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Pain is a subjective experience that is mediated by the social structure and by the contextual aspects of people in pain. From the point of view of those affected, a sociological analysis has been carried out of why society doubts pain and the impact that the lack of credibility has on people in pain. Qualitative methodology is used. In total, 19 semi-structured interviews have been conducted with men and women in pain. Research has shown that pain produces discredit in all dimensions of individual’s social life, from the most intimate to that related to healthcare and production. The lack of credibility takes the form of epistemic injustice, being a reaction produced from the social structure to avoid the impacts that pain could produce on the social system. Epistemic injustice affects anyone in pain, but the form it takes will be related to sufferer’s circumstances. Studying this topic is important because it shows the rigidity of expert systems to deal with some old and new situations related to pain. It also shows the frequent lack of fit between the systems and the sufferers. Finally, the article shows that to deal unfairly with the testimony of people in pain has negative consequences on the treatment of pain. A better understanding of these issues could improve the sufferers’ living conditions., This work was supported by Spain’s State R&D Program Oriented to The Challenges of The Society, 2018 (Grant number: RTI2018-099483-B-100).

El dolor, un problema de primer orden en salud, es la primera causa de consulta médica en atención primaria y del consumo de medicamentos de la población general. Mientras a nivel mundial se asume que el principal problema es la falta de acceso a medicamentos de importantes sectores de población en ciertos países, en otros puntos geográficos se pone el acento en un posible abuso o utilización inadecuada de los mismos. El objetivo principal de este artículo es conocer qué características influyen en el consumo de medicamentos para el dolor de la población española. Para ello se han analizado, por un lado, los datos de la Encuesta Nacional de Salud del año 2017 y, por otro, la Encuesta sobre Percepción Social del Dolor del año 2016. Hemos encontrado que las mujeres, así como las personas de mayor edad y con estudios básicos son las que mayor consumo de medicamentos presentan, pero también que el dolor de origen emocional, que es el que mayor intensidad dolorosa reporta, es el menos medicado de los dolores padecidos, siendo al mismo tiempo un dolor que sufren principalmente las mujeres. Pain is the leading cause of medical consultation in primary care and also of drug use in the general population. In some countries, the main problem is the lack of access to pain medication for large sectors of the population. In other countries, the problem is the abuse or misuse of painkillers and other drugs. The main objective of this article is to know the social factors that influence the consumption of pain medication in the Spanish population. For this purpose, we analyzed data from the 2017 National Health Survey on the one hand and the 2016 Survey on Social Perception of Pain on the other. We have found, among other relevant issues, that women, the elderly age and people with basic education have the highest drug use. Additionally, we found that emotional pain is both the most intense and the least medicalized pain, and it is a pain more women than men suffer from.

Investigar la experiencia del dolor requiere el empleo de una perspectiva teórica constructivista, que permita ir más allá de posiciones analíticas biologicistas y también de las subjetivistas, porque ambas suelen ofrecer análisis incompletos de la realidad. En este artículo se persigue mostrar que los aspectos sociales influyen sobre la percepción del dolor del parto, teniendo en cuenta que está aceptado, científica y comúnmente, que aquel es uno de los dolores más intensos que se puede experimentar. Para ello se han realizado diez grupos de discusión compuestos por mujeres que fueron madres hace no más de dos años, que responden a criterios de edad, nivel de estudios, situación laboral y hábitat. Tras analizar los discursos sociales, los principales resultados muestran que al dolor del parto se le atribuyen sentidos diferentes en función del tipo de maternidad con el que se identifican las mujeres. El tipo de maternidad ejercida está relacionado con las condiciones sociales de vida de las mujeres y con los discursos circulantes en sus entornos que, mayoritariamente, se construyen sobre la base de conocimientos comunes, ajenos al ámbito científico. Observamos, asimismo, que a través de las prácticas sociales relacionadas con la maternidad, las mujeres persiguen la obtención de capital simbólico, que es el reconocimiento social de ser una buena madre. Una práctica útil para obtener capital simbólico es el dolor del parto que, además, introduce una jerarquía del valor social de las mujeres en el campo de la maternidad. El artículo muestra que el dolor tiene una dimensión social que modela su experiencia y también la existencia de un consenso entre las mujeres para asumirlo como una práctica útil y conveniente.

