Year 2020 / Volume 27 / Number 2

Abstract PDF HTML

Original

Ethical problems in the management of pain. Qualitative study through open reflection interview

Rev. Soc. Esp. Dolor. 2020; 27(2): 89-96 / DOI: 10.20986/resed.2020.3729/2019

Jaime Boceta, Ana Peiró, F. Javier Cevas, Loreto Mª Vidal, Marisol Acedo, Víctor Mayoral


ABSTRACT

Introduction: The medical practice in the area of pain associates ethical problems in the care of patients with a disease that causes a functional deterioration, with an uncertain prognosis for their labor reintegration, and a great consumption of family and social resources. After the creation of a working group on bioethics within the Spanish Pain Society (SPS), an attempt is made to analyze these problems.
Objective: To know which are the ethical problems that identify professionals (clinical practice, environment and institutions) which concerns SPS members; encouranging an ethical reflection.
Methodology: Qualitative study, based on a semistructured, open interview, send to members of the SPS (n = 1035), through electronic access, on 4 bioethical aspects: the problems detected in clinical practice, the problems of the work environment, the problems in the work organizations, and possible suggestions. These are grouped as they refer to the indications (beneficence and non-maleficence), justice (understood as equity), autonomy (information and preferences).
Results: A total of 6 % professionals participated in the interview (n = 62/1035). A panel was prepared with the 10 main issues identified. They emphasize the uncertainty in the taking of decisions in the therapeutic, the limitation of the therapeutic effort, the conditioning of the sanitary system, the relations with the pharmaceutical industry and the search of the excellence.
Conclusions: This qualitative study allows identifying ethical problems that interest professionals dedicated to pain. It is convenient to confirm and size them through quantitative studies.



RESUMEN

Introducción: La práctica médica en el área del dolor plantea problemas éticos en la atención a pacientes con una enfermedad que provoca un deterioro funcional, con un pronóstico incierto para su reinserción laboral, y gran consumo de recursos familiares y sociales. Tras la creación de un grupo de trabajo en bioética dentro de la Sociedad Española del Dolor (SED) se intenta analizar dichos problemas.
Objetivo: Conocer los problemas éticos relacionados con el manejo del dolor (práctica clínica, entorno e instituciones) que preocupan a los profesionales miembros de la SED, así como fomentar una reflexión ética.
Metodología: Estudio cualitativo, basado en una entrevista semiestructurada, abierta, enviada a los miembros de la SED (n = 1035), mediante acceso electrónico, sobre 4 aspectos bioéticos: los problemas detectados en la práctica clínica, los problemas del entorno de trabajo, los problemas en las organizaciones de trabajo, y posibles sugerencias. Estos se agrupan según se refieran a las indicaciones (beneficencia y no maleficencia), la justicia (entendida como equidad) o la autonomía (información y preferencias).
Resultados: Participaron en la entrevista un 6 % de los profesionales (n = 62/1035). Se elaboró un panel con las 10 cuestiones principales identificadas. Destacan la incertidumbre en la toma de decisiones en la terapéutica, la limitación del esfuerzo terapéutico, los condicionamientos del sistema sanitario, las relaciones con la industria farmacéutica y la búsqueda de la excelencia.
Conclusiones: Este estudio cualitativo permite identificar problemas éticos que interesan a los profesionales dedicados al dolor. Es conveniente confirmarlos y dimensionarlos mediante estudios cuantitativos.





