Positive effects of a pain education program on patients with chronic pain: observational study / Efeitos positivos de um programa de educação em dor em pacientes com dor crônica: estudo observacional

ABSTRACT BACKGROUND AND OBJECTIVES: Pain education is a tool that helps health professionals in the biopsychosocial approach and in pain management in patients with musculoskeletal pain. The objectives of the study were to verify the effects of a pain education program in patients with chronic musculoskeletal pain. The evaluated outcomes were pain, kinesiophobia, catastrophizing, quality of life, central sensitization and perception of the disease. METHODS: Observational, retrospective study. Data from 24 participants with chronic pain, mean age 57 years, were analyzed, 83% of whom were female. Patients participated in a pain education program, which addressed topics such as acceptance, pain alarm, sleep, relaxation, negative thoughts, return to activities, relationships, and exercises. RESULTS: Participants showed significant changes in the cognitive representation of the disease measured by the Illness Perception Questionnaire (Brief-IPQ) (p<0.01), central sensitization by the CSI (p=0.05), catastrophism (p<0.05), pain (p<0.01), physical aspects by the Short-Form Health Survey (SF-36) (p<0.05) and in the total score of the same Instrument (p<0.05). CONCLUSION: The group applied pain education associated with usual physical therapy had significant effects in relation to the cognitive representation of the disease, central sensitization, catastrophizing and quality of life in patients with chronic musculoskeletal pain.

RESUMO JUSTIFICATIVA E OBJETIVOS: A educação em dor é uma ferramenta que auxilia os profissionais de saúde na abordagem biopsicossocial e no manejo da dor em pacientes com dor musculoesquelética. Os objetivos do estudo foram verificar os efeitos de um programa de educação em dor em pacientes com dor crônica musculoesquelética. Os desfechos avaliados foram dor, cinesiofobia, catastrofização, qualidade de vida, sensibilização central e percepção da doença. MÉTODOS: Estudo observacional, retrospectivo. Foram analisados os dados de 24 participantes com dor crônica, idade média de 57 anos, sendo 83% do sexo feminino. Os pacientes participaram de um programa de educação em dor, que abordou temas como aceitação, alarme da dor, sono, relaxamento, pensamentos negativos, retorno às atividades, relacionamentos e exercícios. RESULTADOS: Os participantes apresentaram mudanças significativas na representação cognitiva da doença mensurada pelo Illness Perception Questionnaire (Brief-IPQ) p<0,01), sensibilização central pelo CSI (p=0,05), catastrofismo (p<0,05), Dor (p<0,01), aspectos físicos pelo Questionário Short-Form Health Survey (SF-36) (p<0,05) e no escore total do mesmo instrumento (p<0,05). CONCLUSÃO: A educação em dor aplicada em grupo associada à fisioterapia usual apresentou efeitos significativos em relação à representação cognitiva da doença, sensibilização central, catastrofização e qualidade de vida nos pacientes com dor crônica musculoesquelética.

Response to fatigue observed through magnetic resonance imaging on the quadriceps muscle in postmenopausal women

OBJECTIVES: Menopause marks the end of women's reproductive period and can lead to sarcopenia and osteoporosis (OP), increasing the risk of falls and fractures. The aim of this study is to evaluate the influence of normal and low bone mineral density (BMD) on muscular activity, observed through inflammatory edema when mapping using magnetic resonance imaging (MRI) on the quadriceps muscle of postmenopausal women. METHODS: This was a cross-sectional study involving 16 older women, who were divided into two groups: osteoporosis group (OG), older women with OP, and control group (CG), older women without OP. The groups were evaluated in terms of nuclear MRI exam before and after carrying out fatigue protocol exercises using an isokinetic dynamometer and squatting exercises. RESULTS: The results of the present study showed that in intragroup comparisons, for both groups, there was a significant increase (p<0.05) in the T2 signal of the nuclear MRI in the quadriceps muscle after carrying out exercises using both thighs. In the intergroup comparison, no statistically significant difference was observed between the OG and CG, pre- (p=0.343) and postexercise (p=0.874). CONCLUSION: The acute muscular activation of the quadriceps evaluated by T2 mapping on nuclear MRI equipment is equal in women with and without OP in the postmenopausal phase. BMD did not interfere with muscle response to exercise when muscle fatigue was reached.

