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1.
Br J Anaesth ; 124(2): 214-221, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31771788

RESUMO

BACKGROUND: Post-surgical pain that lingers beyond the initial few-week period of tissue healing is a major predictor of pain chronification, which leads to substantial disability and new persistent opioid analgesic use. We investigated whether postoperative medical complications increase the risk of lingering post-surgical pain. METHODS: The study population consisted of patients undergoing diverse elective surgical procedures in an academic referral centre in the USA, between September 2013 and May 2017. Multivariable logistic regression, adjusting for confounding variables and patient-specific risk factors, was used to test for an independent association between any major postoperative complication and functionally limiting lingering pain 1-3 months after surgery, as obtained from patient self-reports. RESULTS: The cohort included 11 986 adult surgical patients; 10 562 with complete data. At least one complication (cardiovascular, respiratory, renal/gastrointestinal, wound, thrombotic, or neural) was reported by 13.3% (95% confidence interval: 12.7-14.0) of patients, and 19.7% (19.0-20.5%) reported functionally limiting lingering post-surgical pain. After adjusting for known risk factors, the patients were twice as likely (odds ratio: 2.04; 1.78-2.35) to report lingering post-surgical pain if they also self-reported a postoperative complication. Experiencing a complication was also independently predictive of lingering post-surgical pain (odds ratio: 1.95; 1.26-3.04) when complication data were extracted from the National Surgical Quality Improvement Program registry, instead of being obtained from patient self-report. CONCLUSIONS: Medical complications were associated with a two-fold increase in functionally limiting pain 1-3 months after surgery. Understanding the mechanisms that link complications to pathological persistence of pain could help develop future approaches to prevent persistent post-surgical pain.


Assuntos
Dor Crônica/epidemiologia , Complicações Pós-Operatórias/epidemiologia , Idoso , Estudos de Coortes , Comorbidade , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Missouri/epidemiologia , Dor Pós-Operatória/epidemiologia
2.
J Craniomaxillofac Surg ; 47(12): 1875-1880, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31711995

RESUMO

The aim of this study was to evaluate if patients after orofacial cleft repair experience neurophysiological changes with consecutive chronic pain states after surgery. Patients (n = 48) with a repaired orofacial cleft (CLP) recruited in a support group took part in a survey including five questionnaires. They revealed pain states, described cleft situation and history, and epidemiological data. Patients' quality of life and psychological comorbidity after the surgical procedures were assessed with the Oral Health Impact Profile (OHIP), the Giessen Subjective Complaints List (GSCL) and the Hospital Anxiety and Depression Scale (HADS). Furthermore, psychosocial impairment was documented. 39 out of 48 subjects with CLP reported to have experienced pain during the last 6 months. Pain was proven to be already chronic for 36 persons. Locations of pain were the orofacial region, back and limbs. Neurophysiological perception to cold, warmth, pressure and touch were found to be inhomogeneous. Local disturbances of subjective sensitivity in hard and soft tissues in the operated region are suspicious for neuropathic disorders and peripheral and central sensitization. 16 participants also reported that during dental interventions higher doses of local analgesia were necessary to achieve a pain free condition. Overall participants with CLP demonstrated elevated levels for anxiety and depression. As a conclusion for daily routine, CLP patients are considered to be at a higher risk to develop chronic pain states. To avoid these, proper pain and psychological management must be performed from early childhood. Further clinical studies examining patients with neurophysiological diagnostic tools are needed.


Assuntos
Ansiedade/psicologia , Fenda Labial/cirurgia , Depressão/psicologia , Qualidade de Vida , Ansiedade/epidemiologia , Criança , Pré-Escolar , Dor Crônica/epidemiologia , Fenda Labial/psicologia , Depressão/epidemiologia , Humanos , Inquéritos e Questionários
4.
Afr Health Sci ; 19(2): 1978-1987, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31656480

