Supportive care needs among older Mexican adults with metastatic cancer.

INTRODUCTION: Supportive care needs may vary according to age. The purpose of this research is to describe and compare supportive care needs between older adults with metastatic cancer (age ≥ 65 years) and their younger counterparts. MATERIALS AND METHODS: We conducted a retrospective secondary analysis of a cohort of patients with newly diagnosed metastatic solid tumors. Supportive care needs were assessed at baseline and at a three-month follow-up. Patients were divided into two groups (aged ≥65/<65 years). Differences in clinical characteristics and supportive care needs were compared utilizing descriptive statistics. Multivariate logistic regression models were employed to identify patient characteristics associated with specific supportive care needs. RESULTS: Between 2018 and 2022, 375 patients were enrolled. Median age was 66 years (interquartile range 19-94). At baseline, older adults had a higher number of supportive care needs (4.8 vs. 4.2, p = 0.01) and were at higher risk of malnutrition (75 vs. 65%, p = 0.05). Increasing age (odds ratio [OR] 1.02 (95% confidence interval [CI] 1.0-1.04, p = 0.03) and an estimated life expectancy <6 months (OR 3.0, 95%CI 1.5-6.1; p < 0.01) were associated with higher odds of malnutrition, while a higher educational level was associated with decreased odds (OR 0.68, 95%CI 0.5-0.8; p < 0.01). At three-month follow-up, older adults still had a higher number of supportive care needs (3.8 vs.2.6, p < 0.01) and were more likely to have fatigue (62 vs. 47%, p = 0.02). An estimated life expectancy of <6 months was associated with increased odds of fatigue (OR 3.0, 95%CI 1.5-6.3; p < 0.01). DISCUSSION: Older adults reported significantly more supportive care needs, particularly risk of malnutrition and fatigue. This information can help in the creation of supportive care services tailored to the needs of older individuals.

Cincuenta años del Departamento de Medicina del Dolor y Paliativa del Instituto Nacional de Ciencias Médicas y Nutrición «Salvador Zubirán¼ / Fifty anniversary of the department of pain and palliative medicine at the Instituto Nacional de Ciencias Médicas y Nutrición «Salvador Zubirán¼

Resumen: Introducción: En México, la primera clínica especializada en el alivio del dolor fue fundada en 1972 por el Dr. Ramón De Lille Fuentes en el Instituto Nacional de Ciencias Médicas y Nutrición «Salvador Zubirán¼ (INCMNSZ). Material y métodos: Se realizó una búsqueda histórica documental y entrevistas a quienes han colaborado con el Departamento de Medicina del Dolor y Paliativa del INCMNSZ desde su fundación. Resultados: Nuestra visión es ofrecer atención del dolor, cuidados paliativos y apoyo continuo. Para ello, documentamos nuestra historia y los logros del departamento. Conclusiones: A 50 años de su fundación, el Departamento de Medicina del Dolor y Paliativa del INCMNSZ es un foro de desarrollo científico y de formación de capital humano con un enfoque humanista.

Abstract: Introduction: In Mexico, the first clinic specializing in pain relief was founded in 1972 by Dr. Ramón De Lille Fuentes at the Instituto Nacional de Ciencias Médicas y Nutrición «Salvador Zubirán¼ (INCMNSZ). Material and methods: A historical documentary search and interviews were carried out with those who have collaborated with the Department of Pain and Palliative Medicine of the INCMNSZ since its foundation. Results: Our vision is to offer pain management, palliative care, and ongoing support. To do this, we document the history and achievements of the department. Conclusions: 50 years after its foundation, the INCMNSZ Department of Pain and Palliative Medicine is a forum for scientific development and human capital training with a humanistic approach.

Prescribing Trends in Psychotropic Medications Among Outpatients of a Latin American Healthcare Setting: A Five-Year Retrospective Study.

