RESED (Revista de la Sociedad Española del Dolor — Journal of the Spanish Pain Society) is the official scientific dissemination organ of the Spanish Pain Society (Sociedad Española del Dolor, SED). It is a multidisciplinary journal aimed at healthcare professionals, researchers and managers involved in the comprehensive management of pain.
Immunological therapy in persistent complex regional pain syndrome: a systematic review and narrative synthesis
Background: Immunological pathophysiological mech-anisms have been postulated in Complex Regional Pain Syndrome (CRPS). Clinical features suggest abnormal immune activation, supported in laboratory studies. The purpose of this review is to systematically review the effects of therapies that can modulate the immune system in persistent CRPS. Methods: Articles were screened from PubMed, Embase, Scopus, clinicaltrials.gov, ISRCTN databases and Web of Science for articles, studies and conference abstracts in CRPS and immune therapies from inception up to April 2024. Titles and abstracts were screened, followed by reading the full text and reference lists to determine the final articles for analysis. Studies were restricted to adults and a duration of disease greater than 1 year. Randomised controlled trials were appraised using the Cochrane Risk of Bias (RoB2). Results: A total of 1404 studies were yielded, and 23 articles were retrieved for full-text analysis after reviewing the titles, texts and abstracts. A narrative syn-thesis was used due to the heterogeneity of studies. The immune therapies used were glucocorticoids, thalidomide/lenalidomide, immunoglobulin, plasmapheresis, mycophenolate, anti-TNF-alpha inhibitors and epidermal growth factor receptor inhibitors. There were 16 reports of beneficial effects from non-randomised trials, case series and case reports of treatment with immunomodulating drugs or interventions. Small randomised trials of low-dose immunoglobulin, epidermal growth factor receptor inhibitors and mycophenolate suggest possible treatment benefit, but larger randomised trials of immunoglobulin and lenalidomide demonstrated no effect. Conclusion: The emergence of novel immune therapies for persistent CRPS shows promise, but evidence based on high-quality randomised trials remains limited and does not show a positive effect. Significance Statement: This work summarises the current use of immune-modulating therapies in man-aging patients with persistent Complex Regional Pain Syndrome (CRPS). It complements the current interest in immunological approaches to pain management with the increasing role of immune mechanisms in both pain and CRPS. While promise has been shown in small case reports and cohort studies, the need for high-quality clinical trials is highlighted by the few large randomised controlled trials.
Copyright (c) 2026 Journal of the Spanish Pain Society
New phase in RESED. Let’s make the most of it!
Estimados compañeros, socios de la SED y lectores de RESED, Tal como adelantamos en anteriores editoriales y en el último congreso de la SED, se ha iniciado una nueva andadura de nuestra RESED, lo que redundará en intentar conseguir varios objetivos: Mayor calidad de RESED. Plataforma más actualizada y novedosa, con mayor facilidad de navegación y trazabilidad. Facilidad de publicación por los autores, con acortamiento del tiempo de respuesta a los mismos sobre sus artículos. Mayor facilidad de intervención para los revisores. Mejor visibilidad de RESED y más difusión de sus artículos y contenidos en diferentes plataformas y redes sociales. Se inicia el proceso de indexación en PubMed y otras bases de datos. RESED aspira a ser un puente entre la evidencia científica y la toma de decisiones para los profesionales que tratan el dolor, que tanto impacta en la vida diaria de las personas que lo sufren. Para conseguir estos objetivos, la Junta Directiva de la SED ha invertido importantes recursos, en una apuesta por la seriedad, el rigor y la mejora de RESED, contratando una empresa denominada Alterbiblio, con experiencia en estos temas, para que trabaje conjuntamente con Inspira y los editores jefes de RESED. Se han hecho tres cursos básicos de formación de revisores por Alterbiblio y patrocinados por la SED, siendo la primera sociedad científica que facilita cursos específicos para sus revisores, con el objetivo de que el equipo editorial de RESED sea el mejor preparado y capacitado, lo que redundará en la calidad de lo publicado. La plataforma habitual de RESED en breve sufrirá cambios importantes, que se irán comunicando a todos los socios de la SED y a los lectores de RESED, de cara tanto a remitir como a revisar artículos, así como a conocer las nuevas políticas editoriales impuestas por la modernización de la revista y que también incluirá las normas de utilización de la IA. En un primer paso se hará un volcado de datos al nuevo entorno OJS en la plataforma, seguido de otros cambios. Os pedimos como editores jefes de RESED vuestra colaboración, tanto para entender y manejar la nueva plataforma como para la remisión de artículos de interés, y sobre todo de calidad, para poder situar a nuestra revista RESED en lo más alto como publicación científica, de la cual podamos sentirnos todos orgullosos. Recordad que todos somos RESED.
