COVID-19: sus implicaciones para la práctica de la medicina del dolor / COVID-19: its implications for the practice of pain medicine

Resumen: Introducción: La COVID-19 ha causado muchas muertes en el planeta. A la fecha desconocemos su impacto a largo plazo. La conversión de los centros hospitalarios y el resguardo domiciliario impactaron la atención de los enfermos. Actualmente se ha identificado la presencia de dolor como complicación crónica. Objetivo: Documentar el impacto de la COVID-19 en enfermos con dolor y su cronicidad. Material y métodos: Búsqueda de la literatura en la base de datos PubMed de documentos que en el título presentaran las palabras «COVID¼, «SARS-CoV¼, «Pain¼. No se identificaron metaanálisis. Encontramos revisiones sistematizadas y documentales en las que basamos la información presentada. Conclusiones: La COVID-19 presenta dolor crónico como una manifestación a largo plazo. Es conveniente que se generen líneas de investigación tendientes a documentar este fenómeno.

Abstract: Introduction: COVID-19 has caused many deaths on the planet. To date we do not know its long-term impact. Conversion of hospital centers and home reclusion impacted those with a disease. Currently, the presence of pain has been identified as a chronic complication of COVID-19. Objective: To document the impact of COVID-19 on patients with pain and its chronicity. Material and methods: Literature search in the PubMed database for documents that contained the words «COVID¼, «SARS-CoV¼, «Pain¼ in the title. No meta-analyses were identified. We found systematized and documentary reviews on which we based our information. Conclusions: COVID-19 presents chronic pain as a long-term manifestation. It is advisable to generate lines of research aimed at documenting this phenomenon.

El papel de la microbiota sobre la percepción del dolor visceral / The gut microbiota and its role on visceral pain

Resumen: La microbiota intestinal tiene un impacto bien documentado en diversos aspectos de la salud. En este estudio se recoge la evidencia disponible acerca de la repercusión de la dieta individual y de la microbiota en la percepción del dolor visceral.

Abstract: The gut microbiota has a well-documented impact on various aspects of health. In this study we review the available evidence on the impact of individual diet and microbiota on visceral pain perception.

Consideraciones analgésicas sobre el manejo del dolor agudo en el adulto mayor / Considerations for acute pain analgesic management in the elderly

Resumen: En las últimas décadas se ha registrado un aumento dramático en la esperanza de vida. La principal morbilidad de este grupo poblacional son las enfermedades crónico-degenerativas, las cuales frecuentemente se acompañan de dolor. No es de extrañarse que cada vez más pacientes ancianos sean intervenidos quirúrgicamente; hasta 62% de ellos reportan dolor agudo postoperatorio (DAPO) severo. El envejecimiento se asocia a una respuesta reducida al estímulo doloroso, fenómeno conocido como presbialgesia, lo cual se traduce en menores requerimientos analgésicos. Cuando el paciente anciano cuenta con demencia u otras alteraciones de la cognición se deberán utilizar escalas conductuales. Existen diversas condiciones fisiológicas en el anciano que lo hacen propenso a acumulación de fármacos y retraso en su eliminación. Además, existe un riesgo aumentado de interacciones farmacológicas por polifarmacia, hechos que se deberán tener en cuenta al abordar clínicamente el dolor en el paciente geriátrico. Los antiinflamatorios no esteroideos (AINE) son considerados de riesgo en ancianos frágiles por aumentar el riesgo de sangrado, sin mencionar el potencial daño en pacientes nefrópatas o con trastornos de la coagulación. El paracetamol es un analgésico noble a nivel gástrico, renal y cardiovascular. Es considerado primera línea en osteoartrosis degenerativa. Se sugiere no sobrepasar dos gramos al día en ancianos frágiles. Al utilizar analgésicos opioides se sugiere iniciar con la mínima dosis analgésica y escalar lentamente en caso de que el alivio del dolor lo requiera, evitando así efectos adversos.

