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2.
Adv Gerontol ; 32(4): 492-501, 2019.
Artigo em Russo | MEDLINE | ID: mdl-31800175

RESUMO

The study involving 317 former combatants aged 24 to 69 years was conducted. The aim of the study was to determine the regularities of the age dynamics of stress-induced pathology of combatants to develop the concept of their accelerated aging as a final component of the consequences of combat stress. It turned out that in relation to the period of influence of factors of combat stress and age, first manifests the pathology of the musculoskeletal system, gastrointestinal tract and arterial hypertension, then-cardiovascular disease associated with atherosclerosis. The formation of post-traumatic stress disorder occurred in 289 (91,2%) cases, and the chronic pain syndromes of different localization and different origin - in 192 (60,6%) at different times of the post-war period. But it is post-traumatic stress disorder in combination with chronic pain were decisive in the overall severity of the state of combatants, changes in indicators of free radical oxidation and an increase in biological age. It is proposed to consider accelerated aging, which is formed on the basis of the consequences of severe stress effects, as an independent disease.


Assuntos
Envelhecimento , Doença Crônica , Distúrbios de Guerra , Veteranos , Adulto , Idoso , Doenças Cardiovasculares/etiologia , Dor Crônica/etiologia , Distúrbios de Guerra/complicações , Gastroenteropatias/etiologia , Humanos , Pessoa de Meia-Idade , Transtornos de Estresse Pós-Traumáticos/etiologia , Veteranos/estatística & dados numéricos
3.
Pan Afr Med J ; 33: 303, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31692774

RESUMO

Duodenal duplication is an extremely rare congenital abnormality that occurs mostly in children. It represents only 2% to 12% of all gastrointestinal tract duplication. Its clinical presentation is highly variable and non-specific making the positive diagnosis very difficult. Imaging modalities can help to detect the lesions making the diagnosis more accurate before surgery. Here, we report a case of duodenal duplication revealed by chronic abdominal pain and treated by surgical resection in a 26-year-old man. Even in adults, it is necessary to evoke the diagnosis of duodenal duplication in patients with unexplained abdominal pain. Surgical resection remains the treatment of choice and endoscopic treatment is reserved for selected patients in whom surgery is difficult.


Assuntos
Dor Abdominal/etiologia , Procedimentos Cirúrgicos do Sistema Digestório/métodos , Duodeno/anormalidades , Adulto , Dor Crônica/etiologia , Duodeno/cirurgia , Humanos , Masculino
4.
Unfallchirurg ; 122(11): 854-859, 2019 Nov.
Artigo em Alemão | MEDLINE | ID: mdl-31712850

RESUMO

Young individuals with chronic exercise-induced lower leg pain (ELP) who have normal compartmental muscle pressures and normal imaging occasionally suffer from a nerve entrapment syndrome. These patients have consistently undergone a variety of diagnostic tests and often futile therapies prior to arriving at the correct diagnosis. Awareness among traumatologists regarding these nerve entities is low. A lower leg discomfort that is frequently present at night but worsens during exercise combined with altered foot skin sensations suggests an entrapment of the common peroneal or tibial nerve. If conservative therapies fail, neurolysis is advised.


Assuntos
Dor Crônica/etiologia , Síndromes de Compressão Nervosa/diagnóstico , Nervo Fibular , Nervo Tibial , Exercício , Pé/inervação , Humanos , Perna (Membro)/inervação , Síndromes de Compressão Nervosa/complicações , Síndromes de Compressão Nervosa/terapia
5.
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
6.
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
7.
BMJ ; 367: l5654, 2019 10 16.
Artigo em Inglês | MEDLINE | ID: mdl-31619437

