Capsaicin 8% for Peripheral Neuropathic Pain Treatment: A Retrospective Cohort Study.

BACKGROUND: Chronic neuropathic pain is a disabling condition that affects quality of life. Despite recommendations and guidelines, treatment remains suboptimal as it often does not result in significant symptom relief. Capsaicin 8% patch has been used for the treatment of several peripheral neuropathic pain etiologies with encouraging results. OBJECTIVES: To assess the results of capsaicin 8% patch on neuropathic pain by evaluating pain intensity and the painful treatment area. STUDY DESIGN: Observational retrospective cohort study. SETTING: All patients submitted to capsaicin treatment at the Chronic Pain Unit of the Hospital Centre of Tondela Viseu, from 2011 through 2019. METHODS: Records of capsaicin treatments were reviewed, and the data collected. The primary outcome was pain intensity and painful treatment area reduction between the first and last treatment. Also, the number of treatments performed, neuropathic pain duration, anatomic location, pain etiology, and concomitant oral pain medication at baseline and upon treatment conclusion was also listed. RESULTS: Postsurgical neuropathic pain was the most common etiology (49%), followed by postherpetic (28%). The median (interquartile range [IQR]) baseline pain intensity assessed by the Numeric Rating Scale (NRS-11) was 6 (5-8) and the median (IQR) final NRS-11 was 3 (1-5), with a median (IQR) relative difference of -0.5 (-0.85-0.17) with statistically significant differences (P < 0.001) between baseline and last pain intensity, regarding all groups. Also, there was a reduction in the painful treatment area between baseline and the last evaluation, with a median (IQR) relative difference of -0.4 (-0.625-0.167). LIMITATIONS: A relatively small sample and occasional different timing for pain intensity and pain treatment area assessment due to logistical difficulties. CONCLUSIONS: Capsaicin 8% patch is a valuable option for the treatment of peripheral neuropathic pain, providing a significant reduction in pain intensity and painful area. It is well tolerated and has a high treatment compliance.Ethics Committee Reference Number: 16/16//04/2021.

Intervenções de Enfermagem à Pessoa com Síndrome de Dificuldade Respiratória Aguda em Decúbito Ventral: Construção e Validação de um Protocolo / Nursing Interventions for a person with acute respiratory distress syndrome in ventral decubitus: Construction and Validation of a Protocol

Introdução: A construção e validação de um Protocolo de Intervenções de Enfermagem (PIE) à pessoa com Síndrome de Dificuldade Respiratória Aguda (SDRA) em decúbito ventral (DV), surgiu da necessidade de constituir uma ferramenta de apoio ou guia orientador de uma prática de cuidados de enfermagem à Pessoa em Situação Crítica (PSC) mais diferenciada e uniformizada em contexto de cuidados intensivos. Esta pesquisa visa conhecer a perceção dos enfermeiros sobre a necessidade de um PIE à pessoa com SDRA em DV (estudo I), desenvolver e validar um PIE à pessoa com SDRA em DV, recorrendo a um painel de peritos (estudo II). Metodologia Esta pesquisa inclui dois estudos complementares. O estudo I (descritivo-correlacional) incluiu 30 enfermeiros que exercem funções no Serviço de Medicina Intensiva do Centro Hospitalar de Leiria. Foi aplicado um questionário sobre a perceção da necessidade de um PIE à pessoa com SDRA em DV, sendo utilizados o Teste U de Mann-Whitney e o Teste de Correlação de Spearman. O estudo II (descritivo) recorreu à metodologia delphi. Para tal, constituiu-se um painel de enfermeiros peritos, definiram-se critérios de inclusão e realizaram-se duas rondas aplicando questionários online através da plataforma google forms. Participaram na 1ª ronda 35 enfermeiros peritos e 26 na 2ª ronda. Pretendeu-se obter pelo menos 75% de consenso de inclusão nas respostas fornecidas pelos enfermeiros peritos, sendo que a 2ª ronda surge após análise dos resultados da 1ª ronda. Resultados: O estudo I revelou que a maioria dos enfermeiros apresentam uma tendência positiva para a perceção da necessidade de um PIE à pessoa com SDRA em DV. Verificou-se que a perceção da necessidade de um PIE é superior junto do grupo de enfermeiros que não têm formação especifica na área da SDRA em DV. Confirmou-se, assim a existência de diferenças significativas no que respeita ao facto de ser útil, facilitar a prestação cuidados, e contribuir para a redução de complicações durante o procedimento. O estudo II revelou que apenas uma das 54 intervenções apresentadas aos enfermeiros peritos não obteve consenso de inclusão após as duas rondas do painel delphi e validou a pertinência de intervenções no âmbito das indicações e contraindicações do DV, preparação e execução, complicações, cuidados à pessoa em DV e sua duração. Conclusão: A existência de um PIE validado à pessoa com SDRA em DV é uma ferramenta de apoio à tomada de decisão, assegura uma sequência de cuidados baseados na evidência científica, promove a qualidade e a prática de cuidados de enfermagem à PSC mais diferenciada e uniformizada.

Introduction: The construction and validation of a Nursing Interventions Protocol (NIP) for people with Acute Respiratory Distress Syndrome (ARDS) in the prone position (PP) emerged from the need to provide a support tool or a guide for a more differentiated and standardized nursing practice for critical situation in intensive care context. This research's goal is to understand nurses' perception of the need for a NIP to the person with ARDS in PP (study I), to develop and validate a NIP to the person with ARDS in PP, using an expert panel (study II). Methodology: This research includes two complementary studies. The study I (descriptivecorrelational) included 30 nurses who work in the Intensive Care Unit of the Centro Hospitalar de Leiria. A questionnaire was applied about the perception of the need for a NIP to the person with ARDS in PP, and the Mann-Whitney U Test and the Spearman Correlation Test were used. The study II (descriptive) followed the delphi technique methodology. For such, a panel of expert nurses was established, inclusion criteria were defined, and two rounds conducted applying online questionnaires through the google forms platform. The first round included 35 expert nurses and 26 participated in the second round. The aim was to get at least 75% of inclusion consensus in the answers provided by the expert nurses. The second round came after the analysis of the results of the first round. Results: The study I revealed that most nurses have a positive tendency to perceive the need for a NIP to the person with ARDS in PP. It was found that the perception of the need for a NIP is higher among the group of nurses who do not have specific training in the area of ARDS in PP. These significant differences were confirmed about the fact that it is useful, facilitates care and contributes to reducing complications during the procedure. The study II revealed that only one of the 54 interventions presented to the expert nurses did not reach inclusion consensus after two rounds of the delphi panel. The relevance of interventions in the scope of PP indications and contraindications, preparation and execution, complications, care to the person in PP and its duration, were validated. Conclusion: The existence of a validated NIP to the person with ARDS in PP is a decision support tool, ensures a sequence of care based on scientific evidence, promotes quality and the differentiated and uniformed nursing practice for critical situation.