Dolor crónico tras la cirugía de mama: incidencia, factores de riesgo e impacto en la calidad de vida | Revista Española de Anestesiología y Reanimación

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define el dolor cr&#243;nico postoperatorio &#40;DCPO&#41; como el dolor que se desarrolla o aumenta de intensidad tras un procedimiento quir&#250;rgico en la zona de la mama y que persiste m&#225;s all&#225; del proceso de curaci&#243;n&#44; es decir&#44; al menos 3<span class="elsevierStyleHsp" style=""></span>meses tras el episodio iniciador&#46; Se han excluido otras causas del dolor&#44; tales como dolor preexistente&#44; infecci&#243;n o malignidad&#44; en todos los casos de dolor cr&#243;nico postoperatorio<a class="elsevierStyleCrossRef" href="#bib0160"><span class="elsevierStyleSup">2</span></a>&#46; Inicialmente descrito como un episodio de baja incidencia&#44; el DCPO es actualmente un problema crecientemente reconocido<a class="elsevierStyleCrossRefs" href="#bib0165"><span class="elsevierStyleSup">3&#44;4</span></a>&#44; con una prevalencia que fluct&#250;a del 25 al 60&#37; y donde cerca del 14&#37; de los pacientes presentan dolor cr&#243;nico de moderado a severo&#46; El DCPO es neurop&#225;tico en el 25-31&#37; 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de diciembre del 2020 a diciembre del 2021&#44; en el Centro Hospitalar Universit&#225;rio de S&#227;o Jo&#227;o&#44; un hospital docente terciario de Oporto&#44; Portugal&#46; Dicho estudio fue aprobado por el comit&#233; local de &#233;tica de investigaci&#243;n local &#40;proyecto de investigaci&#243;n n&#46;&#176; 240&#47;19&#41;&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">Incluimos a las pacientes adultas &#40;&#8805; 18 a&#241;os&#41; programadas para cirug&#237;a electiva de mama oncol&#243;gica&#44; quienes otorgaron su consentimiento escrito para participaci&#243;n y publicaci&#243;n de los resultados&#46; Los criterios de exclusi&#243;n fueron pertenecer al sexo masculino&#44; c&#225;ncer de mama bilateral&#44; enfermedad mental o incapacidad de comunicarse&#44; embarazo o lactancia&#44; y el no hablar portugu&#233;s&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">El protocolo anest&#233;sico se estandariz&#243; en todas las pacientes&#58; se utilizaron midazolam&#44; fentanilo y propofol para inducci&#243;n&#44; realiz&#225;ndose la paralizaci&#243;n con rocuronio&#46; Se mantuvo la anestesia con propofol o sevoflurano y fentanilo o remifentanilo&#44; en combinaci&#243;n con analgesia&#47;anestesia regional &#40;bloqueo paravertebral con 2-3&#44;75<span class="elsevierStyleHsp" style=""></span>mg&#47;ml de ropivaca&#237;na&#41; a discreci&#243;n del anestesi&#243;logo asistente&#46; Se administraron acetaminofeno&#44; ketorolaco&#44; tramadol y morfina hacia el final del procedimiento&#44; para analgesia postoperatoria&#46; Todos los datos intraoperatorios fueron debidamente registrados&#46; Postoperatoriamente se administraron acetaminofeno &#40;1<span class="elsevierStyleHsp" style=""></span>g&#44; 4 veces diarias&#41;&#44; ketorolaco &#40;30<span class="elsevierStyleHsp" style=""></span>mg&#44; 3 veces diarias&#41;&#44; tramadol &#40;100<span class="elsevierStyleHsp" style=""></span>mg&#44; 3 veces diarias&#41; y morfina &#40;3-5<span class="elsevierStyleHsp" style=""></span>mg&#44; como analgesia de rescate&#41;&#46; La morfina fue administrada por el m&#233;dico tratante y las enfermeras sobre la base de las puntuaciones de dolor reportadas por la paciente&#44; conforme al protocolo local&#46; Nuestra Unidad del Dolor Agudo est&#225; de servicio continuo y proporciona terapia para el dolor basada en los est&#225;ndares recomendados&#46;</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Resultados</span><p id="par0040" class="elsevierStylePara elsevierViewall">El resultado primario fue la incidencia&#44; las caracter&#237;sticas y los factores asociados al DCPO en las pacientes tratadas mediante cirug&#237;a de c&#225;ncer de mama&#46; El resultado secundario fue el impacto del DCPO en la CdV de la paciente&#46;</p><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Recopilaci&#243;n y evaluaci&#243;n de los datos</span><p id="par0045" class="elsevierStylePara elsevierViewall">Se registraron las caracter&#237;sticas demogr&#225;ficas&#44; estado f&#237;sico de American Society of Anaesthesiologists &#40;ASA&#41;&#44; comorbilidades&#44; medicaci&#243;n diaria y quimioterapia preoperatoria&#44; radioterapia y terapia hormonal&#46; Los datos fueron recopilados utilizando las versiones portuguesas de los cuestionarios validados<a class="elsevierStyleCrossRef" href="#bib0200"><span class="elsevierStyleSup">10</span></a>&#44; que fueron administrados preoperatoriamente &#40;T0&#41;&#44; transcurridos 2<span class="elsevierStyleHsp" style=""></span>d&#237;as &#40;T2&#41;&#44; 3<span class="elsevierStyleHsp" style=""></span>meses &#40;T90&#41; y 6<span class="elsevierStyleHsp" style=""></span>meses &#40;T180&#41; de la cirug&#237;a&#46; Previamente a la cirug&#237;a &#40;T0&#41;&#44; se administraron Pain Catastrophizing Scale &#40;PCS&#41;&#44; Brief Pain Inventory-Short Form &#40;BPI-SF&#41;&#44; Douleur Neuropathique 4 Questionnaire &#40;DN4&#41; y European Organization for Research and Treatment of Cancer Quality of Life Questionnaire &#40;EORTC QLQ-C30&#41; y Breast Cancer Module &#40;QLQ-BR23&#41;&#46; En T2&#44; se administr&#243; BPI-SF&#46; Los cuestionarios T0 y T2 se administraron durante una entrevista presencial&#46; Se revaluaron telef&#243;nicamente todas las pacientes transcurridos 90 d&#237;as &#40;T90&#41; y 180 d&#237;as &#40;T180&#41;&#44; durante los cuales se administraron BPI-SF&#44; DN4&#44; EORTC QLQ-C30 y QLQ-BR23&#46; Se estandarizaron todas las entrevistas para limitar el sesgo del entrevistador&#44; respondiendo las pacientes a las preguntas sin ninguna interferencia del entrevistador&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Cuestionarios</span><p id="par0050" class="elsevierStylePara elsevierViewall">La PCS es una escala autorreportada de 13 &#237;tems que se utiliza para evaluar el pensamiento catastr&#243;fico relacionado con el dolor<a class="elsevierStyleCrossRef" href="#bib0205"><span class="elsevierStyleSup">11</span></a>&#46; El BPI-SF es un cuestionario autorreportado de 9 &#237;tems utilizado para evaluar la severidad del dolor del paciente y su