Mecanismos de modulación central del dolor: revisión de la literatura / Mechanisms of central pain modulation: literature review

RESUMEN: La percepción del dolor resulta de múltiples y dinámicos mecanismos en el sistema nervioso central (SNC) y periférico que inhiben o facilitan el estímulo y respuesta nociceptiva. Sin embargo, la principal capacidad de modulación esta a cargo del SNC. Los estímulos nociceptivos son detectados por terminaciones nerviosas libres de neuronas periféricas que sinaptan con neuronas aferentes secundarias de la médula espinal. Luego estas fibras decusan para formar las vías nociceptivas ascendentes. Una vez alcanzadas las estructuras subcorticales, se activan las neuronas del tálamo, quienes envían el estímulo hacia la corteza somatosensorial, desencadenando la percepción consciente del dolor y activando el sistema inhibitorio descendente. Para que la modulación nociceptiva se realice, es necesaria la participación de diversas sustancias o neurotransmisores que conectan áreas del SNC especializadas. Por lo tanto, el objetivo de este estudio fue realizar una revisión de la literatura respecto de los mecanismos que participan en los procesos de modulación central del dolor.

SUMMARY: Pain perception results from multiple and dynamic mechanisms in the central nervous system (CNS) and peripheral nervous system that inhibit or facilitate stimulation and nociceptive response. However, neuromodulation is mainly a function of the CNS. Nociceptive stimulus is detected by peripheral neurons receptors that synapse with the secondary afferent neurons of the spinal cord. These fibers cross to conform the ascending nociceptive pathways. Once the subcortical structures are reached, the thalamus`s neurons are activated; the thalamus send the stimulus to the somatosensory cortex, triggering the conscious perception of pain and activating the descending inhibitory system. For the nociceptive modulation to be carried out, the participation of various substances or neurotransmitters that connect specialized CNS areas is necessary. Therefore, the aim of this study was to review the literature regarding the mechanisms involved in central pain modulation processes.

Percepción del dolor, rasgos de personalidad y actitud del paciente hacia el tratamiento ortodóntico / Pain perception, personality traits and patient attitude toward orthodontic treatment

Introducción: El dolor inducido por los aparatos de ortodoncia es una de las principales razones que desalientan a los pacientes a buscar tratamiento ortodóntico y puede afectar negativamente su cooperación. Objetivo: Determinar la relación de la percepción del dolor, rasgos de personalidad y la actitud del paciente hacia el tratamiento ortodóntico. Métodos: Estudio transversal y observacional. La muestra estuvo conformada por dos grupos: I) 200 sujetos no tratados (78 varones y 122 mujeres; edad promedio 20,02 ± 2,67 años) y II) 200 sujetos tratados (64 varones y 136 mujeres; edad promedio 20,29 ± 3,88 años). El instrumento para la recolección de datos fue un cuestionario que incluía la evaluación de la expectativa del dolor para sujetos no tratados, experiencia de dolor para sujetos tratados, los perfiles de personalidad de los pacientes y actitudes hacia el tratamiento de ortodoncia. Resultados: No se encontró relación entre la percepción del dolor, los rasgos de personalidad y actitud del paciente hacia el tratamiento ortodóntico (p > 0,05). El estado de tratamiento (presentar ortodoncia) afectó la percepción del dolor hacia el tratamiento ortodóntico (p < 0,05), el género no afectó la percepción del dolor. El estado de tratamiento y el género masculino afectaron la actitud del paciente hacia el tratamiento ortodóntico (p < 0,05). Conclusiones: Los pacientes con mejor actitud mostraron menos dolor y los pacientes con mayor percepción del dolor mostraron una actitud negativa. Los niveles bajos de amabilidad tienen efecto sobre la percepción del dolor del paciente hacia el tratamiento ortodóntico(AU)