RESUMO

OBJECTIVE: To assess the efficacy of three months of antibiotic treatment compared with placebo in patients with chronic low back pain, previous disc herniation, and vertebral endplate changes (Modic changes). DESIGN: Double blind, parallel group, placebo controlled, multicentre trial. SETTING: Hospital outpatient clinics at six hospitals in Norway. PARTICIPANTS: 180 patients with chronic low back pain, previous disc herniation, and type 1 (n=118) or type 2 (n=62) Modic changes enrolled from June 2015 to September 2017. INTERVENTIONS: Patients were randomised to three months of oral treatment with either 750 mg amoxicillin or placebo three times daily. The allocation sequence was concealed by using a computer generated number on the prescription. MAIN OUTCOME MEASURES: The primary outcome was the Roland-Morris Disability Questionnaire (RMDQ) score (range 0-24) at one year follow-up in the intention to treat population. The minimal clinically important between group difference in mean RMDQ score was predefined as 4. RESULTS: In the primary analysis of the total cohort at one year, the difference in the mean RMDQ score between the amoxicillin group and the placebo group was -1.6 (95% confidence interval -3.1 to 0.0, P=0.04). In the secondary analysis, the difference in the mean RMDQ score between the groups was -2.3 (-4.2 to-0.4, P=0.02) for patients with type 1 Modic changes and -0.1 (-2.7 to 2.6, P=0.95) for patients with type 2 Modic changes. Fifty patients (56%) in the amoxicillin group experienced at least one drug related adverse event compared with 31 (34%) in the placebo group. CONCLUSIONS: In this study on patients with chronic low back pain and Modic changes at the level of a previous disc herniation, three months of treatment with amoxicillin did not provide a clinically important benefit compared with placebo. Secondary analyses and sensitivity analyses supported this finding. Therefore, our results do not support the use of antibiotic treatment for chronic low back pain and Modic changes. TRIAL REGISTRATION: ClinicalTrials.gov NCT02323412.


Assuntos
Amoxicilina , Degeneração do Disco Intervertebral/complicações , Deslocamento do Disco Intervertebral/complicações , Dor Lombar , Vértebras Lombares , Adulto , Amoxicilina/administração & dosagem , Amoxicilina/efeitos adversos , Antibacterianos/administração & dosagem , Antibacterianos/efeitos adversos , Dor Crônica/diagnóstico , Dor Crônica/tratamento farmacológico , Dor Crônica/etiologia , Avaliação da Deficiência , Método Duplo-Cego , Feminino , Humanos , Dor Lombar/diagnóstico , Dor Lombar/tratamento farmacológico , Dor Lombar/etiologia , Vértebras Lombares/diagnóstico por imagem , Vértebras Lombares/patologia , Masculino , Pessoa de Meia-Idade , Noruega , Medição da Dor/métodos , Resultado do Tratamento
8.
Rev Assoc Med Bras (1992) ; 65(9): 1174-1180, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31618333

RESUMO

OBJECTIVE: The study aims to explore the relationship between preoperative anxiety and chronic postoperative pain. METHODS: A total of forty rats were divided into four groups, control, single-prolonged stress alone, Hysterectomy alone, and SPS+ Hysterectomy. The paw withdrawal mechanical thresholds (PWMT) were examined. qRT-PCR and western blotting assay were performed to detect the GFAP expression in astrocytes isolated from the anterior cingulate cortex (ACC) region. In addition, the long-term potentiation (LTP) in ACC was examined. RESULTS: Rats in the SPS group or the Hysterectomy alone group had no significant effect on chronic pain formation, but SPS can significantly induce chronic pain after surgery. Astrocytes were still active, and the LTP was significantly increased three days after modeling in the SPS+Hysterectomy group. CONCLUSIONS: anxiety can induce chronic pain by activating astrocytes in the ACC region.


Assuntos
Ansiedade/complicações , Astrócitos/metabolismo , Dor Crônica/etiologia , Dor Pós-Operatória/etiologia , Animais , Dor Crônica/psicologia , Modelos Animais de Doenças , Feminino , Proteína Glial Fibrilar Ácida/metabolismo , Giro do Cíngulo/metabolismo , Membro Posterior , Histerectomia , Potenciação de Longa Duração/fisiologia , Limiar da Dor/fisiologia , Dor Pós-Operatória/psicologia , Período Pré-Operatório , Distribuição Aleatória , Ratos Sprague-Dawley , Estresse Psicológico/etiologia , Fatores de Tempo
9.
Rev Assoc Med Bras (1992) ; 65(9): 1201-1207, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31618338