Introduction Mental health problems affect millions worldwide, and the prescription of psychotropic drugs is increasing globally. The World Health Organization (WHO) has emphasized the need for proper monitoring of psychotropic drug prescriptions. This study aims to characterize and find trends in the prescription of psychotropics in a Latin American General Hospital. Methods The study analyzed the dispensation of psychotropic prescriptions to outpatients at three pharmacies in the central headquarters of Hospital Clínica Bíblica in San José, Costa Rica, from 2017 to 2021. Psychotropic drugs were classified by the Anatomical Therapeutic Chemical (ATC) code, and the amount of each medication dispensed was standardized using the defined daily dose per 10,000 population per day metric. Patients' ages were categorized into four groups: under 18 years, 18 to 39 years, 40 to 64 years, and 65 years and above. The prescriptions were categorized according to medical specialty. Regression analyses were performed to determine the significance of trends observed in the data Results A total of 5793 psychotropic prescriptions were recorded. The average age of the patients was 58 years. The total consumption of psychotropics decreased by 33.94% from 2017 to 2021, with the most significant decline until 2020. However, there was an increase in consumption in 2021. Clonazepam was the most consumed medication, followed by bromazepam and alprazolam, which was the sole drug to exhibit an escalation in usage between 2017 and 2021. Regression analysis showed that only alprazolam and zopiclone had statistically significant trends. The highest number of prescriptions was dispensed to patients aged between 40 and 64 years, followed by those aged over 65 years. Anxiolytics were also the most commonly prescribed group of drugs. General medicine (20.22%), psychiatry (19.95%), and internal medicine (12.73%) were the primary specialties that prescribed psychotropic; 38.6% of prescriptions were associated with the 10th decile of patients, and 44.9% of prescriptions were issued by the 10th decile of physicians.  Conclusion The consumption of psychotropic drugs decreased from 2017 to 2020 but increased in 2021, with alprazolam being the only drug that showed an increase in consumption throughout the entire period. General practitioners and psychiatrists were found to be the specialties that most commonly prescribe these medications. The study found significant trends only for the consumption of alprazolam and zopiclone and for prescription patterns among psychiatrists and internal medicine physicians.

Recomendaciones basadas en la evidencia sobre la nutrición e hidratación en los últimos días de vida / Evidence-based recommendations on nutrition and hydration in the last days of life

Resumen: Introducción: Los cuidados paliativos en México son contemplados como una necesidad en todos los niveles de atención. La nutrición e hidratación en estos enfermos hacia sus últimos días de vida es controversial. Objetivo: Identificar las recomendaciones basadas en la evidencia sobre la nutrición e hidratación en los últimos días de vida. Material y métodos: Se realizó una búsqueda documental sobre la nutrición e hidratación hacia el final de la vida tomando como marco temporal las últimas horas y/o los últimos días de vida del enfermo en el contexto hospitalario. Resultados: Con los criterios de búsqueda seleccionados se identificaron 83 documentos. No se encontraron metaanálisis. Existen dos revisiones sistematizadas de la literatura, un ensayo clínico, cuatro guías de práctica clínica, cuatro reportes de caso y 17 revisiones. Se desglosan los resultados relevantes de lo seleccionado. Conclusiones: Se identifica que existen controversias de fondo sobre la alimentación al final de la vida. Sobre la hidratación existe cierto consenso. Es indispensable contar con un nutriólogo dentro de los servicios de cuidados paliativos de la Nación.

Abstract: Introduction: Palliative care in Mexico is considered a necessity at all levels of care. Nutrition and hydration in these patients towards the last days of life is controversial. Objective: To identify evidence-based recommendations on nutrition and hydration in the last days of life. Material and methods: A documentary search on nutrition and hydration towards the end of life was carried out taking as a time frame the last hours and/or the last days of life of the patient in the hospital context. Results: With the selected search criteria, 83 documents were identified. No meta-analyses were found. There are two systematized literature reviews, one clinical trial, four clinical practice guidelines, four case reports and 17 reviews. The relevant results of the selected documents are broken down. Conclusions: It is identified that there are fundamental controversies about feeding at the end of life. On hydration there is some consensus. It is essential to have a nutritionist within the palliative care services of the Nation.