RESUMO

Introduction: Chronic pain classification in HIV positive patients is essential for diagnosis and treatment. However, this is rarely done despite association with poor outcomes. Methods: A cross-sectional survey of 345 consented patients at a specialized HIV care center in Uganda was conducted. Chronic pain was defined as pain of more than two weeks duration. Data was collected using a socio-demographic questionnaire, the IASP classification of chronic pain; the StEP; Mini Mental Status Examination, Patient Health Questionnaire, Mini International Neuropsychiatric Interview and the World Health Organization quality of life instrument brief version. Chi-square, Fisher's exact, t-test and logistic regression analyses were carried out to determine factors associated with chronic pain. Results: Description of pain aetiology was difficult. Chronic pain was reported in 21.5% of the participants. Non-neuropathic (92.0%) was more common than neuropathic pain (8.0%). Chronic pain was found to be associated with feeling ill [OR=6.57 (3.48 - 12.39)], and worse scores in the quality of life domain for physical health [OR=0.71 (0.60 - 0.83)]. Conclusion: People living with HIV/AIDS commonly have chronic pain that is associated with poor quality of life. More sensitive tools are needed to accurately describe chronic pain in resource limited settings.


Assuntos
Dor Crônica/classificação , Infecções por HIV/complicações , Manejo da Dor/métodos , Adulto , Fármacos Anti-HIV/uso terapêutico , Dor Crônica/epidemiologia , Dor Crônica/etiologia , Comorbidade , Estudos Transversais , Feminino , Infecções por HIV/tratamento farmacológico , Infecções por HIV/psicologia , Humanos , Masculino , Pessoa de Meia-Idade , Neuralgia , Escalas de Graduação Psiquiátrica , Qualidade de Vida , Fatores Socioeconômicos , Inquéritos e Questionários , Uganda/epidemiologia
5.
Am Surg ; 85(10): 1104-1107, 2019 Oct 01.
Artigo em Inglês | MEDLINE | ID: mdl-31657303

RESUMO

Chronic abdominal pain of unknown origin is a challenging diagnosis encountered by clinicians. Patients often undergo an extensive workup and long periods of uncertainty without the establishment of a definitive diagnosis. Diagnostic laparoscopy is a relatively safe procedure that can be used as an effective diagnostic and therapeutic tool in treating this disease. This was a retrospective, single-institution study exploring the efficacy of diagnostic laparoscopy in treating chronic abdominal pain of unknown origin. More than 90 per cent of laparoscopies resulted in a positive finding, with adhesions being the most common. A total of 50 per cent of patients experienced resolution of symptoms on follow-up. Patients were overwhelmingly satisfied with their postoperative outcomes and willing to undergo the procedure again with their outcomes in mind.


Assuntos
Dor Abdominal/diagnóstico , Dor Abdominal/cirurgia , Dor Crônica/diagnóstico , Dor Crônica/cirurgia , Laparoscopia , Dor Abdominal/epidemiologia , Dor Abdominal/etiologia , Dor Crônica/epidemiologia , Dor Crônica/etiologia , Feminino , Humanos , Laparoscopia/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Satisfação do Paciente , Estudos Retrospectivos , Fatores de Tempo , Aderências Teciduais/complicações , Aderências Teciduais/diagnóstico , Aderências Teciduais/cirurgia , Resultado do Tratamento
6.
BMC Public Health ; 19(1): 1375, 2019 Oct 26.
Artigo em Inglês | MEDLINE | ID: mdl-31655569

RESUMO

BACKGROUND: An increasing amount of evidence supports an association between sedentary behaviors and chronic knee pain. However, the association between the total daily duration of sedentary behavior and chronic knee pain in the general population remains unclear. We aimed to analyze the association between sedentary behavior and chronic knee pain in a study population representative of the general Korean population aged > 50 years while also considering the physical activity or body mass index (BMI). METHODS: This cross-sectional study used data from the 6th Korean National Health and Nutrition Examination Survey (KNHANES VI) of 2013-2015, which was completed by 22,948 Korean adult participants aged > 50 years. The participants were divided into two groups based on the status of the chronic knee pain. Data were analyzed using multivariable logistic regression after adjustment for age, sex, and individual factors. RESULTS: Longer sedentary behavior was correlated with chronic knee pain (p for trend = 0.02). Sedentary behavior exceeding 10 h/day was significantly associated with chronic knee pain (adjusted odds ratio, 1.28; p = 0.03). Participants with high levels of physical activity were less likely to suffer from chronic knee pain (adjusted odds ratio, 0.78; p = 0.00), and women with over 10 daily hours of sedentary behavior with high levels of physical activity were more likely to have chronic knee pain. A significant association was noted between chronic knee pain and obesity (≥30.0 kg/m2) individuals (adjusted odds ratio, 3.48; p = 0.04). CONCLUSIONS: Longer duration of sedentary behaviors was correlated with chronic knee pain. Our study suggests the need to encourage reductions in overall sedentary behavior to < 10 h daily. A high physical activity level is recommended, particularly for women > 50 years and those with obesity.