impacto en el funcionamiento diario<a class="elsevierStyleCrossRef" href="#bib0210"><span class="elsevierStyleSup">12</span></a>&#46; El DN4 discrimina el dolor neurop&#225;tico &#40;DN&#41; del dolor nociceptivo y se compone de 10 &#237;tems agrupados en 4 secciones&#46; Los primeros 7 &#237;tems est&#225;n reportados por el paciente y se relacionan con la calidad del dolor y su asociaci&#243;n con sensaciones anormales&#44; y los 3 &#237;tems restantes est&#225;n reportados por el cl&#237;nico y guardan relaci&#243;n con los hallazgos de un examen neurol&#243;gico de la zona dolorosa&#46; Como nuestro inter&#233;s fue recopilar &#250;nicamente los datos autorreportados&#44; se eliminaron los 3 &#250;ltimos &#237;tems de DN4&#44; clasific&#225;ndose a los pacientes con DN de acuerdo con Bouhassira et al&#46; &#40;2008&#41;<a class="elsevierStyleCrossRef" href="#bib0215"><span class="elsevierStyleSup">13</span></a>&#46; EORTC QLQ-C30 y QLQ-BR23 eval&#250;an la calidad de vida&#58; el primero es un cuestionario de 30 &#237;tems y EORTC QLQ-BR23 es un m&#243;dulo espec&#237;fico para la mama que incluye 23 preguntas<a class="elsevierStyleCrossRefs" href="#bib0220"><span class="elsevierStyleSup">14&#44;15</span></a>&#46; Las variables intraoperatorias del procedimiento quir&#250;rgico y anest&#233;sicas se recopilaron prospectivamente&#46;</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">An&#225;lisis estad&#237;stico</span><p id="par0055" class="elsevierStylePara elsevierViewall">Sobre la base de una incidencia predicha del 25&#37;&#44; calculamos que 112 participantes garantizar&#237;an un intervalo de confianza &#40;IC&#41; del 95&#37; para estimar la incidencia del dolor con un margen de error del 8&#37;&#46; Todos los an&#225;lisis estad&#237;sticos se realizaron utilizando SPSS &#40;Statistical Package for the Social Sciences&#44; versi&#243;n 22&#46;0 para Windows&#59; Chicago&#44; IL&#44; EE&#46; UU&#46;&#41;&#46; Las variables continuas se expresaron como mediana y rango intercuart&#237;lico&#44; y la normalidad se evalu&#243; mediante la prueba de Kolmogorov-Smirnov&#46; Las diferencias estad&#237;sticas entre los grupos se compararon utilizando las pruebas de Wilcoxon y U de Mann-Whitney para variables sin distribuci&#243;n normal&#46; Las variables categ&#243;ricas se expresaron como porcentajes&#46; Las diferencias estad&#237;sticas entre los grupos se evaluaron utilizando la prueba de la &#967;<span class="elsevierStyleSup">2</span>&#46; El valor p de 0&#44;05 se consider&#243; significativo para todas las pruebas&#46;</p></span></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0100">Resultados</span><p id="par0060" class="elsevierStylePara elsevierViewall">Un total de 120 pacientes fueron tratadas mediante cirug&#237;a de c&#225;ncer de mama durante el periodo de estudio&#46; De ellas&#44; se excluy&#243; a 8 porque no se pudo contactar con ellas para el seguimiento a 3 y 6 meses&#46; Por tanto&#44; 112 pacientes &#40;93&#44;9&#37;&#41; completaron el estudio&#46; La <a class="elsevierStyleCrossRef" href="#tbl0005">tabla 1</a> muestra las caracter&#237;sticas demogr&#225;ficas&#44; las comorbilidades y los procedimientos quir&#250;rgicos y anest&#233;sicos de las pacientes evaluadas&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0065" class="elsevierStylePara elsevierViewall">La incidencia de DCPO a los 3<span class="elsevierStyleHsp" style=""></span>meses fue del 34&#44;8&#37; &#40;IC del 95&#37;&#58; 26&#44;8-42&#44;8&#37;&#41;&#59; el 19&#44;6&#37; report&#243; dolor moderado y el 15&#44;1&#37; dolor severo&#46; A los 6<span class="elsevierStyleHsp" style=""></span>meses&#44; la incidencia de DCPO hab&#237;a descendido al 20&#44;5&#37; &#40;IC del 95&#37;&#58; 12&#44;5-28&#44;5&#37;&#41;&#59; el 3&#44;6&#37; report&#243; dolor leve&#44; el 8&#44;3&#37; report&#243; dolor moderado&#44; y el 8&#37; report&#243; dolor severo&#46; De ellas&#44; el dolor evaluado por DN4 fue posiblemente neurop&#225;tico en el 81&#44;7&#37; de los casos en T90 y el 16&#44;1&#37; de los casos en T180&#46; La <a class="elsevierStyleCrossRef" href="#tbl0010">tabla 2</a> muestra la severidad y nivel de interferencia del DCPO medidos por BPI-SF en T90&#46;</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><p id="par0070" class="elsevierStylePara elsevierViewall">La <a class="elsevierStyleCrossRef" href="#tbl0015">tabla 3</a> muestra la asociaci&#243;n entre las caracter&#237;sticas demogr&#225;ficas&#44; comorbilidades&#44; factores psicol&#243;gicos&#44; factores cl&#237;nicos y postoperatorios tempranos de los pacientes y la incidencia de DCPO a los 3<span class="elsevierStyleHsp" style=""></span>meses&#46; La diabetes &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;028&#41;&#44; el dolor agudo postoperatorio evaluado mediante BPI-SF en T2 &#40;p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&#41; y PCS medio &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;042&#41; estuvieron significativamente asociados a una mayor incidencia de DCPO&#46; La incidencia de DCPO a los 3 meses no se vio afectada por la edad &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;436&#41;&#44; obesidad &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;306&#41;&#44; radioterapia &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;910&#41; y uso preoperatorio de opioides o gabapentina &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;720 y p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;956&#44; respectivamente&#41;&#46;</p><elsevierMultimedia ident="tbl0015"></elsevierMultimedia><p id="par0075" class="elsevierStylePara elsevierViewall">En los cuestionarios QLQ-C30 y QLQ-BR23&#44; las pacientes que presentaron DCPO a los 3<span class="elsevierStyleHsp" style=""></span>meses reportaron un cambio significativo a peor en cuanto a funcionamiento emocional &#40;p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&#41;&#44; fatiga &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;005&#41;&#44; n&#225;useas y v&#243;mitos &#40;p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&#41;&#44; imagen corporal &#40;p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&#41; y efectos secundarios relacionados con la terapia &#40;p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&#41;&#44; y poco o nulo cambio en los &#237;tems restantes&#46; Dichos resultados se resumen en la <a