Implementation of a Canine Ergonomic Abdominal Simulator for Training Basic Laparoscopic Skills in Veterinarians.

The validity of the CALMA Veterinary Lap-trainer simulator (CVLTS) for training basic veterinary laparoscopic skills was assessed and compared to a simple collapsible mobile box trainer. Ten veterinarian surgeons with no experience in laparoscopic surgery and four experts with at least two years of experience in minimally invasive surgery (MIS) were included. The training curriculum included object transfer, non-woven gauze cutting with curved scissors, and interrupted and continuous intracorporeal sutures, which were practiced on the CVLTS. The initial and final assessments were carried out in both the CVLTS and in a collapsible mobile simulator. These were video-recorded and evaluated by external experts using the Objective Structured Assessment of Technical Skills (OSATS) and a specific scale evaluation in a double-blinded schedule. The time, angular displacement, number, and movement smoothness were recorded using a hands movement assessment system (HMAS). Through a survey, the face validity and content were evaluated. The data were analyzed by a Pearson's proportions comparison or Mann Whitney U test and a bilateral Student's t-test. The experimental group OSATS, specific scores, and HMAS values, with the exception of the smoothness of movements, significantly improved after training, with no statistically significant differences compared to the expert group. No differences were found between the two simulators. The experts' and experimental participants' CVLTS mean score was 4.8. Our data support the CVLTS validations for laparoscopic surgery basic skills training.

Development and validation of a composed canine simulator for advanced veterinary laparoscopic training.

The development of innovative simulation models for veterinary laparoscopic surgery training is a priority today. This study aimed to describe a didactic simulation tool for the training of total laparoscopic gastropexy (TLG) with intracorporeal sutures in dogs. CALMA Veterinary Lap-trainer composite simulator (CLVTS) was developed from a plaster cast of 2 Great Dane canines mimicking the space and the correct position to carry out a TLG. After video instruction, 16 veterinarians with different degrees of experience in minimally invasive surgery (Experts, n = 6 and intermediates, n = 10) evaluated four sequential simulating TLG with intracorporeal suturing in the CLVTS. Subsequently, they completed an anonymous questionnaire analyzing the realism, usefulness, and educational quality of the simulator. The CLVTS showed a good preliminary acceptance (4.7/5) in terms of the usefulness and adequacy of the exercises that, in the participants' opinion, are appropriate and are related to the difficulty of the TLG. In addition, both experienced and intermediate surgeons gave high marks (4.5/5) to the feeling of realism, design, and practicality. There were no significant differences between the responses of the two groups. The results suggest that the CVLTS has both face and content validity. Where it can be practiced in a structured environment for the development of a total laparoscopic gastropexy with intracorporeal suture and without compromising patient safety, but still has some limitations of the scope of the study. Further studies are needed to establish the ability to assess or measure technical skills, including the degree of transferability to the actual surgical environment.

Perioperative chemotherapy in locally advanced gastric cancer in Chile: from evidence to daily practice.

Gastric cancer (GC) is a leading cause of cancer death in Chile. Although recommended in international guidelines since 2006, perioperative chemotherapy was not available to patients in the public health system in Chile until 2016. We conducted an observational study to assess the feasibility of this strategy in public hospitals in Chile (Observational Study of Perioperative Chemotherapy in Locally Advanced Gastric Cancer - PRECISO). Patients with locally advanced, operable GC were offered to receive preoperative chemotherapy with Epirubicin + Cisplatin + Capecitabine (ECX) for three cycles followed by curative surgery. Staging included abdominal CT scan and laparoscopy if peritoneal carcinomatosis was suspected. Postoperative ECX for three cycles was recommended. Between August 2010 and March 2013, 110 patients were screened and 61 enrolled. Median age was 62 years (23-76 years) and most patients had good performance status at baseline (Eastern Cooperative Oncology Group performance status score (ECOG) 0: 42, ECOG 1: 19). Tumour site was proximal in 32 (52%) and medial and distal in 29 (48%) patients. All but four patients (n = 57, 93%) completed three cycles of preoperative chemotherapy. Fifty-six patients were operated and 54 (89%) had a curative resection. Thirty-three patients (54%) had pT0-2, and 18 (30%) had pN0 tumours, with two patients achieving a complete response. As of 20 December 2020, 39 patients died, 32 due to GC, one within 30 days of surgery, two due to intestinal obstruction at 5 and 3 months after surgery and four due to other causes. Five-year survival rate was 38%. We conclude that perioperative chemotherapy is feasible in public hospitals in Chile and should be offered to patients with locally advanced GC.