RESUMO

OBJECTIVES: Inguinal hernioplasty techniques have been improved since the first hernioplasty. Tension-free techniques that apply synthetic mesh materials, as in the Lichtenstein approach, are the gold standard. Laparoscopic hernioplasty is the strongest alternative to Lichtenstein. The superiority of laparoscopic hernioplasty over Lichtenstein is a major topic of debate. In this study, we aimed to find a conclusion to this debate by comparing our totally extraperitoneal (TEP) experiences with Lichtenstein experiences. METHODS: Patients who underwent inguinal hernioplasty at the Gulhane Training and Research Hospital from 2013 to 2018 were included in this retrospective cohort study. The sample included 96 TEP and 90 Lichtenstein patients for a total of 186 patients. The variables assessed were hospitalization duration, postoperative early visual analog scale score, chronic pain, paresthesia, recurrence, and early postoperative complications. Data were collected from patient records and via telephone questionnaire if needed. Data analysis was done by SPSS v20, using chi-square, Fisher's exact, and Mann-Whitney U tests. RESULTS: Male/female ratios were similar between the TEP and Lichtenstein groups. There was no difference in mean age between groups (p=0.1). The hospital stay was shorter (p=0.0001), and early postoperative visual analog scale score was lower in the TEP group (p=0.003). Chronic pain, paresthesia, recurrence, and early postoperative complications (hematoma, seroma, wound infection) were similar. CONCLUSIONS: TEP is superior to Lichtenstein with shorter hospitalization duration and lower rates of early postoperative pain. No difference between the two techniques was found for chronic pain. We believe that laparoscopic hernioplasty approach may be the best alternative technique for inguinal hernia repair.


Assuntos
Hérnia Inguinal/cirurgia , Herniorrafia/métodos , Laparoscopia/métodos , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Dor Crônica/etiologia , Feminino , Seguimentos , Herniorrafia/efeitos adversos , Humanos , Laparoscopia/efeitos adversos , Tempo de Internação , Masculino , Pessoa de Meia-Idade , Dor Pós-Operatória/etiologia , Parestesia/etiologia , Recidiva , Estudos Retrospectivos , Adulto Jovem
10.
Res Vet Sci ; 126: 9-16, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31419617

RESUMO

Disbudding of calves is a standard husbandry procedure to reduce the risk of injuries to other cattle and to workers. Whereas acute pain resulting from disbudding has been studied extensively, little is known about chronic pain as a potential long-term consequence. The goal of the present study was to investigate possible morphological changes in the cornual nerve as a function of disbudding. Samples were collected from 17 randomly selected bulls and from 21 calves from a prospective clinical study. Among the calves, 13 were disbudded and 8 were sham-disbudded. Out of the disbudded calves, 4 showed signs of chronic pain. In all the animals, the infraorbital nerve was used as a methodological check. Morphological analysis included measuring minimal diameters of the axons present in both the cornual and infraorbital nerves. Sympathetic fibers were identified as based on the presence of Tyroxine hydroxylase (TH). TH-negative fibers were considered afferents. Trigeminal ganglia from the calves were immunostained for glial fibrillary acidic protein (GFAP) and Activating transcription factor 3 (ATF3). R. cornualis and N. infraorbitalis differed in terms of axon diameters and proportion of TH-positive fibers. Weak evidence (p > .091) of a difference in axon diameters between control and disbudded calves was found in R. cornualis, but the proportion of TH-positive fibers was alike in both groups. Average glial envelope and the percentages of ATF3-positive neurons revealed no difference between calves with and without signs of pain. Thus, available evidence is insufficient to support neuropathic changes as a result of disbudding in calves.


Assuntos
Bovinos/cirurgia , Cauterização/veterinária , Dor Crônica/veterinária , Cornos/cirurgia , Nervo Acessório/metabolismo , Fator 3 Ativador da Transcrição/metabolismo , Animais , Dor Crônica/etiologia , Masculino , Estudos Prospectivos
11.
Ethiop J Health Sci ; 29(3): 417-419, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-31447512

RESUMO

Background: Appendicitis is the most common cause of acute abdomen. The diagnosis of appendicitis can be easy when it presents with the classical symptoms or is very challenging when present with atypical presentation. Around 20-30% of patients operated on for appendicitis have appendicolithiasis. Appendicolithiasis are usually small in size, and are called giant when more than 2cm in size. Case Detail: A 36 years old man was referred from a district hospital with a diagnosis of cecal cancer. His complaints were right lower quadrant (RLQ) abdominal mass of 03 months and pain of 18 months duration. Colonoscopy was normal but abdominal CT showed a RLQ mass with a dense radio-opaque shadow at its center. Conclusions: Giant appendicolith is a rare condition. A high index of suspicion and careful review of imaging findings is the key in early diagnosis and improved patient outcomes.


