Schizophrenia is associated with severe consequences / Asociación de la esquizofrenia con consecuencias graves

Schizophrenia is an illness that affects millions of individuals. It is typically accompanied by positive, negative and cognitive symptoms. These symptoms are typically associated with the onset and progression of schizophrenia. However, aside from these known symptoms, there are consequences of having schizophrenia. In particular, metabolic syndrome, early death and suicide, diseases, lowered pain perception, sexual dysfunction, aggressive behavior/victimization, stigma, and cognitive deficit are all consequences of having schizophrenia. In this paper, we review the various consequences of having schizophrenia. These consequences should be monitored for, much like the typical symptoms, but are usually omitted from treatment. (AU)

La esquizofrenia es una enfermedad que afecta a millones de individuos, y que normalmente se acompaña de síntomas positivos, negativos y cognitivos. Dichos síntomas están normalmente asociados al inicio y progresión de la esquizofrenia. Sin embargo, aparte de estos síntomas conocidos, existen consecuencias de padecer esquizofrenia. En particular, el síndrome metabólico, la muerte prematura y el suicidio, las enfermedades, la disminución de la percepción del dolor, la disfunción sexual, el comportamiento agresivo/victimización, el estigma, y el déficit cognitivo son consecuencias de padecer esquizofrenia. En este documento, revisamos las diversas consecuencias del padecimiento de esquizofrenia. Deberán supervisarse dichas consecuencias, al igual que los síntomas típicos, aunque normalmente se omiten del tratamiento de la enfermedad. (AU)

Sensibilidad al dolor en pacientes con esquizofrenia: una revisión sistemática y metaanálisis / Pain sensitivity in patients with schizophrenia: a systematic review and meta-analysis

Introducción: En personas diagnosticadas de esquizofrenia se han observado alteraciones en la percepción del dolor.Algunas investigaciones sugieren la existencia de una posiblehiposensibilidad, mientras que otras describen una hipersensibilidad al dolor en personas con esquizofrenia. En definitiva, los estudios presentan resultados contradictorios.Método. Se ha llevado a cabo una revisión sistemática deestudios experimentales y comparativos en 5 bases de datosdiferentes, incluyendo aquellos estudios que evalúan el dolorinducido de manera experimental mediante métodos físicosy comparando los resultados con un grupo control sano. Posteriormente, se ha llevado a cabo un metaanálisis comparando los pacientes con esquizofrenia con los controles sanos,utilizando un modelo de efectos aleatorios.Resultados. Finalmente fueron seleccionados nueve estudios, con un total de 186 participantes diagnosticados deesquizofrenia y 186 controles sanos. En el metaanálisis no seobservaron diferencias significativas en la comparación deanálisis general entre pacientes con esquizofrenia y controlessanos. No obstante, cuando el tipo de estímulo fue estudiadopor separado (mecánico, térmico o eléctrico), se observarondiferencias significativas a favor de una mayor sensibilidad aldolor en los pacientes con esquizofrenia en los estudios queevaluaron el dolor con presión mecánica o isquemia, perono en aquellos que utilizaron métodos térmicos o eléctricos.Conclusiones. El resultado global de nuestra revisión sistemática no respalda la existencia de una alteración en lasensibilidad al dolor en los sujetos con esquizofrenia, aunque un análisis de subgrupos sugiere que cuando el estímulodel dolor es causado por métodos mecánicos, las personascon esquizofrenia presentan una hipersensibilidad al doloren comparación con los controles sanos. Aunque estos resultados son datos novedosos, se requieren más estudios para replicar los resultados. (AU)

Background: Alterations in pain perception have been observed in people diagnosed with schizophrenia. Some researchsuggests the existence of a possible hyposensitivity, while othersdescribe a hypersensitivity to pain in people with schizophrenia.In summary, the studies present contradictory results.Methods. A systematic review of experimental andcomparative studies has been conducted in 5 differentdatabases, including those studies that measure pain experimentally inducing it with physical methods and thatcompares the results with a healthy control group. Afterwards, a meta-analysis was carried out comparing thepatients with schizophrenia to the healthy controls, usingthe random effects model.Results. Nine studies were finally selected, with a totalof 186 participants diagnosed with schizophrenia and 186healthy controls. In the meta-analysis, no significative differences were observed in the general analysis. But when thetype of stimuli was studied separately (mechanical, thermal, or electrical), significative differences in favor of a highersensitivity in the patients with schizophrenia were observedin the studies that measured pain with mechanical pressure or ischemia, not in those that used thermal or electricalmethods.Conclusions. The global result of our systematic reviewdoes not support the existence of an alteration in pain sensitivity in subjects with schizophrenia, although a subgroup analysissuggests that when pain stimulation is caused by mechanicalmethods, people with schizophrenia present hypersensitivity topain compared to healthy controls. Although these results arenovel data, more studies are required to replicate these results. (AU)

Espiritualidade e dor em pacientes com câncer de mama metastático / Spirituality and pain in patients with metastatic breast cancer / Espiritualidad y dolor en pacientes con cáncer de mama metastásico

Resumo Mediante estudo observacional, transversal e quantitativo que utilizou os instrumentos de avaliação Brief Pain Inventory (dor), Functional Assessment of Chronic Illness Therapy Spiritual Well-Being (bem-estar espiritual) e Beck Depression Inventory - Short Form (depressão), busca-se avaliar a influência da espiritualidade e da depressão na percepção de dor de pacientes acometidas por neoplasia de mama metastática. A idade média foi 57,3 anos e, das 30 participantes, 24 (80%) tratavam-se em serviço público; 17 (57%) tinham diagnóstico de câncer de mama há mais de cinco anos; e 27 (90%) realizavam alguma prática religiosa/espiritual. Pacientes com escore de bem-estar espiritual acima da mediana apresentaram menor escore dos sintomas depressivos (3 vs . 6; p =0,021). Não houve diferença significativa em relação à mediana do escore total do bem-estar espiritual quando estratificado pela mediana da percepção de dor (31,5% vs . 28,5%; p =0,405). Maior manifestação de bem-estar espiritual pode estar relacionada a menores índices de depressão.

