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1.
Ann Rheum Dis ; 2024 May 30.
Artigo em Inglês | MEDLINE | ID: mdl-38816064

RESUMO

OBJECTIVES: To determine the proportion of patients with rheumatoid arthritis (RA) with severe persisting pain and to identify predictive factors despite treatment-controlled disease activity. METHODS: This prospective multicentre study included outpatients with RA scheduled for escalation of anti-inflammatory treatment due to active disease and severe pain (Disease Activity Score 28 (DAS28)>3.2 and Visual Analogue Scale (VAS)>50). At week 24, patients were stratified into reference group (DAS28 improvement>1.2 or DAS28≤3.2 and VAS pain score<50), non-responders (DAS28 improvement≤1.2 and DAS28>3.2, regardless of VAS pain score) and persisting pain group (DAS28 improvement>1.2 or DAS28≤3.2 and VAS pain score≥50). The former two subgroups ended the study at week 24. The latter continued until week 48. Demographic data, DAS28-C reactive protein, VAS for pain, painDETECT Questionnaire (PD-Q) to identify neuropathic pain (NeP) and the Pain Catastrophising Scale were assessed and tested for relation to persisting pain. RESULTS: Of 567 patients, 337 (59.4%) were classified as reference group, 102 (18.0%) as non-responders and 128 (22.6%) as patients with persisting pain. 21 (8.8%) responders, 28 (35.0%) non-responders and 27 (26.5%) persisting pain patients tested positive for NeP at week 24. Pain catastrophising (p=0.002) and number of tender joints (p=0.004) were positively associated with persisting pain at week 24. Baseline PD-Q was not related to subsequent persisting pain. CONCLUSIONS: Persisting and non-nociceptive pain occur frequently in RA. Besides the potential involvement of NeP, pain catastrophising and a higher number of tender joints coincide with persisting pain.

2.
Pain Med ; 21(2): e54-e61, 2020 02 01.
Artigo em Inglês | MEDLINE | ID: mdl-31578559

RESUMO

OBJECTIVE: Chronic pain is a debilitating condition of multifactorial origin, often without physical findings to explain the presenting symptoms. Of the possible etiologies of persisting painful symptoms, somatoform disorders and functional somatic syndromes (FSS) are among the most challenging, with a prevalence of 8-20%. Many different somatoform disorders and FSS have overlapping symptoms, with pain being the most prevalent one. The concept of multisomatoform disorder (MSD) has been developed to acknowledge that fact. We hypothesized that the concept of MSD will be reflected in a distinct sensory profile of patients compared with healthy controls and possibly provide insight into the type and pathophysiology of the pain commonly experienced by patients. DESIGN: We performed comprehensive quantitative sensory testing (QST) in 151 patients and 149 matched controls. RESULTS: There were significant differences in the sensory profiles of patients compared with controls. Patients with MSD showed a combination of tactile and thermal hypesthesia combined with mechanical and cold hyperalgesia. This was true for measurements at test and control sites, with the exception of vibration detection threshold and mechanical pain threshold. Among the observed changes, a marked sensory loss of function, as evidenced by an increase in cold detection threshold, and a marked gain of function, as evidenced by a decrease of pressure pain threshold, were most notable. There was no evidence of concurrent medication influencing QST results. CONCLUSIONS: The observed somatosensory profile of patients with MSD resembles that of patients suffering from neuropathic pain with evidence of central sensitization.


Assuntos
Dor Crônica/etiologia , Transtornos Somatoformes/complicações , Distúrbios Somatossensoriais/etiologia , Adulto , Estudos de Casos e Controles , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Medição da Dor/métodos
4.
Cytokine ; 61(2): 389-93, 2013 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-23294973

