Efficacy of Buccal Infiltration with or without Palatal Injection for Posterior Maxillary Teeth Extraction - A Split-Mouth Randomized Trial

ABSTRACT Objective: To evaluate the feasibility of posterior maxillary teeth extraction buccal infiltration with or without the use of palatal injection. Material and Methods: A total of 70 patients underwent extraction of bilateral maxillary posterior teeth under 2% lignocaine hydrochloride with 1:2,00000 adrenaline infiltration in this single-centric split-mouth randomized trial. The test side was administered with a buccal infiltration of 2 mL of anesthetic alone. An extended waiting period of 10 minutes was given before the commencement of the procedure. A standard protocol was followed for the control side. A single operator performed all extractions. Results: A total of 140 posterior maxillary teeth were extracted. Patients marked pain perception on a visual analogue scale in three different instances. During the administration of injections for the test side, the pain score was less than that of the control side and was statistically significant. The overall pain during the extraction procedure was comparable and statistically insignificant. The overall success of the method was 90%. Conclusion: Extraction of posterior maxillary teeth was feasible with a single buccal infiltration without palatal injection in most cases using an extended waiting period. Dentists can attempt extraction without palatal injections with optimal success. However, the alternate technique could be used when there is a necessity for rescue palatal anesthesia.

Efficacy of Higher Gauged Needles or Topical Pre-Cooling for Pain Reduction during Local Anesthesia Injection: A Split-Mouth Randomized Trial

ABSTRACT Objective: To evaluate the efficacy of pre-cooling and the use of higher gauged needles in reducing pain during local anesthetic infiltration. Material and Methods: We conducted a split-mouth randomized controlled trial among 70 patients who require bilateral maxillary local anesthetic (LA) injections for dental treatment. After applying the topical anesthetic, each participant received four local anesthetic injections, two on buccal and two palatal sides. At each visit, the participants received one buccal and one palatal infiltration based on the randomization. On the buccal aspect, participants received LA with a 26G needle injection on one side (control) and a 31G needle (test) on the contralateral side. On the Palatal aspect, participants either received LA with a 31G needle on one side (control). In contrast, the opposite side was preceded by topical ice application (iced cotton swab) before LA with a 31G needle (test). Both the visits were spaced with a gap of 7-10 days based on the participants' feasibility. Participants were asked to rate the pain on a visual analog scale independently for buccal and palatal LA injections. Results: On the Buccal aspect, the mean pain scores were 2.74 ± 1.26 and 2.11 ± 1.26 for control and test groups, respectively (p=0.002). On the Palatal aspect, the mean pain scores were 4.14 ± 1.49 and 4.3 ± 1.80 for control and test groups, respectively (p=0.295). Conclusion: Significant lower pain scores were reported with higher gauge needles (31G) when compared to traditional (26G) needles on the buccal aspect. No significant difference was seen with pre-cooling the injection site on the palatal aspect when used with higher gauged needles (31G).

Correlating cognition and cortical excitability with pain in fibromyalgia: a case control study

Abstract Background: Fibromyalgia is a chronic pain disorder characterized by widespread musculoskeletal symptoms, primarily attributed to sensitization of somatosensory system carrying pain. Few reports have investigated the impact of fibromyalgia symptoms on cognition, corticomotor excitability, sleepiness, and the sleep quality — all of which can deteriorate the quality of life in fibromyalgia. However, the existing reports are underpowered and have conflicting directions of findings, limiting their generalizability. Therefore, the present study was designed to compare measures of cognition, corticomotor excitability, sleepiness, and sleep quality using standardized instruments in the recruited patients of fibromyalgia with pain-free controls. Methods: Diagnosed cases of fibromyalgia were recruited from the Rheumatology department for the cross-sectional, case-control study. Cognition (Mini-Mental State Examination, Stroop color-word task), corticomotor excitability (Resting motor threshold, Motor evoked potential amplitude), daytime sleepiness (Epworth sleepiness scale), and sleep quality (Pittsburgh sleep quality index) were studied according to the standard procedure. Results: Thirty-four patients of fibromyalgia and 30 pain-free controls were recruited for the study. Patients of fibromyalgia showed decreased cognitive scores (p = 0.05), lowered accuracy in Stroop color-word task (for color: 0.02, for word: 0.01), and prolonged reaction time (< 0.01, < 0.01). Excessive daytime sleepiness in patients were found (< 0.01) and worsened sleep quality (< 0.01) were found. Parameters of corticomotor excitability were comparable between patients of fibromyalgia and pain-free controls. Conclusions: Patients of fibromyalgia made more errors, had significantly increased reaction time for cognitive tasks, marked daytime sleepiness, and impaired quality of sleep. Future treatment strategies may include cognitive deficits and sleep disturbances as an integral part of fibromyalgia management.(AU)

Validity of fibromyalgia survey questionnaire (2016) assessed by telephone interview and cross-cultural adaptation to Brazilian Portuguese language

Abstract Background: To verify the validity of the 2016-revised Fibromyalgia Survey Questionnaire (FSQ) by telephone interview compared to self-administration and to produce a valid version of FSQ in Brazilian Portuguese language. Methods: The Brazilian version of FSQ was produced following the recommendations for cross-cultural adaptation. Validity of Brazilian FSQ self-administration was assessed by checking agreement of its results with fibromyalgia diagnosis according the 1990 American College of Rheumatology (ACR) criteria. Reproducibility and validity of FSQ by telephone were assessed by comparing its results with the previous FSQ self-administration. Results: A Brazilian Portuguese version (FSQ-Brazil) was produced. FSQ-Brazil had good internal consistency (Cronbach's alpha between 0.73 and 0.94). Agreement between the results obtained by self-administration of FSQ-Brazil and by telephone interview was substantial or almost perfect for almost all questions about pain sites and all questions about other somatic symptoms (Cohen's kappa higher than 0.6). There were small but significant bias toward higher scores of widespread pain index and fibromyalgia severity scale in the telephone interview compared to self-administration. Fibromyalgia definition by self-administration and telephone interview with FSQ-Brazil both revealed substantial agreement with the diagnosis based on ACR 1990 criteria (Cohen's kappa 0.62 and 0.65; respectively). Conclusions: FSQ-Brazil demonstrated good internal consistency, reproducibility and validity both by self-administration and by telephone interview. However, caution must be taken with the interpretation of quantitative scores of widespread pain index and symptoms severity scale, which slightly differed according the method (self-administration or interview) in our study.(AU)

