Combinar fàrmacs antiemètics amb analgèsics no sempre és favorable

Un equip de recerca de l'Hospital del Mar recomana no coadministrar alguns fàrmacs antiemètics, l'ondasetron i droperidol, que preveuen les nàusees i els vòmits postoperatoris, amb tramadol, donat que interfereixen en l'efectivitat analgèsica d'aquest últim. Per evitar aquesta interacció farmacològica negativa es recomana l'administració d'un altre antiemètic, la dexametasona, que sí ha donat bons resultats en pacients en període postoperatori, a més de potenciar el tractament analgèsic del dolor. Aquest estudi ha sorgit com a resposta a un recent editorial de la Societat Americana d'Anestèsia Ambulatòria (SAMBA), que proposa realitzar profilaxi antiemètica a tots els pacients sotmesos a anestèsia general, argumentant que són fàrmacs inofensius i que el seu preu és actualment raonable

Estimulación de la médula espinal en dolor neuropático refractario en adultos: evaluación de la eficacia, efectividad, seguridad y eficiencia en la neuropatía diabética dolorosa y los síndromes de la cirugía fallida de columna y de dolor regional complejo

Medul·la espinal; Dolor neuropàtic; Estimulació elèctricaMédula espinal; Dolor neuropático; Estimulación eléctricaSpinal cord; Neuropathic pain; Electrical stimulationAquest informe té com a objectiu avaluar la seguretat, l’eficàcia/efectivitat i el cost-efectivitat de la SCS en adults per al tractament del dolor neuropàtic refractari associat a la neuropatia diabètica dolorosa (NDD) i a les síndromes de fallida de la cirurgia d’esquena (FBSS per les seves sigles en anglès, failed back surgery syndrome) i de dolor regional complex (CRPS per les seves sigles en anglès, complex regional pain syndrome) com a tècnica coadjuvant i en comparació amb els tractaments convencionals.Este informe tiene el objectivo de evaluar la seguridad, la eficacia/efectividad y el coste-efectividad de la SCS en adultos para el tratamiento del dolor neuropático refractario asociado a la neuropatía diabética dolorosa (NDD) y a los síndromes de la cirugía fallida de columna (FBSS por sus siglas en inglés, failed back surgery syndrome) y de dolor regional complejo (CRPS por sus siglas en inglés, complex regional pain syndrome) como técnica coadyuvante y en comparación con los tratamientos convencionales.The aim of this HTA report is to evaluate the safety, efficacy/effectiveness and cost-effectiveness of SCS in adults to treat refractory neuropathic pain associated with painful diabetic neuropathy (PDN, NDD in Spanish), failed back surgery syndrome (FBSS), and complex regional pain syndrome (CRPS) as an adjuvant technique and in comparison with conventional treatments

Terapia de neuromodulación periférica PENS (Peripheral electrical nerve stimulation) como tratamiento del dolor crónico refractario de origen neuropático en adultos: evaluación de la seguridad, la eficacia, la efectividad clínica y el coste-efectividad

Teràpia de neuromodulació perifèrica; Dolor crònic; NeuropatiaTerapia de neuromodulación periférica; Dolor crónico; NeuropatíaPeripheral neuromodulation therapy; Chronic pain; NeuropathyL’objectiu d’aquest informe és avaluar la seguretat, l’eficàcia, l’efectivitat clínica i el cost-efectivitat de la PENS com a teràpia coadjuvant per a tractar el DN perifèric crònic refractari en adults, en comparació amb el tractament habitual farmacològic o altres tècniques de neuroestimulació. També s’estableix com a objectiu definir els criteris de selecció de pacients que podrien beneficiar-se de la tècnica i indicacions de tractament.El objetivo del presente informe es el de evaluar la seguridad, la eficacia, la efectividad clínica y el coste-efectividad de la PENS como terapia coadyuvante para tratar el DN periférico crónico refractario en adultos, en comparación con el tratamiento habitual farmacológico u otras técnicas de neuroestimulación. También se establece como objetivo definir los criterios de selección de pacientes que podrían beneficiarse de la técnica e indicaciones de tratamiento.The aim of this report is to evaluate the safety, efficacy, clinical effectiveness and cost-effectiveness of PENS as an adjunctive therapy for the treatment of chronic refractory peripheral NP in adults, compared with standard pharmacological treatment or other neurostimulation techniques. It also aims to define the selection criteria for patients who may benefit from the technique and the indications for treatment

Towards an International Consensus on the Prevention, Treatment, and Management of High-Risk Substance Use and Overdose among Youth