Abstract: Over the last few decades the elderly population is growing by the second. Most of their illnesses are of the chronic degenerative type, many of which are very painful. Also, more and more elderly patients are requiring surgery for a number of reasons; 62% of these patients will experience severe postoperatory pain. Aging is associated with presbialgesia, which is a reduced response to a noxious stimule. When these patients have dementia or other cognitive impairment conductual scales such must be utilized. There elderly might be more sensitive to analgesic drugs due to various and unique physiological aspects. NSAIDs are considered high risk drugs in fragile elderly patients. Acetaminophen is a safe analgesic drug without many gastrointestinal, renal or cardiovascular secondary effects. Nevertheless, a fragile elderly patient should not receive more than 2 grams daily. When giving opioids, one should start with the minimum dose and titrate slowly when needed in order to avoid adverse effects.

[Anaesthetic management of patients in the third trimester of pregnancy undergoing urgent laparoscopic surgery. Experience in a general hospital]. / Cirugía laparoscópica de urgencia en el tercer trimestre de gestación y su manejo anestésico. Experiencia de un hospital general.

BACKGROUND: Laparoscopic surgery is well accepted as a safe technique when performed on a third trimester pregnant woman. OBJECTIVE: The aim is to describe the anaesthetic management of a group of patients undergoing this type of surgery. MATERIAL AND METHODS: An analysis was made of records of 6 patients in their third trimester of pregnancy and who underwent urgent laparoscopic surgery from 2011 to 2013. CLINICAL CASES: The study included 6 patients, with a diagnosis of acute cholecystitis in 4 of them. The other 2 patients had acute appendicitis, both of who presented threatened preterm labour. CONCLUSION: The most frequent indications for laparoscopic surgery during the last trimester of birth were found to be acute cholecystitis and acute appendicitis. Acute appendicitis is related to an elevated risk of presenting threatened preterm labour.

Assessment of pain and other symptoms in Mexican patients with advanced illness.

Palliative care is an approach that improves the quality of life of patients and their families facing the problem associated with life-threatening illness, through the prevention and relief of suffering by means of early identification and impeccable assessment and treatment of pain and other problems, physical, psychosocial, and spiritual. During this stage, several symptoms appear and contribute to a decrement in the quality of life. We performed a retrospective study evaluating medical records of terminally ill patients who attended a specialized pain and palliative medicine service. The Edmonton Symptom Assessment Scale (ESAS) was used to document symptoms intensity. Data analysis was carried out at two times: the initial assessment and the last visit before death. We analyzed thirty-eight cases of which 58% were women (22 cases) and the mean age of the sample was 60.7 years (SD: 15.6). All cases had an oncologic disease classified as end-stage cancer and were considered as palliative patients. Symptom intensity was documented by the ESAS in two different moments: pain 3.7 (SD: 3.2) vs. 4.1 (SD: 3.4), nausea 1.4 (SD: 3.2) vs. 1.8 (SD: 3.3), depression 3.4 (SD: 3.4) vs. 4.3 (SD: 3.7), anxiety 3 (SD: 3.5) vs. 2.4 (SD: 3.6), weakness 4.8 (SD: 3.5) vs. 6.2 (SD: 3.6), dyspnea 1.1 (SD: 2.7) vs. 2.8 (SD: 3.4), anorexia 3.5 (SD: 3.7) vs. 4.7 (SD: 3.8), and somnolence 2.6 (SD: 3.5) vs. 4.9 (SD: 3.5). Statistical significance was found in weakness, dyspnea, and somnolence. We found the ESAS a useful tool for symptom assessment. In this study, we document the prevalence of symptoms at the end of life in a Spanish-speaking country. Physicians trained in pain and palliative medicine managed those symptoms, and we observed that symptoms maintained the same intensity. There is the possibility that the intervention made by those clinicians modified the symptomatic outcome in those patients. Evaluation of effective protocols for symptom management at the end of life is needed.