RESUMO
Introduction: Adaptation to chronic non-oncologic pain is associated with the development of psychopathology and personality disorders, creating severity, chronicity, poorer treatment response, and exacerbations in patients with neuropathy. Objective: To identify the psychopathological and personality proï¬les of patients with chronic nociceptive and neuropathic pain and their association with pain progression and intensity. Method: A cross-sectional, descriptive and comparative study was conducted in the Pain Treatment Unit of Hospital Universitari Sagrat Cor, with systematic randomized recruitment for 25 months; 115 patients were evaluated using the Hamilton Depression and Anxiety Rating Scale (HAM-D, HAM-A) and the Millon Clinical MultiaxialInventory-III (MCMI-III). Results: The neuropathic group achieved signiï¬cantly higher scores for pain intensity and depressive and anxiety symptoms. With greater magnitude and frequency, the neuropathic group related pain intensity and progression with depressive/anxiety symptoms, clinical syndromes, and personality patterns. Both groups revealed tendencies towards a compulsive personality pattern, followed by narcissistic, histrionic, and schizoid patterns. Conclusions: When treating chronic pain, the presence of various psychopathological indicators requires an individualized strategy.
Introducción: La adaptación al dolor crónico no oncológico se asocia al desarrollo de psicopatología y afectaciones de la personalidad, generando severidad, cronicidad, menor respuesta al tratamiento y agravándose ante la neuropatía. Objetivo: Identiï¬car perï¬les psicopatológicos y de personalidad en pacientes con dolor crónico nociceptivo y neuropático, y su relación con la evolución e intensidad del dolor. Método: Estudio transversal, descriptivo y comparativo, realizado en la Unidad de Tratamiento del Dolor del Hospital Universitari Sagrat Cor, con reclutamiento aleatorio sistemático durante 25 meses; 115 pacientes fueron evaluados mediante la Escala de Hamilton para la Depresión y Ansiedad (HAM-D, HAM-A) y el Inventario Clínico Multiaxialde Millon III (MCMI-III). Resultados: El grupo neuropático obtuvo puntuaciones signiï¬cativamente mayores en intensidad del dolor, sintomatología depresiva y ansiosa. Con más magnitud y frecuencia, relacionó la intensidad y evolución del dolor con sintomatología depresiva, ansiosa, síndromes clínicos y patrones de la personalidad. Ambos grupos revelaron tendencia al patrón de personalidad compulsiva, seguido del narcisista, histriónico y esquizoide. Conclusiones: En el tratamiento del dolor crónico, la presencia de distintos indicadores psicopatológicos requiere una estrategia individualizada.
RESUMO
BACKGROUND: The purpose of the present study was to show that sevoflurane is a safe and effective agent for the sedation of newborns and infants who are to undergo magnetic resonance imaging (MRI) examinations. METHODS: The study was performed on 640 infants aged from 1 day to 12 months given sevoflurane in high concentrations--up to 7% at the 2 min induction peak. Following induction and during MRI examination, the children were maintained with spontaneous respiration and sedation levels with a sevoflurane concentration of approximately 1.5-2%, in combination with a mixture of oxygen and nitrous oxide (50% O(2)-50% N(2)O). RESULTS: Sedation proved optimal in 97.9% of cases and complications were one case of vomiting, eight cases of minor hypoxia and two of severe hypoxia. No case of prolonged sedation or postoperative emergence agitation was observed. CONCLUSIONS: Sevoflurane is an ideal agent for this type of diagnostic procedure in newborns and infants. We discuss the need for elaborating specific protocols for pediatric sedation and emphasize the strict observation of recommendations, which include the practical experience and up-to-date specialized training of the anesthesiologist carrying out sedation procedures in children.
