Estudio de intervención sobre el dolor subagudo y crónico en atención primaria: una aproximación a la efectividad de la terapia neural / Intervention study on subacute and chronic pain in Primary Care: an approach to the effectiveness of neural therapy

ObjetivoEvaluar la efectividad de la TN para disminuir el dolor y el consumo de fármacos.DiseñoEstudio de intervención antes-después.EmplazamientoCAP de Llefià en Badalona (Barcelona).Participantes82 pacientes con edades entre 25 y 85 años que presentaban dolor que no remitió después de al menos un mes de evolución.Mediciones principalesSe recogieron datos para la valoración de las variaciones del dolor y sobre el consumo de fármacos antes de la intervención y después a las 2 semanas, 3 meses y 6 meses mediante entrevista personal y para el dolor mediante la escala visual analógica (EVA).ResultadosEVA media preintervención: 7,94 (DE: 1,68), EVA media a las 2 semanas 4,63 (DE: 2,79), a los 3 meses 3,74 (DE: 3,17) y a los 6 meses 3,48 (DE: 3,27) (p<0,001 en las 3 comparaciones, mediante test de Wilcoxon). En cuanto al consumo de fármacos después de la intervención, un 74,4% de los pacientes lo redujeron a las 2 semanas, un 76,8% lo redujeron a los 3 meses y un 80% a los 6 meses.ConclusionesLa TN puede ser eficaz en disminuir el dolor así como el consumo de fármacos. Faltarían ensayos clínicos que lo confirmaran(AU)

ObjectiveTo evaluate the effectiveness of NT in reducing pain and minimising use of analgesics in patients.DesignBefore and after intervention study.SettingLlefià Primary Health Care centre in Badalona (Barcelona).ParticipantsEighty-two patients between the ages of 25 and 85 years old, who suffered pain that did not disappear after a month.Main measurementsData was collected to evaluate any change in pain and the use of analgesics in patients before intervention and then afterwards, at 2 weeks, 3 months and 6 months. This was conducted by means of interviews and use of the Visual Analogue Pain Scale (VAS).ResultsMean VAS pre-treatment: 7.94 (SD: 1.68), mean VAS after two weeks 4.63 (SD: 2.79), after 3 months 3.73 (SD: 3.17), and after 6 months 3.48 (SD: 3,27) (P<.001 in the 3 comparisons, using the Wilcoxon-test for matched data). As regards analgesic use after treatment, 74.4% of patients reduced it after 2 weeks, 76.8% after 3 months and 80% after 6 months.ConclusionsNeural therapy can be effective in reducing pain, as well as the use of analgesics. Further clinical trials would be needed to confirm this assertion(AU)

[Intervention study on subacute and chronic pain in primary care: an approach to the effectiveness of neural therapy]. / Estudio de intervención sobre el dolor subagudo y crónico en atención primaria: una aproximación a la efectividad de la terapia neural.

OBJECTIVE: To evaluate the effectiveness of NT in reducing pain and minimising use of analgesics in patients. DESIGN: Before and after intervention study. SETTING: Llefià Primary Health Care centre in Badalona (Barcelona). PARTICIPANTS: Eighty-two patients between the ages of 25 and 85 years old, who suffered pain that did not disappear after a month. MAIN MEASUREMENTS: Data was collected to evaluate any change in pain and the use of analgesics in patients before intervention and then afterwards, at 2 weeks, 3 months and 6 months. This was conducted by means of interviews and use of the Visual Analogue Pain Scale (VAS). RESULTS: Mean VAS pre-treatment: 7.94 (SD: 1.68), mean VAS after two weeks 4.63 (SD: 2.79), after 3 months 3.73 (SD: 3.17), and after 6 months 3.48 (SD: 3,27) (P<.001 in the 3 comparisons, using the Wilcoxon-test for matched data). As regards analgesic use after treatment, 74.4% of patients reduced it after 2 weeks, 76.8% after 3 months and 80% after 6 months. CONCLUSIONS: Neural therapy can be effective in reducing pain, as well as the use of analgesics. Further clinical trials would be needed to confirm this assertion.