Assuntos
Dor Crônica/epidemiologia , Joelho/patologia , Comportamento Sedentário , Idoso , Idoso de 80 Anos ou mais , Estudos Transversais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Inquéritos Nutricionais , República da Coreia/epidemiologia , Fatores de Risco , Autorrelato , Fatores de Tempo
7.
Int J Behav Med ; 26(5): 569-575, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31489600

RESUMO

BACKGROUND: The opioid epidemic is a significant public health crisis and prescription opioids are often used to manage chronic pain, despite questionable long-term efficacy. Furthermore, co-substance (mis)use is also common among individuals with chronic pain who use opioids. Alcohol has been consistently used to manage chronic pain, partly due to its acute analgesic properties. Cannabis has also recently garnered attention in the context of pain management, though research examining its efficacy for pain has produced mixed results. Nevertheless, there is accumulating evidence that concurrent substance co-use is positively associated with use and misuse of additional substances, particularly among individuals with chronic pain. Thus, the goal of this study was to examine the main and interactive effects of alcohol use problems and cannabis use problems in relation to opioid misuse among adults with chronic pain who use opioids. METHODS: The current sample was comprised of 440 adults with chronic pain using prescription opioids. Substance use problems were assessed using the ASSIST, Current Opioid Misuse Measure, and the Severity of Dependence Scale. Moderated regressions using the PROCESS macro were utilized. RESULTS: Results indicated that alcohol use problems and cannabis use problems each uniquely related to opioid dependence severity and opioid misuse. The interaction of alcohol and cannabis use problems was uniquely related to only opioid misuse, whereby alcohol use was most strongly associated to opioid misuse among those with higher levels of cannabis use problems. CONCLUSIONS: Collectively, these findings suggest there may be utility in assessing and treating alcohol and cannabis use problems among persons with chronic pain who are using opioids for pain management.


Assuntos
Consumo de Bebidas Alcoólicas/epidemiologia , Dor Crônica/tratamento farmacológico , Fumar Maconha/epidemiologia , Transtornos Relacionados ao Uso de Opioides/epidemiologia , Adulto , Alcoolismo/epidemiologia , Analgésicos Opioides/uso terapêutico , Dor Crônica/epidemiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade
8.
Pain Res Manag ; 2019: 6985164, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31485284

RESUMO

Pregnant women with chronic pain present a unique clinical challenge for both chronic pain and obstetrical providers, and clinical guidelines do not exist. The present study describes the prevalence and management of chronic pain during pregnancy in a perinatal mood disorder clinic. A retrospective chart review of pregnant women who presented to the Women's Mental Health Program at the University of Arkansas for Medical Sciences (UAMS) for an initial evaluation from July 2013 to June 2016 was conducted to obtain demographic and medical information, including pharmacological exposures. Data are described using the mean and standard deviation for continuous data and frequency for categorical data. Pain complaints and medications are presented as counts and percentages. Differences between women with and without chronic pain were assessed by t-tests for continuous variables and chi-square analysis for categorical variables. Of the 156 pregnant women, chronic pain conditions were reported by 44 (28.2%). The most common chronic pain complaints included neck and/or back pain (34.1%) and headaches (31.8%). Of subjects with chronic pain, 95.5% were taking at least one prescription medication (mean = 2.6 ± 2.1, range of 0-10). Acetaminophen (43.2%) and opioids (43.2%) were the most common. The complexity of managing maternal benefits of treatment with the risks of fetal exposures presents a uniquely challenging clinical scenario for healthcare providers.