Assuntos
Apendicite/diagnóstico , Litíase/diagnóstico , Dor Abdominal/etiologia , Adulto , Apendicectomia , Apendicite/diagnóstico por imagem , Apendicite/patologia , Apendicite/cirurgia , Apêndice/diagnóstico por imagem , Apêndice/patologia , Apêndice/cirurgia , Dor Crônica/etiologia , Humanos , Litíase/diagnóstico por imagem , Litíase/patologia , Litíase/cirurgia , Masculino , Tomografia Computadorizada por Raios X
12.
Medicine (Baltimore) ; 98(34): e16706, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31441843

RESUMO

OBJECTIVE: Postoperative chronic pain is characterized by high incidence, long duration, and complex pathogenesis. The purpose of this study was to investigate the correlation between the single nucleotide polymorphisms of the CCL2 gene rs4586 (g.5974T>C), CALCA rs3781719 (-692T>C), CX3CL1 rs614230 (2342C>T), and the risk of postoperative chronic pain in Chinese Han women. METHODS: We analyzed the CCL2 gene rs4586, CALCA rs3781719, CX3CL1 rs614230 single nucleotide polymorphism (SNPs) of 350 Chinese Han women with chronic postsurgical pain (CPSP) 6 months after cesarean section and 350 healthy women without chronic pain (HC). The levels of CCL2, CALCA, and CX3CL1 in serum were detected by enzyme-linked immunosorbent assay (ELISA). RESULTS: The CCL2 rs4586 T allele and the CX3CL1 gene rs614230C allele were protective factors for CPSP risk (adjusted OR = 0.766, 95% CI: 0.675-0.865 and OR = 0.336, 95% CI: 0.644-0.835). The CALCA gene rs3781719C allele was a risk factor for CPSP (adjusted OR = 1.273, 95% CI: 1.125-1.424). CCL2 rs4586, CX3CL1 gene rs614230, and CALCA gene rs3781719 locus gene polymorphisms were associated with serum CCL2, CX3CL1, and CALCA protein levels. CONCLUSION: Our results support that CCL2 gene rs4586, CALCA rs3781719, CX3CL1 rs614230 gene polymorphism are associated with the occurrence of chronic pain after cesarean section in Chinese Han women.


Assuntos
Cesárea/efeitos adversos , Dor Crônica/etiologia , Dor Crônica/genética , Dor Pós-Operatória/etiologia , Dor Pós-Operatória/genética , Adulto , Grupo com Ancestrais do Continente Asiático , Peptídeo Relacionado com Gene de Calcitonina/genética , Estudos de Casos e Controles , Quimiocina CCL2/genética , Quimiocina CX3CL1/genética , Ensaio de Imunoadsorção Enzimática , Feminino , Humanos , Polimorfismo de Nucleotídeo Único , Adulto Jovem
13.
BMC Complement Altern Med ; 19(1): 234, 2019 Aug 29.
Artigo em Inglês | MEDLINE | ID: mdl-31464643

RESUMO

BACKGROUND: The neurobiology of persistent pain shares common underlying psychobiology with that of traumatic stress. Modern treatments for traumatic stress often involve bottom-up sensorimotor retraining/exposure therapies, where breath, movement, balance and mindfulness, are used to target underlying psychobiology. Vigorous exercise, in particular Bikram yoga, combines many of these sensorimotor/exposure therapeutic features. However, there is very little research investigating the feasibility and efficacy of such treatments for targeting the underlying psychobiology of persistent pain. METHODS: This study was a randomized controlled trail (RCT) comparing the efficacy of Bikram yoga versus high intensity interval training (HIIT), for improving persistent pain in women aged 20 to 50 years. The participants were 1:1 randomized to attend their assigned intervention, 3 times per week, for 8 weeks. The primary outcome measure was the Brief Pain Inventory (BPI) and further pain related biopsychosocial secondary outcomes, including SF-36 Medical Outcomes and heart rate variability (HRV), were also explored. Data was collected pre (t0) and post (t1) intervention via an online questionnaire and physiological testing. RESULTS: A total of 34 women were recruited from the community. Analyses using ANCOVA demonstrated no significant difference in BPI (severity plus interference) scores between the Bikram yoga (n = 17) and the HIIT (n = 15). Women in the Bikram yoga group demonstrated significantly improved SF-36 subscale physical functioning: [ANCOVA: F(1, 29) = 6.17, p = .019, partial eta-squared effect size (ηp2) = .175 and mental health: F(1, 29) = 9.09, p = .005, ηp2 = .239; and increased heart rate variability (SDNN): F(1, 29) = 5.12, p = .013, ηp2 = .150, scores compared to the HIIT group. Across both groups, pain was shown to decrease, no injuries were experienced and retention rates were 94% for Bikram yoga and 75% for HIIT . CONCLUSIONS: Bikram yoga does not appear a superior exercise compared to HIIT for persistent pain. However, imporvements in quality of life measures and indicator of better health were seen in the Bikram yoga group. The outcomes of the present study suggest vigorous exercise interventions in persistent pain cohorts are feasible. TRIAL REGISTRATION: Australian New Zealand Clinical Trials Registry ( ACTRN12617001507370 , 26/10/2017).