class="elsevierStyleCrossRef" href="#tbl0020">tabla 4</a>&#46;</p><elsevierMultimedia ident="tbl0020"></elsevierMultimedia></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0105">Discusi&#243;n</span><p id="par0080" class="elsevierStylePara elsevierViewall">Los principales hallazgos de nuestro estudio pueden resumirse de la manera siguiente&#46; En primer lugar&#44; aproximadamente un tercio de las pacientes desarrollaron DCPO&#59; en casi todos los casos&#44; el DCPO fue potencialmente neurop&#225;tico&#46; En segundo lugar&#44; el DCPO interfiri&#243; considerablemente en la vida diaria y empeor&#243; la CdV en comparaci&#243;n con las pacientes sin DCPO&#46; En tercer lugar&#44; la diabetes&#44; la catastrofizaci&#243;n y la severidad del dolor agudo postoperatorio estuvieron asociados al DCPO&#46;</p><p id="par0085" class="elsevierStylePara elsevierViewall">La incidencia de DCPO en nuestro estudio es consistente con la literatura<a class="elsevierStyleCrossRefs" href="#bib0175"><span class="elsevierStyleSup">5&#44;16&#44;17</span></a>&#44; aunque la actualizaci&#243;n de nuestra incidencia se basa en la definici&#243;n actual de DCPO por parte de IASP&#46; Los motivos de la reducci&#243;n de la incidencia de DCPO transcurridos 6<span class="elsevierStyleHsp" style=""></span>meses de la cirug&#237;a no est&#225;n claros&#44; aunque es razonable asumir que estas pacientes buscan ayuda a medida que progresa el dolor posquir&#250;rgico&#44; y reciben tratamiento adecuado con un mejor seguimiento&#46; De manera alternativa&#44; el descenso puede ser atribuible a factores psicol&#243;gicos o a la patofisiolog&#237;a del DCPO<a class="elsevierStyleCrossRef" href="#bib0240"><span class="elsevierStyleSup">18</span></a>&#46; Los factores psicol&#243;gicos son importantes para la percepci&#243;n del dolor&#44; habi&#233;ndose demostrado que la resiliencia y el afecto positivo reducen el dolor cr&#243;nico&#46; Adem&#225;s&#44; las pacientes pueden sentirse m&#225;s satisfechas con su vida tras la cirug&#237;a del c&#225;ncer&#44; pudiendo mejorar esto su perfil psicol&#243;gico&#46; Por tanto&#44; la mejora de la CdV y la mejor satisfacci&#243;n con la vida a lo largo del tiempo podr&#237;an reducir la incidencia del dolor en estas pacientes&#46; El papel de las variables contextuales y cognitivas en el dolor cr&#243;nico no solo es importante&#44; sino tambi&#233;n complejo<a class="elsevierStyleCrossRef" href="#bib0240"><span class="elsevierStyleSup">18</span></a>&#46;</p><p id="par0090" class="elsevierStylePara elsevierViewall">En cuanto a la severidad&#44; nuestros hallazgos sugieren que el DCPO es un dolor de alta intensidad que interfiere considerablemente en las actividades diarias&#46; Muchas de nuestras pacientes clasificaron su DCPO como moderado&#44; con interferencia de moderada a severa en la actividad general&#46; El DCPO interfiri&#243; tambi&#233;n en el &#225;nimo de las pacientes&#44; su capacidad de andar&#44; el trabajo normal&#44; las relaciones con otras personas&#44; el sue&#241;o y el disfrute de la vida &#8212;un hallazgo que se repite en otros estudios sobre el dolor posquir&#250;rgico<a class="elsevierStyleCrossRef" href="#bib0240"><span class="elsevierStyleSup">18</span></a>&#46;</p><p id="par0095" class="elsevierStylePara elsevierViewall">Nuestros resultados han reflejado una alta proporci&#243;n de posible DN&#46; El DN inducido por las lesiones nerviosas ha sido propuesto como causa mayor de dolor posquir&#250;rgico cr&#243;nico&#44; sugiriendo una revisi&#243;n previa que la prevalencia de DN difiere de acuerdo con el tipo de cirug&#237;a practicado&#44; y probablemente depende de la probabilidad de lesi&#243;n del nervio iatrog&#233;nico-quir&#250;rgica<a class="elsevierStyleCrossRef" href="#bib0245"><span class="elsevierStyleSup">19</span></a>&#46;</p><p id="par0100" class="elsevierStylePara elsevierViewall">Con respecto a otros factores asociados al dolor&#44; la edad m&#225;s joven&#44; radioterapia&#44; disecci&#243;n de los ganglios axilares y severidad del dolor postoperatorio agudo constituyen los factores de riesgo m&#225;s comunes descritos en la literatura<a class="elsevierStyleCrossRefs" href="#bib0165"><span class="elsevierStyleSup">3&#44;5&#44;20</span></a>&#46;</p><p id="par0105" class="elsevierStylePara elsevierViewall">La edad m&#225;s joven es un factor de riesgo bien conocido para el DCPO y el &#250;nico descrito como independiente<a class="elsevierStyleCrossRefs" href="#bib0170"><span class="elsevierStyleSup">4&#44;6-8</span></a>&#46; Los tumores m&#225;s agresivos&#44; el tratamiento m&#225;s agresivo y la mayor labilidad emocional son algunas explicaciones posibles<a class="elsevierStyleCrossRef" href="#bib0230"><span class="elsevierStyleSup">16</span></a>&#46; La edad media de nuestras pacientes fue de 54 a&#241;os y&#44; a diferencia de otros estudios previos&#44; fuimos incapaces de encontrar una asociaci&#243;n entre la edad y el DCPO&#44; debido posiblemente al peque&#241;o tama&#241;o de nuestra muestra&#46;</p><p id="par0110" class="elsevierStylePara elsevierViewall">Se sabe que la diabetes predispone a los pacientes al dolor cr&#243;nico&#46; De acuerdo con la literatura actual&#44; el dolor cr&#243;nico es muy com&#250;n entre los pacientes diab&#233;ticos&#44; habiendo tenido un impacto significativo en su rutina de autocuidado<a class="elsevierStyleCrossRef" href="#bib0255"><span class="elsevierStyleSup">21</span></a>&#46; En el caso del DCPO&#44; pocos estudios han examinado el impacto de la diabetes en la cronificaci&#243;n del dolor&#46; Andersen et al&#46; &#40;2015&#41;&#44; por ejemplo&#44; no pudieron identificar una asociaci&#243;n<a class="elsevierStyleCrossRef" href="#bib0250"><span class="elsevierStyleSup">20</span></a>&#46; En nuestro estudio&#44; sin embargo&#44; la diabetes estuvo significativamente asociada a una mayor incidencia de DCPO a los 3<span class="elsevierStyleHsp" style=""></span>meses&#46; Estos hallazgos podr&#237;an estudiarse adicionalmente en la investigaci&#243;n futura&#44; pudiendo originar unos planes terap&#233;uticos m&#225;s efectivos y personalizados en estas pacientes<a class="elsevierStyleCrossRef" href="#bib0260"><span class="elsevierStyleSup">22</span></a>&#46;</p><p id="par0115" class="elsevierStylePara elsevierViewall">El perfil psicol&#243;gico &#40;depresi&#243;n&#47;ansiedad&#41; y la catastrofizaci&#243;n