Cannabinoid products for pain management: recommendations from the São Paulo State Society of Anesthesiology.

There is growing interest in using cannabinoids across various clinical scenarios, including pain medicine, leading to the disregard of regulatory protocols in some countries. Legislation has been implemented in Brazil, specifically in the state of São Paulo, permitting the distribution of cannabinoid products by health authorities for clinical purposes, free of charge for patients, upon professional prescription. Thus, it is imperative to assess the existing evidence regarding the efficacy and safety of these products in pain management. In light of this, the São Paulo State Society of Anesthesiology (SAESP) established a task force to conduct a narrative review on the topic using the Delphi method, requiring a minimum agreement of 60% among panelists. The study concluded that cannabinoid products could potentially serve as adjuncts in pain management but stressed the importance of judicious prescription. Nevertheless, this review advises against their use for acute pain and cancer-related pain. In other clinical scenarios, established treatments should take precedence, particularly when clinical protocols are available, such as in neuropathic pain. Only patients exhibiting poor therapeutic responses to established protocols or demonstrating intolerance to recommended management may be considered as potential candidates for cannabinoids, which should be prescribed by physicians experienced in handling these substances. Special attention should be given to individual patient characteristics and the likelihood of drug interactions.

Impact of Cuminaldehyde and Indomethacin Co-Administration on Inflammatory Responses in MIA-Induced Osteoarthritis in Rats.

Osteoarthritis (OA) remains a chronic incurable condition, presenting substantial challenges in treatment. This study explores a novel strategy by investigating the concurrent use of cuminaldehyde, a natural compound, with indomethacin in animal models of MIA-induced OA. Our results demonstrate that the co-administration of cuminaldehyde and indomethacin does indeed produce a superior effect when compared to these compounds individually, significantly enhancing therapeutic outcomes. This effect is evidenced by a marked reduction in pro-inflammatory cytokines IL-6 and IFN-γ, alongside a significant increase in the anti-inflammatory cytokine IL-10, compared to treatments with each compound alone. Radiographic analyses further confirm the preservation of joint integrity and a reduction in osteoarthritic damage, highlighting the association's efficacy in cartilage-reducing damage. These findings suggests that the association of cuminaldehyde and indomethacin not only slows OA progression but also offers enhanced cartilage-reducing damage and fosters the production of protective cytokines. This study underscores the potential benefits of integrating natural products with pharmaceuticals in OA management and stresses the importance of further research to fully understand the mechanisms underlying the observed potentiated effects.

The effect of low dose intra-articular S(+) ketamine on osteoarthritis in rats: an experimental study.

BACKGROUND: This study aimed to investigate the analgesic impact of S(+)-ketamine on pain behavior and synovial inflammation in an osteoarthritis (OA) model. METHODS: Animals were grouped as follows: OA-Saline (n = 24) and OA-Ketamine (n = 24), OA induced via intra-articular sodium monoiodoacetate (MIA); a Non-OA group (n = 24) served as the control. On the 7th day post OA induction, animals received either saline or S(+)-ketamine (0.5 mg.kg-1). Behavioral and histopathological assessments were conducted up to day 28. RESULTS: S(+)-ketamine reduced allodynia from day 7 to 28 and hyperalgesia from day 10 to 28. It notably alleviated weight distribution deficits from day 10 until the end of the study. Significant walking improvement was observed on day 14 in S(+)-ketamine-treated rats. Starting on day 14, OA groups showed grip force decline, which was countered by S(+)-ketamine on day 21. However, S(+)-ketamine did not diminish synovial inflammation. CONCLUSION: Low Intra-articular (IA) doses of S(+)-ketamine reduced MIA-induced OA pain but did not reverse synovial histopathological changes. IRB APPROVAL NUMBER: 23115 012030/2009-05.

Pain as a disease in the new International Classification of Diseases (ICD-11): Latin American expert consensus.

Aims: Pain diagnoses in the 10th version of the International Classification of Diseases (ICD-10) did not adequately support the current management of pain. Therefore, we aimed to review the new 11th revision (ICD-11) in order to analyze its usefulness for the management, coding, research and education of chronic pain from a Latin American perspective. Methods: The Latin American Federation of Associations for the Study of Pain convened a meeting of pain experts in Lima, Peru. Pain specialists from 14 Latin American countries attended the consensus meeting. Results: In ICD-11, chronic pain is defined as pain that persists or recurs longer than 3 months and is subdivided into seven categories: chronic primary pain and six types of chronic secondary pain. Chronic primary pain is now considered a disease in itself, and not a mere symptom of an underlying disease. Conclusion: The novel definition and classification of chronic pain in ICD-11 is helpful for better medical care, research and health statistics. ICD-11 will improve chronic pain management in Latin American countries, for both the pain specialist and the primary care physician.

