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1.
Neuroscience Bulletin ; (6): 342-358, 2022.
Article in English | WPRIM | ID: wpr-929097

ABSTRACT

Central sensitization is essential in maintaining chronic pain induced by chronic pancreatitis (CP), but cortical modulation of painful CP remains elusive. Here, we examined the role of the anterior cingulate cortex (ACC) in the pathogenesis of abdominal hyperalgesia in a rat model of CP induced by intraductal administration of trinitrobenzene sulfonic acid (TNBS). TNBS treatment resulted in long-term abdominal hyperalgesia and anxiety in rats. Morphological data indicated that painful CP induced a significant increase in FOS-expressing neurons in the nucleus tractus solitarii (NTS) and ACC, and some FOS-expressing neurons in the NTS projected to the ACC. In addition, a larger portion of ascending fibers from the NTS innervated pyramidal neurons, the neural subpopulation primarily expressing FOS under the condition of painful CP, rather than GABAergic neurons within the ACC. CP rats showed increased expression of vesicular glutamate transporter 1, and increased membrane trafficking and phosphorylation of the N-methyl-D-aspartate receptor (NMDAR) subunit NR2B and the α-amino-3-hydroxy-5-methyl-4-isoxazole propionic acid receptor (AMPAR) subunit GluR1 within the ACC. Microinjection of NMDAR and AMPAR antagonists into the ACC to block excitatory synaptic transmission significantly attenuated abdominal hyperalgesia in CP rats, which was similar to the analgesic effect of endomorphins injected into the ACC. Specifically inhibiting the excitability of ACC pyramidal cells via chemogenetics reduced both hyperalgesia and comorbid anxiety, whereas activating these neurons via optogenetics failed to aggravate hyperalgesia and anxiety in CP rats. Taken together, these findings provide neurocircuit, biochemical, and behavioral evidence for involvement of the ACC in hyperalgesia and anxiety in CP rats, as well as novel insights into the cortical modulation of painful CP, and highlights the ACC as a potential target for neuromodulatory interventions in the treatment of painful CP.


Subject(s)
Animals , Anxiety/etiology , Chronic Pain/etiology , GABAergic Neurons , Gyrus Cinguli/metabolism , Hyperalgesia/metabolism , Pancreatitis, Chronic/pathology , Rats , Rats, Sprague-Dawley , Receptors, N-Methyl-D-Aspartate/metabolism , Trinitrobenzenesulfonic Acid/toxicity
2.
Actual. osteol ; 17(2): 104-111, 2021. ilus, tab
Article in Spanish | LILACS, BINACIS, UNISALUD | ID: biblio-1370318

ABSTRACT

El síndrome de dolor regional complejo (SDRC) es una patología poco frecuente, caracterizada por dolor crónico y cambios locales del sitio afectado. Ocurre en forma posterior a un traumatismo, o, menos frecuentemente, sin desencadenante claro. El diagnóstico se realiza de forma clínica, evaluando la presencia de hallazgos típicos detallados en los criterios de Budapest, como el dolor continuo y desproporcionado, y síntomas y signos típicos, como edema, asimetría térmica y disminución del rango de movilidad. Los estudios por imágenes, así como la radiografía, la resonancia magnética o el centellograma óseo de 3 fases, también brindan información valiosa, sobre todo en los casos que se presentan con más dudas, y para realizar diagnóstico diferencial de otras patologías. En este sentido, la medición de la densidad mineral ósea por absorciometría dual de rayos X (DXA) se presenta también como herramienta de utilidad, no solo en la fase diagnóstica, al evidenciar la mayor desmineralización del miembro afectado, sino también en la evaluación de la respuesta terapéutica a bifosfonatos. Presentamos el caso de una paciente con SDRC del miembro inferior, donde la densitometría ósea resultó de gran utilidad en su manejo clínico. (AU)


Complex regional pain syndrome (CRPS) is a rare pathology, characterized by chronic pain and local changes of the affected site. It occurs after trauma or, less frequently, without a clear trigger. The diagnosis is made clinically, evaluating the presence of typical findings detailed in the Budapest criteria, such as continuous and disproportionate pain, and typical signs and symptoms, like edema, thermal asymmetry, and decreased range of motion. Imaging studies, such as radiography, magnetic resonance imaging, or 3-phase bone scintigraphy also provide valuable information, especially in cases that present with more doubts, and to make a differential diagnosis with other pathologies. In this regard, the measurement of bone mineral density by dual X-ray absorptiometry (DXA) is also a useful tool, not only in the diagnostic phase, by showing the greater demineralization of the affected limb, but also in the evaluation of the therapeutic response to bisphosphonates. We present the case of a patient with CRPS of the lower limb, where bone densitometry was very useful in her clinical management. (AU)


Subject(s)
Humans , Female , Middle Aged , Complex Regional Pain Syndromes/diagnosis , Complex Regional Pain Syndromes/pathology , Complex Regional Pain Syndromes/drug therapy , Densitometry , Bone Density , Complex Regional Pain Syndromes/diagnostic imaging , Diagnosis, Differential , Diphosphonates/administration & dosage , Chronic Pain/etiology
3.
Dolor ; 30(72): 20-24, nov. 2020.
Article in Spanish | LILACS | ID: biblio-1362442

ABSTRACT

El síndrome de dolor crónico postmastectomía es frecuente en pacientes sometidas a cirugía por cáncer de mamas, llegando a ser invalidante en casos severos. Existen distintos factores de riesgo para que éste se presente, siendo el dolor agudo postoperatorio el único en el cual podemos intervenir. La importancia de implementar estrategias de prevención en el periodo perioperatorio es fundamental. En la mantención de la anestesia general, la utilización de propofol se asocia con menor incidencia de dolor agudo postoperatorio. El uso de anestésicos locales, ya sea por vía tópica, subcutánea y sistémica, ha demostrado su beneficio para disminuir el dolor agudo. No obstante, solo el uso tópico y endovenoso ha sido útil para reducir el dolor hasta 3 meses postcirugía. Técnicas de analgesia regional, como el bloqueo PEC I y II, bloqueo paravertebral y bloqueo del erector de la espina han demostrado ser útiles para reducir el dolor agudo; pero solo el bloqueo paravertebral ha demostrado su utilidad en reducir el dolor hasta 1 año postcirugía. El uso de gabapentina, pregabalina y ketamina desde el periodo preoperatorio disminuyen la incidencia de dolor agudo postoperatorio. En tanto, la venlafaxina y dexmedetomidina demostraron su utilidad para reducir el dolor crónico.


Postmastectomy chronic pain syndrome is common in patients undergoing surgery for breast cancer, becoming invalidating in severe cases. There are different risk factors for this to occur, with acute post-operative pain being the only one in which we can intervene. The importance of implementing prevention strategies in the perioperative period is essential. In the maintenance of general anesthesia, the use of propofol is associated with a lower incidence of acute post-operative pain. The use of local anesthetics, whether topically, subcutaneously and systemically, has shown its benefit in reducing acute pain. However, only topical and endovenous use has been useful to reduce pain up to 3 months after surgery. Regional analgesia techniques, such as PEC I and II block, paravertebral block, and spinal erector block have been shown to reduce acute pain; but only the paravertebral block has shown its usefulness in reducing pain up to 1 year after surgery. The use of gabapentin, pregabalin and ketamine from the preoperative period reduce the incidence of acute postoperative pain. Meanwhile, venlafaxine and dexmedetomidine proved useful in reducing chronic pain.