Assuntos
Analgésicos/uso terapêutico , Dor Crônica/tratamento farmacológico , Dor Crônica/epidemiologia , Complicações na Gravidez/tratamento farmacológico , Complicações na Gravidez/epidemiologia , Adulto , Feminino , Humanos , Gravidez , Prevalência , Estudos Retrospectivos
9.
Mayo Clin Proc ; 94(9): 1707-1717, 2019 09.
Artigo em Inglês | MEDLINE | ID: mdl-31486377

RESUMO

OBJECTIVES: To identify the factors associated with the excess risk of pain observed among older women compared with men. PATIENTS AND METHODS: We used information from a cohort of 851 women and men age 63 years and older who were free of pain during 2012 and were followed up to December 31, 2015. Sociodemographic variables, health behaviors, psychosocial factors, morbidity, and functional limitations were assessed in 2012 during home visits. Incident pain in 2015 was classified according to its frequency, intensity, and number of localizations into lowest, middle, and highest categories. RESULTS: During a mean follow-up of 2.8 years, the incidence of middle and highest pain was 12.5% and 22.6% in women and 12.4% and 12.6% in men, respectively. The age-adjusted relative risk ratios and 95% CIs of middle and highest pain in women versus men were 1.20 (0.79-1.83) and 2.03 (1.40-2.94), respectively. In a mediation analysis, a higher frequency in women than men of osteomuscular disease, impaired mobility, and impaired agility accounted, respectively, for 31.1%, 46.6%, and 32.0% of the excess risk of highest pain in women compared with men. Other relevant mediators were psychological distress (25.2%), depression (8.7%), poor sleep quality (10.7%), and lower recreational physical activity (12.6%). CONCLUSION: A greater frequency of some chronic diseases, worse functional status, psychological distress, and lower physical activity can mediate the excess risk of pain in older women compared with men. TRIAL REGISTRATION: clinicaltrials.gov Identifier: NCT02804672.


Assuntos
Dor Crônica/diagnóstico , Dor Crônica/epidemiologia , Avaliação Geriátrica , Medição da Dor , Idoso , Idoso de 80 Anos ou mais , Estudos de Coortes , Bases de Dados Factuais , Feminino , Comportamentos Relacionados com a Saúde , Humanos , Masculino , Pessoa de Meia-Idade , Prevalência , Prognóstico , Estudos Retrospectivos , Índice de Gravidade de Doença , Fatores Sexuais , Fatores Socioeconômicos , Espanha
10.
Rev. Hosp. Ital. B. Aires (2004) ; 39(3): 81-85, sept. 2019.
Artigo em Espanhol | LILACS | ID: biblio-1048229

RESUMO

El dolor crónico constituye un reto terapéutico especial. Se presenta una revisión narrativa sobre el papel del tratamiento de oxigenación hiperbárica (TOHB) en el tratamiento del dolor neuropático, y sus aplicaciones en dolor crónico, síndromes neurosensitivos disfuncionales y oncodolor. El conocimiento de las indicaciones de TOHB en algiología y su aplicación en la práctica médica puede contribuir a mejorar la calidad de vida del paciente. (AU)


Chronic pain represents a special therapeutic challenge. We present a narrative review on the role of Hyperbaric Oxygen Therapy (HBOT) in the treatment of neuropathic pain, and its applications in chronic pain, dysfunctional neurosensitive syndromes and oncological pain. The knowledge of the indications of HBOT in algiology and its application in medical practice can contribute to improve the quality of life of the patient. (AU)


Assuntos
Dor Crônica/terapia , Oxigenação Hiperbárica/métodos , Membro Fantasma/terapia , Qualidade de Vida , Distrofia Simpática Reflexa/terapia , Cefaleias Vasculares/terapia , Encefalopatias/terapia , Dor Facial/terapia , Fibromialgia/terapia , Causalgia/terapia , Neuropatias Diabéticas/terapia , Edema/terapia , Neuralgia Pós-Herpética/terapia , Dor Crônica/epidemiologia , Dor do Câncer/terapia , Oxigenação Hiperbárica/tendências , Analgesia/métodos , Inflamação/terapia , Neuralgia/terapia
12.
J Altern Complement Med ; 25(10): 1015-1025, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31453711