Complete Article

Nuevo comentario

Security code:
CAPTCHA code image
Speak the codeChange the code
 

Comentarios

No comments in this article

Bibliografía

1. Carmona L, Ballina J, Gabriel R, Laffon A; EPISER Study Group. The burden of musculoskeletal diseases in the general population of Spain: results from a national survey. Ann Rheum Dis. 2001;60(11):1040-5. DOI: 10.1136/ard.60.11.1040.
DOI: 10.1136/ard.60.11.1040
2. Breivik H, Collett B, Ventafridda V, Cohen R, Gallacher D. Survey of chronic pain in Europe: prevalence, impact on daily life, and treatment. Eur J Pain. 2006;10(4):287-333. DOI: 10.1016/j.ejpain.2005.06.009.
DOI: 10.1016/j.ejpain.2005.06.009
3. Katz N. The impact of pain management on quality of life. J Pain Symptom Manage. 2002;24 (1 Suppl):S38-47. DOI: 10.1016/S0885-3924(02)00411-6.
DOI: 10.1016/S0885-3924(02)00411-6
4. Remmers PA, Speer AJ. Clinical strategies in the medical care of Jehovah’s witnesses. Am J Med 2006;119(12):1013-8. DOI: 10.1016/j.amjmed.2006.04.016.
DOI: 10.1016/j.amjmed.2006.04.016
5. Grupo de trabajo Sociedad Española del Dolor. Bioética [acceso: 28 Nov 2016]. Disponible en: www.sed.es
6. De Cossart L, Fish D, Hillman K. Clinical reflection: A vital process for supporting the development of wisdom in doctors. Curr Opin Crit Care 2012;18(6):712-7 DOI: 10.1097/MCC.0b013e328358e239.
DOI: 10.1097/MCC.0b013e328358e239
7. Plack MM, Driscoll M, Blissett S, McKenna R, Plack TP. A method for assessing reflective journal writing. J Allied Health. 2005;34(4):199-208.
8. Mann KV. Reflection: understanding its influence in practice. Med Educ. 2008;42(5):449-51. DOI: 10.1111/j.1365-2923.2008.03081.x.
DOI: 10.1111/j.1365-2923.2008.03081.x
9. Epstein RM, Hundert EM. Defining and assessing professional competence. JAMA. 2002;287(2):226-35. DOI: 10.1001/jama.287.2.226.
DOI: 10.1001/jama.287.2.226
10. Gracey CF, Haidet P, Branch WT, Weissmann P, Kern DE, Mitchell G, et al. Precepting humanism: Strategies for fostering the human dimensions of care in ambulatory settings. Acad Med. 2005;80(1):21-8. DOI: 10.1097/00001888-200501000-00007.
DOI: 10.1097/00001888-200501000-00007
11. Branch WT Jr, Kern D, Haidet P, Weissmann P, Gracey CF, Mitchell G, et al. Teaching the human dimensions of care in clinical settings. JAMA. 2001;286(9):1067-74. DOI: 10.1001/jama.286.9.1067.
DOI: 10.1001/jama.286.9.1067
12. Gracia-Guillén D. Teoría y práctica de la deliberación moral. En: Lydia Feito L, Gracia D, Sánchez M, editores. Bioética: el estado de la cuestión. Madrid: Ed. Triacastela; 2011. p. 101-54.
13. Gracia D. Deliberation and consensus. En: Chadwick R, ten Have H, Meslin EM, editores. The SAGE handbook of health care ethics: Core and emerging issues. London: SAGE Publications Ltd; 2011. p.84-94. DOI: 10.4135/9781446200971.n9.
14. Anwari JS. Medical ethics and chronic pain management. Saudi Med J. 2008;29(6):921-2.
15. Rich BA, Dubois M. Pain, ethics, and public policy. Pain Med. 2011;12(9):1295-6. DOI: 10.1111/j.1526-4637.2011.01219.x.
DOI: 10.1111/j.1526-4637.2011.01219.x
16. Pérez-Castañeda T. Aspectos bioéticos en el manejo del dolor por cáncer [acceso: 12 Mar 2017]. Disponible en: www.cbioetica.org/revista/102/102-0914.pdf
17. Kwon JH, Hui D, Bruera E. A pilot study to define chemical coping in cancer patients using the Delphi method. J Palliat Med. 2015;18(8):703-6.
DOI: 10.1089/jpm.2014.0446
18. Boceta J, de la Torre A, Samper D, Farto M, Sánchez-de la Rosa R. Consensus and controversies in the definition, assessment, treatment and monitoring of BTcP: results of a Delphi study. Clin Transl Oncol. 2016;18(11):1088-97.
DOI: 10.1007/s12094-016-1490-4

Tablas y Figuras

Table I

Table II

Artículos relacionados

Impact on quality of life, depression and analgesic use, are associated with suffering in fibromyalgia patients. A cross-sectional study

Rev. Soc. Esp. Dolor. 2023; 30(3): 159-167 / DOI: 10.20986/resed.2023.4061/2023

Review of the remission and management of a cancer related pain population to a pain unit. What can we improve?

