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1.
Medicine (Baltimore) ; 99(38): e22196, 2020 Sep 18.
Artigo em Inglês | MEDLINE | ID: mdl-32957349

RESUMO

We report the arthroscopic and clinical findings of patients with chronic wrist pain following distal radius fracture (DRF) who underwent diagnostic arthroscopy and arthroscopically-assisted tailored treatment.We retrospectively analyzed the records of 15 patients with chronic wrist pain following DRF, who underwent diagnostic arthroscopy and arthroscopically-assisted tailored treatment from 2010 to 2017. The average patient age was 44 years (range, 20-68 years), average time from injury to treatment 21 ±â€Š23.46 months (range, 3-96 months) and average follow up period 20.13 ±â€Š8.71 months (range, 12-39 months). The functional outcome was evaluated by comparing the preoperative and final follow up values of the range of motion, grip strength, pinch strength, visual analogue scale for pain and quick disabilities of the arm, shoulder and hand score.Based on the arthroscopic findings, synovitis was found in all cases and the pathologic intra-articular lesions were classified into 4 patterns. Triangular fibrocartilage complex rupture was seen in 14 cases, intercarpal and radiocarpal ligament ruptures in 9 cases, ulnar impaction syndrome in 5 cases, and cartilage lesion in 9 cases. In terms of surgical treatment, 15 patients underwent arthroscopic synovectomy, 7 foveal or capsular repair of TFCC, 7 intercarpal Kirschner wires fixation or intercarpal thermal shrinkage, 1 intercarpal ligament reconstruction, 2 Sauve-Kapandji procedure, and 2 unlar shortening osteotomy. Postoperatively, the average range of motion, grip strength, and pinch strength increased significantly. From preoperative to final follow up values, the average visual analogue scale and quick disabilities of the arm score decreased from 5.93 ±â€Š1.58 (range, 3-8) to 1.33 ±â€Š1.29 (range, 0-3) (P = .001) and from 49.38 ±â€Š19.09 to 12.63 ±â€Š7.63 (P = .001), respectively.Diagnostic arthroscopy and arthroscopically-assisted tailored treatment of chronic wrist pain following DRF can provide an accurate diagnosis, significant pain relief, and functional improvement.


Assuntos
Artroscopia/estatística & dados numéricos , Dor Crônica/cirurgia , Fraturas do Rádio/complicações , Traumatismos do Punho/cirurgia , Adulto , Idoso , Artroscopia/métodos , Dor Crônica/etiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Traumatismos do Punho/complicações , Traumatismos do Punho/diagnóstico , Adulto Jovem
2.
PLoS One ; 15(9): e0238634, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32886704

RESUMO

BACKGROUND: Chronic post-surgical pain (CPSP) is one of the post-surgical complications of a Cesarean section. Despite the high rates of Cesarean section worldwide, the incidence of CPSP and the risk factors for this condition remain relatively unknown. The objective of this study was to calculate the incidence of CPSP in women submitted to Cesarean section and to analyze the associated risk factors. MATERIALS AND METHODS: A prospective cohort of 621 women undergoing Cesarean section was recruited preoperatively. Potential presurgical (sociodemographic, clinical and lifestyle-related characteristics) and post-surgical risk factors (the presence and intensity of pain) risk factors were analyzed. Pain was measured at 24 hours and 7, 30, 60 and 90 days after surgery. Following discharge from hospital, data were collected by telephone. The outcome measure was self-reported pain three months after a Cesarean section. The risk factors for chronic pain were analyzed using the log-binomial regression model (a generalized linear model). RESULTS: A total of 462 women were successfully contacted 90 days following surgery. The incidence of CPSP was 25.5% (95%CI: 21.8-29.7). Risk factors included presurgical anxiety (adjusted relative risk [RR] 1.03; 95%CI: 1.01-1.05), smoking (adjusted RR 2.22; 95%CI: 1.27-3.88) and severe pain in the early postoperative period (adjusted RR 2.79; 95%CI: 1.29-6.00). CONCLUSION: One in four women submitted to Cesarean section may develop CPSP; however, the risk factors identified here are modifiable and preventable. Preventive strategies directed towards controlling anxiety, reducing smoking during pregnancy and managing pain soon after hospital discharge are recommended.