RESUMO

Objectives: The treatment goals of patients successfully using ongoing provider-based care for chronic spinal pain can help inform health policy related to this care. Design: Multinomial logistical hierarchical linear models were used to examine the characteristics of patients with different treatment goals for their ongoing care. Settings/Location: Observational data from a large national sample of patients from 125 chiropractic clinics clustered in 6 U.S. regions. Subjects: Patients with nonwork-injury-related nonspecific chronic low-back pain (CLBP) and chronic neck pain (CNP). Interventions: All were receiving ongoing chiropractic care. Outcome measures: Primary outcomes were patient endorsement of one of four goals for their treatment. Explanatory variables included pain characteristics, pain beliefs, goals for mobility/flexibility, demographics, and other psychological variables. Results: Across our sample of 1614 patients (885 with CLBP and 729 with CNP) just under one-third endorsed a treatment goal of having their pain go away permanently (cure). The rest had goals of preventing their pain from coming back (22% CLBP, 16% CNP); preventing their pain from getting worse (14% CLBP, 12% CNP); or temporarily relieving their pain (31% CLBP, 41% CNP). In univariate analysis across these goals, patients differed significantly on almost all variables. In the multinomial logistic models, a goal of cure was associated with shorter pain duration and more belief in a medical cure; a goal of preventing pain from coming back was associated with lower pain levels; and those with goals of preventing their pain from getting worse or temporarily relieving pain were similar, including in having their pain longer. Conclusions: Although much of health policy follows a curative model, the majority of these CLBP and CNP patients have goals of pain management (using ongoing care) rather than "cure" (care with a specific end) for their chiropractic care. This information could be useful in crafting policy for patients facing provider-based nonpharmacologic care for chronic pain.


Assuntos
Dor Crônica , Dor Lombar , Manipulação Quiroprática/psicologia , Cervicalgia , Adulto , Idoso , Dor Crônica/epidemiologia , Dor Crônica/psicologia , Dor Crônica/terapia , Feminino , Metas , Conhecimentos, Atitudes e Prática em Saúde , Humanos , Estudos Longitudinais , Dor Lombar/epidemiologia , Dor Lombar/psicologia , Dor Lombar/terapia , Masculino , Pessoa de Meia-Idade , Cervicalgia/epidemiologia , Cervicalgia/psicologia , Cervicalgia/terapia
13.
Medicine (Baltimore) ; 98(31): e16631, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31374032

RESUMO

BACKGROUND: This systematic review protocol describes the methods that will be used to evaluate the efficacy and safety of ear acupuncture for trauma-related disorders after large-scale disasters. METHODS AND ANALYSIS: The following electronic databases will be searched up to May 2019 without language or publication status restrictions: Medline, EMBASE, the Cochrane Central Register of Controlled Trials, Allied and Complementary Medicine Database, Cumulative Index to Nursing and Allied Health Literature, and PsycARTICLES. We will also search Korean, Chinese, and Japanese databases. Any clinical studies with original data related to ear acupuncture for trauma-related disorders after large-scale disaster will be included. Traumatic stress-related symptoms will be assessed as primary outcomes. Depression, anxiety, adverse events, and total effective rate will be evaluated as secondary outcomes. Two researchers will independently perform the study selection, data extraction, and assessment of study quality. Descriptive analyses of the details of participants, interventions, and outcomes for all included studies will be conducted. Data synthesis and analysis will be performed using RevMan version 5.3. The methodological quality of the included studies will be evaluated according to the study design. ETHICS AND DISSEMINATION: Ethical approval is not required because individual patient data are not included. The findings of this systematic review will be disseminated through a peer-reviewed publication or conference presentations. PROSPERO REGISTRATION NUMBER: CRD42019134658.


Assuntos
Acupuntura Auricular/métodos , Desastres , Saúde Mental , Trauma Psicológico/terapia , Acupuntura Auricular/efeitos adversos , Ansiedade/epidemiologia , Ansiedade/terapia , Dor Crônica/epidemiologia , Dor Crônica/terapia , Depressão/epidemiologia , Depressão/terapia , Humanos , Trauma Psicológico/epidemiologia , Projetos de Pesquisa
14.
Curr Pain Headache Rep ; 23(10): 73, 2019 Aug 06.
Artigo em Inglês | MEDLINE | ID: mdl-31388874