Lourdes Biedma-Velázquez, María Isabel García-Rodríguez, Rafael Serrano-del-Rosal Institute for Advanced Social Studies, Spanish National Research Council (IESA/CSIC), Córdoba, Spain Background: Pain is a perception conditioned both by the painful experience and by each society’s collective imagination. The general objective of the project which this work forms part of it was to discover what citizens think about different aspects of this complex experience. More precisely, this paper’s objective is to get to know which is the worst pain that can be suffered according to Spaniards and what determines that hierarchy, bearing in mind that this work has chosen a broad definition of pain, including pains of different origins, namely, physical, psychological, and emotional pain. Materials and methods: The data from the CIS 3137 study “Social perceptions of pain” have been used, which is a survey module designed by the Institute of Advanced Social Studies (IESA) of the Spanish National Research Council (CSIC). A hierarchical multiple factor analysis has been performed, using the SPSS statistical analysis software, where the dependent variable is the citizen’s opinion on which is the worst pain that can be suffered, recoded according to the origin of pain (physical, psychological, and emotional pain). Sociodemographic variables and variables linked to the experience of pain have been included as independent variables. Results and conclusion: Although the most frequent pains among Spanish citizens are those of a physical origin, especially those linked to musculoskeletal problems and pains of an orofacial origin, when they are asked about the worst pain a person can suffer, they do not mention this type of pain, but those of an emotional origin. It has also been possible to confirm that the pain that citizens refer to when asked about the worst pain that can be suffered, and, therefore, the hierarchy of pain held by Spanish citizens as a group, is conditioned, although not determined, by the pain that has previously been suffered – by one’s own experience of pain. Keywords: pain, social perception, physical pain, psychological pain, emotional pain, experience of pain

The article addresses a thorny issue in our time, sedentarism. Concern over sedentarism pervades current medical discourse as well as public opinion. However, this article does not enter into debate or discuss solutions. Instead, it offers a different perspective on an issue that has been largely defined by the medical profession. Physical activity and sports are a source of health; biological and epidemiological studies have demonstrated this. But health is not merely the absence of disease or the biophysical state of the individual. Culture and living conditions contribute to it. Well-being is also a reflection of elements of a social and not just biological nature. Thus, the study of health and well-being must not ignore the value of the social sciences. Here we analyze the extent to which our lifestyles (active or sedentary) are determinants of our health and subjective well-being. The results provide a reflection on the cost of our lifestyles, not only in regard to our own health and well-being, but also regarding the health system itself. Hence, our diagnosis is based on the idea that, as with health and well-being, our lifestyles depend on cultural prescriptions and not merely medical ones.

Objetivo: Analizar la visión que tienen de su formación y práctica profesional los médicos internos residentes (MIR) que han elegido la especialidad de medicina de familia y comunitaria (MFC) frente al resto de residentes de otras especialidades, para ver las diferencias entre ambos y sus implicaciones para el sistema. Material y métodos: Encuesta online a MIR que comenzaron su formación residencial en Andalucía en 2008. Se realizó un análisis factorial de los componentes principales a partir de variables de opinión sobre aspectos profesionales y formativos con el fin de agruparlas en dimensiones y posteriormente un ANOVA para observar las diferencias entre los 2 grupos estudiados con respecto a dichas dimensiones. Resultados: Se obtuvieron 3 dimensiones que resumen las opiniones de los residentes sobre su formación residencial. Los residentes de MFC tienen una visión más positiva del sistema de formación y le dan más importancia a cuestiones generales de la práctica médica respecto a los residentes de otras especialidades. Conclusiones: Actualmente las políticas sanitarias posicionan al ciudadano como eje del sistema y ponen el acento no solo en cuestiones biológicas sino también en otras de carácter social (prevención, educación, atención de enfermedades comunes y de colectivos con mayores problemas, etc.). A tenor de los resultados los MIR-MFC parecen estar más en consonancia con estos valores, lo cual puede ser indicativo de una mejor adaptación a esta nueva cultura organizativa.

