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ABSTRACT BACKGROUND AND OBJECTIVES: The social distancing of COVID-19 pandemic exacerbated symptoms of chronic pain patients. Furthermore, it is necessary to consider the sociocultural context of coping with the pandemic in different countries. The objective of this study was to evaluate pain, psychoemotional symptoms, sleep quality, and level of physical activity in chronic pain patients during the COVID-19 pandemic in Brazil. METHODS: Individuals with fibromyalgia, migraine and chronic low back pain were included. The survey was performed through a questionnaire elaborated by researchers on the Forms application, from Google Drive, in the period between October 2020 and March 2021, with straight and clear questions about pain, psychoemotional aspects, sleep quality, and level of physical activity. Binary or multinominal logistic regression analysis was performed to identify possible predictors. RESULTS: 973 people were evaluated, 63.5% had fibromyalgia, and 98.3% were female. Anxiety increased the odds ratio in 395% of chronic pain patients to feel pain (ß: 1.375; OR: 3.956; p=0.001) and a greater intensity of pain increases in 62.3% the chance of these individuals not performing physical activity (ß: -0.474; OR: 0.623; p=0.001). Pain intensity increased the odds ratio of having insomnia by 186.9% (ß: 0.625; OR: 1.869; p=0.001) and the chance of taking sleep drugs by 160.4% (ß: 0.472; OR: 1.604; p=0.001). CONCLUSION: The social isolation of COVID-19 pandemic maximized the vicious cycle between painful symptoms, anxiety, and sleep disorders in chronic pain patients in Brazil. The intensification of these factors is associated with the reduction of physical activity levels.
RESUMO JUSTIFICATIVA E OBJETIVOS: A pandemia de COVID-19 exacerbou os sintomas de pacientes com dor crônica. Porém, é necessário considerar o contexto sociocultural de enfrentamento da pandemia nos diferentes países. O objetivo deste estudo foi avaliar a dor, os sintomas psicoemocionais, a qualidade do sono e o nível de atividade física em pacientes com dor crônica durante a pandemia de COVID-19 no Brasil. MÉTODOS: Foram incluídos indivíduos com fibromialgia, enxaqueca e dor lombar. O levantamento foi realizado por meio de questionário elaborado pelos pesquisadores no aplicativo Forms, do Google Drive, entre outubro de 2020 e março de 2021, com perguntas diretas e claras sobre dor, aspectos psicoemocionais, qualidade do sono e nível de atividade física. Análise de regressão logística binária ou multinominal foi realizada para identificar possíveis preditores. RESULTADOS: Foram avaliadas 973 pessoas, 63,5% apresentavam fibromialgia, sendo 98,3% do sexo feminino. A ansiedade aumentou a razão de chances em 395% dos pacientes com dor crônica sentirem dor (ß: 1,375; OR: 3,956; p= 0,001) e a dor aumentou em 62,3% a chance desses indivíduos não realizarem atividade física (ß: -0,474; OR: 0,623; p=0,001). A intensidade da dor aumentou a razão de chances de ter insônia em 186,9% (ß: 0,625; OR: 1,869; p= 0,001) e a chance de tomar fármacos para dormir em 160,4% (ß: 0,472; OR: 1,604; p=0,001). CONCLUSÃO: O isolamento social da pandemia de COVID-19 maximizou o ciclo vicioso entre sintomas dolorosos, ansiedade e distúrbios do sono em pacientes com dor crônica no Brasil. A intensificação desses fatores está associada à redução de atividade física.
ABSTRACT
BACKGROUND: Telerehabilitation as an alternative to physiotherapeutic care has been increasingly implemented in diverse populations. However, this mode of service can evoke beliefs and expectations in patients with fibromyalgia, depending on sociocultural and clinical context, that can cause poor adaptation and dropout from treatment. OBJECTIVE: To explore beliefs and expectations of individuals with fibromyalgia about physical exercises delivered through telerehabilitation. METHODS: Thirty individual semi-structured interviews were conducted via videoconference with women with fibromyalgia recruited during COVID-19 pandemic through intentional sampling. These interviews were guided by four questions addressing the beliefs and expectations about telerehabilitation. The interviews were recorded after consent and transcribed using the MAXQDA® software. The inductive approach was performed in which raw data were coded into categories and subcategories. RESULTS: Participants expect to benefit from telerehabilitation due to flexible hours, no need of travel, socialization, and lower risk of contamination. However, they believe they have difficulties related to the physical absence of the therapist, complexity of the exercises, internet connection problems, adaptation to the domestic routine and availability of schedules. CONCLUSION: Women with fibromyalgia showed positive expectations about telerehabilitation, relating better socialization with other individuals diagnosed with fibromyalgia, home care with flexible schedule and, to provide needed service to underserved. However, they listed barriers such as the physical absence of the therapist and instability of the internet connection and, the FM symptoms themselves.
Subject(s)
COVID-19 , Fibromyalgia , Telerehabilitation , Humans , Female , Motivation , PandemicsABSTRACT
OBJECTIVE: The primary aims of this study are to compare neck disability in masticatory myofascial pain subjects versus asymptomatic controls, and to evaluate the correlation between neck disability and muscle pain. DESIGN: Two groups composed this case-control study: a symptomatic group comprised of 27 subjects diagnosed with masticatory myofascial pain, as determined by the Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD), and a control group comprised of 28 asymptomatic subjects. The collected variables were pain intensity (visual analogue scale), pressure pain threshold of the temporomandibular joint, anterior temporalis, masseter, sternocleidomastoid muscle, upper trapezius and Achilles tendon (digital dynamometer, kgf/cm(2)), and neck disability (Neck Disability Index). Statistical analysis included Student's t-test and the Pearson product-moment correlation coefficient (5% significance level and 95% confidence interval). RESULTS: The symptomatic group showed greater neck disability with a mean (SD) of 11.8 (7), as compared with 2.8 (2.4) for the asymptomatic group (p<0.05). A negative correlation was found between neck disability and pressure pain threshold of the anterior temporalis (r=-0.4, 95% CI -0.6 to -0.15, p=0.002), the sternocleidomastoid (r=-0.35, 95% CI -0.56 to -0.09, p=0.007) and the upper trapezius (r=-0.37, 95% CI -0.58 to -0.12, p=0.005). CONCLUSION: Our results reinforced the clinical interconnection between masticatory and cervical structures, insofar as subjects with masticatory myofascial pain reported greater neck disability, which, in turn, was correlated with regional muscle sensitivity.
