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La espasticidad es un desorden motor que hace parte del síndrome de motoneurona superior y se caracteriza por un incremento dependiente de la velocidad del reflejo tónico de estiramiento o de tono muscular; se acompaña de reflejos miotendinosos exagerados e hiperexcitabilidad del reflejo de estiramiento. Es muy frecuente en pacientes con síndrome de motoneurona superior secundario a diversas patologías como ataque cerebrovascular, lesiones medulares, esclerosis múltiple y parálisis cerebral. Un abordaje multidisciplinario e individualizado es fundamental en el tratamiento de los pacientes; e incluye como pilares el manejo no farmacológico, farmacológico, neuroquirúrgico y ortopédico. El presente trabajo pretende realizar una revisión no sistematizada pero actualizada sobre la historia, epidemiología, fisiopatología, abordaje diagnóstico y terapéutico de la espasticidad, tanto en la población adulta como en la pediátrica; así como plantear un algoritmo terapéutico.

La teoría de la compuerta. Más allá del concepto cientí-fico dos universos científicos dedicados al entendimiento del dolor. Rev Soc Esp Dolor 2013; 20(4): 191-202. ABSTRACTThe quest to acquire knowledge and understanding of pain has had crucial moments in which the evolution of the process has been dramatically changed. These moments have been revelations that have opened the path to rethinking previously accepted knowledge and created new horizons of research, understanding and treatment. When Melzack and Wall first described what would come to be known as the "Gate Control theory" they were able not only to clarify basic aspects of pain development but to lead the way to further basic and clinical research studies. They psychological aspects, the clinical basis and the structural anatomical and physiological components created one of the most complete theories in medical sciences and the ground for the basic management of pain. It has been fifty years since the original article was published in Science magazine (Pain Mechanism: a new theory. A gate control system modulates sensory input from the skin before it evokes pain perception and response. Ronald Melzack and Patrick Wall. Science. November 19, 1965 volume 150, number 3699). It has been recognized even until today as the most cited reference in medical journals in the past 50 years. The paper was written during a very particular moment in scientific history and the context of two very different lives, which illustrates the incredible process that leads to scientific development. The analysis of what this paper has symbolized to pain science must be done not only from a purely scientific view point but from a human one as well. RESUMENLa evolución histórica para el conocimiento del dolor ha tenido momentos cruciales en los que el curso evolutivo se modificó. Esos momentos son situaciones relevantes que cambiaron los conceptos previamente aceptados y abrieron nuevos horizontes de investigación, de entendimiento y de tratamiento. Cuando Melzack y Wall desarrollaron la "Teoría de la Compuerta" lograron aclarar fenómenos básicos del entendimiento del dolor pero igualmente abrieron múltiples tópicos de futuras investigaciones básicas y clínicas. Dieron sustento, con su teoría, a múltiples tratamientos del dolor que son la base de procedimientos que en la actualidad realizamos. Los aspectos psicológicos, el componente clínico y la base estructural anatomofisiológica fueron poco a poco conformando una de las teorías más completas de la ciencia médica y por supuesto principio básico para el mejor tratamiento del dolor. Son 50 años que se cumplen de la publicación de aquel artí-culo en la revista Science (Pain Mechanism: a new theory. A gate control system modulates sensory input from the skin before it evoques pain perception and response. Ronald Melzack and Patrick Wall. Science. 19 november 1965, volumen 150, number 3699), el cual ha sido reconocido hasta la actualidad como la referencia bibliográfica más utilizada en la ciencia médica en los últimos 50 años....

Osborne-Cotterill lesion is an osteochondral fracture located in the posterolateral margin of the humeral capitellum, which may be associated with a defect of the radial head after an elbow dislocation. This lesion causes instability by affecting the lateral ulnar collateral ligament over its capitellar insertion, which is associated with a residual capsular laxity, thereby leading to poor coverage of the radial head, and hence resulting in frequent dislocations. We present a 54-year-old patient, a physician who underwent trauma of the left elbow after falling from a bike and suffered a posterior dislocation fracture of the elbow. The patient subsequently presented episodes of instability, and additional work-up studies diagnosed the occurrence of Osborne-Cotterill lesion. An open reduction and internal fixation of the bony lesion was performed, with reinsertion of the lateral ligamentous complex. Three months after surgery, the patient was asymptomatic, having a flexion of 130º and extension of 0º, and resumed his daily activities without any limitation. Currently, the patient remains asymptomatic 2 years after the procedure. Elbow instability includes a large spectrum of pathological conditions that affect the biomechanics of the joint. The Osborne-Cotterill lesion is one among these conditions. It is a pathology that is often forgotten and easily overlooked. Undoubtedly, this lesion requires surgical intervention.

Un 70 % de pacientes con lesión medular tiene dolor neuropático crónico e incapacitante. El caso que se presenta en este artículo corresponde a un paciente de 23 años de edad, quien sufre un intenso dolor infrasegmentario por causa de un trauma raquimedular. Se le realizó un tratamiento neuroquirúrgico del dolor. En la drezotomía se le hizo una sección selectiva de fibras nociceptivas en los segmentos medulares afectados. Luego de ello, y a los 24 meses, presenta mejoría completa y suspensión de analgésicos.

The current review describes updated information on the evidence-based assessment of substance use disorder. We offer an overview of the state of the science for substance-related assessment targets, instruments (screening, diagnosis, outcome and treatment monitoring, and psychosocial functioning and wellbeing) and processes (relational and technical) as well as recommendations for each of these three components. We encourage assessors to reflect on their own biases, beliefs, and values, including how those relate to people that use substances, and to view the individual as a whole person. It is important to consider a person’s profile of symptoms and functioning inclusive of strengths, comorbidities, and social and cultural determinants. Collaborating with the patient to select the assessment target that best fits their goals and integration of assessment information in a holistic manner is critical. We conclude by providing recommendations for assessment targets, instruments, and processes as well as recommendations for comprehensive substance use disorder assessment, and describe future directions for research.

de diagnóstico (SI5) de disfunción de la articulación sacroiliaca: estudio piloto. Rev Soc Esp Dolor 2014; 21(3): 123-130. Financiación: Hospital Universitario San Ignacio -Pontificia Universidad Javeriana. Bogotá, Colombia.