Factors associated with depressive symptoms in elderly caregivers with chronic pain / Factores asociados con síntomas depresivos en carreras de ancianos con dolor crónico / Fatores associados aos sintomas depressivos em idosos cuidadores com dor crônica

ABSTRACT Objective: to identify factors associated with depressive symptoms in elderly caregivers with chronic pain. Method: the study included people 60 years of age or older who reported chronic pain and cared for another elderly person living in the same household (n=186). Statistical analyzes were performed using the Mann-Whitney test, univariate and multiple logistic regression. Results: most participants had no depressive symptoms (70.4%), 24.2% had mild depressive symptoms and 5.4% had severe symptoms. Univariate analysis showed that the variables family income, number of diseases, number of medications in use, pain intensity, overload and perceived stress were associated with depressive symptoms. Multivariate analysis found an association with perceived stress (95% CI 1.101-1207) and number of medications (95% CI 1.139-1.540) in use. Conclusion: factors associated with depressive symptoms in elderly caregivers with chronic pain were stress and the number of medications in use.

RESUMEN Objetivo: para identificar los factores asociados con los síntomas depresivos en cuidadores mayores con dolor crónico. Método: el estudio incluyó a personas de 60 años de edad o mayores que reportaron dolor crónico y cuidaron a otra persona anciana que vive en el mismo hogar (n=186). Los análisis estadísticos se realizaron con la prueba de Mann-Whitney, regresión logística univariada y múltiple. Resultados: la mayoría de los participantes no tenían síntomas depresivos (70,4%), 24,2% tenían síntomas depresivos leves y 5,4% graves. El análisis univariado mostró que las variables ingreso familiar, número de enfermedades, número de medicamentos en uso, intensidad del dolor, sobrecarga y estrés percibido se asociaron con síntomas depresivos y el análisis multivariado mostró una asociación con el estrés percibido (IC 95% O 1.106 -1,207) y la cantidad de medicamentos (IC 95% O 1,139-1,540) en uso. Conclusión: los factores asociados con los síntomas depresivos en los cuidadores ancianos con dolor crónico fueron el estrés y la cantidad de medicamentos en uso.

RESUMO Objetivo: identificar os fatores associados aos sintomas depressivos de idosos cuidadores com dor crônica. Método: participaram da pesquisa pessoas com 60 anos ou mais, que relataram dor crônica e que realizam cuidado a outro idoso que mora no mesmo domicílio (n=186). Para as análises estatísticas, foram utilizados os testes de Mann-Whitney, regressão logística univariada e múltipla. Resultados: a maioria dos participantes não apresentou sintomas depressivos (70,4%), 24,2% apresentaram sintomas depressivos leves, e 5,4% severos. A análise univariada mostrou que as variáveis renda familiar, número de doenças, número de medicamentos em uso, intensidade da dor, sobrecarga e estresse percebido apresentaram associação com sintomas depressivos e na análise multivariada verificou-se associação com estresse percebido (IC 95% OR 1,106-1,207) e número de medicamentos (IC 95% OR 1.139-1.540) em uso. Conclusão: foram fatores associados aos sintomas depressivos em idosos cuidadores com dor crônica o estresse e o número de medicamentos em uso.

Cross-cultural adaptation and reliability of the pain response to activity and position questionnaire

Abstract Background: The World Health Organization reports that one of the main incapacitating conditions in older adults is osteomusculoskeletal disorders, and among these is low back pain. There are few instruments translated and transculturally adapted with psychometric properties evaluated for older adults with this health condition in Brazil. The Pain Response to Activity and Positioning (PRAP) questionnaire enables classification of older adults through functional performance. The objective of this study was to perform a cross-cultural adaptation and verify the reliability of the PRAP for older Brazilian people with chronic low back pain. Methods: A cross-sectional methodological study from the international study "Back Complaints in the Elders". We included individuals aged ≥60 years, with chronic lumbar pain complaints lasting ≥3 months. The transcultural translation and adaptation process followed the criteria proposed by Beaton and Guilhemeim, 1993. Reliability was tested using an unweighted Cohen's Kappa. Results: Thirty-six (36) older adults participated in the study (71.15 ± 7.23 years, 94.4% female). The intra-rater reliability for Low Back Pain (LBP) was between 0.50-1.00 and 0.23-0.84 for lower limbs, while the inter-rater reliability for LBP was between 0.25-0.63 and between 0.18-0.53 for lower limbs. The criteria for low back pain diagnosis showed intra and inter-rater agreement of 0.52 and 0.47, respectively. Conclusion: The Brazilian version of the instrument showed adequate reliability and ability to classify older adults in the diagnosis of LBP by reporting the performance of daily activities, and is indicated for use in the context of research and clinical practice. Trial registration: There is no trial registration. This is a methodological study.

