Pain Unit

Pain Unit

The Hospital Dr. Gálvez Pain Unit is in charge of the research, diagnosis and treatment of chronic and acute pain. Our Unit has a group of professionals with extensive experience in the treatment of associated pain, the latest technologies and therapeutic advances in this field and updated treatment protocols for different techniques and procedures.

Acute Pain

Postoperative pain or postoperative pain is one that appears as a consequence of the surgical act. This pain appears at the beginning of the intervention and ends with the healing of the surgical pathology that generated it.

It is characterized by being sharp, predictable and self-limited in time. It is basically a pain of nociceptive type, associated with vegetative, psychological, emotional and behavioral reactions. If not treated properly, it can become chronic.

From the physiopathological point of view, it is generated by the manipulations characteristic of the surgical act – tractions and sections of tissues- and the liberation of algógenas substances capable of activating and / or sensitizing the receptors in charge of processing the nociceptive sensation.

The consequences of an uncontrolled postoperative pain are multiple in the different organs and systems: alterations and cardiovascular, respiratory, digestive, neuroendocrine and metabolic, immunological and psychological complications. Along with this, it is important to consider the frequent possibility of chronification of acute postoperative pain that occurs in a variable percentage depending on the type of surgery performed.

Its control is essential not only for an improvement in the comfort of the patient who has undergone surgery, but also because it is associated with a reduction in the incidence of postoperative complications. In this sense, it has been described that certain analgesic techniques -such as perimedular nerve blocks- are associated with lower morbidity and mortality. Also, adequate analgesia provides other benefits such as less impairment cognitive in the postoperative period and a lower risk of appearance of postsurgical chronic pain. On the other hand, thanks to the achievement of effective analgesia, active rehabilitation processes can be carried out that contribute to improving the prognosis of surgeries such as traumatology. The overall result is a better quality of care and a lower hospital cost.

Until recently, parenteral or epidural infusion of opiates have been the “classic” techniques of postoperative pain control. Subsequently, the infusions of local anesthetics were introduced by epidural route and, finally, the use of the previously mentioned selective nerve blocks. These consist in the deposit of a dose of local anesthetic next to a nerve responsible for the sensitivity, in particular that corresponding to the painful area, of a specific anatomical territory in such a way that the pain of the intervened area is abolished. This analgesic technique, in addition of acting selectively, it has the characteristic of giving rise to fewer nausea and vomiting-like side effects produced by the administration of opiates necessary for the control of postoperative pain. This is beneficial for any type of surgery performed, especially for outpatient surgery.

At present, this last modality must be the protagonist of the treatment of postoperative pain thanks to the incorporation of the ECOGRAPHY as a procedure for the realization of blockages. By means of this technique, in addition to neurostimulation, nerve blocks are performed more effectively (success is obtained in more than 90%) and with much fewer side effects because punctures of unwanted structures are not performed. Regional blocking techniques can be performed, according to each case, by means of a single bolus injection or continuous infusion by placing and maintaining a perineural catheter.

In the face of a better and optimal recovery or rehabilitation The patient can even keep a perineural catheter in place and functioning at home, shortening the recovery time and the well-being of the patient in intensely painful postoperatives.

The means required by regional analgesia with ultrasound are the provision of an ultrasound machine and a neurostimulator, catheters and appropriate needles.

On the other hand, continuous administration, both parenteral and epidural or perineural drugs, require the provision of electronic pumps and elastomers (mechanical continuous administration devices by means of an elastic reservoir that self-infuses the infusion).

Analgesia by performing nerve blocks is a notorious benefit for a wide variety of surgical procedures such as the following:

  • Hip surgery (total or partial replacement): iliac fascia blockage.
  • Low abdominal surgery (hysterectomy, appendectomy, cesarean section): TAP blockage (transversus abdominis plane block).
  • Surgery of inguinal hernia: blockage of iliohypogastric and ilioinguinal nerves.
  • Shoulder surgery (arthroplasty, arthroscopy): interscalene brachial plexus block.
  • Knee surgery (total replacement, arthroscopy): femoral and sciatic nerve block.
  • Breast surgery (mastectomy, augmentation or reduction): paravertebral or pectoral nerve block (PECS block).