Chronic pain is one of the most frequent reasons for medical consultation in Latin America. In the tenth revision of the International Classification of Diseases and Related Health Problems (ICD-10), chronic pain was not adequately defined and individual pain diagnoses were poorly defined. For the first time in Latin America, a meeting of pain experts analyzed and reviewed the 11th version of the International Classification of Diseases (ICD-11), when the Latin America Federation of Associations for the Study of Pain organized a meeting of experts from 14 Latin American countries. In ICD-11, chronic pain is recognized as a biopsychosocial phenomenon and defined as pain that continues or returns for more than 3 months. It is split into seven types: chronic primary pain and six types of chronic secondary pain. In ICD-11, chronic primary pain is now considered a disease in itself, not a mere manifestation of other disease. Our article is the first to address the problems, challenges and benefits of using ICD-11 from a Latin American perspective. It will help to facilitate and disseminate the use of this new classification of chronic pain. This will improve chronic pain treatment, statistics, research and development of better health strategies for pain management in Latin America.

Recent advances in the treatment of pain in endometriosis: A bibliometric analysis of experimental models.

Background and Aim: Treatment of endometriosis involves pain relief which is achieved through the administration of analgesics and non-steroidal anti-inflammatory drugs, with or without the addition of hormone therapy. At present, studies investigating endometriosis pain management using experimental rat models and the use of medications are scarce. Therefore, this study aimed to systematically evaluate research trends and critical points in the field of endometriosis pain management using experimental models. Materials and Methods: A total of 30 publications related to this topic that were published from 2012 to 2022 were retrieved from various databases, including Web of Science, Scopus, PubMed, Embase, and CINAHL, using appropriate English keywords. The quality of the publications was evaluated using impact metrics, productivity, term density mapping, and author network. Results: The average publication rate was three articles per year, reaching its peak in 2021 at five articles per year. The United States and China were found to be the most productive countries, with 12 and 10 publications per year, respectively. The field of medicine (37.0%) was the most abundant, although the H-index was relatively low (13:13). Term density mapping involved the search of 542 keywords, of which 35 were selected, with only 8 exhibiting significant density. Conclusion: In the past decade, there has been a shortage of publications that have addressed pain in endometriosis in experimental models and, within this context the majority of the production and publication in this field has been performed by the United States and China. After performing this bibliometric review, it can be inferred that more research is required in this field, to develop new approaches and treatments for endometriotic pain.

The value of the International Association for the Study of Pain to developing countries.

ABSTRACT: Since it was founded, the International Association for the Study of Pain (IASP) has been at the forefront of improving pain research, education, and effective pain management in both developed and developing countries. As IASP activities progressed, major differences between the practice of pain management, education, and research in developed countries compared with developing countries were identified. This led to areas of focus by IASP that included pain education to address poor knowledge of pain assessment and treatment, prioritization of pain management by governments and official national legislation and programs, and availability of pain treatments (especially potent analgesics). A few pioneering IASP members from developing countries in the early years encouraged more multidisciplinary professionals to join IASP and attend conferences. Inauguration of national and regional chapters was also encouraged, and regular continuing medical education programs were held, especially on topics from IASP conferences and global pain events. Many IASP chapters in developing countries have established collaborations with groups from developed countries, whereas IASP also implemented other innovative approaches including the developing countries working group, educational grants, pain camps, and multidisciplinary pain hubs with toolkits to develop pain experts for regions in the developing world. Thus, the influence of IASP in many developing countries has had a multiplier effect on the progress made in effective pain management, education, and research. Nonetheless, challenges remain and include better integration of pain management, education, and research in national health systems and academic programs for health professionals.

Prejudice impairing quality of life in sickle cell disease patients in a developing country: faces of suffering

ABSTRACT Introduction: The perception of prejudice against, and stigmatization of, sickle cell disease (SCD) leads the patient to perceive a different treatment, due to the disease stigma and maybe related to a worse quality of life (QoL). Objectives: Describe and evaluate the perception of the prejudice against the disease and its impact on the quality of life of patients with sickle cell disease. Methods: This is a cross-sectional study conducted between March 2019 and February 2020, with patients diagnosed with SCD. Patients were questioned about the perception of prejudice in any kind of situation, choosing between "Yes" or "No", not differentiating situations related to prejudice. To assess the QoL and impact of the disease, the volunteers answered a version of the SF-36 questionnaire translated and validated into Brazilian Portuguese. Results: In this study, 113 patients with SCD were followed up, 92% were classified as HbSS and the rest, divided between HbSC and HbS-β-0. Regarding the SF-36, the worst scores were in the summary of the physical components (mean 48.19 ± 21.51) and the physical aspect had the lowest mean (30.75 ± €42.65). When questioned if they had already perceived any kind of prejudice, including the SCD, 32.74% answered "Yes". For this comparison, there was a significant difference in the summary of the physical and mental components, with worse QoL for those who had already suffered prejudice. Conclusion: Patients diagnosed with SCD who reported perception of prejudice had statistically significant worse QoL, revealing the negative impact, that might lead to sadness and social isolation.