Validation of Training and Acquisition of Surgical Skills in Veterinary Laparoscopic Surgery: A Review.

At present, veterinary laparoscopic surgery training is lacking in experiences that provide a controlled and safe environment where surgeons can practice specific techniques while receiving experts' feedback. Surgical skills acquired using simulators must be certified and transferable to the operating room. Most models for practicing laparoscopic skills in veterinary minimally invasive surgery are general task trainers and consist of boxes (simulators) designed for training human surgery. These simulators exhibit several limitations, including anatomic species and procedural differences, as well as general psychomotor training rather than in vivo skill recreation. In this paper, we review the existing methods of training, evaluation, and validation of technical skills in veterinary laparoscopic surgery. Content includes global and specific scales, and the conditions a structured curriculum should meet for improving the performance of novice surgeons during and after training. A focus on trainee-specific assessment and tailored-technical instruction should influence training programs. We provide a comprehensive analysis of current theories and concepts related to the evaluation and validation of simulators for training laparoscopic surgery in small animal surgery. We also highlight the need to develop new training models and complementary evaluation scales for the validation of training and acquisition of basic and advanced skills in veterinary laparoscopic surgery.

Peritonitis esclerosante primaria y secundaria: estudio comparativo / Primary and secondary sclerosing peritonitis: comparative study

Resumen Introducción: Existen dos tipos de peritonitis esclerosante (PE): primaria o idiopática y secundaria, generalmente a diálisis peritoneal (DP), y con menor frecuencia a otras patologías abdominales o sistémicas. Su mortalidad es alta. Objetivo: Comparar las características clínicas, estudios diagnósticos y tratamiento de pacientes con Peritonitis Esclerosante Primaria y Secundaria, definir si existen diferencias y determinar los principales elementos clínicos e imagenológicos que permitan hacer un diagnóstico precoz y mejorar los resultados terapéuticos. Material y Métodos: Se analizan 18 casos de PE diagnosticados en nuestro hospital, entre los años 2001-2014. Incluye una serie retrospectiva de 15 casos de PE secundaria (13 por diálisis peritoneal y 2 por cirrosis hepática). Se compara con un estudio prospectivo que incluye 3 pacientes con PE primaria. Resultados: Las principales diferencias se evidencian en la presentación clínica: PE primaria: se presenta con cuadro de obstrucción intestinal y baja de peso de distinta magnitud. PE secundaria: predominan el dolor abdominal, peritonitis recurrente y la falla de ultrafiltración. La tomografía computada de abdomen es útil, sobre todo cuando hay obstrucción intestinal. Ha hecho posible el diagnóstico preoperatorio. Conclusiones: Se requiere un alto índice de sospecha para el diagnóstico precoz de PE, sobre todo para la forma primaria. Debe sospecharse en todo paciente con dolor abdominal, vómitos recurrentes y baja de peso de cualquier magnitud; y en aquellos en diálisis peritoneal durante 5 años o más, que presenten dolor abdominal y/o peritonitis recurrente y/o falla de ultrafiltración.

Introduction: There are two types of sclerosing peritonitis (SP): primary or idiopathic and secondary, generally to peritoneal dialysis, and less frequently, to other abdominal or systemic pathologies. Mortality related to this is high. Objective: To compare the clinical feature, diagnostic studies and treatment of patients with Primary and Secondary Sclerosing Peritonitis, to define whether there are any differences and to establish the main clinical and imaging elements allowing for an early diagnosis and improving the therapeutic results. Material and Methods: An analysis of 18 SP cases diagnosed at our hospital between 2001-2014 was carried out. This includes a retrospective series of 15 cases of secondary SP (13 to peritoneal dialysis and 2 to liver cirrhosis). This is compared against a prospective study that includes 3 patients with primary SP. Results: The main differences became evident in the clinical presentation: Primary SP: occurs in an intestinal obstruction and a loss of weight scenario of varying degrees. Secondary SP: abdominal pain and recurrent peritonitis as well as ultrafiltration failure prevail. CT of the abdomen has proven to be useful, in particular in those cases where there is intestinal obstruction. It has made preoperative diagnostic possible. Conclusions: A high degree of suspicion is required for an SP early diagnosis, especially for the primary form. All patients presenting abdominal pain, recurrent vomiting and any degree of weight loss and those with five or more years of peritoneal dialysis presenting abdominal pain and/or recurrent peritonitis and/or ultrafiltration failure should raise a diagnosis suspicion.