Cerebrospinal Fluid Fistula Secondary to Increased Intra-abdominal Pressure in a Patient with an Intrathecal Pump Due to Prostatic Synovial Sarcoma: A Case Report
Objectives: To describe the clinical case of a cerebrospinal fluid (CSF) fistula in a patient with an intrathecal pump for refractory cancer pain, secondary to increased intra-abdominal pressure caused by prostatic synovial sarcoma. Material and methods: We present the case of a 22-year-old male with poorly differentiated stage IV prostatic synovial sarcoma, treated with an intrathecal morphine pump due to severe pelvic pain unresponsive to systemic opioids. The patient underwent clinical follow-up, imaging studies, therapeutic interventions, and multidisciplinary management. Results: Tumor progression led to significant intra-abdominal compression, resulting in lumbar wound dehiscence, exposure of the intrathecal catheter, and CSF leakage confirmed by fluid analysis. The patient developed postural headache and photophobia. Antibiotics, local wound care, and a blood patch were administered with partial improvement. Due to persistent inflammation and risk of systemic infection, a complete surgical replacement of the intrathecal system was performed. Conclusions: This case highlights a rare but clinically significant complication in patients with intrathecal devices and large pelvic tumors. Increased intra-abdominal pressure can compromise device integrity, leading to CSF fistulas. Close clinical monitoring, multidisciplinary care, and early recognition of device-related complications are essential for optimal management.
Sr. Director: La idea de hablar sobre un tema alrededor de un café surge en 2011 en Suiza, por Jon Underwood y Sue Barsky Reid, como un espacio informal y comunitario donde las personas se reunían para hablar sobre la muerte, sin tabúes ni presiones, donde compartir reflexiones y perder esa connotación negativa; fue-ron los llamados DeathCafé (1,2). Actualmente esta práctica ha demostrado ser una herramienta útil para promover la conversación sobre problemas tabú, normalizando el tema y creando espacios de apoyo (1,2). Desde estas experiencias previas, el Colegio Oficial de Enfermería de Madrid, en colaboración con el Gru-po de Trabajo de Enfermería de la Sociedad Españo-la del Dolor (SED), impulsaron la adaptación de este modelo de encuentro al ámbito del dolor crónico. Esta iniciativa surge con el objetivo de crear espacios comu-nitarios de diálogo que contribuyan a reducir el ais-lamiento, los sentimientos de incomprensión y el sufri-miento añadido que experimentan muchas personas con dolor crónico, al percibir que su dolor no siempre es validado ni abordado de manera empática por los profesionales sanitarios, su entorno o la sociedad en general (3). Tras una primera cita piloto, el 14 de octubre de 2025 dentro del marco del día Mundial del Dolor, rea-lizada con pacientes pertenecientes a asociaciones como Afibrom, Dos Emociones y Moviendo Spain, se constató el beneficio y la necesidad de consolidar este tipo de participación comunitaria, que pasaríamos a denominar PAINcafé. Posteriormente, el primer PAINcafé en el ámbito del dolor crónico, porque no se han encontrado registros previos en la literatura, se celebró el 11 diciembre de 2025 en el Colegio Oficial de Enfermería de Madrid, en una sala acogedora con tazas de café, segura y práctica, donde los asistentes pudieron hablar con liber-tad a las enfermeras, sobre cómo eran sus vidas con dolor crónico, preocupaciones, experiencias de mejora, expectativas, etc. El objetivo del PAINcafé es generar conversaciones saludables sobre el dolor crónico que ayuden a conci-liarse con el momento vital, y promover cambios en el estilo de vida que les acerquen al alivio. Un café compartido entre iguales, para escuchar y ser escuchadas/os, intercambiar consejos prácticos y, sobre todo, sentir que no están solas ni solos. Pensamos que estos encuentros pueden tener el mismo efecto que los grupos de ayuda mutua entre pacientes, muy desarrollados en otras patologías o situaciones (enfermedades cardiovasculares, enferme-dades raras, personas cuidadoras, duelo, etc.) (4,5). En esta actividad, el beneficio es bidireccional; pacientes y profesionales de diferentes disciplinas pode-mos recabar información que nos inspire a innovar en los cuidados analgésicos, influyendo de esta forma en el bienestar de las personas con dolor y su entorno. Ini-ciamos con ello una serie de encuentros participativos que ayuden a dar respuestas a las diferentes necesi-dades de pacientes y profesionales. No se trata de un encuentro de terapia, aunque proporcione bienestar, se trata de crear un lugar donde pararse y conversar alrededor de un buen café.