Evaluación de las características de la prescripción de opioides mayores otorgados por las farmacias de un Hospital General Latinoamericano / Evaluation of the prescription characteristics of major opioids dispensed by the pharmacies of a Latin American General Hospital

Resumen: Introducción: Los opioides se han utilizado para el alivio del dolor en diversos contextos. Su uso puede favorecer efectos indeseables. Actualmente los países industrializados viven una crisis de opioides. Objetivos: Caracterizar los opioides mayores despachados en términos de especialidad médica y de dosis total en miligramos equivalentes a morfina (MME) en un Hospital General Latinoamericano. Material y métodos: Se realizó un estudio retrospectivo y observacional de prescripciones de opioides mayores despachadas en las Farmacias de un Hospital General Latinoamericano entre el año 2017 y 2020. Se tomó información de la base de datos del Ministerio de Salud. Se excluyeron las recetas que contenían estupefacientes no opioides y fentanilo inyectable. Se realizó una estandarización a MME para analizar la distribución de la prescripción según médicos y pacientes. Resultados: La cantidad total de recetas despachadas correspondientes a opioides mayores fue de 5,366 prescripciones. La morfina inyectable fue el medicamento más prescrito (46%) y como principio activo obtuvo 54% de todas las recetas estudiadas (considerando todas las vías de administración). Medicina general prescribió la mayoría de las recetas con un 48%, lo que representó 42% del total de MME. Conclusiones: La morfina es el principio activo preferido por los médicos evaluados en este estudio, la vía de administración parenteral es la más utilizada. Medicina general es el área que más prescribe opioides. Es pertinente crear políticas educativas en materia de opioides; por ello, resulta conveniente caracterizar la prescripción de manera cualitativa considerando información como el diagnóstico y las dosis diarias utilizadas.

Abstract: Introduction: Opioids have been used for pain relief in various settings. Its use can promote undesirable effects. Industrialized countries are currently experiencing an opioid crisis. Objective: To characterize the prescription of major opioids considering the medical area that made the prescription and total dose in milligrams morphine equivalents (MME) at a general hospital in Latin America. Material and methods: A retrospective and observational study was carried out. The number of prescriptions for major opioids dispensed in the pharmacies of a general hospital in Latin America, between 2017 and 2020, were documented. Information was taken from the database of the Ministry of Health. Prescriptions containing non-opioid narcotic drugs and injectable Fentanyl were excluded. A standardization to MME was carried out to analyze the distribution of prescriptions. Results: The total number of prescriptions filled for major opioids was 5,366 prescriptions. Injectable morphine was the most prescribed drug (46%) and as an active principle it obtained 54% of all the prescriptions studied (considering all routes of administration). General medicine prescribed most prescriptions (48%), which represented 42% of the total MME. Conclusions: Morphine is the substance preferred by the doctors evaluated in this study, the parenteral route of administration is the most used. General medicine is the area that prescribes most of the opioids. It is pertinent to create educational policies on opioids; therefore, it is convenient to characterize the prescription qualitatively considering information such as the diagnosis and the daily doses used.

Cancer pain management in Mexico.

BACKGROUND: Pain control is an essential component of high-quality palliative care. Unfortunately, many low-income and middle-income countries lack an appropriate infrastructure to provide palliative care and suffer from a severe lack of access to opioid analgesics to alleviate pain from various conditions such as cancer. OBJECTIVES: We aimed to review the history and current status of cancer pain management in Mexico, a middle-income Latin American country. Our objective was to identify existing barriers to proper, effective opioid use, as well as provide practical recommendations for improvement. METHODS: Using a search of EBSCOhost database, PubMed and Google, we found official documents and peer-reviewed articles related to health legislation, opioid consumption, palliative care infrastructure and palliative care training in Mexico. RESULTS: Despite advances in palliative care and access to opioids in Mexico, there are still several barriers that undermine effective pain management, showing a major gap between policy and practice. Although Mexican legislation and guidelines include adequate palliative care and pain control as a right for all patients with cancer, the lack of adequate infrastructure and trained personnel severely hampers the implementation of these policies. Additionally, there are important barriers to prescribing opioids, many of which are related to attempts at reducing the consumption of recreational drugs. CONCLUSIONS: Although Mexico has made significant improvements in pain control and palliative care, much needs to be done. Expansion of drug availability, improvement of palliative care training, and constant oversight of regulations and guidelines will help to strengthen Mexico's palliative care services.

