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1.
Rev Med Suisse ; 16(685): 500-502, 2020 Mar 11.
Artigo em Francês | MEDLINE | ID: mdl-32167252

RESUMO

Osteoarthritis (OA) remains a prevalent and difficult to treat entity, mostly due to its different phenotypes. Varying constellations of mechanic, metabolic and extrinsic factors such as trauma are main drivers of OA. Anti-inflammatory therapy by anti-interleukin 1 did not show a clear effect neither in hand or knee OA whilst it seem to reduce joint replacement at least in a certain patient populations. Corticosteroids did reduce pain and methotrexate reduced structural progression in recent hand OA trials. More promising for mechanical knee OA are growth factors such as sprifermin or kartogenin which foster the differentiation of chondrocytes. New data are available on joint safety of the subcutaneously administered anti-nerve growth factor (NGF) molecule tanezumab. In OA treatment, pain, structure, and biomechanic impairment need to be addressed.


Assuntos
Osteoartrite , Artroplastia de Substituição , Progressão da Doença , Humanos , Osteoartrite/complicações , Osteoartrite/tratamento farmacológico , Osteoartrite/cirurgia , Osteoartrite do Joelho/tratamento farmacológico , Dor/complicações , Dor/tratamento farmacológico
2.
PLoS One ; 15(1): e0228158, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-31971993

RESUMO

BACKGROUND: Experimental and clinical studies suggested an analgesic effect on chronic pain by motor cortex activation. The present study explored the complex mechanisms of interaction between motor and pain during performing the slow and fast finger tapping task alone and in concomitant with nociceptive laser stimulation. METHOD: The participants were 38 patients with fibromyalgia (FM) and 21 healthy subjects. We used a simultaneous multimodal method of laser-evoked potentials and functional near-infrared spectroscopy to investigate metabolic and electrical changes during the finger tapping task and concomitant noxious laser stimulation. Functional near-infrared spectroscopy is a portable and optical method to detect cortical metabolic changes. Laser-evoked potentials are a suitable tool to study the nociceptive pathways function. RESULTS: We found a reduced tone of cortical motor areas in patients with FM compared to controls, especially during the fast finger tapping task. FM patients presented a slow motor performance in all the experimental conditions, requesting rapid movements. The amplitude of laser evoked potentials was different between patients and controls, in each experimental condition, as patients showed smaller evoked responses compared to controls. Concurrent phasic pain stimulation had a low effect on motor cortex metabolism in both groups nor motor activity changed laser evoked responses in a relevant way. There were no correlations between Functional Near-Infrared Spectroscopy (FNIRS) and clinical features in FM patients. CONCLUSION: Our findings indicated that a low tone of motor cortex activation could be an intrinsic feature in FM and generate a scarce modulation on pain condition. A simple and repetitive movement such as that of the finger tapping task seems inefficacious in modulating cortical responses to pain both in patients and controls. The complex mechanisms of interaction between networks involved in pain control and motor function require further studies for the important role they play in structuring rehabilitation strategies.


Assuntos
Eletroencefalografia , Fibromialgia/complicações , Córtex Motor/fisiopatologia , Dor/complicações , Dor/fisiopatologia , Espectroscopia de Luz Próxima ao Infravermelho , Adulto , Estudos de Casos e Controles , Potenciais Evocados , Feminino , Humanos , Masculino
3.
PLoS One ; 15(1): e0228173, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-31978196