Assuntos
Cesárea/efeitos adversos , Dor Crônica/epidemiologia , Dor Crônica/etiologia , Adulto , Estudos de Coortes , Feminino , Seguimentos , Humanos , Incidência , Estilo de Vida , Análise Multivariada , Gravidez , Fatores de Risco
3.
BMC Surg ; 20(1): 147, 2020 Jul 06.
Artigo em Inglês | MEDLINE | ID: mdl-32631293

RESUMO

BACKGROUND: Chronic postsurgical pain (CPSP) after hernia repair research has mainly relied on unconfirmed self-reporting. We aimed to describe confirmed CPSP incidence, management, and quality of life (QoL) in a 2-year prospective study. METHODS: Multicenter study (GENDOLCAT) of 3890 patients undergoing 4 common surgical procedures in 23 hospitals to develop a risk model for CPSP; 2352 men underwent open hernia repair. Patients with pain were identified by telephone at 1 and 3 months and referred to the hospital 4 months after surgery for a physical examination to confirm CPSP. Three validated tools were used: the Brief Pain Inventory (BPI) for severity, analgesic use, and interference with activities; the SF-12 questionnaire for QoL (validated Spanish version), and the Douleur Neuropathique 4 (DN4). Patients with CPSP were called again at 1 and 2 years. RESULTS: In 1761 patients who underwent hernia repair and were eligible for physical examination for CPSP, the incidence of confirmed pain at 4 months was 13.6% (patient-reported pain, 6.2% at 1 year and 4.0% at 2 years). Neuropathic pain was diagnosed in 38.5% of the CPSP patients at 4 months. The incidences of neuropathic CPSP in patients with mesh or non-mesh repairs were similar (38.6 and 33.3%, respectively). SF-12 physical component scores changed little in all patients, whether or not they developed CPSP. The SF-12 mental component decreased significantly in all patients, but the decrease was clinically significant only in CPSP patients. CPSP interfered with activities (18%), work (15.6%), walking (15%) and mood (10.2%). At 2 years 52.1% of CPSP patients had moderate/intense pain and 28.2% took analgesics. CONCLUSION: CPSP affects QoL-related activities, and although it diminishes over the course of 2 years after surgery, many patients continue to have moderate/intense pain and take analgesics. CPSP and neuropathic pain rates seem to be similar after mesh and non-mesh repair. BPI and SF-12 mental component scores detect effects on QoL. TRIAL REGISTRATION: ClinicalTrials.gov NCT01510496.


Assuntos
Dor Crônica/etiologia , Herniorrafia/métodos , Dor Pós-Operatória/etiologia , Qualidade de Vida , Adulto , Idoso , Analgésicos/administração & dosagem , Virilha/cirurgia , Hérnia Inguinal/cirurgia , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Neuralgia/etiologia , Estudos Prospectivos , Inquéritos e Questionários
4.
Pain Res Manag ; 2020: 3408052, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32714478

RESUMO

Objective: To provide a brief and comprehensive summary of the recent evidence from clinical trials testing psychotherapeutic interventions in patients with fibromyalgia with particular interest in their possible effect on physical pain. Methods: Bibliographical search was performed in PubMed, PsycInfo, Web of Science, Scopus, and Cochrane Library databases. Content of the manuscripts was studied to obtain, if available, the following information: year of publication, location of the research team, design, type of psychotherapeutic intervention tested, pain measures, and a brief description of the psychotherapy, groups, and outcomes regarding physical pain. Results: Initial search eliciting 475 citations got reduced to 13 relevant papers. Most research studies from Spain (n = 8) are randomized control trials (n = 10) and used guided imagery (n = 5) or cognitive behavioral therapy (n = 4). The Visual Analogue Scale (n = 4) and the Fibromyalgia Impact Questionnaire (n = 4) were the physical pain measures mostly used. Improvements on physical pain were reported on all studies with published results; nevertheless, only in five cases, differences were significant. Conclusions: Evidence on the effect of psychotherapy on physical pain in patients with FS was divergent; though most studies report a reduction in pain, this was not always lasting and/or significant. Diversity of the results might be due to the selected psychotherapeutic approaches, assessment tools, and other internal (e.g., personality traits, (sub)clinical psychiatric symptoms, and treatment adherence) and external (e.g., family environment and social support) variables worth to be considered in the future research.