Subject(s)
Humans , Female , Pain, Postoperative/prevention & control , Chronic Pain/prevention & control , Analgesics/therapeutic use , Mastectomy/adverse effects , Pain, Postoperative/etiology , Breast Neoplasms/surgery , Propofol/therapeutic use , Dexmedetomidine/therapeutic use , Chronic Pain/etiology , Pregabalin/therapeutic use , Gabapentin/therapeutic use , Ketamine/therapeutic use , Anesthetics, Local
4.
Dolor ; 30(72): 14-18, nov. 2020. tab, ilus
Article in Spanish | LILACS | ID: biblio-1362436

ABSTRACT

Se llevó a cabo un estudio observacional para analizar si tapentadol de liberación prolongada (LP) puede considerarse un tratamiento de primera línea para pacientes con dolor crónico postraumático (DCPT). Métodos: Se presenta una serie de casos de la práctica clínica real de pacientes con DCPT producido por accidentes de trabajo. Antes de ingresar al estudio, todos los pacientes recibían tramadol, que se interrumpió cuando se inició la administración de tapentadol LP. Las evaluaciones de dolor incluyeron una escala de valoración numérica, el cuestionario DN4 y la escala de Impresión Global de Cambio del Paciente (PGIC, Patients' Global Impression of Change). Se recuperaron y registraron los eventos adversos. Resultados: 94 pacientes participaron en el estudio y 77 (82 %) completaron todas las visitas predefinidas. Cerca de la mitad de los pacientes informaron dolor crónico que tenía una duración de al menos 3 años; se observó un componente neuropático en el 87 % de los pacientes. El puntaje de dolor se redujo en 1,5 puntos luego del primer mes de tratamiento con tapentadol LP y en 2,48 puntos luego de 4 meses (p<0,05). También se asoció la administración de tapentadol LP con una reducción del 28,9 % de la dosis concomitante de pregabalina (p<0,01). De acuerdo con el cuestionario PGIC, el 74 % y el 77,9 % de los pacientes informó mejoría luego de uno y cuatro meses de tratamiento, respectivamente. El perfil de seguridad fue consistente con los datos actuales sobre tapentadol LP. Conclusión: El dolor osteomuscular crónico es una enfermedad prevalente que se caracteriza por tener resultados terapéuticos deficientes y se asocia a una mayor discapacidad y una mala calidad de vida. En este estudio de la práctica clínica real en pacientes que trabajan y que cuentan con un componente de dolor neuropático elevado, se observó que tapentadol LP produce efectos beneficiosos en términos del control del DCPT, y se obtuvieron índices altos de eficacia y seguridad.


An observational study was carried out to analyze whether prolonged-release (PR) tapentadol may be considered a first-line treatment for patients with chronic post-traumatic pain (PTD). Methods: A case series of cases of patients with PTFE caused by work accidents in a real clinical practice setting is described. Before entering the study, all patients were receiving tramadol, which was discontinued when PR tapentadol was started. Pain assessments included a numerical rating scale, the DN4 questionnaire, and the Patients' Global Impression of Change (PGIC) scale. Adverse events were retrieved and described. Results: 94 patients participated in the study and 77 (82%) completed all the predefined visits. About half of the patients reported chronic pain that lasted for at least 3 years. A neuropathic component was reported in 87% of patients. The pain score was reduced by 1.5 points after the first month of treatment with PR tapentadol and by 2.48 points after 4 months (p < 0.05). Administration of PR tapentadol was also associated with a concomitant reduction of pregabalin dose of 28.9% (p < 0.01). According to the PGIC questionnaire, 74% and 77.9% of patients reported improvement after one and four months of treatment, respectively. The safety profile was consistent with current data on PR tapentadol. Conclusion: Chronic musculoskeletal pain is a prevalent disease characterized by poor therapeutic results and associated with increased disability and poor quality of life. In our study in a real clinical practice setting with patients with a high neuropathic pain component, PR tapentadol produced beneficial effects in terms of DCPT control, and high efficacy and safety rates were obtained. Keywords: tapentadol, chronic pain, pain caused by work accidents, chronic post-traumatic pain, evidence from real clinical practice.


Subject(s)
Humans , Male , Female , Adult , Aged , Wounds and Injuries/complications , Accidents, Occupational , Chronic Pain/drug therapy , Tapentadol/therapeutic use , Analgesics, Opioid/therapeutic use , Chronic Pain/etiology , Tapentadol/adverse effects , Analgesics, Opioid/adverse effects
5.
Rev Bras Ginecol Obstet ; 42(8): 486-492, 2020. tab, graf
Article in English | LILACS | ID: biblio-1137862

ABSTRACT

Abstract Objective To determine the average body composition (percentage of body fat), the anthropometric markers, and the intensity of clinical pain in women with a clinical diagnosis of chronic pelvic pain (CPP) secondary to endometriosis. Methods A case-control study performed with 91 women, 46 of whom with CPP secondary to endometriosis and 45 of whom with CPP secondary to other causes. They underwent an evaluation of the anthropometric parameters by means of the body mass index (BMI), the perimeters (waist, abdomen, hip), and the percentage of body fat (%BF), which were assessed on a body composition monitor by bioimpedance; the intensity of the clinical pain was evaluated using the visual analog scale (VAS), and the symptoms of anxiety and depression, using the hospital's anxiety and depression scale (HAD). Results The groups did not differ in terms of mean age, BMI, %BF or regarding the available waist-to-hip ratio (WHR). The mean intensity of the clinical pain by the VAS was of 7.2 ± 2.06 in the group with CPP secondary to endometriosis, and of 5.93 ± 2.64 in the group with CPP secondary to other causes (p = 0.03), revealing significant differences between the groups. Conclusion We concluded that, despite the difference in the pain score assessed between the two groups, there was no difference regarding body composition and anthropometry.


Resumo Objetivo Determinar a composição corporal média (porcentagem de gordura corporal), os marcadores antropométricos, e a intensidade de dor clínica em mulheres com diagnóstico clínico de dor pélvica crônica (DPC) secundária a endometriose. Métodos Um estudo de caso-controle realizado com 91 mulheres, 46 das quais com DPC secundária a endometriose, e 45 das quais com DPC secundária a outras causas. As pacientes foram submetidas à avaliação dos parâmetros antropométricos por meio do índice de massa corporal (IMC), dos perímetros (cintura, abdômen, quadril), e do percentual de gordura corporal (%GC), que foram avaliados emmonitor de composição corporal por bioimpedância; a intensidade clínica da dor foi avaliada usando-se a escala visual analógica (EVA), e os sintomas de ansiedade e depressão, usando a escala de ansiedade e depressão do hospital (EADH). Resultados Os grupos não diferiram quanto à idade média, ao IMC, ao %GC, nem quanto à relação da cintura-quadril (RCQ) disponível. Amédia da intensidade clínica da dor pela EVA foi de 7,2 ± 2,06 no grupo com DPC secundária a endometriose, e de 5,93 ± 2,64 no grupo com DPC secundária a outras causas (p = 0,03), revelando diferenças significativas entre os grupos. Emrelação à EADH, ambos os grupos estavam acima da média de corte. Conclusão Concluímos que, apesar da diferença no escore de dor avaliado entre os dois grupos, não houve diferença com relação à composição corporal e à antropometria.


