Fèlix Bosch

An epidemiological comparison of pain complaints in the general population of Catalonia (Spain)

Epidemiological studies help to establish the health status in a country and allow a better allocation of economic resources. This survey estimated pain prevalence in Catalonia (Spain), analysed its relationship with demographic variables and evaluated pain-associated disabilities. The study was carried out in 1964 adults via phone interviews asking about any pain complaint they experienced in the last 6 months, regardless of its intensity and duration. Overall pain prevalence was 78.6%, significantly lower in men, with a trend to decrease with age. Back (50.9%), head (42%) and legs (36.8%) were the most affected locations. Less educated people reported, in general, higher prevalences. Pain described to be most annoying was related to musculoskeletal disease (26.2%) and migraines (16.5%). Pain was either very severe or unbearable in 33% of the sample, with women and older people reporting higher intensities. Personal and social activities were affected in 25.4% of cases and in 10.4% they became virtually impossible. Both the limitation of activity and the need for bed rest, which occurred in 19.6% of those who suffered pain, were more common amongst unemployed people, whereas 10.2% of workers had to take days off work due to pain, and 3.3% were fully incapacitated by it. In conclusion, the prevalence of pain was clearly higher among women, with an inverse relationship to age. Back pain and headaches were most prevalent and pain was rated as very severe to unbearable in one third of the patients. Pain-associated disabilities were a frequent finding. The present survey reports that pain is a substantial problem in the Catalonian population and generally reflects the characteristics of data previously reported in Anglo-saxon and Scandinavian countries.

The Contributions of Paul Ehrlich to Pharmacology: A Tribute on the Occasion of the Centenary of His Nobel Prize

On the centenary of Paul Ehrlich’s Nobel Prize, this German researcher deserves to be remembered as a pioneer in a large number of scientific disciplines. As a result of his enthusiasm and scientific abilities, dedication, and contacts with other scientists of his time, he was able to make countless contributions in fields as diverse as histology, haematology, immunology, oncology, microbiology and pharmacology, among others. Although the Swedish award was meant to recognize the standardization of the manufacture of antidiphtheria serum, it was the discovery of arsphenamine (Salvarsan) for the treatment of syphilis which won him wider international acclaim. From a pharmacological perspective, Ehrlich’s outstanding contributions include dissemination of the ‘magic bullet’ concept for the synthesis of antibacterials, introduction of concepts such as chemoreceptor and chemotherapy, and linking the chemical structure of compounds to their pharmacological activity. These achievements took place within the framework he established for the transition from experimental pharmacology to therapeutic pharmacology. He introduced a modern research system based on the synthesis of multiple chemical structures for pharmacological screening in animal models of disease states. These contributions were undoubtedly decisive in propitiating the wider development of antibiotics decades later. For these reasons, it is fitting to mark the 100th anniversary of the Nobel Prize awarded to this great scientist by commemorating the importance of his contributions to the advance of pharmacology.

How Does the General Population Treat Their Pain? A Survey in Catalonia, Spain

Several epidemiological studies have shown that pain is a very common complaint in patients who seek medical care. However, the characteristics of how pain is treated in the general population have been studied less. The present survey was conducted to describe and analyze how the general population of Catalonia (Spain) approaches the treatment of their pain complaints. The study was carried out in 1964 adults who were surveyed by phone about the presence of painful events in the last six months, the intensity and location of their pain, what they did to treat their pain, and their resulting level of relief. Data were compared by age and gender. Pain prevalence was high (78.6%) and more frequent in women. The therapeutic strategy most commonly used was a visit to the physician (66.3%), followed by self-medication (27.6%) and alternative medicines (20.5%). Drugs were the primary treatment used by physicians (86.5%), followed by physical therapy (18.1%). Pain in the extremities, back and neck pain were often unsuccessfully treated. Self-medication was often performed with acetylsalicylic acid and paracetamol (acetaminophen), and was commonly used in conjunction with other therapeutic approaches (51.9%). Age (low use of paracetamol in the elderly) and gender (low use of paracetamol in men) were related to the type of drug used in self-medication. Older men, and those with severe pain located in the chest, required hospital admission more commonly. In conclusion, pain is a common reason for seeking medical care and using drugs. Therapeutic approaches are often related to the type of pain, but also to age or gender. Knowledge of these characteristics may allow for a more efficient use of available resources.

Drug-Induced Priapism Its Aetiology, Incidence and Treatment

SummaryPriapism is characterised by a persistent erection that cannot be relieved by sexual intercourse or masturbation. Although priapism subsides spontaneously in a few days, impotence frequently follows. Both vascular and neural mechanisms are implicated in the pathophysiology of priapism, but it is not clear which initiates the process.Idiopathic cases of priapism are the most frequent (near 50%); other medical conditions that can result in priapism are haematological diseases (mainly sickle cell anaemia and leukaemia), traumatism, and neoplastic processes. Drug-induced priapism comprises about 30% of cases. The drugs most frequently implicated are psychotropic drugs (phenothiazines and trazodone), antihypertensives (mainly prazosin) and heparin. Recently, the intracav-ernosal injection of vasoactive drugs (papaverine and phentolamine) has been described in patients treated for impotence. With the exception of heparin, an α-adrenergic blocking mechanism has been suggested in the priapism-inducing action of these drugs.A significant number of anecdotal case reports link priapism and drugs, and it is possible that certain cases of idiopathic priapism could be reclassified if accurate pharmacological anamnesis were to be performed.Priapism must be considered a urological emergency. Surgical procedures are the most preferred treatment for this condition but, in selected cases, drug treatment seems to be an alternative approach.

