Cognitive function in patients with chronic pain treated with opioids: characteristics and associated factors.

BACKGROUND: The paucity of studies regarding cognitive function in patients with chronic pain, and growing evidence regarding the cognitive effects of pain and opioids on cognitive function prompted us to assess cognition via neuropsychological measurement in patients with chronic non-cancer pain treated with opioids. METHODS: In this cross-sectional study, 49 patients were assessed by Continuous Reaction Time, Finger Tapping, Digit Span, Trail Making Test-B and Mini-mental State Examination tests. Linear regressions were applied. RESULTS: Patients scored poorly in the Trail Making Test-B (mean = 107.6 s, SD = 61.0, cut-off = 91 s); and adequately on all other tests. Several associations among independent variables and cognitive tests were observed. In the multiple regression analyses, the variables associated with statistically significant poor cognitive performance were female sex, higher age, lower annual income, lower schooling, anxiety, depression, tiredness, lower opioid dose, and more than 5 h of sleep the night before assessment (P < 0.05). CONCLUSIONS: Patients with chronic pain may have cognitive dysfunction related to some reversible factors, which can be optimized by therapeutic interventions.

CYP2E1 RsaI and 96-bp insertion genetic polymorphisms associated with risk for colorectal cancer.

We investigated a possible association between alcoholism, cigarette smoking, obesity and CYP2E1 RsaI and 96-bp insertion genetic polymorphisms with risk for colorectal cancer (CRC). Patients with CRC (70 women and 61 men) were matched for gender and age to 206 healthy controls. The mean age of the two groups was 62 years. Meat intake, cigarette smoking and alcohol drinking were assessed using a specific frequency questionnaire. The body mass index was also calculated. DNA was extracted from peripheral blood; RsaI polymorphism genotypes were evaluated by PCR-RFLP and 96-bp insertion genetic polymorphisms were evaluated by specific primers. The distributions of CYP2E1 RsaI c1/c1, c1/c2 and c2/c2 genotypes were 90.2, 9.2 and 0.6%, respectively, in controls and 83.9, 13.7 and 2.4% in CRC cases. Allele c2 was associated with increased risk for CRC [odds ratio (OR) = 1.88, 95% confidence interval (95%CI) = 1.02-3.45]. The CYP2E1 RsaI c2/c2 genotype was associated with an increased risk for rectal cancer (OR = 3.23, 95%CI = 1.26-9.03). The 96-bp insertion was slightly more frequent in the CRC group (9.3 vs 11.4%, P = 0.19), especially in females (6.4 vs 11.5%, P = 0.34). Smoking, alcohol drinking or high intake of red meat and CYP2E1 polymorphisms were not associated with increased risk for CRC. The 96-bp insertion was marginally more frequent (P = 0.07) in undernourished CRC subjects. We concluded that the risk for CRC is higher among individuals with allele c2. The CYP2E1 RsaI c2/c2 genotype was associated with an increased risk for rectal cancer.

[Control of the postoperative pain]. / Controle da dor no pós-operatório.

The pain is a frequent symptom during the postoperative period and results in suffering and unnecessary risks for the patient. Studies show the inadequate pain relief after surgery and the relationship with erroneous assessment and non-acquaintance about analgesics methods. The article discuss the postoperative pain management which includes the use of nonsteroidal antiinflammatory drugs, opioids, cognitive-behavior interventions and high-tech like epidural catheter and patient-controlled analgesia systems. Besides the adequate pain control includes the discussion about ethical and economic aspects.

[Chronic pain and depression: study of 92 patients]. / Dor crônica e depressão: estudo EM 92 doentes.

Was examined the influence of depression in the occurrence and pain intensity. Patients presenting advanced cancer (n = 92) were evaluated. The patients were divided in 2 groups, with or without pain during the week preceding the interview. Pain and depression were evaluated. Pain was observed in 62.0% of the cases and lasted 10 months as an average. It was moderate in the majority of patients and severe in 1/5 of them. Depression was related with the presence and intensity of pain. Patients with pain presented higher depression scores than patients without pain (p < 0.05). Higher pain scores were also correlated with higher depressive scores (p < 0.05).

[Evaluation of patients with chronic pain in nursing consultations: Proposal of an instrument for nursing diagnosis]. / Avaliação do doente com dor crônica em consulta de enfermagem: proposta de instrumento segundo diagnósticos de enfermagem.

This article describes the tool used to collect data for nursing evaluation of patients with chronic pain patient in the League Against Pain of the University of São Paulo at Ribeirão Preto Faculty of Medicine, Brazil. The aim is to identify the patients' nursing care needs. The nursing diagnoses proposed by the North American Nursing Diagnosis Association (NANDA) were used to point out the patients' nursing care needs. The Human Response Patterns, in which the nursing diagnoses are classified by NANDA, were used as a framework to construct the tool. The way it is used by nursing undergraduate students, members of the League Against Pain, is also described.