RESUMO

Persistent pain and hypertension often co-occur, and share several biological and lifestyle risk factors. The present study aimed to provide insight into the prevalence of, and factors associated with, hypertension in the largest cohort of patients seeking treatment in 43 tertiary pain clinics in Australia. Adults aged > = 18 years registered to the electronic Persistent Pain Outcomes Collaboration registry between 2013 and 2018 were included if they had persistent non-cancer pain (N = 43,789). Risk Ratios (RRs) compared prevalence of self-reported hypertension with the general and primary care Australian populations, and logistic regression examined factors associated with hypertension. One in four (23.9%) patients had hypertension, which was higher than the Australian adult population (2014-15: RR = 5.86, 95%CI: 5.66, 6.06; 2017-18: RR = 9.40, 95%CI: 9.01, 9.80), and in primary care patients (2011-13: RR = 1.17, 95%CI: 1.15, 1.20). Adjusting for covariates, patients with higher odds of hypertension were older, lived in regions with higher socioeconomic disadvantage, had higher levels of BMI, were born outside the Oceania/Australasia region, and had comorbid arthritis, diabetes, or severe-extremely severe anxiety symptoms. Female patients and those with depression symptoms had lower adjusted odds. Unadjusted analyses showed an association between widespread pain, pain duration, pain severity and interference, and lower pain self-efficacy with hypertension; however, only pain severity remained significant in adjusted analyses. Hypertension was more prevalent in people with persistent pain than in the general community, was associated with more severe pain, and commonly co-occurred with pain-related impairments. Routine hypertension screening and treatment targeting shared mechanisms of hypertension and pain may improve treatment outcomes in the pain clinic setting.


Assuntos
Hipertensão/patologia , Manejo da Dor , Adulto , Fatores Etários , Idoso , Austrália/epidemiologia , Índice de Massa Corporal , Estudos de Coortes , Feminino , Humanos , Hipertensão/complicações , Hipertensão/epidemiologia , Masculino , Pessoa de Meia-Idade , Dor/complicações , Dor/patologia , Prevalência , Sistema de Registros , Risco , Autoeficácia , Índice de Gravidade de Doença , Classe Social , Centros de Atenção Terciária
5.
J Consult Clin Psychol ; 87(10): 859-871, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31556663

RESUMO

OBJECTIVE: Marijuana and nonprescription opioids remain the two most commonly used illicit substances in the United States. They have commonalities, yet the use of both at the same time may have a greater impact on psychological and health outcomes. Research is needed to determine whether dual-use is associated with more negative outcomes than individual substance use. METHOD: We used the National Epidemiologic Survey of Alcohol and Related Conditions (NESARC) Wave 1 (W1; N = 43,093), Wave 2 (W2; N = 34,653), and the more recent NESARC-III (N3; N = 36,171) to compare nonuse with use of marijuana, nonprescription opioids, or both. We examined perceived health, pain interference, pain-related medical conditions, psychiatric conditions, and suicidality. RESULTS: Individual use and dual-use were more common in N3 than in W1. W1 dual-use and nonprescription opioid-only use predicted worse outcomes for most variables prospectively and cross-sectionally, including pain interference and poorer general health. Associations between marijuana-only use and outcomes were not as strong; however, marijuana was associated with depression and suicidal ideation. CONCLUSION: Nonprescription opioid use is concerning with dual-use predicting poorer perceived health and pain interference with work 3 years later along with strong relationships to suicidality and psychiatric conditions. Marijuana and nonprescription opioid dual-use is a possible treatment target. Substance interventions may be enhanced by addressing alternative pain care; chronic conditions; and/or psychiatric comorbidity. Differences in outcomes between substance use and nonuse were smaller recently in N3, particularly for marijuana use only. This may be due to increased access decreasing differences between those using and not using these drugs. (PsycINFO Database Record (c) 2019 APA, all rights reserved).


Assuntos
Uso da Maconha/psicologia , Transtornos Relacionados ao Uso de Opioides/psicologia , Dor/psicologia , Ideação Suicida , Adulto , Feminino , Nível de Saúde , Humanos , Masculino , Pessoa de Meia-Idade , Transtornos Relacionados ao Uso de Opioides/complicações , Dor/complicações , Estados Unidos
6.
Neurology ; 93(12): e1180-e1192, 2019 09 17.
Artigo em Inglês | MEDLINE | ID: mdl-31409737