Concomitant Presence of Ovarian Tumors (Teratoma and Granulosa Cell Tumor), and Pyometra in an English Bulldog Female Dog: A Case Report.

Background: The diagnosis of ovarian tumors in dogs is usually complicated because the clinical signs can be very discrete and can be easily confused with other diseases. There are few reports of ovarian tumors with different cellular characteristics in the same dog. Our objective was to describe an unusual case of the concomitant presence of ovarian teratoma and granulosa cell tumors in a female dog presenting symptoms compatible with pyometra at clinical consultation. Clinical history: A non-spayed 6-years-old female English Bulldog was attended at the consultation, with no history of previous steroid hormonal treatment. The dog had presented regular estrus every 6 months; 3 months elapsed between the last estrus and consultation. The dog had presented vulvar discharge for more than 2 weeks. Clinical and laboratory findings: the patient presented a slightly pale oral mucosa, decay, vulvar edema, and mucous-purulent uterine discharge. The ultrasound examination revealed the presence of neoformations in the ovaries, and evidence of cystic endometrial hyperplasia-pyometra in the uterus. Treatment: We performed a ventral ovariohysterectomy. During the surgical procedure, it was found several masses in the left and right ovaries, exhibiting characteristics of other tissues different from ovarian tissue. All samples were sent for histopathological examination. The diagnosis was a granulosa cell tumor in the left ovary and a well-differentiated teratoma in the right ovary. Conclusion: Practitioners must improve the use of diagnostic tools when attending non-spayed dogs at advanced ages (more than 6 years old), which would probably be at high risk of suffering from undetected ovarian tumors, some of them with malignancy behavior.

Cáncer de la vesícula biliar: análisis preliminar del programa GES para prevención de esta enfermedad / Gallbladder cancer: preliminary evaluation of the GES program to prevent the disease

Objetivo: Analizar datos relacionados con el programa «Colecistectomía como prevención del cáncer de vesícula biliar¼. Método: Se analizan los resultados obtenidos de la página web del DEIS del Ministerio de Salud chileno. Resultados: El año 2006, fecha de inicio del programa, fueron egresados 42.780 pacientes entre 20 y 64 años con diagnósticos correspondientes a los códigos CIE-10, K80-K83. El año 2012, el número de egresos fue de 58.818, lo que significó que desde el año 2006 fueron egresados 39.419 pacientes más que si se hubiesen mantenido los números del año 2006. Por otra parte, desde antes de la puesta en práctica del programa, se aprecia una disminución de la mortalidad ajustada por edad del cáncer de vesícula. Conclusión: Aunque desde la puesta en marcha del programa de prevención del cáncer de vesícula se observa un aumento en el número de casos intervenidos, especialmente durante los años 2011 y 2012, la caída de la tasa de mortalidad parece deberse a factores diferentes al aumento de las colecistectomías.

Goal: To evaluate published data related to the program ‘Cholecystectomy as prevention of Gallbladder Cancer’. Method: Analysis of the results obtained from the DEIS web page (Ministry of Health of Chile). Results: Since 2006, The Chile Ministry of Health began a program to reduce the number of gallbladder cancer cases in Chile. To accomplish the above, Chile Government has guarantied the execution of a cholecystectomy program under parameters of quality, opportunity and financial support between the ages of 35 and 49 years old. During 2006, 42,780 patients corresponding to the ICD 10 codes, K80-K83 between 20 and 64 years old were discharged from Chilean Hospitals. In 2012, six years after the beginning of the program, 58,818 were discharged. The program would make done possible to discharge approximately 39,419 extra patients. On the other hand, during the last ten years, a decrease in the mortality rate of gallbladder cancer has been observed in Chile. Conclusion: Although since the beginning of the program an increase in the number of patients discharged is observed, the decrease in the gallbladder cancer mortality seems not to have relation with the program.

