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.
Licencia. Los artículos publicados en RESED (Revista de la Sociedad Española del Dolor) se distribuyen bajo una licencia Creative Commons Reconocimiento-NoComercial-SinObraDerivada 4.0 Internacional (CC BY-NC-ND 4.0). Esta licencia permite copiar y redistribuir el material en cualquier medio o formato, siempre que se cite adecuadamente la autoría y la fuente original. No se permite el uso comercial de la obra ni la distribución de obras derivadas. Derechos de autoría. Los derechos de explotación de los trabajos publicados corresponden a la Sociedad Española del Dolor. Las personas autoras conservan sus derechos morales sobre la obra y el derecho a difundirla conforme a los términos de la licencia. Autoarchivo. Se permite a las personas autoras depositar la versión publicada de su artículo en repositorios institucionales o temáticos y en su página web personal, citando la publicación original en RESED Acceso abierto. RESED es una revista de acceso abierto: todos sus contenidos son de libre acceso, sin coste para las personas lectoras ni para las autoras.
Replanteando el uso rutinario de infiltraciones con corticoides en la artrosis de rodilla: la prudencia no debe convertirse en inercia
Copyright (c) 2026 Patricia Alfaro de la Torre (Autor/a)
Impacto del dolor lumbar en la funcionalidad, la actividad diaria y la asistencia sanitaria en escolares de 10 a 15 años
Introducción: El dolor lumbar es la novena causa de pérdida de salud a nivel mundial en hombres y mujeres de todas las edades. El dolor lumbar es común en adolescentes y estudios previos sugieren que puede tener un impacto negativo en sus actividades diarias representando un trastorno de salud que podría continúa hasta la edad adulta. El objetivo de este estudio fue analizar las características y el impacto del dolor lumbar en adolescentes. Material y métodos: Estudio transversal a través de un cuestionario en el que participaron escolares de los centros educativos urbanos del Área de Salud de Talavera de la Reina. Las variables incluidas fueron edad, sexo, tiempo de ejercicio, tiempo de sueño, frecuencia e intensidad del dolor lumbar, necesidad de asistencia médica o tratamiento de fisioterapia, faltar al colegio, reducir la actividad física y dificultad para realizar ciertas actividades debido al dolor lumbar. El análisis estadístico se llevó a cabo a través de un análisis descriptivo de las variables. Para la relación entre variables se utilizó la prueba de Chi cuadrado. Se realizó una regresión logística binaria ajustada por las posibles variables de confusión y representada por la Odds Ratio. Resultados: 476 escolares (37%) reportaron dolor lumbar; 234 (49%) eran chicos y 242 (51%) chicas. En el análisis de la relación entre la intensidad del dolor y las variables estudiadas, los chicos mostraron diferencias significativas en el tiempo adecuado de sueño (P = 0,003), así como en la dificultad para llevar la mochila (P = 0,045) y para permanecer de pie durante 10 minutos (P = 0,038). En las chicas, la edad se asoció de manera significativa con la intensidad del dolor (P = 0,032), y se observaron mayores dificultades para permanecer sentadas 45 minutos en la silla del colegio (P = 0,001) y para alcanzar objetos situados en lugares altos (P = 0,036). Aunque estas asociaciones son coherentes con patrones funcionales descritos previamente en población con dolor, las odds ratio obtenidas superiores a 1 en todas las modelizaciones, evidencian cómo la intensidad del dolor se relaciona con la necesidad de asistencia sanitaria, la actividad física, la actividad escolar y ciertas limitaciones en actividades de la vida diaria en esta muestra adolescente. Conclusiones: Existen diferencias entre chicos y chicas en relación con el dolor lumbar y factores como el sueño, la edad, la frecuencia del dolor, la necesidad de asistencia médica, la actividad física y la funcionalidad en tareas cotidianas y escolares. La intensidad del dolor lumbar se asoció de manera significativa con la necesidad de atención sanitaria y medicación, así como con la reducción de la actividad física y la dificultad para realizar actividades básicas, lo que evidencia su repercusión en la calidad de vida de los jóvenes. Futuros estudios deberían incorporar intervenciones tempranas con seguimiento a largo plazo de sus resultados. Estos estudios deberían permitir analizar si intervenciones sobre la educación postural, hábitos de sueño o la promoción de actividad física tienen un efecto sobre el dolor lumbar y su relación con la funcionalidad diaria y la necesidad de asistencia sanitaria entre adolescentes.