RESUMO

OBJECTIVE: To determine the frequency and relative importance of the most meaningful symptoms in facioscapulohumeral muscular dystrophy (FSHD) and to identify the demographic and clinical features that are associated with the greatest disease burden in this population. METHODS: We performed a cross-sectional study involving 328 participants with FSHD. Collectively, participants reported the prevalence and relative importance of 274 symptoms and 15 symptomatic themes. We assessed the association between symptomatic theme prevalence and participants' age, sex, disease duration, pain level, employment status, and education. RESULTS: Participants answered >48,000 questions regarding their disease burden. The symptomatic themes with the highest prevalence in our sample were problems with shoulders or arms (96.9%), limitations with activities (94.7%), core weakness (93.8%), fatigue (93.8%), limitations with mobility and walking (93.6%), changed body image due to the disease (91.6%), and pain (87.7%). Problems with shoulders and arms and limitations with mobility and walking had the greatest effect on participants' lives. Employment status and the report of pain had the most extensive association with the prevalence of symptoms, with employment being associated with 8 of 15 of the symptomatic themes and pain being associated with 7 of 15 of the symptomatic themes. Men and women with FSHD experienced a similar prevalence of all symptomatic themes. CONCLUSIONS: Adults with FSHD experience a variety of symptoms that play an important role in their disease burden. These symptoms have a variable prevalence and importance in the FSHD population and are associated with disease duration, employment status, and pain level.


Assuntos
Distrofia Muscular Facioescapuloumeral/diagnóstico , Distrofia Muscular Facioescapuloumeral/fisiopatologia , Medidas de Resultados Relatados pelo Paciente , Inquéritos e Questionários , Adulto , Idoso , Idoso de 80 Anos ou mais , Estudos Transversais , Fadiga/complicações , Fadiga/diagnóstico , Fadiga/fisiopatologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Distrofia Muscular Facioescapuloumeral/complicações , Dor/complicações , Dor/diagnóstico , Dor/fisiopatologia , Adulto Jovem
7.
Curr Pain Headache Rep ; 23(10): 70, 2019 Aug 01.
Artigo em Inglês | MEDLINE | ID: mdl-31372847

RESUMO

PURPOSE OF REVIEW: Carpal tunnel syndrome (CTS) is an entrapment neuropathy that involves the compression of the median nerve at the wrist and is considered the most common of all focal entrapment mononeuropathies. CTS makes up 90% of all entrapment neuropathies diagnosed in the USA and affects millions of Americans. RECENT FINDINGS: Age and gender likely play a role in the development of CTS, but additional studies may further elucidate these associations. Of known associated risk factors, diabetes mellitus seems to have the greatest association with CTS. One of the most commonly reported symptoms in CTS is a "pins-and-needles" sensation in the first three fingers and nocturnal burning pain that is relieved with activity upon waking. Treatment for CTS is variable depending on the severity of symptoms. Conservative management of CTS is usually considered first-line therapy. In cases of severe sensory or motor deficit, injection therapy or ultimately surgery may then be considered. Still CTS is often difficult to treat and may be reoccurring. Novel treatment modalities such as laser and shockwave therapy have demonstrated variable efficacy though further studies are needed to assess for safety and effect. Given the unknown and potentially complex etiology of CTS, further studies are needed to explore combinations of diagnostic and therapeutic modalities.


Assuntos
Síndrome do Túnel Carpal/cirurgia , Nervo Mediano/cirurgia , Dor/cirurgia , Punho/cirurgia , Síndrome do Túnel Carpal/diagnóstico , Síndrome do Túnel Carpal/fisiopatologia , Humanos , Nervo Mediano/fisiopatologia , Síndromes de Compressão Nervosa/complicações , Síndromes de Compressão Nervosa/cirurgia , Dor/complicações , Fatores de Risco , Punho/inervação
8.
Int J Rehabil Res ; 42(3): 234-239, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31394559