Introduction: The pain induced by orthodontic appliances is one of the main reasonswhy patients are reluctant to seek orthodontic treatment, and may negatively affect their cooperation. Objective: Determine the relationship between pain perception, personality traits and patient attitude toward orthodontic treatment. Methods: A cross-sectional observational study was conducted of a study sample composed of two groups: I) 200 untreated subjects (78 male and 122 female; mean age 20.02 ± 2.67 years) and II) 200 treated subjects (64 male and 136 female; mean age 20.29 ± 3.88 years). The data collection tool was a questionnaire including an evaluation of pain expectation for untreated subjects, pain experience for treated subjects, patients' personality profiles and attitudes toward orthodontic treatment. Results: No relationship was found between pain perception, personality traits and patient attitude toward orthodontic treatment (p > 0.05). Treatment status (untreated or treated) affected pain perception and the attitude toward orthodontic treatment (p < 0.05); gender did not affect pain perception. Treatment status and male gender affected patient attitude toward orthodontic treatment (p < 0.05). Conclusions: Patients with a better attitude experienced less pain, whereas patients with a greater pain perception showed a negative attitude. Low levels of kindness have an effect on pain perception and patient attitude toward orthodontic treatment(AU)

El dolor: algunos criterios desde la Psicología / Pain: some psychological criteria

Introducción: El dolor como experiencia subjetiva desagradable es un síntoma frecuente en los pacientes atendidos en el servicio de Hematología. Este afecta al individuo a nivel psicológico y provoca la aparición de dificultades en las áreas laboral, educacional, familiar y en las relaciones interpersonales. La percepción del dolor puede verse distorsionada como resultado de esta alteración provocada en el paciente. Objetivo: Analizar los factores psicológicos que median la percepción del dolor de los pacientes. Métodos: Se realizó una revisión de la literatura, a través del sitio web PubMed y el motor de búsqueda Google Académico. Se emplearon las palabras clave: dolor, manejo del dolor, evaluación del dolor, psicología del dolor, dolor en hematología, dolor en drepanocitosis, dolor en hemofilia, dolor en leucemia. Análisis y síntesis de la información: Se evidencia el carácter multifacético de esta experiencia subjetiva. Los determinantes y mecanismos del dolor son diversos, lo cual implica que su enfrentamiento requiera un enfoque integral que ayude a los pacientes a desarrollar conciencia acerca de los efectos de la enfermedad que padece y los síntomas del dolor. También es necesario guiarlos en la comprensión de los factores que contribuyen a su magnificación, crear estrategias que les ayuden a minimizar la exposición a estos, y orientarlos para que desarrollen métodos personales que les permitan lidiar con el dolor con un mínimo estrés psicológico. Conclusiones: El dolor es un fenómeno complejo que involucra diversas variables y factores en su funcionamiento. Su manejo requiere un enfoque integral para la atención de los pacientes en su enfrentamiento al dolor(AU)

Introduction: Pain as an unpleasant subjective experience is a frequent symptom in patients treated by the Hematology service. This affects the individual on a psychological level and causes the onset of difficulties in the work, educational, family and interpersonal relationships. The perception of pain can be distorted as a result of this alteration caused in the patient. Objective: To analyze the psychological factors that mediate patients' perception of pain. Methods: A literature review was carried out through the PubMed website and the search engine of Google Scholar. The following keywords were used: dolor [pain], manejo del dolor [pain management], evaluación del dolor [pain assessment], psicología del dolor [pain psychology], dolor en hematología [pain in hematology], dolor en drepanocitosis [pain in sickle cell disease], dolor en hemofilia [pain in hemophilia], dolor en leucemia [pain in leukemia]. Information analysis and synthesis: The multifaceted nature of this subjective experience is evidenced. Pain determinants and mechanisms are diverse, which implies that their coping requires a comprehensive approach that helps patients develop awareness about the disease effects and the pain symptoms. It is also necessary to guide them in understanding the factors that contribute to pain magnification, create strategies that help them minimize pain exposure, and guide them to develop personal methods that allow them to deal with pain with minimal psychological stress. Conclusions: Pain is a complex phenomenon involving several variables and factors in its operation. Its management requires a comprehensive approach to patient care regarding coping with pain(AU)

Escala Perme como preditor de funcionalidade e complicações após a alta da unidade de terapia intensiva em pacientes submetidos a transplante hepático / The Perme scale score as a predictor of functional status and complications after discharge from the intensive care unit in patients undergoing liver transplantation