Subject(s)
Humans , Female , Adult , Body Composition/physiology , Pelvic Pain/etiology , Endometriosis/complications , Endometriosis/epidemiology , Chronic Pain/etiology , Anxiety , Pain Measurement , Body Mass Index , Case-Control Studies , Depression , Middle Aged
6.
Rev. bras. anestesiol ; 69(6): 594-604, nov.-Dec. 2019. tab
Article in English | LILACS | ID: biblio-1057482

ABSTRACT

Abstract Background and objectives: Calcitonin is a polypeptide hormone regulating the metabolism of calcium in the body. For many years calcitonin has been used to maintain and improve bone mineral density and to reduce the fracture rate. Many studies showed that calcitonin had analgesic role in several painful circumstances. This pain-ameliorating effect is irrelevant to its osteoclastic inhibitory effect and mechanisms like altering Na+ channel and serotonin receptor expression or hypothesis including the endorphin-mediated mechanism were used to explain this effect. In this study we performed a thorough review on the role of calcitonin as an analgesic agent in different scenarios and investigated the fact that calcitonin can be a feasible medication to relieve pain. Method: Many studies focused on the analgesic effect of calcitonin in several painful circumstances, including acute pains related to vertebral fractures, metastasis, migraine and reflex sympathetic dystrophy as well as neuropathic pains related to spinal injuries or diabetes, and phantom pain. Also, calcitonin was showed to be a useful additive to local anesthesia in the case of controlling postoperative pain or trigeminal neuralgia more effectively. However we faced some contradictory data for conditions like lumbar canal stenosis, complex regional pain syndrome, phantom pain and malignancies. Conclusion: This study showed that calcitonin could be helpful analgesic agent in different painful situations. Calcitonin can be considered an eligible treatment for acute pains related to vertebral fractures and a feasible alternative for the treatment of the acute and chronic neuropathic pains where other medications might fail.


Resumo Justificativa e objetivos: A calcitonina é um hormônio polipeptídico que regula o metabolismo do cálcio no organismo. Por muitos anos a calcitonina tem sido usada para manter e melhorar a densidade mineral óssea e reduzir a incidência de fraturas. Muitos estudos mostraram que a calcitonina teve efeito analgésico em várias condições físicas de dor. Esse efeito de melhoria da dor é irrelevante diante de seu efeito inibidor osteoclástico e de mecanismos, tais como a alteração do canal de Na+ e da expressão do receptor de serotonina, inclusive a hipótese do mecanismo mediado pela endorfina, que foram usados para explicar esse efeito. Neste estudo, fizemos uma revisão completa sobre o papel da calcitonina como agente analgésico em diferentes cenários e investigamos o fato de que a calcitonina pode ser uma medicação viável para aliviar a dor. Método: Muitos estudos centraram no efeito analgésico da calcitonina em várias condições de dor, inclusive dores agudas relacionadas a fraturas vertebrais, metástases, enxaqueca e distrofia simpática reflexa, bem como dores neuropáticas relacionadas a lesões medulares ou ao diabetes e dor fantasma. Além disso, a calcitonina mostrou ser um aditivo útil à anestesia local para o controle mais efecaz da dor pós-operatória ou neuralgia do trigêmeo. Porém, nos deparamos com alguns dados contraditórios em condições como estenose do canal lombar, síndrome complexa da dor regional, dor fantasma e malignidades. Conclusão: Este estudo mostrou que a calcitonina pode ser um analgésico útil em diferentes condições de dor. A calcitonina pode ser considerada um tratamento elegível para as dores agudas relacionadas a fraturas vertebrais e uma opção viável para o tratamento das dores neuropáticas agudas e crônicas em que outros medicamentos podem falhar.


Subject(s)
Humans , Animals , Calcitonin/therapeutic use , Analgesics/therapeutic use , Calcitonin/pharmacology , Acute Pain/etiology , Acute Pain/physiopathology , Acute Pain/drug therapy , Chronic Pain/etiology , Chronic Pain/physiopathology , Chronic Pain/drug therapy , Analgesics/pharmacology , Neuralgia/etiology , Neuralgia/physiopathology , Neuralgia/drug therapy
7.
Rehabil. integral (Impr.) ; 14(2): 62-70, dic. 2019. tab, ilus
Article in Spanish | LILACS | ID: biblio-1099864

ABSTRACT

INTRODUCTION: Chronic pain is a frequent symptom in patients with Duchenne muscular dystrophy (DMD) as reported, in up to 73%, affecting their normal activities, participation and quality of life; however it is an underdiagnosed symptom, and therefore, undertreated. OBJECTIVE: to establish the prevalence of chronic pain in a population with non-ambulatory DMD attending Instituto Teletón Santiago (ITS). MATERIALS AND METHODS: Descriptive, cross-sectional study in DMD patients of Instituto Teletón Santiago, of 12 years old and older, who were in an early or late non-ambulatory stage. By means of a questionnaire designed by the authors, adapted from 'Brief Pain Inventory' and 'ID-Pain', and administered via telephone, it was possible to obtain data on the presence of acute, chronic pain and its intensity, frequency, location, clinical characteristics and interference with daily life activities and the use of analgesic drugs. Data collected helped to do an estimation of the prevalence of pain in the last week, chronic pain as well as summary measures for location, intensity and clinical characteristics. RESULTS: of 74 active patients with DMD and in compliance with the inclusion criteria, 23 subjects responded the questionnaire (31% response rate); average age was 18.3 years, and 9 months since loss of walking ability; prevalence of acute pain was 13% and 13% for chronic pain; most common localization was in the hips, followed by neck, spine and lower limbs; duration and frequency were variable and of moderate intensity. CONCLUSION: Pain has a lower prevalence in the studied population compared to the literature, however, it affects multiple locations and has an impact on their daily activities, and therefore it is important to record the presence of chronic pain in clinical practice. It is necessary to get a higher response rate in future studies and quantify pain with an instrument developed especially for this population.


INTRODUCCIÓN: El dolor crónico es un síntoma frecuente en pacientes con distrofia muscular de Duchenne (DMD) reportado en hasta un 73%, afectando las actividades, participación y calidad de vida; sin embargo, es un síntoma subdiagnosticado y por ende subtratado. OBJETIVO GENERAL: Determinar prevalencia de dolor crónico en población con DMD en etapa no ambulante que se atiende en Instituto Teletón Santiago (ITS). MATERIALES Y MÉTODOS: Estudio descriptivo, transversal en pacientes con DMD, activos en Instituto Teletón Santiago, de 12 años y más de edad, que se encontraban en etapa no ambulante temprano o tardío. Mediante la aplicación de un cuestionario diseñado por los autores adaptando Brief Pain Inventory e ID-Pain, aplicado vía telefónica, se obtuvo datos sobre la presencia de dolor agudo, crónico, intensidad, frecuencia, localización, tiempo de duración, características clínicas del dolor, interferencia en actividades de vida diaria y uso de fármacos analgésicos. Con los datos recolectados se estimó la prevalencia de dolor crónico, de la última semana y medidas de resumen para localización, intensidad y características clínicas. RESULTADOS: De 74 pacientes activos con diagnóstico de DMD que cumplían criterios de inclusión, se encuestaron 23 sujetos (porcentaje de respuesta de 31%); edad promedio de 18,3 años y 9 años desde pérdida de la marcha; la prevalencia de dolor agudo fue de 13% y de dolor crónico 13%; la localización más frecuente fue en las caderas, seguido por cuello y columna y extremidades inferiores, de duración y frecuencia variable e intensidad moderada. CONCLUSIÓN: El dolor tiene menor prevalencia en la población estudiada en relación con la literatura, sin embargo, afecta múltiples localizaciones e impacta en sus actividades de la vida diaria, por lo que es importante consignar la presencia de dolor crónico en la práctica clínica. Se hace necesario obtener un mayor porcentaje de respuesta en futuros estudios y cuantificar el dolor con un instrumento confeccionado especialmente para esta población.