Background: The main objective of this paper is to analyze the prevalence of each of the different clinical subtypes of temporomandibular disorders (TMD) in a sample of patients with this pathology. In addition, a second objective was to analyze their distribution according to gender. Material and Methods: To this end, the results of 1603 patients who went to the Unit of Temporomandibular Disorders in the Córdoba Healthcare District because they suffered from this pathology were analyzed. In order to diagnose them, the Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD) were applied, analyzing the different Axis I subtypes (myopathy, discopathy and arthropathy) and obtaining the combined Axis I for each patient and the relation of all these variables according to gender. The null-hypothesis test confirmed the lack of connection between the gender variable and the different subtypes in the clinical analysis, and between the former and the combined Axis I of the RDC/TMD. Results: The prevalence was high for the muscle disorders subtype in general, showing an 88.7% prevalence, while the presence of discopathies or arthropathies was much lower. Among discopathies, the most frequent ones were disc displacements with reduction, with 39.7% and 42.8% for the left and right temporomandibular joints (TMJ), respectively, while the prevalence of arthropathies was 26.3% for the right TMJ and 32.9% for the left TMJ. The bivariate analysis on the connection with gender reveals a p≥ 0.05 value for the muscle and arthralgia subtypes. Conclusions: The patients seen at the TMD Unit where mostly middle-aged women whose main clinical axis subtype was the muscle disorder subtype. For their part, both discopathies and arthropathies, although present, are much less prevalent.

When we talk about the “meaning of pain,” we can do so from two main fields. First of all, the biological meaning of pain may be referred to. Second, we can talk about the function or “social meaning” of pain.

Objectives: To examine whether patients who report orofacial pain (OP) and temporomandibular disorders (TMD) have a poorer perception of their oral health-related quality of life and, if so, to what extent, and to analyze the association between oral health perception, sociodemographic variables and reported pain duration. Study Design: 407 patients treated at the OP and TMD units in the Healthcare District of Cordoba, Spain, diagnosed following the standard criteria accepted by the scientific community – the Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD) – were administered the Spanish version of the Oral Health Impact Profile questionnaire (OHIP-14). Bivariate and logistic regression analyses were performed to determine the degree of association between the patients’ OHIP-14 score and pain duration, pain intensity, and various sociodemographic variables. Results: The observed distribution was 89.4% women and 10.6% men. The mean OHIP-14 score was 20.57 ± 10.73 (mean ± standard deviation). A significant association (p

It determines if participating in sports and/or physical activity influences perceived health among the elderly. Basic procedures: Data were drawn from a population subsample of subjects aged 65 - 79 years old that took part in a survey conducted in 2008 by the IESA-CSIC. A regression model was performed with perceived health status with the dependent variable and sociodemographic characteristics and physical activity as independent variables. Results: Physical activity is closely associated to per-ceived health, although sport has little influence on this relationship. Conclusions: Doing exercise or feeling that one is physically active makes the elderly feel better about their health status. However, this age group practises few sports and sport is not found to have an important or constant influence on self-perceived health status among the elderly.

Objetivo: Analizar qué características sociodemográficas y de opinión predicen el respaldo de los ciudadanos a la Ley antitabaco en España. Métodos: Se han analizado los datos de una encuesta telefónica realizada en 2008 por el Centro de Investigaciones Sociológicas (CIS) sobre hábitos relacionados con el tabaco a población española, estableciendo cuotas de sexo y edad y con distribución por comunidades autónomas y tamaño de hábitat. Se ha realizado un análisis descriptivo de los principales resultados y un análisis de regresión logística (stepwise forward). La variable dependiente es la posición ante la ley antitabaco, y las variables independientes, las características sociodemográficas del entrevistado y las opiniones sobre la ley. Resultados: Lo que más predice la posición favorable a la ley es la apreciación de su efectividad, es decir, la percepción de que la ley ayuda a mejorar la salud de la población y a reducir el número de fumadores y la cantidad de cigarrillos fumados. Conclusión: Es necesario que la población apoye políticas sanitarias que son claramente beneficiosas para la salud pública en general. En este sentido, la información sobre la efectividad de la ley se postula como un elemento decisivo para conseguir el respaldo popular necesario para llevar a cabo políticas restrictivas y/o prohibitivas.

Background: Medical residents play two roles that enter into conflict during their educational period: trainees and workers. This dual role can lead to dissatisfaction among residents that can affect both the quality of the services they provide to citizens and the proper functioning of the health services model itself. Aim: To analyse discrepancies between the preferences and expectations of first-year medical residents and whether these differences affect satisfaction with the residency. Method: A questionnaire was administered on-line to the entire population of first-year medical residents of the Autonomous Community of Andalusia (Spain) in 2008. We performed a means contrast test between the indicator discrepancy (difference between preferences and expectations during the residency as a training or a working period), overall satisfaction with the residency and their relationship to other expectations of medical residents. Results: Respondents showing greater discrepancy have a more negative opinion about the residency. Conclusion: There is a gap between what residents prefer and what they expect from the residency, giving rise to dissatisfaction. This gap must be bridged to improve the quality of training received by these new physicians, their satisfaction and hence the delivery of health services to citizens. © 2012 Informa UK Ltd.