Assuntos
Fibromialgia/psicologia , Fibromialgia/terapia , Psicoterapia/métodos , Dor Crônica/etiologia , Dor Crônica/psicologia , Dor Crônica/terapia , Humanos , Espanha
9.
PLoS Med ; 17(6): e1003108, 2020 06.
Artigo em Inglês | MEDLINE | ID: mdl-32502219

RESUMO

BACKGROUND: An estimated 87% of torture survivors experience chronic pain such as brachial plexopathy from upper extremity suspension or lumbosacral plexus injury from leg hyperextension. However, a vast majority of pain is undetected by evaluators due to a lack of diagnostic tools and confounding psychiatric illness. This diagnostic gap results in exclusive psychological treatment rather than multimodal therapies, substantially limiting rehabilitation. We hypothesized that the United Nations Istanbul Protocol (UNIP) would have a sensitivity of approximately 15% for pain detection, and that the use of a validated pain screen would improve its sensitivity by at least 29%, as compared to the reference standard (pain specialist evaluation). METHODS AND FINDINGS: This prospective blind-comparison-to-gold-standard study of survivors of torture, as defined by the World Medical Association, took place at Weill Cornell Medicine between February 1, 2017, and June 21, 2019. 11 women and 9 men, for a total of 20 participants, were included in the analysis. Five participants received 2 UNIP evaluations, for a total of 25 unique evaluations included in the analysis. Participants were representative of a global population, with home countries in Africa, Central America, South Asia, the Caribbean, and the Middle East. Methods of torture experienced were homogeneous, following the predictable pattern of systematic torture. Participants first received the standard evaluation protocol for torture survivors (UNIP) by a trained evaluator, and subsequently received a validated pain screen (Brief Pain Inventory-Short Form [BPISF]) followed by a noninvasive examination by a pain specialist physician (reference standard). The primary outcome was the diagnostic and treatment capability of the standard protocol (index test) versus the validated pain screen (BPISF), as compared to the reference standard. Trained evaluators performing the initial assessment with the UNIP (index test) were blinded to the study, and the pain specialist physician (reference standard) was blinded to the outcome of the initial UNIP evaluation and the BPISF; data from the initial UNIP assessment were not gathered by the principal investigator until all other study procedures were completed. Providers using only the UNIP captured pain in a maximum of 16% of evaluations, as compared to 85% of participants being diagnosed with pain by the reference standard. When employed, the validated pain screen had a sensitivity of 100% (95% CI 72%-100%) and a negative predictive value of 100%, as compared to a sensitivity of 24% (95% CI 8%-50%) and a negative predictive value of 19% (95% CI 5%-46%) for the index test. The difference in the sensitivity of the UNIP as compared to the BPISF was significant, with p < 0.001. No adverse events owing to participation in the study were reported by participants. Limitations of the study include small sample size, its single-site nature, and the exclusion of individuals who did not speak 1 of the 5 study languages. CONCLUSIONS: These data indicate that a validated pain screen can supplement the current global standard assessment of torture survivors, the UNIP, to increase the accuracy of pain diagnosis. TRIAL REGISTRATION: ClinicalTrials.gov NCT03018782.


Assuntos
Dor Crônica/diagnóstico , Medição da Dor/métodos , Refugiados/psicologia , Tortura/psicologia , Adulto , Dor Crônica/etiologia , Feminino , Humanos , Masculino , Medição da Dor/normas , Estudos Prospectivos , Refugiados/estatística & dados numéricos , Reprodutibilidade dos Testes , Sensibilidade e Especificidade , Método Simples-Cego , Sobreviventes/psicologia , Sobreviventes/estatística & dados numéricos
10.
Surgery ; 168(3): 471-477, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32444065

