I was recently asked to see a lady about having an epidural in labour, and was immensely pleased to see that she had read the information card from this website.  It had actually been given to her by her midwife, but it made the discussion about risks flow a bit more rather than being one-sided, with me giving out all the information.  A very gratifying doctor-patient interaction....

Methadone/dolophine is one of the most researched medical treatments available. Studies clearly show that adequate doses of prescribed methadone can help those addicted to illegal opiates in a number of ways. It's effectiveness as a substitute was clearly determined by the Cochrane review of 2004.

It is primarily used as an analgesic and in the treatment of opiate addiction. It's slower metabolism factor and high lipid solubility mean the effects last longer than Morphine-based drugs. Usually taken in a single dose, the effect lasts 24hours, peaking after 2 and it has a half-life of 15 to 60 hours.

Buprenorphine, is another opioid, originally developed for treatment of chronic pain disorders and later as a treatment for opiate addiction. The active ingredient, thebaine( another opium poppy derivative) acts as a strong analgesic and is used as treatment for chronic pain. Unlike full agonists such as heroin and morphine; buprenorphine produces a lesser degree of sedation and respiratory depression and causes no significant impairment of cognitive or motor skills. It is generally administered as a sub-lingual tablet, and it's effect lasts 12 hours, with a half-life of approximately thirty hours. As it also precipitates withdrawal symptoms in people dependent on other opiates it is fast becoming the prefered treatment for heroin addicts.

It is also prescribed as treatment for depression and has been attributed to successful recovery in patients that have participated in clinical trials. But being an opioid, it is a restricted drug with regulatory checks controling prescription.

Both these drugs are used for both shot and long-term opioid maintenance therapy; each with their own advantages and disadvantages. In terms of efficacy, high dose Buprenorphine has been found to be significantly superior to low dose methadone administration. Withdrawal effects are less pronounced on conclusion of treatment and built in receptor antagonists prevent abuse of the drug and induces withdrawal symptoms on the introduction of any other opiates. Buprenorphine’s stronger ability to bind against brain receptors has raised the debate on areas of detoxification and treatment for longer periods just as Scotland's parliament is introducing time limitation on methadone prescriptions.

I'm not a great believer in coincidence really. I firmly believe that things happen for a reason, and that other events can be a catalyst, but there is no such thing as a string of coincidences. OK, one coincidence I could possibly believe, but not lots and lots of them. This I think is how a lot of you have worked out who the boyfriend is, all you have to do is look at the subject of the posts for a few days - what are the odds that we are completely separate people?

I don't want to spell it out completely. He says that he doesn't care who knows, but then I think he must do. People only blog anonymously if they don't want people to know who they are. Now we have both said the same thing here, if you know who I am in real life, and I happen to mention that I have a blog, then I think it would be quite hard to find me. Equally, if you read my blog and don't know me in real life then it would be just as hard to find out exacty who I am, I think. However, if you stumble across my blog, and know my in real life then you could easily work out who I am. The boyfriend says the same thing about his blog, which is why I'm not going to scream out who he is from the rooftops. If you can work it out then all well and good, if you can't then enjoy the mystery.

Another coincidence happened last night. My leg started hurting so, so much. I took some basic painkillers and tried to sleep, but nothing happened. So I took some stronger painkillers, and still nothing happened. Eventually after about 2 and a half hours of being in pain I took some ven stronger painkillers and waited for them to work. They didn't. I don't know if this pain was all in my head, particularly as before I was diagnosed I was completely symptom free, but it was unbearable. My Mum found me crawling to the bathroom to get a glass of water at about 1am, I was in so much pain I couldn't stand, even with crutches, and decided it might be a good idea to get me checked out. She rang the ot of hours GP team, who told her that they didn't deal with palliative care. She tried to explain that I had only just been diagnosed and therefore it wasn't palliative. They still told her the best option was to go to A&E at the Chelsea and Westminster.

She drove me to A&E whilst I was still in my pyjamas, I was in so much pain I couldn't have cared who saw me. The triage nurse was lovely and told me that the wait wasn't that long so it shouldn't be too bad and that she couldn't give me anymore painkillers because of what I had already taken. I only sat in the waiting room for about half anf hour before I was seen by a lovely SHO who admitted that oncology wasn't a speciality of his, but he had completed 4 months in anaesthetics so was over-qualified when it came to pain relief. He gave me some even stronger pain relief and let me sleep in the observation ward for a couple of hours to mae sure that the pain relief was working and the pain wouldn't come back. He then gave my Mum a prescription for 2 week's worth of the analgesic, but only to be taken on an as needed basis, and wished me all the best.

