Impacto da dor orofacial na qualidade de vida de portadores de câncer de boca e orofaringe / Impact of orofacial pain on the quality of life of mouth and oropharynge cancer patients

RESUMO Objetivo investigar o impacto da dor orofacial na qualidade de vida de portadores de câncer de boca e orofaringe. Métodos trata-se de um estudo de corte transversal, observacional, descritivo, com amostra de conveniência. Participaram da pesquisa 30 pacientes de ambos os sexos, na faixa etária de 35 a 75 anos. Para a coleta de dados, foi utilizado questionário sociodemográfico elaborado pelos pesquisadores e o Questionário de Dor McGill. Resultados Os achados experimentais apresentaram resultados relevantes em diversos níveis classificatórios para dor orofacial. As maiores repercussões foram encontradas nos aspectos sociais, como em relação ao sono (40%), apetite/alimentação (78%), higiene pessoal (55%) e lazer (40%), que foram os subitens que tiveram maior impacto da dor na qualidade de vida dos portadores de câncer de boca e orofaringe. Conclusão Portadores de câncer de boca e orofaringe apresentam variados níveis de dor orofacial e sofrem impactos em suas vidas, principalmente nos quesitos relacionados a atividades simples do cotidiano.

ABSTRACT Purpose To investigate the impact of orofacial pain on the quality of life of patients with oral and oropharyngeal cancer. Methods This is a cross-sectional, observational, descriptive study with a convenience sample. Thirty patients of both sexes participated in the research, aged between 35 and 75 years. For data collection, a sociodemographic questionnaire prepared by the researchers, the McGuill pain protocol, was used. Results The experimental findings show us relevant results at different classification levels for orofacial pain. The greatest repercussions were found in social aspects, such as sleep (40%), appetite/food (78%), personal hygiene (55%) and leisure (40%), which were the sub-items that had the greatest impact on pain (or which were the sub-items mostly affected by pain), affecting the the quality of life of patients with oral and oropharyngeal cancer. Conclusion Under these experimental conditions, it is concluded that patients with oral and oropharyngeal cancer present different levels of orofacial pain, and suffer impacts on their lives, especially in matters related to simple daily activities.

Prevalência de dor odontogênica em um serviço de pronto-atendimento odontológico público do Sul do Brasil / Prevalence of odontogenic pain in a public dental urgency service in Southern Brazil

Objetivo: Identificar as principais causas de dor odontogênica que levam à busca pelo atendimento no Serviço de Pronto Atendimento Odontológico (SPAO) da Faculdade de Odontologia da Universidade de Passo Fundo (UPF), que funciona junto ao Hospital São Vicente de Paulo e está ligado ao Sistema Único de Saúde (SUS). Métodos: Realizou-se um estudo epidemiológico transversal e retrospectivo, baseado em dados de prontuários odontológicos de pacientes atendidos entre novembro de 2016 e outubro de 2017. Os dados foram analisados buscando-se a prevalência das diversas origens de dor odontogênica dos pacientes atendidos no período: pulpar (pulpite reversível, pulpite irreversível, necrose); periapical (pericementite, abscesso periapical); ou periodontal (periodontite, abscesso periodontal). Além disso, foi catalogada a conduta realizada durante os atendimentos de urgência. Resultados: Ao todo, foram analisados 1.275 prontuários. Desses, 868 pacientes (68,1%) apresentavam dor ao atendimento. Dos pacientes que relataram dor, 62,3% apresentavam dor odontogênica pulpar; 11,1%, dor periapical; e 12,2%, dor periodontal. A conduta mais adotada para tratamento da dor foi a terapia com analgésicos e/ou antibióticos (21,0% dos casos), seguida por acessos endodônticos (18,7%) e exodontias (17,9%). Conclusão: No serviço de pronto atendimento analisado, prevaleceram os casos de dor de origem pulpar. Os resultados obtidos contribuem para o desenvolvimento de estratégias de controle da dor odontogênica, bem como para a melhoria dos protocolos clínicos adotados na faculdade em questão (AU).

Objective: To identify the main causes of odontogenic pain that lead to people search for care in the Urgency Service of the School of Dentistry of University, Passo Fundo/RS/Brazil (SPAOH), localized in the Hospital São Vicente de Paulo. Methodology: A cross-sectional and retrospective study, carried out between the period from November 1, 2016 to October 31, 2017, when data from dental care records were collected and tabulated. The data were analyzed looking for the prevalence of several causes of odontogenic pain, with pulp origin (reversible, irreversible pulpitis, necrosis); periapical (pericementitis, abscess); periodontal (periodontitis); and others, in addition to the conduct performed in attendance. Results: A total of 1,275 dental records were analyzed, involving 868 patients, of which 68.1% reported the presence of pulp (62.3%), periapical (11.1%) and periodontal (12.2%) odontogenic pains. Analgesic or antibiotic therapies were the most common approaches, totaling 21.0% of cases, followed by endodontic accesses (18.7%) and extractions (17.9%). Conclusion: In the studied dental urgency service, cases of pulp pain prevail. The results obtained contribute to the development of strategies to control odontogenic pain, as well as to the improvement of clinical protocols (AU).

