Eficiencia de las consultas especializadas. A propósito del trabajo “Evaluación de la eficiencia del manejo clínico del dolor neuropático en consultas especializadas frente a consultas generales en unidades asistenciales de neurología en España”

Abstract

With reference to the article "Assessment of the efficiency of the clinical management of neuropathic pain in specialist clinics compared to general clinics in neurology health care units in Spain" by Matias-Guiu et al, a reflection is made on the methodological and operational difficulties of working with results in health, quality of life or costs in something so subjective as pain, and its impact on daily life. It then highlights the importance of the decision to establish a specialist clinic or other type specific care team for neuropathic pain, adding another level of care. Some points are given for the analysis of that decision.

Factors associated with acute postoperative pain in preschool children in a referral clinic in eastern Colombia

“…From the pathophysiological mechanisms of pain, the etiology consists of two components. The rst component involve the nociceptive pain, in which there is tissue injury associated with an in ammatory process that triggers the response mediated by the Aδ receptors that constitute the fast response or primary pain, and by the C receptors that determine the slow response or secondary pain, which is determined by the bers thickness and their conduction speed [12]. Additionally, depending on the receptor's location, pain can be somatic if the lesion is located in soft tissue, skin, musculoskeletal or bone, and visceral if it is located in internal abdominal organs [13].…”

“…Additionally, depending on the receptor's location, pain can be somatic if the lesion is located in soft tissue, skin, musculoskeletal or bone, and visceral if it is located in internal abdominal organs [13]. The second component corresponds to neuropathic pain which originates from an alteration at the level of the central and peripheral nervous system characterized by demyelination and retraction [12,13].…”

“…Firstly, the transduction phase is given by the conversion of the painful stimulus to an action potential that is mediated by the response of in ammatory factors; then occurs the transmission phase where the action potential propagates from the periphery to the somatosensory cortex; thirdly, in the modulation phase, two processes occur: sensitization, which corresponds to the neurochemical activation that favors the capacity to respond to stimuli, and inhibition, which can be opioid, non-opioid and segmental, also known as pain gating. Finally, the last phase consists of perception where the stimulus that reaches the cortex connects with the limbic area and frontal cortex triggering the individual's response and assimilation to pain [12,13]. Some factors have been associated with poor control of acute APP, thus, in 2019, a systematic review and meta-analysis identi ed nine factors statistically signi cant and supported by greater evidence, such as female sex, smoking, history of depressive and anxious symptoms, sleep disorders, high body mass index, presence of preoperative pain, use of preoperative analgesia and young age [14], mainly in under 30 year old patients with a greater tendency to report APP [5].…”