RESUMO

BACKGROUND: Until now, no detailed long-term data regarding patients with declining quality of life or occupational status after laparoscopic Roux-en-Y gastric bypass surgery have been presented. The aim of this study was to evaluate the long-term effect of laparoscopic Roux-en-Y gastric bypass surgery on quality of life and occupational status. METHODS: The study was a single-center register-based cohort study including all patients who underwent laparoscopic Roux-en-Y gastric bypass surgery from 2010 through 2014. Quality of life was based on the validated Moorehead-Ardelt questionnaire, measured preoperatively and postoperatively after 12, 24, and median 63 months. Longitudinal trends of occupational status were created and compared with overall trends in the Danish population. Subgroup analyses were conducted, investigating associations between declining quality of life, declining occupational status, and postoperative chronic abdominal pain. RESULTS: In total, 749 patients were included in the study. All aspects of quality of life improved after laparoscopic Roux-en-Y gastric bypass surgery. After a median follow-up of 63 months, quality of life was significantly reduced in 14% of the patients compared with the preoperative baseline. Lower quality of life was associated with a decline in occupational status (P = .008) and postoperative chronic abdominal pain (P < .0001). Overall, occupational status was unchanged compared with before surgery. Throughout the study period occupational status declined in 21% of the patients. Declining occupational status was associated with declining quality of life (P = .008) and development of chronic abdominal pain (P = .009). CONCLUSION: In general, quality of life and occupational status improved after laparoscopic Roux-en-Y gastric bypass surgery. Subgroups of patients had declining quality of life and declining occupational status both being associated with postoperative chronic abdominal pain.


Assuntos
Emprego/estatística & dados numéricos , Derivação Gástrica/efeitos adversos , Laparoscopia/efeitos adversos , Obesidade Mórbida/cirurgia , Qualidade de Vida , Dor Abdominal/epidemiologia , Dor Abdominal/etiologia , Adulto , Dor Crônica/epidemiologia , Dor Crônica/etiologia , Dinamarca/epidemiologia , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Dor Pós-Operatória/epidemiologia , Dor Pós-Operatória/etiologia , Estudos Prospectivos , Sistema de Registros/estatística & dados numéricos
12.
Clin Podiatr Med Surg ; 37(3): 577-592, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32471620

RESUMO

Optimal healing for fractures requires anatomic reduction and stable fixation. This optimizes not only bone healing, but optimal function within the limb including joint functioning. Proper ligamentous healing is also crucial for optimal functioning. In patients with injuries around the ankle involving distal tibiofibular syndesmotic injuries of the ankle, malreduction of the syndesmosis is a potential consequence that can lead to chronic pain and functional limitations. This article discusses proper ways of evaluating reduction of the syndesmosis and surgical revision for the chronic injury.


Assuntos
Fraturas do Tornozelo/cirurgia , Traumatismos do Tornozelo/cirurgia , Instabilidade Articular/cirurgia , Adulto , Fraturas do Tornozelo/complicações , Fraturas do Tornozelo/diagnóstico , Traumatismos do Tornozelo/complicações , Traumatismos do Tornozelo/diagnóstico , Artralgia/etiologia , Artralgia/cirurgia , Dor Crônica/etiologia , Dor Crônica/cirurgia , Humanos , Instabilidade Articular/complicações , Instabilidade Articular/diagnóstico , Masculino , Reoperação
13.
Artigo em Inglês | MEDLINE | ID: mdl-32357440

RESUMO

BACKGROUND: Chronic pelvic pain syndrome (CPPS) is one of the common diseases in urology and gynecology. CPPS is a multifactorial disorder where pain may originate in any of the urogynecological, gastrointestinal, pelvic musculoskeletal, or nervous systems. The symptoms of CPPS appear to result from an interplay between psychological factors and dysfunction in the immune, neurological, and endocrine systems. The aim of this article was to present new insight about CPPS in order to raise awareness of nursing and medical staff in the identification and diagnosis of the syndrome and to promote an appropriate treatment for each woman who suffers from CPPS. METHODS: A literature review about the factors associated with CPPS and therapeutic interventions for CPPS was conducted. RESULTS: CPPS represents a chronic pain syndrome that combines anatomic malfunction of the pelvic floor muscles with malfunction of pain perception linked with psychological and cognitive factors. CONCLUSIONS: The therapeutic interventions in CPPS cases should, consequently, follow a multidisciplinary approach.