Copyright (c) 2026 Javier Muñoz-Serrano, Sandra García-Durán, Gerardo Ávila-Martín, Pilar Jiménez Tamurejo, Ana Belén Molina-Herrador, Cristina Fernández Pérez, Ana Cecilar Marín-Guerrero (Autor/a)
Factores de riesgo de desarrollo de dolor pélvico crónico en pacientes con endometriosis. Revisión bibliográfica.
La endometriosis es una enfermedad ginecológica crónica y benigna que consiste en el crecimiento de tejido similar al endometrio fuera de la cavidad uterina. Este tejido ectópico actúa como el endometrio eutópico: se engrosa, se degrada y sangra durante el ciclo menstrual. A pesar de ser benigna, la endometriosis infiltra los tejidos y causa una reacción inflamatoria en las zonas donde se implanta. Ambas son responsables de los síntomas clínicos, incluyendo dismenorrea, dolor pélvico crónico, dispareunia, disquecia, disuria y esterilidad. La endometriosis es una enfermedad multifactorial sin una causa conocida. Varios mecanismos pueden contribuir al dolor, incluyendo la compresión o infiltración directa de los nervios, la inflamación y el daño o disfunción de los mismos. El tratamiento del dolor asociado a la endometriosis puede ser médico o quirúrgico. Es esencial una comprensión holística de los factores de riesgo para el desarrollo del dolor pélvico crónico en pacientes con endometriosis. Esta comprensión, junto con un enfoque multidisciplinar, es clave para un diagnóstico y tratamiento adecuados, con el objetivo final de mejorar la calidad de vida de las pacientes.
Copyright (c) 2026 Andrea Carballude García (Autor/a)
Chemical neurolysis with alcohol in the Gasserian ganglion in difficult-to-control cancer facial pain: Case series
Introduction: Head and neck neoplasms cause severe pain and decreases quality of life in patients affected management of pain requires multimodal strategy with interventional procedures to control pain and lower opioids dosages. Case presentation: We identified ten patients attended at the National Institute of Cancerology in Bogotá, Colombia with diagnosis of head and neck neoplasia with relapse and progression who presented facial severe pain who have undergone a neurolytic block with alcohol to the Gasserian ganglion and observed a lower consumption of opioids and less score in the analog numerical scale of pain. Conclusion: This study shows the impact of interventional procedures to ameliorate pain in complex patients with severe facial pain. Describing this experience provides us with progress and a field of study and research that is beneficial for patients and the academic community.
Copyright (c) 2026 Bilena M. Molina Arteta, Edna M. de la Hoz, Angélica M. Cetina, Marcela Hernández Osorio (Autor/a)
Nociplastic pain: facts, controversies and future tasks
Background: Nociplastic pain, a third mechanistic pain descriptor in addition to nociceptive and neuropathic pain is defined as ‘pain that arises from altered nociception’ not fully explained by nociceptive or neuropathic pain mechanisms. Methods: We summarise and extend some discussions of a main session on nociplastic pain at the conference of the European Pain Federation EFIC in Lyon at the 26th April, 2025. Results: We recommend not to mix up concepts and terms: Nociplastic pain is not synonymous with chronic primary pain nor with central sensitization. Nociplastic pain is not a new term for pain of unknown origin. We identified these controversies: ‘Nociplastic’ might not be the best term. Other specialties (e.g., internal medicine) use different terms and concepts for clinical conditions termed as ‘nociplastic pain conditions’ by pain medicine. Fibromyalgia syndrome is not always the prototype of a pure nociplastic pain condition. ‘Nociplasticity’ can be a continuous (and not a separate) component of pain; hence the requirement to ‘exclude’ nociceptive and neuropathic pain to diagnose nociplastic pain has been questioned. Conclusions: Future tasks include additional field testing and eventual modification of the criteria for nociplastic pain; development of pharmacological and psychological treatment guidelines, based on the three pain types; unravelling pathophysiological mechanisms driving altered nociception in pain conditions with substantial nociplastic components; development of umbrella concepts unifying the different views of somatic medicine, psychosocial medicine and pain medicine. Significance Statement: The concept of nociplastic pain has gained growing importance in pain medicine and has been introduced into other specialties such as gynaecology and rheumatology. Clinicians should always strive to identify the major pain mechanisms to guide treatment.