Dor crônica: manejo baseado nos mecanismos / Chronic pain: mechanism based management

A dor crônica (DC) é uma experiência sensorial e emocional desagradável e é definida por períodos contínuos ou persistentes de dor superior a três meses de duração. A classificação da DC, por seu mecanismo, permite um manejo mais adequado e eficiente. O presente trabalho objetiva revisar esta visão e analisar aspectos concernentes à essa questão.

Chronic pain (CP) is a multidimensional sensation with intrinsically unpleasant experiences. It is associated to uninterrupted or persistent periods of pain superior to e three months. CP is classified according to its mechanism, and this distinction is important to make the appropriate management of the condition. The goal of this assessment is to review such concept.

Chronic pain related to quality of sleep / Dor crônica relacionada à qualidade do sono

Objective To determine the relation between the degrees of chronic pain and drowsiness levels. Methods The study was conducted with 115 patients, who answered the questionnaire as diagnostic criteria in the survey. After evaluation based on the protocol of chronic pain registry RDC/TMD− Axis II, the Epworth Sleepiness Scale was applied to assess drowsiness levels. Results Among the participating patients, there were more females (80%), and the type of pain more prevalent was chronic (70.4%). Concerning the grades of chronic pain, grade II predominated (38.3%), corresponding to high pain intensity and low disability. The ratio observed for levels of sleepiness was more prevalent for sleep debt average (38.3%). Conclusion The grades of chronic pain and the levels of sleepiness did not correlate with each other or with the gender of patients. .

Objetivo Determinar a relação entre os graus de dor crônica e os níveis de sonolência. Métodos Participaram 115 pacientes que responderam ao questionário usado como critério diagnóstico na pesquisa. Após avaliação segundo protocolo de registro de dor crônica RDC/TMD − Eixo II, aplicou-se a Escala de Sonolência de Epworth para verificar os níveis de sonolência. Resultados Dentre os pacientes participantes havia mais mulheres (80%) e o tipo de dor mais prevalente era crônica (70,4%). Na relação dos graus de dor crônica, predominou o grau II (38,3%), correspondente à alta intensidade de dor e baixa incapacidade. A proporção observada para os níveis de sonolência mostrou maior prevalência para o débito de sono médio (38,3%). Conclusão Os graus de dor crônica e níveis de sonolência não apresentam correlação entre si, nem com o gênero dos pacientes. .

Dor crônica em idosos residentes em São Paulo, Brasil: prevalência, características e associação com capacidade funcional e mobilidade (Estudo SABE) / Chronic pain among elderly residents in São Paulo, Brazil: prevalence, characteristics, and association with functional capacity and mobility (SABE Study) / Dolor crónico en los ancianos que viven en São Paulo, Brasil: prevalencia, características y asociación con la capacidad funcional y la movilidad (Estudio SABE)

O objetivo foi identificar a prevalência, as características e a associação da dor crônica com capacidade funcional. Estudo transversal com amostra populacional feito por entrevista domiciliar com idosos residentes na cidade de São Paulo, Brasil. Dor crônica foi aquela com duração mínima de seis meses. Nas análises estatísticas utilizou-se teste de associação de RaoScott com significância de p < 0,05. Dor crônica ocorreu em 29,7% dos idosos (IC95%: 25,4-33,9); os locais mais frequentes foram a região lombar (25,4%) e os membros inferiores (21,9%) e foi moderada em 45,8% das vezes e intensa em 46% dos idosos. Dor crônica esteve associada à maior dependência e pior mobilidade (p < 0,001).

The objective was to identify the prevalence and characteristics of chronic pain and the association with functional capacity. This was a cross-sectional study with a population sample of community-dwelling elderly residents in the city of São Paulo, Brazil, using home interviews. Statistical analysis used the RaoScott test of association with p < 0.05. Prevalence of chronic pain was 29.7% (95%CI: 25.4-33.9), most frequent in the lower back (25.4%) and lower limbs (21.9%), and moderate in 45.8% and intense in 46% of the sample. Chronic pain was associated with increased dependence and decreased mobility (p < 0.001).

El objetivo fue identificar la prevalencia, las características y la asociación del dolor crónico con la capacidad funcional. Se trata de un estudio transversal con una muestra poblacional, realizada mediante entrevista domiciliaria con ancianos residentes en la ciudad de São Paulo, Brasil. Fue considerado dolor crónico aquel con una duración mínima de seis meses. En los análisis estadísticos se utilizó el test de asociación de Rao-Scott con significancia de p < 0,05. El dolor crónico se produjo en un 29,7% de los ancianos (IC95%: 25,4-33,9); los lugares más frecuentes fueron la región lumbar (25,4%) y los miembros inferiores (21,9%) y fue moderado en un 45,8% de las veces e intenso en un 46% de los ancianos. El dolor crónico estuvo asociado a una mayor dependencia y peor movilidad (p < 0,001).

Dolor perdurable I. Nosología y epidemiología / [Enduring pain I. Nosology and epidemiology].

