DOLOR CRÓNICO EN CHILE

Physical activity level and physical fitness in subjects with chronic musculoskeletal pain: a cross-sectional study

Background

Low physical activity (PA) levels and low physical fitness (PF) have been reported in subjects with temporality-based chronic pain; however, it is unknown whether there are differences in subjects with nociplastic pain (NP) compared with subjects with non-nociplastic pain (NNP).

Objective

The aim was to compare the levels of PA and PF in patients with chronic, nociplastic, and non-nociplastic musculoskeletal pain.

Methods

This is an analytical, cross-sectional study. The sample comprised 30 patients receiving ambulatory physiotherapy treatment. Pain was classified as NP or NNP according to the International Association for the Study of Pain categorization system. The PA level was measured with the International Physical Activity Questionnaire-Short Form, and the PF level was measured with the hand grip strength test (HGS) to assess upper limb strength, the five Repetition Sit-to-Stand Test (5R-SRTS) to assess lower limb strength and power, and the YMCA 3 Min Step Test (YMCA-3MST) to estimate peak VO2. The results were compared with independent samples t-tests (with p < 0.05 considered significant). Cohen's d was calculated to determine the effect size.

Results

The NP group reported a significantly lower PA level than the NNP group, specifically the vigorous PA (p = 0.0009), moderate PA (p = 0.0002), and total PA (p = 0.005) dimensions. The NP group also showed significantly lower 5R-STS (p = 0.000) and HGS (p = 0.002) results compared with the NNP group. There were no significant differences in the YMCA-3MST between the NP and NNP groups (p = 0.635).

Conclusion

It is possible that the neurophysiological and neuromuscular changes related to NP are associated with a reduced ability to perform vigorous PA. Clinicians should identify the presence of NP comorbidities in conjunction with the diagnosis when establishing the therapeutic goals.

Integrating Noncancer Chronic Pain to Multimorbidity: A Real Practice Challenge in Chile

Chronic noncancer pain (CNCP) is, and continues to be, a global problem that affects people with multimorbidity. The objective is to comment on the gap in Chile in integrating multimorbidity and CNCP in the real practice context despite the advances in public policies and local evidence revealed. Therefore, a pilot is responding to this problem by implementing an approach to incorporate into a multimorbidity comprehensive approach the assessment of CNCP and adding nonmedical services. It is expected to evaluate its impact on the performance of the health system, as well as on people.

Cost analysis of chronic pain due to musculoskeletal disorders in Chile

The magnitude of the cost of chronic pain has been a matter of concern in many countries worldwide. The high prevalence, the cost it implies for the health system, productivity, and absenteeism need to be addressed urgently. Studies have begun describing this problem in Chile, but there is still a debt in highlighting its importance and urgency on contributing to chronic pain financial coverage. This study objective is to estimate the expected cost of chronic pain and its related musculoskeletal diseases in the Chilean adult population. We conducted a mathematical decision model exercise, Markov Model, to estimate costs and consequences. Patients were classified into severe, moderate, and mild pain groups, restricted to five diseases: knee osteoarthritis, hip osteoarthritis, lower back pain, shoulder pain, and fibromyalgia. Data analysis considered a set of transition probabilities to estimate the total cost, sick leave payment, and productivity losses. Results show that the total annual cost for chronic pain in Chile is USD 943,413,490, corresponding an 80% to the five diseases studied. The highest costs are related to therapeutic management, followed by productivity losses and sick leave days. Low back pain and fibromyalgia are both the costlier chronic pain-related musculoskeletal diseases. We can conclude that the magnitude of the cost in our country's approach to chronic pain is related to increased productivity losses and sick leave payments. Incorporating actions to ensure access and financial coverage and new care strategies that reorganize care delivery to more integrated and comprehensive care could potentially impact costs in both patients and the health system. Finally, the impact of the COVID-19 pandemic will probably deepen even more this problem.

The Effect of Sleep Quality on Pain in Chilean Individuals with Musculoskeletal Disorders

Poor sleep quality (SQ) negatively affects pain associated with musculoskeletal disorders (MSD). As the level of economic development of a country determines its sanitary conditions, these can influence the sleep–pain relationship; therefore, it is relevant to generate evidence in the population with MSD in developing countries. This cross-sectional study sought to determine the effect of poor SQ on pain in Chilean individuals with MSD, controlling for sex and duration of pain (in months). Method: A total of 228 individuals were included. SQ was measured with the Pittsburg Sleep Quality Index (PSQI), pain (intensity, interference and distress relative to pain) was measured with visual analog scales. Structural equation modeling (SEM) was performed to analyze the effect of SQ on pain. Results: A high frequency of poor SQ was present in the studied group, and was more prevalent in women. The SEM model evidenced that poor SQ predicts greater pain. Sex influences sleep quality and pain, but not pain duration. Conclusions: These findings indicate that poor SQ predicts higher pain in MSD and that women exhibit worse SQ and more significant pain than men. Our findings support that SQ should be considered in the comprehensive approach to pain in individuals with MSD.

Valoración del riego de adicción a tramadol en pacientes con dolor crónico no oncológico

Objetivo El manejo del dolor crónico no oncológico con analgésicos opioides ha sido de importancia para el control de los síntomas y el restablecimiento de la actividad, sin embargo, el riesgo de adicción asociado a estos medicamentos es ampliamente conocido y evaluado. Este estudio evalúa el riesgo de adicción que presentaban los pacientes con manejo de tramadol describiendo los factores mas frecuentes en la muestra estudiada frente a lo reportado en la literatura. Métodos Una muestra de 76 pacientes de una clínica de dolor que están en manejo con tramadol y se les administra un cuestionario con características demográficas y con la escala Opioid Risk Tool para el riesgo de adicción. Resultados El 57,89% de los sujetos fueron mujeres, el 55,20% se encontraba entre los 29 y 59 años. El riesgo de adicción moderado se encontró en el 9,09% de las mujeres y en el 37,05% de los hombres. La inclusión de otras enfermedades como ansiedad y trastorno de estrés postraumático aumenta el riesgo de adicción a severo en 6,06% de los hombres. Conclusiones La valoración del riesgo de adicción a opioides debe tener en cuenta los factores encontrados en la población colombiana.