Transdermal Opioids and the Quality of Life of the Cancer Patient: A Systematic Literature Review.

OBJECTIVE: This systematic literature review aims to evaluate the effectiveness of transdermal opioids in managing cancer pain and their impact on the quality of life (QoL) of patients. DATA SOURCES: A systematic literature review conducted following the PRISMA protocol, focusing on randomized clinical trials found in the Lilacs, Embase, PubMed, and SciELO databases over the last 20 years. STUDY SELECTION AND DATA EXTRACTION: We included randomized clinical trials, published in English, Portuguese, or Spanish, which assessed the impact of transdermal opioids on the QoL. Data extraction was facilitated using the Rayyan app. DATA SYNTHESIS: Six articles meeting the inclusion and exclusion criteria were analyzed. These studies covered a population ranging from 24 to 422 cancer patients experiencing moderate to severe pain. The risk of bias was assessed in each study, generally being categorized as uncertain or high. RELEVANCE TO PATIENT CARE AND CLINICAL PRACTICE: The findings indicate that the analgesic effectiveness and side effects of transdermal formulations (specifically buprenorphine and fentanyl) for managing moderate to severe cancer pain are comparable to, or in some cases superior to, those of oral opioids traditionally employed. CONCLUSIONS: Transdermal therapy was suggested to have several advantages over oral opioid therapy in enhancing cancer patients' QoL. These benefits span various dimensions, including pain management, physical functioning, mental health, vitality, overall patient improvement, anger/aversion, strength/activity, general QoL, cognitive and emotional functions, fatigue, and insomnia.

The efficacy of Botulinum Toxin in Tennis Elbow: a meta-analysis of randomized clinical trials.

PURPOSE: This study aims to assess the efficacy of botulinum toxin type A (BT-A) in treating tennis elbow. METHODS: We systematically reviewed the literature and included full-text randomized clinical trials (RCTs) published until June 2024, available in PubMed, Scopus, Embase, and Cochrane CENTRAL databases. Eligible studies involved patients with tennis elbow and compared BT-A with placebo or other injectable treatments. Primary outcomes included pain relief, while secondary outcomes assessed quality of life, adverse effects, and grip strength. The risk of bias was evaluated using the Cochrane Risk of Bias tool. RESULTS: Seven RCTs with a total of 381 patients were included. The participants were predominantly middle-aged (mean age 46.64 ± 7.72 years) and diagnosed with chronic tennis elbow. BT-A doses ranged from 20U to 60U. Compared to placebo, BT-A effectively reduced pain at two to four weeks (MD = -1.37; 95% CI = -2.18 to -0.57) and at eight to 12 weeks (MD = -1.13; 95% CI = -1.62 to -0.65). Grip strength was comparable between the BT-A and placebo groups at both time points (2 to 4 weeks: SMD = -0.86; 95% CI -1.78 to 0.05; 8 to 12 weeks: SMD = 0.00; 95% CI = -0.95 to 0.95). CONCLUSION: This meta-analysis suggests that BT-A reduces pain in tennis elbow within two to 12 weeks compared to placebo. Findings are limited by study size, and further research is needed to confirm its efficacy and safety.

Immune response and cytokine profiles in post-laminectomy pain syndrome: comparative analysis after treatment with intrathecal opioids, oral opioids, and non-opioid therapies.

INTRODUCTION: This study explores the interaction between cytokines, cell-mediated immunity (T cells, B cells, and NK cells), and prolonged morphine administration in chronic neuropathic pain patients without cancer-related issues. Despite evidence of opioid immunomodulation, few studies have compared these interactions. METHODS: In a cross-sectional and comparative study, 50 patients with chronic low back radicular pain ("Failed Back Surgery Syndrome") were categorized into intrathecal morphine infusion (IT group, n = 18), oral morphine (PO group, n = 17), and non-opioid treatment (NO group, n = 15). Various parameters, including plasma and cerebrospinal fluid (CSF) cytokine concentrations, lymphocyte immunophenotyping, opioid escalation indices, cumulative morphine dose, and treatment duration, were assessed. RESULTS: CSF IL-8 and IL-1ß concentrations exceeded plasma levels in all patients. No differences in T, B, and NK lymphocyte numbers were observed between morphine-treated and non-treated patients. Higher plasma IL-5 and GM-CSF concentrations were noted in IT and PO groups compared to NO. CSF IFNγ concentrations were higher in PO and NO than IT. Positive correlations included CD4 concentrations with opioid escalation indices, and negative correlations involved NK cell concentrations, CSF TNFα concentrations, and opioid escalation indices. Positive correlations were identified between certain cytokines and pain intensity in IT patients, and between NK cells and cumulative morphine dose. Negative correlations were observed between CSF IL-5 concentrations and pain intensity in IT and PO, and between opioid escalation indices and CSF cytokine concentrations in PO and IT. CONCLUSION: Associations between cytokines, cellular immunity, and prolonged morphine treatment, administered orally and intrathecally were identified.