Subject(s)
Humans , Adolescent , Adult , Muscular Dystrophy, Duchenne/epidemiology , Chronic Pain/epidemiology , Quality of Life , Chile , Epidemiology, Descriptive , Prevalence , Cross-Sectional Studies , Surveys and Questionnaires , Muscular Dystrophy, Duchenne/complications , Muscular Dystrophy, Duchenne/psychology , Chronic Pain/etiology , Chronic Pain/psychology
8.
Rev. colomb. psiquiatr ; 48(3): 182-191, jul.-set. 2019.
Article in Spanish | LILACS, COLNAL | ID: biblio-1058419

ABSTRACT

Resumen Introducción: En este artículo se intenta encontrar, mediante una revisión sistemática, la información que permita establecer alguna conexión entre el dolor crónico y el proceso de duelo, más allá de las relaciones intuitivas que los conectan. Método: Revisión de la literatura médica sobre los artículos que puedan mostrar alguna evidencia de la relación del dolor crónico y el duelo. Resultados: La información disponible sobre ambos temas por separado es abundante, pero cuando se trata de informaciones que los relacionen, es muy poco lo que se encuentra. Conclusión: La relación entre el dolor crónico y el duelo se ha mencionado de manera intuitiva como una condición que se da por sentado. Sin embargo, se ha publicado muy poca evidencia de esa relación, lo cual es una muestra de que es un aspecto muy poco investigado.


Abstract Introduction: The aim of this article was to conduct a systematic review in order to find information that enables a connection between chronic pain and the grieving process to be established, beyond the intuitive relationships that connects them. Methods: The medical literature was reviewed in search of articles that provide some evidence of the connection between chronic pain and grief. Results: The available information on both topics by themselves is profuse but there are very few publications that deal with both issues simultaneously. Conclusions: The connection between chronic pain and grief has been mentioned intuitively as a condition taken for granted. However, little evidence of this relationship has been published, which suggests that this topic has not been widely researched.


Subject(s)
Humans , Male , Female , Grief , Chronic Pain , Publications , Chronic Pain/etiology , Sitting Position , Methods
9.
Rev. Assoc. Med. Bras. (1992) ; 65(9): 1174-1180, Sept. 2019. graf
Article in English | LILACS | ID: biblio-1041070

ABSTRACT

SUMMARY OBJECTIVE The study aims to explore the relationship between preoperative anxiety and chronic postoperative pain. METHODS A total of forty rats were divided into four groups, control, single-prolonged stress alone, Hysterectomy alone, and SPS+ Hysterectomy. The paw withdrawal mechanical thresholds (PWMT) were examined. qRT-PCR and western blotting assay were performed to detect the GFAP expression in astrocytes isolated from the anterior cingulate cortex (ACC) region. In addition, the long-term potentiation (LTP) in ACC was examined. RESULTS Rats in the SPS group or the Hysterectomy alone group had no significant effect on chronic pain formation, but SPS can significantly induce chronic pain after surgery. Astrocytes were still active, and the LTP was significantly increased three days after modeling in the SPS+Hysterectomy group. CONCLUSIONS anxiety can induce chronic pain by activating astrocytes in the ACC region.


RESUMO OBJETIVO O objetivo deste estudo é explorar a relação entre a ansiedade no pré-operatório e a dor crônica no pós-operatório. MÉTODOS Um total de 40 ratos foram divididos em quatro grupos: controle, estresse prolongado (SPS), histerectomia e SPS + histerectomia. Os limiares de retirada da pata em resposta a estímulo mecânico (PWMT) foram examinados. Ensaios qRT-PCR e imunoenzimáticos (western blotting) foram realizados para detectar a expressão de GFAP em astrócitos isolados da região do córtex cingulado anterior (CCA). Além disso, a potenciação de longa duração (LTP) no CCA também foi examinada. RESULTADOS Os ratos no grupo de estresse prolongado e no grupo de histerectomia não apresentaram nenhum efeito significativo na formação de dor crônica. Porém, o estresse prolongado foi capaz de induzir dor crônica significativamente após a cirurgia. Três dias após o modelo, o grupo de SPS + histerectomia ainda apresentava astrócitos ativos e LTP significativamente maior. CONCLUSÃO A ansiedade pode provocar dor crônica através da ativação de astrócitos na região do CCA.


Subject(s)
Animals , Female , Anxiety/complications , Pain, Postoperative/etiology , Astrocytes/metabolism , Chronic Pain/etiology , Pain, Postoperative/psychology , Stress, Psychological/etiology , Time Factors , Random Allocation , Rats, Sprague-Dawley , Pain Threshold/physiology , Long-Term Potentiation/physiology , Disease Models, Animal , Preoperative Period , Chronic Pain/psychology , Glial Fibrillary Acidic Protein/metabolism , Gyrus Cinguli/metabolism , Hindlimb , Hysterectomy
10.
Rev. Assoc. Med. Bras. (1992) ; 65(9): 1201-1207, Sept. 2019. tab, graf
Article in English | LILACS | ID: biblio-1041066

ABSTRACT

SUMMARY OBJECTIVES Inguinal hernioplasty techniques have been improved since the first hernioplasty. Tension-free techniques that apply synthetic mesh materials, as in the Lichtenstein approach, are the gold standard. Laparoscopic hernioplasty is the strongest alternative to Lichtenstein. The superiority of laparoscopic hernioplasty over Lichtenstein is a major topic of debate. In this study, we aimed to find a conclusion to this debate by comparing our totally extraperitoneal (TEP) experiences with Lichtenstein experiences. METHODS Patients who underwent inguinal hernioplasty at the Gulhane Training and Research Hospital from 2013 to 2018 were included in this retrospective cohort study. The sample included 96 TEP and 90 Lichtenstein patients for a total of 186 patients. The variables assessed were hospitalization duration, postoperative early visual analog scale score, chronic pain, paresthesia, recurrence, and early postoperative complications. Data were collected from patient records and via telephone questionnaire if needed. Data analysis was done by SPSS v20, using chi-square, Fisher's exact, and Mann-Whitney U tests. RESULTS Male/female ratios were similar between the TEP and Lichtenstein groups. There was no difference in mean age between groups (p=0.1). The hospital stay was shorter (p=0.0001), and early postoperative visual analog scale score was lower in the TEP group (p=0.003). Chronic pain, paresthesia, recurrence, and early postoperative complications (hematoma, seroma, wound infection) were similar. CONCLUSIONS TEP is superior to Lichtenstein with shorter hospitalization duration and lower rates of early postoperative pain. No difference between the two techniques was found for chronic pain. We believe that laparoscopic hernioplasty approach may be the best alternative technique for inguinal hernia repair.


RESUMO OBJETIVOS As técnicas de hernioplastia inguinal foram melhoradas desde a primeira hernioplastia. Técnicas livres de tensão que aplicam materiais de malha sintética, como na abordagem de Lichtenstein, são o padrão ouro. A hernioplastia laparoscópica é a alternativa mais forte ao Lichtenstein. A superioridade da hernioplastia laparoscópica sobre o Lichtenstein é um dos principais temas debatidos. Neste estudo, procuramos encontrar uma conclusão para esse debate comparando nossas experiências totalmente extraperitoneais (TEP) com as experiências de Lichtenstein. MÉTODOS Pacientes submetidos à hernioplastia inguinal no Gulhane Training and Research Hospital de 2013 a 2018 foram incluídos neste estudo de coorte retrospectivo. A amostra incluiu 96 pacientes TEP e 90 pacientes Lichtenstein para um total de 186 pacientes. As variáveis avaliadas foram tempo de internação, escore da escala analógica visual precoce no pós-operatório, dor crônica, parestesia, recidiva e complicações pós-operatórias precoces. Os dados foram coletados dos prontuários e do questionário por telefone, se necessário. A análise dos dados foi realizada pelo SPSS v20, utilizando os testes qui-quadrado, exato de Fisher e U de Mann-Whitney. RESULTADOS As razões homem/mulher foram semelhantes entre os grupos TEP e Lichtenstein. Não houve diferença na média de idade entre os grupos (p=0,1). A permanência hospitalar foi menor (p=0,1) e a escala visual analógica precoce foi menor no grupo TEP (p=0,003). Dor crônica, parestesia, recorrência e complicações pós-operatórias imediatas (hematoma, seroma, infecção da ferida) foram semelhantes. CONCLUSÕES O TEP é superior ao Lichtenstein, com menor tempo de internação e menores taxas de dor pós-operatória precoce. Nenhuma diferença entre as duas técnicas foi encontrada para dor crônica. Acreditamos que a abordagem de hernioplastia laparoscópica pode ser a melhor técnica alternativa para correção de hérnia inguinal.