Assuntos
Dor Crônica , Dor Pélvica , Dor Crônica/etiologia , Dor Crônica/terapia , Feminino , Humanos , Dor Pélvica/etiologia , Dor Pélvica/terapia , Síndrome
14.
Pain Res Manag ; 2020: 3586767, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32399126

RESUMO

Ehlers-Danlos syndrome (EDS) is a connective tissue disorder characterized by joint hypermobility and skin extensibility and is often accompanied by chronic pain. Rhythmic sensory stimulation (RSS) can be defined as the stimulation of the senses in a periodic manner within a range of low frequencies. Music plus sound delivered through a vibroacoustic device is a form of RSS and has demonstrated utility in managing pain. In this current study, we conducted an open-label pilot study of 15 patients with hypermobile EDS using RSS as the intervention. Posttreatment improvements were seen in 11 of the 15 patients (73%), whereas 3 of the 15 patients (20%) experienced worse outcomes. Of the 14 patients that completed the experiment, 6 participants (43%) were classified as "responders" to the device while 8 participants (57%) were classified as "nonresponders." Responders demonstrated significant improvements in pain interference (51.5 ± 16 preintervention vs. 43.5 ± 16.4 postintervention BPI score) and depression symptoms (34.0 ± 15.9 preintervention vs. 26.8 ± 12.1 postintervention CESD score). Poststudy interviews confirm the improvements of pain interference, mood, and bowel symptoms. Furthermore, analysis of medical conditions within the responder group indicates that the presence of depression, anxiety, irritable bowel syndrome, and fibromyalgia may indicate a greater likelihood for patients to benefit with vibroacoustic applications. These results indicate a possible potential for RSS, delivered using a vibroacoustic device, in managing pain-related symptoms. Further research is necessary to elucidate the exact mechanism behind the physiological benefits of RSS.


Assuntos
Estimulação Acústica/métodos , Dor Crônica/etiologia , Dor Crônica/terapia , Síndrome de Ehlers-Danlos/complicações , Manejo da Dor/métodos , Vibração/uso terapêutico , Adulto , Feminino , Humanos , Pessoa de Meia-Idade , Projetos Piloto
15.
Pain Res Manag ; 2020: 8496527, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32454923

RESUMO

Purpose: Pain experience due to spinal degenerative disease decreases activity of daily living and quality of life. The present cross-sectional study was aimed at examining the sex-specific impact of pain severity, psychosocial factors, and insomnia on the disability due to chronic pain arising from spinal degenerative disease. Methods: In total, 111 outpatients with chronic spinal degenerative on initial diagnosis were analyzed. The definition of chronic spinal degenerative disease was (1) pain duration ≥3 months, (2) findings of nerve root compression on neurological examination and imaging, and (3) localized neck or lower back pain (not widespread, upper or lower limb pain). We used Numerical Rating Scale (NRS), Pain Disability Assessment Scale (PDAS), Hospital Anxiety and Depression Scale (HADS), Pain Catastrophizing Scale (PCS), and Athens Insomnia Scale (AIS) to assess patients. Univariate regression analysis was performed to investigate whether sex influences the PDAS score, and sex-stratified multivariate regression analysis was conducted to identify the variables associated with the PDAS score. Results: Sex was identified as a predictor of the PDAS score (standardized coefficient (ß) = 0.28; 95% confidence interval (CI), 0.10-0.46; p=0.003). In men, the AIS score was associated with PDAS (ß = 0.36, 95% CI 0.09-0.63). Age (ß = 0.31, 95% CI 0.06-0.55) and NRS (ß = 0.40, 95% CI 0.14-0.67) were associated with PDAS in women. HADS-A, HADS-D, and PCS were not associated with PDAS in both sexes. Conclusion: Insomnia was associated with disability in men, whereas aging and pain severity were associated with disability in women. Catastrophic thinking was not associated with disability in both sexes.