Background and Objectives: Now more than ever, there is an obvious need to reduce the overall burden of disease and risk of premature mortality that are associated with mental health and substance use disorders among young people. However, the current state of research and evidence-based clinical care for high-risk substance use among youth is fragmented and scarce. The objective of the study is to establish consensus for the prevention, treatment, and management of high-risk substance use and overdose among youth (10 to 24 years old). Materials and Methods: A modified Delphi technique was used based on the combination of scientific evidence and clinical experience of a group of 31 experts representing 10 countries. A semi-structured questionnaire with five domains (clinical risks, target populations, intervention goals, intervention strategies, and settings/expertise) was shared with the panelists. Based on their responses, statements were developed, which were subsequently revised and finalized through three iterations of feedback. Results: Among the five major domains, 60 statements reached consensus. Importantly, experts agreed that screening in primary care and other clinical settings is recommended for all youth, and that the objectives of treating youth with high-risk substance use are to reduce harm and mortality while promoting resilience and healthy development. For all substance use disorders, evidence-based interventions should be available and should be used according to the needs and preferences of the patient. Involuntary admission was the only topic that did not reach consensus, mainly due to its ethical implications and resulting lack of comparable evidence. Conclusions: High-risk substance use and overdoses among youth have become a major challenge. The system’s response has been insufficient and needs substantial change. Internationally devised consensus statements provide a first step in system improvement and reform

Unitats del dolor al SISCAT: cartera de serveis i nivells de complexitat

Unitats del dolor; Hospitals; Cartera de serveis; SISCATUnidades del dolor; Hospitales; Cartera de servicios; SISCATPain units; Hospitals; Portfolio of services; SISCATLes unitats del dolor són unitats de tipus funcional pròpies de l’àmbit hospitalari, on diferents professionals d’un mateix centre sanitari treballen conjuntament per a l’abordatge del pacient amb dolor. Aquestes presten l’atenció en l’àmbit hospitalari i, dins d’aquest, majoritàriament, en l’entorn de les consultes externes hospitalàries o de l’hospital de dia o àrees de tècniques especials. A més, els procediments més complexos s’han de realitzar en entorns de tipus quiròfan. Així, es fa palesa la necessitat de disposar d’una major concreció en la cartera de serveis de les unitats del dolor i recomanacions per al maneig del dolor a Catalunya, garantint en tot moment la qualitat i seguretat d’aquesta prestació, amb l’objectiu de millorar la qualitat de vida de les persones que pateixen dolor i garantir l’equitat d’accés per a la població, tot ordenant els fluxos quan sigui necessari. Per assolir aquests objectius, cal establir una codificació correcta de les diferents tècniques i/o procediment

Assessment of diagnostic criteria for the identification of central sensitization in patients with osteoarthritis pain: Results from a Delphi survey.

To assess diagnostic criteria and currently used tools for the identification of central sensitization (CS) in patients with joint pain due to osteoarthritis (OA).Qualitative, cross-sectional and multicenter study based on a 2-round Delphi surveyPublic and private medical centers attending patients with joint pain.A total of 113 specialists in traumatology, physical medicine and rehabilitation, pain management, rheumatology, primary care physicians and geriatrics were enrolled in the study.Participants completed an ad-hoc 26-item questionnaire available from a microsite in Internet.The questionnaire was divided into 6 sections with general data on CS, impact of CS in patients with knee osteoarthritis (KOA), diagnostic criteria for CS, non-pharmacological and pharmacological treatment of CS and usefulness of the concept of CS in the integral management of patients with KOA. Consensus was defined as 75% agreement.Diagnostic criteria included pain of disproportionate intensity to the radiological joint lesion (agreement 86.7%), poor response to usual analgesics (85.8%), progression of pain outside the site of the lesion (76.1%) and concurrent anxiety and depression (76.1%). Based on the opinion of the specialists, about 61% of patients with KOA present moderate-to-severe pain, 50% of them show poor response to conventional analgesics, and 40% poor clinical-radiological correlation. Patients with KOA and CS showed higher functional disability and impairment of quality of life than those without CS (88.5%) and have a poor prognosis of medical, rehabilitation and surgical treatment (86.7%). Early diagnosis and treatment of CS may preserve function and quality of life during all steps of the disease (90.3%).The management of patients with osteoarthritis pain and CS requires the consideration of the intensity of pain related to the joint lesion, response to analgesics, progression of pain to other areas and concurrent anxiety and depression to establish an adequate therapeutic approach based on diagnostic criteria of CS