Isokinetic evaluation of the trunk muscle strength in housewives with fibromyalgia: a cross-sectional study

Abstract Background: It is known that physical activity and muscular performance are reduced in fibromyalgia (FM) syndrome. This study aims to compare the performance of trunk muscles in women with FM and healthy controls and evaluate the correlation between trunk muscle strength and FM severity. Methods: Forty-six patients with FM and 42 age- and body mass index-matched healthy housewives without FM were included in the FM and control groups, respectively. The Fibromyalgia Impact Questionnaire (FIQ) was used for the assessment of FM severity. The pain intensity was evaluated using the visual analogical scale (VAS). An isokinetic dynamometer was used to measure the isokinetic trunk muscle strength. The peak torque (PT) values were recorded. The psychological status of the patients was evaluated using the Beck Depression Inventory. Results: There was no statistically significant difference in terms of age, BMI, and BDI scores in two groups (p > 0.05, for all). The isokinetic trunk extensor PT values were significantly lower in the FM group (p = 0.002 for 60°/s, and p < 0.001 for 90°/s and 120°/s) than control group. There was a statistically significant negative correlation between FIQ score and isokinetic extensor muscle parameters. Conclusion: The results indicate that trunk extensor muscles were significantly weaker in FM patients. Trunk extensor muscle strength decreased as FM severity increased in FM patients.(AU)

Mat Pilates is as effective as aquatic aerobic exercise in treating women with fibromyalgia: a clinical, randomized and blind trial

Abstract Background: The mat Pilates method is the therapeutic modalities which can be used in fibromyalgia treatment. Although there are no well-designed studies that prove the effectiveness of the mat Pilates method in this population. The objective was to evaluate the effectiveness of the mat Pilates method for improving symptoms in women with fibromyalgia. Methods: A single blind randomized controlled trial in which 42 women with fibromyalgia were randomized into two groups: mat Pilates and aquatic aerobic exercise. The exercises were performed twice a week for 12 weeks. Two evaluations were performed: one at baseline (T0), and another at 12 weeks after randomization (T12). The primary outcome was pain measured by the Visual Analogue Scale (VAS). Secondary outcomes were function (Fibromyalgia Impact Questionnaire), sleep (Pittsburgh Sleep Quality Index [PSQI]), quality of life (Short Form 36 [SF-36]), fear avoidance (Fear Avoidance Beliefs Questionnaire [FABQ-BR]) and pain catastrophizing (Pain-Related Catastrophizing Thoughts Scale [PRCTS]). Results: There was improvement in both groups in relation to pain and function (p < 0.05). The aspects related to quality of life and the FABQ questionnaire only showed improvement in the mat Pilates group (p < 0.05). There was improvement in the PSQI and PRCTS variables only in the aquatic aerobic exercise group (p < 0.05), but no differences were observed between the groups for any of the evaluated variables. Conclusion: Significant improvements were observed in the two groups in relation to the disease symptoms, and no differences were observed between mat Pilates and aquatic aerobic exercise in any of the measured variables. Trial registration: ClinicalTrials.gov Identifier (NCT03149198), May 11, 2017. Approved by the Ethics Committee of FACISA/UFRN (Number: 2.116.314).(AU)

Efeitos da abreviação do jejum pré-operatório com solução de carboidrato e proteína em sintomas pós-operatórios de cirurgias ginecológicas: ensaio clínico randomizado controlado duplo-cego / Effects of preoperative fasting abbreviation with carbohydrate and protein solution on postoperative symptoms of gynecological surgeries: double-blind randomized controlled clinical trial

RESUMO Objetivo: investigar os efeitos da abreviação do jejum pré-operatório, uma recomendação do protocolo de "Aceleração da Recuperação Total Pós-operatória" (ACERTO), em sintomas pós-operatórios de pacientes submetidas à cirurgias ginecológicas. Métodos: estudo controlado, randomizado, duplo-cego, de 80 cirurgias ginecológicas realizadas no período de janeiro a junho de 2016. As pacientes foram aleatoriamente alocadas em dois grupos: Grupo Controle, com 42 pacientes, e Grupo Suco, com 38, e que receberam, respectivamente, 200ml de solução inerte ou 200ml de líquido enriquecido com carboidrato e proteína quatro horas antes da cirurgia. Os sintomas pós-operatórios estudados foram sede, fome, dor, agitação, satisfação e bem-estar, em ambos os grupos. Para medir a intensidade dos sintomas foi utilizada a Escala Visual Analógica (EVA), associada à Escala Facial (EF) para dor, aplicadas dez horas após a cirurgia. Resultados: as pacientes do Grupo Suco apresentaram menos dor (3,51x1,59), sede (3,63x0,85), fome (3,86x2,09) e agitação (2,54x0,82) em relação ao Grupo Controle (P<0,05). As variáveis satisfação (6,89x8,68) e bem-estar (5,51x7,12) foram maiores (P<0,05) quando houve a ingestão do líquido contendo carboidrato e proteína (Grupo Suco) em relação à solução inerte (Grupo Controle). Conclusão: a abreviação do jejum pré-operatório com líquido contendo carboidrato e proteína antes de cirurgias ginecológicas reduz sede, fome, dor, agitação e favorece maior satisfação e bem-estar do que a ingestão de solução inerte.