I got home at about 5am this morning, whereupon my Dad hadn't even realised we'd been out. The leg feels better now and I feel so stupid for making such a fuss over some pain. I have realised that things have changed now though. When I went to A&E before I was immediately flagged as the "bipolar, borderline self-harmer" no matter what I was there for. Now that label has been replaced with "cancer patient". I guess it shows how medics rank diagnoses in terms of importance. I have been told that the Chelsea & Westminster will contact the orthopaedic oncologist to let her know what happened and I have been advised to talk to the Macmillan Nurse about it all next week. Everyone took it so seriously, and yet a part of me is still utterly convinced that it was psychosomatic and not a coincidence at all.

Ruth

I'm not just growing into arthritis as I get older, I've had osteo arthritis since I was 32, and I can tell you, with absolute certainty, that the only thing you'll get from exercising with arthritis is more pain - I know this because, while I've had arthritis, I've been a backpacker (the proper kind, not some numb-nuts kid on a gap year break - proper backpackers carry everything they need for their comfort and survival on their back and, above all, we walk; we don't take up space on third-world public transport, travelling in the company of a backpack the size of a small wardrobe!), I was a touring cyclist and a rambler (hiker in the US), too.

Consider, for a moment, the mechanical implications of arthritis. What happens, in either osteo arthritis (OA), or rheumatoid arthritis (RA), though the processes are different, is that the bearing surfaces of the joints are destroyed - to a greater or lesser degree (of the two, RA is the most destructive, as it can destroy the entire joint, but for my purposes, we'll stick with the basics, loss of the bearing surface). As I turned 30, I began to realise that, at the end of a day's walking (usually 10-15 miles), and long before I reached my destination, I was in agony, and my left hip would seize up to the point of immobility. It took a couple of years to figure out what the problem was, and it turned out to be OA.

Even then, exercise was thought of as a remedy, and I endured physio three times a week for several years before I simply stopped going, as it wasn't having any effect. Well, no beneficial effect anyway - what it did was make me much worse. I'd go in without pain (remember, this was mainly a problem after a walk in those days), and come out barely mobile.

A little later, on holiday in Austria, I picked up an alpenstock - essentially, a walking stick on steroids, shod with a soft metal tip (soft metal grips rocks, hard metals, like steel, skate off), which allowed me to transfer some of the weight from my hip, and it kept me walking for many years afterwards, though I certainly wasn't pain-free. By the way, if your left leg is the problem, the stick goes in your right hand, and vice-versa, though in films and on TV (House is a prime example), the non-disabled actor will always use it on the same side, which is useless; it is more dramatic, though, as it makes it slightly harder to walk, exaggerating the pretend disability. These days, of course, walkers have a wide selection of hiking staffs in varying degrees of sophistication., and very good they are, too. If you have a disability, though, avoid those with "walking-stick" handles; they're too thin and will hurt, and maybe damage, your hand.

Throughout my thirties, I took a lot of anti-inflammatory drugs (still do, when I can, but they damage my stomach), but not a single doctor would accept that I was in as much pain as I said I was. Now in my early sixties, I have OA in the majority of my joints, to some degree.

Anyway, I digress slightly, so let's get back to damaged bearing surfaces. In a car, for example, or any machinery, for that matter, if a bearing starts to wear out, you treat it gently, and get it fixed as soon as you can. In the body, the same logic should prevail, because no amount of exercise is going to make a worn-out joint any less worn out. True, exercise can strengthen the muscles, tendons and ligaments that support a joint, but for the joint itself the result is likely to be more damage, and certainly more pain.

In OA, the bearing surface becomes roughened, and I was told by my physios that one purpose of exercise was to wear away the roughness, which would reduce the pain. That makes sense but - and trust me on this, because I've been there and, right now, I'm back there again - the process is agonising. True, if you can get through it (and coping with pain happens at least as much in your head** as with the aid of drugs, I'm afraid), then you will see some, possibly dramatic, improvement.

** No, I'm not saying pain is psychological, it most definitely isn't, but the way a person deals with pain is. After all, pain is entirely subjective - no-one else can know your pain, you own it, but one person's excruciating pain is another's bloody nuisance; it's all about perception. That doesn't stop it being real, though. It's what enables a person to walk to a hospital carrying their severed arm, while someone else will be utterly wiped out by a sprained wrist.

