Neuropathic pain evaluation tools / Instrumentos de avaliação da dor neuropática

ABSTRACT BACKGROUND AND OBJECTIVES: Pain is a subjective symptom which may be measured by means of its several features, such as intensity, quality, location, duration and impact on daily activities. Due to the lack of means to better classify such symptoms, several studies have used intensity as the only evaluation measurement. To develop other types of research it was necessary the development of new tools to identify and measure remaining domains of pain. This review aimed at describing and analyzing available tools for neuropathic pain diagnosis and evaluation. CONTENTS: Several tools were developed to evaluate neuropathic pain. Among them there are those validated for neuropathic pain in general, such as Leeds Assessment of Neuropathic Symptoms and Signs Pain Scale and its self-report version (self-administered LANNS), Douleur Neuropathique 4 Questions, Neuropathic Pain Questionnaire and its short form (NPQshort form), painDetect and ID-Pain. These are the most widely used tools worldwide for having a cutoff point, which makes them more objective tools. Other tools are Neuropathic Pain Scale, Pain Quality Assessment Scale and Neuropathic Pain Symptom Inventory. Tools translated and validated for the Portuguese language are Leeds Assessment of Neuropathic Symptoms and Signs Pain Scale, Douleur Neuropathique 4 Questions and Neuropathic Pain Symptom Inventory. CONCLUSION: There are several tools which may be used to screen neuropathic pain, while others were developed for its evaluation. Among them there are those more objective and more commonly used. Some of these tools were translated and validated for the Brazilian Portuguese language.

RESUMO JUSTIFICATIVA E OBJETIVOS: Dor é um sintoma subjetivo que pode ser mensurado por meio de suas várias características, como intensidade, qualidade, localização, duração e impacto nas atividades diárias. Devido à falta de meios para caracterizar com maior propriedade esses sintomas, vários estudos se utilizaram da intensidade como sua única medida de avaliação. Para o desenvolvimento de outros tipos de pesquisa, fazia-se necessária a elaboração de novos instrumentos para identificação e mensuração dos demais domínios da dor. O objetivo desta revisão foi a descrição e análise dos instrumentos disponíveis para o diagnóstico e avaliação de dor neuropática. CONTEÚDO: Inúmeros instrumentos foram desenvolvidos para a avaliação da dor neuropática. Dentre eles estão aqueles que foram validados para dores neuropáticas em geral, como a Leeds Assessment of Neuropathic Symptoms and Signs Pain Scale e sua versão autoaplicável (self-administered LANNS), o Douleur Neuropathique 4 Questions, o Neuropathic Pain Questionnaire e sua versão mais curta (NPQ-short form), o painDetect e o ID-Pain. Esses são os mais utilizados internacionalmente por apresentarem um ponto de corte, o que os torna instrumentos mais objetivos. Os demais instrumentos são a Neuropathic Pain Scale, a Pain Quality Assessment Scale e o Neuropathic Pain Symptom Inventory. Os instrumentos traduzidos e validados para o português são a Leeds Assessment of Neuropathic Symptoms and Signs Pain Scale, o Douleur Neuropathique 4 Questions e o Neuropathic Pain Symptom Inventory. CONCLUSÃO: Há diversos instrumentos que podem ser utilizados para o rastreio de dor neuropática; outros foram desenvolvidos para sua avaliação. Dentre eles há aqueles mais objetivos e mais utilizados. Alguns desses instrumentos foram traduzidos e validados para o português do Brasil.

Study of the use of analgesics by patients with headache at a specialized outpatient clinic (ACEF).

OBJECTIVE: To evaluate the use of analgesics in headache diagnosed in Outpatients Headache Clinic (ACEF), as well as his involvement in the activities of the patients. METHOD: 145 patients with headache seen at ACEF during the period August/July 2009/2010 underwent a questionnaire and interview with neurologist responsible for the final diagnosis according to ICHD-II. RESULTS: Relationship Women:Men 7:1. 1) Prevalence: Migraine without aura (52.4%), migraine with aura (12.4%), chronic migraine (15.2%) and medication overuse headache (MOH) (20%). 2) Analgesic drugs used: Compounds with Dipyrone (37%), Dipyrone (23%), Paracetamol (16%) compound with Paracetamol (6%), triptans (6%) and non steroidal anti-inflammatory drugs (12%). There was a significant decrease in the duration of pain and less interference in the activities of the headache patients after the use of analgesics. CONCLUSION: Prevalence of MOH has been increasing in population level and specialized services. New studies emphasizing the MOH are needed to assist in the improvement of their diagnostic and therapeutic approach.