Abstract This observational, cross-sectional and quantitative study, by means of the assessment instruments Brief Pain Inventory, Functional Assessment of Chronic Illness Therapy Spiritual Well-Being and Beck Depression Inventory - Short Form, evaluated the influence of spirituality and depression in the pain perception of patients with metastatic breast cancer. Mean age was 57.3 years. Of the 30 participants, 24 (80%) were treated in a public service, 17 (57%) had been diagnosed with breast cancer for more than 5 years, and 27 (90%) were religious or spiritual. Patients with spiritual well-being scores above the median had lower depressive symptom scores (3 vs. 6; p =0.021). The median total score of spiritual well-being showed no significant difference when stratified by median pain perception (31.5% vs. 28.5%; p =0.405). Greater spiritual well-being may be related to lower rates of depression.

Resumen Este estudio observacional, transversal y cuantitativo utilizó los instrumentos Brief Pain Inventory (dolor), Functional Assessment of Chronic Illness Therapy Spiritual Well-Being (bienestar espiritual) y Beck Depression Inventory - Short Form (depresión), para evaluar si la espiritualidad y la depresión influencian en la percepción del dolor en pacientes con cáncer de mama metastásico. La edad promedio fue de 57,3 años; de las 30 participantes, 24 (80%) recibían atención pública; 17 (57%) tenían diagnóstico de cáncer de mama hace más de cinco años; y 27 (90%) solían tener alguna práctica religiosa/espiritual. Aquellas con puntuación de bienestar espiritual superior a la mediana tuvieron una puntuación más baja de síntomas depresivos (3 vs. 6; p =0,021). No hubo diferencias significativas en la mediana de la puntuación total de bienestar espiritual cuando se estratificó por la percepción mediana del dolor (31,5% vs. 28,5%; p =0,405). Una mayor sensación de bienestar espiritual se relacionó a bajas tasas de depresión.

Effectiveness of mirror therapy in phantom limb pain: a literature review.

INTRODUCTION: Phantom limb pain (PLP) is a type of neuropathic pain that affects the territory of an amputated limb or other surgically removed body parts. Between 60% and 90% of amputees suffer from PLP during follow-up. There are a range of therapeutic options for PLP, both pharmacological (gabapentin, amitriptyline, tricyclic antidepressants, etc) and non-pharmacological (transcutaneous electrical nerve stimulation, hypnosis, acupuncture, etc). A widely accepted hypothesis considers PLP to be the consequence of postamputation cortical reorganisation. New treatment approaches, such as mirror therapy (MT), have been developed as a result of Ramachandran's groundbreaking research in the 1990s. This review analyses the current evidence on the efficacy of MT for treating PLP. DEVELOPMENT: We performed a literature review of publications registered from 2012 to 2017 on the CINAHL, Cochrane, Scopus, and PubMed (including Medline) databases using the descriptors "phantom limb" and "mirror therapy." We identified 115 publications addressing MT in PLP. Of these, 17 (15%) contributed useful information for pooled analysis. CONCLUSIONS: MT seems to be effective in relieving PLP, reducing the intensity and duration of daily pain episodes. It is a valid, simple, and inexpensive treatment for PLP. The methodological quality of most publications in this field is very limited, highlighting the need for additional, high-quality studies to develop clinical protocols that could maximise the benefits of MT for patients with PLP.

Efectividad de la terapia de espejo en el dolor del miembro fantasma. Una revisión actual de la literatura / Effectiveness of mirror therapy in phantom limb pain: A literature review

Introducción: El dolor del miembro fantasma (DMF) es un dolor de tipo neuropático que afecta al territorio de una extremidad amputada o a otras partes del cuerpo extirpadas quirúrgicamente. El 60-90% de los amputados sufren DMF durante el seguimiento. Se han descrito opciones terapéuticas para DMF, farmacológicas (gabapentina, amitriptilina, antidepresivos tricíclicos...) y no farmacológicas (TENS, hipnosis, acupuntura...). Una hipótesis predominante considera este fenómeno consecuencia de la reorganización cortical postamputación, y, tras investigaciones innovadoras de Ramachandran en los 90, se han desarrollado nuevos enfoques de tratamiento como la terapia de espejo (TE). En la presente revisión se analiza la evidencia actual publicada sobre la eficacia de la TE para el tratamiento del DMF.DesarrolloSe realizó una revisión bibliográfica, abarcando desde 2012 a 2017, de publicaciones registradas en las bases de datos Cinahl, Cochrane, Scopus y Pubmed (incluyendo Medline). Los descriptores utilizados para la búsqueda fueron los términos Phantom Limb y Mirror Therapy. Se identificaron 115 publicaciones que abordaban TE en DMF. De estas, 17 (15%) aportaban información útil para el análisis conjunto.ConclusionesLa TE parece ser efectiva en el alivio del DMF, reduciendo la intensidad y duración de los episodios de dolor diarios. Por otra parte, constituye un método válido, sencillo y muy económico. La calidad metodológica de la mayoría de las publicaciones en este campo es muy limitada, destacando la necesidad de estudios adicionales de alta calidad para desarrollar protocolos clínicos que puedan maximizar los beneficios de TE en pacientes con DMF. (AU)