RESUMO Objetivo: Avaliar a pontuação da escala Perme de mobilidade como preditor de funcionalidade e complicações no pós-operatório de pacientes submetidos a transplante hepático. Métodos: A amostra foi composta por 30 pacientes que realizaram transplante hepático. Os pacientes foram avaliados em dois momentos, a fim de verificar a percepção da dor, o grau de dispneia, a força muscular periférica e a funcionalidade do paciente de acordo com a escala Perme. Os dados coletados foram analisados por estatística descritiva e inferencial. Para comparar médias entre as avaliações, foi aplicado o teste t de Student para amostras pareadas. Em caso de assimetria, o teste de Wilcoxon foi utilizado. Na avaliação da associação entre as variáveis quantitativas, os testes de correlação de Pearson ou Spearman foram aplicados. Resultados: Foram incluídos 30 indivíduos que realizaram transplante hepático. Houve predomínio de pacientes do sexo masculino, e a média de idade foi 58,4 ± 9,9 anos. A patologia de base mais prevalente foi a cirrose por vírus C (23,3%). Foram registradas associações significativas entre o tempo de ventilação mecânica e a escala Perme na alta da unidade de terapia intensiva (r = -0,374; p = 0,042) e entre o número de atendimentos fisioterapêuticos (r = -0,578; p = 0,001). Quando comparados os resultados da avaliação inicial e na alta hospitalar, houve significativa melhora da funcionalidade (p < 0,001). Conclusão: Mobilidade funcional, força muscular periférica, percepção da dor e dispneia melhoram significativamente no momento da alta hospitalar em relação à admissão na unidade de internação.

ABSTRACT Objective: To assess the Perme mobility scale score as a predictor of functional status and complications in the postoperative period in patients undergoing liver transplantation. Methods: The sample consisted of 30 patients who underwent liver transplantation. The patients were evaluated at two time points to determine their perception of pain, degree of dyspnea, peripheral muscle strength, and functional status according to the Perme scale. The collected data were analyzed by descriptive and inferential statistics. To compare the means between the evaluations, Student's t test for paired samples was applied. In case of asymmetry, the Wilcoxon test was used. In the evaluation of the association between the quantitative variables, the Pearson or Spearman correlation tests were applied. Results: A total of 30 individuals who underwent liver transplantation were included. The patients were predominantly male, and the mean age was 58.4 ± 9.9 years. The most prevalent underlying pathology was cirrhosis C virus (23.3%). Significant associations of the time on mechanical ventilation with the Perme scale score at discharge from the intensive care unit (r = -0.374; p = 0.042) and the number of physical therapy treatments (r = -0.578; p = 0.001) were recorded. When comparing the results of the initial evaluation and the evaluation at hospital discharge, there was a significant improvement in functional status (p < 0.001). Conclusion: Functional mobility, peripheral muscle strength, pain perception, and dyspnea are significantly improved at hospital discharge compared with those at inpatient unit admission.

Variables associated with endometriosis-related pain: a pilot study using a visual analogue scale / Variáveis associadas à dor relacionada à endometriose: estudo piloto usando uma escala analógica visual

Abstract Objective Endometriosis is a complex disease, and pain is an important component of the syndrome. One of the most used methods to assess pain is the visual analogue scale (VAS). The aim of the present research was to study the pain experienced by patients who referred to our unit for endometriosis, using the VAS to understand the variables that could influence it. Methods We have conducted a prospective study from February 2012 to December 2016, enrolling 388 patients who referred to a university hospital, in Florence, Italy. We have included in the present study patients during their follow-up for endometriosis; we have also included patients who underwent surgery with a histological diagnosis of endometriosis. We have collected sociodemographic and clinical information regarding age, body mass index (BMI), smoking habit, number of pregnancies, and endometriosis staging. Finally, we have administered the VAS for several symptoms. Results Dysmenorrhea was the symptom associated with the highest perception of pain (mean VAS score of 5.76). The logistic regression showed that the stage of endometriosis could influence the pain associated to constipation and to dysuria. The linear regression showed that age couldinfluencethe pain associated to constipation, to dyspareunia,and to dysmenorrhea. A positive correlation was found between dysmenorrhea and chronic pelvic pain(CPP), between dysmenorrhea and dyspareunia, and between constipation and dysuria. Conclusion Using a validated method, the VAS, we have studied the pain experienced by a group of patients with a history of endometriosis and observed that smoking habit and BMI did not influence the VAS scores, and that dysmenorrhea was associated with the highest perception of pain.