ABSTRACT Objective: to investigate the effects of preoperative fasting abbreviation, a recommendation of Postoperative Accelerated Total Recovery protocol (ACERTO protocol), on postoperative symptoms of patients undergoing gynecological surgeries. Methods: a double-blind randomized controlled study of 80 gynecological surgeries performed from January to June 2016. The patients were randomly allocated into two groups: Controle Group, with 42 patients, and Juice Group, with 38 patients, who received 200ml inert solution or 200ml carbohydrate- and protein-enriched liquid, respectively, four hours before surgery. The postoperative symptoms studied were thirst, hunger, pain, agitation, satisfaction, and well-being in both groups. To measure the intensity of symptoms, we used the Visual Analog Scale (VAS), associated with the Facial Scale (FS) for pain, applied ten hours after surgery. Results: patients in the Juice Group had less pain (3.51x1.59), thirst (3.63x0.85), hunger (3.86x2.09), and agitation (2.54x0,82) in relation to the Controle Group (P<0.05). Satisfaction (6.89x8.68) and well-being (5.51x7.12) variables were higher (P<0.05) when the carbohydrate- and protein-containing liquid (Juice Group) was ingested in relation to the inert solution (Controle Group). Conclusion: the abbreviation of preoperative fasting with carbohydrate- and protein-containing liquid before gynecological surgeries reduces thirst, hunger, pain, agitation, and favors greater satisfaction and well-being than inert solution ingestion.

Comparison of the effects of low-level laser and pulsed and continuous ultrasound on pain and physical disability in chronic nonspecific low back pain: a randomized controlled clinical trial

Abstract Objective: To compare the short-term effects of pulsed laser and pulsed and continuous ultrasound on pain and functional disability in women with chronic non-specific low back pain. Methods: The sample was composed of 100 volunteers randomly allocated into four groups: The Pulsed Laser Group (n = 26) was treated with 3 J/cm2; the Pulsed Ultrasound Group (n = 24; 3 MHz) was treated with 1 W/cm2; the Continuous Ultrasound Group (n = 26; 1 MHz) was treated with 1 W/cm2; and a Control Group (n = 24), where the patients were still waiting for treatment. Before and after 10 sessions of treatment, the intensity of pain was assessed using the visual analogue scale (VAS), the quality of pain was evaluated using the McGill pain questionnaire and functional disability was investigated using the Roland-Morris questionnaire. Results: The three treated groups exhibited a decrease in pain (p < 0.001); the Pulsed Laser Group showed the greater relative gain (91.2%), Meanwhile, the Control Group exhibited a worsening of - 5.8%. The three treated groups demonstrated improvement in the quality of pain (McGill) in the total, sensory and affective dimensions (p < 0.005; p < 0.002; p < 0.013, respectively). All treated groups showed a decrease in functional disability (p < 0.001), but the Pulsed Ultrasound Group showed the highest relative gain (83.3%). Conclusions: The three modalities have significant effects to decreasing low back pain and improving functional disability in women with non-specific chronic low back pain, but the pulsed low-level laser had the best results on pain while the pulsed ultrasound had the best results on improve the functional disability. Trial registration:ClinicalTrials.gov: NCT02150096.

Relation between magnesium and calcium and parameters of pain, quality of life and depression in women with fibromyalgia

Abstract Objective: Determine food intake and levels of serum magnesium (Mg) and calcium (Ca) and correlate these minerals with pain, quality of life and depression risk in women with and without fibromyalgia (FM). Patients and methods: Fifty-three women diagnosed with FM and 50 healthy women participated in the study, where all of them had equivalent age and body mass index (BMI). All women underwent anthropometric assessment, physical exams of pain perception threshold and tender point (TP) count, blood sample collection, and filling out of FM impact questionnaire (FIQ), Patient Health Questionnaire-9 (PHQ-9), and 3-day dietary record (DR). Results: Dietary intake of Mg and Ca was substantially lower by women with FM. There were no differences in levels of serum Mg and Ca in the groups under analysis. For the FM group, dietary intake of Mg and Ca had inverse correlation with TP and direct relation with the pain threshold. Conclusions: Although women with FM had lower dietary intake of Mg and Ca, serum levels for these nutrients were not different between the groups. Low dietary intake of minerals correlated with worsened pain threshold parameters.

Assistance flowchart for pain management in a Neonatal Intensive Care Unit / Flujograma asistencial para manejo del dolor en Unidad de Terapia Intensiva Neonatal / Fluxograma assistencial para manejo da dor em Unidade de Terapia Intensiva Neonatal

ABSTRACT Objective: To describe and discuss the process of developing a flowchart collectively constructed by the health team of a Neonatal Intensive Care Unit for the management of neonatal pain. Method: This is a descriptive and an exploratory study with a qualitative approach that used Problem-Based Learning as a theoretical-methodological framework in the process of developing the assistance flowchart for the management of neonatal pain. Results: Based on this methodology, there was training in service and the discussion of key points of pain management by the health team, which served as input for the construction of the flowchart. Final considerations: The assistance flowchart for pain management, based on scientific evidence, provided means to facilitate the decision-making of the health team regarding the pain of the newborn. It is suggested to use the flowchart frequently to promote the permanent education of the team and identify possible points to be adjusted.

RESUMEN Objetivo: Describir y discutir el proceso de desarrollo de un diagrama de flujo construido colectivamente por el equipo de salud de una Unidad de Terapia Intensiva Neonatal para el manejo del dolor neonatal. Método: Se trata de un estudio descriptivo, exploratorio, con un abordaje cualitativo que utilizó el Aprendizaje Basado en Problemas como referencial teórico-metodológico en el proceso de desarrollo del diagrama de flujo asistencial del manejo del dolor neonatal. Resultados: A partir de esta metodología ocurrió una capacitación en servicio y la discusión de puntos claves del manejo del dolor por el equipo de salud, los cuales sirvieron de subsidios para la construcción del diagrama de flujo. Consideraciones finales: El flujograma asistencial del manejo del dolor, construido a partir de evidencias científicas, proporcionó medios para facilitar la toma de decisión del equipo de salud frente al dolor del recién nacido. Se sugiere la aplicación del diagrama de flujo con frecuencia para promover la educación permanente del equipo e identificar posibles puntos a ser ajustados.