Synthesis and evaluation of tacrine-related compounds for the treatment of Alzheimer's disease

Abstract A number of polycyclic compounds related to tacrine have been prepared by condensation of ortho-aminobenzonitriles and 2-aminocyclopentenecarbonitrile with several C2v-symmetric diketones under AlCl3 or ZnCl2 catalysis. Monocondensation products 8 together with syn- and anti-dicondensation products 9 and 10, respectively, were formed in different proportions depending mainly on the starting diketone. These compounds were separated by column chromatography, fully characterized by spectroscopic and elemental analyses and tested as acetylcholinesterase (AchE) inhibitors. Syn- and anti-compounds 9 and 10, derived from diketones 7y and 7z, have significant anti-AchE activity although compounds 8 and derivatives of diketones 7v, 7w and 7x were inactive in the range of concentrations studied. Compound 9ay was the most potent of the group, being 4.4-fold less active than tacrine as anti-AchE in biochemical assays, but only slightly less potent in biological studies and 3-fold less toxic. Compound 9ay was also able to reverse cognitive deficits in middle-aged rats.

Religious beliefs of patients and caregivers as a barrier to the pharmacologic control of cancer pain.

Clinical Pharmacology & Therapeutics (2002) 72, 107–111; doi: 10.1067/mcp.2002.126180

A survey of postoperative pain treatment in children of 3-14 years.

There is a lack of information concerning the characteristics of pediatric postoperative pain in Southern European countries. The aim of this study was to document how postoperative pain in children was managed routinely at Spanish surgical wards.

A survey of pain complaints and treatment by general practitioners in the Spanish public health organization.

The therapeutic habits of general practitioners are an important clue when drug therapy is considered, because they are treating the most frequent complaints. When pain problems are considered, it would be valuable to determine the characteristics of the pain consultations and their therapeutic attempts to solve these complaints. The present study was designed to elucidate the characteristics of pain diagnoses and treatment approaches at primary-care level in Spain. A total of 299 patients were evaluated, considering pain location, diagnostic syndrome, previous therapies, and treatments selected by the 13 participating physicians. Limb and back pain were the most frequent pain complaints. A third of the patients had received previous treatment and 36% were self-medicating, mainly with aspirin or paracetamol. Physicians prescribed diclofenac at full doses, but aspirin and paracetamol were used at subtherapeutic dosages. The study showed that (a) rheumatic pain was the most frequent at primary-care level, (b) a high level of self-medication was determined, therefore recommending a careful drug history. and (c) misconceptions about analgesic drugs may partially explain the therapeutic failure in some patients. Educational programs in rheumatic pain and analgesic therapy for general practitioners are strongly recommended.

Meta-analysis of efficacy of zinc acexamate in peptic ulcer.

Zinc acexamate (ZAC) is a new drug for the treatment of peptic ulcer. The present study was performed in order to evaluate the clinical efficacy of ZAC in peptic ulcer, using a meta-analysis of all randomized clinical trials performed with this drug. Eighteen studies were reviewed, but only 13 were considered in the final analysis. The total number of patients was 757. Control groups included placebo or H2 receptor antagonist drugs. Healing rate, assessed by endoscopy, was selected as the criterion for evaluating drug efficacy. The meta-analysis was performed using a modified version of the Mantel-Haenszel method. ZAC proved to be better than placebo in the treatment of peptic ulcer (pooled odds ratio: POR = 5.55; 95% confidence interval: 95% CI = 2.20-14.04) and not different from H2 receptor antagonist drugs when compared in patients with gastric (POR = 1.14; 95% CI = 0.47-2.72), duodenal (POR = 0.97; 95% CI = 0.13-7.33) or both ulcer types (POR = 1.10; 95% CI = 0.74-1.64). The present results show that ZAC is an effective drug for the treatment of peptic ulcer.

A pilot survey of pain prevalence in schoolchildren

Abstract The present survey analyzed the prevalence of pain and its etiology in a sample of Spanish schoolchildren in relation to age and gender. The survey considered 571 students (57.8% girls) 6 to 15 years of age from two schools. A questionnaire was used to ask children about their present pain, their worst pain experience and the causes of both. Pain prevalence was 27.1% and no gender difference was seen but the younger group had a higher prevalence (32.7%). Most children (72.9%) were able to describe their present pain etiology, which was often related with medical illnesses (79.6%). Almost all children (90.5%) described their worst pain event and statistical differences (p < 0.001) were seen between younger (77.6%) and older children (95.6%). These differences by age were observed both in boys (p < 0.001) and girls (p < 0.05). The cause of the worst pain was significantly related with age (p < 0.001), and surgery and trauma events were more frequent in boys (p < 0.05). In conclusion, pain is a comm...