Subject(s)
Humans , Male , Female , Adolescent , Adult , Aged , Aged, 80 and over , Young Adult , Laparoscopy/methods , Herniorrhaphy/methods , Hernia, Inguinal/surgery , Pain, Postoperative/etiology , Paresthesia/etiology , Recurrence , Retrospective Studies , Follow-Up Studies , Laparoscopy/adverse effects , Chronic Pain/etiology , Herniorrhaphy/adverse effects , Length of Stay , Middle Aged
11.
Rev. Soc. Bras. Clín. Méd ; 17(3): 147-152, jul.-set. 2019. ilus.
Article in Portuguese | LILACS | ID: biblio-1284216

ABSTRACT

A síndrome de Ehlers-Danlos é estabelecida por distúrbios hereditários do tecido conjuntivo que tem como manifestações principais a hipermobilidade articular, a hiperextensibilidade da pele e a fragilidade de tecidos, como articulações, ligamentos, pele, vasos sanguíneos e órgãos internos. São reconhecidos 13 subtipos, de acordo com Classificação Internacional de 2017. Dentre estes, abordamos o hipermóvel, cujo diagnóstico é eminentemente clínico, com manifestações sistêmicas distintas. Esse artigo refere-se ao caso de uma paciente diagnosticada com síndrome de Ehlers-Danlos hipermóvel, tendo como intuito a atualização acerca dos novos critérios diagnósticos, assim como o diagnóstico precoce de tal raropatia.


Ehlers-Danlos syndrome is established through hereditary disorders of connective tissue, and has as its manifestations: joint hypermobility, skin hyperextensibility, and fragility of tissues such as joints, ligaments, skin, blood vessels, and internal organs. Thirteen subtypes have been recognized according to the 2017 International Classification. Among these, the hypermobile type, the diagnosis of which is eminently clinical, with distinct systemic manifestations, will be addressed. This article refers to the case of a patient diagnosed with hypermobile Ehlers-Danlos syndrome, with the objective of updating the new diagnostic criteria, as well as the early diagnosis of such a rare disease.


Subject(s)
Humans , Female , Adult , Rare Diseases/diagnosis , Ehlers-Danlos Syndrome/diagnosis , Joint Instability/diagnosis , Physical Education and Training , Physical Therapy Department, Hospital , Echocardiography, Doppler , Tomography, X-Ray Computed , Cognitive Behavioral Therapy , Fatigue Syndrome, Chronic/etiology , Cardiology Service, Hospital , Exercise Tolerance/genetics , Muscle Weakness/etiology , Dilatation, Pathologic/diagnostic imaging , Joint Dislocations/etiology , Ehlers-Danlos Syndrome/complications , Ehlers-Danlos Syndrome/genetics , Ehlers-Danlos Syndrome/therapy , Osteoarthritis, Spine/diagnostic imaging , Striae Distensae/etiology , Musculoskeletal Pain/etiology , Chronic Pain/etiology , Intestinal Diseases/etiology , Joint Instability/complications , Joint Instability/genetics , Joint Instability/therapy , Anesthesia Department, Hospital , Mitral Valve Insufficiency/diagnostic imaging , Occupational Therapy Department, Hospital
12.
Adv Rheumatol ; 59: 45, 2019. tab, graf
Article in English | LILACS | ID: biblio-1088615

ABSTRACT

Abstract Background: The World Health Organization Disability Assessment Schedule (WHODAS) 2.0 is a generic instrument to assess disability. Pain and psychological factors seem to play a pronounced disabling role in fibromyalgia (FM). There are few studies that investigate the factors associated with disability in patients with fibromyalgia from the patient's perspective. Information about FM disability using self-reported questionnaires is limited. This study aimed to assess the relationship between the ordinal response variable (degree of disability), and four explanatory variables: pain intensity, depression, anxiety, and alexithymia. Methods: One hundred fifteen women with FM were enrolled in the cross-sectional study. For the assessment of disability the WHODAS 2.0 (36-item version) was used. Univariate and multivariate (ordinal logistic regression) analyses were performed to assess the relationship between pain (Visual Analogue Scale), depression and anxiety (Hospital Anxiety and Depression Scale), alexithymia (Modified Toronto Alexithymia Scale) and disability. Results: Disability was detected by global WHODAS score in 114 patients (99%), with the corresponding percentages for mild, moderate and severe disability being 11.3, 46.96 and 40.87%, respectively. Global WHODAS score was more severe among subjects with depression (50 vs 36.4, p < 0.001, effect size = 0.33) and alexithymia (50 vs 33.6, p < 0.001, effect size = 0.38). Pain intensity mean scores for mild, moderate and severe disability were 5.0, 6.1 and 7.3, respectively (p < 0.001, omega-squared = 0.12). Pain intensity explained the global disability degree and its domains except for the cognitive one. Whereas, depression explained cognitive and personal relation domains. On the other hand, alexithymia explained global disability degree and all domains of WHODAS 2.0 questionnaire. Conclusions: Most of the patients with fibromyalgia perceived themselves with moderate to severe disability. The main explanatory variables of the perceived disability were the pain intensity and psychological factors (alexithymia and depression).


Subject(s)
Humans , Female , Fibromyalgia/physiopathology , Chronic Pain/etiology , Cross-Sectional Studies/instrumentation , Mood Disorders/etiology , Affective Symptoms/etiology , Disability Evaluation
13.
Rev. bras. neurol ; 54(4): 19-25, out.-dez. 2018. tab
Article in Portuguese | LILACS | ID: biblio-967831

ABSTRACT

FUNDAMENTO: A dor é um sintoma não motor frequente em indivíduos com doença de Parkinson (DP). Pode estar associada aos sinais motores ou surgir no início da doença. Os mecanismos subjacentes à dor na DP ainda não são bem elucidados e muitos fatores podem influenciá-la, como o uso de levodopa e a presença de outros sintomas não motores, como depressão. OBJETIVOS: Descrever a prevalência e caracterizar a dor em pacientes com DP de um centro terciário referência em pesquisa e assistência clínica. MÉTODOS: Foram recrutados pacientes com diagnóstico de DP idiopática a partir do ambulatório de neurologia do Centro de Especialidades Médicas (CEM) da Santa Casa de Belo Horizonte/MG. Um questionário para coleta de dados sociodemográficos e clínicos foi aplicado. A função cognitiva, gravidade dos sinais e sintomas, depressão, distúrbios de sono e fadiga foram avaliados. A dor foi mensurada por meio do Questionário de McGill e Escala Visual Numérica. RESULTADOS: Participaram do estudo 45 pacientes, sendo que 19 (42,2%) apresentavam queixa de dor e, em sua maioria, após o diagnóstico de DP (74%). Não houve diferença entre os grupos com dor e sem dor para os parâmetros clínicos avaliados, com exceção da fadiga que foi mais prevalente (p=0,036) e mais grave (p=0,031) nos pacientes com dor. CONCLUSÃO: A dor é um sintoma prevalente em pacientes com DP atendidos no CEM. A partir dos resultados obtidos pelo McGill, observou-se que a dor crônica e profunda, acometendo principalmente os membros inferiores, com importantes aspectos sensoriais e afetivos, foi comum nos pacientes avaliados.


