Cancer-Related Pain Management in Suitable Intrathecal Therapy Candidates: A Spanish Multidisciplinary Expert Consensus.

A consensus is needed among healthcare professionals involved in easing oncological pain in patients who are suitable candidates for intrathecal therapy. A Delphi consultation was conducted, guided by a multidisciplinary scientific committee. The 18-item study questionnaire was designed based on a literature review together with a discussion group. The first-round questionnaire assessed experts' opinion of the current general practice, as well as their recommendation and treatment feasibility in the near future (2-3-year period) using a 9-point Likert scale. Items for which consensus was not achieved were included in a second round. Consensus was defined as ≥75% agreement (1-3 or 7-9). A total of 67 panelists (response rate: 63.2%) and 62 (92.5%) answered the first and second Delphi rounds, respectively. The participants were healthcare professionals from multiple medical disciplines who had an average of 17.6 (7.8) years of professional experience. A consensus was achieved on the recommendations (100%). The actions considered feasible to implement in the short term included effective multidisciplinary coordination, improvement in communication among the parties, and an assessment of patient satisfaction. Efforts should focus on overcoming the barriers identified, eventually leading to the provision of more comprehensive care and consideration of the patient's perspective.

Incidencia del síndrome posmastectomía. Análisis retrospectivo / Incidence of postmastectomy pain syndrome. Retrospective analysis

INTRODUCCIÓN: El síndrome de dolor posmastectomía (SDPM) aparece recogido en la nueva clasificación ICD-11 (International Classification of Diseases 11th Revision) como un subgrupo de dolor crónico posquirúrgico. Waltho y Rockwell han consensuado recientemente en un artículo de revisión lo que ellos denominan síndrome de dolor poscirugía mamaria (estos criterios han sido publicados en nuestra lengua en una carta al Director en la RESED), que describen esta situación como un dolor que se produce después de cualquier cirugía de mama; es de, al menos, intensidad moderada, presenta características neuropáticas, se localiza en la mama, pared torácica, axila o brazo ipsilateral, tiene una duración mínima de 6 meses, ocurre al menos el 50 % del tiempo y puede ser exacerbado por los movimientos de la cintura escapular. Es probablemente secundario a una lesión del nervio intercostobraquial o intercostales durante la disección a nivel axilar, lo que explica las características neuropáticas de este dolor. La incidencia documentada de SDPM varía según las publicaciones entre un 11 y un 57 %, bajando a un 5-10 % en caso de que sea severo, destacando que hasta el 65 % de los casos presentan características neuropáticas. El objetivo primario de este trabajo es determinar la frecuencia y la intensidad de la incidencia del SDPM y el secundario identificar posibles factores de riesgo para su desarrollo. MATERIA Y MÉTODOS: Se realizó un análisis retrospectivo de todas las mastectomías parciales o totales con o sin vaciamiento ganglionar realizadas entre el 1 de enero de 2017 y el 31 de diciembre 2017. RESULTADOS: De los 119 pacientes analizados, 30 pacientes refirieron dolor (25,2 %). La intensidad fue leve en 24 pacientes, moderado en 4 y severo en 2. No hubo relación entre el riesgo de dolor crónico y cualquiera de las variables analizadas. DISCUSIÓN: En nuestra opinión, parece necesario realizar nuevos estudios prospectivos que incluyan una definición consensuada del SDPM para evaluar los posibles factores de riesgo que afecten tanto en incidencia, intensidad e impacto en la calidad de vida de nuestros pacientes

INTRODUCTION: The posmastectomy pain syndrome (PMPS) is included in the new ICD-11 (International Classification of Diseases 11th Revision) classification under the postsurgical pain syndrome subset. Waltho and Rockwell have recently consensuated what they call post breast surgery pain syndrome (PBSPS) and conclude that a complete definition of PBSPS is pain that occurs after any breast surgery; is of at least moderate severity; possesses neuropathic qualities; is located in the ipsilateral breast/chest wall, axilla, and/or arm; lasts at least 6 months; occurs at least 50 % of the time; and may be exacerbated by movements of the shoulder girdle. The published incidence of PMPS varies between 11-57 % according to different sources. The incidence lowers to 5-10 % when the pain is judged severe. Up to the 65 % of the patients present neuropathic characteristics. The aim of this article is to primary to determine the frequency and intensity of the incidence of, and seconddly to elucidate possible risk factors to influence its appearance. MATERIAL AND METHOD: A retrospective analysis, of all partial or total mastectomies with or without axillary nodal resection, performed between January the 1st 2017 December 31st 2017, was carried out. RESULTS: A total number 119 patients were studied, 30 of which (25,2 %) declared to feel pain. The intensity was low in 24 patients, moderate in 4 and severe in 2. No relationship was found between the appearance of chronic pain and any of the variables studied. DISCUSSION: We judge necessary to perform new prospective studies which include a consensuated definition of PMPS to clearly elucidate possible risk factors that can contribute either to the incidence, intensity or impact in quality of life of our patients