Recommendations for reporting manuscripts on immersive interventions for pain. A practical proposal based on RATE-XR and INVIRTUE
Copyright (c) 2026 José Ferrer Costa, Rafael Gálvez Mateos (Autor/a)
Peripheral nerve stimulation in chronic neuropathic pain: a review of the clinical evidence
Chronic neuropathic pain affects approximately 6-10 % of the general population and is associated with significant functional, psychological, and socioeconomic burden. Despite advances in pharmacological management, a substantial proportion of patients fail to achieve adequate pain control with first-line therapies. In this context, peripheral nerve stimulation (PNS) has emerged as a minimally invasive, targeted neuromodulation technique that allows anatomically directed treatment of the affected neuropathic territory. This review summarizes the available clinical evidence on PNS, including randomized controlled trials, prospective multicenter studies, and systematic reviews published between 2005 and 2024. Current data demonstrate clinically meaningful pain reductions (≥ 50 %) in a significant proportion of patients with refractory localizado neuropathic pain, along with sustained functional improvement and reduced opioid consumption. The safety profile is favorable, with a low incidence of serious adverse events. Overall, PNS represents an effective and safe therapeutic option whose early and rational integration into stepwise chronic neuropathic pain management algorithms is supported by growing evidence and recent international consensus recommendations.
Copyright (c) 2026 Daniel Pérez Ajami, Andrés Alegre Cortés, Sonia Arnal García, Esteban Estupiñán Valido, José Javier Martínez Antequera, M.ª del Carmen Buil Peralta (Autor/a)
Motor imagery and its application in patients with musculoskeletal pain: a review of effects and underlying mechanisms
The primary aim of this review was to explore the current state of the art of motor imagery (MI) and its application in the context of musculoskeletal pain. By examining studies in this field, we aimed to investigate both the effects and the potential underlying mechanisms of MI-based interventions. In addition to discussing its effectiveness, the review seeks to understand how MI may influence nociceptive processing and pain, with the goal of providing valuable insights into its therapeutic potential and guiding the development of targeted clinical interventions.
Copyright (c) 2026 Ferran Cuenca Martínez, Enrique Velasco Serna (Autor/a)
Experiencia con hidromorfona para el tratamiento del dolor crónico intenso: el estudio SS-PAIN
Objetivo: La hidromorfona es un potente opioide administrado como comprimidos diarios de liberación prolongada con buen perfil de tolerancia y seguridad. El estudio SS-PAIN tiene como objetivo evaluar las impresiones de los médicos sobre el efecto de la hidromorfona en la calidad del sueño y su perfil de seguridad en pacientes con dolor crónico intenso en España. Material y métodos: Este es un estudio ecológico de datos agregados recopilados de médicos que tienen experiencia en el manejo de pacientes con dolor crónico intenso. Los datos se recopilaron mediante un cuestionario de 35 preguntas sobre los últimos 5 pacientes que acudieron a la consulta para tratar el dolor crónico intenso. Las preguntas se centraron en los efectos de la hidromorfona de liberación prolongada y otros opioides sobre el sueño y su perfil de seguridad. Resultados: Un total de 89 médicos respondieron al cuestionario. El tiempo medio de evolución del dolor de sus pacientes fue de 10,7 meses. Los pacientes tratados con hidromorfona tuvieron un sueño mejor y más prolongado que con otros opioides. Según los médicos, una media del 19,2 % frente al 44,8 % de los pacientes tenía mala calidad del sueño, y el 71,1 % frente al 55,4 % dormía más de 5 h/noche con hidromorfona u otros opioides, respectivamente. Los médicos consideraron que la hidromorfona mejoró la calidad de vida de los pacientes principalmente debido a la dosis diaria (85,4 %) y su buen perfil de seguridad (77,5 %). Los principales aspectos considerados al administrar hidromorfona como tratamiento para el manejo del dolor fueron polimedicación (59,6 %), eventos adversos (48,3 %) y comorbilidades (38,2 %), siendo recomendada para ancianos, pacientes inmunodeprimidos o con insuficiencia renal o hepática. Los médicos consideraron que el estreñimiento (65,2 %), somnolencia (48,3 %) y náuseas (44,9 %) fueron los principales acontecimientos adversos de la hidromorfona. Sin embargo, la hidromorfona fue considerada como el opioide con menos interacciones (83,1 %). Conclusiones: Los médicos consideran que, en base a los resultados de sus últimos pacientes, la hidromorfona de liberación prolongada es una alternativa adecuada para tratar el dolor crónico intenso debido a los efectos beneficiosos sobre la calidad del sueño y el perfil de seguridad, lo que lleva a la satisfacción tanto del paciente como del especialista.
Copyright (c) 2026 Jonatan Pérez Toro, Antonio Serrano García, Martín del Avellanal Calzadilla (Autor/a) https://creativecommons.org/licenses/by-nc-nd/4.0
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.
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.
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.
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.
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.
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.
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, 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.
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.
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.
Epidural blood patch in patient with idiopatic intracraneal hypotension
Caffeine in the treatment of fibromyalgia, therapeutic proposal.
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.
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.
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.