Validez de la escalera analgésica de la OMS en reumatología

Pain is a common symptom in oncologic patients. Pain mechanism is characterized by being nociceptive, and there is evidence of opioids' efficacy in its control. Its treatment is usually temporary in most patients. Rheumatic diseases are the most frecuent cause of cronic non malignant pain.There are diferent types of mechanism of musculoeskeletic pain (somatic, neuropatic, miofascial). The treatment of this group of diseases is normaly cronic and opioid drugs have a variable efficacy depending on the type of disease. The WHO Ladder was designed as a tool to achieve cancer pain relief, on a simple and effective method. In 1986 the World Health Organization (WHO) released a set of guidelines about the cancer pain relief and one of the central components of the guidelines was the “three-step analgesic ladder”. The WHO Ladder is based on the use of some drugs that by a simple method of scalation allows the control of pain between the 70-95% of cases of cancer pain. There are some studies which have validated its effectiveness, in spite of their methodological limitations. Although the WHO analgesic ladder was designed to get cancer pain relief, its use has been generalizated to the management of any kind of pain, including musculoeskeletal tipe. In patients with rheumetic diseases, the WHO ladder is used to modulate therapeutic decissions in accordance to control pain. It is not clear that may use on the same way of in cancer pain, because more important than the intensity of the pain is to know the type of disease that suffer the patient. In adittion, in some patients with musculoeskeketal pain there are situations in which is not addecuate to follow the normal order of WHO analgesic ladder; and in some cases, it would be contraindicated.