Survey of chronic pain in Chile - prevalence and treatment, impact on mood, daily activities and quality of life.

Background and aims The prevalence of chronic non-cancer pain has not been specifically reported in Chile. Methods In order to assess its prevalence and impact, we designed a tool based on previously published survey studies. We analyzed a sample of 784 subjects to determine the prevalence of chronic non-cancer pain, with a maximum variability of 50%, a confidence interval (CI) of 95%, and an estimation error of 3.5%. Finally, a cross-sectional cell phone survey was conducted on a nationally representative probability sample of 865 subjects of over 18 years, in November 2013. The prevalence of chronic non-cancer pain was estimated by using expansion factors according to national projections by age group and gender, from the Chilean National Institute of Statistics for the year 2010. Results The estimated prevalence of chronic non-cancer pain was 32.1% (95% CI: 26.5-36.0). The respondents with chronic non-cancer pain presented the following results: 65.7% had moderate pain, and 20.8%, severe pain; 65.6% had somatic pain, 31.7% neuropathic pain, and 2.7% visceral pain. Approximately 70% reported they were receiving some kind of pharmacological treatment with certain frequency. In 64.9%, medication was prescribed by a physician. The prevalence of sick leave in workers was 30.22%, with a median duration of 14 days (interquartile range: 14; range: 1-60). Conclusions Chronic non-oncological pain occurs in 32% of Chilean adults. These figures provide the first measurement of chronic non-cancer pain in the Chilean population. Implications Chronic non-oncological pain impact as a public health problem is revealed, given the high prevalence found, and the elevated private and social costs involved.

Costs and consequences of chronic pain due to musculoskeletal disorders from a health system perspective in Chile.

BACKGROUND: Chronic pain is a prevalent and distressing condition caused by an unceasing pain lasting more than 3 months or a pain that persists beyond the normal healing time. There is evidence of inadequate management partly explained by the unawareness regarding the magnitude of the problem. OBJECTIVES: To estimate the annual expected costs and consequences of chronic pain caused by musculoskeletal diseases from the health system perspective in Chile. METHODS: A Markov cohort model was built to represent chronic pain and estimate expected costs and consequences over 1-year time horizon. Transition probabilities were obtained through expert elicitation. Consequences examined were: years lost to disability (YLD), depression, anxiety, and productivity losses. Direct health care costs were estimated using local sources. Probabilistic sensitivity analysis was performed to characterize second-order uncertainty. RESULTS: The annual expected cost due to musculoskeletal chronic pain was estimated in USD $1387.2 million, equivalent to 0.417% of the national GDP. Lower back pain and osteoarthritis of the knee explained the larger proportion of the total cost, 31.8% and 27.1%, respectively. Depression attributed to chronic pain is another important consequence accounting for USD $94 million (Bayesian credibility interval 95% $49.1-$156.26). Productivity losses were also important cost, although early retirement and presenteeism were not measured. Chronic pain causes 137,037 YLDs. CONCLUSION: Chronic pain is not only an important cause of disability but also responsible for high social and financial burden in Chile. Public health programs focused on managing chronic pain may decrease burden of disease and possibly reduce costs.

Validación primera encuesta chilena de dolor crónico no oncológico / Chilean validation survey of chronic non cancer pain

Existen escasos estudios sobre prevalencia de dolor crónico no oncológico en nuestro país. Objetivo: Realizar y presentar un instrumento validado que permita estimar la prevalencia y el impacto del dolor crónico no oncológico en Chile. Método: Se diseñó un instrumento basado en European Survey of Pain, Pain Survey U.S. Population, Canadian Chronic Pain Survey y la Encuesta Prevalencia de Dolor de la Federación Latinoamericana de Dolor. Se realizó una encuesta sobre teléfonos móviles, en un estudio piloto, en una muestra probabilística representativa a nivel nacional de 20 sujetos, mayores de 18 años de edad. Resultados: Se realizó un instrumento validado de 27 secciones, en el cual se determinó una prevalencia de 30,2 (IC95 por ciento: 22,5 – 37,4). Conclusiones: Presentamos un instrumento validado con el objetivo de determinar la prevalencia y las características clínicas del dolor crónico no oncológico a nivel chileno...

There are few studies on the prevalence of chronic non-cancer pain in our country. Aim of Investigation: To make and present a validated instrument that will allow to estimate the prevalence and impact of chronic non-cancer pain in Chile. Methods: We designed an instrument based on the European Survey of Pain, the US Population-Based Pain Survey, the Canadian Chronic Pain Survey and the Latin American Federation of Pain Prevalence Survey. A cross sectional cell phone survey was conducted in a pilot study in a nationally representative probability sample of 20 subjects, over 18 years old. Results: We made a validated instrument of 27 sections, the prevalence of chronic non-cancer pain was 30.2 (95 percent CI 22.5 - 37.4). Conclusions: We present a validated instrument to determine the prevalence and clinical characteristics of non-cancer chronic pain in Chilean people...

Parte I: dolor en niño / Pain in children: part I

La intención de este capítulo es mostrar las particularidades que el niño presenta frente al dolor: lo perjudicial que puede ser para la evolución de la enfermedad o la recuperación de un procedimiento, y que aún cuando hay muchas cosas que no sabemos, con lo que se conoce y se cuenta, debiera hacerse más que lo habitualmente se ve en una práctica clínica.

Actualizaciones en hipertermia maligna / Malignant hyperthermia: update

La hipertermia maligna es una miopía metabólica donde todos los anestésicos inhalatorios (excepto el N2O) y la succinilcolina son agentes gatillantes.La herencia en humanos es autosómica dominante. Se presenta en todas las edades y razas siendo más frecuente en niños y adultos jóvenes. La alteración fisiológica básica es un aumento desmedido del calcio intracelular muscular. La HM se puede desencadenar durante la anestesia o en el período de recuperación, siendo el aumento del CO2 el signo clínico más sensitivo y específico. El tratamiento precoz con drantoleno es efectivo.E l único test diagnóstico aceptado en la actualidad es el de contractura con halotanocafeína.

Evaluación y cuidados preoperatorios del paciente cardiopata / Preoperative care evaluation of cardiac patients

El cardiópata tiene mayor morbimortalidad quirúrgica debido a falla ventricular; insuficiencia coronaria; hipertensión; arritmias y enfermedad trombroembólica. La evaluación preoperatoria tiene como objetivos detectar la existencia de patología cardiovascular y precisar su naturaleza; prevenir las eventuales complicaciones y proponer la forma de tratarlas en caso de producirse. Especial importancia tiene la pesquisa de insuficiencia coronaria y de isquemia miocárdica; de insuficiencia cardíaca y de alteraciones del ritmo, así como su corrección o compensación. Igualmente importante es el cuidadoso control postoperatorio inmediato. Los riesgos operatorios son tanto mayores mientras más cercana es la intervención a un infarto previo del miocardio. La morbimortalidad es también mayor en los hipertensos severos; los portadores de estenosis aórtica y los pacientes con capacidad funcional III y IV