Analgesia: Aportación de la Unidad del dolor José Luis De la Calle Reviriego Unidad para el Estudio y Tratamiento del Dolor Hospital Universitario

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1 Analgesia: Aportación de la Unidad del dolor José Luis De la Calle Reviriego Unidad para el Estudio y Tratamiento del Dolor Hospital Universitario Ramón y Cajal. Madrid

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5 PAIN Ò 154 (2013) Neuropathic pain in the community: More under-treated than refractory? Nicola Torrance a,, Janice A. Ferguson a, Ebenezer Afolabi b, Michael I. Bennett c, Michael G. Serpell d, Kate M. Dunn e, Blair H. Smith a a Medical Research Institute, University of Dundee, Dundee, UK b Division of Applied Health Sciences, University of Aberdeen, Aberdeen, UK c Academic Unit of Palliative Care, University of Leeds, Leeds, UK d School of Medicine, University of Glasgow, Glasgow, UK e Institute of Primary Care & Health Sciences, University of Keele, Keele, UK

6 Hindawi Publishing Corporation Pain Research and Treatment Volume 2014, Article ID , 15 pages Research Article Clinical Characteristics, Patient-Reported Outcomes, and Previous Therapeutic Management of Patients with Uncontrolled Neuropathic Pain Referred to Pain Clinics José de Andrés, 1 José-Luis de la Calle, 2 María Pérez, 3 and Vanessa López 3 1 Anesthesia, Critical Care, and Multidisciplinary Pain Management Department, Valencia University General Hospital, Valencia University Medical School, Valencia, Spain 2 Pain Unit, Hospital Ramón y Cajal, Madrid, Spain 3 Medical Unit, Pfizer España, Avenida de Europa, 20 BParqueEmpresarialLaMoraleja,28108 Alcobendas, Madrid, Spain Correspondence should be addressed to María Pérez; maria.perez2@pfizer.com

7 Malignant/radiation/ chemotherapy-induced pains n = 62 8,8% n = ,4% Specialty n = ,7% n = 54 7,8% n = 99 14,3% n = 21 3,0% n = 17 n = 48 2,5% 6,9% n = 56 8,1% n = 32 4,5% n = 36 5,1% n = 58 8,2% n = ,3% n = 36 5,2% n = 24 3,5% n = 39 5,6% n = ,1% Primary care Rehabilitation Traumatology Rheumatology n = 56 7,9% Neurology Neurosurgery Other surgeries Other specialties Neuropathy Radiculopathy Plexopathy Postsurgery/trauma Central neuropathic pain Other neruopathic pain Neuralgia Nerve entrapment syndrome Complex regional pain syndrome Malignant/radiation/ chemotherapy-induced pains (a) (b) Figure 1: Specialists referring patients and clinical entities referred to pain clinics.

8 Characteristic Overall N =728 Primary care N =118 Table 2: Pain characteristics. Traumatology N =242 Neurology N =56 Neurosurgery N =58 Rehabilitation N =36 Rheumatology N =32 Other surgeries N =62 Other specialties N =102 DN4 (0 10), mean ± SD 6.6 ± ± ± ± ± ± ± ± ± 1.6 VAS, mean ± SD 74.5 ± ± ± ± ± ± ± ± ± 17.3 Duration of pain (yrs), mean ± SD 2.6 ± ± ± ± ± ± ± ± ± 2.3 Causes for uncontrolled pain, % Misdiagnosis Nonoptimized treatment Use of ineffective drugs Subtherapeutic dose Other Lack of compliance Intolerance Other Causes of neuropathic pain, % Neuropathy Diabetic Other Neuralgia Trigeminal Other Radiculopathy Nerve entrapment syndrome Plexopathy Complex regional pain syndrome Postsurgery/trauma Malignant/radiation/chemotherapy-induced pain Central neuropathic pain Other neuropathic pains DN4: neuropathic pain diagnostic questionnaire; SD: standard deviation; VAS: visual analog scale; Yrs: years.

9 Characteristic Diabetic neuropathy N =26 Other neuropathies N =22 Trigeminal neuralgia N =32 Other neuralgia N =24 Table 3: Type of pain by clinical entity. Radiculopathy N =298 Nerve entrapment syndrome N =39 Plexopathy N =24 Complex regional pain syndrome N =36 Postsurgery/trauma N =54 Oncological pain N =99 Central neuropathic pain N =21 Spontaneous pain, % Lancinating Burning Paraesthesias Dysaesthesias Evoked pain, % Static allodynia Dynamic allodynia Thermal allodynia Mechanical hyperalgesia Hyperpathia

10 Table 7: Pharmacological treatment, reasons for uncontrolled pain, and treatment satisfaction by clinical entity. Characteristic Nerve entrapment Complex regional Central Diabetic neuropathy Other neuropathies Trigeminal neuralgia Other neuralgia Radiculopathy Plexopathy Postsurgery/trauma Oncological pain syndrome pain syndrome neuropathic pain N =26 N =22 N =32 N =24 N =298 N =24 N =54 N =99 N =39 N =36 N =21 VAS, mean ± SD 77.5 ± ± ± ± ± ± ± ± ± ± ± 13.3 WHO-DAS II Interference with life (severe/extreme), % Number of previous treatments, mean ± SD 2.30 ± ± ± ± ± ± ± ± ± ± ± 1.81 Treatment at the time of inclusion, % Paracetamol NSAIDs Opiods Tramadol Others AED Pragabalin Gabapentin Carbamazepine/ oxcarbazepine Other Antidepressants Duloxetine Tricyclics Other Other drugs Causes for uncontrolled pain, % Misdiagnosis Nonoptimized treatment Use of ineffective drugs Subtherapeutic dose Other Lack of compliance Intolerance Other SATMED-Q Total score, mean ± SD 51.0 ± ± ± ± ± ± ± ± ± ± ± 19.1 Efficacy, mean ± SD 26.0 ± ± ± ± ± ± ± ± ± ± ± 26.1 AED: antiepileptic drugs; NSAIDs: nonsteroidal anti-inflammatory drugs; SATMED-Q: Treatment Satisfaction with Medicines Questionnaire; SD: standard deviation; VAS: visual analog scale; WHO-DAS II: World Health Organization Disability Assessment Schedule II; Yrs: years.

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15 Unidad para el Estudio y Tratamiento del Dolor

16 Trigeminal Ganglion Block and Neurolysis

17 Table 1. Indications for trigeminal ganglion blockade and neurolysis. Tic douloureux Secondary trigeminal neuralgias Palliation of cancer-related pain Refractory cluster headaches Atypical facial pain Surgical anesthesia

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19 Radiofrecuencia en la Neuralgia del Trigémino

20 BLOQUEO NEUROLÍTICO DEL PLEXO CELIACO y ESPLÁCNICO

21 Unidad para el Estudio y Tratamiento del Dolor

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27 PLEXO HIPOGÁSTRICO SUPERIOR

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39 Sistemas Espinales

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42 Unidad para el Estudio y Tratamiento del Dolor

43 Unidad para el Estudio y Tratamiento del Dolor

44 Implante de Catéter Intratecal

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48 SISTEMAS PORT A CATH

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50 Bomba de infusión implantable

51 Unidad para el Estudio y Tratamiento del Dolor Implante de la bomba

52 Muchas gracias!