Assuntos
Dor Crônica , Terapia por Exercício , Treinamento Intervalado de Alta Intensidade , Ferimentos e Lesões/complicações , Ioga , Adulto , Dor Crônica/etiologia , Dor Crônica/terapia , Estudos de Viabilidade , Feminino , Humanos , Pessoa de Meia-Idade , Projetos Piloto , Adulto Jovem
14.
Cardiovasc Intervent Radiol ; 42(11): 1530-1536, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31338552

RESUMO

PURPOSE: This retrospective study was conducted to compare the clinical outcomes of transcatheter arterial embolisation for chronic knee pain in patients with mild-to-moderate versus severe knee osteoarthritis. MATERIALS AND METHODS: This study included patients (n = 41) who were refractory to conservative treatments and who underwent transcatheter arterial embolisation using imipenem/cilastatin sodium between June 2017 and July 2018. A total of 71 knees, including 30 bilateral cases, were treated and categorised into two groups according to the Kellgren-Lawrence grade: mild-to-moderate osteoarthritis (n = 59, Kellgren-Lawrence grade 1-3) and severe osteoarthritis (n = 12, Kellgren-Lawrence grade 4). The clinical outcomes were measured by the visual analogue scale score. RESULTS: There were no significant differences in age, body mass index or baseline visual analogue scale scores between the two groups. The mean visual analogue scale scores in the mild-to-moderate osteoarthritis group were significantly decreased at 1 day, 1 week, 1 month, 3 months, and 6-months (5.5 at baseline vs. 3.2, 3.1, 2.9, 2.2, and 1.9, after treatment; all P = .00). These improvements were maintained at a mean of 10 ± 3 months (range 6-19 months) post-treatment. The visual analogue scale scores were significantly decreased in the severe osteoarthritis group for 1 month post-treatment (6.3 at baseline vs. 4.1, 4.1, and 4.4 at 1 day, 1 week, and 1 month; all P < .01). However, a decrease in pain was not statistically significant from 3 to 6 months (5.4 and 5.9 at 3 months and 6 months, respectively). CONCLUSION: Transcatheter arterial embolisation effectively relieved pain in patients with mild-to-moderate osteoarthritis. In patients with severe osteoarthritis, pain severity decreased for 1 month but gradually increased to the initial severity score within 3 months. LEVEL OF EVIDENCE: 4, Case series.


Assuntos
Artralgia/terapia , Dor Crônica/terapia , Embolização Terapêutica/métodos , Osteoartrite do Joelho/terapia , Adulto , Idoso , Idoso de 80 Anos ou mais , Artralgia/etiologia , Dor Crônica/etiologia , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Osteoartrite do Joelho/complicações , Estudos Retrospectivos , Índice de Gravidade de Doença , Resultado do Tratamento
15.
Curr Pain Headache Rep ; 23(8): 59, 2019 Jul 25.
Artigo em Inglês | MEDLINE | ID: mdl-31342191