Resumo Objetivo A endometriose é uma doença complexa, e a dor é um componente importante da enfermidade. Um dos métodos mais utilizados para avaliar a dor é a escala visual analógica (EVA). O objetivo da presente pesquisa foi estudar a dor sentida pelas pacientes que se referiram à nossa unidade para endometriose, usando a EVA para entender as variáveis que poderiam influenciá-la. Métodos Realizamos um estudo transversal de fevereiro de 2012 a dezembro de 2016, envolvendo 388 pacientes que se referiram a um hospital universitário, em Florença, Itália. Incluímos nossos pacientes do estudo durante o acompanhamento da endometriose; incluímos também pacientes que sesubmeteramàcirurgia comdiagnóstico histológico de endometriose. Coletamos informações sociodemográficas e clínicas sobre idade, índice de massa corporal (IMC), hábito de fumar, número de gravidezes e estágio da endometriose. Finalmente, administramos a EVA para vários sintomas. Resultados A dismenorreia foi o sintoma associado à maior percepção de dor (média do escore EVA de 5,76). A regressão logística mostrou que o estágio da endometriose poderia influenciar a dor associada à constipação e à disúria. A regressão linear mostrou que a idade poderia influenciar a dor associada à constipação, à dispareunia e à dismenorreia. Uma correlação positiva foi encontrada entre dismenorreia e dor pélvica crônica, entre dismenorreia e dispareunia, e entre constipação e disúria. Conclusão Utilizando um método validado, a EVA, estudamos a dor sentida por um grupo de pacientes com história de endometriose e observamos que o hábito de fumar e o IMC não influenciaram os escores EVA, e que a dismenorreia foi associada à maior percepção de dor.

Guia prático para o manejo da dor / Guia prático para o manejo da dor

O estudo da dor e suas particularidades é de grande importância para o tratamento de diversas patologias e para a melhora na qualidade de vida dos pacientes. A maioria das disfunções orgânicas tem a dor como um ponto importante da sua manifestação. Dessa maneira, é justificável a elaboração de conteúdo para auxiliar os profissionais da saúde no entendimento e tratamento das principais causas de dores agudas e crônicas. Este livro foi elaborado com o objetivo de servir como um guia prático para o manejo da dor por profissionais e acadêmicos de Medicina. Engloba temas como conceitos e aspectos biopsicossociais da dor, além de questões mais complexas como a fisiologia da dor e o tratamento medicamentoso com o arsenal terapêutico existente. Finalmente, também trata dos diversos tipos de dor mais prevalentes e o conhecimento básico que envolve seu manejo.

Regiones del encéfalo vinculadas a la interpretación del dolor / Regions of the brain involved with the interpretation of the pain

Introducción: Entre el lugar del daño tisular y la percepción del dolor, ocurre una serie de eventos electroquímicos que se conocen como nocicepción y comprenden cuatro procesos neurofisiológicos conocidos como: transducción, transmisión, modulación y percepción. Objetivo: Aportar información actualizada sobre las regiones del encéfalo vinculadas a la interpretación del dolor. Material y Método: Se realizó una revisión bibliográfica, con vistas a esclarecer la interpretación de la señal nociceptiva. Se consultaron treinta y cinco artículos científicos, se determinó escoger un total de veintinueve por su relación directa con el propósito de la búsqueda, veintitrés de los cuales corresponden a los últimos 5 años publicados en revistas internacionales y nacionales. Desarrollo: Los axones nociceptivos se clasifican como A δ; y C, participan en la conducción de los potenciales de acción de la periferia al sistema nervioso central. La transmisión de la señal en forma de potenciales de acción se descodifica en áreas relacionadas con aspectos cognoscitivos, afectivo, emocional y conductual del dolor. Este disímil conjunto de estructuras se reconoce en la actualidad como matriz encefálica del dolor. Conclusiones: La matriz del dolor, corresponde a áreas encefálicas como las cortezas somestésicas SI y SII, implicadas en el aspecto discriminativo del dolor. La corteza cingulada anterior y la corteza insular están asociadas al componente afectivo emocional del dolor(AU)