Complex regional pain syndrome secondary to sacrococcygeal dislocation following trauma to the lumbosacral region. case report

ABSTRACT Introduction: The complex regional pain syndrome (CRPS) is a rare condition characterized by inflammatory, vasomotor and central nervous system (CNS) involvement. Its clinical presentation can be subacute, acute or chronic, and may have severe effects on the patient's quality of life. Case description: 21-year-old female patient with trauma in the lumbosacral region associated with pain and functional limitation. Diagnostic imaging showed sacrococcygeal dislocation with subsequent inflammatory and acute and chronic autonomic symptoms that were treated medically and surgically. The patient responded to treatment with long-term improvement of the symptoms. Discussion: In this case, CRPS occurred after trauma and caused subacute symptoms that became even more acute until reaching a chronic presentation. Inflammation, vasomotor dysfunction and CNS involvement made this case a multidisciplinary diagnostic and therapeutic challenge. Conclusion: CRPS is a rare disease that is difficult to diagnose. However, diagnosis should be timely in order to initiate personalized treatment, since this disease considerably affects the patient's quality of life.

RESUMEN Introducción. El síndrome doloroso regional complejo (SDRC) es una patología poco frecuente que se caracteriza por causar compromiso a nivel inflamatorio, vasomotor y del sistema nervioso central (SNC). Su presentación clínica puede ser subaguda, aguda o crónica y puede afectar considerablemente la calidad de vida del paciente. Presentación del caso. Paciente femenina de 21 años con trauma en región lumbosacra asociado a dolor y limitación funcional, a quien se le practicaron imágenes diagnosticas que evidenciaron luxofractura sacrococcígea con posterior presencia de síntomas inflamatorios y autonómicos (agudos y crónicos) que se trataron con medicamentos y cirugía. La paciente respondió al tratamiento con mejoría de la sintomatología a largo plazo. Discusión. El SDRC se presentó posterior a un traumatismo y ocasionó sintomatología subaguda que se agudizó hasta llegar a la presentación crónica de la enfermedad. La inflamación, la disfunción vasomotora y el compromiso del SNC hacen de este caso un reto diagnóstico y terapéutico multidisciplinario. Conclusión. El SDRC es una patología poco frecuente y de difícil diagnóstico; sin embrago, es necesario diagnosticarlo de forma oportuna para poder iniciar un tratamiento personalizado, ya que es una enfermedad que compromete considerablemente la calidad de vida del paciente.

Contralateral Mirror Image Spreading in Post-Stroke Complex Regional Pain Syndrome

The long-term prognosis of complex regional pain syndrome is difficult to predict because of its unclear pathophysiology. The syndrome can spontaneously spread to other regions in the body. We report a case in which a complex regional pain syndrome that occurred in a 75-year-old male patient after a stroke spread to the opposite side.

Complex regional pain syndrome in the orofacial region. Case report / Síndrome complexa de dor regional em região orofacial. Relato de caso

ABSTRACT BACKGROUND AND OBJECTIVES: The complex regional pain syndrome is characterized by presenting autonomic, sensory and motor difficult to control changes of the chronic evolution. Its pathophysiology and treatment are not fully defined, and the search for an increasingly effective treatment is a subject of medical concern. The involvement of the orofacial region has an even rarer incidence, and the literature reports only 14 cases in five decades. The objective of this report was to warn physicians and researchers about the importance of a correct diagnosis and to show the possibility of controlling this dysfunction with conservative treatment. CASE REPORT: A 68-year-old female patient, who after a facial trauma and three subsequent surgical procedures, developed orofacial complex regional pain syndrome. Several therapeutic regimens were performed, and after the last one she became completely asymptomatic: oxcarbazepine (900mg/day), morphine-controlled liberation (120mg/day), fluoxetine (40mg/day) and clonazepam (2mg/day), electrotherapy and oral rehabilitation. CONCLUSION: The diagnosis criteria for complex regional pain syndrome recommended by the International Association for the Study of Pain, revised in 2007, should be followed. The treatment of this neuropathic syndrome includes anticonvulsants, tricyclics, opioids, electrotherapy and somatic and stellate ganglion block, the latter when the pain is maintained by the sympathetic nervous system. In this report of an orofacial complex regional pain syndrome II, pain control was shown without the need for sympathetic ganglion block, which can be a warning to the medical class to a correct diagnosis and an effective and less invasive treatment.