han sido objeto de mucha investigaci&#243;n en las pacientes de c&#225;ncer de mama&#44; aunque con resultados conflictivos<a class="elsevierStyleCrossRefs" href="#bib0230"><span class="elsevierStyleSup">16&#44;20&#44;23</span></a>&#46; Aunque la evidencia actual sugiere que los factores psicol&#243;gicos son importantes para la percepci&#243;n del dolor&#44; nosotros no encontramos una asociaci&#243;n entre la ansiedad o la depresi&#243;n y el desarrollo de DCPO&#46; La catastrofizaci&#243;n&#44; sin embargo&#44; estuvo asociada al DCPO&#44; hallazgo que tambi&#233;n ha sido reportado en estudios previos sobre dolor posquir&#250;rgico agudo y cr&#243;nico&#46;</p><p id="par0120" class="elsevierStylePara elsevierViewall">Otro hallazgo importante de nuestro estudio fue la falta de asociaci&#243;n entre la radioterapia y el desarrollo de dolor cr&#243;nico&#44; aun cuando esto ha sido descrito a menudo como factor de riesgo de DCPO<a class="elsevierStyleCrossRefs" href="#bib0230"><span class="elsevierStyleSup">16&#44;20</span></a>&#46; Esta discrepancia podr&#237;a deberse al peque&#241;o n&#250;mero de mujeres que recibieron radioterapia en la poblaci&#243;n de nuestro estudio &#40;solo el 10&#37;&#41;&#46;</p><p id="par0125" class="elsevierStylePara elsevierViewall">El dolor preoperatorio es otro factor de riesgo bien conocido y ampliamente estudiado de DCPO&#46; Parece predisponer al paciente al dolor cr&#243;nico&#44; ya que la transici&#243;n del dolor agudo al dolor cr&#243;nico es facilitada por la sensibilizaci&#243;n al dolor central y perif&#233;rica a largo plazo<a class="elsevierStyleCrossRefs" href="#bib0165"><span class="elsevierStyleSup">3&#44;16&#44;20&#44;24</span></a>&#46; En nuestro estudio&#44; el 18&#44;8&#37; de las mujeres reportaron dolor preoperatorio en el cuestionario BPI-SF&#44; pero ello no guard&#243; relaci&#243;n con el DCPO&#46;</p><p id="par0130" class="elsevierStylePara elsevierViewall">No encontramos asociaci&#243;n entre el &#237;ndice de masa corporal &#40;IMC&#41; y el DCPO&#46; La literatura sobre esta cuesti&#243;n es escasa e inconsistente&#58; algunos estudios no encontraron asociaci&#243;n&#44; mientras que otros identificaron una relaci&#243;n lineal positiva entre el IMC y el DCPO<a class="elsevierStyleCrossRefs" href="#bib0230"><span class="elsevierStyleSup">16&#44;25</span></a>&#46;</p><p id="par0135" class="elsevierStylePara elsevierViewall">El DCPO es un proceso complejo que implica lesi&#243;n traum&#225;tica del nervio&#44; inflamaci&#243;n&#44; y sensibilizaci&#243;n perif&#233;rica y central&#46; Un cuerpo amplio de la literatura ha mostrado de forma consistente que el dolor postoperatorio agudo severo est&#225; asociado al desarrollo de DCPO<a class="elsevierStyleCrossRefs" href="#bib0165"><span class="elsevierStyleSup">3&#44;6&#44;16&#44;20</span></a>&#46; En l&#237;nea con estos hallazgos&#44; tambi&#233;n encontramos que el DCPO fue m&#225;s com&#250;n entre las pacientes con puntuaciones m&#225;s altas de dolor agudo postoperatorio&#46; La fiabilidad de estos hallazgos muestra la necesidad de tratar pronta y efectivamente el dolor agudo tras la cirug&#237;a de mama&#46;</p><p id="par0140" class="elsevierStylePara elsevierViewall">Las evaluaciones de la CdV son ahora una parte importante del cuidado del c&#225;ncer de mama&#46; El primer estudio sobre la calidad de vida en el c&#225;ncer de mama fue publicado en 1974 por Moore et al&#46;<a class="elsevierStyleCrossRef" href="#bib0280"><span class="elsevierStyleSup">26</span></a> y&#44; desde entonces&#44; se han realizado progresos considerables en cuanto a la evaluaci&#243;n de la CdV en las pacientes de c&#225;ncer de mama&#46; La primera literatura muestra que las pacientes que recibieron tratamiento contra el c&#225;ncer reportaron peores capacidad funcional y s&#237;ntomas&#44; en comparaci&#243;n con los individuos sanos&#46; La funci&#243;n cognitiva&#44; las cuestiones sexuales&#44; la fatiga y los problemas del sue&#241;o se encontraron entre los problemas a largo plazo m&#225;s ampliamente reportados<a class="elsevierStyleCrossRefs" href="#bib0190"><span class="elsevierStyleSup">8&#44;9</span></a>&#46; M&#225;s recientemente&#44; autores tales como Yfantis et al&#46; &#40;2020&#41; encontraron que las pacientes demostraron una CdV bastante buena&#44; con s&#237;ntomas de intensidad baja&#47;moderada tras el tratamiento del c&#225;ncer de mama<a class="elsevierStyleCrossRef" href="#bib0185"><span class="elsevierStyleSup">7</span></a>&#46; Esta tendencia en t&#233;rminos de mejora de la CdV puede explicarse por el progreso realizado en t&#233;rminos de las herramientas de cribado del c&#225;ncer de mama y las opciones terap&#233;uticas en los &#250;ltimos a&#241;os&#44; y tambi&#233;n por la introducci&#243;n de sistemas de atenci&#243;n sanitaria de apoyo&#44; con asesoramiento y respaldo social para las pacientes de c&#225;ncer&#46; Sin embargo&#44; seg&#250;n se refleja en nuestro estudio&#44; el DCPO empeor&#243; la CdV&#44; es decir&#44; el funcionamiento emocional&#44; la fatiga&#44; las n&#225;useas y los v&#243;mitos y la imagen corporal&#44; e increment&#243; la incidencia de los efectos secundarios relacionados con la terapia&#46; Esto muestra el impacto negativo del DCPO y la necesidad de identificarlo y tratarlo de manera temprana&#46; La reducci&#243;n de la CdV reportada por las pacientes de DCPO deber&#237;a animar a los profesionales y autoridades sanitarios a investigar e implementar estrategias de prevenci&#243;n de este tipo de dolor&#46;</p><p id="par0145" class="elsevierStylePara elsevierViewall">Nuestro estudio tiene diversas fortalezas&#46; Se trata de un estudio prospectivo observacional sobre el dolor cr&#243;nico posquir&#250;rgico&#44; tras un procedimiento espec&#237;fico con baja tasa de p&#233;rdida durante el seguimiento&#46; Utilizamos las definiciones ICD-11 y realizamos una evaluaci&#243;n amplia basada en cuestionarios validados&#44; un an&#225;lisis detallado de la incidencia y severidad del DCPO&#44; factores relacionados con los pacientes e impacto del DCPO en la CdV&#46;</p><p id="par0150" class="elsevierStylePara elsevierViewall">Una de las principales limitaciones de nuestro estudio ata&#241;e al tipo de anestesia administrado&#44; ya que una gran proporci&#243;n de nuestras pacientes &#40;89&#44;7&#37;&#41; fue sometida a cirug&#237;a de c&#225;ncer de