Introduction: Phantom limb pain (PLP) is a type of neuropathic pain that affects the territory of an amputated limb or other surgically removed body parts. Between 60% and 90% of amputees suffer from PLP during follow-up. There are a range of therapeutic options for PLP, both pharmacological (gabapentin, amitriptyline, tricyclic antidepressants, etc) and non-pharmacological (transcutaneous electrical nerve stimulation, hypnosis, acupuncture, etc). A widely accepted hypothesis considers PLP to be the consequence of postamputation cortical reorganisation. New treatment approaches, such as mirror therapy (MT), have been developed as a result of Ramachandran's groundbreaking research in the 1990s. This review analyses the current evidence on the efficacy of MT for treating PLP.DevelopmentWe performed a literature review of publications registered from 2012 to 2017 on the CINAHL, Cochrane, Scopus, and PubMed (including Medline) databases Using the descriptors “phantom limb‿ and “mirror therapy.‿ We identified 115 publications addressing MT in PLP. Of these, 17 (15%) contributed useful information for pooled analysis.ConclusionsMT seems to be effective in relieving PLP, reducing the intensity and duration of daily pain episodes. It is a valid, simple, and inexpensive treatment for PLP. The methodological quality of most publications in this field is very limited, highlighting the need for additional, high-quality studies to develop clinical protocols that could maximise the benefits of MT for patients with PLP. (AU)

Comparison of gingival inflammatory parameters and pain perception on periodontal probing - a cross sectional study, part II / Comparación de parámetros inflamatorios gingivales y percepción del dolor en el sondaje periodontal - un estudio transversal, parte II

Background: Probing of the periodontal pocket is an essential part of the diagnosis of periodontal disease and 15-77% of untreated periodontal patients experience pain during probing. Therefore, the objective of this study is to evaluate the pain perceived by patients with dental plaque-induced gingivitis and chronic periodontitis during periodontal probing and the main objective includes the evaluation of the relationship between pain perceived during periodontal probing and gingival inflammatory parameters. Material and Methods: A total of 475 participants were recruited into the study. The patients were divided into two groups: Group-A (Gingivitis Group - 275 patients) and Group-B (Chronic Periodontitis Group - 200 patients). Clinical parameters included analysis of bleeding on probing, simplified gingival index, pocket depth on probing, and clinical attachment level. Pain score was recorded using the HP VAS scale and all patients participated in the study after a detailed explanation of the study protocol. Results: A significant difference in pain perception was noted between groups, highlighting the role of the degree of inflammation in the examination of periodontal parameters. Conclusion: Within the limitations of the present study, we can conclude that pain perception is directly correlated with the degree of inflammation in periodontitis rather than plaque-induced gingivitis during periodontal probing. Therefore, some form of adjuvant topical anesthesia may be considered in order to reduce pain levels in severely inflamed patients, to encourage continued acceptance of supportive periodontal therapy.

Antecedentes: El sondaje de la bolsa periodontal es una parte esencial en el diagnóstico de la enfermedad periodontal. 15-77% de los pacientes periodontales no tratados experimentan dolor durante el sondaje. Por lo tanto, el objetivo de este estudio es evaluar el dolor percibido por pacientes con gingivitis inducida por placa dental y periodontitis crónica durante el sondaje periodontal y el objetivo principal incluye la evaluación de la relación entre el dolor percibido durante el sondaje periodontal con parámetros inflamatorios gingivales. Material y Métodos: Un total de 475 sujetos fueron reclutados en el estudio. Los sujetos se dividieron en 2 grupos: Grupo - A (Grupo de gingivitis - 275 pacientes) y Grupo - B (Grupo de periodontitis crónica - 200 pacientes). Los parámetros clínicos incluyeron el análisis del sangrado al sondaje, el índice gingival simplificado, la profundidad de la bolsa al sondaje y el nivel de inserción clínica. La puntuación del dolor se registró utilizando la escala HP VAS y todos los pacientes participaron en el estudio después de una explicación detallada del protocolo del estudio. Resultados: Se notó una diferencia significativa en la percepción del dolor en el grupo B que en el grupo A, lo que significa el papel del grado de inflamación en el examen de los parámetros periodontales. Conclusión: Dentro de las limitaciones del presente estudio, podemos concluir que la percepción del dolor se correlaciona directamente con el grado de inflamación que se observa en la periodontitis más que con la gingivitis inducida por la placa dental durante el sondaje periodontal. Por lo tanto, se puede considerar alguna forma de anestesia tópica adyuvante para reducir los niveles de dolor en pacientes gravemente inflamados para fomentar la aceptación continua de la terapia periodontal de apoyo.

Evaluation of pain perception on periodontal probing in patients with dental plaque induced gingivitis and chronic periodontitis - a cross sectional study, part I / Evaluación de la percepción del dolor al sondaje periodontal en pacientes con gingivitis inducida por placa dental y periodontitis crónica: un estudio transversal, parte I

Background: Probing of periodontal pockets is an essential part in the diagnosis of periodontal disease. Fifteen to seventy seven percent of untreated periodontal patients experience pain during probing. Hence the aim of this study is to evaluate the pain perceived by patients with gingivitis and periodontitis during periodontal probing. The goals of this study were to compare the patients' pain perception when using a conventional UNC15 probe and a manual pressure sensitive periodontal probe, and to relate the clinical features of gingivitis and periodontitis to the discomfort associated with periodontal probing. Material and Methods: A total of 475 subjects were recruited into the study. The subjects were initially divided into two groups ­ Group ­ A (Gingivitis group - 275 patients) and Group ­ B (Chronic Periodontitis group -200 patients) according to the AAP 1999 Classification. These two groups were further subdivided into two groups each (Gingivitis ­ Conventional Probe ­ GCP, Gingivitis ­ Manual Pressure Sensitive Probe ­ GMPS, Periodontitis - Conventional Probe ­ PCP, Periodontitis ­ Manual Pressure Sensitive Probe ­ PMPS) using a computer generated program of random numbers. Results: A significant difference was noted in pain perception when pressure sensitive probe was used compared to conventional UNC-15 probe. Reduced Bleeding on Probing and Pain scores were noted in Chronic periodontitis subjects with use of pressure sensitive probe, which was statistically significant (p<0.001). Conclusion: Dentistry has changed its focus towards painless dentistry. In this context, the present study presents data towards use of manual pressure sensitive probes, which offers an advantage of low cost when compared to more advanced computerized systems with reduced pain during periodontal examination. It could result in a positive attitude of the patients towards continuous supportive periodontal therapy thereby monitoring periodontal health.