Assuntos
Ansiedade/etiologia , Depressão/epidemiologia , Avaliação da Deficiência , Distúrbios do Início e da Manutenção do Sono/etiologia , Doenças da Coluna Vertebral/complicações , Doenças da Coluna Vertebral/psicologia , Adulto , Idoso , Ansiedade/epidemiologia , Dor Crônica/etiologia , Dor Crônica/psicologia , Estudos Transversais , Depressão/etiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Qualidade de Vida , Fatores Sexuais , Distúrbios do Início e da Manutenção do Sono/epidemiologia
16.
Pain Res Manag ; 2020: 5759265, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32351639

RESUMO

Background: Tapentadol prolonged release (PR) has been shown effective and generally well tolerated in a broad range of chronic pain conditions. This subgroup analysis investigated its benefits for elderly patients with severe chronic osteoarthritis (OA) pain in routine clinical practice. Patients and Methods. Data of all patients with chronic OA pain were extracted from the database of a prospective, 3-month noninterventional tapentadol PR trial. The data of elderly OA patients (>65 years of age; n = 752) were compared with the data of younger OA patients (≤65 years; n = 282). Results: Almost all patients (elderly 98.7% and younger patients 99.3%) had received long-term analgesic medication prior to the start of tapentadol PR treatment but presented with severe pain accompanied by considerable impairments in sleep quality and quality of life measures. Tapentadol PR provided effective pain relief in both patient groups, with slightly better outcomes in younger patients. However, the mean baseline pain intensity of 7.1 (SD 1.5) was reduced by 3.8 points (p ≤ 0.001), and sleep and quality of life measures had also markedly improved in the elderly: quality of sleep by 3 points, quality of life by 3.4 points, social activities by 3 points, and independence by 2.7 points (p ≤ 0.001 for all measures; 11-point scale). At the end of observation, 68% of the elderly had clinically relevant pain reductions of at least 50% (vs baseline), and 87.9% attained either their intended pain reduction target and/or an additional individual treatment target (both predefined during baseline examination). Only 8.4% of the elderly experienced adverse drug reactions, most frequently nausea (2.7% of patients) and dizziness (1.5%). Conclusion: Tapentadol PR provided effective and well-tolerated treatment of severe chronic OA pain for elderly patients in routine clinical practice. The favorable tolerability profile in particular suggests tapentadol PR as a treatment option before classical strong opioids are considered.


Assuntos
Analgésicos Opioides/uso terapêutico , Preparações de Ação Retardada/uso terapêutico , Osteoartrite/tratamento farmacológico , Manejo da Dor/métodos , Tapentadol/uso terapêutico , Idoso , Dor Crônica/tratamento farmacológico , Dor Crônica/etiologia , Feminino , Humanos , Masculino , Osteoartrite/complicações , Estudos Prospectivos , Qualidade de Vida
18.
J Surg Res ; 252: 222-230, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32289579

RESUMO

BACKGROUND: Investigate the diagnostic and therapeutic utility of laparoscopy in the management of patients with chronic abdominal pain of unknown origin. METHODS: Ovid MEDLINE, PubMed, and SCOPUS databases were queried to identify relevant published studies. Data on the diagnostic and therapeutic utility of laparoscopy were abstracted and summarized. RESULTS: Laparoscopy achieved a diagnosis in 65% to 94% of patients with chronic abdominal pain of unknown origin. Common intraoperative findings included adhesions, chronic appendicitis, hernias, and enlarged mesenteric lymph nodes. These findings corresponded with the therapeutic procedures that were performed, including laparoscopic adhesiolysis, appendectomy, and hernia repair. Therapeutic utility of laparoscopy based on pain relief, patient satisfaction, and quality of life ranged from 63% to 94%. CONCLUSIONS: Based on current available evidence, diagnostic laparoscopy (DL) is a safe and effective method for identifying organic causes of chronic abdominal pain. Laparoscopic treatment also resulted in substantial pain relief for a majority of patients. However, the efficacy of laparoscopic adhesiolysis remains controversial. We would recommend the use of DL as an early diagnostic tool, but more robust studies are needed to establish the breadth of its therapeutic utility in clinical practice.