Is exercise worth it, though? Well, only you can decide that, but I would say to Arthritis Care, NICE, and all the other organisations, and doctors and physios, who have adopted the exercise-is-best mantra without question, that if you want us to exercise more, what we want from you, to enable that to happen, is the provision of effective pain control, by which I do NOT mean Paracetamol and Ibuprofen. We want - hell, we are entitled to - much more than that.

Currently, I have DHC Continus - it only took 30 years!! - plus 30/500 Co-codamol and Paracetamol (yes, I know about the risks of combining drugs which contain Paracetamol - I'm not an idiot), and by combining them in ways I'm sure my GP wouldn't approve of, I can get better pain control. In theory, DHC Continus should wreak havoc on my COPD - in practice, the effect is imperceptible, at least for now.

For example, taking 2 60mg DHC Continus and 2 Paracetamol is very effective (and as DHC-C is a sustained release product, you can continue with the Paracetamol throughout the day, subject to the usual limits). On a say when I know I need to be active, I take 1 DHC-C and 2 30/500 Co-codamol (this gives me 60mg sustained-release dihydrocodeine, 60mg codeine tartrate and 1,000mg Paracetamol). I've no idea why, but I know that it works very well indeed, and far better than the 2 DHC-C I'm supposed to take of a morning. I also have Naproxen (a non-steroidal anti-inflammatory drug - NSAID), and while it's beneficial, it causes gastric bleeding if I take it without the buffering effect of a substantial meal but, as I'm trying to lose weight, a substantial meal is a thing of the past!

One final plea - is it remotely possible for someone involved in the development of new drugs to come up with an effective analgesic that doesn't cause massive constipation? One that didn't shut down my breathing or erode my gastric mucosa would be nice, too. Just a thought...

La Onda corta requiere de una serie de conocimienos en distintos aspectos que puntualizamos.

• Técnicas de aplicación del método capacitativo.
• Técnicas de colocación de los electrodos en el método capacitativo.
• Técnicas en la aplicación de la distancia electrodo/piel.
• Técnicas de aplicación del método inductivo.
• Técnicas de aplicación de la onda corta pulsátil

Una correcta aplicación de esta técnica, sobre todo en la modalidad pulsante que es la indicada por el Dr. Giosiosa, produce dentro de la química biológica una serie de fenómenos que ayuda al tratamiento del trauma o lesión o bien de la cronicidad.

En el caso de Radham se trata de una lesión deportiva que tratada adecuadamente no tiene por que dejar secuelas.

Volviendo a las nociones básicas sobre honda corta cabe expresar que las ondas cortas corresponden a ondas de radiofrecuencia cuyos valores fluctúan entre 3 y 300 MHz del espectro electromagnético (An. 1), se propagan en el vacío y a la velocidad de la luz. Los equipos de onda corta de uso terapéutico utilizan valores de frecuencia de 40,68; 27,12 y 13,56 MHz, siendo los de 27,12 MHz los más utilizados. Tienen la capacidad de atravesar tanto cuerpos conductores (eléctricos) como no conductores (dieléctricos) y al ser absorbidas por estos se incrementa el movimiento vibratorio de sus moléculas constituyentes, que se traducen en un aumento de temperatura ^{(Beiser, 1991; Rodríguez, 2000; Sendra, 1998)}.

Desde hace unos pocos años comenzó a implementarse la ONDA CORTA PULSÁTIL, una técnica modificada que permite aumentar el alcance y posibilidades que brinda esta terapéutica.
La terapéutica por onda corta tiene como fundamento elevar la temperatura corporal.
La onda corta actúa por inducción y se diferencia del calor por convección o irradiado y del calor por conducción o contacto, por ser estos de una escasa profundidad.
Tal como se la viene empleando desde sus comienzos (año1935), esta basada en la aplicación a nivel del tejido corporal de ondas eléctricas de frecuencias muy altas (radiofrecuencia), que son transmitidas hacia los tejidos mediante 2 placas metálicas forradas en goma (aislante), las que forman un campo eléctrico capacitivo. Esto produce dentro del mismo tejido una elevación de la temperatura como consecuencia de la alta conductibilidad eléctrica a la inducción de radiofrecuencia.
Los efectos biológicos derivados del mecanismo de acción descripto incluyen un marcado incremento en la tasa metabólica, aumento del riego sanguíneo, aumento de la oxigenación en los tejidos, reducción de la excitabilidad nerviosa, efecto miorrelajante, efecto analgésico y antiinflamatorio, descenso de la presión sanguínea, y aumento de la sudoración.