Abordaje toraco-abdominal de la fístula broncobiliar / Thoraco-abdominal approach in bronchobiliary fistula

La fístula broncobiliar es una entidad poco usual en nuestro medio y poco descrita en la literatura científica. Se caracteriza por una comunicación anómala entre el árbol bronquial y la vía biliar, y se asocia a la presencia de bilis en el esputo (bilioptisis). Según su etiología, puede ser secundaria a la obstrucción distal de la vía biliar por patología benigna, maligna, infecciosa o iatrogénica. Se presenta el caso de un paciente de 33 años, que cursó con una fístula broncobiliar secundaria a la derivación de la vía biliar percutánea por una lesión estenótica del confluente biliar, en quien ­por medio de un abordaje torácico y abdominal­ se practicó una lobectomía inferior por videotoracoscopia (Video-Assisted Thoracoscopy Surgery, VATS) y hepatectomía con reconstrucción de la vía biliar por laparotomía. Teniendo en cuenta lo inusual del caso, con pocos reportes en la literatura, se concluye la dificultad para establecer la posible etiología de las estenosis de la vía biliar en un paciente joven, sin poderse descartar la enfermedad maligna. Al hacer el diagnóstico, se debe tratar y corregir la causa; la cirugía sigue siendo el pilar del tratamiento y, con el advenimiento de la cirugía mínimamente invasiva, se puede hacer un manejo combinado para aprovechar los beneficios de la técnica, como se hizo en este caso

Bronchobiliary fistula is a rare entity in our environment and it is poorly described in the scientific literature. It is characterized by an abnormal communication between the bronchial tree and the biliary tract, and is associated with the presence of bile in the sputum (bilioptysis). According to its etiology, it may be secondary to a distal obstruction of the bile duct due to a benign, malignant, infectious, or iatrogenic pathology. We present the case of a 33-year-old patient who had a bronchobiliary fistula secondary to a percutaneous biliary tract bypass due to a stenotic lesion of the biliary confluent in whom an inferior lobectomy by video-assisted thoracoscopy surgery (VATS) was performed with hepatectomy with biliary tract reconstruction by laparotomy, a combined thoracic and abdominal approach. Given the low incidence of this type of cases and the scarce literature reports, our conclusion is that it is difficult to define the possible etiology of the bile duct stenosis in young patients, and that a malignant pathology cannot be ruled out. Once the diagnosis is established, the cause should be treated. Surgery remains the mainstay of treatment, and with the advent of minimally invasive surgery a combined type of management can be performed so as to take advantage of the benefits of this technology

Primer trasplante renal en Colombia en paciente con infección por VIH / First kidney transplant in Colombia in a patient with HIV infection

La infección por el virus de la inmunodeficiencia adquirida (VIH) ha aumentado su prevalencia a nivel mundial, la tercera parte de los pacientes desarrollan compromiso de la función renal y pueden llegar a requerir terapia de reemplazo renal. La terapia antirretroviral altamente efectiva (HAART) ha mejorado la supervivencia de los pacientes con dicha infección y ha motivado que esta población sea hoy considerada para ingresar a lista de trasplantes. Presentamos el caso de un paciente con enfermedad renal crónica secundaria a toxicidad por indinavir, quien permaneció durante cuatro años en hemodiálisis y recibe injerto renal de donante vivo, ha tenido seguimiento durante siete años con evolución favorable, sin rechazo, infecciones oportunistas ni complicaciones cardiovasculares, en manejo con terapia HAART logrando óptimo control virológico e inmunológico. La infección por VIH no es una contraindicación para recibir un trasplante renal y contribuye a mejorar calidad de vida y morbimortalidad en esta población. (Acta Med Colomb 2015; 40: 162-165).

Infection by human immunodeficiency virus (HIV) has increased its prevalence worldwide. One third of patients develop renal function involvement and might require renal replacement therapy. The highly active antiretroviral therapy (HAART) has improved survival of patients with this infection and this has motivated that this population be now considered for entering a transplant list. We report the case of a patient with chronic kidney disease secondary to toxicity by indinavir, who spent four years in hemodialysis and receives renal graft from living donor, has been followed up for 7 years with favorable evolution, without rejection, opportunistic infections or cardiovascular complications, and is being managed with HAART achieving optimal virological and immunological control. HIV infection is not a contraindication for renal transplantation and contributes to improving quality of life, morbidity and mortality in this population. (Acta Med Colomb 2015; 40: 162-165).

