XXV Congreso de la Asociación Andaluza del Dolor

31 in October of 2016
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Resumen elaborado por la Dra. Inmaculada Herrador

Hospital Universitario Reina Sofia, Cordova

Between days 27 and 29 de Octubre se celebró en Cádiz el XXV Congreso de la Asociación Andaluza de dolor y asistencia continuada. Ha sido muy enriquecedor compartir e intercambiar con mis compañeros la información que se ha tratado.

Referente a la mesa de DIO, se abordaron tres temas importante:

  • Actualización en DIO por Inmaculada Herrador Montiel (Anestesióloga)
  • Medical liability and patient treatment with opioids: marco jurídico y problemas prácticos por Ricardo Ruiz de la Serna (Licenciado en derecho)
  • Seguridad de los opioides por Sergio Maldonado Vega ( Anestesiólogo)

Desde el punto de vista legal, Ricardo Ruiz de la Serna hizo una exposición magnífica de la importancia que tiene el obtener el consentimiento informado por escrito cuando se prescriban opioides a nuestros pacientes por todas las implicaciones de responsabilidad civil médica que conlleva.

Referente a la mesa de Trending topics en dolor también se abordaron tres temas de relevancia:

  • Formación en dolor por Milagros Rivera Pérez
  • Latest posts in pharmacological treatment of chronic pain by Juan Caballero Callejas
  • Rotation of opioids (ROP)por Inmaculada Herrador Montiel

En cuanto a la ROP, que como todos sabemos se usa en caso de dolor refractario, después de hacer una revisión bibliográfica la conclusión fundamental es que las tablas de equivalencia de opioides deben usarse de forma orientativa ya que más que dosis equianalgésicas son una ratio de conversión inicial. La ROP por lo tanto, no es un mero cálculo matemático por toda la variabilidad individual que existe en la respuesta a los opioides y las propiedades farmacodinámicas y farmacocinéticas de los distintos compuestos químicos que existen en el mercado.

Reunión de expertos: breakthrough cancer pain

22 in October of 2016
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Alicante was made in a meeting of experts in the area to discuss various aspects ON cancer breakthrough pain.

The assistants, experts in the management of cancer breakthrough pain (DIO), They are corresponding to different specialties thus providing a multidisciplinary approach of this clinical situation present in Pain Units, Palliative units, Services of Medical Oncology and Radiation Oncology Services.

The discussion centered around a series of questions related to the approach of breakthrough cancer pain from the experience of each of the participants to reach consensus answers.

The questions raised are as follows:

  1. How do you choose between them fentanyls? Is there any preference according to the route of administration?
  2. Importance of attributes: Speed ​​of action according to the route of administration
  3. Importance of attributes: Metering accuracy and range of doses. Prescribed dose at the start
  4. Monitoring the evaluation of analgesic efficacy
  5. Importance of attributes: Comfort in the administration and enforcement in bedridden patients
  6. Importance of attributes: Ease of explanation and support materials
  7. Accessibility laboratory for consultations and questions. Product experience

pdfDesarrollo de las respuestas y documento final

 

Inter and intra-patient variability in breakthrough pain episodes of opioid-treated patients with underlying chronic pain

17 in October of 2016

 

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Soc Rev Esp Pain. 2016; 23(1): 6-15

This article published in 2016, I find it very interesting in terms of the assessment of breakthrough pain (A) in 50 patients: 23 oncological and 27 chronic benign pain observing the great interindividual variability as both intrapatient exists as to the characteristics of the DI: type of pain, intensity and duration of each episode; situation that often see in our daily clinical practice.

Starting from the premise that pain is a symptom and changing and evolving, that is why, treatment should be dynamic, I seem very successful using a journal where the patient and their family environment,es, can actively participate; since for the successful treatment of DI it is essential to good health education to improve compliance and minimize potential adverse effects.

Selección y comentarios: Pull. Immaculate Farrier Montiel

 

What to Do, and What Not to Do, When Diagnosing and Treating Breakthrough Cancer Pain (BTcP): Expert Opinion

13 in October of 2016

captura-de-pantalla-2016-10-13-a-las-17-39-00What to Do, and What Not to Do, When Diagnosing and Treating Breakthrough Cancer Pain (BTcP): Expert Opinion

Working Group Nientemale OF, R. Vellucci, G. Fanelli, R. Pannuti, C. Peruselli, S. Adamo, G. Alongi, F. Amato, The. Consoletti, The. Lamarca, S. Liguori, C. Lo Presti, A. Maione, S. Mameli, F. Marinangeli, S. Marulli, In. Minotti, D. Miotti, The. Montanari, G. Moruzzi, S. Palermo, M. Parolini, P. Poli, In. Tirelli, A. Valle, and P. Romualdi