RESUMO

INTRODUCTION: The etiology of multisomatoform disorder (MSD) is still largely unknown, but genetic factors seem to have an influence on pathogenesis. Pain is a major symptom of MSD and polymorphisms of different proinflammatory cytokines have been found associated with pain in former studies. Therefore, we presumed that cytokine polymorphisms could also be associated with MSD. PATIENTS AND METHODS: Groups of 148 MSD patients with pain as the leading clinical symptom and 149 age and gender matched healthy controls participated in this study. Nine cytokine polymorphisms were genotyped and statistically analyzed for associations with MSD. RESULTS: Allelic and genotypic associations were found for rs16944 (interleukin 1ß), rs1800629 (tumor necrosis factor) and rs909253 (lymphotoxin α). After correcting for multiple testing, the association of rs1800629 with MSD remained significant. The rare A-allele was correlated with MSD (p=0.007). DISCUSSION: Since the common G-allele of rs1800629 (TNFα) occurs much more often in the control group than in the MSD group it is assumed to be protective. Being carrier of the A-allele seems to be a risk factor for MSD.


Assuntos
Estudos de Associação Genética , Predisposição Genética para Doença , Polimorfismo de Nucleotídeo Único/genética , Transtornos Somatoformes/genética , Fator de Necrose Tumoral alfa/genética , Alelos , Estudos de Casos e Controles , Demografia , Feminino , Alemanha , Haplótipos/genética , Humanos , Masculino , Pessoa de Meia-Idade
5.
J Neurochem ; 123(4): 589-601, 2012 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-22891703

RESUMO

Many extracellular factors sensitize nociceptors. Often they act simultaneously and/or sequentially on nociceptive neurons. We investigated if stimulation of the protein kinase C epsilon (PKCε) signaling pathway influences the signaling of a subsequent sensitizing stimulus. Central in activation of PKCs is their transient translocation to cellular membranes. We found in cultured nociceptive neurons that only a first stimulation of the PKCε signaling pathway resulted in PKCε translocation. We identified a novel inhibitory cascade to branch off upstream of PKCε, but downstream of Epac via IP3-induced calcium release. This signaling branch actively inhibited subsequent translocation and even attenuated ongoing translocation. A second 'sensitizing' stimulus was rerouted from the sensitizing to the inhibitory branch of the signaling cascade. Central for the rerouting was cytoplasmic calcium increase and CaMKII activation. Accordingly, in behavioral experiments, activation of calcium stores switched sensitizing substances into desensitizing substances in a CaMKII-dependent manner. This mechanism was also observed by in vivo C-fiber electrophysiology corroborating the peripheral location of the switch. Thus, we conclude that the net effect of signaling in nociceptors is defined by the context of the individual cell's signaling history.


Assuntos
Proteína Quinase Tipo 2 Dependente de Cálcio-Calmodulina/metabolismo , Cálcio/metabolismo , Neurônios/metabolismo , Nociceptores/fisiologia , Limiar da Dor/fisiologia , Agonistas Adrenérgicos beta/farmacologia , Análise de Variância , Animais , Células Cultivadas , AMP Cíclico/análogos & derivados , AMP Cíclico/farmacologia , Estimulação Elétrica , Inibidores Enzimáticos/farmacologia , Gânglios Espinais/citologia , Hiperalgesia/tratamento farmacológico , Hiperalgesia/fisiopatologia , Inositol 1,4,5-Trifosfato/farmacologia , Isoproterenol/farmacologia , Masculino , Fibras Nervosas/efeitos dos fármacos , Fibras Nervosas/fisiologia , Neurônios/efeitos dos fármacos , Limiar da Dor/efeitos dos fármacos , Proteína Quinase C-épsilon/metabolismo , Transporte Proteico/efeitos dos fármacos , Ratos , Ratos Sprague-Dawley , Receptores Acoplados a Proteínas G/metabolismo , Rianodina/farmacologia , Transdução de Sinais/efeitos dos fármacos , Transdução de Sinais/fisiologia , Canais de Cátion TRPV/metabolismo , Tionucleotídeos/farmacologia , Uridina Trifosfato/farmacologia
6.
Dis Markers ; 2022: 7958375, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35242246