Effect of Combined Training on Body Image, Body Composition and Functional Capacity in Patients with Breast Cancer: Controlled Clinical Trial.

OBJECTIVE: Evaluate the effect of combined training on body image (BI), body composition and functional capacity in patients with breast cancer. As also the relationship of BI with body composition and functional capacity. METHODS: This was a Controlled Clinical Trial study, this study including 26 patients with breast cancer (30 to 59 years). The training group (n = 13) underwent 12 weeks of training, including three 60-min sessions of aerobic exercise and resistance training, and two sessions of flexibility training per week; each flexibility exercise lasted 20s. The Control Group (n = 13) received only the standard hospital treatment. Participants were evaluated at baseline and after 12 weeks. BI (primary outcomes) was assessed using the Body Image After Breast Cancer Questionnaire; Body composition was estimated with the indicators: Body mass index; Weight, Waist hip Ratio; Waist height ratio; Conicity index; Reciprocal ponderal index; Percentage of fat; Circumference of the abdomen and waist; Functional capacity by cardiorespiratory fitness (cycle ergometer) and strength (manual dynamometer). The statistic was performed in the Biostatistics and Stata 14.0 (α = 5%). RESULTS: The patients in the training group showed a reduction in the limitation dimension (p = 0.036) on BI, However, an increase in waist circumference was observed in both groups. In addition an increase in VO2max (p < 0.001) and strength in the right (p = 0.005) and left arms (p = 0.033). CONCLUSION: Combined training demonstrates to be an effective and non-pharmacological strategy to patients with breast cancer, with improvement on BI and functional capacity, changing related variables negatively when there is no physical training.

OBJETIVO: Avaliar o efeito do treinamento combinado na imagem corporal (IB), composição corporal e capacidade funcional em pacientes com câncer de mama. Assim como a relação do IB com a composição corporal e capacidade funcional. MéTODOS:: Este foi um estudo de Ensaio Clínico Controlado, este estudo incluiu 26 pacientes com câncer de mama (30 a 59 anos). O grupo de treinamento (n = 13) foi submetido a 12 semanas de treinamento, incluindo três sessões de 60 min de exercício aeróbio e treinamento de resistência, e duas sessões de treinamento de flexibilidade por semana; cada exercício de flexibilidade durou 20s. O Grupo Controle (n = 13) recebeu apenas o tratamento hospitalar padrão. Os participantes foram avaliados no início e após 12 semanas. O IB (desfechos primários) foi avaliado por meio do Body Image After Breast Cancer Questionnaire; A composição corporal foi estimada com os indicadores: índice de massa corporal; Peso, relação cintura-quadril; Relação da altura da cintura; Índice de conicidade; Índice ponderal recíproco; Porcentagem de gordura; Circunferência do abdômen e cintura; Capacidade funcional por aptidão cardiorrespiratória (cicloergômetro) e força (dinamômetro manual). A estatística foi realizada na Bioestatística e no Stata 14.0 (α = 5%). RESULTADOS: Os pacientes do grupo de treinamento apresentaram redução da dimensão da limitação (p = 0,036) no IB, porém, foi observado aumento da circunferência da cintura em ambos os grupos. Além disso, um aumento do VO2máx (p <0,001) e da força nos braços direito (p = 0,005) e esquerdo (p = 0,033). CONCLUSãO:: O treinamento combinado demonstra ser uma estratégia eficaz e não farmacológica para pacientes com câncer de mama, com melhora do IB e da capacidade funcional, alterando variáveis relacionadas negativamente quando não há treinamento físico.

Effect of Combined Training on Body Image, Body Composition and Functional Capacity in Patients with Breast Cancer: Controlled Clinical Trial / Efeito do treinamento combinado na imagem corporal, composição corporal e capacidade funcional em pacientes com câncer de mama: ensaio clínico controlado

Abstract Objective Evaluate the effect of combined training on body image (BI), body composition and functional capacity in patients with breast cancer. As also the relationship of BI with body composition and functional capacity. Methods This was a Controlled Clinical Trial study, this study including 26 patients with breast cancer (30 to 59 years). The training group (n = 13) underwent 12 weeks of training, including three 60-min sessions of aerobic exercise and resistance training, and two sessions of flexibility training per week; each flexibility exercise lasted 20s. The Control Group (n = 13) received only the standard hospital treatment. Participants were evaluated at baseline and after 12 weeks. BI (primary outcomes) was assessed using the Body Image After Breast Cancer Questionnaire; Body composition was estimated with the indicators: Body mass index; Weight, Waist hip Ratio; Waist height ratio; Conicity index; Reciprocal ponderal index; Percentage of fat; Circumference of the abdomen and waist; Functional capacity by cardiorespiratory fitness (cycle ergometer) and strength (manual dynamometer). The statistic was performed in the Biostatistics and Stata 14.0 (α = 5%). Results The patients in the training group showed a reduction in the limitation dimension (p = 0.036) on BI, However, an increase in waist circumference was observed in both groups. In addition an increase in VO2max (p < 0.001) and strength in the right (p = 0.005) and left arms (p = 0.033). Conclusion Combined training demonstrates to be an effective and non-pharmacological strategy to patients with breast cancer, with improvement on BI and functional capacity, changing related variables negatively when there is no physical training.