Tercera Cumbre Nacional de Delegados y Vocales de la Asociación Mexicana para Estudio y Tratamiento del Dolor (AMETD) / Third National Summit of Delegates and Vocals of the Mexican Association for the Study and Treatment of Pain (AMETD)

Resumen: La Asociación Mexicana para el Estudio y Tratamiento del Dolor nació en la década de los ochenta. Desde su fundación ha intervenido activamente en la educación continua de la nación y ha colaborado en la elaboración de documentos gubernamentales sobre diversos tópicos. En esta ocasión, durante la tercera reunión de delegados y vocales, se ponen a consideración diversas recomendaciones generales en materia de educación y regulación de opioides.

Abstract: The Mexican Association for the Study and Treatment of Pain was born in the eighties. Since its foundation, it has actively participated in the continuing education of the Nation and has collaborated in the preparation of government documents on various subjects. On this occasion, during the third meeting of delegates and members, various general recommendations regarding education and regulation of opioids are put for consideration.

Consideraciones analgésicas sobre el manejo del dolor agudo en el adulto mayor / Considerations for acute pain analgesic management in the elderly

Resumen: En las últimas décadas se ha registrado un aumento dramático en la esperanza de vida. La principal morbilidad de este grupo poblacional son las enfermedades crónico-degenerativas, las cuales frecuentemente se acompañan de dolor. No es de extrañarse que cada vez más pacientes ancianos sean intervenidos quirúrgicamente; hasta 62% de ellos reportan dolor agudo postoperatorio (DAPO) severo. El envejecimiento se asocia a una respuesta reducida al estímulo doloroso, fenómeno conocido como presbialgesia, lo cual se traduce en menores requerimientos analgésicos. Cuando el paciente anciano cuenta con demencia u otras alteraciones de la cognición se deberán utilizar escalas conductuales. Existen diversas condiciones fisiológicas en el anciano que lo hacen propenso a acumulación de fármacos y retraso en su eliminación. Además, existe un riesgo aumentado de interacciones farmacológicas por polifarmacia, hechos que se deberán tener en cuenta al abordar clínicamente el dolor en el paciente geriátrico. Los antiinflamatorios no esteroideos (AINE) son considerados de riesgo en ancianos frágiles por aumentar el riesgo de sangrado, sin mencionar el potencial daño en pacientes nefrópatas o con trastornos de la coagulación. El paracetamol es un analgésico noble a nivel gástrico, renal y cardiovascular. Es considerado primera línea en osteoartrosis degenerativa. Se sugiere no sobrepasar dos gramos al día en ancianos frágiles. Al utilizar analgésicos opioides se sugiere iniciar con la mínima dosis analgésica y escalar lentamente en caso de que el alivio del dolor lo requiera, evitando así efectos adversos.

Abstract: Over the last few decades the elderly population is growing by the second. Most of their illnesses are of the chronic degenerative type, many of which are very painful. Also, more and more elderly patients are requiring surgery for a number of reasons; 62% of these patients will experience severe postoperatory pain. Aging is associated with presbialgesia, which is a reduced response to a noxious stimule. When these patients have dementia or other cognitive impairment conductual scales such must be utilized. There elderly might be more sensitive to analgesic drugs due to various and unique physiological aspects. NSAIDs are considered high risk drugs in fragile elderly patients. Acetaminophen is a safe analgesic drug without many gastrointestinal, renal or cardiovascular secondary effects. Nevertheless, a fragile elderly patient should not receive more than 2 grams daily. When giving opioids, one should start with the minimum dose and titrate slowly when needed in order to avoid adverse effects.

Patient Navigation to Improve Early Access to Supportive Care for Patients with Advanced Cancer in Resource-Limited Settings: A Randomized Controlled Trial.