mama sin anestesia regional&#46; Esto dificulta la detecci&#243;n de posibles diferencias&#44; en t&#233;rminos de DCPO&#44; posiblemente relacionadas con la anestesia&#46; Aunque se sabe que las t&#233;cnicas de anestesia regional protegen contra el dolor<a class="elsevierStyleCrossRef" href="#bib0285"><span class="elsevierStyleSup">27</span></a>&#44; el n&#250;mero de pacientes de nuestro estudio que recibieron anestesia regional fue demasiado peque&#241;o para abordar su impacto en el DCPO de manera adecuada&#46; Sin embargo&#44; la evidencia del papel de la anestesia regional&#44; es decir&#44; el bloqueo paravertebral&#44; es a menudo contradictoria<a class="elsevierStyleCrossRef" href="#bib0290"><span class="elsevierStyleSup">28</span></a>&#46; Por ejemplo&#44; una revisi&#243;n sistem&#225;tica en Cochrane reflej&#243; que la anestesia regional&#44; es decir&#44; el bloqueo paravertebral&#44; redujo el riesgo de DCPO<a class="elsevierStyleCrossRef" href="#bib0285"><span class="elsevierStyleSup">27</span></a>&#44; mientras que un metaan&#225;lisis reciente concluy&#243; que el bloqueo paravertebral no preven&#237;a el DCPO<a class="elsevierStyleCrossRef" href="#bib0295"><span class="elsevierStyleSup">29</span></a>&#46; La anestesia regional es una t&#233;cnica importante para reducir la severidad del dolor postoperatorio agudo<a class="elsevierStyleCrossRef" href="#bib0300"><span class="elsevierStyleSup">30</span></a>&#44; que constituye un factor de riesgo conocido de DCPO&#46; En nuestro estudio&#44; las pacientes que presentaron DCPO reportaron dolor postoperatorio leve &#40;severidad media<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>3&#41; de media&#44; lo cual sugiere que el protocolo analg&#233;sico postoperatorio multimodal utilizado en nuestras pacientes proporcion&#243; un manejo adecuado del dolor agudo&#44; aun cuando pocas pacientes recibieron anestesia regional&#46;</p><p id="par0155" class="elsevierStylePara elsevierViewall">Nuestra muestra se obtuvo de un &#250;nico hospital&#44; lo cual pudo introducir alg&#250;n sesgo con respecto a las t&#233;cnicas quir&#250;rgicas y el tratamiento del dolor agudo&#44; y limitar la generalizabilidad de nuestros resultados&#46;</p></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0110">Conclusiones</span><p id="par0160" class="elsevierStylePara elsevierViewall">Aunque los avances terap&#233;uticos sobre el c&#225;ncer de mama han incrementado las tasas de supervivencia&#44; tambi&#233;n han causado ciertos efectos adversos&#44; siendo uno de los m&#225;s importantes el DCPO&#44; que afecta a la salud f&#237;sica y mental de las pacientes&#44; as&#237; como a sus actividades diarias&#46; Este estudio realiza una aportaci&#243;n a la evidencia suministrada por la investigaci&#243;n anterior sobre el DCPO y conciencia a los profesionales sanitarios sobre la importancia de educar a las pacientes sobre el riesgo de DCPO y emprender acciones para prevenir y tratar esta situaci&#243;n&#46;</p></span><span id="sec0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0115">Autor&#237;a</span><p id="par0165" class="elsevierStylePara elsevierViewall">Los autores declaran que todos hicieron contribuciones sustanciales a la concepci&#243;n y dise&#241;o del estudio&#44; o adquisici&#243;n de datos&#44; o an&#225;lisis e interpretaci&#243;n de datos&#44; hasta la redacci&#243;n el art&#237;culo o revisarlo cr&#237;ticamente para obtener informaci&#243;n intelectual importante&#44; y a la aprobaci&#243;n final de la versi&#243;n a ser presentado&#46;</p></span><span id="sec0055" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0120">Conflicto de intereses</span><p id="par0170" class="elsevierStylePara elsevierViewall">Los autores declaran no tener ning&#250;n conflicto de intereses&#46;</p></span></span>"
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            0 => "Breast cancer"
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    "resumen" => array:2 [
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        "titulo" => "Resumen"
        "resumen" => "<span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Introducci&#243;n y objetivos</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">El c&#225;ncer de mama es la neoplasia m&#225;s frecuentemente diagnosticada y el dolor cr&#243;nico postoperatorio &#40;DCPO&#41; es un problema relacionado con la terapia crecientemente reconocido&#46; Evaluamos la incidencia del DCPO&#44; sus caracter&#237;sticas&#44; factores asociados e impacto en la calidad de vida &#40;CdV&#41; del paciente&#46;</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Materiales y m&#233;todos</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Se realiz&#243; un estudio prospectivo observacional de 6<span class="elsevierStyleHsp" style=""></span>meses en pacientes tratados mediante cirug&#237;a de mama en un hospital universitario terciario&#46; Los datos se recopilaron utilizando diversos cuestionarios&#58; Pain Catastrophizing Scale&#44; Brief Pain Inventory-Short Form&#44; Douleur Neuropathique 4&#44; European Organization for Research and Treatment of Cancer Quality of Life Questionnaire y Breast Cancer Module&#46;</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Resultados</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Un total de 112 pacientes completaron el estudio&#44; de los cuales aproximadamente un tercio &#40;34&#44;8&#37;&#41; desarrollaron DCPO y casi todos ellos dolor neurop&#225;tico potencial&#46; El DCPO interfiri&#243; con la vida diaria de los pacientes y redujo su CdV&#46; La diabetes &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;028&#41;&#44; la catastrofizaci&#243;n &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;042&#41; y la gravedad del dolor posoperatorio agudo &#40;p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&#41; se asociaron a DCPO&#46;</p></span> <span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">Conclusiones</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Este estudio ampl&#237;a nuestra comprensi&#243;n sobre el DCPO y muestra el impacto de este s&#237;ndrome&#46; Los profesionales sanitarios deben ser conscientes del DCPO&#44; y tomar medidas para prevenirlo y tratarlo&#44; proporcionando a los pacientes la informaci&#243;n suficiente&#46;</p></span>"