Trabajo muy interesante con alto contenido docente para el reconocimiento del DIO y su tratamiento. El trabajo realiza una revisión sobre el DIO y su tratamiento y aporta unas recomendaciones respecto a qué hacer / y no hacer en el tratamiento del DIO. Ha sido escrito por un grupo de expertos italianos en dolor. El trabajo ha recibido alguna crítica que es adecuadamente contestada por los autores. Altamente recomendable su lectura así como la réplica de los autores a la crítica recibida (ésta también está disponible en esta web)

Selección y comentarios: Dr. Miguel Angel Benitez Rosario

Reply-Letter to the Editor: What to Do, and What Not to Do, When Diagnosing and Treating Breakthrough Cancer Pain: Expert Opinion

13 in October of 2016

captura-de-pantalla-2016-10-13-a-las-17-13-17Reply-Letter to the Editor: What to Do, and What Not to Do, When Diagnosing and Treating BreakthroughCancer Pain (BTcP): Expert Opinion.

pdfWorking Group Nientemale OF, Vellucci R, Fanelli G, Cortesi PA, pans R, Peruselli C, Romualdi P

Drugs. 2016 Jul;76(10):1063-5. two: 10.1007/s40265-016-0594-z

It is a replica of the authors to criticism by a previously published work. In this case, the reply goes beyond a discussion or justification of what is published, It includes an important reflection on the Infra-cancer pain and DIO and criticism of the use of fentanyls quick action by high costs,es.

Selección y comentarios: Dr. Miguel Angel Benitez Rosario

Breakthrough cancer pain: twenty five years of study

13 in October of 2016

captura-de-pantalla-2016-10-13-a-las-17-00-31Breakthrough cancer pain: twenty-five years of study.

Merchant S, Portenoy RK.

Pain. 2016 Sep 19. [Epub ahead of print]

Interesting work of opinion on the DIO by two of the authors who have published more about it or were initiated by the identification of these crises painful. The paper describes the beginnings of the characterization of the DIO, the changes that have occurred in their conception and resolve outstanding issues. Recommended reading

Selección y comentarios: Dr. Miguel Angel Benitez Rosario

Presentation Scientific Committee

4 in October of 2016

dr-benitezDr. Miguel Angel Benitez Rosario

Specialist Palliative Care

Hospital Universitario Ntra. Sra. La Candelaria, Tenerife

Curriculum summarized

dra-herradorPull. Immaculate Farrier Montiel

Specialist in Anesthesiology, Resuscitation and Pain Therapy

Hospital Universitario Reina Sofia, Cordova

Curriculum summarized

dra-morillaPull. Idoia Morilla Ruíz

Specialist Radiation Oncology and Medical Oncology

Catalan Institute of Oncology, Hospital Duran i Reynalds, Barcelona

Curriculum summarized

Cover Letter Scientific Committee

Dear partners

In recent years, we have made progress in understanding, clinical diagnosis and treatment of this type of severe pain is known as breakthrough pain that occurs in a high percentage of our cancer patients, increasing by increased survival rates of many cancers.

(more…)

Breakthrough cancer pain: visión rápida

12 in September of 2016
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Concept

Breakthrough pain is seen as a crisis of rapid onset and short duration of pain that occurs in a patient whose baseline pain is adequately controlled or mild.

Breakthrough pain is considered a different pain syndrome, independent, baseline pain. It does not correspond to episodes of different baseline pain intensity of uncontrolled.
The duration of these pain crises is variable, from few minutes to 1 time, but more often are less episodes 45 minutes. The intensity is usually moderate to severe since the onset of the crisis pain. The number of episodes of pain varies between patients, from rare to frequent.

The concept of breakthrough pain includes three types of pain:

  • which it appears after a triggering element (for example an unusual effort), and it is categorized as incidental pain,
  • which it appears without apparent cause, I considered as idiopathic or spontaneous pain or actual breakthrough,
  • el asociado a actividades diagnósticas médicas y/o curas de enfermería, conocido como dolor procedimental

En cualquier caso ha de considerarse que la presencia de un dolor irruptivo se corresponde con un incremento de los estímulos álgicos y no con un fallo de la eficacia del tratamiento analgésico basal.

(more…)

Actualizaciones en dolor irruptor

7 in September of 2016
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The term breakthrough pain (Dolor Irruptivo-DI) It is defined for the first time in 1990 by Portenoy and Fine, as: "Transitory exacerbation of pain that occurs in a context of stable baseline pain in a patient treated with opioids chronically".

For diagnosis a number of requirements are established:

1.-Existence of a stable analgesia during 48 previous hours

2.-Existence of controlled baseline pain during 24 previous hours

3.-Presence of temporary exacerbations of intense or stabbing pain during 24 previous hours

Captura de pantalla 2016-09-07 a las 11.05.47Hoy en día se distinguen tres tipos:

1.-dolor incidental predecible (asociado al movimiento, activity, intake, cleanliness, asociado a pruebas diagnósticas y curas de enfermería, etc..)

2.-dolor incidental impredecible (distention associated with hollow viscera, cough, bladder spasms, isquemia, etc.)

3.-dolor irruptivo espontáneo (independiente del estímulo)

(more…)