RESUMO Objetivo: Descrever e discutir o processo de desenvolvimento de um fluxograma construído coletivamente pela equipe de saúde de uma Unidade de Terapia Intensiva Neonatal para o manejo da dor neonatal. Método: Trata-se de um estudo descritivo, exploratório, com abordagem qualitativa que usou a Aprendizagem Baseada em Problemas como referencial teórico-metodológico no processo de desenvolvimento do fluxograma assistencial do manejo da dor neonatal. Resultados: A partir desta metodologia ocorreu uma capacitação em serviço e a discussão de pontos chaves do manejo da dor pela equipe de saúde, que serviram de subsídios para construção do fluxograma. Considerações finais: O fluxograma assistencial do manejo da dor, construído a partir de evidências científicas, forneceu meios para facilitar a tomada de decisão da equipe de saúde frente à dor do recém-nascido. Sugere-se a aplicação do fluxograma com frequência para promover a educação permanente da equipe e identificar possíveis pontos a serem ajustados.

Antinociceptive local effect of the combination of dexketoprofen trometamol and chlorhexidine gluconate in a formalin test: an additive effect

ABSTRACT A drug delivery system (DDS) with analgesic and antibacterial properties would be desirable for the local control of post-operatory pain and the prevention for surgical site infection (SSI). The objective of the present study was to evaluate the antinociceptive effect of the combination between dexketoprofen trometamol (DXT) and chlorhexidine gluconate (CHX) in the formalin pain model. Different doses of CHX were combined with DXT and were locally administered in rats paw simultaneously with 5% formalin dilution. Flinches were documented and the antinociceptive effect was calculated. The area under the curve of each experimental group were calculated and the % of antinociception were compared. The groups of CHX and DXT showed similar antinociceptive effect. The combination groups (DXT-CHX) showed higher antinociceptive effect that the one obtained with individual molecules. Besides the confirmation of DXT local antinociceptive properties, CHX also showed a positive effect; and an additive effect when combined with DXT

Influência da realidade virtual sobre a dor, fadiga, capacidade funcional e qualidade de vida na fibromialgia: estudo de caso / Influence of virtual reality on pain, fatigue, functional capacity and quality of life in fibromyalgia: a case study

Objetivo: Avaliar o efeito da Realidade Virtual (RV) associado a exercícios físicos na qualidade de vida, fadiga, níveis de dor e capacidade funcional em uma mulher com Fibromialgia (FM). Métodos: Trata-se de um estudo de caso que avaliou uma paciente com diagnóstico de FM, antes e após a intervenção com a RV associada a prática de exercícios físicos. Os instrumentos de avaliação utilizadas foram: Questionário de Impacto da Fibromialgia, Questionário de Capacidade Funcional, a Escala Visual analógica de Dor, Escala de Pensamento catastrófico sobre a dor, Escala de severidade da fadiga e avaliação do limiar de dor à pressão sobre os 18 tender points por meio de um algômetro de pressão digital. O tratamento ocorreu durante 6 semanas, com 2 sessões de tratamento por semana, totalizando 12 sessões. Resultados: O estudo proposto mostrou que o tratamento associado a RV promoveu uma melhora no impacto da FM na qualidade de vida da voluntária, uma diminuição na catastrofização da dor e uma diminuição da fadiga. Também foi possível notar uma melhora no limiar de dor a pressão em 16 tender points. Conclusão: Um programa de reabilitação para pessoas com FM que envolva a RV somado a prática de exercícios físicos contribuiu para melhora dos aspectos cognitivo e físico. A associação destas duas terapias foi benéfica, uma vez que estímulos cognitivos e a prática de uma atividade física foi capaz de promover melhora na função, na fadiga, na qualidade de vida e na percepção de dor desses

Objective: The objective of this study was to evaluate the effect of Virtual Reality (VR) associated with physical exercises on quality of life, fatigue, pain levels, and functional capacity in a woman with Fibromyalgia. Methods: This is a case report that evaluated one patient diagnosed with FM before and after the intervention with RV associated with physical exercise. The evaluation scales used were: Fibromyalgia Impact Questionnaire, Health Assessment Questionnaire, Visual Analogue Scale for Pain, Pain Catastrophizing Scale, Fatigue Severity Scale and pressure pain threshold evaluation at the 18 tender points with a digital pressure algometer. Treatment was conducted for 6 weeks, with 2 sessions per week, totaling 12 treatment sessions. Results: The study showed that treatment with VR promoted an improvement in the impact of FM in the volunteer's quality life, a decrease in catastrophic sensation of pain and a decrease in fatigue. It was also possible to notice an improvement in the pressure pain threshold at 16 tender points. Conclusion: A rehabilitation program for people with FM that involves VR combined with the practice of physical exercises contributed to the improvement of cognitive and physical aspects. The association of these two therapies was beneficial, since cognitive stimuli and the practice of a physical activity could promote improvements in function, fatigue, quality of life, and pain perception of these individuals

Hiperalgesia secundária na lombalgia crônica inespecífica / Secondary hyperalgesia in chronic nonspecific low back pain

Objetivo: A hiperalgesia secundária pode estar presente na lombalgia crônica inespecífica. O estudo comparou o limiar de tolerância de dor à pressão (LTDP) nos músculos paravertebrais lombares e torácicos em indivíduos com lombalgia crônica inespecífica correlacionando-as com a incapacidade, mobilidade funcional, idade e índice de massa corporal. Método: Trata-se de um estudo transversal no qual participam indivíduos de ambos os sexos diagnosticados com lombalgia crônica não específica, com idade entre 18 a 65 anos, possuindo dor de intensidade moderada a grave e com o tempo de dor de > 12 semanas. Os voluntários foram avaliados em relação a intensidade da dor por meio da Escala Visual Analógica (EVA), incapacidade pelo questionário Roland Morris, mobilidade funcional pelo teste Timed Up and Go e limiar de tolerância de à dor à pressão (LTDP) pela algometria. Foram usados o teste t e feita Correlação de Pearson para análise dos dados que foi feita no programa Graph Pad Instat. Resultados: Participaram do estudo, 50 indivíduos (53,75±13,65 anos) e quando comparados os valores de LTDP entre a região torácica e lombar não foi verificada diferença significativa (p=0,19). Foi observada correlação moderada apenas entre o LTDP lombar e torácica (r=0,65). Outras correlações embora algumas significantes, todas foram fracas. Conclusão: Os dados deste estudo permitem concluir que provavelmente indivíduos com lombalgia crônica apresentam hiperalgesia secundária, pois os indivíduos apresentaram valores semelhantes entre o LTDP lombares e torácicas, além de apresentar correlação significante entre estas duas medidas