The impact of patients controlled analgesia undergoing orthopedic surgery / O impacto da analgesia controlada pelos pacientes submetidos a cirurgias ortopédicas

ABSTRACT INTRODUCTION: The currently common musculoskeletal disorders have been increasingly treated surgically, and the pain can be a limiting factor in postoperative rehabilitation. RATIONALE: Patient controlled analgesia (PCA) controls pain, but its adverse effects can interfere with rehabilitation and in the patient discharge process. This study becomes important, since there are few studies evaluating this correlation. OBJECTIVES: To compare the outcomes of patients who used and did not use patient controlled analgesia in postoperative orthopedic surgery with respect to pain, unscheduled need for O2 (oxygen), and time of immobility and in-hospital length of stay. METHODS: This is an observational, prospective study conducted at Hospital Abreu Sodré from May to August 2012. The data was daily obtained through assessments and interviews of patients undergoing total hip arthroplasty (THA) and total knee arthroplasty (TKA), thoracolumbar spine arthrodesis (long PVA), cervical spine arthrodesis (cervical AVA) and lumbar spine arthrodesis (lumbar PVA). RESULTS: The study showed some differences between groups, namely: the painful level was higher in the group undergoing lumbar PVA without PCA compared with the group with PCA (p = 0.03) and in the group of long PVA without PCA in the early postoperative period. This latter group used O2 for a longer time (p = 0.09). CONCLUSION: In this study, PCA was useful for analgesia in patients undergoing lumbar PVA and probably would have influenced the usage time of O2 in the group of long PVA in face of a larger sample. The use of PCA did not influence the time of leaving the bed and the in-hospital length of stay for the patients studied.

RESUMO INTRODUÇÃO: As disfunções musculoesqueléticas, comuns atualmente, têm sido cada vez mais tratadas cirurgicamente e a dor é pode ser um fator limitante na reabilitação pós-operatória. JUSTIFICATIVA: A analgesia controlada pelo paciente (PCA) controla a dor, porém seus efeitos adversos podem interferir no processo de reabilitação e alta dos pacientes. Esta pesquisa torna-se importante, pois poucos estudos avaliam essa correlação. OBJETIVOS: Comparar a evolução dos pacientes que usaram e não usaram PCA no pós-operatório de cirurgias ortopédicas em relação à dor, à necessidade de O2 (oxigênio) não programada e ao tempo de imobilização e internação hospitalar. MÉTODOS: Estudo observacional, prospectivo, feito no Hospital da AACD de maio a agosto de 2012. Obtiveram-se dados diários por meio de avaliação e entrevista dos pacientes submetidos à artroplastia total de quadril (ATQ) e joelho (ATJ), artrodese de coluna toracolombar (AVP longa), coluna cervical (AVA cervical) e coluna lombar (AVP lombar). RESULTADOS: O estudo evidenciou algumas diferenças entre os grupos: o nível álgico foi maior no grupo submetido à AVP lombar sem PCA em relação ao com PCA (p = 0,03) e no grupo de AVP longa sem PCA no primeiro pós-operatório. Nesse último grupo, houve uso de O2 por mais tempo (p = 0,09). CONCLUSÃO: Neste estudo, a PCA mostrou-se útil para analgesia em pacientes submetidos à AVP lombar e provavelmente teria influência no tempo de uso de O2 no grupo de AVP longa caso a amostra fosse maior. O uso da PCA não influenciou no tempo de saída do leito e de internação hospitalar nos pacientes estudados.