Chronic pain has gone from being a symptom to a disease of great complexity, as it not only affects the patient's physical well-being, but also interacts in a complex way with psychological and social factors. The patient not only feels the pain; the affected person, suffers, sees how their quality of life is dramatically altered and how their daily activities, even the simplest, are disturbed. At a social level, your environment also suffers. In cancer pain this is aggravated by the patient's concern about his illness.
In recent decades, we have made significant progress in our understanding of the basic mechanisms of pain, and pharmacological treatments with new analgesics , as well as interventional techniques , have been greatly expanded.. New technologies have been developed, such as radiofrequency, spinal cord stimulation or implantable systems (mechanical or electronic), which with radiological help, are performed accurately and safely, increasing the number of techniques available to control pain .
Since our first publications, with the only morphic derivatives that existed 30 years ago, such as the Brompton Solution or oral controlled-release morphine, we have now had a wide range of opioids available in all the ways, such as transdermal, oral and nasal. We also have opioids almost immediate action for breakthrough pain and implantable systems for continuous administration of opioids, alone or associated with other drugs such as local anesthetics or spinal clonidine .
There is what we call interventional techniques, which are punctures, directed by image, for the infiltration of a specific medication in order to block the nerve ending that causes pain. They are very useful when pharmacological treatment fails, examples are the blockage of the celiac plexus in pancreatic tumors; vertebroplasty in metastatic vertebral fractures; continuous nerve blocks in plexus compression or spinal implantable systems, which allow much smaller doses of opioids to be administered directly into the spinal space, resulting in greater analgesia with fewer side effects .