Objective: Secondary hyperalgesia may be present in chronic nonspecific low back pain. The study compared pressure pain threshold (PPT) in the lumbar and thoracic paravertebral muscles in individuals with non-specific chronic low back pain correlating them with disability, functional mobility, age and body mass index. Method: This is a cross-sectional study involving individuals of both sexes diagnosed with non-specific chronic low back pain, aged between 18 and 65 years, with pain of moderate to severe intensity and with pain time of > 12 weeks. The volunteers were evaluated for pain intensity through the Visual Analogue Scale (VAS), disability by the Roland Morris questionnaire, functional mobility by the Timed Up and Go test, and pressure pain threshold (PPT) by algometry. We used the t-test and made Pearson's correlation for data analysis that was done in the Graph Pad Instat program. Results: Fifty individuals (53.75 ± 13.65 years) participated in the study, and when comparing PPT values between the thoracic and lumbar regions, no significant difference was observed (p = 0.19). Moderate correlation was observed only between lumbar and thoracic PPT (r = 0.65). Other correlations, though some significant, were all weak. Conclusion: The data from this study allow us to conclude that individuals with chronic low back pain may present with secondary hyperalgesia, since the individuals presented similar values between the lumbar and thoracic PPTs, in addition to having a significant correlation between these two measures

Impacto de um programa estruturado de hidrocinesioterapia em pacientes com osteoartrite de joelho / Impact of a structured aquatic therapy program on patients with knee osteoarthritis

A osteoartrite é uma doença articular degenerativa, reumática crônica, multifatorial de alta prevalência, atinge 10% da população com mais de 65 anos. Afeta igualmente ambos os sexos, sendo que na mulher a incidência é maior após o período da menopausa. Esta doença compreende 65% das causas de incapacidade, atrás somente de doenças cardiovasculares e mentais. A reabilitação do paciente com artrose é um processo complexo que envolve procedimentos especializados Objetivo: Avaliar os efeitos de um programa de hidrocinesioterapia sobre a capacidade de realização de atividades da vida diária em pacientes com osteoartrite. Métodos: Este é um estudo prospectivo, onde vinte e seis pacientes com histórico de osteoartrite de joelho foram submetidos a um programa de tratamento em hidrocinesioterapia, com frequência de duas vezes por semana com duração de 50 minutos cada sessão. O programa consistia de quatro fases, sendo elas: aquecimento, alongamento, fortalecimento e relaxamento. Estes pacientes foram avaliados pré e pós-tratamento. Utilizando como método de avaliação a goniometria, escala de dor EVA e Teste de Caminhada de Seis Minutos. Resultados: Houve melhora significante da amplitude de movimento ao realizar flexão dos joelhos acometidos, também foi visto diminuição significativa da dor e melhora significante na capacidade de realização das atividades de vida diária avaliada por meio da distância percorrida no teste de caminhada de seis minutos. Conclusão: Houve melhora da capacidade de realizar AVD e da capacidade física, assim como redução do quadro álgico e aumento da amplitude de movimento

Osteoarthritis is a pervasive, chronic rheumatic, multifactorial, degenerative joint disease, afflicting 10% of the population over 65 years of age. It affects both genders, and in women the incidence is higher after menopause. This disease comprises 65% of the causes of disability, exceeded only by cardiovascular and mental disorders. The rehabilitation of patients with osteoarthritis is a complex process that involves specialized procedures Objective: To evaluate the effects of a hydrotherapy program on the ability to perform activities of daily living in patients with osteoarthritis. Method: This is a prospective study where twenty-six patients with knee osteoarthritis history underwent a treatment program in aquatic therapy, often twice a week lasting 50 minutes each session. The program consisted of four phases, namely: warming up, stretching, strengthening, and relaxation. These patients were evaluated before and after treatment. Assessments were done with the goniometer, EVA pain scale, and Six Minute Walk Test. Results: There was significant improvement in range of motion when performing flexion of the affected knees, as well as a significant decrease in pain and a significant improvement in the ability to perform the activities of daily living, assessed by the distance walked in the six-minute walk test. Conclusion: There was an improved ability to perform ADLs and inn physical capacity, as well as reduced pain and increased range of motion

Pain assessment in elderly with dementia: Brazilian validation of the PACSLAC scale / Avaliação de dor em idosos dementados: validação da versão brasileira da escala PACSLAC

ABSTRACT Objective To validate the Pain Assessment Checklist for Seniors with Limited Ability to Communicate – Portuguese in demented elderly and to analyze its measurement properties. Methods We evaluated 50 elderly with dementia, residing in a nursing home and with limited communication ability, when exposed to potentially painful situations. The tool was applied at two different moments. First, two interviewers applied it simultaneously, and the intensity of pain was asked based on the caregiver’s opinion. After 14 days, with no analgesic intervention, one of the interviewers applied it again. Results The sample comprised more females, aged over 80 years, with dementia due to Alzheimer, presenting musculoskeletal pain of moderate to severe intensity. The psychometric properties of the tool demonstrated appropriate internal consistency (Cronbach’s alpha coefficient of 0.827). The scale had excellent reproducibility, according to the intraclass correlation coefficient, and the tool has been duly validated. Conclusion The Pain Assessment Checklist for Seniors with Limited Ability to Communicate – Portuguese had adequate measuring properties for use with elderly presenting limited communication.

