[MUSIC] [MUSIC] [MUSIC] [MUSIC] Greetings. Today we meet again with Dr. María Camila Bustos, who is an expert on the subject of chronic pain and neuropathic pain from the point of view of public health. We will cover in this video what are the possible solutions that are available from the point of view of public health for Latin American countries, Regarding neuropathic pain, more specifically in postherpetic neuralgia diseases, diabetic polyneuropathy and lumbar pain with radiculopathy. >> Well, greetings. Thank you very much, Sergio, for inviting me to this space. Well, I am María Camila Bustos, I am a general practitioner, I had an experience in research focused on chronic pain during my first years after graduating from medicine and during this experience was where I felt the need to learn a little more from public health, understanding that this was a problem that was not resolved simply from clinical research. That's why I went to do a master's degree in public health at Boston University and I returned to Colombia recently, where I dedicate myself to, to the work of health economics. So, I am here with great pleasure to talk about the problem of pain chronic in Latin America. [MUSIC] >> Using an example could you explain, what is the economic burden of chronic disease on society? >> The economic burden of a chronic disease could be defined from an example such as low back pain, which is one of the most prevalent pathologies of chronic pain and the leading cause of years lost due to disability and the first cause of labor absenteeism, for example, in countries like Colombia. This financial burden can be measure from different fronts depending on the perspective we take. If we take it from the point of view of the health system only, we can think a lot about how much the treatment costs, how much it costs to treat the secondary effects of having this pathology, above all, if it is treated at what time, in primary, secondary or tertiary prevention. And, if we see it from the point of view of society, then the economic burden takes the broadest possible perspective and we look at the opportunity costs from loss of productivity, absenteeism from work, of loss of income, both for the patient and for society itself. And it can even be taken to levels of analysis of economic development. And, on the other hand, many times it is left a little more invisible in the discussion, but Every day we begin to talk about quality of life and how the economic burden It is also related to the patient's quality of life, their ability to enjoy of his eh, of his relatives, of the activities he likes to do. And it also begins to take on a more qualitative and human part of that burden. >> Let's say it is recognized that access to health services for patients with chronic pain and specifically those patients with neuropathic pain, It is very limited access. Let's say that from a public health point of view, What would be the ideal model of health care for this type of patient? >> So, from public health the ideal model, the first keyword there It is the comprehensive and interdisciplinary treatment. This means that it is a coordinated treatment because it is a chronic pathology, requires sustained attention in however long, as you say, not only sustained, but that it does not have significant variations over time, that is, that it is not fragmented between the different specialties that treat it. Chronic pain is characterized by being a pathology in itself, I call it patients without an owner, because they go from one specialty to another, being one as a problem that is common to so many specialties, but that nobody completely appropriates them, because leaving aside the pain clinics, and care ends up becoming very fragmented. So, the first thing, the comprehensive care of, of the patient. And the second key word there is opportunity in, in attention. And that is where we need to start focusing more on primary prevention, in identifying risks for chronic pain, so you don't have to deal with the consequences late stages of this disease that is highly prevalent and very costly for society. >> What do you consider to be the steps to start building strategies in Latin America? >> From an analysis of the gaps that exist, from the structural point of view of health systems and from a seen not only from the system, from the framework of policies, but also from the quality of the provision of services and the use of services and also of the patients themselves, the first point is awareness of this problem in health systems, that is, what is its prevalence, what is the magnitude of the problem in terms of how many people are affected and what are the costs or the human and economic burden of this pathology. We need this awareness to come from the patients and from health professionals. Another important point is, and you taking it from the health professionals more forward, is the generation of more information on the subject, to the extent that we can generate more clinical translational research, economic, qualitative and quantitative of the problem, we will be able to diagnose it better and thus design better solutions for the future. And, finally, taking all this to the implementation in research in health services as such. Practical research in implementation science to find, for example, solutions to problems such as centralization of care, that in rural areas of Latin American countries, as is very common, receive the same attention that they receive in the most developed urban centers. So, there are three important points, awareness both of the population in general, generation of more information to mobilize towards change and generate urgency of the importance of addressing this situation and, third, put this information into practice, because only in theory, well no, we don't solve anything. >> As Dr. María Camila has been able to demonstrate, chronic pain is a big problem for society, especially for health systems, as well as patients who suffer from it. She gave us different tools that can be applied for these diseases and how we can solve them in a clinical setting. [MUSIC] [MUSIC] [MUSIC] [SOUND]