Practice points• Adequate pain management starts with an appropriate syndromic diagnosis based on a detailed clinical history, comprehensive physical examination and correct interpretation of additional medical tests.• Appropriate syndromic classification of pain is based on its clinical characteristics, as well as on a meticulous assessment of the intensity of pain by applying standard scales. The patient's psychosocial situation must be taken into account when attempting to optimize management and predict the response to treatment.• As with all types of chronic pain, assessment of patients with cancer pain should take into account the individual profile of the patient (age, comorbidities, functionality, previous exposure to drugs such as opioids and polypharmacy) and the type, intensity and potential clinical course of the pain. Only thus will it be possible to decide on the best approach, based on aspects such as efficacy, safety, tolerability and cost. Multimodal strategies are the most successful.• Multimodal approaches include interventional, psychological, rehabilitative and integrative therapies.• Various formulations of fentanyl have been reported for the treatment of breakthrough pain, as follows: transmucosal, intranasal, sublingual, buccal tablets and gingival. However, these formulations are not available in Latin America.• In Latin America, the WHO guidelines have proven critical for justifying to local governments the key role of opioids such as morphine and the need for an adequate supply. Nevertheless, availability of opioids in the region remains poor.• Treatment of severe pain should be with a strong opioid, in most cases with oral formulations. Other routes (intravenous, subcutaneous, spinal (epidural and intrathecal) may only be necessary in refractory cases.• Extended-release opioids (morphine, oxycodone and hydromorphone) can be supplemented with immediate-release formulations as needed. Assessment of comorbidities is essential when deciding on the best option.For reprint orders, please contact: reprints@futuremedicine.com

Objective: This study aimed at exploring the compassion attitudes and needs for awareness and training related to a compassionate approach for Medicine, Nursing, and Psychology students, as well as for the academic and administration personnel from the Universidad Técnica Particular de Loja (UTPL, Ecuador) Health Sciences area. Methods: A cross-sectional observational study, based on a self-administered questionnaire through a sample of 788 UPTL students. STROBE guidelines were followed and applied. Results: A positive correlation was found between life engagement and compassion for others, from others, and self-compassion. The Nursing students were those who reported having previous experiences of contact with people with an advanced disease or in an end-of-life situation and having received some type of training compared to Medicine and Psychology students and lecturers (faculty members). Differences were found on the “self-compassion” and “compassion for others” subscales, noting a higher level of compassion among Psychology students. Conclusions: To implement the philosophy of compassionate universities it is necessary to design trainings that include the students, the faculty members, and the administrative staff, centered on sensitization and training about assistance, care, and accompaniment at the end of life, as well as cultivating compassion in the workplace.

Background: The current mental health state of healthcare professionals and students during the COVID-19 pandemic in Ecuador remains understudied and how to improve their mental health is a challenge.Objective: This study aimed to explore the anxiety and depressive symptomatology among healthcare students and professionals in Ecuador and to examine the role of psychological inflexibility, loneliness, and psychological stress as predictors of anxiety and depression symptoms.Methods: A total of 191 undergraduate and graduate healthcare students in clinical practice (early-career healthcare professionals) in Ecuador were surveyed between January and March 2021 using standardized measures of psychological stress (PSS), psychological inflexibility (AAQ), loneliness (UCLA), alcohol consumption (AUDIT-C), and anxiety and depressive symptomatology (PHQ). Macro Process for SPSS (models 4 and 7) were used to test mediation effects.Results: Alcohol consumption varied between men and women and anxiety and depression symptomatology was generally low among the sample. Psychological inflexibility and loneliness mediated the impact of stress on anxiety and depressive mood in participants, regardless of gender and previous personal history of COVID-19.Discussion: Implications of psychological inflexibility and the prevention and coping with stress in healthcare professionals during COVID-19 are further discussed.

(1) Background: This study aimed to explore the symptoms, functional status, and depression in patients with chronic diseases in Loja, Ecuador. (2) Methods: A cross-sectional study was carried out with patients over 60 years old having at least one chronic disease and cared for in healthcare centers of the Health Ministry of Ecuador or living in associated geriatric centers. (3) Results: The sample comprised 283 patients with a mean age of 76.56 (SD 7.76) years. The most prevalent chronic diseases were chronic obstructive pulmonary disease, followed by arterial hypertension and diabetes. Patients with a joint disease had the worst scores for the majority of the symptoms assessed with the Edmonton Scale. Cancer, dementia, and arterial hypertension contributed the most to the dependence levels assessed with the Barthel Index. Dementia contributed the most to the poor performance status evaluated with the Karnofsky Performance Status. Cancer and diabetes contributed the most to depression. Patients with a higher number of chronic diseases reported worse functional status. (4) Conclusions: Targeted interventions to address symptoms, functional status, and depression in patients with chronic diseases are needed.

Latin-American guidelines for the use of opioids in CNOP should improve pain relief and patients' quality of life by increasing access to these effective agents.