RESUMO Objetivo Validar o Pain Assessment Checklist for Seniors with Limited Ability to Communicate – Portuguese em idosos dementados e analisar as propriedades de suas medições. Métodos Foram avaliados 50 idosos dementados, residentes de uma casa de repouso e com capacidade de comunicação verbal limitada, quando expostos a situações potencialmente dolorosas. A ferramenta foi utilizada em dois momentos diferentes. Primeiro, foi aplicada por dois entrevistadores simultaneamente, e a intensidade da dor foi questionada com base na opinião do cuidador. Depois de 14 dias, sem intervenção de analgésico, a ferramenta foi aplicada novamente por um dos entrevistadores. Resultados A amostra teve predominância de mulheres, acima de 80 anos de idade, com demência de Alzheimer, apresentando dores musculoesqueléticas com intensidade moderada a grave. As propriedades psicométricas do instrumento demonstraram consistência interna adequada (coeficiente alfa de Cronbach de 0,827). A escala teve excelente reprodutibilidade, de acordo com o coeficiente de correlação intraclasse, e o instrumento demonstrou validade adequada. Conclusão O Pain Assessment Checklist for Seniors with Limited Ability to Communicate – Portuguese teve propriedades de medição adequadas para idosos com limitações de comunicação.

Validación del cuestionario para graduación de dolor crónicoen pacientes chilenos con patología musculoesquelética / Validation of the graduation of chronic pain in patients with chilean musculoskeletal pathology

Introducción: el dolor crónico es una condición que afecta a 1 de cada 5 personas en el mundo, comprometiendo diferentes áreas de la calidad de vida. El cuestionario para graduación de dolor crónico (CGDC) fue desarrollado como una forma de evaluar y monitorear a estos pacientes, con altos niveles de fiabilidad y validez. Objetivos: Desarrollar una versión española del CGDC, adaptado culturalmente a Chile y determinar su validez y fiabilidad, en el Hospital Clínico de la Universidad de Chile. Material y métodos: El cuestionario fue traducido y adaptado culturalmente de acuerdo a las recomendaciones internacionales. Se aplicó SF-36 v2.0 en 130 pacientes condolor musculoesquelético crónico (más de 6 meses). La fiabilidad se calculó con Alfa de Cronbach y el índice de validez se evaluó mediante la comparación de las respuestas de la CGDC para cada categoría con las subescalas del SF-36 v.2. Resultados: La versión chilena de la CGDC fue válida. Se obtuvieron altos niveles de confiabilidad con alfa de Cronbach> 0,7. Se observaron correlaciones significativas del SF -36,especialmente con las subescalas que tienen alta capacidad de medir el dolor y la salud física (p <0,01). Conclusiones: Los resultados presentados aquí confirman la fiabilidad y validez de la versión chilena del CGDC en la evaluación de pacientes con dolor musculoesquelético crónico.

Introduction: chronic pain is a condition that affectss 1 in every 5 people in the world, compromising different areas of quality of life. The Chronic Pain Graded questionnaire (CPG) was developed as a form to assess and monitor these patients, with high levels of reliability and validity. Objectives: To develop a spanish version of the chronic pain graded questionnaire, culturally adapted to Chile determine its reliability and convergent construct validity , in the University of Chile Clinical Hospital. Materials and Methods: The chronic pain graded questionnaire was translated and culturally adapted accordingt o international recommendations. It was applied with SF -36 v2.0 questionnaire in 130 patients with chronic musculoskeletal pain (more than 6 months). The reliability was calculated with de Alpha the Cronbach Index and de validity was assessed by comparing the responses of the CPG for each category with the subscales of SF-36 v.2. Results: The Chilean version of the CBDC was valid. High levels of reliability was obtained with Cronbach’s alpha > 0.7. Compared with the SF -36 significant correlations were observed, especially with the SF -36 subscales having high ability to measure pain and physical health ( P < 0.01). Conclusions: The results presented here confirm the reliability and validity of the Chilean version of the chronic pain graded questionnaire in the evaluation of patients with chronic musculoskeletal pain.

Effects of smoking on venous cannulation pain: a randomized prospective trial / Efeitos do tabagismo sobre a dor durante o cateterismo venoso: um estudo prospectivo e randomizado / Efectos del tabaquismo sobre el dolor durante el cateterismo venoso: un estudio prospectivo y aleatorizado

BACKGROUND AND OBJECTIVES: It has been demonstrated that smoking increases pain perception; however the effect of smoking on perception of pain during venous cannulation is not known. The purpose of this study is to determine whether or not smoking has an effect on pain perception due to peripheral venous cannulation. METHODS: 220 patients scheduled to have elective surgery were enrolled in the study and were divided into two groups (Group S and C, n = 110 for each) according to their smoking habits. Numerical rating scale was introduced to the patients and then peripheral venous cannulation at the dorsum of the hand was made with a 20 G intracath. Pain perception of the patients was scored by subsequent numerical rating scale questioning. RESULTS: The demographic characteristics of the groups were identical. Numerical rating scale scores in Group S and C were 3.31 ± 1.56 and 1.65 ± 1.23, respectively (p < 0.001). CONCLUSION: Pain perception due to peripheral venous cannulation is higher in smokers. Future studies on pain treatment should consider the smoking habits of patients. .

JUSTIFICATIVA E OBJETIVOS: Sabe-se que o tabagismo aumenta a percepção de dor; porém, o efeito do tabagismo sobre a percepção da dor durante o cateterismo venoso não é conhecido. O objetivo deste estudo foi determinar se o tabagismo tem ou não algum efeito sobre a percepção da dor durante a punção venosa periférica. MÉTODOS: Foram incluídos no estudo 220 pacientes agendados para cirurgia eletiva randomicamente alocados em dois grupos: Grupo S (n = 110) e Grupo C (n = 110), de acordo com seus hábitos tabagísticos. Os pacientes foram instruídos sobre o uso da escala numérica de classificação da dor e, em seguida, a punção venosa periférica foi feita no dorso da mão com um cateter de calibre 20G (Intracath(r)). A percepção de dor dos pacientes foi posteriormente registrada de acordo com os escores da escala numérica. RESULTADOS: As características demográficas dos grupos eram idênticas. Os escores da escala numérica de dor dos grupos S e C foram 3,31 ± 1,56 e 1,65 ± 1,23, respectivamente (p < 0,001). CONCLUSÃO: A percepção da dor por causa da punção venosa periférica é maior em fumantes. Estudos futuros sobre o tratamento da dor devem considerar os hábitos tabagísticos dos pacientes. .