Antecedentes: El sondaje de los sacos periodontales es una parte esencial en el diagnóstico de la enfermedad periodontal. Del quince al setenta y siete por ciento de los pacientes periodontales no tratados experimentan dolor durante el sondaje. De ahí que el objetivo de este estudio fué evaluar el dolor percibido por pacientes con gingivitis y periodontitis durante el sondaje periodontal. Los objetivos de este estudio fueron comparar la percepción del dolor de los pacientes al usar una sonda UNC15 convencional y una sonda periodontal sensible a la presión manual, y relacionar las características clínicas de la gingivitis y la periodontitis con la incomodidad asociada con el sondaje periodontal. Material y Métodos: Un total de 475 sujetos fueron reclutados en el estudio. Los sujetos se dividieron inicialmente en dos grupos - Grupo - A (grupo de Gingivitis - 275 pacientes) y Grupo - B (grupo de Periodontitis Crónica - 200 pacientes) de acuerdo con la Clasificación AAP 1999. Estos dos grupos se subdividieron en dos grupos cada uno (Gingivitis - Sonda convencional - GCP, Gingivitis - Sonda manual sensible a la presión - GMPS, Periodontitis - Sonda convencional - PCP, Periodontitis - Sonda manual sensible a la presión - PMPS) usando un programa generado por computadora de datos aleatorios. números. Resultados: Se notó una diferencia significativa en la percepción del dolor cuando se usó una sonda sensible a la presión en comparación con la sonda UNC-15 convencional (p<0,001). Conclusion: La odontología ha cambiado su enfoque hacia una odontología sin dolor. En este contexto, el presente estudio presenta datos hacia el uso de sondas manuales sensibles a la presión, que ofrece una ventaja de bajo costo en comparación con sistemas computarizados más avanzados con reducción del dolor durante el examen periodontal. Podría resultar en una actitud positiva de los pacientes hacia la terapia periodontal de apoyo continuo, monitoreando así la salud periodontal.

Avaliação da dor em mulheres com câncer cérvico-uterino durante a braquiterapia / Pain evaluation in women with cervical-uterine neoplasms during brachytherapy / Evaluación del dolor en mujeres con cáncer cérvico-uterino durante la braquiterapia

RESUMO Objetivo: avaliar a intensidade da dor em mulheres submetidas à braquiterapia pélvica. Método: estudo transversal, analítico, quantitativo realizado em instituição oncológica (Santa Catarina/Brasil), incluindo 97 mulheres em braquiterapia pélvica, com (grupo 1) ou sem (grupo 2) sedação anestésica. Coleta de dados entre setembro de 2018 a julho de 2019, por entrevista estruturada e no prontuário da paciente. Intensidade da dor avaliada em cinco momentos por escala visual analógica. Análise incluiu medidas de frequência, teste qui-quadrado, análise de resíduos padronizados ajustados, equações de estimações generalizadas, teste post-hoc de Bonferroni; nível de significância 0,05. Resultados: 51 mulheres (52,6%) referiram dor prévia à braquiterapia, 73 (75,3%) após. Na retirada dos aplicadores, grupo 1 atingiu 55,9% na proporção de presença de dor, grupo 2 36,8%. Houve significância da percepção dolorosa por momento/sedação (p<0,001). Conclusão: percepção dolorosa observada na maioria das mulheres. Os resultados contribuíram para revisão do protocolo institucional para sedação endovenosa e melhor controle álgico.

ABSTRACT Objective: to evaluate pain intensity in women undergoing pelvic brachytherapy. Method: cross-sectional, analytical, quantitative study conducted in an oncology institution (Santa Catarina/Brazil), including 97 women undergoing pelvic brachytherapy, with (group 1) or without (group 2) anesthetic sedation. Data collection between September 2018 to July 2019, by structured interview and in the patient's medical record. Pain intensity assessed at five time points by visual analog scale. Analysis included frequency measures, chi-square test, adjusted standardized residuals analysis, generalized estimating equations, Bonferroni post-hoc test; significance level 0.05. Results: 51 women (52.6%) reported pain before brachytherapy, 73 (75.3%) after. At the removal of the applicators, group 1 reached 55.9% in the proportion of presence of pain, group 2, 36.8%. There was significance of pain perception by moment/sedation (p<0.001). Conclusion: pain perception observed in most women. The results contributed to revision of the institutional protocol for intravenous sedation and better pain control.

RESUMEN Objetivo: evaluar la intensidad del dolor en mujeres sometidas a braquiterapia pélvica. Método: estudio transversal, analítico y cuantitativo realizado en una institución de oncología (Santa Catarina/Brasil), incluyendo 97 mujeres sometidas a braquiterapia pélvica, con (grupo 1) o sin (grupo 2) sedación anestésica. Recogida de datos entre septiembre de 2018 y julio de 2019, mediante entrevista estructurada y en la historia clínica del paciente. La intensidad del dolor se evaluó en cinco momentos mediante una escala analógica visual. El análisis incluyó medidas de frecuencia, prueba de chi-cuadrado, análisis de residuos estandarizados ajustados, ecuaciones de estimación generalizadas, prueba post-hoc de Bonferroni; nivel de significación 0,05. Resultados: 51 mujeres (52,6%) refirieron dolor antes de la braquiterapia, 73 (75,3%) después. Al retirar los aplicadores, el grupo 1 alcanzó el 55,9% en la proporción de presencia de dolor, el grupo 2 el 36,8%. Hubo significación de la percepción del dolor según el momento/sedación (p<0,001). Conclusión: La percepción del dolor se observó en la mayoría de las mujeres. Los resultados contribuyeron a revisar el protocolo institucional de sedación endovenosa y a mejorar el control del dolor.

Effectiveness of mirror therapy in phantom limb pain: A literature review. / Efectividad de la terapia de espejo en el dolor del miembro fantasma. Una revisión actual de la literatura.