BACKGROUND: Pain is a common non-motor symptom in Parkinson´s Disease (PD). It can be associated to motor signs or can arise in the beginning of the disease. Mechanisms of pain in PD are not completely understood. Moreover, many factors can interfere, such as use of levodopa and presence of other non-motor symptoms as depression. OBJECTIVES: The aim of this study was to describe prevalence and characterization of pain in PD patients from a research and clinical terciary care center in Belo Horizonte, Minas Gerais, Brazil. METHODS: PD patients from the Neurology Center of Santa Casa Hospital (Belo Horizonte, MG, Brazil) were recruted. Socio-demographic and clinical data were collected. Cognitive function, severity of PD signs and symptoms, depression, sleep disturbance and fatigue were evaluated. Pain was measured by McGill Pain Questionnaire and Visual Numeric Scale (VNS). RESULTS: Forty-five PD patients participated in the study and 42,2% had pain complaints, mostly (74%) after PD diagnosis. No difference between group with pain or without pain for clinical parameters was detected, except for fatigue, which was more prevalent (p=0,036) and more severe (p=0.031) in patients with pain. CONCLUSION: Pain was very prevalent in PD patients from CEM. Results obtained from McGill showed that chronic and deep pain, mostly in lower limbs, with important physical and affective features was very common in this sample of PD patients.


Subject(s)
Humans , Male , Female , Aged , Parkinson Disease/complications , Parkinson Disease/diagnosis , Chronic Pain/diagnosis , Chronic Pain/epidemiology , Prevalence , Cross-Sectional Studies , Surveys and Questionnaires/standards , Lower Extremity , Fatigue , Chronic Pain/etiology
14.
Arch. argent. pediatr ; 116(5): 649-654, oct. 2018. ilus, tab
Article in English, Spanish | LILACS, BINACIS | ID: biblio-973666

ABSTRACT

El objetivo de este estudio fue evaluar a los pacientes con fiebre mediterránea familiar (familial Mediterranean fever, FMF) y dolor abdominal crónico resistentes al tratamiento con colchicina. Se incluyó a 48 pacientes diagnosticados en nuestro consultorio de reumatología pediátrica que tenían dolor abdominal a pesar del tratamiento con colchicina. A todos los pacientes se los derivó a un gastroenterólogo pediátrico. Se registraron las características del dolor, tales como aparición, duración y frecuencia; se planificó una endoscopía digestiva para obtener un diagnóstico diferencial. Se determinó la presencia de una mutación del gen MEFV en 46 pacientes. La mediana de la duración del tratamiento fue de 2,8 años. Aproximadamente el 60% de los pacientes tenían dolor abdominal todos los días o de dos a tres veces a la semana; en el 73% de los casos, duró menos de tres horas. A 41 pacientes se les realizó una endoscopía digestiva alta. La gastroduodenitis es un hallazgo frecuente en los pacientes con FMF y dolor abdominal persistente a pesar del tratamiento. Los pacientes con los puntajes más altos de severidad de la enfermedad tenían inflamación digestiva grave.


The aim of the study to evaluate familial mediterranean fever (FMF) patients with chronic abdominal pain unresponsive to colchicine treatment. Forty-eight patients who diagnosed in our Pediatric Rheumatology clinics and suffering from abdominal pain despite colchicine treatment were include. All patients were referred to a pediatric gastroenterologist. The pain characteristics such as onset, duration and frequency were recorded; gastrointestinal (GI) endoscopy was planned for differential diagnosis. MEFV mutation was determined in 46 patients. The median duration of treatment was 2.8 years. Approximately 60% of the patients suffered from abdominal pain every day or 2-3 times a week, in 73% of the cases it lasted less than three hours. Forty-one patients underwent upper GI endoscopy. Gastroduodenitis is a common finding in persisting abdominal pain despite therapy of FMF patients. The patients with the highest disease severity scores had severe inflammation within the entire GI system.


Subject(s)
Humans , Child , Adolescent , Familial Mediterranean Fever/complications , Abdominal Pain/epidemiology , Colchicine/administration & dosage , Chronic Pain/etiology , Familial Mediterranean Fever/drug therapy , Abdominal Pain/etiology , Endoscopy, Gastrointestinal/methods , Duodenitis/diagnosis , Duodenitis/etiology , Chronic Pain/epidemiology , Gastritis/diagnosis , Gastritis/etiology
15.
Arch. argent. pediatr ; 116(2): 112-118, abr. 2018. graf, tab
Article in English, Spanish | LILACS, BINACIS | ID: biblio-887456

ABSTRACT

Introducción. Los síndromes dolorosos más comunes (cefalea, dolor abdominal y dolor musculoesquelético) aparecen o empeoran durante la adolescencia, y son frecuente motivo de consulta. Objetivo. Evaluar la asociación de edad, sexo, obesidad, desarrollo puberal, nivel de escolarización, trabajo y constitución familiar con la consulta por dolor en adolescentes. Población y métodos. Estudio de casos y controles realizado entre el 1/2/14 y el 30/6/15. Criterios de inclusión: edad 10 a 20 años, ambos sexos, consultaron por dolor (casos) o para control de salud y/o apto físico escolar (controles). Se utilizaron los test de chi² y de Student. Se calcularon Odds Ratios (OR). Se construyó un modelo de regresión logística binaria para evaluar independientemente cada variable asociada con dolor. Resultados. Se evaluaron 4224 historias clínicas; se incluyeron 237 casos y 468 controles. Los adolescentes con dolor tuvieron: mayor edad (p < 0,0001; OR 2,3; IC 95%: 1,6-3,2); mayor cantidad de mujeres (p < 0,0001; OR 2,24; IC 95%: 1,61-3,12); 3) mayor desarrollo puberal (p= 0,0035; OR 2,16; IC 95%: 1,3-3,6); mayor abandono escolar (p < 0,0001; OR 13,4; IC 95%: 3,9-42,9); y mayor actividad laboral (p= 0,0001; OR 3,04; IC 95%: 1,7-5,3). Solamente la edad, sexo femenino y abandono escolar se asociaron independientemente a la consulta por dolor. No hubo diferencias significativas con obesidad y constitución familiar. Conclusión. Edad mayor, sexo femenino y abandono escolar fueron factores de riesgo independientes en la consulta por dolor en adolescentes. La pubertad y el trabajo se asociaron, pero no fueron factores de riesgo independientes.


