Toxina botulínica y ozono intrarticular en la artrosis / Intra-articular botulinum toxin and ozone in osteoarthritis

El dolor por osteoartrosis continúa siendo una de las principales causas de consulta médica debido a la insuficiente eficacia de los tratamientos establecidos, y por ello surge la necesidad de buscar nuevas terapias que mejoren la respuesta analgésica. La inyección intrarticular de toxina botulínica y/o de ozono medicinal son dos de las nuevas opciones a considerar en esta patología. Realizamos en este capítulo una revisión del manejo de estas dos opciones analgésicas.(AU)

Osteoarthritis pain continues to be one of the main causes of medical visit due to the insufficient efficacy of established treatments, therefore, the need arises to search for new therapies that improve the analgesic response. Intra-articular injection of botulinum toxin and/or medicinal ozone are two of the new options to consider in this pathology.We develop in this chapter a review of the management of these two analgesic options.(AU)

Usability, Acceptability, and Usefulness of an mHealth App for Diagnosing and Monitoring Patients With Breakthrough Cancer Pain.

BACKGROUND: Breakthrough pain is a major problem and a source of distress in patients with cancer. We hypothesized that health care professionals may benefit from a real-time mobile app to assist in the diagnosis and monitoring of breakthrough cancer pain (BTcP). OBJECTIVE: This study aimed to test the usability, acceptability, and usefulness in real-world practice of the mobile App INES·DIO developed for the management of patients with BTcP. METHODS: This study consisted of a survey of a multidisciplinary sample of 175 physicians who evaluated the mobile app after testing it with 4 patients with BTcP each (for a total of 700 patients). The digital profile of the physicians, use of the different resources contained in the app, usefulness of the resources, acceptability, usability, potential improvements, intention to use, and additional resources to add were recorded. RESULTS: Of the 175 physicians, 96% (168/175) were working in public hospitals. They had an average of 12 (SD 7) years of experience in BTcP and almost all (174/175, 99.43%) had an active digital profile. The Eastern Cooperative Oncology Group and Karnofsky performance scales, the Visual Analogue Scale, and the Davies algorithm to diagnose BTcP were the most frequently used tools with patients and were assessed as very useful by more than 80% (140/175) of physicians. The majority (157/175, 90%) answered that App INES·DIO was well designed and 94% (165/175) would probably or very probably recommend it to other colleagues. More than two-thirds indicated that the report provided by the app was worth being included in patients' clinical records. The most valued resource in the app was the recording of the number, duration, and intensity of pain flares each day and baseline pain control to enhance diagnosis of BTcP. Additional patient-oriented cancer pain educational content was suggested for inclusion in future versions of App INES·DIO. CONCLUSIONS: Our study showed that App INES·DIO is easy to use and useful for physicians to help diagnose and monitor breakthrough pain in patients with cancer. Participants suggested the implementation of additional educational content about breakthrough pain. They agreed on the importance of adding new clinical guidelines/protocols for the management of BTcP, improving their communication skills with patients, and introducing an evidence-based video platform that gathers new educational material on BTcP.

Characteristics and outcomes of chronic pain patients referred to hospital pain clinics: a prospective observational study.

BACKGROUND: Understanding the patient referral patterns and medical profiles of patients attending hospital pain clinics, and the therapies offered to them, can provide a useful starting point for evaluating their effectiveness and identifying areas for improvement. METHODS: A prospective observational study was carried out. Sociodemographic and clinical data were gathered at twelve centres. The diagnoses and pain treatments provided by the referring doctors were compared with the ones provided by pain clinicians. Pain severity and patients' quality of life were measured prospectively. Descriptive statistics were compared. RESULTS: Two-hundred sixty-nine patients referred to 12 outpatient hospital pain clinics in Catalonia were followed for 3 months. Most were referred by orthopaedists (50.0%) or primary care physicians (20.2%). The mean age and time since pain onset were 59.4 and 4.1 years, respectively. Pain clinicians changed the diagnostic labels of 48.5% of the patients. Nearly all patients (89.2%) were receiving pain medications prior to referral. Treatment was modified in 94.8%. Pain clinicians used more interventional and/or alternative therapies (65.1% of patients), opioids (46.8%) and co-adjuvants (38.2%). Three months after referral, the 24-h worst and current pain severity had decreased by 30.9% and 27.8% on average, respectively. The mean (effect size) improvements in a quality of life (the EuroQol 5 Dimensions index) and pain (visual analogue scale) scores were, respectively, 0.16 (0.73) and 6.7 (0.31). CONCLUSIONS: Pain clinicians refined the diagnoses and treatments of patients referred to hospital pain clinics and improved outcomes. Relatively few patients are referred from primary care considering the prevalence of chronic pain in this setting.