RESUMO

OBJECTIVE: Patients suffering from chronic pain often present with multifactorial underlying conditions, sometimes without concrete pathological physical findings. Functional somatic syndromes (FSS) and somatoform disorders show a high prevalence of 8-20% and are often associated with adverse childhood experiences (ACE) and chronic stress. As many different FSS have overlapping symptoms, the concept of multisomatoform disorder (MSD) has been introduced as an encompassing concept. We hypothesize that a common neurohumoral profile is present in patients with MSD that is distinct from gender- and age-matched controls and thus provides insight into possible common underlying mechanisms. DESIGN: In 151 patients with MSD (138 females) and 149 matched controls (131 females), we determined ACE by the Childhood Trauma Questionnaire (CTQ) and chronic stress by the Trier Inventory for Chronic Stress (TICS). Furthermore, the serum levels of leptin, FSH, LH, cortisol, DHEA-S, and IGF-1 have been assessed. RESULTS: There were significant differences in the levels of leptin, FSH, IGF-1, and cortisol between patients and controls, mainly driven by female participants. Levels of leptin were significantly correlated with BMI in patients, in controls, and in the female subgroup. This correlation was exaggerated in female patients when compared to female controls. Both CTQ and TICS predicted MSD directly and indirectly through the levels of leptin. CONCLUSION: There is evidence of a distinct neurohumoral profile in female patients with MSD when compared to matched healthy controls, similar to what has been demonstrated in other chronic pain states. The observed profile can be taken as possible evidence for a dysregulated response to chronic stress and metabolic balance as well as a state of hypocortisolism and HPA-axis dysfunction. ACE and chronic stress play a major role in the development of MSD and altered neurohumoral profile.


Assuntos
Experiências Adversas da Infância/psicologia , Neurotransmissores , Dor/etiologia , Transtornos Somatoformes/epidemiologia , Feminino , Humanos , Sistema Hipotálamo-Hipofisário/metabolismo , Leptina/sangue , Masculino , Pessoa de Meia-Idade , Sistema Hipófise-Suprarrenal/metabolismo , Fatores Sexuais , Transtornos Somatoformes/psicologia , Estresse Psicológico/metabolismo , Estresse Psicológico/psicologia , Inquéritos e Questionários
7.
Rheumatology (Oxford) ; 50(4): 756-61, 2011 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-21149243

RESUMO

OBJECTIVE: Comparison of overall RA-related costs and of relative contribution of single-cost domains before and after the introduction of TNF-blocking agents in Germany. METHODS: Two cohorts of RA outpatients (ACR '87 criteria) with long-standing disease are assessed in terms of disease-related costs and cost composition (n = 106 patients in 1997-98 and n = 180 patients in 2002 with similar patient characteristics). Full-cost analyses are performed including direct disease-related costs (medical and non-medical) and productivity costs as collected by patient questionnaires. Absolute costs (€/patient/year) are compared and the impact of single-cost domains on overall costing in RA is estimated (relative proportions of cost components within samples). RESULTS: Overall costs are comparable (1997-98: €4280; 2002: €3830; not significant). Differences can be observed in medication (1997-98: €550; 2002: €1580; P < 0.001) and hospitalization costs (1997-98: €1240; 2002: €500; P < 0.001). Productivity costs are significantly lower (€1480 vs €850; P < 0.05) in 2002. The impact of medication costs is outstanding in the 2002 sample (42 vs 12%), the proportion of hospitalization costs is substantially lower (29 vs 13%). Costs for DMARDs in 2002 are mostly driven by TNF blockers (37%). The number of DMARDs per patient is higher in 2002 as are costs for osteoporosis medication and gastroprotective treatment. CONCLUSION: Although overall costs before and after the introduction of TNF blockers are comparable, the decrease in hospitalization and productivity costs is promising in terms of future long-term cost savings. The development of these aspects and of the increasing medication costs will have to be evaluated with longer time frames.