Rethinking routine corticosteroid injections for knee osteoarthritis: prudence must not mean inertia
Physiological mechanisms of medical electroacupuncture and its clinical utility in nociplastic pain: a literature review
Chronic non-oncological nociplastic pain is a prevalent condition worldwide. The non-pharmacological therapeutic pillar is proposed as the first-line treatment, and the development of these tools should be encouraged. The aim of this review is to study the current basic and clinical evidence regarding the mechanisms and usefulness of acupuncture and electroacupuncture in pain relief, improvement in quality of life, and functionality in patients with fibromyalgia, temporomandibular disorder, irritable bowel syndrome, and interstitial cystitis/bladder pain syndrome; and to provide an update on the pathophysiology of nociplastic pain, particularly in the clinical entities under study. A search was conducted for systematic reviews and meta-analyses of controlled clinical trials on acupuncture or electroacupuncture in the four nociplastic pain entities under study. Three biomedical electronic databases were reviewed: PubMed, Cochrane Library, and Lilacs Plus. Out of 124 studies, thirty-nine met the inclusion criteria. A second literature search was performed regarding the pathophysiology of nociplastic pain and the mechanisms through which acupuncture and electroacupuncture could have positive effects on the outcomes studied. A qualitative analysis of the literature obtained from both searches was performed. The evidence found is of low quality but suggests the effectiveness of acupuncture and electroacupuncture on the outcomes and populations studied. There is a correlation between the pathophysiological mechanisms of nociplastic chronic pain and the signaling pathways modulated by acupuncture and electroacupuncture, which could explain their potential benefits in these clinical entities. This review suggests that acupuncture and electroacupuncture could be useful therapeutic tools for both somatic and visceral nociplastic pain. However, higher-quality clinical evidence is needed to confirm their effectiveness and expand their use, thereby strengthening their role as a first-line treatment in non-oncological chronic pain, which is a key component of the non-pharmacological approach.
Let's advance in anatomic thermology for interventional pain techniques, Letter to the Editor.
Risk Factors for Developing Chronic Pelvic Pain in Patients with Endometriosis: A Narrative Review.
This narrative review is presented to elucidate the risk factors present in patients diagnosed with endometriosis that lead to the development of chronic pelvic pain. The ultimate goal is to establish more effective and personalized therapies, avoiding the consequences of persistent pain. Endometriosis is a chronic, benign gynecological disease characterized by the growth of endometrial-like tissue outside the uterine cavity. This ectopic tissue acts like the eutopic endometrium: it thickens, breaks down, and bleeds during the menstrual cycle. Despite being benign, endometriosis infiltrates tissues and causes an inflammatory reaction in the areas where it is implanted. Both are responsible for the clinical symptoms, including dysmenorrhea, chronic pelvic pain, dyspareunia, dyschezia, dysuria, and infertility. Endometriosis is a multifactorial disease with no known cause. Several mechanisms may contribute to pain, including direct compression or infiltration of nerves, inflammation, and nerve damage or dysfunction. Treatment of pain associated with endometriosis can be medical or surgical. A holistic understanding of the risk factors for the development of chronic pelvic pain in patients with endometriosis is essential. This understanding, along with a multidisciplinary approach, is key to proper diagnosis and treatment, with the ultimate goal of improving patients’ quality of life.