The efficacy of botulinum toxin in neuropathic pain: a systematic review.

Introduction: Neuropathic pain (NP) is characterised as a lesion or disease directly affecting the somatosensory system. This study aims to analyse the efficacy of botulinum toxin type A (BT-A) in the treatment of neuropathic pain. Methods: This systematic literature review, guided by PRISMA, applied the PICO strategy with the following criteria: (P = patients with neuropathic pain, I = botulinum toxin, C = placebo or active drug, and O = pain relief). Results: Fourteen articles, all randomised controlled trials with a placebo control, were included in the review. A total of 645 patients were randomised, with 353 patients receiving treatment with botulinum toxin type A in doses ranging from 25U to 400U. The evaluated studies addressed trigeminal neuralgia, diabetic polyneuropathy, post-herpetic neuralgia, spinal cord injury, phantom limb pain, and peripheral neuropathic pain after trauma or surgery. Conclusion: BT-A has emerged as a promising treatment for various origins of neuropathic pain. Therefore, future studies should adopt stricter criteria regarding dosage and routes of administration to ensure effective and consistent BT-A application.

Evaluation of Mandibular Bone Microstructure in CT Scans of People with Sickle Cell Disease.

OBJECTIVE: Sickle cell disease (SCD) is a common inherited disease, and is characterized by a genetic modification that determines the production of a hemoglobin with altered morphology. This anatomical change of hemoglobin leads to vaso-occlusive disorders and premature hemolysis of the cell, causing chronic anemia and bone marrow hyperplasia due to increased hematopoietic demand. As a consequence, several skeletal changes are reported in the skull, spine, ribs, pelvis, femur, and metatarsals. In the craniofacial region, dentofacial deformities are described, especially maxillary protrusion. However, studies evaluating bone microarchitecture are scarce. The aim of this study is to evaluate the mandibular bone microstructure of people with SCD on computed tomography (CT) scans. MATERIALS AND METHODS: Morphometric parameters were analyzed on CT scans of the mandible of people with SCD and people without this disease or any other disease affecting bone metabolism, matched for sex and age. STATISTICAL ANALYSIS: The results were compared by Student's t-test for paired samples and for an error probability of 5%. RESULTS: This study demonstrated that the mandibular bone of people with SCD presents significantly less number, connectivity and thickness of bone trabeculae, as well as having a lower fractal dimension and greater porosity. CONCLUSION: Mandibular bone of people with SCD has lower bone density and more widely spaced trabeculae.

Evaluating the efficacy of botulinum toxin in treating complex regional pain syndrome: A systematic review.

Complex Regional Pain Syndrome (CRPS) is characterized by pain, swelling, limited range of motion, skin changes, vasomotor instability, and bone demineralization. This study aims to assess the efficacy of botulinum toxin type A (BoNT-A) in the treatment of CRPS. We conducted a systematic literature review following the PRISMA guidelines, using the PICO strategy (Patient, Intervention, Comparison and Outcome) with the following criteria: P = Patients with CRPS; I = Botulinum toxin; C = Placebo or active drug; and O = Pain relief. Three randomized controlled trials with placebo controls were included, involving a total of 64 patients, 36 of whom received BoNT-A in doses ranging from 40U to 200U. The studies examined both lumbar sympathetic block and local application methods. Botulinum toxin shows promise in alleviating pain associated with CRPS, particularly when used as an adjunct to lumbar sympathetic blockade. However, the limited number of studies and small sample sizes impede reaching definitive conclusions regarding its efficacy and safety. Notably, local applications (intradermal or subcutaneous) require further investigation, as current evidence is insufficient and reports indicate patient discomfort. While preliminary findings suggest potential benefits of BoNT-A in managing CRPS, larger randomized trials are necessary to confirm its efficacy and safety.