RESUMO JUSTIFICATIVA E OBJETIVOS: A síndrome complexa de dor regional se caracteriza por apresentar alterações autonômicas, sensitivas e motoras de evolução crônica de difícil controle. Sua fisiopatologia não está totalmente definida e a busca por um tratamento cada vez mais eficaz é objeto de preocupação médica. O comprometimento da região orofacial tem uma incidência ainda mais rara e a literatura relata apenas 14 casos em cinco décadas. O objetivo deste relato foi alertar médicos e pesquisadores para a importância de um diagnóstico correto e mostrar a possibilidade de controle dessa disfunção com o tratamento conservador. RELATO DO CASO: Paciente do sexo feminino, 68 anos, após trauma facial e três intervenções cirúrgicas posteriores, desenvolveu quadro de síndrome complexa de dor regional orofacial. Foram realizados vários esquemas terapêuticos, o último dos quais tornou-a completamente assintomática: oxcarbazepina (900mg/dia), morfina de liberação controlada (120mg/dia), fluoxetina (40mg/dia) e clonazepam (2mg/dia), eletroterapia e reabilitação oral. CONCLUSÃO: Os critérios de diagnóstico para a síndrome complexa de dor regional, preconizados pela International Association for the Study of Pain, revisados em 2007, devem ser seguidos. O tratamento desta síndrome neuropática inclui anticonvulsivantes, tricíclicos e opioides, eletroterapia, bloqueio somático e de gânglio estrelado, este último quando a dor for mantida pelo sistema nervoso simpático. Neste relato de uma síndrome complexa de dor regional II orofacial foi mostrado o controle da dor sem a necessidade de bloqueio do gânglio simpático, o que pode alertar a classe médica para um correto diagnóstico e um tratamento eficaz e menos invasivo.

Complex regional pain syndrome: new concepts regarding diagnosis and treatment

Antecedentes: Los autores presentan una revisión crítica sobre el cuadro clínico, el diagnóstico, clasificación y tratamientodel síndrome de dolor regional complejo, discutiendo todos los métodos de tratamiento y haciendo hincapié en que la reabilitación debe ser empleada con el fin de obtener un mejor resultado. Aspecto psicológico debe ser discutido en el tratamiento y también se anima equipo multidisciplinario para participar en él.

Background: The authors presented a critical review about the clinical picture, diagnosis, classification and treatment ofcomplex regional pain syndrome, discussing all methods of treatment and emphasizing that the reabiltation must be employed in order to obtain a better result. Psychological aspect must be involved in the treatment and also multidisciplinary team is encouraged to take part on it.

Nivel de actividad física y grado de discapacidad en pacientes con dolor lumbar crónico / Level of physical activity and degree of disability in patients with chronic low back pain / Nivel de atividade física e grau de deficiêcia em pacientes com dor lombar crónico

OBJETIVO: Determinar, en una población colombiana, el nivel de actividad física y el nivel de discapacidad en pacientes con dolor lumbar crónico y establecer la eventual existencia de asociación entre estas variables. MATERIALES Y MÉTODOS: En una unidad externa de rehabilitación en Manizales (Colombia), pacientes con dolor lumbar crónico completaron tanto el cuestionario de actividad física de Baecke como el de incapacidad de dolor lumbar de Oswestry. RESULTADOS: Un total de 125 pacientes participaron en el estudio. El valor promedio del índice de Baecke fue de 7,9±0,9 con valores para hombres y mujeres de 7,8±0,1 y 8,0±0,7 respectivamente, sin que lograra demostrar una diferencia estadísticamente significativa entre los sexos. El valor promedio del índice de Oswestry fue de 40,7±18,3 con valores para hombres y mujeres de 38,4±18,8 y 42,4±17,7 respectivamente, sin que tampoco se lograra demostrar una diferencia estadísticamente significativa entre los sexos. Un valor del coeficiente de correlación de Pearson >0,05 demostró la inexistencia de relación entre el nivel de actividad física y el grado de discapacidad en los pacientes. CONCLUSIONES: Los resultados describen una población de pacientes con dolor lumbar crónico que, comparada con lo reportado en otros estudios en estos pacientes, puede ser considerada como más activa y menos discapacitada, pero en la cual no existe correlación entre el nivel de actividad física y el grado de discapacidad. Así las cosas, los pacientes con dolor lumbar crónico parecen variar los niveles de actividad independientemente del grado de discapacidad.

OBJECTIVE: To determine the level of physical activity and the level of disability in patients with chronic low back pain in a Colombian population and to establish the possible association between these variables. MATERIALS AND METHODS: In an outpatient rehabilitation unit in Manizales (Colombia), patients with chronic low back pain completed both the Baecke Physical Activity Questionnaire and Oswestry Lumbar Pain Inability. RESULTS: A total of 125 patients participated in the study. The average value of the Baecke index was 7.9 ± 0.9, with values for men and women of 7.8 ± 0.1 and 8.0 ± 0.7 respectively, without being able to demonstrate a statistically significant difference between the Sexes. The average value of the Oswestry index was 40.7 ± 18.3 with average values for males and females of 38.4 ± 18.8 and 42.4±17.7 respectively. There was no statistically significant difference between the sexes. A Pearson correlation coefficient > 0.05 showed no relationship between the level of physical activity and the degree of disability in the patients. CONCLUSIONS: Results describe a population of patients with chronic low back pain who, compared to other studies in these patients, may be considered as more active and less disabled but in which there is no correlation between the level of physical activity and the degree of disability. Thus, patients with chronic low back pain appear to vary physical activity levels independently of the degree of disability.