BACKGROUND: The early integration of supportive care in oncology improves patient-centered outcomes. However, data are lacking regarding how to achieve this in resource-limited settings. We studied whether patient navigation increased access to multidisciplinary supportive care among Mexican patients with advanced cancer. MATERIALS AND METHODS: This randomized controlled trial was conducted between August 2017 and April 2018 at a public hospital in Mexico City. Patients aged ≥18 years with metastatic tumors ≤6 weeks from diagnosis were randomized (1:1) to a patient navigation intervention or usual care. Patients randomized to patient navigation received personalized supportive care from a navigator and a multidisciplinary team. Patients randomized to usual care obtained supportive care referrals from treating oncologists. The primary outcome was the implementation of supportive care interventions at 12 weeks. Secondary outcomes included advance directive completion, supportive care needs, and quality of life. RESULTS: One hundred thirty-four patients were randomized: 67 to patient navigation and 67 to usual care. Supportive care interventions were provided to 74% of patients in the patient navigation arm versus 24% in usual care (difference 0.50, 95% confidence interval [CI] 0.34-0.62; p < .0001). In the patient navigation arm, 48% of eligible patients completed advance directives, compared with 0% in usual care (p < .0001). At 12 weeks, patients randomized to patient navigation had less moderate/severe pain (10% vs. 33%; difference 0.23, 95% CI 0.07-0.38; p = .006), without differences in quality of life between arms. CONCLUSION: Patient navigation improves access to early supportive care, advance care planning, and pain for patients with advanced cancer in resource-limited settings. IMPLICATIONS FOR PRACTICE: The early implementation of supportive care in oncology is recommended by international guidelines, but this might be difficult to achieve in resource-limited settings. This randomized clinical trial including 134 Mexican patients with advanced cancer demonstrates that a multidisciplinary patient navigation intervention can improve the early access to supportive and palliative care interventions, increase advance care planning, and reduce symptoms compared with usual oncologist-guided care alone. These results demonstrate that patient navigation represents a potentially useful solution to achieve the adequate implementation of supportive and palliative care in resource-limited settings globally.

Providing Supportive and Palliative Care Using Telemedicine for Patients with Advanced Cancer During the COVID-19 Pandemic in Mexico.

COVID-19 has overwhelmed the capacity of health care systems, limiting access to supportive and palliative care for patients with advanced cancer. Telemedicine has emerged as a tool to provide care continuity to patients while limiting the risk of contagion. However, implementing telemedicine in resource-limited settings is challenging. We report the results of a multidisciplinary patient-navigator-led telemedicine supportive care program in Mexico City. One-hundred sixty-three telemedicine interventions were provided to 45 patients (median age 68, 57% female). A quarter of the patients had less than or equal to elementary school education, and 15% lived in a rural area. The most common interventions were psychological care (33%), pain and symptom control (25%), and nutritional counseling (13%). Half of the interventions were provided by video conferencing. The most common patient-reported barrier was limited experience using communication technology. Our results demonstrate the feasibility of providing supportive and palliative care interventions using telemedicine in resource-limited settings.

The role of zinc in human health.

El zinc (Zn) es un oligoelemento esencial para muchas funciones biológicas, que incluyen desde la mineralización ósea hasta la transcripción genómica. El déficit en la ingesta de Zn produce alteraciones que en conjunto se han denominado síndrome de deficiencia de Zn. La ingesta diaria recomendada presenta un rango de 7.5 a 15 mg/día para hombres adultos y de 5.5 a 12 mg/día para mujeres adultas. En México, el déficit de Zn es un problema de salud pública, pues afecta a cerca de un cuarto de la población pediátrica nacional. Este documento presenta al lector una mirada global y regional sobre el problema que se aborda, y destaca la necesidad de generar líneas de investigación que aporten mayor información sobre el impacto de este micronutriente en la población mexicana.Zinc (Zn) is an essential trace element for many biological functions including bone mineralization and genomic ­transcription, among others. The set of clinical manifestations deriving from the deficiency of Zn intake are known as Zn deficit syndrome. Zn recommended dietary allowances ranges from 7.5 to 15 mg/day in adult man, and from 5.5 to 12 mg/day in adult females. In Mexico, the deficit of Zn is a public health problem affecting nearly a quarter of pediatric population. This document presents a global and regional overview of this problem, highlighting the need of further research related to the importance of this micronutrient in Mexican population.

Symptom Assessment and Early Access to Supportive and Palliative Care for Patients With Advanced Solid Tumors in Mexico.