Introduction: A series of electrochemical events called nociception occur between the tissue damage and the perception of pain. They include four neurophysiological processes known as: transduction, transmission, perception, and modulation. Objective: To provide up-to-date information about the regions of the brain involved with the interpretation of pain. Material and Method: A bibliographic review was carried out with the aim of clarifying the interpretation of the nociceptive signal. Thirty-five scientific articles were consulted, and a total of twenty-nine were chosen due to their direct relationship with the aim of the search, twenty-three of which correspond to the last five years of publication in national and international journals. Development: Nociceptive axons are classified as Aδ; and C, and participate in the conduction of action potential of the peripheral nervous system (PNS). The transmission of the signal in the form of action potential is decoded in areas related to cognoscitive, affective, and emotional aspects, and the behavioral area of pain. This dissimilar group of structures is recognized at present as the brain matrix of pain. Conclusions: The pain matrix corresponds to brain areas such as SI and SII somatosensory cortices, implied in the discriminative aspect of pain. Both the anterior cingulate cortex (ACC) and the anterior insular cortex (AIC) are associated with the emotional and affective component of pain(AU)

Acute physical and psychological stress effects on visceral hypersensitivity in male rat: role of central nucleus of the amygdala / Efeitos agudos do estresse físico e psicológico na hipersensibilidade visceral em rato macho: papel do núcleo central da amídala

ABSTRACT Objective: The aim of this study was to investigate the effects of acute physical and psychological stress and temporary central nucleus of the amygdala (CeA) block on stress-induced visceral hypersensitivity. Methods: Forty two male Wistar rats were used in this study. Animals were divided into 7 groups (n = 6); 1 - Control, 2 - physical stress, 3 - psychological stress, 4 - sham, 5 - lidocaine, 6 - lidocaine + physical stress and 7 - lidocaine + psychological stress. Stress induction was done using a communication box. Results: Abdominal withdrawal reflex (AWR) score was monitored one hour after stress exposure. AWR score significantly heightened at 20, 40 and 60 mmHg in the psychological stress group compared with control (p < 0.05), while, it was almost unchanged in other groups. This score was strikingly decreased at 20, 40 and 60 mmHg in lidocaine + psychological stress group compared with psychological stress with no tangible response on physical stress. Total stool weight was significantly increased in psychological stress group compared with control (0.72 ± 0.15, 0.1 ± 0.06 g) (p < 0.05), but it did not change in physical stress compared to control group (0.16 ± 0.12, 0.1 ± 0.06 g) (p < 0.05). Concomitant use of lidocaine with stress followed the same results in psychological groups (0.18 ± 0.2, 0.72 ± 0.15 g) (p < 0.05), while it did not have any effect on physical stress group (0.25 ± 0.1, 0.16 ± 0.12 g) (p < 0.05). Conclusions: Psychological stress could strongly affect visceral hypersensitivity. This effect is statistically comparable with physical stress. Temporary CeA block could also reduce visceral hypersensitivity post-acute psychological stress.