Combinar fàrmacs antiemètics amb analgèsics no sempre és favorable

Un equip de recerca de l'Hospital del Mar recomana no coadministrar alguns fàrmacs antiemètics, l'ondasetron i droperidol, que preveuen les nàusees i els vòmits postoperatoris, amb tramadol, donat que interfereixen en l'efectivitat analgèsica d'aquest últim. Per evitar aquesta interacció farmacològica negativa es recomana l'administració d'un altre antiemètic, la dexametasona, que sí ha donat bons resultats en pacients en període postoperatori, a més de potenciar el tractament analgèsic del dolor. Aquest estudi ha sorgit com a resposta a un recent editorial de la Societat Americana d'Anestèsia Ambulatòria (SAMBA), que proposa realitzar profilaxi antiemètica a tots els pacients sotmesos a anestèsia general, argumentant que són fàrmacs inofensius i que el seu preu és actualment raonable

Effect of door-locking policy on inpatient treatment of substance use and dual disorders

OBJECTIVE: Substance use treatment is often performed inside locked wards. We investigate the effects of adopting a policy of open-door treatment for a substance use treatment and dual diagnosis ward. METHODS: This is a prospective open-label study investigating 3-month study periods before opening (P1), immediately after (P2), and 1 year after the first period (P3). Data on committed patients, coercion (seclusion, forced medication, absconding events with subsequent police search), violence, and substance use was collected daily. We applied generalised estimating equation models. RESULTS: The mean daily number of patients with ongoing commitment changed from 2.64 (P1) to 2.12 (P2) to 0.96 (P3), corresponding to a reduction of relative risk (RR) for having an ongoing commitment by 20% in P2 (RR 0.80; 95% CI 0.66-0.98) and 67% in P3 (RR 0.33; 95% CI 0.25-0.42). The mean daily number of coercive events was 0.29, 0.13, and 0.05, corresponding to a risk for undergoing coercive measures reduced by 56% (RR 0.44; 95% CI 0.22-0.90) and 85% (RR 0.15; 95% CI 0.05-0.45). Substance use, violence or ward atmosphere did not differ significantly. CONCLUSIONS: Our results support findings from general psychiatric wards of reduced coercion after adopting a primarily open-door policy. However, coercive events were rare during all periods. The widespread practice of restricting the freedom of inpatients with substance use disorders by locking ward doors is highly questionable

Towards an International Consensus on the Prevention, Treatment, and Management of High-Risk Substance Use and Overdose among Youth

Background and Objectives: Now more than ever, there is an obvious need to reduce the overall burden of disease and risk of premature mortality that are associated with mental health and substance use disorders among young people. However, the current state of research and evidence-based clinical care for high-risk substance use among youth is fragmented and scarce. The objective of the study is to establish consensus for the prevention, treatment, and management of high-risk substance use and overdose among youth (10 to 24 years old). Materials and Methods: A modified Delphi technique was used based on the combination of scientific evidence and clinical experience of a group of 31 experts representing 10 countries. A semi-structured questionnaire with five domains (clinical risks, target populations, intervention goals, intervention strategies, and settings/expertise) was shared with the panelists. Based on their responses, statements were developed, which were subsequently revised and finalized through three iterations of feedback. Results: Among the five major domains, 60 statements reached consensus. Importantly, experts agreed that screening in primary care and other clinical settings is recommended for all youth, and that the objectives of treating youth with high-risk substance use are to reduce harm and mortality while promoting resilience and healthy development. For all substance use disorders, evidence-based interventions should be available and should be used according to the needs and preferences of the patient. Involuntary admission was the only topic that did not reach consensus, mainly due to its ethical implications and resulting lack of comparable evidence. Conclusions: High-risk substance use and overdoses among youth have become a major challenge. The system’s response has been insufficient and needs substantial change. Internationally devised consensus statements provide a first step in system improvement and reform.Medicine, Faculty ofNon UBCEmergency Medicine, Department ofPediatrics, Department ofPsychiatry, Department ofReviewedFacultyResearcherOthe

Status quo of pain-related patient reported outcomes and perioperative pain management in 10 415 patients from 10 countries: analysis of registry data

Postoperative pain is common at the global level, despite considerable attempts for improvement, reflecting the complexity of offering effective pain relief. In this study, clinicians from Mexico, China, and eight European countries evaluated perioperative pain practices and patient-reported outcomes (PROs) in their hospitals as a basis for carrying out quality improvement (QI) projects in each country