Assuntos
Artrite Reumatoide/economia , Artrite Reumatoide/epidemiologia , Redução de Custos/estatística & dados numéricos , Efeitos Psicossociais da Doença , Custos de Cuidados de Saúde/estatística & dados numéricos , Adulto , Idoso , Antirreumáticos/economia , Antirreumáticos/uso terapêutico , Artrite Reumatoide/tratamento farmacológico , Estudos de Coortes , Análise Custo-Benefício , Eficiência , Feminino , Alemanha/epidemiologia , Hospitalização/economia , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Resultado do Tratamento , Fator de Necrose Tumoral alfa/antagonistas & inibidores
8.
Anesth Analg ; 110(1): 211-5, 2010 Jan 01.
Artigo em Inglês | MEDLINE | ID: mdl-19910617

RESUMO

Tumor necrosis factor (TNF)-alpha has been identified as a pathogenic factor in many immunologically based diseases and complex regional pain syndrome (CRPS). In this case series, we used radiolabeled technetium anti-TNF-alpha antibody to scintigraphically image TNF-alpha in 3 patients with type 1 CRPS. The results show that TNF-alpha was localized only in affected hands of patients with early-stage CRPS. No uptake was seen in clinically unaffected hands and late-stage CRPS. Our findings support the growing evidence for neuroimmune disturbance in patients with CRPS and may have important further implications for specific anticytokine treatment in patients with CRPS.


Assuntos
Anticorpos Monoclonais , Compostos Radiofarmacêuticos , Distrofia Simpática Reflexa/sangue , Fator de Necrose Tumoral alfa/metabolismo , Adulto , Anticorpos Monoclonais/farmacocinética , Feminino , Mãos/diagnóstico por imagem , Humanos , Processamento de Imagem Assistida por Computador , Infliximab , Marcação por Isótopo , Masculino , Pessoa de Meia-Idade , Projetos Piloto , Cintilografia , Compostos Radiofarmacêuticos/farmacocinética , Medronato de Tecnécio Tc 99m , Distribuição Tecidual , Contagem Corporal Total , Adulto Jovem
9.
Appl Psychophysiol Biofeedback ; 35(3): 207-17, 2010 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-20237953

RESUMO

Previous studies reported that respiratory feedback (RFB) aids in alleviating chronic pain. However, to date, this adjunct treatment has not been rigorously tested against non-contingent (placebo) feedback. Forty-two patients with chronic low back pain were randomized to either RFB or non-contingent RFB. Both groups performed a daily 30-min home training for 15 consecutive days. A respiratory associated relaxation index (RI) was measured. Pain levels and a somatosensory profile were assessed before and after intervention. Additionally, pain levels were assessed 3 months after the end of intervention. Secondary outcome parameters included daily functioning, psychopathology, and suggestibility. T-tests showed higher and significant pain reductions for RFB, compared to non-contingent RFB. Between-group comparisons reached no significance. However, changes were more pronounced in the RFB condition, which was also true for the course of the RI and the psychopathological scores. This is the first study using a non-contingent respiratory placebo feedback in a randomized, controlled design. Within this design previous positive findings of symptom reductions in patients treated with RFB could partially replicated. Nonetheless, tendencies suggest that contingent feedback patients compared to placebo patients profit more from RFB in the long run regarding reduction of chronic pain and psychological distress.


Assuntos
Biorretroalimentação Psicológica/métodos , Dor Lombar/terapia , Respiração , Adolescente , Adulto , Idoso , Doença Crônica/terapia , Método Duplo-Cego , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Medição da Dor , Seleção de Pacientes , Inquéritos e Questionários , Resultado do Tratamento
10.
J Manipulative Physiol Ther ; 32(5): 364-71, 2009 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-19539119

RESUMO

OBJECTIVE: This study evaluated if patients with complex regional pain syndrome (CRPS) would have an increase in range of motion (ROM) after myofascial release and a similar ROM decrease after jaw clenching, whereas in healthy subjects these effects would be minimal or nonexistent. METHODS: Documentation of patients with CRPS (n = 20) was established using the research diagnostic criteria for CRPS, questionnaires, average pain intensity for the past 4 weeks, and the temporomandibular index (TMI). Healthy subjects (n = 20, controls) also underwent the same testing. Hip ROM (alpha angle) was measured at 3 time points as follows: baseline (t1), after myofascial release of the temporomandibular joint (t2), and after jaw clenching for 90 seconds (t3). Comparison of the CRPS and control groups was made using t tests. RESULTS: Mean TMI total score and mean pain reported for the last 4 weeks were significantly different between the 2 groups (P < .0005). Hip ROM at t1 was always slightly higher compared to t3, but t2 was always lower in value compared to t1 or t3 for both groups. The differences of all hip ROM values between the groups were significant (P < .0005). Moreover, the difference between t1 or t3 and t2 was significantly different within the CRPS group (t1 = 48.7 degrees ; t2 = 35.8 degrees ; P < .0005). CONCLUSIONS: The results suggest that temporomandibular joint dysfunction plays an important role in the restriction of hip motion experienced by patients with CRPS, which indicated a connectedness between these 2 regions of the body.