Criterios de derivación en hiperplasia benigna de próstata para atención primaria / Referral criteria for benign prostatic hyperplasia in primary care

La hiperplasia benigna de próstata (HPB) es una enfermedad con alta prevalencia entre los varones de más de 50 años que requiere una continuidad asistencial entre los 2 niveles existentes en nuestro país, el de atención primaria (AP) y el de atención especializada; motivo por el que era necesario consensuar unos criterios de derivación o de continuidad que sirvan de orientación a ambos colectivos. La historia clínica del paciente, el Índice Internacional de Síntomas Prostáticos (IPSS, International Prostate Symptom Score), el tacto rectal y el antígeno prostático específico (PSA, prostate-specific antigen) son herramientas accesibles en el ámbito de la AP que permiten un diagnóstico adecuado de la HBP. Conscientes de tal necesidad, las sociedades científicas de atención primaria (Sociedad Española de Médicos de Atención Primaria [SEMERGEN], Sociedad Española de Medicina General [SEMG] y Sociedad Española de Medicina de Familia y Comunitaria [semFYC]) y la Asociación Española de Urología (AEU) elaboraron este documento de consenso. A los pacientes con IPSS<8 se los deberá mantener en vigilancia y evaluar anualmente; en los pacientes con IPSS 8-20, si el tamaño de la próstata es pequeño, se recomienda el tratamiento con bloqueadores alfa y evaluación al primer y tercer mes, si el tamaño de la próstata es grande se recomienda el tratamiento con bloqueadores alfa o inhibidores de la 5-alfa-reductasa y evaluación al tercery sexto mes, y en el caso de pacientes con próstata grande y PSA 41,5 ng/ml se recomienda el tratamiento combinado y la evaluación al primer y sexto mes. En este documento se establecen unos criterios de derivación al urólogo claros, que facilitan el tratamiento de este tipo de pacientes. Se derivarán al urólogo aquellos pacientes con HBP que no presenten mejoría al tercer mes de tratamiento con bloqueadores alfa, o al sexto mes de tratamiento con inhibidores de la 5-alfa-reductasa(AU)

Se derivarán también los pacientes con síntomas del tracto urinario inferior en los que se observe algún hallazgo patológico durante el tacto rectal, IPSS >20, PSA >10 ng/ml o PSA >4 ng/ml y PSA libre <20% o pacientes con edades < 50 años y sospecha de HBP, así como aquellos pacientes con alguna complicación urológica(AU)

Benign prostatic hyperplasia (BPH) is a high prevalence condition in men over 50 years that requires continued assistance between primary care and urology. Therefore, consensus around common referral criteria was needed to guide and support both levels. Medical history, symptom assessment with International Prostate Symptom Score (IPSS) questionnaire, digital rectal examination and prostate-specific antigen (PSA) measurement are diagnostic tests available for general practitioners that allow setting a correct BPH diagnose. Patients with an IPSS<8 should be monitored by evaluating them annually. Treatment with α-blockers and an evaluation at the first and third month is recommended in patients with an IPSS 8-20 and if the prostate is small, if the prostate size is large treatment with α-blockers or 5α-reductase inhibitors and evaluation at the third and six month is recommended, and in patients with a large prostate and a PSA >1.5ng/ml combined treatment and evaluation at the first and sixth month is recommended. Some clear criteria for referral to urology are established in this document, which help in the management of these patients. Those patients with BPH who do not show any improvement at the third month of treatment with α-blockers, or the sixth month with 5α-reductase inhibitors, will be referred to urology. Patients will also be referred to urology if they have lower urinary tract symptoms, a pathological finding during rectal examination, IPSS>20, PSA>10ng/ml or PSA>4ng/ml and free PSA<20% or if they are <50 years with suspected BHP, or if they have any urological complication(AU)

[Referral criteria for benign prostatic hyperplasia in primary care]. / Criterios de derivación en hiperplasia benigna de próstata para atención primaria.

Benign prostatic hyperplasia (BPH) is a high prevalence condition in men over 50 years that requires continued assistance between primary care and urology. Therefore, consensus around common referral criteria was needed to guide and support both levels. Medical history, symptom assessment with International Prostate Symptom Score (IPSS) questionnaire, digital rectal examination and prostate-specific antigen (PSA) measurement are diagnostic tests available for general practitioners that allow setting a correct BPH diagnose. Patients with an IPSS<8 should be monitored by evaluating them annually. Treatment with alpha-blockers and an evaluation at the first and third month is recommended in patients with an IPSS 8-20 and if the prostate is small, if the prostate size is large treatment with alpha-blockers or 5alpha-reductase inhibitors and evaluation at the third and six month is recommended, and in patients with a large prostate and a PSA >1.5 ng/ml combined treatment and evaluation at the first and sixth month is recommended. Some clear criteria for referral to urology are established in this document, which help in the management of these patients. Those patients with BPH who do not show any improvement at the third month of treatment with alpha-blockers, or the sixth month with 5alpha-reductase inhibitors, will be referred to urology. Patients will also be referred to urology if they have lower urinary tract symptoms, a pathological finding during rectal examination, IPSS>20, PSA>10 ng/ml or PSA>4 ng/ml and free PSA<20% or if they are <50 years with suspected BHP, or if they have any urological complication.