Prevalencia y características clínicas del dolor en pacientes con enfermedad crónica avanzada

OBJECTIVES: Determine pain prevalence and clinical characteristics in patients with advanced chronic disease and identify breakthrough pain frequency. DESIGN: Observational, descriptive, cross-sectional study. LOCATION: Three primary care teams and one intermediate care hospital. PARTICIPANTS: All patients with advanced chronic disease. MAIN MEASUREMENTS: A semi-structured interview was performed to collect demographic, clinical, and specific variables of pain using validated scales. Patient location (home, nursing home or hospital) and advanced chronicity trajectory (organ failure, oncological disease, dementia, or multimorbidity) were recorded. Pain was assessed based on the Brief Pain Inventory (BPI) and, in cases of disabling dementia, using the Pain Assessment in Advanced Dementia (PAINAD). A statistical descriptive, comparative analysis between variables was performed using the R software. RESULTS: Of all patients selected, 223 (60.4%) were included. Prevalence of pain: 83.9% (n = 187), with no differences based on location or trajectory. Significant differences in pain intensity based on location (P = .0046) (moderate-severe in patients at home, moderate in hospital patients, and mild in nursing home patients) and on trajectory (P < .0001) (moderate-severe in patients with organ failure and multimorbidity, moderate in patients with cancer, and mild in patients with dementia). Global functional impact of pain was mild-moderate, emotional impact was severe in 41.5% of patients (n = 51), and breakthrough pain was observed in 8.6% (n = 13). CONCLUSIONS: Pain must always be explored and assessed in patients with advanced chronicity, since it was highly prevalent in all locations and trajectories, being particularly intense in patients at home with organ failure and multimorbidity. Breakthrough pain was found in non-oncological trajectories.