Rev. Soc. Esp. Dolor. 2023; 30(1): 7-14 / DOI: 10.20986/resed.2023.4010/2022
Alfonso Carregal, Mónica Mayo, Teresa Fernández, María Vieito
RESUMEN
Objetivos: Determinar las características demográficas, clínicas y de manejo analgésico de una población con dolor oncológico remitida a nuestra unidad de dolor (UD). Descripción de su manejo clínico una vez recibidos en la unidad. Detectar aspectos de mejora.
Material y métodos: Estudio retrospectivo y descriptivo, realizado durante un periodo de 23 meses, entre noviembre de 2019 y diciembre de 2021, de todos los pacientes oncológicos derivados a la UD, cuya causa de derivación fuera dolor de origen oncológico.
Resultados: Se analizaron 78 pacientes, el 63,2 % hombres y el 46,8 % mujeres. La edad media poblacional fue de 64,84 ± 12,623 años. El 44,7 % fueron remitidos por servicios quirúrgicos. El 75 % presentaba dolor moderado o severo. Los tumores más frecuentes fueron los abdominales (31,6 %), y cabeza y cuello (22,4 %). La causa del dolor fue en 48,7 % de los casos de la infiltración tumoral y en un 60,5 % un dolor de origen de mixto. En el momento de la remisión el 60 % de los pacientes recibía opioides mayores, con una dosis de equivalentes diarios de morfina (EDM) de 163,57 ± 167,10 mg y el 38 % recibía antineuropáticos. El tiempo medio para atender a estos pacientes desde el momento de solicitarla fue de 9,18 ± 9,73 días. Se realizó intervencionismo menor en el 56,6 % (43) de los pacientes y mayor en el 2,6 % (2). Se inició en la UD el tratamiento con fármacos antineuropáticos en el 68,4 % de los casos. Tras el manejo en la UD, un 72,4 % de los pacientes refirieron mejoría del dolor.
Conclusiones: Mejorar la tasa de remisión de pacientes desde servicios como Oncología médica y Atención primaria. Mejorar los tiempos de remisión a las unidades de dolor. Ajustar mejor los tratamientos analgésicos antes de la remisión. Generar un protocolo de remisión sencillo de pacientes que incluyan pautas básicas de manejo del dolor. Mejorar el diagnóstico de dolor neuropático. Aumentar la cartera de servicios de intervencionismos de la UD. Las unidades de dolor pueden mejorar el dolor en los pacientes con dolor oncológico. Crear comités de multidisciplinares de dolor oncológico.
ABSTRACT
Aim: Studying the demographic profile, clinical characteristics and analgesic management of an oncologic population sent to our pain unit. To describe the pain management in our unit. To detect management aspects to be improved.
Methodology: Retrospective and descriptive study, performed in a period of 23 months, between November 2019 and December 2021, of all patients sent to our pain unit for cancer pain management.
Results: A total of 78 patients were analyzed, 63,2 % men and 46,8 % women. The average age was 64,84 ± 12,623 years. 44,7 % were sent by surgical services. In 75% the pain was moderate or severe. The main cancer location was abdominal (31,6 %), and head and neck (22,4 %). In 48,7 % the pain was originated by tumoral infiltration and in 60,5 % the pain was judged to be mixed. At the moment of the arrival 60 % of patients were on opioids, with an average dose of 163,57 ± 167,10 mg EDM and 38 % were on antineurophatic drugs. The average time to attend the patients from the moment or request was 9,18 ± 9,73 days. A minor interventional procedure was performed in 56,6 % (43) of the patients, and a major intervention in 2,6 % (2). We started antineurophatic drugs in 68,4 % of the cases. During the period of pain management in our unit a 72,4% of the patients referred an improvement of their cancer related pain.
Conclusions: It is necessary to improve the rate of remission from medical oncology departments and primary care physicians. To reduce the remission time to our unit from the referral services. To improve analgesic management before referral. To create an easy protocol for remission of patients that includes basic pain management instructions. To improve the rate of neuropathic pain diagnosis before referral. To expand our interventional technics portfolio. Pain units can improve cancer related pain management. To create multidisciplinary cancer pain comities.
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