Resumo Objetivo Avaliar o efeito do treinamento combinado na imagem corporal (IB), composição corporal e capacidade funcional em pacientes com câncer de mama. Assim como a relação do IB com a composição corporal e capacidade funcional. Métodos Este foi um estudo de Ensaio Clínico Controlado, este estudo incluiu 26 pacientes com câncer de mama (30 a 59 anos). O grupo de treinamento (n = 13) foi submetido a 12 semanas de treinamento, incluindo três sessões de 60 min de exercício aeróbio e treinamento de resistência, e duas sessões de treinamento de flexibilidade por semana; cada exercício de flexibilidade durou 20s. O Grupo Controle (n = 13) recebeu apenas o tratamento hospitalar padrão. Os participantes foram avaliados no início e após 12 semanas. O IB (desfechos primários) foi avaliado por meio do Body Image After Breast Cancer Questionnaire; A composição corporal foi estimada com os indicadores: índice de massa corporal; Peso, relação cintura-quadril; Relação da altura da cintura; Índice de conicidade; Índice ponderal recíproco; Porcentagem de gordura; Circunferência do abdômen e cintura; Capacidade funcional por aptidão cardiorrespiratória (cicloergômetro) e força (dinamômetro manual). A estatística foi realizada na Bioestatística e no Stata 14.0 (α = 5%). Resultados Os pacientes do grupo de treinamento apresentaram redução da dimensão da limitação (p = 0,036) no IB, porém, foi observado aumento da circunferência da cintura em ambos os grupos. Além disso, um aumento do VO2máx (p <0,001) e da força nos braços direito (p = 0,005) e esquerdo (p = 0,033). Conclusão O treinamento combinado demonstra ser uma estratégia eficaz e não farmacológica para pacientes com câncer de mama, com melhora do IB e da capacidade funcional, alterando variáveis relacionadas negativamente quando não há treinamento físico.

Cuminaldehyde Effects in a MIA-Induced Experimental Model Osteoarthritis in Rat Knees.

Osteoarthritis (OA) is a chronic degenerative disease that has a significant global impact. It is associated with aging and characterized by widespread joint destruction. Cuminaldehyde is a biologically active component of essential oils that has shown promise in the treatment of nociceptive and inflammatory diseases. This study investigated the effects of cuminaldehyde on an experimental model of osteoarthritis induced in rat knees. Cuminaldehyde was found to be as effective as indomethacin in reducing pain in all evaluated tests, including forced walking, functional disability of weight distribution on the legs, and spontaneous pain in animals with osteoarthritis. The knees of animals treated with cuminaldehyde had significantly higher radiographic and histopathological scores than those of animals that did not receive the treatment. Cuminaldehyde also modulated the production of pro-inflammatory cytokines. In vitro assays showed that cuminaldehyde preferentially inhibits COX-2 enzyme activity. In silico studies demonstrated that cuminaldehyde has satisfactory energy affinity parameters with opioid receptors and COX-2. These findings suggest that cuminaldehyde's anti-inflammatory activity is multifactorial, acting through multiple pathways. Its nociceptive activity occurs via central and peripheral mechanisms. Cuminaldehyde modulates the immune response of the inflammatory process and may be considered a leading compound for the development of new anti-inflammatory and analgesic drugs.

Map of pain education in Latin America: current state and perspectives.

The Latin American Map of Pain Education initiative has developed steadily in recent years. A recent survey yields important new data on the current state and allows outlining of the next steps to improve pain education in Latin American countries. A survey conducted by Federación Latinoamericana de Asociaciones para el Estudio del Dolor (FEDELAT) with data from 19 Latin American countries showed that a generally observed barrier is the lack of adequately trained pain professionals and the insufficient number of pain centers. There is a need for formal programs of pain education and palliative care in undergraduate and graduate programs. These programs should be accessible not only to physicians but to all types of healthcare professionals involved in the management of pain patients. The article includes some recommendations that will certainly be helpful in improving pain education over the next decade in Latin America.

