nuestra opinión una fuerteasociación entre la fibromialgia y un halo de síntomas quecondicionan sin duda la calidad de vida de los pacientes.Discusión:La sintomatología relacionada con el sueño se considerala segunda en importancia en este síndrome. Las alteracionesdel sueño y la depresión acompañarían al dolor, empeorandomás la calidad de vida de los pacientes. Cabe señalar,como aportación de nuestro estudio, que este complejosintomático se desarrolla a lo largo del tiempo, por lo queconsideramos de gran interés que la valoración individualde cada síntoma mediante instrumentos específicos se realicedesde el inicio del proceso

Objective:The aim of this study was to assess the relationship betweenthe depressive disorder, sleep disorders and their influenceon pain in patients with fibromyalgia.Material and methods:A population of 31 patients diagnosed of fibromyalgia accordingto the criteria of the American College of Rheumatologyand 29 controls with similar demographic characteristicswere studied. Both groups completed the sleep sub-scaleof the Multiphasic Personality Inventory (MMPI) and theBeck´s Depression Inventory (BDI) and underwent an assessmentof pain threshold with a hand-held algometer both indisease-defining points and in control points. Findings wereprocessed using the SPSS V8 software. Means and dispersionmeasurements were estimated for both groups. The statisticalsignificance of the differences found was estimatedthrough parametric tests, given the normal distribution ofthe populations. Lineal regression and multiple regressionadjusted for the continuous study variables were used tomeasure association. Linearity of determinations linked totime of evolution was estimated using the Levene test.Results:The most relevant results were the differences found intotal sleep disorders (p < 0.001) and its sub-scales, withthe exception of sleepwalking and cycle. Depressive symptomatologyassessed using the BDI test showed differencesbetween cases and controls (p < 0.001), confirming in thepatients a linear growth of the measures associated to timeof evolution. Pain Threshold was also significantly higherin cases versus controls (p < 0.001) at all time points examined.Adjusted multiple regression analysis of these variablessuggested a synergic effect between pain, sleep disordersand BDI score, with an adjusted r2 close associationbetween fibromyalgia and several symptoms that certainlyaffect the quality of life of patients.Discussion:Sleep-associated symptoms are considered the secondin relevance in this syndrome. Sleep disorders and depressionseem to accompany pain, further worsening the qualityof life of these patients. It must be stressed, as the contributionof our study, that this symptomatology evolveswith time, so we consider very important to perform an individualassessment of each symptom using specific toolssince the beginning of the process

Spinal cord stimulation: a possible therapeutic alternative for chronic mesenteric ischaemia.

A 78-year-old male patient had chronic, unrelieved abdominal pain due to mesenteric ischaemia. Unsuccessful pharmacological approaches included oral morphine plus coadjuvants as well as a sympathetic celiac plexus block which gave pain relief that lasted for 72 h. In order to obtain long-lasting relief, a trial epidural stimulating electrode was implanted after obtaining informed consent and Ethical Committee approval. Complete analgesia was achieved during a trial period of 2 weeks. Thereafter, a spinal cord stimulator was implanted. At the time of writing, 11 months after implantation, the degree of analgesia is complete. We believe that spinal cord stimulation may represent an alternative approach in controlling pain due to mesenteric ischaemia.

Safety and efficacy of intrathecal baclofen infusion by implantable pump for the treatment of severe spinal spasticity: a spanish multicenter study.

Objective. To assess long-term efficacy, safety and functional benefit of intrathecal baclofen for severe spinal spasticity. Materials and Methods. This prospective multicenter study was performed in two stages: the first one consisted of an intrathecal bolus injection of baclofen, and the second of a continuous intrathecal baclofen infusion by means of an implantable pump. The sample consisted of 72 adult patients with severe spinal spasticity. Sixty-four were implanted and followed for 36 months. Muscular tone, spasms, and functional scales were evaluated before and periodically after administration of the drug, with a follow-up period of 36 months. Results. A very significant decrease in tone and spasms was observed in all cases (p < 0.001). Tolerance appeared during the first 12 months, increasing doses from a mean initial dose of 83.2 µg (range 25-200 µg) to a mean final dose of 270 µg (range 25-800 µg). Later on, efficacy remained stable, except in cases of mechanical problems of the infusion system.

Chronic pain in the spinal cord injured: statistical approach and pharmacological treatment.

We include in this article the results of a postal inquiry into chronic pain in SCI patients in Valencia (Spain), and our experience with their management. A mailed questionnaire including lesion and chronic pain data was sent to all of the 380 SCI patients who live in the region of Valencia. We received 202 answers, with 145 questionnaires being accurately answered and these were analysed for this study. The results show that chronic pain (that is, lasting more than 6 months) is very common (65.5%). The most frequent type was deafferentation pain (phantom pain), described as burning or a painful numbness. Since 1988 we have been treating a sample of 33 patients suffering from resistant pain according to the following therapies: 1 amitriptyline + clonazepam+NSAID (nonsteroidal antiinflammatory drugs); 2 amitriptyline + clonazepam + 5-OH-tryptophane + TENS (transcutaneous electrical nerve stimulation); 3 amitriptyline + clonazepam + SCS (spinal cord stimulation); 4 morphine, by continuous intrathecal infusion. After almost 4 years using these therapies we can affirm that the results regarding analgesia reached 80% in all cases, and that morphine used by intrathecal route is very safe and useful in selected patients.