RESUMO

We aim to explore factors contributing to community reintegration and health-related quality of life (HRQoL) among community-dwelling older adults three months after discharge from inpatient rehabilitation following hip fracture. We performed a prospective cohort study with follow-up. Thirty-three consecutive patients (age 66-89) after surgery for hip fracture repair were recruited from an inpatient rehabilitation unit. Participants were 65+ years old, did not have dementia, and were independent in basic activities of daily living (BADL) at discharge. We examined the contribution of independent variables measuring BADL, cognition, emotional status, pain and social support to the explained variance of two main outcomes: the Reintegration to Normal Living Index (RNLI), measuring self-reported ability to participate in activities and return to life roles; and the Medical Outcomes Study Short-Form Health Survey (SF-12), assessing mental and physical aspects of HRQoL. Stepwise regression analyses revealed that: social support and pain while walking significantly explained 42.1% of variance in the RNLI; social support significantly explained 31.1% of the variance in the SF-12-physical subscale; the number of falls in the previous year, social support and executive functions assessed by the clock drawing test significantly explained 61.9% of the variance in the SF-12 mental subscale. Social support, pain while walking and the number of falls in the previous year can predict community reintegration and HRQoL among older adults three months after discharge from rehabilitation following a surgical hip fracture repair. These factors need to be addressed in rehabilitation programs.


Assuntos
Integração Comunitária , Fraturas do Quadril/reabilitação , Vida Independente , Qualidade de Vida , Acidentes por Quedas , Idoso , Idoso de 80 Anos ou mais , Estudos de Coortes , Função Executiva , Feminino , Seguimentos , Fraturas do Quadril/cirurgia , Humanos , Masculino , Dor/complicações , Alta do Paciente , Apoio Social
9.
Enferm. clín. (Ed. impr.) ; 29(4): 245-247, jul.-ago. 2019.
Artigo em Espanhol | IBECS | ID: ibc-182919

RESUMO

El cóccix es un hueso con morfología y movilidad propia y puede presentar dolor por causas traumáticas como el parto dificultoso o con terminación instrumental. Sufrir coccidinia puede imposibilitar la realización de las actividades de la vida diaria y afectar desde la esfera física hasta el área psicosocial, dando gran morbilidad a la puérpera. El presente artículo resalta los factores que predisponen a la puérpera a sufrir coccigodinia y qué acciones realizar para su alivio y mejora. La coccidinia posparto es el dolor que aparece tan pronto se adopta posición sentada tras el parto. Son factores de riesgo la morfología del cóccix, el índice de masa corporal, el parto vaginal, el parto instrumental, multiparidad, sexo femenino, edad madura y con periné corto en mujer con parto difícil. Entre las actividades para mejorar el dolor se encuentran los analgésicos y coadyuvantes, la rehabilitación y el masaje del suelo pélvico, las infiltraciones, la psicoterapia y, por último, la cirugía


The coccyx is a bone with its own morphology and mobility and pain can occur due to trauma such as a difficult or instrumental delivery. Coccydynia can make it impossible to carry out the activities of daily life, its affects can be both physical and psychosocial, and causes great maternal morbidity. This article highlights the factors that predispose women to coccydynia and actions to relieve and improve it. Postpartum coccydynia is pain that appears as soon as a sitting position is adopted after delivery. Coccyx morphology, body mass index, vaginal delivery, instrumental delivery, multiparity, female sex, mature age and short perineum in women with difficult delivery are risk factors. The activities to improve pain begin with analgesia and coadjuvants, rehabilitation and pelvic floor massage, infiltrations, psychotherapy or, finally, surgery


Assuntos
Humanos , Feminino , Cóccix , Manejo da Dor , Dor/complicações , Pelve , Fatores de Risco , Período Pós-Parto , Enfermeiras Obstétricas
10.
Int J Orthop Trauma Nurs ; 34: 36-42, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31257007

RESUMO

BACKGROUND: Individuals who are resilient are more likely to engage in functional tasks and exercise post hip fracture. There may be a genetic predisposition to being resilient. OBJECTIVES: This study tested the direct and indirect association of 10 candidate genes, age, cognition, gender, comorbidities, pain and social activity on resilience, function and exercise post hip fracture. METHOD: This was a descriptive study including 172 community dwelling older adults. Measures included: age, gender, cognition (Modified Mini Mental Status Exam), comorbidities, social activities (self-report), DNA (GRM1, NTRK1, NTRK2, GNB3, NPY, SLC6A15. SLC6A4, BDNF, CR1TR1, FKBP5), pain (areas of pain and Numeric Rating Scale), function (Physical and Instrumental Activities of Daily Living; Lower Extremity Gains Score; Short Physical Performance Battery; Grip Strength) and exercise (Yale Physical Activity Scale). RESULTS: The majority of participants were Caucasian (93%), 50% were women and the average age was 81.09 (SD = 7.42). There were significant associations between resilience and single nucleotide polymorphisms from GRM1, NTRK1, NTRK2, GNB3, NPY and SLC6A15. Resilience, age, cognition, social activity, pain and genetic variability were directly and/or indirectly associated with exercise and/or function. DISCUSSION: This study highlights the importance of resilience for engagement in exercise and function after hip fracture and provides preliminary evidence for a genetic role for resilience.