CAREGIVERS OF PATIENTS WITH CANCER AT THE END OF LIFE: PSYCHOLOGICAL SUFFERING AND REDUCED WELFARE / CUIDADORES DE PACIENTES COM CÂNCER NO FINAL DA VIDA: SOFRIMENTO PSÍQUICO E REDUÇÃO DE BEM-ESTAR

Introduction: Caregivers of end-of-life patients are exposed to great emotional overload and suffering. This study aims to investigate signs of psychological distress (depression, anxiety and anguish) and the presence of well-being in caregivers of patients at the end of life hospitalized in an oncology palliative care ward. Methods: This is a cross-sectional descriptive study, which included a non-probabilistic sample of 90 main caregivers of individuals hospitalized in the palliative care sector of a cancer reference hospital. The subjects were assessed for the presence of well-being using the Well-Being Assessment Questionnaire (GCQ); the presence of anguish (distress) through the Distress Thermometer; and anxiety and depression by the Anxiety and Depression Scale. Statistical correlations were made between the variables. Results: Female caregivers who lived with the patient had lower levels of well-being. Anxious symptoms were present in 76%, with higher scores in caregivers with less education, who lived with the patient and who cared for other people. Depressive symptoms were present in 55%, with a higher rate in caregivers who lived with the patient. Women and caregivers who performed rotation had a higher distress score. Well-being was inversely proportional to depression, distress and anxiety. Conclusion: This analysis showed higher rates of depression, anxiety and anguish among caregivers, as well as lower well-being. The improvement in well-being can alleviate anxiety, depressive and anguish symptoms. Strategies to improve communication and welcoming in the hospital environment can promote well-being and reduce the symptoms of psychic illness in caregivers of patients at the end of life.

Introdução: Cuidadores de pacientes em fim de vida estão expostos a grande sobrecarga emocional e sofrimento. Esse estudo objetiva investigar sinais de sofrimento psíquico (depressão, ansiedade e angústia) e presença de bem-estar em cuidadores de pacientes no fim da vida hospitalizados em enfermaria de cuidados paliativos oncológicos. Métodos: Trata-se de estudo descritivo transversal, o qual contou com uma amostra não probabilística de 90 cuidadores principais de indivíduos hospitalizados no setor de cuidados paliativos de um hospital referência em câncer. Os sujeitos foram avaliados quanto à presença de bem-estar por meio do Questionário de Avaliação do Bem-Estar (GCQ); a presença de angústia (distress) através do Termômetro de Distress; e ansiedade e depressão pela Escala de Depressão e Ansiedade. Foram feitas correlações estatísticas entre as variáveis. Resultados: Cuidadores do gênero feminino e que residiam com o paciente apresentaram menores índices de bem-estar. Sintomas ansiosos estiveram presentes em 76%, com maiores escores em cuidadores com menor escolaridade, que residiam com o paciente e que cuidavam de outras pessoas. Sintomas depressivos apresentaram-se em 55%, com maior índice em cuidadores que residiam com o paciente. Mulheres e cuidadores que realizavam rodízio apresentaram maior escore de angústia. Bem-estar foi inversamente proporcional a depressão, angústia e ansiedade. Conclusão: A partir desta análise demonstrou-se maiores índices de depressão, ansiedade e angústia entre cuidadores, assim como menor bem-estar. A melhora no bem-estar pode aliviar sintomas ansiosos, depressivos e angústia. Estratégias para a melhoria da comunicação e acolhimento no ambiente hospitalar podem promover bem-estar e redução dos sintomas de adoecimento psíquico de cuidadores de pacientes no final da vida.

Prejudice impairing quality of life in sickle cell disease patients in a developing country: faces of suffering.

INTRODUCTION: The perception of prejudice against, and stigmatization of, sickle cell disease (SCD) leads the patient to perceive a different treatment, due to the disease stigma and may be related to a worse quality of life (QoL). OBJECTIVES: Describe and evaluate the perception of the prejudice against the disease and its impact on the quality of life of patients with sickle cell disease. METHODS: This is a cross-sectional study conducted between March 2019 and February 2020, with patients diagnosed with SCD. Patients were questioned about the perception of prejudice in any kind of situation, choosing between "Yes" or "No", not differentiating situations related to prejudice. To assess the QoL and impact of the disease, the volunteers answered a version of the SF-36 questionnaire translated and validated into Brazilian Portuguese. RESULTS: In this study, 113 patients with SCD were followed up, 92% were classified as HbSS and the rest, divided between HbSC and HbS-ß-0. Regarding the SF-36, the worst scores were in the summary of the physical components (mean 48.19 ± 21.51) and the physical aspect had the lowest mean (30.75 ±€42.65). When questioned if they had already perceived any kind of prejudice, including the SCD, 32.74% answered "Yes". For this comparison, there was a significant difference in the summary of the physical and mental components, with worse QoL for those who had already suffered prejudice. CONCLUSION: Patients diagnosed with SCD who reported perception of prejudice had statistically significant worse QoL, revealing the negative impact, that might lead to sadness and social isolation.

Adverse effects of cannabinoid use: what is the safety paradigm? / Efeitos adversos do uso dos canabinoides: qual o paradigma de segurança?