RESUMO

PURPOSE OF REVIEW: Multiple sclerosis (MS) is an autoimmune disorder of the central nervous system that can lead to severe physical, cognitive, and neurological deficits that often manifest in young adults. Central neuropathic pain is a common presenting symptom, often prompting patients to seek treatment with opioids, NSAIDS, antiepileptics, and antidepressants despite minimal effectiveness and alarming side-effect profiles. Additionally, spasticity occurs in more than 80% of MS patients and is an important consideration for further study in treatment. RECENT FINDINGS: Related to inconsistencies in pain presentation and clinical reporting, current studies continue to investigate clinical patient presentation to define chronic pain characteristics to optimize treatment plans. Although often neuropathic in origin, the complex nature of such pain necessitates a multimodal approach for adequate treatment. While psychiatric comorbidities typically remain unchanged in their severity over time, physical conditions may lead to worsening chronic pain long-term, often due to decreased quality of life. The prevalence of neuropathic pain is ~ 86% in patients with multiple sclerosis and most commonly presents as extremity pain, trigeminal neuralgia, back pain, or headaches. As MS symptoms are frequently unremitting and poorly responsive to conventional medical management, recent attention has been given to novel interventions for management of pain. Among these, medicinal cannabis therapy, targeted physical therapy, and neuromodulation offer promising results. In this review, we provide a comprehensive update of the current perspective of MS pathophysiology, symptomatology, and treatment.


Assuntos
Dor Crônica/etiologia , Dor Crônica/terapia , Esclerose Múltipla/complicações , Esclerose Múltipla/fisiopatologia , Manejo da Dor/métodos , Humanos , Neuralgia/etiologia , Neuralgia/terapia
16.
J Opioid Manag ; 15(2): 147-158, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31343716

RESUMO

Transdermal buprenorphine (TDB) has demonstrated effectiveness in treating a range of chronic pain conditions, including cancer pain, nociceptive pain, and neuropathic pain and has a favorable safety profile. Worldwide, clinical experience of its use is relatively limited. There is considerable misunderstanding about the pharmacology, mechanism of action, and safety of buprenorphine. There is also limited guidance on the appropriate use of TDB for chronic pain management. This article presents an overview of TDB and also provides practical recommendations for its use as part of a multifaceted strategy in chronic cancer and non-cancer pain.


Assuntos
Analgésicos Opioides/administração & dosagem , Buprenorfina/administração & dosagem , Dor Crônica , Neoplasias/complicações , Analgésicos Opioides/uso terapêutico , Buprenorfina/uso terapêutico , Dor Crônica/tratamento farmacológico , Dor Crônica/etiologia , Humanos , Manejo da Dor , Medição da Dor , Adesivo Transdérmico
17.
Reumatismo ; 71(2): 113-117, 2019 Jul 09.
Artigo em Inglês | MEDLINE | ID: mdl-31309786

RESUMO

Angioleiomyomas are benign tumors originating in the vascular smooth muscles. The tumor typically presents as a painful, solitary, small subcutaneous nodule. Herein, we have described a case report of chronic leg pain due to angioleiomyoma. We outline the clinical, radiological and histopathological features of this rare diagnosis for a painful nodule of extremity. Although rare, angioleiomyoma should be included in the differential diagnosis of chronic leg pain.


Assuntos
Angiomioma/complicações , Dor Crônica/etiologia , Neoplasias de Tecidos Moles/complicações , Adulto , Feminino , Humanos , Perna (Membro) , Tela Subcutânea
18.
Dtsch Med Wochenschr ; 144(14): 965-968, 2019 07.
Artigo em Alemão | MEDLINE | ID: mdl-31311046

RESUMO

HISTORY: A 68-year-old woman presented with chronic back pain, a poor general condition, weight loss of 20 kg in the last 6 months and paretic hands. FINDINGS AND DIAGNOSIS: The patient had pareses of hand- and finger muscles on both sides with corresponding deficits proven by EMG. MRI revealed an intraspinal mass affecting the cervical and thoracic spine with myelon compression. Histologically IgG4-positive plasma cells were detected and IgG4-RD with spinal pseudotumor and resulting cervicothoracic myelopathy were diagnosed. THERAPY AND COURSE: After initiation of high-dose glucocorticoid therapy (100 mg i. v. over 7 days with reduction afterwards) and cyclophosphamide-pulse-therapy (initially 750 mg i. v., cumulative dose of 4500 mg in 6 months), the general condition and motor deficits improved. CONCLUSIONS: The CNS are a rare manifestation of IgG4-RD. The tumor typically grows displacing, is best visualized on MRI or PET-CT, presenting clinically the corresponding pain and neurological deficits and shows characteristic histology. Steroids and, as in our case helpful, advanced immunosuppression can be a promising treatment option.


