Advances and Pitfalls of Specialized Pain Care through Public and Private Health Care Providers in Catalonia and the Balearic Islands: A Physician's Survey.

Optimal diagnosis and treatment of pain require a multidisciplinary approach that demands considerable coordination and forethought. A cross-sectional physician survey based on an online questionnaire was carried out to assess the adoption of multidisciplinary working patterns, compare the public and private models, and provide an update on the resources and organization of specialized pain care in Catalonia and the Balearic Islands. Active pain practitioners identified through the Catalan Health Service and Pain Society databases were sent an invitation in December 2020. Of the 321 physicians contacted, 91 (28.3%) answered and 71 provided complete responses (commonly anesthesiologists, representing 92 different sites; some worked at public and private sites). Up to 78.7% reported working in pain management teams, but only 53.5% were regularly involved in teaching or research activities. Thus, the proportion of multidisciplinary sites lies somewhere in-between. Median wait times were significantly shorter and within the recommended standards in private practices (e.g., 15 vs. 90 days in public practices for noncancer patients). In turn, private practices were slightly less staffed and equipped, albeit the differences did not reach statistical significance. Respondents made a median of 530 regular and 30 emergency visits per year, of which 190 involved interventional procedures. They offered a wide range of pharmacological and interventional therapies, although psychotherapy and the most sophisticated procedures were only available in ≤50% of sites. Pain clinicians and facilities are reasonably available in Catalonia, but barely more than half are truly multidisciplinary. Public and private practices differ in some aspects; the latter seems to be more accessible, but it is restricted to patients who can afford it. Compared to previous reports, this update shows both advances and outstanding issues. Multidisciplinary care could be expanded by incorporating more psychologists and some interventional procedures. The public practices should reduce wait times.

Estudio cuasi experimental sobre la efectividad de la musicoterapia para reducir la ansiedad ante una técnica intervencionista en la unidad del dolor / Quasi-experimental study on effectiveness of music therapy to reduce anxiety before an interventional technique in the pain unit

OBJETIVOS: Valorar la eficacia de la musicoterapia en la disminución de la ansiedad en pacientes a los que se les realiza técnica intervencionista (TI) en la Unidad del Dolor (UD) del Hospital Universitario Sagrat Cor de Barcelona. MATERIAL Y MÉTODO: Estudio cuasi experimental con grupo control, prospectivo, pre y postintervención, transversal, no aleatorizado. Aprobado por el Comité Ético de Investigación IDC Salud Catalunya. Población estudio: pacientes programados para realización de TI en la UD. Criterios inclusión: > 18 años de edad. Indicación de TI. Criterios exclusión: trastorno psiquiátrico, incapacidad contestar variables de estudio. Grupo intervención: se ha realizado la TI reproduciéndose aleatoriamente la música elegida, libre de contaminación acústica. Grupo control: se ha realizado la TI sin musicoterapia. Se ha empleado la escala visual análoga modificada como instrumento de medida para valorar el nivel de ansiedad. RESULTADOS: 80 pacientes (71,6 % mujeres, media de edad 66,7 [SD 14] años, 49,4 % estudios medios, 64,2 % pensionistas). El 60,5 % no realiza tratamiento con ansiolíticos. El 59 % presenta lumborradiculalgia, se les realiza bloqueo epidural caudal. Al 33,3 % se les realiza técnica intervencionista por primera vez. En el grupo control el valor de EVA intra es de 5,83 (SD 3,2) y en el grupo de musicoterapia de 5,0 (SD 2,2), esta diferencia no es estadísticamente significativa (F = 1,614, p = 0,208). En el valor de EVA postintervención sucede lo mismo. En el grupo control el valor de EVA post es de 3,7 (SD 3,3) y en el grupo de musicoterapia de 3,1 (SD 2,4); esta diferencia no es estadísticamente significativa (F = 0,755, p = 0,387). En el grupo control el valor de la escala visual analógica intra es de 4,3 (SD 3,1) y en el grupo de musicoterapia de 3,0 (SD 2,0), esta diferencia sí es estadísticamente significativa (F = 4,83, p = 0,031). En el grupo control el valor de la escala visual analógica post es de 2,7 (SD 2,8) y en el grupo de musicoterapia de 1,3 (SD 1,5); esta diferencia también es estadísticamente significativa (F = 7,427, p = 0,008). El 81,5 % considera que ha recibido suficiente información sobre la técnica intervencionista y el 18,5 % están satisfechos. El 95,1 % considera que los profesionales le han aportado confianza y seguridad y el 4,9 % restante se consideran satisfechos. De los que han valorado (40 pacientes) si la música ha creado un ambiente relajado el 80 % se consideran muy satisfechos y el 20 % restante satisfechos. CONCLUSIÓN: Aunque el dolor no se ve mejorado significativamente en el grupo intervencionista sí lo hace la ansiedad tanto en la fase intra como en la post TI. Los pacientes se sienten muy satisfechos sobre la información recibida y consideran muy satisfactoria la confianza y seguridad que les aportan los profesionales. Además, el grupo de musicoterapia considera, en general, muy satisfactorio el ambiente relajado que les crea la música. La musicoterapia es una excelente herramienta terapéutica, fácil de usar, accesible y económica, que puede utilizarse como coadyuvante en las TI en la UD