Rev. Soc. Esp. Dolor. 2023; 30(1): 7-14 / DOI: 10.20986/resed.2023.4010/2022

Attitudes and current knowledge of the spanish pain treatment specialist regarding medical cannabis

Rev. Soc. Esp. Dolor. 2022; 29(13): 52-57 / DOI: 10.20986/resed.2022.4032/2022

Practical aspects of product selection and titration with medical cannabis for chronic pain management

Rev. Soc. Esp. Dolor. 2022; 29(13): 43-51 / DOI: 10.20986/resed.2022.4031/2022

Bone pain management with opioid medication in a patient with Camurati-Engelmann disease: a case report

Rev. Soc. Esp. Dolor. 2022; 29(1): 51-55 / DOI: 10.20986/resed.2021.3930/2021

Use of 8 % capsaicin patches for the treatment of lumbar neuropathic pain

Rev. Soc. Esp. Dolor. 2022; 29(1): 28-33 / DOI: 10.20986/resed.2022.3995/2022

OFA in major surgery. Experience at a secondary level hospital

Rev. Soc. Esp. Dolor. 2022; 29(1): 8-14 / DOI: 10.20986/resed.2022.3991/2022

New opioids with different intracellular mechanism of action; is a new therapeutic window opening up?

Rev. Soc. Esp. Dolor. 2021; 28(5): 292-297 / DOI: 10.20986/resed.2021.3891/2021

Genicular nerve radiofrequency in osteoarthritis-related chronic knee pain

Rev. Soc. Esp. Dolor. 2021; 28(3): 154-168 / DOI: 10.20986/resed.2021.3900/2021

Prescribing habits for neuropathic pain management in Spain: results of the survey of the neuropathic pain working group of the Spanish Pain Society

Rev. Soc. Esp. Dolor. 2021; 28(3): 137-147 / DOI: 10.20986/resed.2021.3911/2021

Botulinum toxin for the treatment of myofascial pain syndrome

Rev. Soc. Esp. Dolor. 2021; 28(2): 100-110 / DOI: 10.20986/resed.2021.3902/2021

Evolution of low back pain in cancer patients treated with interventional pain management

Rev. Soc. Esp. Dolor. 2021; 28(2): 76-81 / DOI: 10.20986/resed.2021.3901/2021

Parsonage-turner after rabies vaccination due to bat bite: case report

Rev. Soc. Esp. Dolor. 2021; 28(1): 57-61 / DOI: 10.20986/resed.2021.3832/2020

Management and perception of therapeutic adherence of breakthrough cancer pain by oncologists in Spain

Rev. Soc. Esp. Dolor. 2021; 28(1): 19-26 / DOI: 10.20986/resed.2021.3824/2020

Implementation and evaluation of a multimodal analgesia protocol for total knee arthroplasty including ultrasoundguided adductor canal block and periarticular local anesthetic infiltration

Rev. Soc. Esp. Dolor. 2021; 28(1): 9-18 / DOI: 10.20986/resed.2021.3847/2020

Interventional management of osteoarthritic pain

Rev. Soc. Esp. Dolor. 2021; 28(13): 85-90 / DOI: 10.20986/resed.2021.3853/2020

Adaptation of the chronic pain unit of the Hospital Complex from Vigo to the state of alarm due to the SARS-CoV-2 pandemic

Rev. Soc. Esp. Dolor. 2020; 27(6): 392-393 / DOI: 10.20986/resed.2020.3827/2020

Transitional pain clinic

Rev. Soc. Esp. Dolor. 2020; 27(6): 369-374 / DOI: 10.20986/resed.2020.3840/2020

Splanchnic nerve block for the treatment of benign chronic abdominal pain. a case report and literature review

Rev. Soc. Esp. Dolor. 2020; 27(4): 273-277 / DOI: 10.20986/resed.2020.3818/2020

Biomechanical factors related to surgical outcomes on patients treated with lumbar arthrodesis in a high complexity center in Colombia