RESUMEN Objetivo: O objetivo desse estudo foi investigar os efeitos do estresse físico e psicológico agudo e bloqueio temporário do núcleo central da amídala (CeA) na hipersensibilidade visceral induzida por estresse. Métodos: Quarenta e dois ratos Wistar machos foram empregados nesse estudo. Os animais foram divididos em 7 grupos (n = 6): 1 - Controle, 2 - estresse físico, 3 - estresse psicológico, 4 - simulacro, 5 - lidocaína, 6 - lidocaína + estresse físico e 7 - lidocaína + estresse psicológico. A indução do estresse foi feita com o uso de uma caixa de comunicação. Resultados: O escore do reflexo de retirada abdominal (RRA) foi monitorado uma hora depois da exposição ao estresse. O escore RRA aumentou significativamente a 20, 40 e 60 mmHg no grupo de estresse psicológico versus controle (p < 0,05), enquanto que praticamente permaneceu inalterado nos demais grupos. Esse escore diminuiu drasticamente a 20, 40 e 60 mmHg no grupo de lidocaína + estresse psicológico versus estresse psicológico, sem resposta tangível no estresse físico. O peso total das fezes aumentou significativamente no grupo de estresse psicológico versus controle (0,72 ± 0,15, 0,1 ± 0,06 g) (p < 0,05), mas não houve mudança no grupo de estresse físico versus controle (0,16 ± 0,12, 0,1 ± 0,06 g) (p < 0,05). O uso simultâneo da lidocaína com o estresse acompanhou os mesmos resultados nos grupos psicológicos (0,18 ± 0,2, 0,72 ± 0,15 g) (p < 0,05), enquanto que não foi observado qualquer efeito no grupo de estresse físico (0,25 ± 0,1, 0,16 ± 0,12 g) (p < 0,05). Conclusões: O estresse psicológico pode afetar fortemente a hipersensibilidade visceral. Esse efeito é estatisticamente comparável com o estresse físico. Um bloqueio temporário do CeA também pode reduzir a hipersensibilidade visceral pós-estresse psicológico agudo.

Differences in pain perception, health-related quality of life, disability, mood, and sleep between Brazilian and Spanish people with chronic non-specific low back pain

ABSTRACT Background Cultural and social factors play an important role in the development and persistence of Low Back Pain (LBP). Nevertheless, there are few studies investigating differences in LBP features between countries. Objective To determine differences in pain perception between individuals with LBP living in Brazil and Spain. Method Thirty Spanish individuals and 30 age- and sex-comparable Brazilian individuals with LBP were recruited from the Public Health Services of both countries. The Numerical Pain Rating Scale and the pain rating index (PRI), the number of words chosen (NWC), and the present pain index (PPI) extracted from the McGill Pain Questionnaire were used to assess pain. The Oswestry Disability Index, the Short Form-36, Beck Depression Inventory-II, and Pittsburgh Sleep Quality Index were also applied. Differences between countries and the correlation between demographic and clinical variables in each country were assessed with parametric and the nonparametric tests. Results A significant Country by Gender interaction was found for the PRI total score (P=0.038), but not for intensity of pain, disability, PPI, or NWC, in which Spanish women exhibited greater pain ratio than Spanish men (P=0.014), and no gender differences were identified in Brazilians. The Spanish group showed a consistent pattern of correlations for clinical data. Within Brazilian patients, fewer correlations were found and all of the coefficients were lower than those in the Spanish group. Conclusion The pain perception in patients with LBP is different depending on the country. Within Spanish patients, LBP is considered a more global entity affecting multidimensional contexts.

Exercise is associated with better quality of life in patients on TSH-suppressive therapy with levothyroxine for differentiated thyroid carcinoma / O exercício está associado com melhor qualidade de vida em pacientes em terapia de supressão de TSH com levotiroxina para o carcinoma diferenciado de tireoide