RESUMO

PURPOSE OF REVIEW: To assess patterns of utilization and variables of facet joint interventions in managing chronic spinal pain in a fee-for-service (FFS) Medicare population from 2009 to 2016, with a comparative analysis from 2000 to 2009 and 2009 to 2016. RECENT FINDINGS: From 2009 to 2016, facet joint interventions increased at an annual rate of 2% per 100,000 Medicare population compared to 10.2% annual rate of increase from 2000 to 2009. Lumbosacral facet joint nerve block episodes decreased at an annual rate of 0.1% from 2009 to 2016, with an increase of 16.2% from 2000 to 2009. In contrast, lumbosacral facet joint neurolysis episodes increased at an annual rate of 7.6% from 2009 to 2016 and the utilization rate also increased at an annual rate of 26% from 2000 to 2009. The ratio of lumbar facet joint block episodes to lumbosacral facet joint neurolysis episodes changed from 6.7 in 2000 to 2.2 in 2016. From 2009 to 2016, cervical and thoracic facet joint injections increased at an annual rate of 0.6% compared to cervicothoracic facet neurolysis episodes of 9.2%. During 2000 to 2009, annual increase of cervical facet joint injections was 18% compared to neurolysis procedures of 26%. The ratio of cervical facet joint injections episodes to neurolysis episodes changed from 8.85 in 2000 to 2.8 in 2016. In summary, based on available data, utilization patterns of facet joint interventions demonstrated an increase of 2% per 100,000 Medicare population from 2009 to 2016, with an annual decline of lumbar facet joint injection episodes.


Assuntos
Dor Crônica/cirurgia , Medicare/economia , Procedimentos Neurocirúrgicos , Articulação Zigapofisária/cirurgia , Dor nas Costas/cirurgia , Dor Crônica/epidemiologia , Humanos , Manejo da Dor/métodos , Estados Unidos
15.
Transfus Apher Sci ; 58(4): 434-438, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31326289

RESUMO

BACKGROUND: Pain affects over 50% of adults with sickle cell disease (SCD), and this pain is largely managed outside of the hospital. While chronic transfusion therapy is used to decrease the rate of acute pain events in patients with SCD, less is known about its impact on the day-to-day experience of pain. To address this knowledge gap, we provided pain diaries to patients with SCD receiving chronic transfusion. PATIENTS AND METHODS: A convenience sample of chronically-transfused adults with SCD successfully completed a diary over the course of at least 2 transfusion events. Patients receiving simple transfusions and red cell exchanges were included. Pain was rated on a scale of 0 to 10 each day, and patient laboratory values, co-morbidities, and hospital utilization were also obtained using the electronic medical record. The mean pain scores pre- and post-transfusion were evaluated using both a random effects-expectation maximization regression tree analysis and a generalized linear mixed regression model. RESULTS: Ten subjects (63%) in this cohort were defined as having chronic pain, while the remaining four (27%) subjects had episodic pain. Despite chronic transfusion and a suppressed HbS% (22.5% (16.5-25.9)), 10 patients (63%) continued to report nearly daily pain, and on almost 70% of diary days, the pain was significant (≥5/10). When the relationship between HbS% and reported pain intensity was examined, no association was found. DISCUSSION: These results suggest that, even with regular transfusions and a low HbS%, daily pain persists in many adults with SCD.


Assuntos
Anemia Falciforme , Dor Crônica , Transfusão de Eritrócitos , Adulto , Anemia Falciforme/epidemiologia , Anemia Falciforme/fisiopatologia , Anemia Falciforme/terapia , Dor Crônica/epidemiologia , Dor Crônica/fisiopatologia , Feminino , Humanos , Masculino , Medição da Dor
16.
Medicine (Baltimore) ; 98(28): e16450, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31305475

RESUMO

Persistent postsurgical pain (PPP) is defined as the discomfort that lasts >3 months postoperatively. The primary aim of this retrospective study was to estimate the risk of developing moderate-to-severe PPP after primary total knee arthroplasty (TKA). The secondary goal was to explore potential predictors of this outcome.Data were collected via hospital arthroplasty registry and chart review. The risk of moderate-to-severe PPP, defined as ≥4 on the numerical rating scale (NRS) at minimum of 3 months post-surgery, was calculated. Multivariable logistic regression was used to estimate the association of patient demographics, diagnoses, length of hospital stay, and preoperative NRS with the odds of developing PPP. Exploratory, simple logistic regression was used to estimate the association of perioperative factors with the odds of developing PPP on a subset of patients (n = 72).The risk of PPP after TKA was 31.3% (95% confidence interval [CI]: 27.5-35.0) (n = 578). Every 2-point increase in baseline NRS was associated with 1.66 (95% CI: 1.37-2.03) times the odds of developing PPP (P < .001). African-Americans (vs whites) had 1.82 (95% CI: 1.03-3.22) times the odds of developing PPP (P = .040). Exploratory analysis suggested that the adductor canal saphenous nerve (vs femoral nerve) blocks were associated with 2.87 (95% CI: 1.00-8.26) times the odds of developing PPP (P = .049).This study estimated a high risk (31.3%) of moderate-to-severe PPP after primary TKA. This study suggested that higher preoperative pain scores might be associated with greater odds of developing PPP. Moreover, this study suggested the possibility that racial differences and types of peripheral nerve blocks might be associated with greater odds of developing moderate-to-severe PPP after TKA surgery. However, the evidence obtained from our exploratory analysis of limited data certainly requires further exploration in large-scale studies.