OBJECTIVE: To assess the efficacy of music therapy in reducing anxiety in patients undergoing interventional technique (IT) in the Pain Unit (UD) of the University Hospital Sagrat Cor in Barcelona. MATERIAL AND METHOD: Quasi-experimental study with a control group, prospective, pre- and post-intervention, transversal, non-randomized. Approved by the Research Ethics Committee IDC Salud Catalunya. Study population: patients scheduled to perform IT in the UD. Inclusion criteria: > 18 years old. IT indication. Exclusion criteria: psychiatric disorder, inability to answer study variables. Intervention group: IT has been performed by randomly playing the chosen music, free of noise pollution. Control group: IT has been performed without music therapy. The modified analog visual scale has been used as a measuring instrument to assess the level of anxiety. RESULTS: 80 patients (71.6 % women, mean age 66.7 (SD 14) years, 49.4 % average studies, 64.2 % pensioners). 60.5 % do not perform treatment with anxiolytics. 59 % have low back pain, caudal epidural block is performed. 33.3 % underwent interventional technique for the first time. In the control group the value of intra VAS is 5.83 (SD 3.2) and in the music therapy group 5.0 (SD 2.2), this difference is not statistically significant (F = 1.614, p = 0.208). The same happens in the value of post-intervention EVA. In the control group the value of post VAS is 3.7 (SD 3.3) and in the music therapy group 3.1 (SD 2.4), this difference is not statistically significant (F = 0.755, p = 0.387). In the control group the value of the intra analog visual scale is 4.3 (SD 3.1) and in the music therapy group 3.0 (SD 2.0), this difference is statistically significant (F = 4, 83 p = 0.031). In the control group the value of the post analog visual scale is 2.7 (SD 2.8) and in the music therapy group 1.3 (SD 1.5), this difference is also statistically significant (F = 7.427, p = 0.008). 81.5 % consider that they have received enough information about the interventionist technique and 18.5 % are satisfied. 95.1 % consider that the professionals have given him confidence and security and the remaining 4.9 % are considered satisfied. Of those who have assessed (40 patients) if music has created a relaxed atmosphere, 80% are considered very satisfied and the remaining 20 % satisfied. CONCLUSION: Although pain is not significantly improved in the interventionist group, anxiety does in both the intra and post-IT phases. Patients feel very satisfied about the information received and consider the confidence and security provided by professionals very satisfactory. In addition, the music therapy group considers, in general, the relaxed atmosphere created by the music. Music therapy is an excellent therapeutic tool, easy to use, accessible and economical, which can be used as an adjunct in IT in the UD