Advance directives: autonomy and dignity at the end of life
Advance care planning by means of the so-called advance directives is a tool that allows patients to express, either orally or in writing, their preferences, values and goals in regarding the treatments they wish or do not wish to receive in the future, in the event of losing the capacity to communicate them themselves. It is a key mechanism to ensure respect for the autonomy of patients who find themselves in a clinical situation that makes it impossible for them to communicate. Although it represents an essential strategy for the humanization of end-of-life care, its integration into clinical practice remains uncertain. Therefore, there is a need to explore its implementation from primary care to the hospital settings, which could improve quality of life, reduce uncertainty and strengthen the bond between patients and health care professionals. This article provides a narrative review of the conceptual, regulatory, clinical and ethical foundations of advance directives, with an emphasis on their applicability in the Colombian context. To this end, a search was conducted into the current literature available on advanced care planning, advanced directives, palliative care, and end-of-life decision-making in the MedLine (PubMed), Lilacs, and Science Direct databases, from which 30 articles were included. The results showed that, although advance directives have been shown to contribute to comprehensive medical care and improve the quality of life of patients and their families, there are significant barriers to their implementation. Finally, it was concluded that advanced directives are an essential tool for promoting ethical, individualized, and respectful end-of-life care, and that strengthening them requires the training of health professionals, as well as public policies that facilitate their access and effective application.
Assessment of Quality of Life with the Use of Tapentadol in Adult Patients with Chronic Low Back Pain: A Cross-Sectional Study
Introduction: Low back pain is a common chronic condition and represents the second most frequent cause of medical consultations worldwide. It is estimated that up to 80% of the population experiences it at least once in their lifetime. Studies have reported that between 6.3% and 15.4% of individuals develop low back pain for the first time each year, with an annual recurrence risk ranging from 1.5% to 36%. Objective: To describe the quality of life using the SF-36 scale in patients aged 18 years or older with a diagnosis of chronic low back pain who received pharmacological management prescribed by the pain clinic service with extended-release tapentadol for a minimum of 3 continuous months (12 weeks) at doses of 50 mg and 100 mg orally every 12 hours. Methods: A cross-sectional study was conducted. Patients aged 18 years or older with a diagnosis of chronic multifactorial low back pain lasting more than 3 months were included. Sociodemographic and clinical variables were extracted from electronic medical records. Data analysis employed the IQVIA Quality Metric scoring system, developed and validated by the creators of the SF-36 scale, to calculate individual and domain scores. A descriptive analysis of the variables was performed, considering their nature and distribution type, using measures of central tendency and dispersion. Statistical analyses were conducted using the R programming language, version 4.3.3, a free and open-source software. Results: Treatment with tapentadol resulted in significant improvements in most domains of the SF-36 scale, demonstrating a positive impact on the perceived quality of life of patients. All eight evaluated domains showed statistically significant p-values (p < 0.05). Conclusion: This study suggests that extended-release tapentadol treatment can enhance the perceived quality of life in patients with chronic low back pain, positively influencing physical, emotional, and social aspects. These findings reflect notable improvements in functionality and overall well-being by alleviating pain, thereby enabling patients to improve mobility and social interactions.
Analgesic Effect of Ultrasound-Guided Erector Spinae Plane Block versus External Oblique Intercostal Plane Block in Patients Undergoing Laparoscopic Cholecystectomy: A Randomized Controlled Trial
Background: Laparoscopic cholecystectomy (LC) is considered one of the most common procedures globally. The associated postoperative pain is still a crucial problem after this procedure. We aimed to evaluate the analgesia of bilateral external oblique intercostal (EOI) versus bilateral erector spinae plane blocks effect in cases undergoing LC. Methods: A prospective randomized double-blind controlled study done on 93 cases who were listed for elective LC. Cases were randomized into three equal groups. Group A (ESP) had ultrasound (US) guided bilateral erector spinae plane block. Group B (EOI) had US guided bilateral EOI plane block. Group C (Control) had our institute’s standard analgesia plan with no block. Results: A significant difference was indicated between group A and B contrasted to group C regarding MAC consumption, intraoperative fentanyl consumption, time for first call of analgesia and post-operative 24 hours nalbuphine consumption (p-value <0.05). However, group A showed a significant greater time for first call of analgesia and lower 24 hours nalbuphine consumption than group B. Additionally, no significant difference was indicated between studied groups regarding nausea, vomiting, hematoma, and allergy (p-value ˃0.05). Conclusion: US-ESP block for LC supplies a better postoperative analgesia quality and longer duration, and reducing the postoperative analgesic consumption when contrasted to EOI plane block.