Rev. Soc. Esp. Dolor. 2020; 27(3): 160-167 / DOI: 10.20986/resed.2020.3759/2019

Erector spinalis plane block as a neuropathic pain management in post-burned pediatric patient

Rev. Soc. Esp. Dolor. 2020; 27(2): 127-132 / DOI: 10.20986/resed.2020.3776/2019

Efficacy of a preincisional analgesic strategy with ibuprofen, paracetamol and dexamethasone in laparoscopic cholecystectomy. Prospective observational study

Rev. Soc. Esp. Dolor. 2020; 27(2): 104-112 / DOI: 10.20986/resed.2020.3778/2019

E-consults, a new tool for pain management. Results of its implementation in an organizational structure of integrated management (EOXI)

Rev. Soc. Esp. Dolor. 2020; 27(2): 97-103 / DOI: 10.20986/resed.2020.3756/2019

Neurolytic procedures for pancreatic cáncer pain: a systematic review and a proposal for an algorithm treatment

Rev. Soc. Esp. Dolor. 2019; 26(6): 342-358 / DOI: 10.20986/resed.2019.3715/2018

Applicability of scales/indicators for pain monitoring in critically ill patients incapable of verbalizing: a systematic review of the literature

Rev. Soc. Esp. Dolor. 2019; 26(5): 293-303 / DOI: 10.20986/resed.2019.3726/2019

New strategies for postoperative pain control in tonsillectomy surgery. Is all that glitters gold?

Rev. Soc. Esp. Dolor. 2019; 26(5): 270-275 / DOI: 10.20986/resed.2019.3742/2019

Optimization of postoperative pain management based on a new technological tool. Pain map

Rev. Soc. Esp. Dolor. 2019; 26(3): 154-165 / DOI: 10.20986/resed.2019.3696/2018

Project adapta: adequacy of treatment in breakthrough cancer pain

Rev. Soc. Esp. Dolor. 2019; 26(1): 31-43 / DOI: 10.20986/resed.2018.3661/2018

Evidence-based recommendations for the management of neuropathic pain (review of the literature)

Rev. Soc. Esp. Dolor. 2018; 25(6): 349-358 / DOI: 10.20986/resed.2018.3673/2018

Experience in two hospitals about the observation of pain responses in hospitalized preterm infants

Rev. Soc. Esp. Dolor. 2018; 25(5): 271-277 / DOI: 10.20986/resed.2018.3633/2017

Pharmacological management of acute postoperative pain in Spain. Data from the national survey by the Spanish Pain Society (SED)

Rev Soc Esp Dolor 2018; 25(2): 70-85 / DOI: 10.20986/resed.2017.3593/2017

Pain management in cancer patients receiving radiotherapy: GORVAMUR study, a prospective, observational, epidemiological study

Rev Soc Esp Dolor 2017; 24(5): 241-255 / DOI: 10.20986/resed.2017.3570/2017

Factors associated with pain intensity in Mexican patients hospitalized in postoperative period

Rev Soc Esp Dolor 2017; 24(1): 4-10 / DOI: 10.20986/resed.2016.3442/2016

Instrucciones para citar

Boceta J, Peiró A, Cevas F, Vidal L, Acedo M, Mayoral V, et all. Ethical problems in the management of pain. Qualitative study through open reflection interview. Rev Soc Esp Dolor 2020; 27(2): 89-96 / DOI: 1020986/resed20203729/2019


Descargar a un gestores de citas

Descargue la cita de este artículo haciendo clic en uno de los siguientes gestores de citas:

Métrica

Este artículo ha sido visitado 55006 veces.
Este artículo ha sido descargado 43 veces.

Estadísticas de Dimensions


Estadísticas de Plum Analytics

Ficha Técnica

Recibido: 23/02/2019

Aceptado: 03/02/2020

Prepublicado: 16/03/2020

Publicado: 17/04/2020

Tiempo de revisión del artículo: 314 días

Tiempo de prepublicación: 387 días

Tiempo de edición del artículo: 419 días


Compartir

Este artículo aun no tiene valoraciones.
Reader rating:
Rate this article:
Send by e-mail
© 2024 Revista de la Sociedad Española del Dolor
ISSN: 1134-8046   e-ISSN: 2254-6189

       Indexada en:
Política de Privacidad