Assuntos
Dor nas Costas , Dor Crônica , Doença Relacionada a Imunoglobulina G4 , Compressão da Medula Espinal , Idoso , Dor nas Costas/diagnóstico por imagem , Dor nas Costas/etiologia , Dor Crônica/diagnóstico por imagem , Dor Crônica/etiologia , Feminino , Humanos , Doença Relacionada a Imunoglobulina G4/complicações , Doença Relacionada a Imunoglobulina G4/diagnóstico , Doença Relacionada a Imunoglobulina G4/patologia , Compressão da Medula Espinal/diagnóstico por imagem , Compressão da Medula Espinal/etiologia
19.
Orv Hetil ; 160(27): 1047-1056, 2019 Jul.
Artigo em Húngaro | MEDLINE | ID: mdl-31264469

RESUMO

Orofacial pain is the common name of a variety of disorders from inflammatory diseases to neuropathic pain syndromes. This condition is quite common, it may involve 7% of the whole population. Patients (and doctors) are not aware of the origin of their complaints, therefore initial management falls among the variety of healthcare professionals. The aim of our review was to summarize the current evidence of chronic orofacial pain including diagnosis, management and pitfalls. Orv Hetil. 2019; 160(27): 1047-1056.


Assuntos
Dor Crônica/diagnóstico , Dor Crônica/terapia , Dor Facial/diagnóstico , Dor Facial/terapia , Neuralgia/complicações , Medição da Dor/métodos , Dor Crônica/etiologia , Depressão , Dor Facial/etiologia , Humanos , Comunicação Interdisciplinar , Resultado do Tratamento
20.
Eur J Pediatr ; 178(9): 1395-1403, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31325029

RESUMO

The objective of this prospective cohort study was to compare fructose malabsorption in patients with functional chronic abdominal pain and in healthy children. The sample was divided into two groups: asymptomatic children and pain-predominant functional gastrointestinal disorders according to the Rome IV criteria. All children were tested for fructose malabsorption by a standardized breath hydrogen test. Hydrogen and methane were measured and the test was presumed positive when it exceeded 20 ppm above baseline. If positive, patients were given a low-fructose diet and the response was evaluated. One hundred five children were included (34 healthy children, 71 with functional chronic abdominal pain), with similar demographic characteristics in both groups (35.2% male, age 9.5 ± 2.8 years). Hydrogen levels in breath were tested through a hydrogen test for fructose demonstrating malabsorption in 58.8% of healthy children (95%CI 40.8%-76.8%) and in 40.8% of children with chronic abdominal pain (95%CI 28.7%-53.0%), removing those who had bacterial overgrowth. Twenty-one of 31 patients with symptoms and a positive test (72.4%) reported an improvement on a low-fructose diet.Conclusion: Fructose malabsorption is more common in asymptomatic children than in patients with chronic abdominal pain. Better standardized test conditions are necessary to improve accuracy of diagnosis before using this test in clinical practice. What is Known: • Although fructose malabsorption is believed to be related with chronic abdominal pain, high-quality evidence is lacking. • Concerns have raised regarding the use of breath hydrogen test for fructose malabsorption in children with chronic abdominal pain. What is New: • Fructose malabsorption is not more common in children with pain-predominant functional gastrointestinal disorders than in asymptomatic children. • Improvement in symptoms with low-fructose diet may indicate that, although patients with pain-predominant functional gastrointestinal disorders did not have a higher percentage of malabsorption, they had greater fructose intolerance.


Assuntos
Dor Abdominal/etiologia , Dor Crônica/etiologia , Dieta com Restrição de Carboidratos , Açúcares da Dieta/metabolismo , Frutose/metabolismo , Síndromes de Malabsorção/diagnóstico , Dor Abdominal/dietoterapia , Adolescente , Doenças Assintomáticas , Testes Respiratórios , Estudos de Casos e Controles , Criança , Pré-Escolar , Dor Crônica/dietoterapia , Feminino , Humanos , Síndromes de Malabsorção/complicações , Síndromes de Malabsorção/dietoterapia , Síndromes de Malabsorção/fisiopatologia , Masculino , Estudos Prospectivos , Resultado do Tratamento
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