JUSTIFICACIÓN Y OBJETIVOS: Se sabe que el tabaquismo aumenta la percepción de dolor; sin embargo, el efecto del tabaquismo sobre la percepción del dolor durante el cateterismo venoso no se conoce. El objetivo de este estudio fue determinar si el tabaquismo tiene o no algún efecto sobre la percepción del dolor durante la punción venosa periférica. MÉTODOS: Fueron incluidos en el estudio 220 pacientes programados para cirugía electiva aleatoriamente ubicados en 2 grupos: grupo S (n = 110) y grupo C (n = 110), de acuerdo con sus hábitos tabáquicos. A los pacientes se les informó sobre el uso de la escala numérica de clasificación del dolor y a continuación se realizó la punción venosa periférica en el dorso de la mano con un catéter de calibre 20 G (Intracath(r)). La percepción de dolor de los pacientes fue posteriormente registrada de acuerdo con las puntuaciones de la escala numérica. RESULTADOS: Las características demográficas de los grupos eran idénticas. Las puntuaciones de la escala numérica de dolor de los grupos S y C fueron 3,31 ± 1,56 y 1,65 ± 1,23 respectivamente (p < 0,001). CONCLUSIÓN: La percepción del dolor por punción venosa periférica es mayor en los fumadores. Estudios futuros sobre el tratamiento del dolor deben tener en cuenta los hábitos tabáquicos de los pacientes. .

Prevalência da disfunção miofascial em indivíduos com dor lombar / Prevalence of myofascial dysfunction in patients with low back pain

Objetivo: Examinar a prevalência da disfunção miofascial em indivíduos com dor lombar equantificar limiar de dor destes através do algômetro. Método: Foram avaliados 70 indivíduoscom idade média de 48 (± 11,76) com história de dor lombar crônica, sendo investigada a presençade pontos-gatilho nos músculos: quadrado lombar, iliopsoas, glúteos máximo, médio e mínimo,e piriforme. A prevalência foi determinada pela porcentagem de indivíduos com pontos gatilhospresentes e o limiar de dor foi determinado pela média de três avaliações de pressão de cadaponto-gatilho. Resultados: Demonstraram que 90% dos indivíduos apresentaram disfunçãomiofascial, dentre eles, 76% no músculo quadrado lombar, 69% no glúteo médio, 56% nopiriforme, 40% no glúteo mínimo, 31% no íliopsoas e 29% no glúteo máximo. O limiar de dor porpressão dos músculos quadrado lombar foi de 1,71 Kg/cm2, de 2,39 Kg/cm2 para o glúteo médio,de 2,34 Kg/cm2 para o piriforme, de 2,58 Kg/cm2 para o glúteo mínimo, de 2,11 Kg/cm2 para oiliopsoas e de 2,19 Kg/cm2 para o glúteo máximo. Conclusão: Na amostra analisada, os dadosdeste estudo demonstram a grande prevalência desta disfunção e sugere que a mesma mereceatenção específica no tratamento da lombalgia em indivíduos com dor crônica.

Objective: This study aimed to examine the prevalence of myofascial dysfunction in patients withlow back pain, which is the area most frequently afflicted, and to quantify the pain threshold forthese evaluations using an algometer. Method: We evaluated 70 patients with a history of chroniclow back pain in search of trigger points that would elicit the patient?s pain. The muscles testedwere the quadratus lumborum, iliopsoas, gluteus maximus, medius, minimus, and piriformis. Theprevalence of myofascial dysfunction was determined by the percentage of patients with triggerpoints. The pain threshold was determined by the average of three assessments of pressure foreach trigger point. Results: The results showed that 90% of patients had myofascial dysfunction,76% of whom had trigger points in the quadratus lumborum, 69% in the gluteus medius, 56% inthe piriformis, 40% in the gluteus minimus, 31% in the iliopsoas, and 29% in the gluteus maximus.The pressure pain threshold of the quadratus lumborum was 1.71 kg/cm2, 2.39 kg/cm2 for thegluteus medius, 2.34 kg/cm2 for the piriformis, 2.58 kg/cm2 for the gluteus minimus, 2.11 kg/cm2for the iliopsoas and 2.19 kg/cm2 for the gluteus maximus. Conclusion: Our data demonstrate thehigh prevalence of this disorder and suggest that it deserves specific attention in the treatment oflow back pain in patients with chronic pain

Tratamento intensivo do linfedema, pós-tratamento de câncer de mama, em pacientes com lesão neurológica / Intensive treatment of breast cancer-related lymphedema in patients with neurological injuries

O objetivo do presente estudo é relatar o tratamento intensivo do linfedema, após câncer de mama, em paciente com perda da força muscular do membro. Relata-se o caso de uma paciente de 51 anos de idade, que evoluiu com linfedema pós-tratamento do câncer de mama, com mastectomia + esvaziamento axilar + quimioterapia e radioterapia. Após procurar a Clínica Godoy para tratamento em agosto de 2012, foi avaliada com a bioimpedância e volumetria inicial e diária. Realizou tratamento intensivo durante três dias consecutivos, por um período de 6 horas, com Terapia Linfática Manual, Terapia Linfática Mecânica (RA Godoy®) e uso de braçadeira de gorgorão, sendo feitos ajustes diários. Na avaliação inicial, apresentava dor de intensidade 10 (Escala de Dor), parestesia em todo o braço e uma diferença de volume total do edema de 577g em relação ao membro contra-lateral. No primeiro dia de tratamento obteve redução da parestesia com o uso da braçadeira de gorgorão e Terapia Linfática Mecânica; no segundo dia, a dor havia diminuído para a intensidade sete (Escala de Dor); no terceiro dia, a dor diminuiu para intensidade cinco (Escala de Dor) e a diferença de volume total do edema passou a ser de 193g. A paciente retornou para sua casa mantendo as mesmas recomendações e tratamento propostos na clínica. O acompanhamento é feito com avaliações de rotina e orientações sobre a importância do uso da braçadeira de gorgorão e drenagem linfática mecânica.