Epidural, Subdural Hematoma and Subarachnoid Hemorrhage Following Interlaminar Epidural Injection: A Case Report and Literature Review
Epidural injection is a widely used technique in Chronic Pain Units for the treatment of sciatica refractory to medical treatment. Neuroaxial hemorrhages secondary to this technique are uncommon but clinically significant due to the irreversible damage that can result from the lack of early diagnosis and treatment. We present a case of epidural and subdural hematoma with an atypical presentation following an interlaminar epidural injection with local anesthetic and corticosteroids. Additionally, we conduct a review of the literature and the management carried out, emphasizing the importance of clinical assessment and reevaluation, as well as the high index of clinical suspicion required for this condition.
Comparative Study Between Psoas Compartment Block Versus Local Anesthesia with Remifentanil Sedation for Endovascular Repair of Abdominal Aortic Aneurysm (EVAR): A Prospective Randomized Study.
Background: To evaluate the applicability of psoas compartment block for endovascular abdominal aortic aneurysm repair compared with local anesthesia with remifentanil sedation. Methods: Prospective, randomized, single blinded study over 30 patients divided into 2 equal groups, 15 patients underwent elective endovascular abdominal aortic aneurysm repair under psoas compartment block (PCB group), whereas another 15 patients were operated under local anesthesia with remifentanil infusion (LR group). Results: The mean VAS values showed statistically significant better values in LR group when compared to PCB group (P< 0.001). Ramsay Sedation score showed statistically significant deep sedation in LR group on comparison to PCB group (P< 0.001). In patients under remifentanil sedation (LR group), the heart rate and mean arterial blood pressure decreased significantly after induction of anesthesia and stayed low but without any clinical significance throughout the procedure (P< 0.001). Conclusions: The current study demonstrated that endovascular abdominal aortic aneurysm repair under psoas compartment block or local anesthesia with Remifentanil sedation is safe and effective procedure for the treatment of abdominal aortic aneurysms, with improved perioperative results.
Narrative review of locoregional anesthetic techniques in cardiovascular surgery
Locoregional anesthesia recently has been described and used in thoracic and cardiac procedures, referring to better perioperative pain control, shorter extubation times, and shorter time in the Intensive Care Unit (ICU). In this narrative review, a search was carried out in different databases, among the most prominent are PubMed and Google Scholar, in which the most used techniques of locoregional analgesia in cardiovascular surgery, the description of the procedure, efficacy, advantages and disadvantages of each. From the foregoing, ultrasound-guided puncture stands out to minimize errors and it is a great utility for performing the technique adequately, controlling postoperative pain in recent hours and the ease of performing these techniques. However, it should be noted that despite locoregional anesthesia being a better analgesia technique. It has not been shown to be more efficient than epidural analgesia
Incidence of Acute Postoperative Pain in non-ambulatory Surgeries at a High-complexity Referral Center.
Introduction: Inadequate control of Acute Postoperative Pain (APOP) remains prevalent, impacting patient recovery and outcomes. This study aimed to determine the incidence of APOP in non-ambulatory surgeries and identify associated risk factors and pain management strategies. Methods: A monocentric prospective analytical cohort study in 2019. Data collection included preoperative, intraoperative, and postoperative variables. Pain assessments were performed using the Numeric Rating Scale (NRS). Univariate, bivariate, and logistic regression analyses were used to explain APOP and the evaluated variables. Results: The study included 355 patients, with an 82.81% incidence of APOP. Most surgeries were elective (81.69%), with orthopedic and abdominal/pelvic surgeries being the most common. Pain intensity peaked at 24 hours postoperatively. Factors associated with moderate to severe APOP included active substance use, lack of peripheral nerve blockade, and general anesthesia. Discussion: The general incidence of APOP is slightly higher than some international standards. There is a high incidence of mild pain, suggesting improved APOP control. However, moderate to severe APOP is lower than internationally reported. There was no significant association was found between surgical categories and pain risk. Preoperatively, male sex was a protective factor, while substance use was a risk factor for moderate to severe pain. Postoperatively, factors such as general anesthesia, experiencing postoperative pain crises, and lack of analgesic strategies were associated with higher pain likelihood. Conclusion: The study found that APOP incidence aligns with international and national standards. Lack of access to specialized services and inadequate management could contribute to pain persistence. Some identified risk factors include male sex, lack of regional analgesic management, and surgery under general anesthesia.