ABSTRACT BACKGROUND AND OBJECTIVES: Interest in the use of marijuana (Cannabis sativa) for medicinal purposes has increased exponentially in recent decades, and the plant and its derivatives are becoming more frequently found in prescriptions for patients with chronic pain. All prescription drugs and illicit substances have adverse effects, even those from plants, fruits, and flowers, as has been well established with the use of tobacco, alcohol, and opium. Marijuana is no exception. The purpose of this study was to review and synthesize the evidence related to the adverse effects promoted by plant-derived cannabinoids, and the implications for the safety of using these substances in pain patients. CONTENTS: A narrative review was conducted based on articles published in scientific journals indexed in Pubmed and Scielo between the years 2000 and 2022. CONCLUSION: The evidence is still contradictory and weak on many aspects of adverse effects and clearly there is a need for further research and advances towards a more detailed elucidation of these effects for both non-medical and medical cannabis use. Screening and monitoring of such use, identifying situations of vulnerability to mental illness and dependence, with careful surveillance for adverse effects, is critical.

RESUMO JUSTIFICATIVA E OBJETIVOS: O interesse na utilização da maconha (Cannabis sativa) com fins medicinais aumentou de forma exponencial nas últimas décadas e a planta e seus derivados vêm se tornando mais frequentemente encontrados nas prescrições médicas de pacientes com dor crônica. Todos os fármacos prescritos e substâncias ilícitas têm efeitos adversos, mesmo aquelas provenientes de plantas, frutas e flores, como já ficou bem estabelecido com o uso do tabaco, álcool e ópio. A maconha não é exceção. O objetivo deste estudo foi revisar e sintetizar as evidências relacionadas aos efeitos adversos promovidos pelos canabinoides derivados da planta, e às implicações sobre a segurança do uso destas substâncias em pacientes com dor. CONTEÚDO: Foi realizada uma revisão narrativa baseada em artigos publicados em revistas científicas indexadas no Pubmed e Scielo, entre os anos de 2000 e 2022. CONCLUSÃO: As evidências ainda são contraditórias e frágeis em relação a muitos aspectos dos efeitos adversos e claramente há a necessidade de mais pesquisas e avanços para uma elucidação mais detalhada destes efeitos tanto para o uso não medicinal quanto médico de cannabis. É fundamental uma triagem e monitoramento desse uso, identificando situações de vulnerabilidade a doenças mentais e dependência, com cuidadosa vigilância de efeitos adversos.

Glia function in the endocanabinoid system: narrative review / Função da glia no sistema endocanabinoide: revisão narrativa

ABSTRACT BACKGROUND AND OBJECTIVES: Evidence has highlighted a role of glial cell activation, and their interaction with different neural systems, especially the endocannabinoid system, in the mechanisms involved in the chronicity and maintenance of pain. The aim of this review is to bring an update on published data that demonstrate the interaction between glial cells and the endocannabinoid system in the pathophysiology of chronic pain and its treatment. CONTENTS: A narrative review was performed based on a research in the Medline database, using the Keywords "endocannabinoid", "glial cells", "microglial", "astrocytes", "neuroinflammation". CONCLUSION: Deepening the knowledge about the function of glial cells in the endocannabinoid system will open the possibility of acting on the pathophysiological origin of the pain chronification process, attenuating the mechanisms involved in central sensitization.

RESUMO JUSTIFICATIVA E OBJETIVOS: A evidência científica tem ressaltado um papel da ativação das células da glia e de sua interação com diversos sistemas neurais, com destaque para o sistema endocanabinoide e mecanismos envolvidos na cronificação e manutenção da dor. O objetivo deste estudo foi atualizar os dados publicados que mostrem a interação entre as células da glia com o sistema endocanabinoide na fisiopatologia da dor crônica e seu tratamento. CONTEÚDO: Foi realizada uma revisão narrativa baseada em pesquisa na base de dados Medline, com uso dos unitermos "endocannabinoid", "glial cells", "microglial", "astrocytes", "neuroinflammation". CONCLUSÃO: O aprofundamento do conhecimento acerca da função das células da glia no sistema endocanabinoide abrirá a possibilidade de atuação sobre a origem fisiopatológica do processo de cronificação de dor, atenuando os mecanismos envolvidos na sensibilização central.

The declaration of lima on pain in childhood.

The Declaration of Lima on Pain in Childhood is a call into action to improve the care provided to children and adolescents with pain.