Assuntos
Artroplastia do Joelho , Dor Crônica/epidemiologia , Dor Pós-Operatória/epidemiologia , Idoso , Feminino , Seguimentos , Humanos , Incidência , Masculino , Bloqueio Nervoso , Medição da Dor , Estudos Retrospectivos , Fatores de Risco , Índice de Gravidade de Doença
17.
Biol Aujourdhui ; 213(1-2): 59-64, 2019.
Artigo em Francês | MEDLINE | ID: mdl-31274104

RESUMO

The current treatment of migraine attacks is triptans and NSAIDs, but the calcitonin gene-related peptide (CGRP) has emerged as a key neuropeptide target for migraine therapy. Despite an off target class effect on liver enzymes, two CGRP receptor antagonists, ubrogepant and rimegepant, remain in development, together with a 5-HT1F receptor agonist (lasmiditan), for which cardiovascular contraindications that limit the utility of triptans do not exist. Importantly, to avoid an excessive use of acute medication with the risk of medication overuse, prophylactic therapeutics are the best choice. To date, monoclonal antibodies which block CGRP actions are on the market all over the world but not yet in France. The research is very active in different directions and targets notably hypothalamic neuropeptides because the hypothalamus hosts many key neuropeptide systems that seem to play a role in migraine physiopathology. These neuropeptides include orexins, oxytocin, neuropeptide Y (NPY) and pituitary adenylate cyclase-activating polypeptide (PACAP). In addition, other promising drugs for the treatment of migraine are nitric oxide synthase inhibitors and acid-sensing ion channel (ASIC) blockers.


Assuntos
Dor Crônica/terapia , Transtornos de Enxaqueca/prevenção & controle , Transtornos de Enxaqueca/terapia , Manejo da Dor/métodos , Terapias em Estudo/métodos , Doença Aguda , Analgésicos/uso terapêutico , Quimioprevenção/métodos , Quimioprevenção/tendências , Dor Crônica/epidemiologia , Drogas em Investigação/uso terapêutico , França/epidemiologia , Humanos , Transtornos de Enxaqueca/patologia , Manejo da Dor/tendências , Terapias em Estudo/tendências
18.
Rev Bras Anestesiol ; 69(3): 227-232, 2019.
Artigo em Português | MEDLINE | ID: mdl-31160047

RESUMO

BACKGROUND AND OBJECTIVES: Pain is one of the most common reason for seeking medical care. This study aimed to analyze patients with chronic pain in Maricá, Rio de Janeiro State, Brazil. METHODS: A transversal retrospective study with 200 patients, who were treated in ambulatory care in a public hospital from June 2014 to December 2015. The variables analyzed were: pain intensity, type of pain, anatomical location, diagnosis and treatment. The data were submitted to statistical analysis, the Fisher's exact test was applied, and the probability p was significant when ≤0.05. RESULTS: We analyzed 200 patients with chronic pain, most of them female (83%). Mean age was 58.6±13.01 years old. The patients were classified in groups by age, six groups with ten years of difference between them. Main age range was the 50-59 years old group, with 49 females (32%) and 5 males (15%). About 65.5% of the total of patients (131) had severe pain (Numeric Rating Sacale was 9.01). Mixed pain was predominant, affecting 108 patients (92 females and 16 males, what represents 55% and 47% of the total of females and males, respectively, that participate in the study). The most prevalent anatomical pain (159 patients, 131 females and 28 males) was in the lower limbs. Lower back pain was present in 113 of the 200 patients (94 females and 19 males). In the 30-39, 50-59, 60-69 years old group, the results for pain locations were significant: p=0.01, p=0.0069, p=0.0003, respectively. CONCLUSION: The prevalence of chronic pain was associated with females in 50-59 years old and severe mixed pain. It was located mainly in lower limbs and lumbar region. The most frequent diagnosis was low back pain followed by fibromyalgia. The patients were informed about their disease and treatment.