Epidural blood patch in patient with idiopatic intracraneal hypotension
Temporomandibular pain and its relationship with the alteration of the Frankfort plane. Narrative Review from Physiotherapy
Introduction: Worldwide studies indicate that temporomandibular disorders (TMD) and headaches are closely related pathologies, due to anatomical, physiological and biomechanical convergences. The prevalence of headache associated with temporomandibular pain varies between 48% and 77%, and around 45% in pure headaches. Objective: To establish, according to the available evidence, the possible relationships between temporomandibular pain and alteration of the craniofacial plane, in order to establish the variables that are related. Methodology: This is a narrative review of electronic search of articles selected in databases: MEDLINE, PEDro, BVS, Clinical Key, Ebsco host, Science Direct, Scielo and Scopus and gray literature of randomized clinical trials, quasi-experimental studies, cross-sectional studies, cohort studies. Results: show that TMD are predicted by the positioning of the Frankfort plane or craniocervical posture p=0.002; being higher and/or rotated 95% CI; People who present TMD with headaches or migraines have a lower prognosis than those who do not present them p= 0.015. Conclusion: Temporomandibular pain has an association with the Frankfort plane or craniocervical posture, generating as a consequence pain at the craniocervical level, which can manifest as headache, migraine or simply a headache; The greatest relationship between temporomandibular pain and the Frankfort plane or craniocervical posture occurs when it is higher or rotated.
Relationship between the level of physical activity, sleep quality and anxiety with catastrophization in people with fibromyalgia
Fibromyalgia (FM) has been described as a central sensitization syndrome characterized by primary, generalized chronic musculoskeletal pain (MCPE) with hyperalgesia at specific points, with other somatic symptoms, sleep and cognitive disturbances. The objective of this study is to analyze the relationship between level of physical activity, quality of sleep and anxiety with catastrophizing in people with Fibromyalgia (FM) who are treated at the Chile Pain Center, a psychological center specialized in persistent physical pain.
Caffeine in the treatment of fibromyalgia, therapeutic proposal.
Experience of hydromorphone for intense chronic pain treatment: the SS-PAIN study
Objective: Hydromorphone is a potent opioid administered as daily extended-release tablets with good tolerance and safety profile. The SS-PAIN study aims to assess the impressions of physicians on the effect of hydromorphone on sleep quality and its safety profile in patients with severe chronic pain in Spain. Material and methods: This is an ecological study of aggregated data collected from physicians who have experience in managing patients with severe chronic pain. Data were collected using a 35-question survey on the last five patients who came to the consultation to treat severe chronic pain. The questions were focused on the effects of extended-release hydromorphone and other opioids on sleep and their safety profile. Results: A total of 89 physicians answered the survey. The average time of their patients’ pain evolution was 10.7 months. Patients treated with hydromorphone had better and more prolonged sleep than with other opioids. According to the physicians, a mean of 19.2% vs 44.8% of patients had poor sleep quality, and 71.1% vs 55.4% slept more than 5 hours/night with hydromorphone or other opioids, respectively. Physicians considered that hydromorphone improved the patients’ quality of life mainly due to the daily dosage (85.4%) and its good safety profile (77.5%). The main aspects considered when administering hydromorphone as a treatment for pain management were polypharmacy (59.6%), adverse events (48.3%), and comorbidities (38.2%), being recommended for the elderly, immunosuppressed patients or those with impaired renal or hepatic function. Physicians considered that constipation (65.2%), somnolence (48.3%) and nausea (44.9%) were the main adverse events of hydromorphone. Nevertheless, hydromorphone was considered to be the opioid with less interactions (83.1%). Conclusions: Physicians consider that, based on the results of their last patients, extended-release hydromorphone is an adequate alternative for treating severe chronic pain due to the beneficial effects on sleep quality and safety profile, leading to the satisfaction of both the patient and the specialist.
