Resumen

MARTINEZ-SALIO, A.; VICENTE, L.; ACEDO, M. S.  y  URBANO, M.. The role of the neurologist in the Pain Unit?. Rev. Soc. Esp. Dolor [online]. 2005, vol.12, n.3, pp.146-153. ISSN 1134-8046.

Introduction: In the Multidisciplinary Chronic Pain Unit at the University Hospital "12 de Octubre" work a full-time anesthesiologist, a full-time specialist in internal medicine and a full-time rheumatologist. They are supported by an occupational therapist and a psychologist. We review the usefulness of a neurology support service, which was originally aimed to contribute to the management of patients with neuropathic pain, an specialty that in our hospital setting has traditionally not been involved in the care of these patients referred to pain units. Methods: We describe the activity of a neurology service over a six-month period. Such service is integrated in the Pain Unit and it is staffed by a neurologist that one day during the week assesses the patients referred to him by the Unit, issues an interconsultation report and discuss his/her opinion with the referring physician or with the whole Unit. Demographic data, source of referrals to the Unit, reason of the referral to the Unit, reason of the referral to the neurology service, prior treatment, pain severity, length of evolution, diagnosis, presence and severity of neuropathic pain, presence or absence of occupational or legal psychiatric disorders, and whether the etiological diagnosis changed after consultation, physiopathogenic mechanisms involved in pain, and study plan, treatment, follow-up and destination. Results: The analysis of our study population, compared to the overall population of patients referred to the Unit, shows that our subpopulation has a greater mean age compared to the population referred to the Unit and is of a high complexity, not only due to pain, but also to chronicity, severity and a long history of prior treatments. Interestingly, a significant percentage of the patients referred did not have neuropathic pain. Etiological diagnosis was changed in a few cases, but is most of them a better exploration of physiopathogenic mechanisms involved in neuropathic pain resulted in the variation of diagnosis study, therapeutic options and prognosis. Finally, when comparing the patients referred to our service with those of an outpatient neurology service, the absence of headaches and central pain conditions that could benefit from therapeutic options provided by a pain unit is surprising. Conclusions: We have shown how a consultant neurologist can be useful in a Pain Unit in order to contribute to the etiological diagnosis of complex patients, to confirm or discard the presence of neuropathic pain, to contribute to the study and description of several positive phenomena that are present and its potential relationship with specific physiopathological mechanisms, as the basis for ordering additional tests and treatments aimed to such mechanisms, to explain the patient the nature of his/her pain, and to help in the follow-up and prognosis. We believe that the model of a consultant neurologist integrated in a multidisciplinary chronic pain unit or working in parallel with an existing pain unit, improves the health care and the range of therapeutic options provided to patients with chronic pain.

Palabras clave : Neuropathic pain; Multidisciplinary Pain Unit; Elderly; Pain management; Neurology.

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