INTRODUCTION: Phantom limb pain (PLP) is a type of neuropathic pain that affects the territory of an amputated limb or other surgically removed body parts. Between 60% and 90% of amputees suffer from PLP during follow-up. There are a range of therapeutic options for PLP, both pharmacological (gabapentin, amitriptyline, tricyclic antidepressants, etc) and non-pharmacological (transcutaneous electrical nerve stimulation, hypnosis, acupuncture, etc). A widely accepted hypothesis considers PLP to be the consequence of postamputation cortical reorganisation. New treatment approaches, such as mirror therapy (MT), have been developed as a result of Ramachandran's groundbreaking research in the 1990s. This review analyses the current evidence on the efficacy of MT for treating PLP. DEVELOPMENT: We performed a literature review of publications registered from 2012 to 2017 on the CINAHL, Cochrane, Scopus, and PubMed (including Medline) databases Using the descriptors "phantom limb‿ and "mirror therapy.‿ We identified 115 publications addressing MT in PLP. Of these, 17 (15%) contributed useful information for pooled analysis. CONCLUSIONS: MT seems to be effective in relieving PLP, reducing the intensity and duration of daily pain episodes. It is a valid, simple, and inexpensive treatment for PLP. The methodological quality of most publications in this field is very limited, highlighting the need for additional, high-quality studies to develop clinical protocols that could maximise the benefits of MT for patients with PLP.

Avaliação da dor em mulheres com câncer cérvico-uterino durante a braquiterapia / Pain evaluation in women with cervical-uterine neoplasms during brachytherapy / Evaluación del dolor en mujeres con cáncer cérvico-uterino durante la braquiterapia

RESUMO Objetivo: avaliar a intensidade da dor em mulheres submetidas à braquiterapia pélvica. Método: estudo transversal, analítico, quantitativo realizado em instituição oncológica (Santa Catarina/Brasil), incluindo 97 mulheres em braquiterapia pélvica, com (grupo 1) ou sem (grupo 2) sedação anestésica. Coleta de dados entre setembro de 2018 a julho de 2019, por entrevista estruturada e no prontuário da paciente. Intensidade da dor avaliada em cinco momentos por escala visual analógica. Análise incluiu medidas de frequência, teste qui-quadrado, análise de resíduos padronizados ajustados, equações de estimações generalizadas, teste post-hoc de Bonferroni; nível de significância 0,05. Resultados: 51 mulheres (52,6%) referiram dor prévia à braquiterapia, 73 (75,3%) após. Na retirada dos aplicadores, grupo 1 atingiu 55,9% na proporção de presença de dor, grupo 2 36,8%. Houve significância da percepção dolorosa por momento/sedação (p<0,001). Conclusão: percepção dolorosa observada na maioria das mulheres. Os resultados contribuíram para revisão do protocolo institucional para sedação endovenosa e melhor controle álgico.

ABSTRACT Objective: to evaluate pain intensity in women undergoing pelvic brachytherapy. Method: cross-sectional, analytical, quantitative study conducted in an oncology institution (Santa Catarina/Brazil), including 97 women undergoing pelvic brachytherapy, with (group 1) or without (group 2) anesthetic sedation. Data collection between September 2018 to July 2019, by structured interview and in the patient's medical record. Pain intensity assessed at five time points by visual analog scale. Analysis included frequency measures, chi-square test, adjusted standardized residuals analysis, generalized estimating equations, Bonferroni post-hoc test; significance level 0.05. Results: 51 women (52.6%) reported pain before brachytherapy, 73 (75.3%) after. At the removal of the applicators, group 1 reached 55.9% in the proportion of presence of pain, group 2, 36.8%. There was significance of pain perception by moment/sedation (p<0.001). Conclusion: pain perception observed in most women. The results contributed to revision of the institutional protocol for intravenous sedation and better pain control.

RESUMEN Objetivo: evaluar la intensidad del dolor en mujeres sometidas a braquiterapia pélvica. Método: estudio transversal, analítico y cuantitativo realizado en una institución de oncología (Santa Catarina/Brasil), incluyendo 97 mujeres sometidas a braquiterapia pélvica, con (grupo 1) o sin (grupo 2) sedación anestésica. Recogida de datos entre septiembre de 2018 y julio de 2019, mediante entrevista estructurada y en la historia clínica del paciente. La intensidad del dolor se evaluó en cinco momentos mediante una escala analógica visual. El análisis incluyó medidas de frecuencia, prueba de chi-cuadrado, análisis de residuos estandarizados ajustados, ecuaciones de estimación generalizadas, prueba post-hoc de Bonferroni; nivel de significación 0,05. Resultados: 51 mujeres (52,6%) refirieron dolor antes de la braquiterapia, 73 (75,3%) después. Al retirar los aplicadores, el grupo 1 alcanzó el 55,9% en la proporción de presencia de dolor, el grupo 2 el 36,8%. Hubo significación de la percepción del dolor según el momento/sedación (p<0,001). Conclusión: La percepción del dolor se observó en la mayoría de las mujeres. Los resultados contribuyeron a revisar el protocolo institucional de sedación endovenosa y a mejorar el control del dolor.

Reencuentros con el dolor: Autoetnografía / Reuniting with pain: Self-ethnography

El recordar circunstancias que condujeron a sufrimiento en la vida es un proceso complejo; se revive situaciones que muchas veces se desean olvidar, pero que son parte importante en la construcción de la subjetividad. Nos pareció pertinente volver a revisar la experiencia de una de las investigadoras, sometida a varias intervenciones quirúrgicas y con dolor crónico. Se hizo uso del método autoetnográfico que, a través de indagar la memoria y la vivencia, busca reconocer los significados de dolor postquirúrgico que aporten al repensar el cuidado de enfermería. Este trabajo visibiliza las memorias de cuidado vividas alrededor del sufrimiento de dolor posquirúrgico, considerado uno de los principales problemas de calidad asistencial.