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        "resumen" => "<span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Introduction and objectives</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Breast cancer is the most frequently diagnosed malignancy&#44; and chronic pain after breast surgery &#40;CPBS&#41; is an increasingly recognized therapy-related problem&#46; We evaluated CPBS incidence&#44; characteristics&#44; associated factors&#44; and impact on patient quality of life &#40;QoL&#41;&#46;</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Materials and methods</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Six-month observational prospective study in patients undergoing breast surgery in a tertiary university hospital&#46; Data were collected using several questionnaires&#58; Pain Catastrophizing Scale&#44; Brief Pain Inventory-Short Form&#44; Douleur Neuropathique 4 Questionnaire&#44; and European Organization for Research and Treatment of Cancer Quality of Life Questionnaire and its Breast Cancer Module&#46;</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Results</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">A total of 112 patients completed the study&#46; Approximately&#44; one third &#40;34&#46;8&#37;&#41; developed CPBS&#44; almost all with potentially neuropathic pain&#46; CPBS interfered with patients&#8217; daily life and reduced their QoL&#46; Diabetes <span class="elsevierStyleItalic">&#40;p</span>&#61;&#46;028&#41;&#44; catastrophizing <span class="elsevierStyleItalic">&#40;p</span>&#61;&#46;042&#41;&#44; and acute postoperative pain severity <span class="elsevierStyleItalic">&#40;p</span>&#60;&#46;001&#41; were associated with CPBS&#46;</p></span> <span id="abst0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0055">Conclusions</span><p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">This study broadens our understanding of CPBS and shows the impact of this syndrome&#46; Healthcare workers need to be aware of CPBS and take steps to prevent and treat it&#44; and provide patients with adequate information&#46;</p></span>"
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">18 &#40;15&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">IV</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2 &#40;1&#44;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleBold">&#205;ndice de masa corporal &#40;kg</span><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleBold">&#215;</span><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleBold">m</span><span class="elsevierStyleSup"><span class="elsevierStyleBold">&#8211;2</span></span><span class="elsevierStyleBold">&#41;&#44; M &#40;P</span><span class="elsevierStyleInf"><span class="elsevierStyleBold">25-</span></span><span class="elsevierStyleBold">P</span><span class="elsevierStyleInf"><span class="elsevierStyleBold">75</span></span><span class="elsevierStyleBold">&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">27&#44;476 &#40;23&#44;6-30&#44;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleBold">Depresi&#243;n&#47;ansiedad&#44; n&#46; &#40;&#37;&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">47 &#40;39&#44;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleBold">Diabetes&#44; n&#46; &#40;&#37;&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">16 &#40;13&#44;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleBold">Quimioterapia&#44; n &#40;&#37;&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">45 &#40;37&#44;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleBold">Radioterapia&#44; n &#40;&#37;&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">12 &#40;10&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleBold">Terapia hormonal&#44; n &#40;&#37;&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">13 &#40;10&#44;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleBold">Opioides&#44; n &#40;&#37;&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">8 &#40;6&#44;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleBold">Gabapentinas&#44; n &#40;&#37;&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4 &#40;3&#44;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleBold">F&#225;rmacos psicoactivos&#44; n &#40;&#37;&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">55 &#40;45&#44;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleBold">PCS total&#44; M &#40;P</span><span class="elsevierStyleInf"><span class="elsevierStyleBold">25</span></span><span class="elsevierStyleBold">-P</span><span class="elsevierStyleInf"><span class="elsevierStyleBold">75</span></span><span class="elsevierStyleBold">&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">11 &#40;3&#44;3-27&#44;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleBold">Dolor preoperatorio</span><a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a><span class="elsevierStyleBold">&#44; n &#40;&#37;&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">21 &#40;18&#44;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleBold">Posible dolor neurop&#225;tico</span><a class="elsevierStyleCrossRef" href="#tblfn0010"><span class="elsevierStyleSup">b</span></a><span class="elsevierStyleBold">&#44; n &#40;&#37;&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">8 &#40;6&#44;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleBold">Factores quir&#250;rgicos</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleBold">Procedimiento quir&#250;rgico</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Tumorectom&#237;a&#44; n &#40;&#37;&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">37 &#40;31&#44;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Tumorectom&#237;a y mamoplastia&#44; n &#40;&#37;&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">18 &#40;15&#44;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Mamoplastia terap&#233;utica&#44; n &#40;&#37;&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">9 &#40;7&#44;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Mastectom&#237;a simple&#44; n &#40;&#37;&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">13 &#40;10&#44;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Mastectom&#237;a radical&#44; n &#40;&#37;&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">6 &#40;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Mastectom&#237;a radical modificada&#44; n &#40;&#37;&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">28 &#40;23&#44;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Mastectom&#237;a e IBR&#44; n &#40;&#37;&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">6 &#40;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">ALND&#44; n &#40;&#37;&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2 &#40;1&#44;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleBold">SLNS</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">No&#44; n &#40;&#37;&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">23 &#40;19&#44;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">SLNB&#44; n &#40;&#37;&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">56 &#40;47&#44;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Muestra axilar&#44; n &#40;&#37;&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1 &#40;0&#44;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">ALND&#44; n &#40;&#37;&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">39 &#40;32&#44;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleBold">Factores anest&#233;sicos</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Sue&#241;o&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">6 &#40;15&#44;4&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">16 &#40;41&#44;0&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Disfrute de la vida&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">21 &#40;53&#44;9&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">10 &#40;25&#44;7&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0 &#40;0&#44;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
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          "leyenda" => "<p id="spar0070" class="elsevierStyleSimplePara elsevierViewall">En negritas&#44; diferencia significativa&#44; p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;05&#46;</p><p id="spar0075" class="elsevierStyleSimplePara elsevierViewall">DCPO&#58; dolor cr&#243;nico postoperatorio&#59; M&#58; mediana&#59; PCS&#58; Pain Catastrophizing Scale&#59; P<span class="elsevierStyleInf">25</span>&#58; Percentil 25&#59; P<span class="elsevierStyleInf">75</span>&#58; Percentil 75&#46;</p>"
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                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Pacientescon DCPO&#40;N<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>39&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Pacientessin DCPO&#40;N<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>73&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-head\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">p&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">Edad&#44; M &#40;P<span class="elsevierStyleInf">25</span>-P<span class="elsevierStyleInf">75</span>&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">49 &#40;46-66&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">54 &#40;47-66&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&#44;436<a class="elsevierStyleCrossRef" href="#tblfn0020"><span class="elsevierStyleSup">b</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t">Obesidad&#44; n &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">8 &#40;21&#44;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">22 &#40;30&#44;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">0&#44;306<a class="elsevierStyleCrossRef" href="#tblfn0015"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t">Depresi&#243;n&#47;ansiedad&#44; n &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">19 &#40;48&#44;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">24 &#40;32&#44;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;101<a class="elsevierStyleCrossRef" href="#tblfn0015"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Diabetes&#44; n &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">9 &#40;23&#44;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">6 &#40;8&#44;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleBold">0&#44;028</span><a class="elsevierStyleCrossRef" href="#tblfn0015"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Quimioterapia&#44; n &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">15 &#40;38&#44;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">27 &#40;37&#44;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;878<a class="elsevierStyleCrossRef" href="#tblfn0015"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Radioterapia&#44; n &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4 &#40;10&#44;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">7 &#40;9&#44;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;910<a class="elsevierStyleCrossRef" href="#tblfn0015"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Terapia hormonal&#44; n &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">5 &#40;12&#44;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">7 &#40;9&#44;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;598&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Uso preoperatorio cr&#243;nico de opioides&#44; n &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2 &#40;5&#44;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">6 &#40;6&#44;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;720<a class="elsevierStyleCrossRef" href="#tblfn0015"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Uso cr&#243;nico de gabapentina&#44; n &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1 &#40;2&#44;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2 &#40;2&#44;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;956<a class="elsevierStyleCrossRef" href="#tblfn0015"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Nivel de catastrofizaci&#243;n cl&#237;nicamente relevante &#40;PCS<span class="elsevierStyleHsp" style=""></span>&#62;<span class="elsevierStyleHsp" style=""></span>30&#41;&#44; n &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">9 &#40;23&#44;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">13 &#40;17&#44;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;504&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Puntuaci&#243;n PCS total &#62;<span class="elsevierStyleHsp" style=""></span>11 &#40;mediana de la muestra&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">26 &#40;66&#44;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">34 &#40;46&#44;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleBold">0&#44;042</span><a