Effectiveness and safety of tapentadol prolonged release for severe, chronic low back pain with or without a neuropathic pain component: results of an open-label, phase 3b study.

OBJECTIVE: This open-label, phase 3b study evaluated the effectiveness and tolerability of tapentadol prolonged release and tapentadol immediate release (for acute pain episodes) for severe, chronic low back pain with or without a neuropathic pain component that was inadequately managed in patients taking World Health Organization (WHO) Step I or II analgesics or who were not regularly treated with analgesics. RESEARCH DESIGN AND METHODS: Average baseline pain intensity was greater than 5 (11-point numerical rating scale-3 [NRS-3; 3-day average pain intensity]) with WHO Step I or II analgesics and greater than 6 with no regular analgesic regimen. WHO Step II analgesics were discontinued before starting study treatment; WHO Step I analgesics or co-analgesics were continued at the same dose. Patients received tapentadol prolonged release (50-250 mg bid) during a 5-week titration and 7-week maintenance period. Tapentadol immediate release was permitted for acute pain episodes (tapentadol prolonged release and immediate release maximum combined dose, ≤500 mg/day). The painDETECT questionnaire was used to define subsets of patients based on the probability of a neuropathic pain component to their low back pain as 'negative', 'unclear', or 'positive'. CLINICAL TRIAL REGISTRATION: NCT00983385. MAIN OUTCOME MEASURE: The primary endpoint was the change from baseline to week 6 in average pain intensity (NRS-3), using the last observation carried forward to impute missing scores. RESULTS: In the painDETECT negative (n = 49) and unclear/positive (n = 126) subsets, respectively, mean (SD) changes in pain intensity from baseline to week 6 were -2.4 (2.18) and -3.0 (2.07; both p < 0.0001). Among patients who had not received prior WHO Step II treatment, lower doses of tapentadol prolonged release were generally required with increasing likelihood of a neuropathic pain component. Based on the painDETECT questionnaire and the Neuropathic Pain Symptom Inventory (NPSI), tapentadol prolonged release treatment was also associated with significant improvements in neuropathic pain symptoms, with decreases in the number of pain attacks and the duration of spontaneous pain in the last 24 hours in patients with low back pain with a neuropathic pain component (painDETECT unclear or positive score at baseline or screening). The most common treatment-emergent adverse events (incidence ≥10%, n = 176) were nausea, dizziness, headache, dry mouth, fatigue, constipation, diarrhea, nasopharyngitis, and somnolence. CONCLUSIONS: Tapentadol prolonged release was well tolerated and effective for managing severe, chronic low back pain with or without a neuropathic pain component.

Study to evaluate the profile of patients attending pain units in Spanish hospitals for the first time (PANDHORA study).

UNLABELLED: SUMMARY  AIM: To define the sociodemographic and clinical profile of patients attending the pain unit for the first time. PATIENTS & METHODS: Cross-sectional epidemiological survey of 823 patients included by 165 physicians from 107 pain units in Spanish hospitals. RESULTS: Mean ± standard deviation age was 59 ± 15.1 years; 66.4% were women. The referring clinicians were orthopedic specialists (35.1% of patients) and general practitioners (24.9% of patients). Mean pain intensity (visual numeric scale) was 7 ± 1.8 points. Pain lasted 3-12 months in 33.7% of patients. Pain was noncancer-related in 96.3% and musculoskeletal-based in 68.6% and affected mainly the lumbar area (55.3%) and the lower limbs (40.8%). On their first visit, 7.8% of patients had not received analgesics, whereas 55.2% were taking NSAIDs, 45.1% paracetamol, 31.6% weak opioids and 15.7% strong opioids. CONCLUSION: Musculoskeletal pain was predominantly chronic, long-lasting, lumbar and more common in women. NSAIDs are the drugs most commonly prescribed by referring clinicians. Before attending the pain unit, strong opioids and antiepileptic drugs are used much less frequently.