Costos de la atención postaborto en hospital es de Lima, Perú

Objetivos: Determinar el costo de atención de los abortos incompletos en los hospitales públicos y de abortos electivos en una institución privada. Diseño: Investigación prospectiva. Participantes: Mujeres con aborto incompleto. Metodología: En 120 mujeres con aborto incompleto complicado o no complicado en cuatro hospitales públicos de Lima y 40 mujeres en una clínica privada, se estableció el tiempo que demandó la atención, costo de personal, medicamentos, insumos, equipos y funcionamiento del hospital; igualmente el costo de bolsillo, transporte, cuidado de los niños y del hogar y el ingreso dejado de percibir. Todas firmaron un consentimiento informado. Principales medidas de resultados: Costos de atención. Resultados: La permanencia en tres hospitales, hasta el alta, por aborto incompleto no complicado fue alrededor de 6 horas, siendo mayor en uno de ellos por la normativa interna. En los cuatro hospitales, las complicaciones del aborto ameritaron una permanencia mayor. Las mujeres de aborto electivo requirieron la mitad del tiempo de aquellas con aborto incompleto no complicado en los hospitales. El costo total para la atención de abortos incompletos no complicados fue similar en los cuatro hospitales, entre US$ 110 y US$ 150; y para abortos complicados varió entre US$ 376 y US$ 858. El costo total de atención de los abortos electivos fue similar a la atención del aborto no complicado en los hospitales. Conclusiones: La permanencia de las mujeres con aborto no complicado fue relativamente corta en los hospitales. El costo de atención de los abortos complicados y no complicados demandó un monto importante para los hospitales y las propias mujeres. Los costos del aborto electivo estuvieron al alcance de las mujeres y ninguno de ellos evidenció complicación alguna.

Objectives: To determine care costs of incomplete abortions at public hospitals and elective abortions at a private institution. Design: Prospective study. Participants: Women with incomplete abortion. Methods: In 120 women with either complicated or non-complicated incomplete abortion in four public hospitals and 40 women in a private hospital, time for attention, cost of personal, drugs, materials, equipments and hospital functioning were determined; also pocket cost, transportation, children and home care and non-perceived income. All women signed informed consent. Main outcome measures: Care costs. Results: Hospital stay at three hospitals for non-complicated incomplete abortion until discharge was about 6 hours, more in one hospital because of internal norms. Abortion complications at the four hospitals required longer stay. Women with elective abortion required half the time of those with non-complicated incomplete abortion at hospitals. Total cost for non-complicated incomplete abortions care was similar at the four hospitals, between US$ 110 and US$ 150, and for complicated abortions between US$ 376 and US$ 858. Elective abortions care total cost was similar to that of non-complicated abortions care at hospitals. Conclusions: Non-complicated abortion stay of women was relatively short at hospitals. Complicated and non-complicated abortions care demanded an important cost for hospitals and women themselves. Elective abortion costs were accesible to every woman and none had complications.

Gastric leak after sleeve gastrectomy: analysis of its management.

BACKGROUND: Bariatric surgery is increasingly being performed and sleeve gastrectomy (SG) has proved to be effective and safe. Among its complications, leaks are the most serious and life threatening. METHODS: The focus of the study is nine patients who underwent a SG and developed a gastric leak after surgery. Our data were obtained from the clinical charts of the patients and through interviews with the surgeon who performed the index surgery. RESULTS: Eight patients underwent SG at outside institutions while one was operated at Clinica Alemana. Three patients developed symptoms within 5 days after surgery, while the rest were diagnosed after 10 days from the surgery. A CT scan was the method used to confirm the diagnosis in all patients. The three patients who had a leak detected during the immediate postoperative period underwent laparoscopic reoperation. Among the rest of the patients, percutaneous drainage was employed in one patient as the primary procedure while the other underwent surgical drainage. An esophageal endoluminal stent was employed in four patients. The leak closed in all patients with the healing time ranging from 21 to 240 days. CONCLUSIONS: Diagnosis of a leak after a SG required a greater index of suspicion in order to perform an early diagnosis. Sepsis control and nutritional support are the cornerstones of this treatment. Evolution is characterized by longer periods of time that are necessary in order to wait until the leak closes. Management must be tailored to each patient.

[Pancreatic VIPoma. Report of one case]. / VIPoma pancreático. Caso clínico.

Neuroendocrine tumors are uncommon, including VIPoma that produces vasoactive intestinal polypeptide. We report a 45-year-old female presenting with a history of diarrhea lasting three months. An abdominal CAT scan showed a solid tumor in the body of the pancreas. A fine needle aspiration biopsy of the tumor was compatible with a neuroendocrine tumor. The patient was subjected to a partial pancreatectomy, excising a 4 cm diameter tumor. The pathological study was compatible with a neuroendocrine carcinoma. There was no regional lymph node involvement. During the postoperative period the results of serum vasoactive intestinal polypeptide were received. These were 815.9 pg/ml before surgery and normalized after the operation.