Pain disorders are extraordinarily prevalent throughout clinical medicine, and are highly co-morbid with various psychiatric disorders, particularly those including depression or anxiety. Assessment of such patients tends to be based on diagnostic criteria that may not reflect the complexity of the clinical problem and can result in prioritizing somatic aspects of painful syndromes at the expense of psychiatric aspects or, conversely, over-emphasize psychiatric aspects. In the first part of this overview we consider current nosological perspectives and their potential clinical consequences, epidemiological data that underscore the association of comorbid painful and affective or anxious syndromes, and consider the importance of psychiatric assessment and treatment of such patients. The major overlap between pain disorders and psychiatric disorders, as well as the unsatisfactory state of treatments available for chronic pain syndromes, encourage a comprehensive approach to assessing and clinically managing patients with chronic pain. Many programs for pain disorder patients offer narrowly specialized treatment options. To be preferred are multi-disciplinary teams with expertise in internal medicine, neurology, pain management, and rehabilitation, as well as psychology and psychiatry. In the second part of this overview, we propose that psychiatrists can serve a key role in leading comprehensive assessment and management of complex and challenging pain-psychiatric patients who are typically only partially responsive to available treatments.

Opioid therapy in non-cancer chronic pain patients: trends and efficacy in different types of pain, patients age and gender

In both developing and developed countries, chronic pain remains a real issue and a true disease that affects up to 42% of the population in some areas. Opioids are widely used for the management of chronic pain with variations in prescribing practices, indications and observed efficacy. To analyze trends in opioids prescribing and patient response in chronic non-cancer pain conditions. Retrospective study of 1500 casenotes of patients suffering variable non-cancer chronic pain conditions. Detailed review of those cases who were managed using opioids. Statistical analysis using "SOFA" software set. The prevalence of opioids prescribing in patients suffering this condition was thus around 35% [n=526]. Women older than 50 years were more likely than men to have a chronic pain condition and to be given opioid therapy for 1 year or more. Opioid efficacy on neuropathic and mixed types of pain was found to be significant with relatively low rate of drop-out and limited side-effects that are not life threatening. Overall, patients stopped or changed their opioid medication due to inefficacy in only 12.7% of cases. The simple fact of having pain is itself a source of self-reported disability regardless of the actual physiological or pathological mechanism. Policy makers should be aware of the huge impact of chronic pain disease and of its serious effects on social and economical well-being. In developing countries, chronic pain could represent a real challenge for all parties. Multimodal management, including opioids, appears crucial for the approach of this disease

Effectiveness of cognitive-behavioral therapy and amitriptyline in patients with chronic temporomandibular disorders: a pilot study

The aim of this pilot study was to evaluate the effectiveness of cognitive-behavioral therapy (CBT) and use of amitriptyline, a tricyclic antidepressant, in patients with chronic temporomandibular disorders (TMD). Forty-seven women (mean age = 35.4 years old) with chronic TMD were enrolled in the study and divided into 4 groups: amitriptyline; amitriptyline and CBT; placebo and CBT; and placebo only (control). Patients were managed for 7 consecutive weeks. Follow-up evaluations were done at the 1st, 7th and 11th weeks of treatment. The presence and severity of pain, levels of depression, and quality of life and sleep were measured. Data were analyzed using ANOVA, Chi-square and Cochran tests, considering a significance level of 5 percent. Improvements were found for all factors considered in the intragroup analysis, although no significant differences were detected among groups. However, at the end of the treatment (11 weeks of follow-up), these positive outcomes persisted only for the women treated with amitriptyline and CBT. The obtained results suggest that the combination of amitriptyline and CBT may be effective in reducing pain and depression levels as well as in improving the quality of life and sleep in patients with chronic TMD.

O objetivo deste estudo piloto foi avaliar a eficácia do uso de uma terapia cognitivo comportamental (TCC) e da amitriptilina, um antidepressivo tricíclico, no tratamento de pacientes portadores de disfunções temporomandibulares (DTM) crônicas. Quarenta e sete mulheres (com 35,4 anos em média) diagnosticadas com DTM crônica foram selecionadas e divididas em 4 grupos: amitriptilina; amitriptilina + TCC; placebo + TCC; e placebo (controle) e controle. As pacientes foram submetidas às terapias por 7 semanas consecutivas. As reavaliações aconteceram 1, 7 e 11 semanas após o início da terapia (11 semanas de avaliações). Foram avaliados a presença e severidade de dor, o nível de depressão, a qualidade de vida e do sono. Os dados foram avaliados através de ANOVA, Qui-quadrado e teste de Cochran, considerando um nível de significância de 5 por cento. Foram observadas melhoras significantes em todos os fatores avaliados para todos os grupos, porém não foram observadas diferenças entre os grupos. Após o final da terapia, os resultados positivos persistiram apenas para o grupo amitriptilina + TCC. Os resultados sugerem que o uso associado de amitriptilina e TCC no tratamento de pacientes portadores de DTM crônicas pode ser efetivo na melhora da dor, nível de depressão, qualidade de vida e do sono.