Use of unsaponifiable extract therapy from avocado and soybean oils for the treatment of pain in patients with osteoarthritis in Colombia. A descriptive observational study in primary care.
Introduction Osteoarthritis (OA) is a chronic condition that causes pain and disability, limiting the daily activities of millions of adults worldwide. It is estimated that the global prevalence of OA is 3.8%, this being higher in women older than 60 years. It has been shown that the use of alternative therapies such as the extract of unsaponifiables from avocado and soybean oils can reduce joint pain and stiffness and may result in considering a reduction in the dose of conventional pharmacological treatment. Objective To establish the clinical effect and safety of therapy with unsaponifiable extracts from avocado and soybean oils in patients attended by a group of primary care general practitioners in Colombia. Materials and methods A real-life prospective cohort study was carried out, in a 6-month follow-up period, including patients over 18 years of age who attended the primary care consultation in 12 Colombian cities, who had a diagnosis OA clinicians, who had a prescription for pharmacological therapy for the treatment of pain and who were candidates for receiving Persea gratissima Mill insaponifiables 100 mg.; Glycine max (L) Merr. unsaponifiables 200 mg. Baseline variables and clinical variables such as the anatomical location of the OA, analog scale of pain, edema, and stiffness were collected. Patients who attended three check-ups over six months were considered fully adherent patients, and patients with low adherence were those who only attended one check-up during follow-up. Results 117 patients entered the study, 74% were women, mostly 65 years of age or older. The average of the visual analog scale of pain was 6.6 ± 1.69 at the beginning, while at 6 months of follow-up the average was 2.6 ± 1.32. Other symptoms such as edema and stiffness also decreased, especially in patients who had full adherence. Conclusions As other studies have shown, therapy with unsaponifiable extracts from avocado and soybean oils shows a considerable decrease and improvement in joint pain and other associated symptoms.
18 months after the launch of the manuscript submission platform in the Journal of the Spanish Society of Pain; An analysis of their successes and challenges.
Comité Editorial Revista de la Sociedad Española del Dolor
Editorial by the President of the Spanish Pain Society
21 Congreso de la Sociedad Española del Dolor Málaga 2025
Healthcare practitioner and other professionals' perspectives on gabapentinoid misuse and dependence: a systematic review of qualitative studies
Background and objective: The global rise in gabapentinoid prescriptions for chronic pain has been striking. However, this trend has been accompanied by growing concerns about misuse and dependence. This qualitative systematic review aimed to synthesise the perspectives of healthcare practitioners and other professionals on these emerging challenges. Databases and Data Treatment: Six databases (MEDLINE, Scopus, Web of Science, CINAHL, EMBASE, PsycINFO) were searched to May 2025. Eligible studies used qualitative or mixed methods to explore professional views on gabapentinoid misuse or dependence. Studies focusing solely on patient perspectives or therapeutic use were excluded. Methodological quality was assessed using the Critical Appraisal Skills Programme checklist. Data were analysed using thematic synthesis, and confidence in the findings was evaluated using GRADE-CERQual. Results: After screening 1584 records, 19 original studies were included. Most were conducted in substance use treatment and law enforcement settings, where professionals frequently encounter vulnerable populations and more severe patterns of misuse than in general clinical care. Reported drivers of misuse included polydrug use, opioid substitution, psychological distress and poor access to non-pharmacological care. Signs of misuse included early refills, dose escalation and reluctance to taper. Professionals described ethical tensions in prescribing and dispensing and proposed harm reduction strategies, including prescriber education, regulatory reform, expanded treatment access and public awareness. Conclusions: Gabapentinoid misuse is shaped by clinical, social and structural factors. Tackling these challenges requires systemic responses that go beyond individual prescribers. Lessons from opioid policy responses should inform balanced, compassionate and evidence-informed strategies to reduce harm and improve care. Significance Statement: This is the first systematic review to synthesise professional perspectives on gabapentinoid misuse and dependence, drawing on studies from Europe, North America, the Middle East and Africa. Integrating insights from healthcare, law enforcement and policy settings, it reveals the structural drivers behind rising misuse—including opioid regulation, socioeconomic hardship and limited access to alternatives—and highlights gaps in clinical guidance. The findings offer actionable, cross-sector strategies to support safer prescribing, informed policy and more effective harm reduction.