OBJETIVO: Determinar, em uma povoação colombiana, o nível de atividade física e o nível de deficiência em pacientes com dor lombar crônico e estabelecer a eventual existência de associação entre estas variáveis. MÉTODOS: Em uma unidade externa de reabilitação em Manizales (Colômbia), pacientes com dor lombar crônico completaram tanto o questionário de atividade física de Baecke como o de deficiência de dor lombar de Oswestry. RESULTADOS: Um total de 125 pacientes participaram no estudo. O valor meio do índice de Baecke foi de 7,9±0,9 com valores para homens e mulheres de 7,8±0,1 y 8,0±0,7 respectivamente, sem que lograsse demonstrar uma diferencia estatisticamente significativa entre os sexos. O valor meio do índice de Oswestry foi de 40,7±18,3 com valores para homens e mulheres de 38,4±18,8 e 42,4±17,7 respectivamente, sem que tampouco se lograsse demonstrar uma diferencia estatisticamente significativa entre os sexos. Um valor do coeficiente de correlação de Pearson >0,05 demonstrou a inexistência de relação entre o nível de atividade física e o grau de deficiência nos pacientes. CONCLUSÕES: Os resultados descrevem uma povoação de pacientes com dor lombar crônico que, comparada com o reportado em outros estudos em estes pacientes, pode ser considerada como mais ativa e menos deficiência, mas na qual não existe correlação entre o nível de atividade física e o grau de deficiência. Assim as coisas, os pacientes com dor lombar crônico parecem variar os níveis de atividade independentemente do grau de deficiência.

Síndrome regional complejo: revisión bibliográfica / Complex regional pain syndrome: a review

El síndrome de dolor regional complejo es una entidad clínica difícil de diagnosticar, especialmente cuando no se está familiarizado con el término. Para poder identificarlo es necesario conocerlo; produce un dolor espontáneo que cursa con hiperalgesia y alodinia como fenómenos distorsionados sensoriales, variaciones de flujo sanguíneo, sudoración y cambios tróficos por un estado inflamatorio localizado seguido por una etapa de desórdenes crónicos neuropáticos. Su presencia está relacionada más frecuentemente a un trauma inespecífico o un daño directo sobre una estructura nerviosa en las extremidades. Clásicamente es dividido en dos formas: Tipo I, anteriormente denominado Distrofia simpática refleja y el Tipo II, más conocido por el término de Causalgia. No ha sido posible establecer su fisiopatología, sin embargo se reconoce que se involucra todo el sistema nervioso para su instauración. Dentro de la práctica diaria del médico forense costarricense, se presenta la valoración de daño corporal en el ámbito laboral, penal y contencioso administrativo, por lo que es trascendental aprender a identificarlo, pues hay casos con factores en los cuales este síndrome puede ser planteado como secuela directa.

The complex regional pain syndrome is a clinical entity that is difficult to diagnose, especially when you are not familiar with the term. In order to identify it, it is necessary to know it well. It produces spontaneous pain like hyperalgesia and allodinya causing sensory distorted phenomena, variations of blood flow, sweating, and trophic changes by a localized inflammatory condition, followed by a stage of chronic neuropathic disorders. Its presence is most often related to an unspecified trauma or direct damage to a nerve structure in the extremities. Generally, it is divided in two forms: type I, formerly known as reflex sympathethic dystrophy, and type II, better known as causalgia. Though it has not been possible to establish its pathophysiology, it is recognized that the entire nervous system is involved. In daily practice, a Costa Rican forensic doctor is presented with the assessment of bodily harm in the fields of work accidents, criminal agressions, and administrative litigation. Since there are cases in which this syndrome may be directly related, it is extremely important to learn how to identify it successfully.

A influência da suplementação de sulfato de condroitina na dor e nos aspectos funcionais associados à osteoartrose / Influence of chondroitin sulfate supplementation in pain and functional aspects associated with osteoarthritis

Introdução: A osteoartrose é a principal causa de limitação da funcionalidade e incapacidade nos idosos. Dentre os tratamentos farmacológicos está a suplementação com sulfato de condroitina. Objetivo: Realizar uma revisão sistemática sobre a influência do sulfato de condroitina na dor e aspectos funcionais associados à osteoartrose. Métodos: Foram utilizados os descritores "osteoarthritis" e "chondroitin". Os artigos foram selecionados de forma independente e cega, por dois pesquisadores. Foram incluídos somente ensaios clínicos primários, escritos na língua portuguesa, inglesa e espanhola entre 2005 a 2013. A escala PEDro foi utilizada como instrumento de avaliação. Resultados: Foram encontrados 1.916 estudos, permanecendo nove artigos para a análise. Dos nove analisados, quatro mostraram a eficácia da suplementação do sulfato de condroitina na redução da dor e da incapacidade funcional, enquanto cinco investigações não mostraram efeitos estatisticamente significantes. Conclusões: A influência do sulfato de condroitina na dor e aspectos funcionais na osteoartrose permanece questionável.

