Labor del médico rehabilitador dentro de una Unidad Multidisciplinar del Dolor / The role of the rehabilitation doctor in a Multidisciplinary Pain Unit

Introducción. Las Unidades del Dolor tienden a estar formadas por un equipo multidisciplinar de especialistas. En 1947 Bonica, basándose en el éxito de una colaboración con un ortopeda, un neurocirujano y un psiquiatra estableció la primera clínica multidisciplinar del dolor. El objetivo del trabajo es describir la labor del médico rehabilitador en la Unidad del Dolor del Hospital 12 de Octubre. Material y método. Se describe el organigrama de trabajo del médico rehabilitador en una Unidad del Dolor y el proceso de evaluación y tratamiento que habitualmente lleva a cabo. También se ha realizado un análisis descriptivo de los pacientes que han sido atendidos durante 10 meses (noviembre 2004-agosto 2005). Resultados. Consiste en una colaboración un día por semana en la que los pacientes tras ser vistos por el equipo fijo de la Unidad reciben una valoración y tratamiento desde el punto de vista rehabilitador. Se valoraron 74 pacientes con una edad media de 59,9 años. El motivo de consulta principal fue el de dolor lumbar. Realizaron rehabilitación el 69 % y se recomendaron medidas ortoprotésicas al 46 %. El grado de satisfacción tras la visita con el médico rehabilitador de la Unidad fue bueno en el 54 % de los pacientes. Conclusiones. La experiencia de los distintos especialistas y una visión multidisciplinar del dolor ayudan a mejorar la atención y el tratamiento de nuestros pacientes. La presencia de un médico rehabilitador en una Unidad Multidisciplinar del Dolor enriquece la atención y las opciones terapéuticas de los pacientes con dolor crónico

Introduction. In a Chronic Pain Unit works a multidisciplinary equipment of specialist. In 1947, Bonica made the first multicisciplinary clinic of being based on the success of a collaboration with an orthopedics, a neurosurgerist and a psychiatrist. The objective of this work is to describe the work of the Rehabilitation doctor in the Unit of the Pain Hospital 12 de Octubre. Material and method. A description of the organizational chart of work of the rehabilitator doctor in a Unit of the Pain, and the process of evaluation and treatment has taken place that habitually carries out. Also a descriptive analysis of the patients has been made who have been taken care of during 10 months (November 2004-Agost 2005). Results. A day per week consists of a collaboration in which the patients after being seen by the stationary equipment of the Unit, receive a valuation an treatment from the rehabilitator point of view. 74 patients with an average age of 59,9 years valued themselves. The main reason for consultation was the one of lumbar pain. Of the valued patients they made rehabilitation 69 % and ortoprotésicas measures in 46 % of the cases were recommended. The degree of satisfaction after the visit with the rehabilitator doctor of the unit was good in 54 % of the patients. Conclusions. The experience of the differents specialist and the multidisciplinary viewpoint of the pain, help to improve the attention and treatment of our patients. We have shown how consultant rehabilitation doctor can be useful in a Pain Unit and improves the health care and the range of therapeutic options provided to patients with chronic pain

Intrathecal therapy: rationale, technique, clinical results.

In 35 patients a subcutaneously implanted injection port/reservoir was used to provide intrathecal morphine to relieve pain due to cancer. The reservoir offers an alternative to rather expensive devices. It can be used for repeated injections or for infusion. It is easy to locate and facilitates ambulatory treatment. The injections were carried out by members of the patient's family after they had been taught how to do it. Initially, doses of 0.25-0.5 mg of morphine resulted in pain relief for 14 to 24 hours. After 5 weeks of treatment morphine requirements increased to 0.75-2 mg. Side-effects were minimal, and three delayed CSF fistula, two of them confirmed by isotope tracking with Tc99m, closed spontaneously.

Intraventricular morphine for intractable cancer pain: rationale, methods, clinical results.

The experience with the administration of intraventricular morphine for the control of malignant pain in 197 patients is analyzed. Small doses of morphine injected via a ventricular reservoir provided satisfactory control of otherwise intractable pain in terminal cancer-patients. Complete analgesia together with a favourable behavioral response was obtained without noticeable neurological changes or side-effects annoying or severe enough for the patients to discontinue therapy. Tolerance was much less marked than with parenteral opiates. Chronic intraventricular therapy can be safely performed on an outpatient basis by injecting the opiate once or twice a day. The method may be improved by using refillable continuous-infusion devices and new drugs, able to retain the analgesic effects of morphine while eliminating the unwanted ones.

Intraventricular morphine for control of pain in terminal cancer patients.

Satisfactory control of intractable pain has been achieved in 17 terminal cancer patients by injecting small doses of morphine into the lateral cerebral ventricle via an Ommaya reservoir. Pain relief together with a favorable behavioral response was obtained without interference with other sensory modalities, noticeable physical changes, or side effects annoying or severe enough for the patient to discontinue therapy. Eleven patients developed tolerance, but this phenomenon does not require withdrawal of treatment. Chronic intraventricular morphine administration can be safely performed on an outpatient basis, and results in control of midline, bilateral, and diffuse pain associated with orofacial and disseminated cancer. However, this experience is preliminary and further clinical trials are needed to determine the place of this method of therapy in the management of chronic pain.