RESUMO
Introduction: Diabetic neuropathies are the most prevalent chronic complications of diabetes, characterized by pain and substantial morbidity. Although many drugs have been approved for the treatment of this type of pain, including gabapentin, tramadol (TMD), and classical opioids, it is common to report short-term results or potentially severe side effects. TMD, recommended as a second-line treatment can lead to unwanted side effects. Cannabidiol (CBD) has been gaining attention recently due to its therapeutic properties, including pain management. This study aimed to characterize the pharmacological interaction between CBD and TMD over the mechanical allodynia associated with experimental diabetes using isobolographic analysis. Materials and Methods: After diabetes induction by streptozotocin (STZ), diabetic rats were systemically treated with CBD or TMD alone or in combination (doses calculated based on linear regression of effective dose 40% [ED40]) and had the mechanical threshold evaluated using the electronic Von Frey apparatus. Both experimental and theoretical additive ED40 values (Zmix and Zadd, respectively) were determined for the combination of CBD plus TMD in this model. Results: Acute treatment with CBD (3 or 10 mg/kg) or TMD (2.5, 5, 10, or 20 mg/kg) alone or in combination (0.38+1.65 or 1.14+4.95 mg/kg) significantly improved the mechanical allodynia in STZ-diabetic rats. Isobolographic analysis revealed that experimental ED40 of the combination (Zmix) was 1.9 mg/kg (95% confidence interval [CI]=1.2-2.9) and did not differ from the theoretical additive ED40 2.0 mg/kg (95% CI=1.5-2.8; Zadd), suggesting an additive antinociceptive effect in this model. Conclusions: Using an isobolographic analysis, these results provide evidence of additive pharmacological interaction between CBD and TMD over the neuropathic pain associated with experimental diabetes induced by STZ.
RESUMO
O objetivo do presente trabalho foi avaliar as caracteriÌsticas de morbidade dos pacientes de uma unidade de emergência referenciada, atraveÌs de um questionaÌrio que conteÌm o iÌndice de comorbidades de Charlson (ICC), o escore Hospital (EH) e a escala ECOG (EE), além de verificar se os idosos pontuam mais que os demais. Trata-se de um estudo observacional, transversal e descritivo, em que foram avaliados 73 pacientes. A média de idade dos participantes foi de 53,6 anos e os idosos totalizaram 46,6% dos pacientes. A média global de pontos do ICC foi de 4,3, a do EH foi de 4,8, e a da EE foi de 1,1. No grupo dos não idosos, a média do ICC foi de 2,7, enquanto no grupo dos idosos foi de 6,1, com significância estatística. Os resultados obtidos sugerem que a maior parte dos atendimentos de urgência e emergência são de idosos com alta prevalência de comorbidades.
This study aimed to evaluate morbidity information of patients from a referral emergency service, through a questionnaire containing Charlson Comorbidity Index (CCI), Hospital Score (HS) and ECOG performance status (PS), besides verifying if the elderly got higher scores than the others. It is an observational, cross-section and descriptive study, which evaluated 73 patients. The average age of the participants was 53.6 years and 46.6% of them were elderly. The global score average of CCI, HS and PS were, respectively: 4.3, 4.8 and 1.1. The average score of CCI was 1.83 for the non-elderly group, while, for the elderly group, it was 7.72. This was statistically significant. The granted data suggests that the majority of the emergency services is provided to elderly with high prevalence of comorbidities.