Study of the use of analgesics by patients with headache at a specialized outpatient clinic (ACEF) / Estudo do uso de analgésicos em pacientes com cefaleia em um ambulatório especializado (ACEF)

Objective : To evaluate the use of analgesics in headache diagnosed in Outpatients Headache Clinic (ACEF), as well as his involvement in the activities of the patients. Method : 145 patients with headache seen at ACEF during the period August/July 2009/2010 underwent a questionnaire and interview with neurologist responsible for the final diagnosis according to ICHD-II. Results : Relationship Women:Men 7:1. 1) Prevalence: Migraine without aura (52.4%), migraine with aura (12.4%), chronic migraine (15.2%) and medication overuse headache (MOH) (20%). 2) Analgesic drugs used: Compounds with Dipyrone (37%), Dipyrone (23%), Paracetamol (16%) compound with Paracetamol (6%), triptans (6%) and non steroidal anti-inflammatory drugs (12%). There was a significant decrease in the duration of pain and less interference in the activities of the headache patients after the use of analgesics. Conclusion : Prevalence of MOH has been increasing in population level and specialized services. New studies emphasizing the MOH are needed to assist in the improvement of their diagnostic and therapeutic approach. .

Objetivo : Avaliar a utilização de analgésicos nas cefaleias diagnosticadas no Ambulatório de Cefaleias (ACEF), bem como a sua intervenção nas atividades dos pacientes. Método : 145 pacientes com cefaleia atendidos no ACEF durante o período entre Agosto/2009 a Julho/2010 foram submetidos a um questionário e à entrevista com médico neurologista responsável pelo diagnóstico final, segundo a ICHD-II. Resultados : Relação Mulheres:Homens de 7:1. 1) Prevalência: Migrânea sem aura (52,4%), migrânea com aura (12,4%), migrânea crônica (15,2%) e CEM (20%). 2) Analgésicos utilizados: Compostos com Dipirona (37%), Dipirona (23%), Paracetamol (16%), compostos com Paracetamol (6%), triptanos (6%) e drogas antiinflamatórias esteroidais (12%). Houve uma diminuição significativa da duração da dor e menor interferência da cefaleia nas atividades dos pacientes após o uso dos analgésicos. Conclusão : Prevalência da cefaleia por uso excessivo de medicamento (CEM) vem aumentando em nível populacional e em serviços especializados. Novos estudos enfatizando a CEM são necessários para auxiliar na melhora da sua abordagem diagnóstica e terapêutica. .

Latin American consensus on guidelines for chronic migraine treatment.

Chronic migraine is a condition with significant prevalence all around the world and high socioeconomic impact, and its handling has been challenging neurologists. Developments for understanding its mechanisms and associated conditions, as well as that of new therapies, have been quick and important, a fact which has motivated the Latin American and Brazilian Headache Societies to prepare the present consensus. The treatment of chronic migraine should always be preceded by a careful diagnosis review; the detection of possible worsening factors and associated conditions; the stratification of seriousness/impossibility to treat; and monitoring establishment, with a pain diary. The present consensus deals with pharmacological and nonpharmacological forms of treatment to be used in chronic migraine.

Latin American consensus on guidelines for chronic migraine treatment / Consenso latino-americano para as diretrizes de tratamento da migranea cronica

Chronic migraine is a condition with significant prevalence all around the world and high socioeconomic impact, and its handling has been challenging neurologists. Developments for understanding its mechanisms and associated conditions, as well as that of new therapies, have been quick and important, a fact which has motivated the Latin American and Brazilian Headache Societies to prepare the present consensus. The treatment of chronic migraine should always be preceded by a careful diagnosis review; the detection of possible worsening factors and associated conditions; the stratification of seriousness/impossibility to treat; and monitoring establishment, with a pain diary. The present consensus deals with pharmacological and nonpharmacological forms of treatment to be used in chronic migraine.

A migrânea crônica é uma condição com prevalência significativa ao redor do mundo e alto impacto socioeconômico, sendo que seu manuseio tem desafiado os neurologistas. Os avanços na compreensão de seus mecanismos e das condições a ela associadas, bem como nas novas terapêuticas, têm sido rápidos e importantes, fato que motivou as Sociedades Latino-americana e Brasileira de Cefaleia a elaborarem o presente consenso. O tratamento da migrânea crônica deve ser sempre precedido por uma revisão cuidadosa do diagnóstico, pela detecção de possíveis fatores de piora e das condições associadas, pela estratificação de gravidade/impossibilidade de se tratar e pelo monitoramento com um diário da dor. Este consenso apresenta abordagens farmacológicas e não-farmacológicas para tratar a migrânea crônica.