Rev. Soc. Esp. Dolor. 2020; 27(6): 369-374 / DOI: 10.20986/resed.2020.3840/2020
Marcos Bolívar, Martín Toro, María Eugenia Seijas, Amalia Bolívar, Marcos Bolívar
ABSTRACT
Persistent postoperative pain is pain that develops after a surgical procedure, which the patient did not present before surgery. It is becoming more and more frequent and a prevalence ranging between 10 % and 50 % of adult patients undergoing major surgery is reported. It should be considered an important public health problem not only because of the anguish and disability it produces, but it may have contributed to the opioid epidemic in the 1980s, and part of the tools used for its treatment may have contributed to this crisis in the United States, by promoting the long-term use of opioids in patients with non-cancer pain.
In order to reduce the severity of postoperative acute pain, a fundamental risk factor involved in the origin of PPP, multidisciplinary approaches are required, aimed at preventing and treating the different risk factors that anticipate this disease. This is how the Transitional Pain Service or Transitional Pain Clinic appears in 2014. It is a novel program that aims to effectively control of acute postoperative acute pain, facilitate opioid weaning, reduce the development of chronic pain disability, and help decrease deaths related to opioid over prescription. This model of care was created to effectively manage patients' perioperative pain, maintain function, reduce opioid use, and monitor the efficacy of these interventions. It focuses on persistent postoperative pain in three stages: 1) pre-operative, 2) post-operative in the hospital setting, 3) post-operative in the outpatient setting up to 6 months after surgery. This program offers services focused on: 1) Introduction and optimization of multimodal analgesia, to improve pain management and facilitate weaning from opioids; 2) Non-pharmacological interventions including physical therapy and acupuncture; and 3) Psychological interventions by a trained pain psychology team, around an acceptance and commitment therapy model.
The new situation we are experiencing with COVID-19 demands innovations in medical care, as non-urgent medical care is reduced or abolished and it is time to look for different options from conventional ones for patient follow-up, it is the time of Telehealth. For now, it is necessary to leverage Video Tele Heath and Transitional Pain Service to continue monitoring our patients.
RESUMEN
El dolor posoperatorio persistente es un dolor que se desarrolla posterior a un procedimiento quirúrgico que el paciente no lo presentaba antes de la cirugía. Es cada vez más frecuente y se reporta una prevalencia que oscila entre el 10 y el 50 % de los pacientes adultos sometidos a cirugía mayor. Debe ser considerado un problema de salud pública importante, no solo por la angustia y discapacidad que produce, sino porque pudo haber contribuido con la epidemia de los opioides en la década de los años 80, ya que parte de las herramientas usadas para su tratamiento pudo haber contribuido a esa crisis en los Estados Unidos, al promoverse el uso de los opioides a largo plazo en pacientes con dolor de tipo no oncológico.
Para lograr disminuir la severidad del dolor agudo posoperatorio, factor de riesgo fundamental involucrado en el origen del dolor posoperatorio persistente, se requiere de enfoques multidisciplinarios dirigidos a prevenir y tratar los diferentes factores de riesgo que anticipan esta enfermedad. Es así como aparece en el año 2014 el Servicio de Dolor Transicional o Clínica de Dolor Transicional. Es un programa novedoso que tiene como objetivo controlar eficazmente el dolor agudo posoperatorio, facilitar el destete de opioides, reducir el desarrollo de la discapacidad por dolor crónico y ayudar a disminuir las muertes relacionadas con la prescripción excesiva de opioides. Este modelo de atención se creó para controlar eficazmente el dolor perioperatorio de los pacientes, mantener la función, reducir el consumo de opioides y controlar la eficacia de estas
intervenciones. Se enfoca en el DPP en tres etapas: 1) preoperatorio, 2) posoperatorio en el ámbito hospitalario, 3) posoperatorio en el ámbito ambulatorio hasta 6 meses después de la cirugía.
Los servicios que ofrece este programa se enfocan en: 1) introducción y optimización de la analgesia multimodal para mejorar el manejo del dolor y facilitar el destete de los opioides; 2) intervenciones no farmacológicas, que incluyen la fisioterapia y la acupuntura; y 3) intervenciones psicológicas realizadas por un equipo de psicología del dolor capacitado en torno a un modelo de Terapia de Aceptación y Compromiso.
La nueva situación que vivimos con la COVID-19 demanda de innovaciones en la atención médica al disminuirse o abolirse atenciones médicas no urgentes, y es el momento de buscar opciones diferentes a las convencionales para el seguimiento de los pacientes; es el tiempo de la telesalud. Se impone por ahora apalancarnos en vídeo Tele Salud y los servicios de dolor transicional para seguir controlando nuestros pacientes.
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