BACKGROUND: Early specialized palliative care improves quality of life of patients with advanced cancer, and guidelines encourage its integration into standard oncology care. However, many patients fail to obtain timely palliative/supportive care evaluations, particularly in limited-resource settings. We aimed to determine the proportion of patients with advanced cancer who received an assessment of symptoms and were referred to supportive and palliative care services during the first year after diagnosis in a Mexican hospital. METHODS: Individuals with newly diagnosed advanced solid tumors and 1 year of follow-up at the oncology clinics in the Instituto Nacional de Ciencias Medicas y Nutricion Salvador Zubiran in Mexico City from October 2015 to April 2016 were included in this retrospective study. RESULTS: Seventy-seven patients were included. Forty-two (54.5%) were referred to the various supportive care services during the first year after diagnosis, and 23 (29.8%) were referred to the palliative care clinic. The most commonly assessed symptoms by oncologists were pain (77.9%), anorexia (74.0%), fatigue (68.8%), and nausea (55.8%), while depression/anxiety were evaluated in 10 (12.9%) patients. The oncologist offered to clarify treatment goals in 39 (50.6%) cases and evaluated the understanding of diagnosis/illness and prognosis in 22 (28.5%). CONCLUSION: Palliative and supportive care services were widely underutilized, which may be related to a lack of standardized symptom assessments and poor end-of-life communication. Novel strategies are needed to improve the implementation of tools for systematic symptom assessment and to optimize the integration of supportive care interventions into oncology care in developing countries.

Antecedentes de la medicina paliativa en México: educación continua en cuidados paliativos / Background of palliative medicine in Mexico: continuous paliative care education

Resumen: Objetivo: Dar a conocer el desarrollo de los cuidados paliativos en una nación de habla hispana. Método: Búsqueda documental y entrevista directa a médicos involucrados activamente en el desarrollo de los cuidados paliativos en México. Resultados: En la década de los 70, nacen las clínicas del dolor en México y el movimiento paliativo ve la luz una década después. No es sino hasta fechas recientes que la legislación de este país se ha desarrollado en forma satisfactoria para esta área médica. Conclusiones: México se sitúa dentro de los pocos países que cuentan con legislación acerca de los cuidados paliativos. El marco legal actual define de manera clara el proceder médico y paramédico e incluso forman parte los derechos sanitarios de sus habitantes.

Abstract: Aim: To share with the medical community the development of palliative care in an Spanish speaking country. Method: Documental research and direct interview to physicians actively involved in the development of palliative care in Mexico. Results: Pain clinics in were born in early seventies and the palliative care movement during the eighties. It is recently that the legislation in this nation favors palliative care. Conclusions: Mexico is now among those countries with a legislation that includes palliative care. The laws and legislation of that country define and guide those health care providers that interact with palliative patients, and also stablish palliative care as a health right for its habitants.

Propofol-Based Palliative Sedation to Treat Antipsychotic-Resistant Agitated Delirium.

Delirium is a common problem in terminally ill patients that is associated with significant distress and, hence, considered a palliative care emergency. The three subtypes of delirium are hyperactive, hypoactive, and mixed, depending on the level of psychomotor activity and arousal disturbance. When agitated delirium becomes refractory in the setting of imminent dying, the agitation may be so severe that palliative sedation (PS) is required. Palliative sedation involves the administration of sedative medications with the purpose of reducing level of consciousness for patients with refractory suffering in the setting of a terminal illness. Propofol is a sedative that has a short duration of action and a very rapid onset. These characteristics make it relatively easy to titrate. Reported doses range from 50 to 70 mg per hour. The authors present a case of antipsychotic-resistant agitated delirium treated with a propofol intravenous infusion.

Assessment of pain and other symptoms in Mexican patients with advanced illness.