Qualidade de vida relacionada à saúde de profissionais de enfermagem na Bahia na pandemia da COVID-19 / Health-related quality of life of nursing professionals in Bahia, Brazil, in the COVID-19 pandemic / Calidad de vida de los profesionales de enfermería en Bahía, Brasil, en la pandemia COVID-19

Objetivo: Identificar fatores associados à qualidade de vida relacionada à saúde de profissionais de enfermagem da Bahia durante a pandemia da COVID-19. Método: Estudo transversal, amostragem tipo snowball com 113 enfermeiras(os) e técnicas(os) de enfermagem. De setembro/2020 a maio/2021, num formulário eletrônico, coletaram-se informações sociodemográficas, ocupacionais, epidemiológicas e de qualidade de vida, avaliada pelo questionário WHOQOL-BREF nos seus domínios Físico, Psicológico, Relações sociais e Meio ambiente. Utilizou-se regressão linear múltipla para identificar fatores associados à variação dos domínios do WHOQOL-BREF. Resultados: Baixos escores de qualidade de vida associaram-se significantemente a várias características dos profissionais: ser caso suspeito de COVID-19, no domínio Físico; ficar sem exercer a profissão por causa da COVID-19, nos domínios Físico e Psicológico; trabalhar exclusivamente em instituições privadas, no domínio Relações sociais; ter mais idade, no domínio Relações sociais; e não receber apoio social de outras pessoas, nos domínios Físico, Psicológico, Relações sociais e Meio Ambiente. Conclusão e implicações para a prática: Ter mais idade, vínculo exclusivo com instituição privada, ser caso suspeito de COVID-19, ficar sem exercer a profissão por causa da COVID-19 e não receber apoio social associaram-se à baixa qualidade de vida de profissionais de enfermagem durante a pandemia

Objective: To identify factors associated with the health-related quality of life of nursing professionals in Bahia, Brazil, during the COVID-19 pandemic. Method: Cross-sectional study with snowball sampling including 113 nurses and nursing technicians. From September 2020 to May 2021, sociodemographic, occupational, epidemiological, and quality of life information was collected in an electronic form and evaluated with the WHOQOL-BREF questionnaire, according to its Physical, Psychological, Social relations, and Environmental domains. Multiple linear regression was used to identify factors associated with variation in the four quality of life domains of the WHOQOL-BREF. Results: Low quality of life mean scores were significantly associated with being a suspected case of COVID-19 (in the Physical domain), withdrawing from professional practice due to COVID-19 (Physical and Psychological domains), working exclusively in private institutions (Social relations), older age (Social relations), and lack of social support (in the Physical, Psychological, Social Relations, and Environmental domains). Conclusion and implications for the practice: Older age, exclusive work in private institutions, being a suspected case of COVID-19, withdrawing from professional practice due to COVID-19, and lack of social support were associated with lower quality of life of nursing professionals during the pandemic

Objetivo: Identificar factores asociados a la calidad de vida relacionada con la salud de los profesionales de enfermería de Bahía, Brasil, durante la pandemia de COVID-19. Método: Estudio transversal, muestreo bola de nieve, con 113 enfermeros y técnicos de enfermería. De septiembre 2020 a mayo 2021, en formulario electrónico, fueron recolectadas informaciones sociodemográficas, ocupacionales, epidemiológicas y de calidad de vida, evaluadas por el cuestionario WHOQOL-BREF en sus dominios Físico, Psicológico, Relaciones Sociales y Medio Ambiente. Se utilizó la regresión lineal múltiple para identificar factores asociados con los dominios del WHOQOL-BREF. Resultados: Los puntajes bajos de calidad de vida se asociaron significativamente con ser un caso sospechoso de COVID-19 (en el dominio Físico); no ejercer la profesión a causa del COVID-19 (dominios Físico y Psicológico); trabajar exclusivamente en instituciones privadas (Relaciones Sociales); mayor edad (Relaciones Sociales); y no recibir apoyo social (en los dominios Físico, Psicológico, Relaciones Sociales y Medio Ambiente). Conclusión e implicaciones para la práctica: Mayor edad, tener vinculación exclusiva con una institución privada, ser caso sospechoso de COVID-19, no ejercer la profesión a causa del COVID-19 y no recibir apoyo social se asociaron con la baja calidad de vida de los profesionales de enfermería durante la pandemia