Effect of concurrent training (aerobic+resistance) more static stretching on flexibility in women with breast cancer / Efeito do treinamento concorrente (aeróbio + resistência) mais alongamento estático na flexibilidade em mulheres com câncer de mama

Objective. was to assess flexibility in women with breast cancer who underwent concurrent training (aerobic+resistance) (CT) more static stretching. Methods. This was a controlled pilot study, with 31 women (age 30 to 59) under breast cancer treatment, 14 women were allocated to a training group (TG) who underwent CT more static stretching, concomitant to hospital treatment and 17 women for the control group (CG) who only underwent hospital treatment. The CT more static stretching was performed in 12 weeks with 5 sessions per week, three sessions (aerobic+resistance) and two sessions (stretching exercises) on alternate days. The flexibility of the shoulder was measured by means of the 360º Sanny pendulum goniometer and the flexibility of the lower limbs was assessed through the sit-and-reach test. Data were analyzed using repeated measures ANOVA Test and Bonferroni Post-hoc using SPSS 21 software, with α of 5%. Results. The TG presented increased flexibility in the horizontal abduction of the right shoulder (p=0.001) and in the lower limbs (p<0.001), but the CG showed a reduction in the horizontal abduction of the right shoulder (p=0.003). The effect size for horizontal abduction of the right shoulder was medium (p=0.508) and for the lower limbs was large (p=0.839). Conclusion. CT more static stretching may be a therapeutic intervention to increase flexibility of upper and lower limbs in women with breast cancer. (AU)

Objetivo. Avaliar a flexibilidade em mulheres com câncer de mama que realizaram treinamento concorrente (aeróbio + resistência) (TC) mais alongamento estático. Métodos. Este foi um estudo piloto controlado, com 31 mulheres (de 30 a 59 anos) em tratamento para câncer de mama, 14 mulheres foram alocadas em um grupo de treinamento (GT) que realizaram TC mais alongamento estático, concomitante a tratamento hospitalar e 17 mulheres para o grupo de controle (GC) que somente realizaram tratamento hospitalar. O TC mais alongamento estático foram realizados em 12 semanas com 5 sessões semanais, três sessões (aeróbia + resistência) e duas sessões (exercícios de alongamento) em dias alternados. A flexibilidade do ombro foi medida por meio do goniômetro de pêndulo 360º Sanny e a flexibilidade de membros inferiores foi avaliada por meio do teste de sentar e alcançar. Os dados foram analisados usando o Teste ANOVA de medidas repetidas e Post-hoc de Bonferroni no software SPSS 21, com α de 5%. Resultados. O GT apresentou aumento da flexibilidade na abdução horizontal do ombro direito (p=0,001) e nos membros inferiores (p<0,001), mas o GC apresentou redução da abdução horizontal do ombro direito (p=0,003). O tamanho do efeito para abdução horizontal do ombro direito foi médio (p=0,508) e para membros inferiores foi grande (p=0,839). Conclusão. O TC mais alongamento estático podem ser uma intervenção terapêutica para aumentar a flexibilidade de membros superiores e inferiores em mulheres com câncer de mama. (AU)

Ansiedade, Depressão, Dor e Fadiga em Pacientes com Câncer de Mama que Realizaram Treinamento Combinado / Anxiety, Depression, Pain and Fatigue in Patients with Breast Cancer who Submitted to Combined Training / Ansiedad, Depresión, Dolor y Fatiga en Pacientes con Cáncer de Mama con Entrenamiento Combinado

Introdução: Apesar do aumento na sobrevida de pacientes com neoplasias de mama, muitas persistem com ansiedade, depressão, fadiga e dor mesmo após o tratamento anticancerígeno, fatores associados a uma pior qualidade de vida. Objetivo: Avaliar a influência do treinamento combinado na ansiedade, depressão, dor e fadiga em pacientes com câncer de mama. Método: Ensaio controlado randomizado com 26 pacientes em quimioterapia, radioterapia ou acompanhamento clínico em um centro de referência em tratamento de câncer, com idade 30 a 59 anos, não praticantes de treinamento físico nos últimos três meses. O grupo experimental (GE) (n=13) foi submetido a três sessões por semana de treinamento aeróbico e resistido em 12 semanas, com duração de 60 minutos, e duas sessões de treinamento de flexibilidade por semana com duração de 20 segundos em três séries. O grupo controle (GC) (n=13) realizou somente o tratamento hospitalar convencional. Todas as avaliações foram realizadas no tempo basal e após 12 semanas. Resultados: As pacientes do GE apresentaram redução significativa da ansiedade (p=0,0242), intensidade da dor (p=0,0290) e dimensão comportamental da fadiga (0,0033). Não foram observadas diferenças na depressão (p=0,0803), interferência da dor nas atividades habituais (p=0,0933) e dimensões afetiva (p=0,0583) e sensorial/cognitiva/emocional (p=0,5525) da fadiga. O GC permaneceu inalterado em todas as variáveis. Conclusão: O treinamento combinado, envolvendo exercícios aeróbios, de resistência e de flexibilidade durante 12 semanas, apresenta efeitos benéficos na ansiedade, fadiga e dor em pacientes com câncer de mama