Remembering circumstances that led to suffering in life is a complex process, reviving situations that often wish to forget but are an important part in the construction of subjectivity. It seemed pertinent to revisit the experience of one of the researchers, who underwent several surgical interventions and with chronic pain. We used the autoethnographic method that, through investigating memory and experience, seeks to recognize the meanings of postsurgical pain that contribute to rethinking nursing care. This work brings together the memories of care lived around the suffering of post-surgical pain, considered one of the main problems of quality of care.

Percepción del dolor, rasgos de personalidad y actitud del paciente hacia el tratamiento ortodóntico / Pain perception, personality traits and patient attitude toward orthodontic treatment

Introducción: El dolor inducido por los aparatos de ortodoncia es una de las principales razones que desalientan a los pacientes a buscar tratamiento ortodóntico y puede afectar negativamente su cooperación. Objetivo: Determinar la relación de la percepción del dolor, rasgos de personalidad y la actitud del paciente hacia el tratamiento ortodóntico. Métodos: Estudio transversal y observacional. La muestra estuvo conformada por dos grupos: I) 200 sujetos no tratados (78 varones y 122 mujeres; edad promedio 20,02 ± 2,67 años) y II) 200 sujetos tratados (64 varones y 136 mujeres; edad promedio 20,29 ± 3,88 años). El instrumento para la recolección de datos fue un cuestionario que incluía la evaluación de la expectativa del dolor para sujetos no tratados, experiencia de dolor para sujetos tratados, los perfiles de personalidad de los pacientes y actitudes hacia el tratamiento de ortodoncia. Resultados: No se encontró relación entre la percepción del dolor, los rasgos de personalidad y actitud del paciente hacia el tratamiento ortodóntico (p > 0,05). El estado de tratamiento (presentar ortodoncia) afectó la percepción del dolor hacia el tratamiento ortodóntico (p < 0,05), el género no afectó la percepción del dolor. El estado de tratamiento y el género masculino afectaron la actitud del paciente hacia el tratamiento ortodóntico (p < 0,05). Conclusiones: Los pacientes con mejor actitud mostraron menos dolor y los pacientes con mayor percepción del dolor mostraron una actitud negativa. Los niveles bajos de amabilidad tienen efecto sobre la percepción del dolor del paciente hacia el tratamiento ortodóntico(AU)

Introduction: The pain induced by orthodontic appliances is one of the main reasonswhy patients are reluctant to seek orthodontic treatment, and may negatively affect their cooperation. Objective: Determine the relationship between pain perception, personality traits and patient attitude toward orthodontic treatment. Methods: A cross-sectional observational study was conducted of a study sample composed of two groups: I) 200 untreated subjects (78 male and 122 female; mean age 20.02 ± 2.67 years) and II) 200 treated subjects (64 male and 136 female; mean age 20.29 ± 3.88 years). The data collection tool was a questionnaire including an evaluation of pain expectation for untreated subjects, pain experience for treated subjects, patients' personality profiles and attitudes toward orthodontic treatment. Results: No relationship was found between pain perception, personality traits and patient attitude toward orthodontic treatment (p > 0.05). Treatment status (untreated or treated) affected pain perception and the attitude toward orthodontic treatment (p < 0.05); gender did not affect pain perception. Treatment status and male gender affected patient attitude toward orthodontic treatment (p < 0.05). Conclusions: Patients with a better attitude experienced less pain, whereas patients with a greater pain perception showed a negative attitude. Low levels of kindness have an effect on pain perception and patient attitude toward orthodontic treatment(AU)

[The body hurts, and what about social pain? Does it hurts too?] / El cuerpo duele, y el dolor social ¿duele también?

This paper studies the concept of «social pain¼ and its relationship with physical pain. An in-depth review of its physiology has been carried out, including similarities and differences in processing with relation to physical pain, as well as the interactions between both processes. Social pain is defined as an unpleasant emotional experience which is triggered when the individual feels excluded or rejected by people or social groups with whom they wish have a relationship. This perceived situation produces the same feelings of suffering as that of physical pain. This kind of pain is processed in the same brain areas as physical pain in its affective dimension. It may be revived mentally, even though the interpersonal conflictive situation may have ended long ago. Both types of pain are sources of stress. The confluence of both situations in the same individual adds complications and more pressure to that which is already exerted separately by both stressing factors. This circumstance must be taken into account when dealing with patients with chronic pain.

Dolor y emoción, una reflexión para el profesional en ciencias de la salud / Pain and emotion, a reflection for the health practitioner

En esta revisión se propone reflexionar sobre el papel que juegan las emociones en relación con una experiencia desagradable para el ser humano denominada dolor. El estímulo doloroso provoca situaciones de discapacidad en mayor o menor medida, según como sea evaluado y afrontado, llegando a provocar alteraciones emocionales y cognitivas que generan una disminución en la calidad de vida de la persona/paciente, en aspectos funcionales, psicológicos, laborales y sociales. Se realiza entonces una revisión de la literatura que permite entregar al profesional de la salud una reflexión sobre el manejo integral del paciente que consulta por un síntoma, que de no ser manejado apropiadamente desencadenará un síndrome doloroso que interferirá en su diario vivir y terminará amenazando su existencia.

This review proposes to reflect on the role that emotions play in relation to an unpleasant experience for the human being called pain. The painful stimulus causes situations of disability to a greater or lesser extent, depending on how it is evaluated and addressed, leading to emotional and cognitive alterations that generate a lower quality of life in the person/patient, from functional, psychological, occupational and social aspects. A bibliographic review is carried out, which allows the health professional to reflect on the integral management of the patient who consults for a symptom, that, if not managed properly, will trigger a painful syndrome that interferes and threatens its existence.

