Advances and Pitfalls of Specialized Pain Care through Public and Private Health Care Providers in Catalonia and the Balearic Islands: A Physician's Survey.

Optimal diagnosis and treatment of pain require a multidisciplinary approach that demands considerable coordination and forethought. A cross-sectional physician survey based on an online questionnaire was carried out to assess the adoption of multidisciplinary working patterns, compare the public and private models, and provide an update on the resources and organization of specialized pain care in Catalonia and the Balearic Islands. Active pain practitioners identified through the Catalan Health Service and Pain Society databases were sent an invitation in December 2020. Of the 321 physicians contacted, 91 (28.3%) answered and 71 provided complete responses (commonly anesthesiologists, representing 92 different sites; some worked at public and private sites). Up to 78.7% reported working in pain management teams, but only 53.5% were regularly involved in teaching or research activities. Thus, the proportion of multidisciplinary sites lies somewhere in-between. Median wait times were significantly shorter and within the recommended standards in private practices (e.g., 15 vs. 90 days in public practices for noncancer patients). In turn, private practices were slightly less staffed and equipped, albeit the differences did not reach statistical significance. Respondents made a median of 530 regular and 30 emergency visits per year, of which 190 involved interventional procedures. They offered a wide range of pharmacological and interventional therapies, although psychotherapy and the most sophisticated procedures were only available in ≤50% of sites. Pain clinicians and facilities are reasonably available in Catalonia, but barely more than half are truly multidisciplinary. Public and private practices differ in some aspects; the latter seems to be more accessible, but it is restricted to patients who can afford it. Compared to previous reports, this update shows both advances and outstanding issues. Multidisciplinary care could be expanded by incorporating more psychologists and some interventional procedures. The public practices should reduce wait times.

Prevalence of central and peripheral neuropathic pain in patients attending pain clinics in Spain: factors related to intensity of pain and quality of life.

BACKGROUND: The objective of the study was to estimate the prevalence of pure central neuropathic pain (CNP) and peripheral neuropathic pain (PNP) among patients attending pain clinics in Spain. The study also aimed to analyze factors associated with pain intensity and quality of life (QoL). METHODS: A cross-sectional study was performed including 53 patients with pure CNP and 281 with pure PNP attending in 104 pain clinics in Spain. The revised grading system proposed in 2008 to determine a definite, probable or possible diagnosis of NP was used. Pain features, psychological variables and QoL were assessed. Descriptive, bivariate and multivariate analyses were performed. RESULTS: The prevalence of pure CNP and PNP amongst neuropathic pain patients was 2.4% (95% CI: 1.7;3.1) and 12.9% (95% CI: 1.5;14.3), respectively. Comorbid anxiety, depression or sleep disorders were high in both groups, but higher in CNP patients (51.1%, 71.4%, respectively). Pain intensity in PNP patients was associated with the presence of depression and sleep disturbances. However, in CNP patients, it was related with pain in the lower limbs. The impairment of QoL was greater in CNP patients than in PNP patients; pain location, presence of depression and sleep disturbance were the factors that most negatively affected QoL. Among PNP patients, women and those with higher pain intensity had worse QoL. CONCLUSION: Pain intensity and QoL are affected by different factors in patients suffering from CNP or PNP. Identifying these factors could serve to guide therapeutic strategies and improve the QoL of patients.

Psychometric properties of the MOS (Medical Outcomes Study) Sleep Scale in patients with neuropathic pain.

OBJECTIVE: This study assessed the psychometric properties of the MOS Sleep Scale in neuropathic pain (NeP). METHODS: Psychometric properties were tested in patients with neuropathic pain enrolled in a prospective study exploring the effectiveness of gabapentin for 3 months. Participants also completed scales for pain intensity, anxiety, depression, disability, and health-related quality of life. Feasibility, reliability, validity and sensitivity to change were measured in this study. RESULTS: Six-hundred-three patients [58.4+/-14.4 years (65.1% female), mean+/-SD] with pain for 1.2+/-3.3 years were included. The MOS Sleep Scale was acceptable (items with missing data <10% and floor and ceiling effects <50% per item and <15% per domain) and reliable (Cronbach's alpha between 0.64 and 0.87, and test-retest intraclass correlation coefficients between 0.79 and 0.91, p<0.001 for all cases). After adjusting for confounders, the MOS Sleep Scale was able to distinguish between sex, present pain intensity, level of disability and presence of anxiety or depression. Correlations with other scales were moderate; rho-coefficients between -0.21 and 0.57 (p<0.01, all cases). The scale was sensitive to change after treatment with gabapentin; after adjusting, responders (50% reduction in baseline pain) showed a decrease in sleep problems index of -25.6+/-14.3 points vs. -12.1+14.5 points in nonresponders (F=80.5, df=1/398, p<0.0001). Score reduction in summary index and subscales correlated significantly with pain intensity reduction (Pearson r-coefficients between 0.428 and 0.116, p<0.01, all cases). CONCLUSIONS: The MOS Sleep Scale showed good psychometric properties and was sensitive to changes in patients with NeP of broad aetiology.