Assuntos
Dor Abdominal/cirurgia , Apendicite/diagnóstico , Dor Crônica/cirurgia , Hérnia Abdominal/diagnóstico , Laparoscopia , Aderências Teciduais/diagnóstico , Dor Abdominal/diagnóstico , Dor Abdominal/etiologia , Apendicite/complicações , Apendicite/cirurgia , Dor Crônica/diagnóstico , Dor Crônica/etiologia , Hérnia Abdominal/complicações , Hérnia Abdominal/cirurgia , Humanos , Medição da Dor , Aderências Teciduais/complicações , Aderências Teciduais/cirurgia , Resultado do Tratamento
19.
Transplant Proc ; 52(5): 1388-1393, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-32307139

RESUMO

Aiming to investigate the prevalence of chronic pain and its impact on quality of life of lung transplantation (LTx) recipients, we performed a transversal study collecting data using a standard interview model in 2 different periods: first, in 2016 we studied LTx recipients after 3 to 11 months of the transplantation; and second, in 2019, we studied the same patients after 39 to 55 months of transplantation surgery. The chosen questionnaires were the Brief Pain Inventory and Short-Form Health Survey. Chronic pain was identified in 47.2% of the analyzed recipients at the initial interview and in 40.7% at the second evaluation. In both periods, the domain quality of life was the most affected in contrast to functional capacity, which was the least affected. On the first analysis, a moderate negative correlation was found between pain intensity and functional capacity domains (-0,42/P = .010), pain (-0,46/P = .005), and mental health (-047/P = .004); meanwhile, the second survey showed a moderate/high negative correlation for most of the domains, except for the mental health (-0,036/P = .120). We conclude that the prevalence of chronic pain after LTx is high, and the pain intensity had a moderate negative correlation with domains such functional capacity, mental health, and pain at the first analysis in contrast to the moderate/high negative correlation for almost every domain, except mental health, at the second analysis.


Assuntos
Dor Crônica/etiologia , Dor Crônica/psicologia , Transplante de Pulmão/efeitos adversos , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/psicologia , Adulto , Dor Crônica/epidemiologia , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/epidemiologia , Prevalência , Qualidade de Vida/psicologia , Inquéritos e Questionários
20.
Pain Pract ; 20(6): 639-646, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-32255266

RESUMO

OBJECTIVES: To compare the efficacy and safety between leucocyte-rich platelet-rich plasma (LR-PRP) and corticosteroid in fluoroscopically guided caudal epidural injection for patients with complex chronic lumbar spinal pain. STUDY DESIGN: A prospective randomized controlled double-blinded study. METHODS: Fifty eligible patients with complex chronic degenerative spinal pain were randomly assigned with a 1:1 allocation ratio to receive caudal epidural injection of corticosteroid (triamcinolone acetonide, 60 mg) or LR-PRP (isolated from 60 mL autologous blood) under fluoroscopic guidance. Levels of low back pain, quality of life, and complications (or adverse effects) were evaluated at 1, 3, and 6 months after treatment. Pain levels and quality of life were assessed using the VAS and Short Form 36-Item Health Survey (SF-36), respectively. RESULTS: No significant difference was shown at baseline between the 2 groups. Compared with the pretreatment values, there were significant reductions in the VAS score in both groups. A significantly lower VAS score at 1-month follow-up was detected in patients who received corticosteroid injection. However, the scores were lower in the LR-PRP group at 3- and 6-month follow-up. SF-36 responses at 6 months showed significant improvement in all domains in the LR-PRP group. There were no complications or adverse effects related to treatment at 6-month follow-up in either group. CONCLUSIONS: Both autologous LR-PRP and corticosteroid for caudal epidural injections under fluoroscopic guidance are equally safe and therapeutically effective in patients with complex chronic lumbar spinal pain. However, LR-PRP is superior to corticosteroid for a longer pain-relieving effect and improvement in quality of life.


Assuntos
Anti-Inflamatórios/uso terapêutico , Dor Lombar/terapia , Plasma Rico em Plaquetas , Doenças da Coluna Vertebral/terapia , Triancinolona Acetonida/uso terapêutico , Adulto , Dor Crônica/etiologia , Dor Crônica/terapia , Método Duplo-Cego , Feminino , Humanos , Injeções Epidurais , Dor Lombar/etiologia , Masculino , Pessoa de Meia-Idade , Manejo da Dor/métodos , Projetos Piloto , Estudos Prospectivos , Qualidade de Vida , Doenças da Coluna Vertebral/complicações , Resultado do Tratamento
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