Dolor en pacientes hospitalizados en una institución de salud de tercer nivel / Pain in hospitalized patients in a third-level health care institution

Abstract Introduction: Pain is one of the major symptoms experienced by hospitalized patients. Objective: To establish the hospital care quality indicators associated with pain management (prevalence, intensity, and interference) in adult inpatients, following the implementation of strategies framed within the pain-free Hospital Policy at a third-level institution. Methodology: Observational, descriptive, cross-sectional trial. Patients over 18 years of age, hospitalized for more than 24hours, and who previously signed their informed consent were included. The Brief Pain Inventory - Short Form in Spanish was adminis tered for pain evaluation, and the sex and service differences were estimated using the Wilcoxon test for quantitative variables and x2 for qualitative variables. Results: Three hundred thirty-eight participants were includ ed. The prevalence of pain was 43.4%, with a higher percentage among females (52.1% vs 28.8%, P <0.001) and in the surgical services (48.0% vs 37.5%, P = 0.05). Women showed higher intensity in the "minimum pain" item (median 3 interquartile range 2-5 vs median 2 interquartile range 0-1, P=0.009). The activities with the highest interference were sleep and general activity in both sexes and services. Discussion: The hospital quality of care indicators herein measured allow for an enhanced approach to characterize pain in this population group, with a view to improving pain identifica tion and management in the future to provide a more comfortable experience for the patient.

Resumen Introducción: El dolor es uno de los principales síntomas que presentan los pacientes hospitalizados. Objetivo: Establecer los indicadores de la calidad del cuidado hospitalario relacionados con el manejo del dolor (prevalencia, intensidad e interferencia) en pacientes adultos hospitalizados posterior a la implementación de estrategias enmarcadas en la Política Clínica sin dolor de una institución de tercer nivel. Metodología: Estudio observacional descriptivo de corte transversal. Se incluyeron pacientes mayores de 18 años con más de 24 horas de hospitalización y previa firma de consenti miento informado, se aplicó el instrumento Brief Pain Inventory -Short Form (Inventario Breve de Dolor) en español para la evaluación del dolor. Las diferencias por género y servicio se estimaron a través del test de Wilcoxon para las variables cuantitativas y X2 para las variables cualitativas. Resultados: Se incluyeron 338 participantes. La prevalencia de dolor fue 43,4%, siendo más alta en mujeres (52,1% vs. 28,8%, p = < 0.001) y servicios quirúrgicos (48,0% vs. 37,5%, p = 0.05). Las mujeres presentaron mayor intensidad en el ítem "dolor mínimo" (mediana 3 Rango intercuartílico 2-5 vs. mediana 2 Rango intercuartílico 0-1, p = 0.009). Las actividades con mayor interferencia fueron el sueño y la actividad general en ambos sexos y servicios. Discusión: Los indicadores de la calidad del cuidado hospita lario medidos en este estudio permiten caracterizar de una mejor forma el dolor en este tipo de población, lo cual permite mejorar a futuro la identificación y manejo de éste síntoma para brindar mayor confort al paciente.

Pain scores for intravenous cannulation and arterial blood gas test among emergency department patients. / Dolor asociado a las técnicas de inserción de catéteres venosos y extracción de sangre arterial en el área de urgencias.

OBJECTIVES: To analyse vein catheterisation and blood gas test-related pain among adult patients in the emergency department and to explore pain score-related factors. METHOD: An observational and multicentre research study was performed. Patients undergoing vein catheterisation or arterial puncture for gas test were included consecutively. After each procedure, patients scored the pain experienced using the NRS-11. RESULTS: 780 vein catheterisations and 101 blood gas tests were analysed. Venipuncture was scored with an average score of 2.8 (95% CI: 2.6-3), and arterial puncture with 3.6 (95%CI 3.1-4). Iatrogenic pain scores were associated with moderate - high difficulty procedures (P<.001); with the choice of the humeral rather than the radial artery (P=.02) in the gas test and correlated to baseline pain in venipunctures (P<.001). Pain scores related to other variables such as sex, place of origin or needle gauge did not present statistically significant differences. CONCLUSIONS: Vein catheterisation and blood gas test-related pain can be considered mild to moderately and moderately painful procedures, respectively. The pain score is associated with certain variables such as the difficulty of the procedure, the anatomic area of the puncture or baseline pain. A better understanding of painful effects related to emergency nursing procedures and the factors associated with pain self-perception could help to determine when and how to act to mitigate this undesired effect.

Manejo del dolor neuropático inducido por quimioterapia y radioterapia en un Servicio de Cuidados Paliativos / Management of neuropathic pain induced by chemotherapy and radiotherapy in a Palliative Care Service

Introduction: The prevalence of pain in patients with cancer ranges between 40 and 60 % and the third part is produced by neuropathy induced by chemotherapy. The aim of the present investigation was to describe the treatment of a group of patients with neuropathy secondary to chemo and radiotherapy at a cancer center in Guayaquil, Ecuador. Methods: The present descriptive study includes records of patients who presented neuropathic pain after antineoplastic treatment (chemotherapy - radiotherapy) who were treated in the palliative care area of the Solca-Guayaquil hospital. The type of treatment is described, analgesic control at 3 and 6 months. Results: 150 patients attended for pain in the service were registered, of which 70 patients were admitted to the study for neuropathic pain, 80 patients were excluded because they presented nociceptive pain. In the study group of 70 cases with neuropathic pain, 50 cases (71.4 %) were due to the administration of chemotherapy and radiotherapy, 20 cases (28.6 %) were without treatment. The 50 oncological patients with neuropathic pain caused as a side effect of the oncological treatment all received 5 types of pharmacological treatments. The treatment drop-out rate was 6 cases (12 %). The remaining cases presented improvement after 6 months of treatment, 44 cases (88 %). No patient required blocking for pain control. Conclusions: The therapeutic intervention for the management of neuropathic pain secondary to chemo or radiotherapy was effective in 88% of the cases at a period greater than 6 months. In the control of pain, 5 additive therapeutic levels were used in each level with opioids, tricyclic antidepressants and strong opioids.

