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1.
Pain Med ; 16 Suppl 1: S37-43, 2015 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-26461075

RESUMO

OBJECTIVE: Cognitive effects and sedation (CES) are prevalent in chronic nonmalignant pain populations receiving long-term opioid therapy and are among the most common reasons patients discontinue opioid use. In this narrative review, we describe the phenomenology, epidemiology, mechanisms, assessment, and management of opioid-related CES. DESIGN: We reviewed the empirical and theoretical literature on CES in opioid-treated populations with chronic pain. Data on long-term opioid therapy (≥ 3 months in duration) in chronic nonmalignant pain patients were sought. RESULTS: The phenomenology of CES includes: inattention, concentration difficulties, memory deficits, psychomotor dysfunction, perceptual distortions, and executive dysfunction and somnolence, sleep disorders, and lethargy. Deficits may be caused by unrelieved pain or opioid therapy alone, or from a combination of these and other factors. Mechanisms include central nervous system effects, for example, direct toxic effects on neurons resulting in decreased consciousness; direct effects on processing and reaction resulting in cognitive or psychomotor impairment, and inhibitory effects on cholinergic activity. Pharmacological management approaches may include opioid dose reduction and rotation or psychostimulant use. Nonpharmacological approaches may include cognitive-behavioral therapy, mindfulness-based stress reduction, acupuncture, exercise, and yoga. CONCLUSIONS: The most prevalent CES include: memory deficits (73-81%), sleep disturbance (35-57%), and fatigue (10%). At its most severe, extreme cognitive dysfunction can result in frank delirium and decreased alertness can result in coma. Emotional distress, sleep disorders, and other comorbidities and treatments can worsen CES, particularly among the elderly. Conclusions about the neuropsychological domains affected by opioids are limited due to the heterogeneity of studies and methodological issues.


Assuntos
Analgésicos Opioides/farmacologia , Transtornos Cognitivos/tratamento farmacológico , Cognição/efeitos dos fármacos , Transtornos Relacionados ao Uso de Opioides/tratamento farmacológico , Dor/tratamento farmacológico , Humanos , Medição da Dor
2.
Clin Neuropsychol ; 35(8): 1485-1497, 2021 11.
Artigo em Inglês | MEDLINE | ID: mdl-32449495

RESUMO

OBJECTIVE: Neuropsychological evaluations in a geriatric population have an assortment of challenges due to increased risk in the population for chronic/acute medical conditions, varied psychiatric disorders, and chronic negative lifestyle behaviors, all which impact one's cognitive functioning. One relatively new challenge is conducting cognitive evaluations within an elderly transgender population. There is a considerable lack of specific normative data in neuropsychological evaluations for transgender individuals due to the prevalence of binary gender categorization in current scoring protocols. However, a reasonable question is whether gender is such a significant normative factor, as the field of neuropsychology once thought? METHOD: The current article reports on these issues in the context of a case of an 85-year-old transgender female who was referred to an outpatient neuropsychology service due to cognitive and functional declines. RESULTS: Her performance on the neuropsychological evaluation indicated significant decline across many of the cognitive domains measured. When using binary male and female normative data, scores did not statistically differ across the majority of the domains. CONCLUSIONS: Overall, it was difficult to determine nuanced gender differences due to the patient's marked cognitive impairment. Potentially, differences may be more obvious in a less impaired individual.


Assuntos
Demência , Pessoas Transgênero , Idoso , Idoso de 80 Anos ou mais , Cognição , Demência/complicações , Demência/diagnóstico , Demência/epidemiologia , Feminino , Humanos , Masculino , Testes Neuropsicológicos , Neuropsicologia
3.
Appl Neuropsychol Child ; 6(4): 335-344, 2017.
Artigo em Inglês | MEDLINE | ID: mdl-27366934

RESUMO

In adults, left temporal lobe pathology is typically associated with verbal memory deficits, whereas right temporal lobe pathology is thought to produce visual memory deficits in right-handed individuals. However, in children and adolescents with temporal lobe pathology, conclusions regarding material specificity of memory deficits remain unclear. The goal of the present case series is to examine the profile of verbal and visual memory impairment in children with temporal lobe tumors. Three patients with identified right temporal tumors and three patients with left temporal tumors are included. The Wide Range Assessment of Memory and Learning-Second Edition (WRAML-2) was administered as part of a larger neuropsychological battery. As anticipated, participants with right temporal lesions showed impaired visual memory relative to intact verbal memory. Interestingly, although the discrepancies between verbal and visual indices were less extreme, those with left temporal lesions showed a similar memory profile. These seemingly counterintuitive findings among left temporal tumor patients likely reflect less hemispheric specialization in children in comparison to adults and the fact that early developmental lesions in the left hemisphere may lead to functional reorganization of language-based skills.


Assuntos
Neoplasias Encefálicas/psicologia , Transtornos da Memória/psicologia , Memória/fisiologia , Convulsões/psicologia , Lobo Temporal/diagnóstico por imagem , Adolescente , Neoplasias Encefálicas/complicações , Neoplasias Encefálicas/diagnóstico por imagem , Criança , Feminino , Humanos , Inteligência/fisiologia , Masculino , Transtornos da Memória/diagnóstico por imagem , Transtornos da Memória/etiologia , Testes Neuropsicológicos , Convulsões/complicações , Convulsões/diagnóstico por imagem
4.
Clin J Pain ; 30(3): 205-13, 2014 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-23689351

RESUMO

OBJECTIVES: Smoking is associated with chronic pain and pain-related functional impairment. Some studies suggest that pain activates smoking urges and others suggest that smoking is analgesic. We evaluated these associations using ecological momentary assessment, a method for real-time measurement of health-related phenomena. METHODS: For 1 week, 36 chronic pain patients who smoked a mean of 17.5 (SD=9.4) cigarettes per day completed multiple daily assessments on a handheld computer. RESULTS: The sample included 67% women and 39% whites; 67% had back pain, with an average (SD) worst pain severity during the past week of 8.6 (1.5) on a 0 to 10 numeric rating scale. Patients completed an average (SD) of 44 (24) random assessments. At each assessment, the patient recorded pain "right now" on a 0 to 10 scale, whether he/she was "about to smoke," and if he/she had "just smoked in the past 30 minutes," pain before smoking. After controlling for other significant correlates of pain, patients who were about to smoke had more pain than at other times (M [SD]=6.5 [2.3] vs. 5.2 [2.4]; P<0.01), but pain before and after smoking was not different (M [SD]=6.1 [2.2] vs. 5.9 [2.3]; P=0.18). DISCUSSION: These findings support the hypothesis that smoking behavior is triggered by pain, but smoking is not analgesic. Future studies should clarify potential explanatory mechanisms for this pain-related trigger and evaluate tailored cessation strategies for pain patients.


Assuntos
Dor Crônica/psicologia , Fumar , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Aplicativos Móveis , Medição da Dor , Autorrelato , Fatores Socioeconômicos , Fatores de Tempo
5.
Clin Neuropsychol ; : 1-3, 2017 Nov 15.
Artigo em Inglês | MEDLINE | ID: mdl-29139327
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