Assuntos
Articulação do Quadril/fisiopatologia , Dor/diagnóstico , Dor/fisiopatologia , Amplitude de Movimento Articular/fisiologia , Transtornos da Articulação Temporomandibular/fisiopatologia , Transtornos da Articulação Temporomandibular/terapia , Adulto , Aparelhos de Tração Extrabucal , Feminino , Humanos , Masculino , Mandíbula , Pessoa de Meia-Idade , Dor/etiologia , Medição da Dor , Modalidades de Fisioterapia , Estudos Prospectivos , Índice de Gravidade de Doença , Inquéritos e Questionários , Transtornos da Articulação Temporomandibular/complicações , Fatores de Tempo
11.
Int J Rehabil Res ; 31(4): 342-6, 2008 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-19008684

RESUMO

The objective of this study was to investigate the long-term efficacy of inpatient rehabilitation using sleeping neck support in patients suffering from chronic cervicobrachialgia. A prospective, randomized clinical trial with a 12-month follow-up was done. A total of 149 patients suffering from chronic cervicobrachialgia received a 4-week inpatient rehabilitation programme. The patients were randomly divided into two groups. The patients in one group were given a special neck pillow to use during and after the rehabilitative treatment (n=76); the patients in the other group were not given the pillow (n=73). Two weeks before, during, and after (3, 6, 9, and 12 months) the 4-week treatment period, the patients completed a questionnaire dealing with the intensity of their cervicobrachial complaints (pain intensity, muscular tension, paraesthesia, and sleep disorders caused by pain or paraesthesia). During the inpatient treatment period, no significant differences were detected between the groups; however, 1-12 months after discharge, the group with sleeping neck support showed a significantly (P<0.05) smaller increase in the intensity of cervical spine pain. Sleep disturbances caused by pain were also reduced significantly (P<0.001 after 3 months, respectively, P<0.05 after 12 months). Inpatient rehabilitative treatment has sustained effects in patients suffering from chronic cervicobrachialgia, particularly when a sleeping neck support is added.


Assuntos
Roupas de Cama, Mesa e Banho , Neurite do Plexo Braquial/reabilitação , Neurite do Plexo Braquial/classificação , Doença Crônica , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Modalidades de Fisioterapia , Centros de Reabilitação , Índice de Gravidade de Doença , Sono , Inquéritos e Questionários
12.
Artigo em Alemão | MEDLINE | ID: mdl-18671173

RESUMO

The endocannabinoid system reduces sensitization processes. Low doses of cannabinoids may enhance the potency of opioid-drugs and reduce the risk of tolerance to opioids. So far no cannabinoid has been approved for the treatment of acute pain due to lack of consistent data. In contrast, a Cannabis Based Medicine spray consisting of delta9-tetrahydrocannabinol and cannabidiol has been approved for the treatment of neuropathic pain in patients with multiple sclerosis. The adjunct of cannabidiol and the oromucosal formulation increase the therapeutic index of delta9-tetrahydrocannabinol. The differentiation of analgetic effects and cannabimimetic effects may be increased while compounds--such as ajulemic acid--are used which preferentially act on peripheral cannabinoid receptors and exert receptor independent effects. A further approach in this direction is the use of enzymes which metabolize endocannabinoids.