The aim of this study is to report on the intensive treatment of lymphedema resulting from breast cancer therapy in a 51-year-old patient who experienced loss of muscle strength of the arm. This patient developed lymphedema after a mastectomy, axillary resection, chemotherapy and radiation therapy to treat breast cancer. When the patient arrived at the Clinica Godoy for treatment in August 2012, she was evaluated using bioimpedance and volumetry before and then every day during treatment. Intensive treatment was carried out for six hours per day on three consecutive days employing Manual Lymphatic Therapy, Mechanic Lymphatic therapy (RA Godoy®) and a grosgrain compression sleeve with daily adjustments to the size. In the initial physical examination the patient reported a score for the intensity of pain of 10 (Pain Scale), paresthesia in the entire arm and there was a 577 mL difference in volume due to edema compared to the contralateral limb. On Treatment Day 1 the paresthesia was reduced using the grosgrain sleeve and Mechanical Lymphatic Therapy; on Treatment Day 2, the pain had dropped to an intensity of 7 (Pain Scale); on Treatment Day 3, the pain decreased to an intensity of 5 (Pain Scale) and the difference in the volume of edema was only 193 mL. The patient returned home but followed the recommendations and treatment program used at the clinic. Monitoring was by routine assessments and guidance on the importance of using the grosgrain sleeve and Mechanical Lymphatic Therapy to maintain the results and prevent neurological damage.

Adaptacao e validacao do WHODAS 2.0 em utentes com dor musculoesqueletica / Adaptacion y validacion del WHODAS 2.0 en usuarios con dolor musculoesqueletico / Adaptation and validation of WHODAS 2.0 in patients with musculoskeletal pain

OBJETIVO Validar a versão em português do World Health Organization Disability Assessment Schedule (WHODAS 2.0). MÉTODOS A versão original de 36 itens do WHODAS 2.0, administrada por entrevista, foi traduzida para o português de acordo com orientações internacionais e testada em nove participantes da população em geral. A versão em português foi administrada em 204 pacientes com patologia musculoesquelética. Foram coletados os dados sociodemográficos e de saúde dos pacientes, assim como o número de locais onde apresentavam dor e sua intensidade. O WHODAS 2.0 foi novamente administrado por um segundo entrevistador, um a três dias após a primeira entrevista, para avaliar a confiabilidade interavaliadores. A validade de constructo foi avaliada quanto a: capacidade do WHODAS 2.0 para diferenciar participantes com diferentes locais com dor e associação entre o WHODAS 2.0 e a intensidade da dor. A consistência interna também foi avaliada. RESULTADOS A versão portuguesa do WHODAS 2.0 teve fácil compreensão, apresentou boa consistência interna (α = 0,84) e confiabilidade interavaliadores (CCI = 0,95). Mostrou ser capaz de detectar diferenças estatisticamente significativas entre indivíduos com diferente número de locais com dor (p < 0,01) e indicar que maior incapacidade está associada à maior intensidade da dor (r = 0,44, p < 0,01), indicando validade de constructo. CONCLUSÕES A versão portuguesa do WHODAS 2.0 mostrou-se confiável e válida quando utilizada em pacientes com dor associada à patologia musculoesquelética. .

OBJETIVO Validar la versión en portugués del World Health Organisation Disability Assessment Schedule (WHODAS 2.0). MÉTODOS La versión original con 36 ítems del WHODAS 2.0, administrada por entrevista, fue traducida al portugués de acuerdo con orientaciones internacionales, y evaluada en nueve participantes de la población en general. La versión en portugués fue aplicada en 204 pacientes con patología musculoesquelética. Se colectaron los datos sociodemográficos y de salud de los pacientes, así como el número de lugares donde presentaban dolor y su intensidad. El WHODAS 2.0 fue nuevamente aplicado por un segundo entrevistador, uno a tres días posteriores a la primera entrevista para evaluar la confiabilidad inter-evaluadores. La validez del constructo fue evaluado con relación a: capacidad del WHODAS 2.0 para diferenciar participantes con diferentes lugares con dolor y asociación entre el WHODAS 2.0 y la intensidad del dolor. La consistencia interna también fue evaluada. RESULTADOS La versión en portugués del WHODAS 2.0 fue de fácil comprensión, presentó buena consistencia interna (α= 0,84) y confiabilidad inter evaluadores (CCI=0,95). Mostró ser capaz de detectar diferencias estadísticamente significativas entre individuos con diferente número de lugares con dolor (p˂0,01) e indicar que mayor incapacidad está asociada con la mayor intensidad del dolor (r=0,44, p˂0,01), indicando validez del constructo. CONCLUSIONES la versión en portugués del WHODAS 2.0 se mostró confiable y valida al ser utilizada en pacientes con dolor asociado a la patología musculo esquelética. .

OBJECTIVE To validate the Portuguese version of the World Health Organization Disability Assessment Schedule (WHODAS 2.0). METHODS The original, 36 item version of the WHODAS 2.0, administered through an interview, was translated into Portuguese following international guidelines and tested on 9 participants from the general population. The Portuguese version was then administered to 204 patients with musculoskeletal pain. The patients’ socio-demographic and health data were collected, as were the number of sites where they were experiencing pain and the intensity of that pain. The WHODAS 2.0 was administered again by a second interviewer within three days to determine its inter-rater reliability. Construct validity was assessed according to the ability of WHODAS 2.0 to discriminate between patients with different numbers of pain sites and the correlation between WHODAS 2.0 scores and pain intensity. Internal consistency was also assessed. RESULTS The Portuguese version of the WHODAS 2.0 is easily understood and has good internal consistency (α = 0.84), as well as, very good inter-rater reliability (ICC = 0.95). In addition, it was able to detect statistically significant differences between patients with different numbers of pain sites (p < 0.01) and showed that higher levels of disability are associated with more intense pain (r = 0.44, p < 0.01), indicating that it has construct validity. CONCLUSIONS The Portuguese version of the WHODAS 2.0 has shown to be reliable and valid when administered to patients with musculoskeletal pain. .