Introduction: Despite the increase of the survival of patients with breast cancer, many persist with anxiety, depression, fatigue, and pain even after anticancer treatment, factors associated with a worse quality-oflife. Objective: Evaluate the influence of combined training on anxiety, depression, pain and fatigue in breast cancer patients. Method: Randomized controlled trial with 26 patients undergoing chemotherapy, radiotherapy, or clinical follow-up at a referral centre for cancer treatment, aged 30 to 59 years, not practicing physical training in the last three months. The experimental group (EG) (n=13) was submitted to 3 sessions per week of aerobic and resistance training, for 12 weeks, lasting 60 minutes, and 2 sessions per week of flexibility training lasting 20 seconds in 3 sets. The control group (CG) (n=13) submitted only to conventional hospital treatment. All assessments were performed at baseline and after 12 weeks. Results: EG patients showed a significant reduction in anxiety (p=0.0242), pain intensity (p=0.0290) and the behavioral dimension of fatigue (0.0033). No differences were observed in depression (p=0.0803), interference of pain in usual activities (p=0.0933) and affective (p=0.0583) and sensory/ cognitive/emotional (p=0.5525) dimensions of fatigue. The GC remained unchanged in all variables. Conclusion: Combined training involving aerobic, resistance and flexibility exercises for 12 weeks has beneficial effects on anxiety, fatigue and pain in breast cancer patients

Introducción: A pesar del aumento de la supervivencia de las pacientes con cáncer de mama, muchas persisten con ansiedad, depresión, fatiga y dolor incluso después del tratamiento anticanceroso, factores asociados a una peor calidad de vida. Objetivo: evaluar la influencia del entrenamiento combinado sobre la ansiedad, la depresión, el dolor y la fatiga en pacientes con cáncer de mama. Método: Ensayo controlado aleatorio con 26 pacientes bajo quimioterapia, radioterapia o seguimiento clínico en un centro de referencia para el tratamiento del cáncer, con edades comprendidas entre los 30 y los 59 años, que no han practicado entrenamiento físico en los últimos tres meses. El grupo experimental (GE) (n=13) fue sometido a tres sesiones semanales de entrenamiento aeróbico y de resistencia en 12 semanas, de 60 minutos de duración, y a dos sesiones semanales de entrenamiento de flexibilidad de 20 segundos en tres series. El grupo de control (GC) (n=13) sólo realizó el tratamiento hospitalario convencional. Todas las evaluaciones se realizaron al inicio y después de 12 semanas. Resultados: Los pacientes del GE mostraron una reducción significativa de la ansiedad (p=0,0242), la intensidad del dolor (p=0,0290) y la dimensión conductual de la fatiga (0,0033). No se observaron diferencias en la depresión (p=0,0803), la interferencia del dolor en las actividades habituales (p=0,0933) y las dimensiones afectivas (p=0,0583) y sensoriales/cognitivas/emocionales (p=0,5525) de la fatiga. El GC se mantuvo sin cambios en todas las variables. Conclusión: El entrenamiento combinado de ejercicios aeróbicos, de resistencia y de flexibilidad durante 12 semanas presenta efectos beneficiosos sobre la ansiedad, la fatiga y el dolor en pacientes con cáncer de mama

Self-efficacy and fear of pain to movement in chronic low back pain: an intervention developed by nurses.

OBJECTIVE: To test the effect of interventions to chronic low back pain developed by nurses in the Program to Increase Self-efficacy and Reduce the Fear of Pain and Avoidance of Movement. METHOD: Clinical trial, with 81 patients, carried out in 2016, at the Pain Outpatient Clinic in São Luís, Maranhão, Brazil. The groups received: A (education and exposure), B (education) and C (control). Chi-square, Fisher's Exact, ANOVA and Kruskal Wallis tests were performed. RESULTS: Patients in groups A and B improved self-efficacy, anxiety, depression, and disability, compared to group C. The reduction in fear of pain and avoidance of movement was greater in Group A, which also showed a decrease in current pain and overall scores compared to Group B and C. CONCLUSION: Education was effective in increasing the Self-Efficacy Belief. For the Belief of Fear of Pain and Avoidance of Movement and pain intensity, the association with exposure showed better results.

End-of-life experience and its toll on quality of life and spirituality: a cross-sectional study.

BACKGROUND: Breast and cervical/uterine cancer affect body parts that have symbolic meaning for women. Women with this diagnosis at the end-of-life often experience anxiety and depression that severely impacts their quality of life (QoL). AIMS: This study aims to determine how the end-of-life experience impacts on the QoL and spirituality of women with advanced cancer. METHODS: End-of-life patients and their caregivers were evaluated regarding religious and spiritual coping, depression and self-efficacy. Caregivers were interviewed regarding patients' QoL at the end-of-life. A spearman correlation test was used to evaluate correlation between variables. FINDINGS: Several dimensions of positive religious and spiritual coping stood out for patients at the end of life. However, patients often experienced a negative revaluation of God. Patients reported experiencing low self-efficacy, depression and high levels of stress. The length of hospital stay, time spent in intensive care units and depression also correlated to the amount of worry and stress a patient experienced. CONCLUSIONS: The end-of-life patients had a poor quality of life, and experienced depression, but also used spiritual beliefs and religion as a means of coping with their end-of-life experience.