Palliative care is an approach that improves the quality of life of patients and their families facing the problem associated with life-threatening illness, through the prevention and relief of suffering by means of early identification and impeccable assessment and treatment of pain and other problems, physical, psychosocial, and spiritual. During this stage, several symptoms appear and contribute to a decrement in the quality of life. We performed a retrospective study evaluating medical records of terminally ill patients who attended a specialized pain and palliative medicine service. The Edmonton Symptom Assessment Scale (ESAS) was used to document symptoms intensity. Data analysis was carried out at two times: the initial assessment and the last visit before death. We analyzed thirty-eight cases of which 58% were women (22 cases) and the mean age of the sample was 60.7 years (SD: 15.6). All cases had an oncologic disease classified as end-stage cancer and were considered as palliative patients. Symptom intensity was documented by the ESAS in two different moments: pain 3.7 (SD: 3.2) vs. 4.1 (SD: 3.4), nausea 1.4 (SD: 3.2) vs. 1.8 (SD: 3.3), depression 3.4 (SD: 3.4) vs. 4.3 (SD: 3.7), anxiety 3 (SD: 3.5) vs. 2.4 (SD: 3.6), weakness 4.8 (SD: 3.5) vs. 6.2 (SD: 3.6), dyspnea 1.1 (SD: 2.7) vs. 2.8 (SD: 3.4), anorexia 3.5 (SD: 3.7) vs. 4.7 (SD: 3.8), and somnolence 2.6 (SD: 3.5) vs. 4.9 (SD: 3.5). Statistical significance was found in weakness, dyspnea, and somnolence. We found the ESAS a useful tool for symptom assessment. In this study, we document the prevalence of symptoms at the end of life in a Spanish-speaking country. Physicians trained in pain and palliative medicine managed those symptoms, and we observed that symptoms maintained the same intensity. There is the possibility that the intervention made by those clinicians modified the symptomatic outcome in those patients. Evaluation of effective protocols for symptom management at the end of life is needed.

Evaluation of sleep quality in subjects with chronic nononcologic pain.

A survey conducted by the National Sleep Foundation found that 20% of Americans have sleep disorders and 45% experience chronic pain. Several authors evaluated the interrelationship between these functions using various instruments such the Pittsburgh Sleep Quality Index (PSQI) and identified that 34% of subjects in the general population have a poor quality of sleep, but there are few studies that assess the quality of sleep in patients with chronic pain of nonmalignant origin. We undertook this study to evaluate the quality of sleep using the PSQI in patients with chronic pain unrelated to cancer. We conducted a clinical, nonrandomized, uncontrolled, descriptive, and prospective study, applying the PSQI through a direct one-time interview to 311 subjects with chronic pain unrelated to cancer. According to the categorization of the PSQI between good and poor sleepers, 89% of the subjects were poor sleepers (n = 276). There are significant differences in pain intensity according to the categorization of the PSQI, with a higher intensity shown in the "poor sleepers" (analysis of variance [ANOVA], P = .030). Using a linear regression model to estimate the curve, a higher score is rated on the PSQI global score (ANOVA, P = .000, R(2) = .46) with the increase of the intensity of the pain. We conclude that "poor sleepers" or those who considered their sleep as "poor quality" have significantly higher pain intensity. This suggests that intensity of pain plays a role in evaluating the quality of sleep in the subjective perception of sleep and instruments that assess quality.

Practice guidelines for the management of low back pain. Consensus Group of Practice Parameters to Manage Low Back Pain.

It has been documented that pain in its diverse modalities is the most common cause of medical attention. In Mexico, an increase in its frequency has promoted its consideration in several health programs. On the other hand, inadequate pain management will cause severe physical, psychoaffective, and socioeconomic repercussions for patients, families, and public health services. Despite this panorama, there has not been an agreement to establish better diagnostic and therapeutic methods for the management of chronic pain. A consensus group was reunited and was integrated by medical experts from private and public institutions and from various states of the Mexican Republic. To assure the development of these practice guidelines, these experts had experience in the assessment and treatment of conditions causing pain. With the guidelines used by other consensus groups, meetings were held to analyze and discuss published literary evidence for the management of low back pain. The recommendations were classified according to their methodological strength. As a result of this meeting, consensus recommendations were based on evidence and operational conclusions of such proactive educational plans, institutional policies and diagnostic recommendations for pharmacological and nonpharmacological treatment in order for Mexican physicians to provide a better therapeutic approach to low back pain.