Introduction: Osteoarthritis is the leading cause of limitation of functionality and disability in the elderly. The supplementation with chondroitin sulfate is among the pharmacological treatments. Objective: To conduct a systematic review of the influence of chondroitin sulfate on pain and functional aspects associated with osteoarthritis. Methods: The keywords "osteoarthritis" and "chondroitin" were used. The articles were selected independently and blindly by two researchers. Only primary clinical trial, written in Portuguese, English and Spanish in the period between 2005 to 2013 were included. The PEDro scale was used as an evaluation tool. Results: A total of 1.916 studies with appropriate descriptors were found, and nine of these papers remained for analysis. Of these nine studies analyzed, four showed the effectiveness of supplementation of chondroitin sulfate in reducing pain and functional disability, while five studies showed no statistically significant effects. Conclusions: The influence of chondroitin sulfate in pain and functional aspects in osteoarthritis remains questionable.

Quantitative methods for somatosensory evaluation in atypical odontalgia

A systematic review was conducted to identify reliable somatosensory evaluation methods for atypical odontalgia (AO) patients. The computerized search included the main databases (MEDLINE, EMBASE, and Cochrane Library). The studies included used the following quantitative sensory testing (QST) methods: mechanical detection threshold (MDT), mechanical pain threshold (MPT) (pinprick), pressure pain threshold (PPT), dynamic mechanical allodynia with a cotton swab (DMA1) or a brush (DMA2), warm detection threshold (WDT), cold detection threshold (CDT), heat pain threshold (HPT), cold pain detection (CPT), and/or wind-up ratio (WUR). The publications meeting the inclusion criteria revealed that only mechanical allodynia tests (DMA1, DMA2, and WUR) were significantly higher and pain threshold tests to heat stimulation (HPT) were significantly lower in the affected side, compared with the contralateral side, in AO patients; however, for MDT, MPT, PPT, CDT, and WDT, the results were not significant. These data support the presence of central sensitization features, such as allodynia and temporal summation. In contrast, considerable inconsistencies between studies were found when AO patients were compared with healthy subjects. In clinical settings, the most reliable evaluation method for AO in patients with persistent idiopathic facial pain would be intraindividual assessments using HPT or mechanical allodynia tests.

Impacto del manejo con neuroestimulación en un paciente con síndrome doloroso complejo y cambios tróficos severos. Reporte de caso / Impact of the use of neurostimulation for the management of a patient with complex pain syndrome and severe trophic changes. Case report

Introducción: Causas frecuentes de síndrome doloroso regional complejo (SDRC) son el trauma y la cirugía en extremidades. Algunos casos resultan demuy difícil manejo a pesar de la utilización de altas dosis de analgésicos, antiinflamatorios y terapia física lo cual motiva la búsqueda de terapias intervencionistas que frenen su progresión. Descripción del caso y resultados: Presentamos el caso de un paciente a quien se le diagnosticó SDRC tipo i con cambios tróficos severos y marcada limitación funcional, que fue manejado con múltiples terapias farmacológicas y bloqueos nerviosos sin mejoría evidente, a quien posteriormente se decidió realizar una prueba con neuroestimulación, la cual fue favorable. Meses después se obtuvo una mejoría sustancial ya que presentó mejoría del dolor «de un 100%¼; disminución del edema y retorno progresivo al aspecto normal de la mano, recuperación parcial de la fuerza y disminución de su limitación funcional, explicable por la adición de esta terapia de manera definitiva. Conclusión: La neuroestimulación ejerce un impacto notable sobre la evolución del SDRC con cambios tróficos en pacientes con pobre respuesta al manejo farmacológico indicado. El inicio temprano de esta intervención facilita la recuperación funcional y psicológica al paciente que, usualmente, se encuentra en una etapa productiva de su vida.

Introduction: Limb trauma and surgery are frequent causes of complex regional pain syndrome (CRPS). Some cases are very difficult to manage despite the use of high-dose analgesics, anti-inflammatory agents and physical therapy; hence the need to look for interventional therapies to slow its progression. Case description and results: We present the case of a patient diagnosed with CRPS type I with severe trophic changes and marked functional limitation, managed with multiple pharmacological therapies and nerve blocks without apparent improvement. The patient decided to try neurostimulation with favourable results and substantial improvement months later reported as «100% improvement¼ of pain; reduced oedema; progressive recovery of the normal appearance of the hand; partial recovery of strength, and improved function attributable to the use of this additional therapy. Conclusion: Neurostimulation has a noticeable impact on the course of the complex regional pain syndrome accompanied by trophic changes in patients with a poor response to there commended pharmacological management. Early initiation of this intervention facilitates functional and psychological recovery of the patients, who are usually in the productive stage of their lives.