Introduction. The most common painful syndromes (headache, abdominal pain and musculoskeletal pain) develop or worsen during adolescence and are a common reason for consultation. Objective. Evaluate the association of age, sex, obesity, pubertal development, schooling level, employment and family structure with consultation for pain in adolescents. Population and methods. Case-control study conducted between February 1st, 2014 and June 30th, 2015. Inclusion criteria: ages 10 to 20 years, both sexes, consultation for pain (cases), or a checkup and/or school physical (controls). χ² test and Student" s tests were used. Odds ratios (OR) were calculated. A binary logistic regression model was constructed to independently assess each pain-related variable. Results. A total of 4224 medical records were evaluated; 237 cases and 468 controls were included. Adolescents with pain exhibited: greater age (p < 0.0001; OR 2.3; 95% CI: 1.63.2); greater number of females (p < 0.0001; OR 2.24; 95% CI: 1.61-3.12); greater pubertal development (p < 0.0035; OR 2.16; 95% CI: 1.33.6); greater school dropout level (p < 0.0001; OR 13.4; 95% CI: 3.9-42.9); greater employment levels (p < 0.0001; OR 3.04; 95% CI: 1.7-5.3). Only age, female sex and school dropout were independently associated with consultation for pain. There were no significant differences with obesity and family structure. Conclusion. Older age, female sex and school dropout were independent risk factors in consultation for pain in adolescents. Puberty and employment were associated, but were not found to be independent risk factors.


Subject(s)
Humans , Male , Female , Child , Adolescent , Young Adult , Abdominal Pain/etiology , Musculoskeletal Pain/etiology , Chronic Pain/etiology , Headache/etiology , Syndrome , Case-Control Studies , Logistic Models , Odds Ratio , Cross-Sectional Studies , Retrospective Studies , Risk Factors
16.
Rev. bras. anestesiol ; 68(1): 100-103, Jan.-Feb. 2018.
Article in English | LILACS | ID: biblio-897796

ABSTRACT

Abstract Background and objectives Sympathectomy is one of the therapies used in the treatment of chronic obstructive arterial disease (COAD). Although not considered as first-line strategy, it should be considered in the management of pain difficult to control. This clinical case describes the evolution of a patient with inoperable COAD who responded properly to the lumbar sympathetic block. Case report A female patient, afro-descendant, 69 years old, ASA II, admitted to the algology service due to refractory ischemic pain in the lower limbs. The patient had undergone several surgical procedures and conservative treatments without success. Vascular surgery considered the case as out of therapeutic possibility, unless limb amputation. At that time, sympathectomy was indicated. After admission to the operating room, the patient was monitored, positioned and sedated. The blockade was performed with the aid of radioscopy, bilaterally, at L2-L3-L4 right and L3 left levels. On the right side, at each level cited, 3 mL of absolute alcohol with 0.25% bupivacaine were injected without vasoconstrictor, and on the left side only local anesthetic. The procedure was performed uneventfully. The patient was discharged with complete remission of the pain. Conclusion Neurolitic block of the lumbar sympathetic chain is an effective and safe treatment option for pain control in patients with critical limb ischemia patients in whom the only possible intervention would be limb amputation.


Resumo Justificativa/objetivos A simpatectomia é uma das terapêuticas usadas no tratamento dadoença arterial obstrutiva crônica (DAOP). Embora não seja considerada como estratégia de primeira linha, deve ser lembrada no manejo dos quadros de dor de difícil controle. Este caso clínico descreve a evolução de uma paciente portadora de DAOP inoperável que respondeu adequadamente ao bloqueio simpático lombar. Relato de caso Paciente do sexo feminino, parda, 69 anos, estado físico II, acompanhada no serviço de algologia devido a dor isquêmica refratária em membros inferiores. A paciente já havia sido submetida a diversas abordagens cirúrgicas e tratamentos conservadores, sem sucesso. A cirurgia vascular considerou o caso como fora de possibilidade terapêutica, a não ser amputação do membro. Nesse momento, foi indicada simpatectomia. Após admissão no centro cirúrgico, a paciente foi monitorada, posicionada e sedada. O bloqueio foi feito com auxílio da radioscopia, bilateralmente, nos níveis L2-L3-L4 à direita e L3 à esquerda. Do lado direito, em cada nível citado, foram injetados 3 mL de álcool absoluto com bupivacaína 0,25% sem vasoconstritor e do lado esquerdo somente o anestésico local. O procedimento foi feito sem intercorrências. A paciente recebeu alta com completa remissão da dor. Conclusão O bloqueio neurolítico da cadeia simpática lombar é uma opção de tratamento eficaz e segura para controle da dor em pacientes portadores de isquemia crítica, nos quais a única intervenção possível seria a amputação do membro.


Subject(s)
Humans , Female , Aged , Autonomic Nerve Block/methods , Chronic Pain/surgery , Pain Management/methods , Critical Illness , Lower Extremity/blood supply , Chronic Pain/etiology , Ischemia/complications , Lumbosacral Plexus
17.
An. bras. dermatol ; 93(1): 86-94, Jan.-Feb. 2018. tab, graf
Article in English | LILACS | ID: biblio-887155

ABSTRACT

Abstract: The low prevalence of erythromelalgia, classified as an orphan disease, poses diagnostic and therapeutic difficulties. The aim of this review is to be an update of the specialized bibliography. Erythromelalgia is an infrequent episodic acrosyndrome affecting mainly both lower limbs symmetrically with the classic triad of erythema, warmth and burning pain. Primary erythromelalgia is an autosomal dominant inherited disorder, while secondary is associated with myeloproliferative diseases, among others. In its etiopathogenesis, there are neural and vascular abnormalities that can be combined. The diagnosis is based on exhaustive clinical history and physical examination. Complications are due to changes in the skin barrier function, ischemia and compromise of cutaneous nerves. Because of the complexity of its pathogenesis, erythromelalgia should always be included in the differential diagnosis of conditions that cause chronic pain and/or peripheral edema. The prevention of crisis is based on a strict control of triggers and promotion of preventive measures. Since there is no specific and effective treatment, control should focus on the underlying disease. However, there are numerous topical and systemic therapies that patients can benefit from.


Subject(s)
Humans , Erythromelalgia/etiology , Diagnosis, Differential , Erythromelalgia/diagnosis , Erythromelalgia/prevention & control , Chronic Pain/etiology , Nervous System Diseases/complications
18.
Medwave ; 18(6): e7273, 2018.
Article in English, Spanish | LILACS | ID: biblio-948457

ABSTRACT

Resumen INTRODUCCIÓN: La artritis reumatoide es la artritis inflamatoria más común a nivel mundial. El dolor crónico lleva a pacientes a usar terapias complementarias, entre las cuales se ha planteado la acupuntura MÉTODOS: Para responder esta pregunta utilizamos Epistemonikos, la mayor base de datos de revisiones sistemáticas en salud, la cual es mantenida mediante búsquedas en múltiples fuentes de información, incluyendo MEDLINE, EMBASE, Cochrane, entre otras. Extrajimos los datos desde las revisiones identificadas, reanalizamos los datos de los estudios primarios, realizamos un metanálisis y preparamos una tabla de resúmen de los resultados utilizando el método GRADE. RESULTADOS Y CONCLUSIONES: Identificamos siete revisiones sistemáticas que en conjunto incluyeron 20 estudios primarios, todos correspondientes a ensayos aleatorizados. Concluimos que el uso de acupuntura probablemente tiene un impacto mínimo o nulo en la artritis reumatoide.


Abstract INTRODUCTION: Rheumatoid arthritis is the most common inflammatory arthritis worldwide. Chronic pain leads patients to use complementary therapies, including acupuncture. METHODS: To answer this question we used Epistemonikos, the largest database of systematic reviews in health, which is maintained by screening multiple information sources, including MEDLINE, EMBASE, Cochrane, among others. We extracted data from the systematic reviews, reanalyzed data of primary studies, conducted a meta-analysis and generated a summary of findings table using the GRADE approach. RESULTS AND CONCLUSIONS: We identified 7 systematic reviews including 20 studies overall, all of them randomized trials. We concluded the use of acupuncture probably has little or no impact in rheumatoid arthritis.