Objective : To evaluate if a supervised exercise training program improves the quality of life (QoL) of differentiated thyroid carcinoma (DTC) patients on TSH-suppressive therapy with levothyroxine (L-T4).Subjects and methods : Initially, a cross-sectional study was performed to compare the QoL and the health-related quality of life (HRQoL) between subclinical hyperthyroidism (SCH) patients (n = 33) and euthyroid subjects (EU; n = 49). In the prospective phase of the study, SCH patients were randomized in a non-blinded fashion to either participate (SCH-Tr = trained patients; n = 16) or not (SCH-Sed = untrained patients; n = 17) in a supervised exercise training program. The exercise program consisted of 60 minutes of aerobic and stretching exercises, twice a week, during twelve weeks. The QoL was assessed by the application of the WHOQOL-Bref, and the SF-36 was used to assess the HRQoL.Results : SCH patients had statistically lower scores than EU on the “physical” domain of WHOQOL-Bref, besides “physical function”, “role-physical”, “bodily pain”, “general health”, “vitality”, “role-emotional”, and “mental-health” domains of SF-36. After three months, SCH-Tr patients showed improvement in the “physical” and “psychological” domains of WHOQOL-Bref (p < 0.05), and in the “physical function”, “role-physical”, “bodily pain”, “vitality” and “mental health” domains of SF-36.Conclusion : Patients on TSH-suppressive therapy with L-T4 for DTC had impaired QoL and HRQoL compared to EU, but it was improved after 3-months of an exercise training program. Exercise seems to play an important role in the follow-up of DTC patients, since it seems to minimize the adverse effects of the treatment on QoL and HRQoL. Arq Bras Endocrinol Metab. 2014;58(3):274-81.

Objetivo : Avaliar se um programa de exercícios supervisionado melhora a qualidade de vida (QV) de pacientes com carcinoma diferenciado de tireoide (CDT) em tratamento de supressão de TSH com levotirotoxina (L-T4).Sujeitos e métodos : Inicialmente, foi feito um estudo cruzado para se comparar a QV e a qualidade de vida relacionada à saúde (QVRS) em pacientes com hipertireoidismo subclínico (HSC, n = 33) e indivíduos eutiroides (EU; n = 49). Na fase prospectiva do estudo, os pacientes com HSC foram randomizados de forma não cega para participar (HSC-Tr = pacientes treinados; n = 16) ou não (HSC-Sed = pacientes não treinados; n = 17) de um programa de exercícios supervisionado. O programa de exercícios consistiu de 60 minutos de atividade aeróbica e alongamento, duas vezes por semana, por 12 semanas. A qualidade de vida foi avaliada pelos questionários WHOQOL-Bref, e a QVRS pelo SF-36.Resultados : Os pacientes com HSC apresentaram escores estatisticamente mais baixos do que os EU no domínio “físico” do WHOQOL-Bref, além dos domínios “função física”, “papel físico”, “dor corporal”, “saúde geral”, “vitalidade”, “papel emocional” e “saúde mental” do SF-36. Após três meses, os pacientes HSC-Tr mostraram melhora nos domínios “físico” e “psicológico” do WHOQOL-Bref (p < 0,05) e nos domínios “função física”, “papel físico”, “dor corporal”, “vitalidade” e “saúde mental” do SF-36.Conclusão : Os pacientes em terapia de supressão de TSH com L-T4 para CDT apresentaram QV e QVRS afetados negativamente quando comparados com sujeitos EU, mas essas avaliações melhoraram após ...

Pain pressure threshold algometry of the abdominal wall in healthy women

The objective of this study was to determine the inter- and intra-examiner reliability of pain pressure threshold algometry at various points of the abdominal wall of healthy women. Twenty-one healthy women in menacme with a mean age of 28 ± 5.4 years (range: 19-39 years) were included. All volunteers had regular menstrual cycles (27-33 days) and were right-handed and, to the best of our knowledge, none were taking medications at the time of testing. Women with a diagnosis of depression, anxiety or other mood disturbances were excluded. Women with previous abdominal surgery, any pain condition or any evidence of inflammation, hypertension, smoking, alcoholism, or inflammatory disease were also excluded. Pain perception thresholds were assessed with a pressure algometer with digital traction and compression and a measuring capacity for 5 kg. All points were localized by palpation and marked with a felt-tipped pen and each individual was evaluated over a period of 2 days in two consecutive sessions, each session consisting of a set of 14 point measurements repeated twice by two examiners in random sequence. There was no statistically significant difference in the mean pain threshold obtained by the two examiners on 2 diferent days (examiner A: P = 1.00; examiner B: P = 0.75; Wilcoxon matched pairs test). There was excellent/good agreement between examiners for all days and all points. Our results have established baseline values to which future researchers will be able to refer. They show that pressure algometry is a reliable measure for pain perception in the abdominal wall of healthy women.