Ilioingional-iliohypastric block for inguinal hernioplasty in fragile patients
Introduction: Inguinal hernia repair is one of the most performed surgical procedures each year and the incidence is reported to be up to 60 % of moderate to severe postoperative pain, which is why, one would expect to perform this type of surgery with minimal anesthetic risks, rapid recovery and prompt medical discharge, ilioinguinal-iliohypogastric block is a safe anesthetic option for fragile patients with multiple cardiopulmonary comorbidities and anatomical alterations that difficulty neuraxial anesthetic techniques. Case presentation: We present the clinical case of an 88-year-old adult patient ASA III, for elective inguinal hernioplasty, under regional anesthesia: Ilioinguinal-Iliohypogastric block under ultrasound guidance plus sedation, complementary analgesic management with paracetamol and anti-inflammatory drugs, discharge from outpatient surgery to his home and postoperative control without complications. Discussion: Inguinal herniorrhaphy is undoubtedly one of the most frequent surgical procedures in any hospital, increasingly required in fragile adult patients, so it is very important to choose an individualized anesthetic technique that allows early recovery and good postoperative pain control, regional anesthesia: Ilioinguinal-iliohypogastric block offers such advantages, in addition to being part of the strategy to provide multimodal analgesia with other adjuvants as we have demonstrated in this case report and as described in the current literature, compared to general or neuraxial anesthesia. Conclusion: Inguinal hernioplasty with regional anesthesia using ilioinguinal-iliohypogastric block is a safe and effective technique, which makes it ideal for patients in the geriatric age group considered fragile due to their multiple pathologies and polymedication and should be increasingly considered for this type of patient, especially with the objective of avoiding perioperative complications and better pain control postoperative.
Caudal epidural haemorrhagic patch: a safe alternative for spontaneous intracranial hypotension syndrome
Introduction: In the differential diagnosis of headache, spontaneous intracranial hypotension should be considered. Initial treatment is conservative; however, it is often ineffective. An epidural blood patch is recommended if symptoms persist for more than two weeks, or earlier in cases of severe clinical presentation. Case presentation: A 24-year-old patient was admitted to the Neurology Department with bilateral pressing headache associated with neck stiffness and nausea, with a 25-day history. The patient had previously been evaluated twice in the Emergency Department without improvement despite prescribed treatment. No cerebrospinal fluid leak was identified on imaging studies. A diagnosis of spontaneous intracranial hypotension was established. Due to persistent symptoms, a caudal epidural blood patch was performed 13 days after admission, resulting in complete and immediate resolution of symptoms. The patient was discharged three days after the blood patch, asymptomatic. Discussion: In spontaneous intracranial hypotension, treatment is not standardized. Traditionally, a non-targeted epidural blood patch has been performed via the lumbar approach; however, the caudal approach is a valid and safe option, as it avoids the risk of accidental dural puncture and the consequent potential clinical worsening. Conclusion: The caudal approach may be a safer alternative to the interlaminar approach for performing an epidural blood patch; however, further studies are needed.
Phantom limb pain. Understanding and therapeutic approach beyond mirror therapy
The phantom limb pain is defined as a kind of neuropathic pain, however, it has its own characteristics due to the cortical changes that occur after an amputation and the phantom limb sensation that involves. The present review of the literature offers a synthesis of the pathophysiological theories, its presentation and clinical evaluation. Finally, explore the different treatment strategies both non -pharmacological and pharmacological, offering information on the usefulness of techniques and their relationship with the disease, as well as the results of the studies, mainly of the clinical trials and the systematic reviews and meta -analysis, to expose the best therapeutic options.