[Non-oncologic chronic pain relief with opioids]. / Alívio da dor crônica não neoplásica com opiáceos.

Opioids for non cancer pain control are controversial. The evaluation of the pain relief, changes in quality of life and complications due to long term infusion of opioids in the lumbar subarachnoid space in 11 patients with non cancer pain were the goals of this study. Patients were previously treated with drugs and surgical procedures, without significant pain relief. Patients were asked to compare pain characteristics and daily life activities before and after this treatment. The long term spinal opioids through implantable pumps for non-oncologic pain produced pain relief but did not improve the quality of life in the majority of the cases.

[Cultural concepts and the pain experience]. / Conceitos culturais e a experiência dolorosa.

The aim of this investigation was to examine the influence of cultural factors in the pain intensity. Patients presenting advanced cancer and pain, under treatment in an outpatients oncologic unit were evaluated. Pain and cultural factors were evaluated through interviews based on the use of instruments adapted to portuguese language: Patient Pain Questionnaire. Pain lasted 10 months as an average. It was moderate in the majority of patients and severe in 1/5 of them. Cultural misconceptions about the impossibility of cancer pain control and the idea that doctors prescribe excessive amount of analgesics, were correlated with, higher intensities of pain (p < 0.05).

[Intrathecal opioids in chronic non-malignant pain: relief and life quality]. / Opiáceo intratecal na dor crônica não neoplásica. Alívio e qualidade de vida.

The use of opioids for treatment of non-malignant pain is controversial. The evaluation of pain relief and of the quality of life of 11 severely incapacitated chronic non-cancer pain patients treated with long term intrathecal infusion of opioids trought implantable pumps was performed. The mean duration of pain complaints was 5.3 years. The mean pain intensity was 8.6. In 7 patients, pain episodes lasted at least 6 hours daily. The mean duration of the therapy was 19.6 months. After the treatment the mean pain score became 3.9. In only 1 patient, the duration of pain episodes was still longer than 6 hours. Quality of life improved in 36.36% of the cases. The long term spinal opioids through implantable pumps for non-malignant pains results in pain relief but not necessarily improves the quality of life.

[League against pain: a teaching experience]. / Liga de dor: uma experiência de ensino.

The anatomical and physiological basis of pain are subjects of the basic sciences in health sciences undergraduate curriculum. Disciplines focussing pain concepts and pain therapy are not traditional in the medical and nursing schools programs. The description of the organization of the League Against Pain and the presentation the students' opinions about their participation in this educational program were the objectives of the study. The League is composed by nursing and medical students and professionals (physicians of many specialties and nurses). The objectives of the League are: the improvement of the teaching about pain subjects in the nursing and medical schools; the development of research in epidemiological, clinical and therapeutic aspects of pain; the development and promotion of a model of multidisciplinary and multiprofessional assistance to chronic pain patients. The students considered had improved their abilities in pain control and in professional-patients relationship; usefulness and satisfaction with the program; need for inclusion of the program in the undergraduate courses and that the League is a good model for teaching of medical and nursing students in pain.

[League against pain: an experiment in extracurricular teaching]. / Liga de dor: uma experiência de ensino extracurricular.

Although anatomical and physiological base of pain are subject of the basic sciences in health undergraduate curriculum, it is not usually to have pain concepts and therapy into undergraduate programs. Describing the League Against Pain objectives and organization and the students' opinions about their participation in this league were the aim of this study. The League Against Pain Statute was consulted to describe its objectives and organization. The opinions of all of the students that attended the League Against Pain program in 1995 and 1996 were investigated. The League Against Pain was organized at an university hospital in 1995. It is composed by nurses and medical students and professionals (physicians in varied specialties and nurses). All the activities are voluntary and the students are the managers of the League. The objectives of the League are: improving the quality of teaching of pain subjects in nursing and medical schools; developing research in epidemiological, clinical and therapeutics aspects of pain and to promote a model of multidisciplinary and multiprofessional assistance. The most frequent students' opinions about their participation in the League were: their abilities in pain control and in professional and client relationship were improved; they achieved their objectives; that pain should be included into undergraduate courses; and they would recommend the League for other students. The results are promising. The students' opinions about their experience in the League Against Pain have showed that the League Against Pain could be an usefull model to introduce pain subjects to undergraduate nursing and medical students.

[Pain, depression, and cultural concepts]. / Dor, depressão e conceitos culturais.