class="elsevierStyleCrossRef" href="#tblfn0015"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Dolor preoperatorio<a class="elsevierStyleCrossRef" href="#tblfn0025"><span class="elsevierStyleSup">c</span></a>&#44; n &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">7 &#40;17&#44;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">14 &#40;19&#44;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;874<a class="elsevierStyleCrossRef" href="#tblfn0015"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Severidad media del dolor agudo<a class="elsevierStyleCrossRef" href="#tblfn0030"><span class="elsevierStyleSup">d</span></a> M &#40;P<span class="elsevierStyleInf">25</span>-P<span class="elsevierStyleInf">75</span>&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">3 &#40;0-5&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0 &#40;0-1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleBold">&#60;</span><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleBold">0&#44;001</span><a class="elsevierStyleCrossRef" href="#tblfn0020"><span class="elsevierStyleSup">b</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Peor severidad del dolor agudo<a class="elsevierStyleCrossRef" href="#tblfn0025"><span class="elsevierStyleSup">c</span></a> M &#40;P<span class="elsevierStyleInf">25</span>-P<span class="elsevierStyleInf">75</span>&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4 &#40;0-7&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0 &#40;0-3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleBold">&#60;</span><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleBold">0&#44;001</span><a class="elsevierStyleCrossRef" href="#tblfn0020"><span class="elsevierStyleSup">b</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
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              "identificador" => "tblfn0020"
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          "leyenda" => "<p id="spar0085" class="elsevierStyleSimplePara elsevierViewall">En negritas&#44; diferencia significativa&#44; nivel p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;05&#46;</p><p id="spar0090" class="elsevierStyleSimplePara elsevierViewall">CdV&#58; calidad de vida&#59; DCPO&#58; dolor cr&#243;nico postoperatorio&#59; EORTC QLQ-C30 y QLQ-BR23&#58; European Organization for Research and Treatment of Cancer Quality of Life Questionnaire and its Breast Cancer Module&#59; M&#58; mediana&#59; P<span class="elsevierStyleInf">25</span>&#58; percentil 25&#59; P<span class="elsevierStyleInf">75</span>&#58; percentil 75&#59; T90&#58; 90 d&#237;as postoperatorios&#46;</p>"
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                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">EORTC-QLQ-C30&#47;EORTC-QLQ-BR23&#44; M &#40;P25-P75&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Pacientescon DCPO&#40;N<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>39&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Pacientessin DCPO&#40;N<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>73&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">p&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Estatus global T90&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">10 &#40;9-12&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">10 &#40;8-12&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;352<a class="elsevierStyleCrossRef" href="#tblfn0035"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Funcionamiento f&#237;sico T90&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">8 &#40;6-12&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">7 &#40;5-9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;216<a class="elsevierStyleCrossRef" href="#tblfn0035"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Funcionamiento del rol T90&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2 &#40;2-4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2 &#40;2-4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;505<a class="elsevierStyleCrossRef" href="#tblfn0035"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Funcionamiento emocional T90&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">9 &#40;7-10&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">6 &#40;4-8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001<a class="elsevierStyleCrossRef" href="#tblfn0035"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Funcionamiento cognitivo T90&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2 &#40;2-3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2 &#40;2-3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#44;000<a class="elsevierStyleCrossRef" href="#tblfn0035"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Funcionamiento social T90&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2 &#40;2-3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2 &#40;2-3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;181<a class="elsevierStyleCrossRef" href="#tblfn0035"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Fatiga T90&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">6 &#40;3-7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4 &#40;3-5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;005<a class="elsevierStyleCrossRef" href="#tblfn0035"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">N&#225;useas y v&#243;mitos T90&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2 &#40;2-3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2 &#40;2-2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001<a class="elsevierStyleCrossRef" href="#tblfn0035"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Dolor T90&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3 &#40;2-5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2 &#40;2-3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;008<a class="elsevierStyleCrossRef" href="#tblfn0035"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Imagen corporal T90&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">9 &#40;4-11&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t">&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001<a class="elsevierStyleCrossRef" href="#tblfn0035"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t\ttable-entry\n
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