Caracterización del perfil cognitivo y funcional motor en pacientes con síndrome doloroso regional complejo y dolor neuropático: serie de casos / Cognitive profile characterization and functional motor in patients with complex regional syndrome painful and nerve pain: case series

El dolor es una experiencia sensorial y emocional desagradable, asociada a daño tisular, real o potencial. Dos causas de dolor neurológico son el Síndrome Doloroso Regional Complejo -SDRC- y dolor neuropático -DNP-. El dolor afecta la función cognitiva y el funcionamiento motor. Es objetivo describir el perfil cognitivo y funcional motor en pacientes con SDRC y DNP. Estudio descriptivo en seis pacientes, tres con SDRC y tres con DNP. Evaluación neuropsicológica y perfil de funcionamiento mediante clasificación internacional del funcionamiento. Los pacientes con SDRC y DNP poseen un déficit estructural y fisiológico en las redes centrales y periféricas del dolor, limitación en las funciones de las extremidades comprometidas y restricciones en las actividades y participación de diferente nivel. El dolor como enfermedad crónica afecta la función cognitiva y emocional de quien lo sufre, debido a que diferentes estructuras cerebrales se ven afectadas ante su presencia.

Pain is an unpleasant sensory and emotional experience associated with tissue damage, actual or potential. Two causes of neuropathic pain include Complex Regional Pain Syndrome, CRPS and neuropathic pain-DNP. Pain affects cognitive function and motor functioning. Describing the functional and cognitive profile in patients with CRPS engine and DNP is the objective of this study. Descriptive study in six patients, three of them suffer from CRPS and the other three cope with DNP. Neuropsychological assessment and performance profile by International Classification of Functioning. Discussion: The SDRC and DNP have a structural and physiological deficit in central and peripheral pain networks, limitation in functions of involved limbs, restrictions in the activities, and participation of different levels. As a chronic disease, pain affects cognitive and emotional function of the sufferer, due to different brain structures are affected because its presence.

Síndrome de dolor regional complejo / Complex regional pain synndrome

El Síndrome de Dolor Regional Complejo (SDRC) es una enfermedad crónica, que se caracteriza por dolor y alteraciones sensitivas, motoras y autonómicas, a menudo sigue a trauma de un miembro, su curso es variable y, tanto su fisiopatología como el tratamiento, no están claramente establecidos. El objetivo de esta revisión es presentar una actualización de los aspectos generales de la enfermedad y mostrar parte de la evidencia existente en relación a las alternativas terapéuticas de la misma, tanto las conservadoras como las intervencionales. Es importante tener en consideración algunos puntos que limitan el objetivo de obtención de evidencia de buena calidad para el tratamiento de este síndrome. Lo primero es que el diagnóstico es clínico y los criterios para realizarlo han variado en el tiempo. Segundo, es la ausencia de criterios estandarizados para medir los resultados al tratamiento. Y, por último, ya que se trata de un síndrome crónico cuya manifestación principal es el dolor, existe respuesta a placebo...

The Regional Pain Syndrome Complex (CRPS ) is a chronic disease, which is characterized by pain and sensory, motor and autonomic disturbances, often follows trauma, the course and the pathophysiology are variable. The aim of this review is to provide an update on the general aspects of the disease and show the evidence in relation to therapeutic alternatives...

Sintomas e limitações funcionais de pacientes com síndrome da dor patelofemoral / Symptoms and functional limitations of patellofemoral pain syndrome patients

JUSTIFICATIVA E OBJETIVOS: A síndrome da dor patelofemoral (SDPF) é uma das desordens mais comuns que afetam a articulação do joelho. O objetivo deste estudo foi avaliar sintomas e limitações funcionais de pacientes com SDPF. MÉTODO: Foram estudados 26 pacientes com SDPF (GSDPF) e 31 clinicamente saudáveis (GC), pareados em idade, estatura e massa corporal. Foi aplicada uma ficha de avaliação e o questionário de Kujala. Em seguida os pacientes realizaram 2 testes funcionais, agachar e subir e descer um step por 30 segundos, além de serem orientados a deambular por um percurso de 8 metros em superfície nivelada, subir e descer de uma escada e rampa, sendo a ordem de realização destas atividades aleatória. Foi avaliada a intensidade da dor pela escala analógica visual (EAV) antes e após cada atividade. Para o tratamento estatístico foram utilizados os testes de Wilcoxon e U Mann-Whitney, com significância de p < 0,05. RESULTADOS: O GSDPF apresentou menor pontuação (75,8 ± 11,8 pontos) no questionário de Kujala em comparação ao GC (100 ± 0,0 pontos) (p = 0,001). Constatou-se que dos 26 pacientes com SDPF, 23 relataram sentir dor ao agachar, 18 ao subir e descer escadas, 25 ao ajoelhar, 14 ao correr, 16 ao ficar sentado por tempo prolongado e 9 ao praticar esportes. A intensidade da dor pela EAV confirmou estas afirmações, ocorrendo exacerbação da dor após agachar (p = 0,001), subir e descer de um step (p = 0,001), caminhar em superfície plana (p = 0,01), subir e descer escada (p = 0,001) e rampa (p = 0,01) nos pacientes com SDPF. CONCLUSÃO: A SDPF pode levar a dor e limitações funcionais que comprometem a realização das atividades de vida diária.