Subject(s)
Humans , Arthritis, Rheumatoid/therapy , Acupuncture Therapy/methods , Chronic Pain/therapy , Randomized Controlled Trials as Topic , Databases, Factual , Treatment Outcome , Chronic Pain/etiology
19.
Rehabil. integral (Impr.) ; 12(2): 75-84, dic. 2017. tab, graf
Article in Spanish | LILACS | ID: biblio-882778

ABSTRACT

Introduction: Pain results in deterioration of the emotional and social status of children and young people with cerebral palsy (CP). Prevalence values are high and vary between 32 and 69%. Despite of these figures, pain is underestimated by parents and health care team. Objective: Quantify the number of patients with chronic pain according to their ability to communicate and establish the association between pain, age and severity of the Gross Motor Function Classification (GMFCS). Method: Cross-sectional descriptive and analytic study in 8 to 20 year-old with CP. A questionnaire was administered to parents and caregivers to establish the presence of and characterize chronic pain. Results: 187 patients were included; 51% (IC95%:43,6-58,0%) experienced chronic pain, corresponding to 54% (IC95%: 45,0-62,0%) of patients that are able to communicate and 43% (IC95%: 29-57%) unable to communicate. Chronic pain was observed mainly in lower extremities, with weekly or daily frequency, of moderate to severe intensity, which limits regular activities in more than 50% of patients. No significant association was observed between the presence of chronic pain, age and GMFCS. Conclusion: Findings provide important information to improve the quality of care for patients with CP and chronic pain. Systematic evaluations must be implemented in order to provide timely and effective treatment for pain. Key words: Cerebral palsy, chronic pain, children, youth.


Introducción: El dolor produce un deterioro del estado emocional y social de niños y jóvenes con parálisis cerebral (PC). Las prevalencias son elevadas y varían entre 32% y 69%. A pesar de estas cifras, el dolor es subvalorado por padres y equipo de salud. Objetivo: Cuantificar el número de pacientes con dolor crónico según su capacidad de comunicar y determinar asociación con edad y severidad del compromiso motor grueso (GMFCS). Método: Estudio descriptivo-analítico y transversal en niños y jóvenes con PC de 8-20 años de edad. Se aplicó cuestionario a los padres/cuidadores para establecer la presencia de dolor crónico y caracterizarlo. Resultados: Se incluyeron 187 pacientes. Un 51% (IC 95%:43,6-58,0%) presentó dolor crónico, correspondiendo 54% (IC 95%: 45,0-62,0%) a pacientes comunicadores y 43% (IC95%: 29-57%) no comunicadores. El dolor crónico se localizó principalmente en extremidades inferiores, con frecuencia semanal o diaria, de intensidad moderada a severa, que limita las actividades habituales en más del 50% de los pacientes. No se encontró asociación significativa entre la presencia de dolor crónico, edad y GMFCS. Conclusión: Los hallazgos otorgan información importante para mejorar la calidad de atención de los pacientes con PC y dolor crónico. Se deben implementar sistemas de evaluación sistemática y tratar de forma oportuna y efectiva el dolor. Palabras claves: Parálisis cerebral, dolor crónico, niños.


Subject(s)
Humans , Male , Female , Child , Adolescent , Young Adult , Cerebral Palsy/epidemiology , Chronic Pain/epidemiology , Cerebral Palsy/complications , Epidemiology, Descriptive , Cross-Sectional Studies , Surveys and Questionnaires , Chronic Pain/etiology
20.
Rev. bras. reumatol ; 57(5): 438-444, Sept.-Oct. 2017. tab, graf
Article in English | LILACS | ID: biblio-899441

ABSTRACT

Abstract Objective: To determine the prevalence of Chronic Low Back Pain and predictors of Back Muscle Strength in patients with Systemic Lupus Erythematosus. Methods: Cross-sectional study. Ninety-six ambulatory patients with lupus were selected by non-probability sampling and interviewed and tested during medical consultation. The outcomes measurements were: Point prevalence of chronic low back pain, Oswestry Disability Index, Tampa Scale of Kinesiophobia, Fatigue Severity Scale and maximal voluntary isometric contractions of handgrip and of the back muscles. Correlation coefficient and multiple linear regression were used in statistical analysis. Results: Of the 96 individuals interviewed, 25 had chronic low back pain, indicating a point prevalence of 26% (92% women). The correlation between the Oswestry Index and maximal voluntary isometric contraction of the back muscles was r = −0.4, 95% CI [−0.68; −0.01] and between the maximal voluntary isometric contraction of handgrip and of the back muscles was r = 0.72, 95% CI [0.51; 0.88]. The regression model presented the highest value of R 2 being observed when maximal voluntary isometric contraction of the back muscles was tested with five independent variables (63%). In this model handgrip strength was the only predictive variable (β = 0.61, p = 0.001). Conclusions: The prevalence of chronic low back pain in individuals with systemic lupus erythematosus was 26%. The maximal voluntary isometric contraction of the back muscles was 63% predicted by five variables of interest, however, only the handgrip strength was a statistically significant predictive variable. The maximal voluntary isometric contraction of the back muscles presented a linear relation directly proportional to handgrip and inversely proportional to Oswestry Index i.e. stronger back muscles are associated with lower disability scores.


Resumo Objetivo: Determinar a prevalência de lombalgia crônica (LBC) e os preditores de força muscular nas costas (FMC) em pacientes com lúpus eritematoso sistêmico (LES). Métodos: Estudo transversal. Selecionaram-se 96 pacientes ambulatoriais com LES por amostragem não probabilística, entrevistados e testados durante consultas médicas. As medidas de desfecho foram: prevalência ocasional de LBC, Índice de Incapacidade de Oswestry, Escala Tampa para Cinesiofobia, Escala de Gravidade da Fadiga e contrações isométricas voluntárias máximas (CIVM) de preensão manual e dos músculos das costas. Usaram-se o coeficiente de correlação e a regressão linear múltipla na análise estatística. Resultados: Dos 96 indivíduos entrevistados, 25 apresentavam LBC, o que indicou uma prevalência circunstancial de 26% (92% mulheres). A correlação entre o Índice de Incapacidade de Oswestry e a contração isométrica voluntária máxima dos músculos das costas foi de r = -0,4, IC 95% [-0,68; -0,01] e entre a CIVM de preensão manual e dos músculos das costas foi de r = 0,72, IC 95% [0,51; 0,88]. O modelo de regressão apresentou o maior valor de R2 observado quando a CIVM dos músculos das costas foi testada com cinco variáveis independentes (63%). Nesse modelo, a força de preensão manual foi a única variável preditiva (ß = 0,61, p = 0,001). Conclusões: A prevalência de LBC em indivíduos com LES foi de 26%. A CIVM dos músculos das costas foi 63% prevista por cinco variáveis de interesse. No entanto, apenas a força de preensão manual foi uma variável preditiva estatisticamente significativa. A CIVM dos músculos das costas apresentou uma relação linear diretamente proporcional à força de preensão manual e inversamente proporcional ao Índice de Incapacidade de Oswestry (ou seja, músculos das costas mais fortes estão associados a menores pontuações de incapacidade).


Subject(s)
Humans , Male , Female , Adult , Low Back Pain/etiology , Muscle Strength , Chronic Pain/etiology , Back Muscles/physiopathology , Lupus Erythematosus, Systemic/complications , Linear Models , Prevalence , Cross-Sectional Studies , Risk Factors , Low Back Pain/diagnosis , Low Back Pain/physiopathology , Low Back Pain/epidemiology , Chronic Pain/diagnosis , Chronic Pain/physiopathology , Chronic Pain/epidemiology , Middle Aged
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