Assuntos
Assistência Ambulatorial , Dor Crônica/epidemiologia , Fibromialgia/epidemiologia , Dor Lombar/epidemiologia , Adulto , Idoso , Brasil , Dor Crônica/terapia , Estudos Transversais , Feminino , Fibromialgia/terapia , Humanos , Dor Lombar/terapia , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Adulto Jovem
19.
Br J Surg ; 106(7): 845-855, 2019 06.
Artigo em Inglês | MEDLINE | ID: mdl-31162663

RESUMO

BACKGROUND: Chronic pain is reported after 10-35 per cent of inguinal hernia operations. The aim was to compare quality of life (QoL) after total extraperitoneal (TEP) and Lichtenstein hernia repairs in the setting of an RCT with operations performed by department-certified hernia surgeons. METHODS: Men aged 30-75 years with an ASA grade I-II primary inguinal hernia were randomized to TEP or Lichtenstein repair. Primary endpoint was pain at 1 year assessed with the Inguinal Pain Questionnaire (IPQ). Clinical examination, IPQ, SF-36® and study-specific questions were recorded before surgery, and at 1 and 3 years. RESULTS: Some 416 patients (202 TEP and 214 Lichtenstein) had surgery; 95·2 per cent completed 1-year and 89·9 per cent 3-year follow-up. At 1 year 'pain during last week' was reported by 6·9 per cent after TEP and by 9·8 per cent after Lichtenstein repair (P = 0·303), and 'pain right now' by 3·7 and 5·9 per cent respectively (P = 0·315). Favourable outcomes for TEP were duration of operation, 30-day complications, time to full recovery, foreign body sensation and sick leave. Groin sensory changes diminished after TEP but increased after Lichtenstein repair. Preoperative QoL was affected, especially in the physical subscales, but was restored to normal after surgery. At 1 and 3 years, 98·3 and 97·4 per cent respectively of the patients were satisfied; 1·6 per cent (6 of 374) suffered a recurrence at 3 years, four after TEP and two after Lichtenstein repair. CONCLUSION: In the medium term, both TEP and Lichtenstein hernia repair had similar outcomes after 1 year, with high rates of patient satisfaction and low rates of chronic pain and recurrence. There were short-term advantages for pain and recovery rate after TEP repair. Registration number: NCT00803985 ( www.clinicaltrials.gov).


Assuntos
Dor Crônica/prevenção & controle , Hérnia Inguinal/cirurgia , Herniorrafia/métodos , Dor Pós-Operatória/prevenção & controle , Adulto , Idoso , Dor Crônica/diagnóstico , Dor Crônica/epidemiologia , Dor Crônica/etiologia , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Medição da Dor , Dor Pós-Operatória/diagnóstico , Dor Pós-Operatória/etiologia , Satisfação do Paciente/estatística & dados numéricos , Peritônio , Qualidade de Vida , Recidiva , Resultado do Tratamento
20.
Pain Res Manag ; 2019: 9675654, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31198479

RESUMO

Pain is common among patients with head and neck cancer (HNC). However, there are very limited data on chronic pain among HNC patients treated with radiation therapy (XRT). In this retrospective study, we focused on the characteristics of chronic post-XRT pain in such patients. Post-XRT pain is common among HNC patients; however, we found discrepancy between frequency of treatment and frequency of chronic pain, suggesting poor documentation of pain in the medical records. Among patients who reported to have chronic post-XRT pain, most of them described having severe pain and used descriptors of neuropathic pain. Pharynx was the commonest site of cancer as well as the commonest site of cancer-related chronic pain; squamous cell carcinoma was the most frequent histological pattern, and opioids were used most often to treat such chronic pain. There was a significant association between chronic pain and number of sites of pain, and chronic pain was also associated with use of opioids.


Assuntos
Dor do Câncer/etiologia , Neoplasias de Cabeça e Pescoço/radioterapia , Adulto , Idoso , Dor do Câncer/epidemiologia , Dor Crônica/epidemiologia , Dor Crônica/etiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Radioterapia/efeitos adversos , Radioterapia/métodos , Estudos Retrospectivos
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