Puede consultarse en nuestra biblioteca mayor bibliografía usada por los profesionales del haras para el uso de este equipo y técnica fisioterapéutica.

En las fotos que siguen puede verse a Radham en sus sesiones (4 por semanas en días alternos de cuarenta minutos cada una en modalidad pulsante) de onda corta pulsatil.

En cuanto al E.M.A.R, su aplicación está indicada para obtener analgesia en la fase aguda del trauma. En este blog hemos colocado un trabajo del Dr. Scipion (excelente cirujano que nos operara de cólico a un caballo de nuestra propiedad) y colaboradores, al cual remitimos. En las fotos puede verse a Radham con el tratmiento en cuestión.

When ATP is metabolised in the absence of oxygen, lactic acidosis occurs. Myocardial lactic acidosis results in defibrillation and resuscitation being made more difficult"

We have been learning about ATP at Uni, about metabolism, aerobic and anaerobic metabolism etc etc...
You're probably thinking right now "yeah whatever", and you are about to klick further to some other website, or shut the computer down.


Thats what we felt like at Uni, no idea how this small miniscule stuff will affect us.

But wll th above says is the following:
When your heart doesn't pump enough blood around the body, your body does not receive enough oxygen. Your cells get filled up with lactic acid. More lactic acid reduces the chance of survival.

=> Get that heart pumping, fast!


I was deeply satisfied, and am on the lookout for further bonds between theoretical stuff and reality.

--


I got in touch with 'my' paramedic in Germany that I did thisjob with.
I asked him if he would, being put in the same situation, consider alarming the emergency doctor, to give the patient some analgesics (pain killer). Answer: Probably not, because

Good to get some feedback on these things. I will be able to pick this topic up in a six months time, when we start on pharmacology; and then again in a years time when my training picks up on the actual on-road drugs we use.

Esta clasificación de analgésicos se construyó para el tratamiento del dolor agudo. La información se obtuvo de revisiones sistemáticas de estudios aleatorizados, doble ciego, de dosis única, en pacientes con dolor de moderado a severo. La variable resultado evaluada en cada revisión fue la misma - es decir, al menos un alivio del dolor de un 50% durante 4-6 horas. La medida del dolor era estándar y había sido validada.

Esta clasificación funciona porque solo contiene manzanas, y no es una ensalada de frutas. Se comparan las mismas cosas, y existe un único elemento comparativo llamado placebo. La información se presenta con diferentes formatos, pero la fuente definitiva es una tabla completa, que incluye el número de pacientes comparados, el porcentaje con al menos un alivio del dolor de un 50% con el analgésico, el número necesario a tratar (NNT) y los valores mínimo y máximo del intervalo de confianza del 95%. Esta Tabla se actualiza a medida que se vaya disponiendo de más información.

Mucha de la información tiene que ver con fármacos o dosis que no se usan con frecuencia, por lo que tienen tan solo un interés académico. La Figura muestra los NNTs para un número de fármacos y dosis de uso frecuente. Los detalles se muestran en la Tabla 1, que está vinculada con las revisiones completas.

Figura Clasificación de los números necesarios a tratar (NNT) para conseguir al menos un alivio del dolor del 50% durante 4-6 horas en pacientes con dolor de moderado a severo.

muy clarificadora y muy distinta de las prácticas habituales ¿no?

Direi che, come spesso faccio, demando a chi è più informato e dotto di me la parte esplicativa, per soffermarmi maggiormente su alcune riflessioni a riguardo. In tal senso sicuramente la voce Partoanalgesia di Wikipedia può dare alcune informazioni che in aggiunta con quelle riportate in questo sito Parto Indolore completano il quadro dando indicazioni sui centri che la praticano.

Se avete dato una letta alle pagine di questi due siti, avete forse conosciuto per la prima volte delle metodologie che spesso vengono etichettate come innaturali e per questo vengono bandite.

Esiste infatti il concetto che naturale è bene ed artificiale è male. Come molti concetti assoluti creati dall'uomo, anche questo ha dei forti limiti. Mi domando se quando andiamo dal dentista per toglierci un dente, non chiediamo l'anestesia ovvero se devono operarmi, ad es. di appendicite, forse non chiederei un attenuazione del dolore. Questo è sbagliato?