The influence of personal, cultural and affective factors and of the characteristics of the neoplastic diseases in the occurrence of pain and pain intensity in 92 patients presenting advanced cancer was evaluated. Pain usually moderate or severe during past week before the interview occurred in 62.0% of the patients. The duration of pain symptomatology lasted 10 months as an average. There was a higher proportion of patients with head and neck tumors in the group with pain than without pain. Cultural misconceptions about cancer pain control and the idea that doctors prescribe excessive amount of analgesics were correlated with higher intensities of pain (p < 0.05). Patients with pain presented higher depression scores than patient without pain (p < 0.05). Higher pain scores were correlated with higher depressive scores (p < 0.05).

[Proposal to adapt the McGill Pain Questionnaire into Portuguese]. / Questionário de dor McGill: proposta de adaptação para a língua Portuguesa.

Pain is a multidimensional and subjective experience. The developing instruments for the assessment of the multiple components of pain is necessary for the comprehension of the suffering, to delineate therapeutic programs and to evaluate their efficacy. The McGill pain questionnaire has been considered the best instrument to assessment the sensitive-discriminative, affective-motivational and cognitive-avaliative dimensions of pain. The aim of this study is to present the adaptation of McGill to portuguese language.

[Data collection in nursing: report of a teaching experience]. / A coleta de dados em enfermagem: relato de uma experiência de ensino.

After courses of Assessment of Adults questionnaires were sent to 84 nurses in order to know if their practice of physical examination was modified by them. These nurses worked in different hospitals and graduated schools. The majority of them related that they improved their knowledge about the matter and modified their practice.

[Analgesia in cancer: beliefs and an update]. / Analgesia em câncer: crenças e atualização.

Cancer pain relief is not yet adequate, but there are resources for this. Professional's misconception and the tabu about that pain in cancer is inevitable have been contributing to this problem. Important nurses' knowledge lacuna about pain relief in cancer was found by this study. The WHO program about pain relief in cancer is presented too.

[The teaching of patient evaluation: the delineation of the content of nursing diagnosis]. / O ensino da avaliação do paciente: delineamento do conteúdo pelo diagnóstico de enfermagem.

The nursing care is based on the nursing assessment. In the nurse's professional activity there aren't clarity and consensus about the clinical entities, problems or phenomenons that nurses intended to care. Difficulties in deciding what should be collected are determined by this indefinition, that it is also present in nursing graduate courses. In this article the authors discuss that the Nursing Diagnosis can be the framework for the nursing assessment.

[The peridural catheter for domiciliary analgesia: a therapy for cancer pain]. / Catéter peridural para analgesia domiciliar: uma terapia para a dor oncológica.

An epidural catheter can be chosen for domiciliary oncological pain relief when relief is not achieved with oral drugs. The patient/relatives put in the central nervous systems the analgesic solution, through this peridural catheter. This article discusses how pain relief occurs, the infusion systems of opioids in the peridural space, the complications and side effects of this therapy.

[The specific characteristics of the physical exam performed by the nurse]. / Características específicas do exame físico realizado pelo enfermeiro.

The purpose of this work is focused on the physical examinations made by the nurse, identifying four basic assumption originated from the performance of this procedure. It also suggests indicative guidelines of specificity to the nursing physical examinations.

[Pain: its occurrence and evolution in the postoperative period of heart and abdominal surgery]. / Dor: ocorrência e evolução no pós-operatório de cirurgia cardíaca e abdominal.

The high incidence and low resolution of the pain after surgery are shown in international literature. During the five days after the cardiac and abdominal surgery, these patients were asked once a day about their pain. Nearly 50% of the patients answers showed pain complaints. At the cardiac patients 47% did not take treatment during the last four hours, although the medicine was prescribed by the doctor to be used in eventual necessity. Similar occurrences happened with abdominal patients where no medicine was given in 68.2% events of their pain complaints. So, we find that the under-identification and undertreatment of the pain are like the other studies.

[Body posture and oxygenation. 2. Patients with bilateral lung dysfunction]. / Posição corporal e oxigenação. Parte 2--pacientes com disfunção pulmonar bilateral.

The purpose of this study was to analyse the effects of sitting, supine and lateral positions on arterial oxygen tension (PaO2) and arterial carbon dioxide tension (PaCO2), in 22 adults patients, carier of some pulmonary bilateral disfunction, in recent post-operative cardiac surgery. The diagnosis of the pulmonary disfunction was done through radiographic torax evaluation. The patients stayed during 15 minutes in each position and after this, the arterial blood gases were measured. Based on Friedman test and Multiple Comparation test (a = 0.05), no significant changes in PaO2 and PaCO2 were noted.