BACKGROUND AND OBJECTIVES: Patellofemoral pain syndrome (PFPS) is one of the commonest disorders affecting knee joint. This study aimed at evaluating symptoms and functional limitations of PFPS patients. METHOD: Participated in this study 26 PFPS patients (PFPSG) and 31 clinically healthy patients (CG), paired by age, height and body mass. Evaluation cards and Kujala questionnaire were applied. Then patients went through two functional tests: crouching, climbing and descending a step for 30 seconds, in addition to being oriented to walk 8 m in a leveled surface, to climb and descend a stair and a ramp, and such activities were randomly performed. Pain intensity was evaluated through the visual analog scale (VAS) before and after each activity. Wilcoxon and U Mann-Whitney tests were used for statistical analysis, considering significant p = 0.05. RESULTS: The PFPS group had lower scores (75.8 ± 11.8) in Kujala questionnaire, as compared to the C group (100 ± 0.0) (p = 0.001). From 26 PFPS patients, 23 reported pain when crouching, 18 when climbing or descending stairs, 25 when kneeing, 14 when running, 16 when sitting for a long period and 9 when practicing sports. Pain intensity by VAS has confirmed such statements with pain exacerbation after crouching (p = 0.001), climbing and descending a step (p = 0.001), walking on a leveled surface (p = 0.01), climbing and descending a stair ( p = 0.001) and ramp (p = 0.01) in patients with PFPS. CONCLUSION: PFPS may lead to pain and functional limitations which impair daily life activities.

Duloxetina no tratamento da dor lombar inflamatória crônica em pacientes portadores de espondilite anquilosante: relato de casos / Duloxetine to treat chronic inflammatory low back pain in ankylosing spondylitis patients: case reports

JUSTIFICATIVA E OBJETIVOS: A espondilite anquilosante (EA) é uma doença inflamatória crônica de etiologia autoimune, cujo principal sintoma é a lombalgia crônica de caráter inflamatório, cujo tratamento e complicações representam um encargo considerável para a sociedade. Novas opções terapêuticas têm sido buscadas para o tratamento da dor lombar inflamatória refratárianos pacientes com EA. O objetivo foi apresentar dois pacientes portadores de EA com dor lombar refratária ao usode anti-inflamatórios não esteroides (AINES), que apresentaram importante melhora clínica com a duloxetina.RELATO DOS CASOS: Dois pacientes do sexo masculino com EA e dor lombar crônica inflamatória refratária ao uso de AINES, que usaram duloxetina (60 mg/dia) e apresentaram melhora clínica importante do quadro doloroso. CONCLUSÃO: A duloxetina se mostrou eficaz para a redução da intensidade da dor lombar crônica inflamatória em pacientes portadores de EA.

BACKGROUND AND OBJECTIVES: Ankylosing spondylitis (AS) is a chronic inflammatory autoimmune disease. Its major symptom is chronic inflammatory low back pain, which treatment and complications represent a considerable burden to society. New therapeutic options have been studied to treat refractory inflammatory low back pain in AS patients. The objective was to present two AS patients with low back pain refractory to non-steroid anti-inflammatory drugs (NSAIDs), who presented important clinical improvement with duloxetine.CASE REPORTS: Two male patients with AS and chronic inflammatory low back pain refractory to NSAIDs,who used duloxetine (60 mg/day) and presented major clinical improvement.CONCLUSION: Duloxetine was effective to decrease chronic inflammatory low back pain intensity in AS patients.

Síndrome doloroso regional complejo: [revisión] / Complex regional pain syndrome: [review]

Introducción. El síndrome doloroso regional complejo (SDRC) es una entidad que se presenta después de una lesión. Sus principales características son dolor, cambios en la coloración y temperatura de la piel, edema y cambios tróficos. Objetivo. Presentar una revisión actualizada de la literatura para mejorar la comprensión de este síndrome. Metodología. Se seleccionaron 48 artículos de revistas indexadas y 4 capítulos de libros sobre medicina del dolor. Conclusión. El SDRC suele ser de difícil manejo, y de no ser tratado adecuadamente, la funcionalidad de la extremidad afectada puede verse comprometida. El diagnóstico temprano y el manejo oportuno reducen la severidad y duración de esta entidad.

Introduction. Complex Regional Pain Syndrome (CRPS) is a chronic disabling disorder that occurs after an injury. Pain, changes in the color and temperature of the skin, edema and trophic changes are the main characteristics of this syndrome. Objective. To provide a current literature overview of the CRPS to improve its understanding.Methodology. An extensive literature search both in indexed journals and pain medicine books was performed. Forty eight articles and 4 book chapters about pain medicine were included. Conclusion. CRPS is difficult to manage and if it is not treated adequately, functionality of the affected limb can be compromised. Early diagnosis and treatment may reduce the severity and duration of this condition.

Causalgia após trauma por projétil de arma de fogo: relato de caso / Post-traumatic causalgia due to firearm projectiles: case report

Causalgia é um tipo de doença neurológica crônica pertencente à Síndrome Dolorosa Regional Complexa, normalmente associada ao trauma. A sintomatologia é caracterizada por dor espontânea em queimação, hiperalgesia, edema, instabilidade vasomotora, alteração da função motora e anormalidades autonômicas. É rara, pouco conhecida e envolve várias teorias acerca de sua fisiopatologia. São descritas neste trabalho as manifestações de paciente masculino, de 20 anos, atendido no Pronto Socorro do Hospital Risoleta Tolentino Neves, vítima de múltiplas lesões por projéteis de arma de fogo, que evoluiu com manifestações compatíveis com causalgia.