Pain from intramuscular vaccine injection in adults / Percepción de dolor después de una inyección intramuscular en adultos

Background: Vaccine use has been increasing worldwide, and adult populations are presented with more opportunities to experience pain from vaccine injection. The insertion of a needle through the skin is the most common source of iatrogenic pain, and needle phobia is a major concern in medical practice. However, it is unclear which factors play major roles in the perception of pain from vaccine injection in adults. Aim: To evaluate the influences of patient characteristics on pain perception due to intramuscular vaccine injection in healthy adult volunteers. Material and Methods: The injection of hepatitis B vaccine using a 24 mm, 24-G needle was performed as a uniform stimulus, and the intensity of injection pain was measured immediately after the injection using a 100-mm visual analogue scale (VAS). The influences of patient characteristics on pain intensity were investigated. Results: One hundred sixty volunteers (65 males, 95 females) were enrolled in this study. The average VAS score was 20.8 ± 17.1 (range 0 to 67) in males and 34.4 ± 19.7 (range 2 to 76) in females (P < 0.001). However, there were no correlations between VAS score and age, body mass index or maximal pain score from previous painful experiences. The VAS score was also not affected by the experience of previous vaccine injections, a history of childbirth in females, or religion. Conclusions: Gender appears to be the only major factor that influences the pain of intramuscular vaccine injection. Therefore, pain-reducing methods will be needed when performing injection procedures, particularly in women.

Antecedentes: La inserción de una aguja para inyecciones es la forma más común de inducción de dolor iatrogénico. No se sabe qué factores afectan la percepción del dolor. Objetivo: Evaluar la influencia de características propias de los pacientes en la percepción de dolor después de una inyección intramuscular. Material y Métodos: Se utilizó como estímulo, la inyección intramuscular de vacuna de hepatitis B, mediante una aguja de 24 mm (24 G). La intensidad del dolor fue evaluada inmediatamente después de la inyección utilizando una escala visual análoga de 100 mm (VAS). Se evaluó la influencia de las características de los pacientes en la intensidad del dolor. Resultados: Participaron 160 voluntarios (65 hombres). El puntaje VAS fue 20,8 ± 17,1 (rango 0 a 67) en hombres y 34,4 ± 19,7 (rango 2 a 76) en mujeres (p < 0,01). No hubo asociación entre el puntaje VAS y edad, índice de masa corporal, haber experimentado previamente dolor, haber dado a luz en mujeres o religión. Conclusiones: El género es la única variable que se asocia con la percepción de dolor después de una inyección intramuscular.

[ effects of testosterone and gonadectomy conditions on nociception and their effect on morphine-induced analgesia in male mice, using the formalin test]

There are too many disagreements about the effects of gender and sex hormones on the behavioral responses to noxious stimuli and morphine analgesia. The purpose of this study was to determine the different effects of testosterone and gonadectomy conditions on pain and morphine-induced analgesia, using the formalin test. The present study was conducted at Razi University, in Kermanshah. Sixty three male NMRI mice were divided into nine groups [n=7]. The effects of gonadectomy and testosterone on responses to noxious stimuli were evaluated in five groups [G1 to G5]. The effects of these factors on morphine-induced analgesia were investigated in other groups [G6 to G9]. According to grouping, each group received normal saline, testosterone, testosterone solvent or morphine and some groups were also gonadectomized and separately received these agents. Finally, the formalin test was taken from all groups. Data were statistically analyzed by one-way ANOVA. The results showed that the response to the painful stimuli had no significant difference in 5 minutes [acute pain] in all groups. Testosterone increased the response to the noxious stimuli in sub acute pain [10-30 minutes] and chronic phase [15-60 minutes] stages. This increase was significant in the group receiving testosterone compared with the gonadectomized group in both stages. In the presence of morphine, there were no significant differences in response to painful stimulus in 5 minutes [acute pain] in all groups. But testosterone in the presence of morphine caused an increased in pain score in sub acute pain [10-30 minutes] and chronic phase [15-60 minutes] stages. Testosterone increased the response to the painful stimuli in sub acute and chronic pain stages. Testosterone also reduced morphine-induced analgesia in peripheral and chronic pain stages in mice