VIPoma pancreático: Caso clínico / Pancreatic VIPoma: Report of one case

Neuroendocrine tumors are uncommon, including VIPoma that produces vasoactive intestinal polypeptide. We report a 45-year-old female presenting with a history of diarrhea lasting three months. An abdominal CAT scan showed a solid tumor in the body of the pancreas. A fine needle aspiration biopsy of the tumor was compatible with a neuroendocrine tumor. The patient was subjected to a partial pancreatectomy, excising a 4 cm diameter tumor. The pathological study was compatible with a neuroendocrine carcinoma. There was no regional lymph node involvement. During the postoperative period the results of serum vasoactive intestinal polypeptide were received. These were 815.9 pg/ml before surgery and normalized after the operation.

Revisión sistemática de la literatura: tratamiento del dolor central en esclerosis múltiple / Systematic review of the literature: tratment for central pain in multiple sclerosis

INTRODUCCIÓN: el dolor es un síntoma muy común en pacientes con Esclerosis Múltiple (EM), 42 al 65 por ciento de los enfermos lo presentan, y es calificado como el síntoma más severo entre el 8 y el 32 por ciento. OBJETIVO: evaluar la efectividad analgésica de las terapias farmacológicas en dolor central en pacientes con esclerosis múltiple (EM), con el fin de proporcionar recomendaciones basadas en la evidencia para la práctica clínica. METODOLOGÍA: se identificaron ensayos aleatorios sobre terapias farmacológicas del tratamiento del dolor central en pacientes con esclerosis múltiple, en Medline (1965-Septiembre de 2007), Embase (2000 - 2007), y Lilacs (1990-2007). RESULTADOS: la insuficiente calidad de los estudios disponibles justifica investigación adicional. CONCLUSIONES: se necesitan más estudios clínicos basados en la evidencia, donde arrojen mejores resultados de los tratamientos farmacológicos o no farmacológicos, con gran eficacia y efectividad y con menos efectos adversos, que evite el abandono de los tratamientos por parte de los pacientes garantizando mejor calidad de vida y desempeño de sus actividades de la vida cotidiana.

INTRODUCTION: pain is a very common symptom in patients with Multiple Sclerosis, 42 to 65% of patients present it. As the severe symptom, pain in these patients is between 8 to 32%. All central pain syndromes are presented by injury or dysfunction of the central nervous system, causing severe disability and deterioration in the quality of life of patients. OBJECTIVE: to assess the analgesic effectiveness of pharmacotherapies in central pain in patients with Multiple Sclerosis (MS), in order to provide evidence-based recommendations for clinical practice METHODOLOGY: search strategy: we identified randomized trials of pharmacotherapies treatment of central pain in patients with Multiple Sclerosis, MEDLINE (1965-September 2007), EMBASE (2000 to 2007), and Lilacs (1990-2007). Additional reports were identified from the reference lists of retrieved articles. Date of the most recent search: September 2007. Selection criteria: clinical studies randomized controlled double blind, duration of treatment equal to 1 or more days, compared to placebo or one or more pharmacological therapies in patients with Multiple Sclerosis, with a subjective evaluation of pain as primary or secondary results. Data collection and analysis: seven studies were considered eligible, of whom 4 are cannabinoids studies, a study with morphine IV, another with Lidocaina and Mexiletina and finally a combination of Lofepramina, Vitamin B12 and phenylalanine. RESULTS: the inadequate quality of available studies warrants further investigation. Intervention trials with pharmacological therapy (cannabinoids, morphine, lidocaine, mexiletine, lofepramina combination of Vitamin B12, L-phenylalanine) or other intervention undoubtedly require adequate sample sizes, designs, randomized controlled parallel group and clinically relevant outcome measures reliable, and sensitive. But in studies with cannabinoids, it is observed that it is better than placebo, and that in terms of clinical relevance, impact on patient functioning and quality of life related to health has a beneficial effect. CONCLUSIONS: more studies are needed based on clinical evidence, which yield the best results of non-pharmacological or pharmacological treatments, with high efficiency and effectiveness with fewer side effects, which prevent the abandonment of treatment by patients. And to ensure a better quality of life and performance of their daily life activities. Although the evidence that cannabis and single cannabinoids are effective in pain management, are not conclusive, this is enough to order clinical trials of cannabinoids that may provide more clinical information about the effectiveness and presentation of adverse effects. The poor quality of the available studies warranted further investigations.