Dolor postoperatorio: factores de riesgo y abordaje / Postoperative pain: risk factors and approach

ResumenEl dolor es una experiencia universal pero única para cada individuo. El proceso patológico que culmina en una intervención quirúrgica es una de las principales fuentes de dolor, muchas veces abordado y manejado de manera subóptima o en entornos que carecen de la organización adecuada. La utilización de la historia clínica y examen físico para la identificación de factores de riesgo conocidos para dolor postoperatorio agudo y crónico son fundamentales al elaborar un plan de manejo del dolor efectivo. Según las recomendaciones, se obtiene una mejor respuesta con el uso de terapia multimodal farmacológica y no farmacológica que involucra celecoxib preoperatorio, anestesia regional periférica o neuraxial, manejo de dolor postoperatorio con antiinflamatorios no esteroideos (AINES), acetaminofén, gabapentina o pregabalina; implementación de terapia cognitiva y de comportamiento. Monitoreo y valoración periódica del paciente para evaluar su respuesta a analgésicos y efectos adversos asociado a coordinación y planeamiento eficaz de protocolos y guías en cada centro de salud, se han visto de utilidad al valorar a un grupo tan heterogéneo e impredecible.

Abstract:Pain is a universal experience but unique for every individual. The pathological processes that end in a surgical intervention are some of the main pain sources, often approached and managed suboptimally or without proper organization. The use of clinical history and physical examination to identify known risk factors to postoperative acute and chronic pain are fundamental to elaborate an effective pain management plan. According to recommendations, the outcome improves with pharmacological and non-pharmacological multimodal analgesia, including celecoxib before surgery, peripheral regional anesthesia or neuraxial techniques, management of postoperative pain with nonsteroidal anti-inflammatory drugs, acetaminophen, gabapentin or pregabalin; implementation of cognitive - behavioral therapy. Monitoring and periodic assessments associated with coordination and planning of protocols and guidelines in every clinical center, have been useful to evaluate a heterogeneous and unpredictable group, in order to establish the patients' response to analgesics and their adverse effects.

Satisfacción de las mujeres atendidas con el parto culturalmente adecuado en Loreto, Orellana (2016) / Satisfaction of assisted women with the culturally appropriate childbirth in Loreto, Orellana (2016)

Introducción: los países con mayor presencia indígena tienen niveles más altos de mortalidad materna en la región. Por lo que resulta necesario tomar medidas para reducir la mortalidad materna y neonatal. Para evaluar la satisfacción de las mujeres atendidas el Estado creó guías de atención al parto culturalmente adecuado. Objetivos: analizar el nivel de satisfacción de las mujeres atendidas en el Centro de Salud de Loreto con el parto culturalmente adecuado y su relación con la percepción del dolor. Métodos: se realizó un estudio cuantitativo, descriptivo, prospectivo, de corte longitudinal desde marzo hasta mayo de 2016. La muestra estuvo constituida por 62 mujeres atendidas en dicho período. Resultados: en el grupo estudiado predominaron las adolescentes con 53 por ciento y las mujeres con edades comprendidas entre 20 y 35 años (39 por ciento). Del total de mujeres, 38 de ellas se sintieron satisfechas con la atención durante el parto y el 54,8 por ciento refirieron dolor muy intenso durante este. Conclusiones: el nivel de satisfacción fue alto y la percepción del dolor durante el trabajo de parto fue muy elevado. Hubo una relación significativa entre el dolor y el nivel de satisfacción(AU)

Introduction: The countries with the largest indigenous populations have higher levels of maternal mortality in the region. It is necessary to take measures to reduce maternal and neonatal death. To this end, the State prepared guidelines for the culturally appropriate childbirth care and the evaluation of satisfaction. Objectives: To analyze the level of satisfaction of women with culturally appropriate childbirth and its relation with labor pain perception in the health center of Loreto. Methods: A prospective, longitudinal, descriptive and quantitative study was conducted in the period from March to May 2016 in a sample of 62 women seen during that period. Results: In the study group, adolescents (53 percent) and women aged between 20 and 35 years (39 percent) predominated. Thirty eight women were satisfied with care during childbirth and 54.8 percent reported very intense labor pain. Conclusions: The levels of satisfaction and of perception of pain during labor were high and very high, respectively. There was significant association between pain and level of satisfaction(AU)

[Usefulness of a multidimensional self-administered questionnaire for the clinical management of a pain treatment unit]. / Utilidad de un cuestionario autoadministrado multidimensional para la gestión de una unidad clínica de tratamiento de dolor.

OBJECTIVE: To study the feasibility of a multidimensional self-administered questionnaire before the patient is seen at the first visit in a clinical Pain Treatment Unit (PTU) of a tertiary hospital, and its impact on the management of patients in the first visit. PATIENTS AND METHODS: Cross-sectional study. Self-administered questionnaire that gathered: socio-demographic data, medical history of pain, pain perception (intensity and characteristics), comorbidity of pain and patient expectations of analgesic treatment ("What do you expect from our treatment? If we cannot resolve your pain, what level of pain would you be willing to live with?). A descriptive analysis was performed. RESULTS: A total of 293 consecutive patients (31% men, 69% women), mean age (SD) 62 (16) years-old, were included in 2011. All patients completed and returned the questionnaire before the first visit to the PTU. The questionnaire was completed fully and correctly by 80% (234, 95% CI: 75-84) of the patients, and the rest completed the questionnaire with some points unanswered. About 24% (70/293, 95% CI: 19-29) of the patients should not have been referred to the PTU [20% were not attended]. A small percentage (9%,26/293, 95% CI: 6-13) were evaluated as «urgent'¼ and visited over the following 7 days, with 19% (56/293, 95%CI: 15-24) being «preferential¼ (visited before 15 days) and 52% (152/293, 95% CI: 46-58) as «non-urgent/non-preferential¼ (visited before 60 days). Almost one third (30%, 87/293, 95% CI: 25-35) did not need a second visit to the PTU. Patient expectations: 21% expected complete pain relief and 64% would accept a lower pain intensity score of 4. CONCLUSION: The use of a multidimensional self-administered questionnaire before the first visit to a clinical Pain Treatment Unit of a tertiary hospital was a practicable and useful tool for the management of patients on the first visit. Likewise, the questionnaire provided information on the patient's perception of pain and the expectations concerning the analgesic treatment.