Causalgia is a kind of chronic neurological disorder which is part of the Complex Regional Pain Syndrome, usually associated to trauma. Its symptoms are severe burning pain, hyperalgesia, edema, abnormal vasomotor activity, impairment of motor function and autonomic dysfunction. It is a rare, poorly known disease, which involves various theories in regard to its physiopathology. We report, in this article, a clinical case of a 20-year-old male patient, who was treated in the Emergency Room of Risoleta Tolentino Neves Hospital, victim of multiple lesions by firearm projectiles and evolved with symptoms compatible to the clinical features of Causalgia.

Síndrome Dolorosa Regional Complexa: atualização / Complex Regional Pain Syndrome: an update about the subject

A Síndrome Dolorosa Regional Complexa (SDRC) representa acometimento neurológico crônico, engloba várias patologias caracterizadas pela presença de dor espontânea em queimação, hiperalgesia, edema, instabilidade vasomotora, alteração da função motora e anormalidades autonômicas. Há piora evidente da dor com alguns estímulos, como mudanças de temperatura, toque e movimento. Sua incidência é em menos de 2% da população, sendo leve em 30 a 40% após as fraturas e traumas cirúrgicos. A idade média de acometimento é de 41 anos, com predomínio em mulheres (3:1). Associa-se em 65% dos casos ao trauma, 19% no pós-operatório, 2% após processos inflamatórios e 4% após outros fatores, como punção venosa. Não há evidências de que existam fatores de risco que predisponham ao seu desenvolvimento. O diagnóstico é clínico e por exclusão. O tratamento, apesar de difícil e pouco eficaz, deve ser realizado de forma multidisciplinar, instituído em fase precoce da doença, com o objetivo de impedir seu agravamento.

The Complex Regional Pain Syndrome (CRPS) is a chronic neurological syndrome, that encompasses several diseases characterized by the presence of spontaneous burning pain, hyperalgesia, edema, abnormal vasomotor activity, changes in motor function and autonomic abnormalities. There is clear worsening of pain with some stimuli, such as changes in temperature, touch and movement. United States data estimate the incidence of chronic CRPS in less than 2% of the population, and takes into SDRC 30-40% after fractures and surgical trauma. The average age of patients is 41 years, predominantly in females (3:1). About 65% of the cases are related to trauma, 19% in the postoperative period, 2% after inflammatory processes and 4% after other factors, such as venipuncture. There is no evidence that there are risk factors that predispose to its development. The diagnosis is purely clinical and by exclusion. The treatment, although difficult and inefficient, should be accomplished through a multidisciplinary approach and be established at an early stage of the disease in order to prevent its increase.

Síndrome de dolor regional complejo tipo II: manejo interdisciplinario / Type II complex regional pain syndrome: multidisciplinary approach

El síndrome de dolor regional complejo tipo II o causalgia es un cuadro que se presenta con dolor intenso y síntomas autonómicos importantes, que alteran la calidad de vida de los pacientes. Sus mecanismos fisiopatológicos todavía están en discusión y la evidencia disponible para su manejo aún es escasa. Actualmente, la tendencia es hacia un manejo interdisciplinario que abarque terapias psicológicas, de rehabilitación, en conjunto con un correcto manejo del dolor.

Type II complex regional pain syndrome causes accute pain and autonomous symptoms that alter the patient's quality of life. Discussion with respect to the syndrome physiopathologic mechanisms is still open and available evidence is scarce. The present trend is the multidisciplinary approach with teams using psychological, rehabilitation and pain management therapies.

Diagnosis and Treatment of Complex Regional Pain Syndrome

The complex regional pain syndromes (CRPS I and CRPS II), also known as reflex sympathetic dystrophy and causalgia, have been recognized for the past 2,500 years. Despite its long history, the diagnosis and treatment of CRPS are still challenging. These syndromes can be characterized by discrete sensory, motor, and autonomic findings, but many patients with CRPS continue to suffer for years without the diagnosis. Although much progress has been made in the understanding of CRPS, many questions still remain unanswered. CRPS is probably a disease of the central nervous system. Yet, peripheral inflammatory processes, abnormal sympathetic- afferent coupling, and adrenoreceptor pathology may also be part of the picture. A close multidisciplinary approach amongst the pain medicine consultants, psychologist, physical and occupational therapists, and neurologist is necessary to achieve the maximum treatment outcomes. If conventional treatment (e.g. pharmacotherapy) fails to show a significant response within 12 weeks, an interventional technique such as spinal cord stimulation (SCS) needs to be tried. The current concepts of CRPS could be replaced by a new mechanism-based term or group of terms in the near future leading to improved clinical guidelines. This article reviews the different aspects of CRPS including its definition, classification, epidemiology and natural history, clinical presentation, pathophysiology and management.