Study Medicine at the University of Cantabria (belongs to the class of 2001), completed his specialty in Anesthesiology and Resuscitation at the Hospital Marqués de Valdecilla, which he completed in 2006, and completed a Master’s Degree in Physiology and Pain Treatment at the Autonomous University of Barcelona. In addition, he has recently been recognized with the Award for Professional Merit in the Hospital field of the College of Physicians of Cantabria.
In an interview with Medical Writing analyzes the challenges in pain treatment, the role of new technologies and the future of this specialty. But Maldonado He is also a chronic pain patient.That is why he takes advantage of the conversation with this newspaper to tell his experience, what it has allowed him to learn and how to treat people with this type of ailments.
The Marqués de Valdecilla Hospital is a benchmark in many fields, such as Cardiology or Pneumology, is it also your Pain Unit?
Even if it is because the devil knows more for being old than for being a devil, the truth is that the Valdecilla Pain Unit is one of those that has been active the longest. I have had the opportunity to have more extensive training than many of my colleagues, so when doubts arise I am always there to contribute the value of experience.
What are the newest or upcoming techniques in the field of pain treatment?
The evolution of pain treatment is being significant in many aspects where technology has begun to be implemented. In this sense, the branch that has had a more important projection in recent years has been that of spinal cord stimulation as a complex treatment of pain with neuropathic characteristics, which are the most significant source of progress in chronic pain.
Especially at a pharmacological level, the development of treatments, especially biological ones, has been very important. In addition, in other areas of Medicine it will reach the treatment of specific pain for each medical specialty or specific pathology, especially in regard to neuropathic pain. However, there are still great unknowns that hang over the future of this specialty. There are many open doors, but the future remains to be seen.
How has the integration of new technologies allowed avoiding or reducing the consumption of analgesics to treat pain?
In the past we only had a series of basic techniques. Now, the use of imaging tests for complex interventional techniques and later the incorporation of ultrasound systems has allowed us to make the techniques more sophisticated, make them much more precise, improve the results and, with it, to the extent possible. , improve the patient’s pain level. This, in turn, makes it possible to reduce pharmacological treatments that, on the other hand, are still necessary. The only thing we want is that they are the most suitable for the patient.
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“About 80 percent of people who have chronic pain will develop an emotional disorder” |
What savings does reducing pharmaceuticals mean for the health system?
There are three advantages. The first is that, from an economic perspective, it is difficult to establish how much can be saved on pharmaceuticals. Yes, as there is less consumption overall, there will be less abusive use, but the aspects that will mean a reduction in costs are, as a second advantage, that the patient who has less pain, if it is a patient with an active working life, will be able to return to work, generate less sick leave and fewer temporary disabilities. To a certain extent, early retirements are also reduced due to the limitations of pain, so this has a very positive and important social cost that must be pursued.
As a third advantage, the quality of life of our patients improves. Whether they are patients of working age or retired patients, they are individuals who are going to depend less on third parties and, directly or indirectly, it means fewer resources, be they family, financial, or through dependency aid, etc. , and those factors that are more difficult to measure are very real, since we know that the economic consumption of chronic pain is very significant.
In this sense, does the priority of Pain Units have to be to seek quality of life?
Of course, the most important objective is for the patient to improve their quality of life, to give back as much as possible and, in this sense, Pain Units are increasingly going to become multidisciplinary units. Until now, we were used to working in bubbles, but more and more we are seeing the need to work in as coordinated a way as possible. What we are looking for is that the sum generates an exponential response.
For this reason, Pain Units are becoming more multidisciplinary units where, for example, clinical psychology professionals, rheumatologists, or the pelvic floor unit team, which includes urologists, general surgeons, gynecologists, rehabilitators, and physiotherapists. In our own unit, we already have, in addition to anesthesiologists, neurosurgeons in the back unit. We all always work trying to address the same problem, pain, but from many combined perspectives, which delves into improving results.
When it comes to treating pain, what weight does mental health have?
Very much, in fact, the association between affective-emotional disturbances in patients and chronic pain is bidirectional and highly significant. It is considered that about 80 percent of people with chronic pain will develop, at any given time, an emotional disorder. Typically they are depressive disorders or adjustment disorders that we call associated with emotional suffering.
But conversely, we know that those patients who have a depressive picture, faced with a painful circumstance, will unfortunately be able to develop chronic pain, so that the relationship is bidirectional. We are always going to find this handicap of the emotional component of the patient, that is very clear.
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“New technologies have made it possible to reduce pharmacological treatments” |
Are new technologies and techniques a good fit for professionals? Do they need a lot of training to learn how to handle them?
This is one of the main complications. Although there are different training options, they often require either a large amount of time or financial dedication, since they are often courses and training abroad. Or even at the national level, but it involves significant displacements and this is one of the biggest handicaps, being able to train the staff who deal with pain is always something that we have to try to forge and find a way to do it.
You, in addition to being a professional, are also patient. Precisely, as a patient, how do you consider the treatment of pain in the SNS to be?
I had an accident a little over two years ago that caused me a spinal cord injury, as well as several severe fractures in the rest of my extremities. I have also developed chronic pain secondary to my spinal cord injury.
Within chronic pain treatments, I consider myself a lucky person, since, first of all, my access and my knowledge as a professional give me an advantage, logically. Secondly, I have learned that although we dedicate ourselves to pain, there are certain types of pain, and in this case, mine, that of spinal cord injury, which is rare. There are not a large number of patients that we can handle in a Pain Unit. Thus, during my stay at the Hospital for Paraplegics in Toledo I have learned things about pain in patients with spinal cord injury that I had not managed until now. So I have been treated as a patient, I have learned as a professional and, in turn, I have transmitted my learning to my patients with injuries like mine. So, this double game of patient-doctor brings me closer to the people I deal with, at the same time they teach me.
What are the lessons that you have learned yourself that you can apply to other patients?
Chronic pain patients are often affected, especially by misunderstanding and sometimes by exhaustion. It’s not easy to explain to someone how much things hurt you. Many people do not get to believe what the patient suffers.