Health is a key area for humans and the main indicator of the quality of life we enjoy. For this reason health has been studied, analysed, and discussed across numerous scientific disciplines from a wide range of theoretical perspectives. From the quantitative point of view, it is noteworthy that life expectancy in Western countries has reached its highest level in the history of mankind1. Medical research has made significant contributions to our understanding of the human organism, as well as the treatment and prevention of many diseases. These advances have had a direct impact not only on increased life expectancy, but have also changed the concept of medical practice, which is increasingly focused on “adding life to years rather than adding years to life” (Herrera & Duran, 1995). Indeed, in medical practice today, the patient’s quality of life has become as or even more important than the disease itself. From the qualitative standpoint, this has led to a significant change in how health is conceived. Health is now understood as a multidimensional concept that in addition to purely medical aspects (morbidity, mortality, life expectancy ), encompasses physical elements (physical surrounding, housing, the environment, etc.), social components (occupational health and safety, education and health care, equitable distribution of available resources, etc.), lifestyle (adequate diet, physical exercise, tobacco and alcohol consumption, etc.), the healthcare system (physical and human resources, hospital care, social security, research, etc.), and others.

Objective: A study is made of the influence of gender, educational level, marital status, income, social support, and perceived general and oral health upon pain intensity in a sample of patients with temporomandibular joint disorders (TMJD) explored in primary care (AP). Design: A review was made of 899 patients from Córdoba Healthcare District (Spain) referred to the primary care TMJD Unit by their primary care physician and/or dentist. Of these subjects, 151 failed to meet the inclusion criteria. The remaining 748 subjects were explored according to the corresponding research diagnostic criteria (RDC/TMJD). A bivariate analysis was made the association of pain intensity to the demographic and psychological characteristics of the patients, and to perceived general and oral health, followed by a multivariate linear regression analysis to explain pain intensity as a function of the rest of the variables. The SPSS version 19.0 statistical package was used. Results: The patient age ranged from 18-86 years, with a mean of 45.8 years (± 15.8), and a female predominance of 5:1. The characteristic pain intensity (CPI) score was almost 15 points higher on average in women than in men (p

To analyse differences in the satisfaction of health service users associated with the sex of the attending doctor.Data obtained from the Primary Care Services User Survey (2005), part of a project regarding user satisfaction with the Andalusian Public Health Services. A bivariate analysis was conducted, the two variables being doctors sex and user satisfaction, as was an ANOVA, taking as a dependent variable the indicator of general satisfaction and as independent variables the characteristics of the individual and that of the system, including physician sex.In the bivariate analysis a relation was confirmed between doctors sex and satisfaction with the components of the health service received. Nevertheless, this influence disappears in the analysis of dependence, which includes sociodemographic and system variables.Differences between practices by male and female doctors are confirmed, but not the differences in general satisfaction with the service received.

El artículo aborda un tema espinoso en nuestra época. La preocupación por el sedentarismo impregna el discurso médico, pero también el de la opinión pública. El trabajo no entra en el debate ni provee soluciones. Ofrece una perspectiva diferente sobre un asunto acotado antaño al colectivo médico. La actividad física y el deporte son fuente de salud. Los estudios biológicos y epidemiológicos así lo han demostrado. Pero la salud no es sólo la ausencia de enfermedad ni el estado biofísico de una persona. A ella contribuyen la cultura y las condiciones de vida. El bienestar es también reflejo de elementos de naturaleza social, y no sólo biológica. Por ende, su estudio no debe desdeñar el valor de las ciencias sociales. Aquí se analiza en qué grado nuestros estilos de vida (activos o sedentarios) son determinantes de nuestra salud y bienestar subjetivos. Los resultados permiten reflexionar sobre el coste de los mismos, no sólo para nuestra sensación de salud y bienestar, sino también para el propio sistema sanitario. De ahí que nuestro prospecto se eleve sobre la idea de que, al igual que esos elementos, nuestros estilos de vida dependen de prescripciones culturales antes que meramente médicas.