Assuntos
Moduladores de Receptores de Canabinoides/administração & dosagem , Canabinoides/administração & dosagem , Endocanabinoides , Dor/tratamento farmacológico , Dor/prevenção & controle , Animais , Alemanha , Humanos , Resultado do Tratamento
13.
Anesth Analg ; 105(4): 1148-51, table of contents, 2007 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-17898403

RESUMO

Cytokines, particularly tumor necrosis factor-alpha, may play an important role in the mediation of mechanical hyperalgesia and autonomic signs in complex regional pain syndrome 1. We performed an IV regional block with low-dose administration of the tumor necrosis factor-alpha antibody, infliximab, in a patient with typical clinical signs of complex regional pain syndrome 1 (moderate pain, edema, hyperhidrosis, elevated skin temperature compared with the contralateral side). A significant improvement of clinical variables was observed 24 h after infliximab treatment. Almost complete remission was reached within 8 wk, but sensory signs improved only after 6 mo. No adverse events were observed.


Assuntos
Anti-Inflamatórios/administração & dosagem , Anticorpos Monoclonais/administração & dosagem , Síndromes da Dor Regional Complexa/terapia , Bloqueio Nervoso , Síndromes da Dor Regional Complexa/metabolismo , Síndromes da Dor Regional Complexa/fisiopatologia , Feminino , Humanos , Infliximab , Pessoa de Meia-Idade , Limiar da Dor , Limiar Sensorial , Fator de Necrose Tumoral alfa/metabolismo
14.
Anesth Analg ; 104(2): 295-300, 2007 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-17242083

RESUMO

Auricular acupuncture can be an effective treatment for acute anxiety, but there is a lack of direct comparisons of acupuncture to proven standard drug treatments. In this study we compared the efficacy of auricular acupuncture with intranasal midazolam, placebo acupuncture, and no treatment for reducing dental anxiety. Patients having dental extractions (n = 67) were randomized to (i) auricular acupuncture, (ii) placebo acupuncture, and (iii) intranasal midazolam and compared with a no treatment group. Anxiety was assessed before the interventions, at 30 min, and after the dental extraction. Physiological variables were assessed continuously. With the no treatment group as control, the auricular acupuncture group, and the midazolam group were significantly less anxious at 30 min as compared with patients in the placebo acupuncture group (Spielberger Stait-Trait Anxiety Inventory X1, P = 0.012 and <0.001, respectively). In addition, patient compliance assessed by the dentist was significantly improved if auricular acupuncture or application of intranasal midazolam had been performed (P = 0.032 and 0.049, respectively). In conclusion, both, auricular acupuncture and intranasal midazolam were similarly effective for the treatment of dental anxiety.


Assuntos
Acupuntura Auricular/métodos , Ansiedade ao Tratamento Odontológico/terapia , Terapia por Acupuntura/métodos , Terapia por Acupuntura/psicologia , Acupuntura Auricular/psicologia , Adulto , Ansiedade ao Tratamento Odontológico/tratamento farmacológico , Ansiedade ao Tratamento Odontológico/psicologia , Feminino , Humanos , Masculino , Midazolam/uso terapêutico , Pessoa de Meia-Idade , Extração Dentária/métodos , Extração Dentária/psicologia
15.
J Rehabil Med ; 39(1): 77-80, 2007 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-17225042

RESUMO

OBJECTIVE: To study the efficacy of a flexible orthotic device in patients with osteoporosis. DESIGN: Open observational study. PATIENTS: Fifty patients with osteoporosis. METHODS: An open observational study was performed on 50 patients with osteoporosis in order to investigate the efficacy of a new osteoporosis orthotic device, which is an elastic back support with paravertebral air chamber pads. The outcome parameters were pain, activities of daily living, individual compliance and comfort. The observation period was approximately 2.5 months, and the orthotic device was worn continuously during daytime. RESULTS: There was a highly significant reduction in pain under exertion from mean 6.1 (SD 1.7) to 4.5 (SD 1.4) (p < 0.00001), pain when driving (from 5.2 (SD 2.4) to 3.8 (SD 1.9) (p < 0.00001)), and pain at rest from 4.1 (SD 2.4) to 3.1 (SD 1.9) (p < 0.0001). About 50% of the patients judged their ability to perform everyday activities as "much better"or "better". If physiotherapy was interrupted upon onset of orthosis treatment, the results were significantly worse than in patients with continued physiotherapy. CONCLUSION: This orthotic device could be a useful addition to the medical care of patients with osteoporosis and a complement to drug treatment and physiotherapy with regular exercises, which should be continued.