Il problema è che spesso il piano morale/etico viene sovrapposto a quello medico, facendo si che alcune scelte debbano essere prese partendo da un visuale che condiziona in maniera decisa chi le deve operare. Un breve inciso, che ritengo necessario per non dare spazio a fraintendimenti, la mia posizione su eutanasia, aborto, clonazione e pena di morte è unica: non sono strade per me accettabili in quanto violano il sacro rispetto per la vita umana e la dignità dell'uomo. Di questo è il caso di parlare un'altra volta, ma spero che faccia comprendere che per alcuni potrei apparire un oscurantista che nega la libertà della scienza e che invece sul parto indolore si comporta in maniera dissociata.

Quello che vorrei sottolineare e cercare di far comprendere, è proprio la necessità di confrontarsi con il dolore e non di negarlo perché a questo è chiamata la battaglia che quotidianamente ognuno di noi combatte. Che si tratti di dolore fisico, psicologico, esistenziale, il dolore è una componente della vita di ogni persona, ineliminabile ed in alcuni casi utile, perché ci segnala una situazione di malessere o di difficoltà, ci spinge a cercare una soluzione, quando è possibile. Ci spinge anche, in taluni casi, a renderci conto che da soli non ci possiamo salvare, per cui entrano in gioco molteplici aspetti, religiosi e scientifici, per cercare una soluzione che altri possano darci.

Il dolore ci rende umani, perché davanti a persone che soffrono, il cuore palpita e si muove spesso da egoismi ingessati. Il dolore ci mette dunque in movimento, ci fa porre domande e ci chiede una risposta per cercarne sia la radice che la soluzione. Ebbene nel parto il dolore è connesso sia alla morfologia dell'essere umano che, per qualcuno, alla Gen 3, 16, nella quale c'è la "condanna" al parto doloroso come "colpa" da scontare per il peccato originale.

Non appare il contesto per approfondire i riflessi morali e teologici del testo biblico indicato, ma sicuramente cercare una strada che possa attenuare il dolore non è un peccato in sé. Non lo è andare dal dentista, non lo è prendere un analgesico perché abbiamo un mal di testa,il fatto di attenuare e cercare di eliminare il dolore non è sbagliato.

Il problema è che moralmente si sente e percepisce un retaggio che ci dice che dobbiamo soffrire quando partoriamo, che dobbiamo accettarlo e dato che tante donne lo hanno fatto prima, perché si dovrebbe cercare una strada alternativa. Vero che tante donne lo hanno fatto e continuano a farlo, ma anche in mille altri contesti medici, in precedenza, si operava senza poter intervenire sul dolore, questo non vuol certo dire che si dovrebbe smettere di utilizzare anestesie ed analgesie. Il punto è che con il dolore ci si deve confrontare, personalmente, senza fuggirlo e nascondendosi dietro ad artificiosi strumenti per negarlo, ma se si può liberamente scegliere di attenuarlo od eliminarlo, perché non farlo anche nel parto?

Credo che una scelta consapevole e personale richieda un confronto con se stessi, delle riflessioni profonde, consapevolezza che il dolore c'è, non è eliminabile, ma che se in alcuni contesti ed esperienze posso cercare di attenuarlo e gestirlo, senza negarlo, allora questo è un bene.

Non credo e rinnego il soggettivismo personalizzante che relativizzi tutto. Ritengo che esistono valori universali e credo, personalmente, ma non da solo, in Gesù Cristo. Per questo quanto dico non è un invito a crearsi la propria formuletta esistenziale per mettere in un angolo il dolore ed eliminarlo. Bensì suggerisco il confronto con la sofferenza che ci vede rispondere in maniera personale, perché ognuno di noi è fatto ad immagine di Dio, ma è unico e nella sua unicità ha diritto di vivere e scegliere nella totale libertà come vuole confrontarsi con il mistero del dolore.

San Francesco diceva che tutto ciò che abbiamo è dono di Dio, l'unica cosa che è veramente nostra è la libertà che abbiamo di fronte al dolore, di come scegliamo di viverlo. Lui, grande Santo e Uomo, suggeriva di donare il dolore che provavamo a Dio, perché l'unica cosa che potevamo realmente donare a Colui che ci ama più di ogni altra creatura. Ritengo che ognuno di noi debba essere libero di comprendere come e quanto stare di fronte al dolore, aspirando sempre, alla pienezza di libertà di un cuore che sapeva amare come quello di Francesco, immagine del vero grande cuore di Gesù, capace di morire per amore nostro.