Chronic Pain

According to the current definition of the IASP (International Association for the Study of Pain), chronic pain is an unpleasant sensory and emotional experience, which is experienced associated with present and / or potential tissue damage and persists beyond the time of recovery of a tissue (more than ninety days or three months). For patients, pain is one of the disorders that most affects their daily life and disables them, which makes it one of the main reasons for medical consultation around the world. The frequency of chronic pain in the adult population in Spain is very high. The epidemiological evidence, From the majority of developed countries, it has shown that chronic pain is a widespread public health problem. In community-based surveys, 15% -25% of adults experience chronic pain at some point in their lives, a figure that increases to 50% in adults over 65 years of age. A recent epidemiological study in Spain on pain in primary care consultations shows that 30.9% of the population sample reported chronic pain, with a high neuropathic component.

Despite the magnitude of the problem and the medical, scientific and social interest involved in the care and treatment of people with chronic pain, this is an undervalued aspect that usually is not given adequate treatment.

The care services for the care of people with pain are created with the purpose of attending fundamentally to the patient who suffers chronic oncological and non-oncological pain. These services are heterogeneous, both in its origin as in its organization, portfolio of services and professionals that integrate them. Since only comprehensive programs have proven their effectiveness and cost-effectiveness; the approach must be multidisciplinary, involving here what underlies chronic pain as a complex problem that must be understood in a multi-dimensional manner for its definitive management.

The Pain Management Unit of the Hospital Dr. Gálvez offers patients with disorders that cause chronic pain personalized attention based on rapid diagnosis and comprehensive treatment.

After assessing the fact that the diagnosis or therapeutic procedures indicate the possibility that the patient’s painful system has to be diagnosed and treated by acting on the neurophysiological cause of its production, patients are referred by other medical specialists.

The treatment of chronic pain, part of a clinical diagnosis of the causes of pain production, At the level of the functioning of the nerve pathways involved in its production, it is supported in procedures that aim to cure pain through mechanisms that regulate pain transmission systems. To achieve this permanent or lasting modulation, minimally invasive techniques are used that result in a significant and prolonged or permanent reduction of pain, which are based on nerve blocks, muscle blocks, drugs, etc.

The pathologies treated by the Chronic Pain Unit of the Hospital Dr. Gálvez are the following:

  • Oncological Pain: primary tumors and Metastasis.
  • Peripheral neuropathies: alcohol and diabetes.
  • Trigeminal and glossopharyngeal neuralgia.
  • Herpes pain: Postherpetic neuralgia and herpes Zoster
  • Post-surgical pain: post-sternotomy, postoracotomy, postmastectomy, post inguinal hernia.
  • Musculoskeletal pain: Myofascial syndrome, muscle contractures, pyramidal syndrome, trigger points.
  • Painful Complex Syndrome Type I and II: Sudek’s disease, reflex sympathetic dystrophy, Causalgia.
  • Spine pain: sciatica, back pain, radiculalgias, radiculopathies, facet pain, lumbar, thoracic and cervical disc hernias, degenerative osteoarthritis, vertebral fractures, canal stenosis.
  • Joint pains: knee, hip, hand, elbow, shoulder, ankle, sacroiliac joint.
  • Headaches: cluster pain, tension headaches, migraines, hemicraneas.
  • Pain caused by terminal diseases.
  • Fibromyalgia

The services offered by the Chronic Pain Unit are:

  • Hospital interconsultations.
  • Preparation of a comprehensive and personalized clinical history, evaluation and monitoring of patients with chronic pain in outpatient consultation, with a pharmacological management according to the pluripathology usually present.
  • Articular blocks: It consists in the injection of a local anesthetic and / or corticoid in joints with degenerative pathology, not susceptible to surgical treatment.
  • Epidural blockages: The technique involves the introduction of a medication (local anesthetic and / or corticosteroid) through a special needle in the lumbar spine, in a place called “epidural space” to treat pain in the lower back, pelvis and legs.
  • Infiltration of trigger points at the diagnostic level with local anesthetic and therapeutic with botulinum toxin, in different myofascial chronic pain syndromes at cervical and dorsal level.
  • Nervous blockages, diagnostic and therapeutic: Consists of the injection of a local anesthetic and / or corticoids in the path of the nerve whose entrapment or stretching is considered responsible for the neuralgia (pain in the path).
  • Treatment of the different causes of lumbociatic syndrome not susceptible to surgical treatment, for example: psoas syndrome, lumbar quadratus, pyramidal and lumbar facet joints.
  • Treatment of chronic sacroileitis.