Assuntos
Aparelhos Ortopédicos , Osteoporose Pós-Menopausa/reabilitação , Atividades Cotidianas , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Pessoa de Meia-Idade , Osteoporose Pós-Menopausa/psicologia , Medição da Dor , Modalidades de Fisioterapia , Qualidade de Vida , Inquéritos e Questionários , Resultado do Tratamento
19.
Genet Test Mol Biomarkers ; 16(8): 892-6, 2012 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-22784335

RESUMO

The etiology of multisomatoform disorder (MSD) is largely unknown, but an influence of genetic factors is likely. Since pain is a major component of MSD and dopamine as well as serotonin are involved in pain pathways, genes of the dopaminergic and serotonergic system are promising candidate genes and we assumed that polymorphisms could be associated with MSD. One hundred forty-nine patients with MSD and 149 age- and gender-matched healthy controls participated in this study. DNA from all participants was genotyped for 22 single nucleotide polymorphisms (SNPs) within genes of the dopaminergic and serotonergic system by polymerase chain reaction, a restriction enzyme analysis, and pyrosequencing. The distribution of SNP alleles, genotypes, and haplotypes was compared between patients and controls. Neither an allelic nor a genotypic association was found for any individual SNP, but testing for a haplotypic association revealed that a haplotype of the serotonergic genes HT(1B) and HT(1D) indicated a lower risk. However, this statistically insignificant protective effect became highly significant on the background of two DAT1 haplotypes. Interestingly, if these two DAT1 haplotypes are analyzed without considering the serotonergic genes as confounders, they are significantly associated with an enhanced risk. Taking into account observations from recent publications, this apparent contradiction might be explained with the complex interaction of the dopaminergic and serotonergic systems. To conclude, our results reveal an involvement of polymorphisms in dopaminergic and serotonergic genes in the etiology of MSD in patients of German descent, but their exact role in MSD requires further investigation.


Assuntos
Dopamina/fisiologia , Predisposição Genética para Doença , Serotonina/fisiologia , Transtornos Somatoformes/genética , Adulto , Estudos de Casos e Controles , Feminino , Haplótipos , Humanos , Masculino , Pessoa de Meia-Idade , Projetos Piloto , Polimorfismo de Nucleotídeo Único , Fatores de Risco
20.
Genet Test Mol Biomarkers ; 14(3): 293-7, 2010 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-20373853

RESUMO

The etiology of multisomatoform disorder (MSD) is largely unknown, but genetic disposition may be one of several risk factors. As pain is a major component of MSD, and polymorphisms in the catechol-O-methyltransferase (COMT) gene are associated with COMT enzymatic activity and pain sensitivity, we assumed that COMT polymorphisms could be associated with MSD. One hundred and forty-nine patients with MSD and 149 age- and sex-matched healthy controls participated in this study. The inclusion criteria for MSD were in accordance with the structured clinical interview of the diagnostic and statistical manual of mental disorders IV. DNA from MSD patients and controls was genotyped for six single-nucleotide polymorphisms (SNPs) within the COMT locus by polymerase chain reaction and restriction enzyme analysis. The distribution of COMT SNP alleles, genotypes, and haplotypes was compared between patients and controls. None of the investigated SNPs, including the functionally relevant common SNP in codon 158 (Val158Met), showed a statistically significant allelic, genotypic, or haplotypic association with MSD. We conclude that COMT polymorphisms on their own do not seem to play a relevant role as major genetic risk factors for MSD.


Assuntos
Catecol O-Metiltransferase/genética , Polimorfismo de Nucleotídeo Único/genética , Transtornos Somatoformes/genética , Adulto , Alelos , Estudos de Casos e Controles , Feminino , Frequência do Gene , Predisposição Genética para Doença , Genótipo , Alemanha , Haplótipos/genética , Humanos , Masculino , Pessoa de Meia-Idade , Reação em Cadeia da Polimerase , Grupos Populacionais/genética , Transtornos Somatoformes/diagnóstico
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