M.Bat

Además, se echa en falta una mayor rotación de los médicos de familia por las unidades del dolor, porque, en ocasiones, "vemos algunas desviaciones desde las consultas de primaria que no están justificadas. La formación en las Facultades de Medicina no es mala, dado que todos los textos de Farmacología hacen especial hincapié en el dolor, pero falta la parte práctica con los anestesistas, intensivistas y neurocirujanos, que son las tres grandes especialidades que están abordando el dolor en los hospitales".
Por ejemplo, el uso prolongado de opioides puede provocar reacciones adversas como tolerancia, hiperalgesia, efectos hormonales e inmunosupresión. Pero, por el contrario, el especialista ha recordado que también hay evidencia de que la administración de opioides en dosis analgésicas es protectora, puesto que el dolor por sí mismo puede ser inmunosupresor.
"En dolor crónico no existen grandes estudios para población anciana, pero, en general, se aceptan una serie de recomendaciones para su uso. De cualquier modo, el uso de opioides en dolor crónico no oncológico ha demostrado su utilidad en grandes series".
Con anterioridad, el uso de opioides en dolor crónico no maligno estaba reservado a aquellos pacientes en los que fracasaban otros tratamientos. Sin embargo, hoy en día están indicados en todo dolor persistente que causa aflicción, incapacidad o impacto negativo en la calidad de vida, no existiendo evidencia de que los pacientes ancianos se beneficien menos de programas de manejo de dolor.

Aparte de didáctico , es muy ilustrativo de lo que pasa diariamente en nuestras consultas donde pacientes medianamente controlados con otros analgésicos son impulsados a cambiar de tratamiento más caro, más peligroso y no más eficaz

"A friend told her about a "pain patch" that worked well"
Los pacientes por consejos de amigos, o por que el especialista no sabe hacer recetas, acuden a su medico de cabecera por los dichosos parches:

"Anne, who disliked taking pills and was interested in the convenience of changing a patch only every 3 days, made an appointment to see her family physician to discuss the transdermal fentanyl patch"

Los médicos de familia bien por desconocimiento, falta de argumentos, o porque es muy difícil ir constantemente contracorriente, caen en la trampa e inician el tratamiento:

"She decided to try it and was started on a 25-µg patch every 3 days"

Empiezan con el parche y no solo mejora el dolor sino que aparecen los efectos secundarios algunos leves, otros no tanto:

"After day 3 of using the patch, Anne’s son informed her physician that his mom had become somnolent, confused, and had fallen"

En fin luego se resuelve, pero sirve de lección para evitar la alegría parchera que invade los hospitales de nuestro país, y que probablemente se recrudecerá con la aparición de un nuevo modelo aerodinámico de parche. Conviene pues recordar los puntos clave de este caso publicado y que se resumen en:

• If they have not been using opioids, patients should not be given even the lowest doses of fentanyl via patch. -Si no se ha usado previamente opioides, los pacientes no deben recibir fentanilo ni siquiera en las dosis más bajas-. Referencia de la misma monografía del producto, curiosamente en la ficha técnica española del producto no se recoge esta consideración e incluso sugieren una dosis para pacientes que no reciben opiáceos.
• When rotating to a fentanyl patch, it is important to start low and go slow, especially in elderly or debilitated patients. -Cuando se rota a los parches de fentanilo, es importante comenzar con dosis bajas e ir despacio en los sucesivos incrementos de dosis, especialmente en pacientes ancianos o debilitados-. (curiosamente la dosis de 12 microgramos aunque esta en el directorio de medicamentos autorizados no parece estar comercializada)
• Fentanyl patches are not ideal for end-of-life care, especially when there is uncontrolled pain. -Los parches de fentanilo no son el medicamento idoneo para pacientes terminales, en particualr cuando hay dolor no controlado-. ¿ Puedes adivinar en que tipo de pacientes se prescriben más lo parches de fentanilo en las dolorosas unidades?.

¡que dolor de unidades!

Desde lo parches Sor Virginia (y sin olvidar la nefasta THS y los paganos parches de nicotina) un parche no había tenido tanto éxito, sin embargo no hay que olvidar que su indicación es para el tratamiento del dolor crónico persistente, moderado a severo, que requiere administración continua por un período de tiempo prolongado y no puede ser manejado con otros medicamentos tales como opiáceos.

Para recordarlo conviene leer:

• BIT dedicado al manejo del dolor crónico (ojo tiene una errata en la tabla del anexo 2).
• Información terapéutica del Sistema Nacional de Salud· citado anteriormente.
• ficha crítica del boletín del país vasco
• Boletin farmaco terapéutico de Castilla -La Mancha