Assuntos
Exercício Físico , Genótipo , Fraturas do Quadril/complicações , Fraturas do Quadril/genética , Dor/complicações , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Dor/enfermagem , Amplitude de Movimento Articular , Recuperação de Função Fisiológica/genética
11.
Int J Mol Sci ; 20(13)2019 Jul 06.
Artigo em Inglês | MEDLINE | ID: mdl-31284573

RESUMO

Aging of the population makes of dementia a challenge for health systems worldwide. The cognitive disturbance is a serious but not the only issue in dementia; behavioral and psychological syndromes known as neuropsychiatric symptoms of dementia remarkably reduce the quality of life. The cluster of symptoms includes anxiety, depression, wandering, delusions, hallucinations, misidentifications, agitation and aggression. The pathophysiology of these symptoms implicates all the neurotransmitter systems, with a pivotal role for the glutamatergic neurotransmission. Imbalanced glutamatergic and GABAergic neurotransmissions, over-activation of the extrasynaptic N-methyl-D-aspartate (NMDA) receptors and alterations of the latter have been linked to the development of neuropsychiatric symptoms experienced by almost the entire demented population. Drugs with efficacy and safety for prevention or long term treatment of these disorders are not available yet. Aromatherapy provides the best evidence for positive outcomes in the control of agitation, the most resistant symptom. Demented patients often cannot verbalize pain, resulting in unrelieved symptoms and contributing to agitation. Bergamot essential oil provides extensive preclinical evidence of analgesic properties. Incidentally, the essential oil of bergamot induces anxyolitic-like effects devoid of sedation, typical of benzodiazepines, with a noteworthy advantage for demented patients. These data, together with the reported safety profile, form the rational basis for bergamot as a neurotherapeutic to be trialed for the control of behavioral and psychological symptoms of dementia.


Assuntos
Demência/tratamento farmacológico , Demência/psicologia , Neurofarmacologia , Dor/tratamento farmacológico , Óleos Vegetais/uso terapêutico , Autofagia/efeitos dos fármacos , Demência/complicações , Humanos , Dor/complicações , Óleos Vegetais/farmacologia , Sinapses/efeitos dos fármacos , Sinapses/metabolismo
12.
Z Gerontol Geriatr ; 52(6): 607-622, 2019 Oct.
Artigo em Alemão | MEDLINE | ID: mdl-31346680

RESUMO

The causes of pain must always be clarified, as long as it can be justified. In dementia the placebo effect can be lacking. A treatment on demand is difficult to implement. Correctly applied nonmedicinal treatment has few unwanted effects but mostly needs constant support by personnel. Medications with anticholinergic effects should be used with caution due to the high risk of delirium and falling. With analgesics and coanalgesics the principles of geriatric treatment must also be adhered to: start low, go slow. Complaints that can be triggered by analgesics or coanalgesics should be recorded before starting treatment. Education and clarification by therapists are given priority. Multimorbidity and polypharmacy restrict the analgesic treatment. Strategies of self-efficacy and other psychological procedures have limited implementation. The course of treatment is difficult to monitor.


Assuntos
Analgésicos/uso terapêutico , Delírio , Demência/complicações , Manejo da Dor/métodos , Dor/tratamento farmacológico , Idoso , Delírio/induzido quimicamente , Delírio/prevenção & controle , Demência/psicologia , Humanos , Dor/complicações , Polimedicação
14.
Eur J Pharmacol ; 858: 172443, 2019 Sep 05.
Artigo em Inglês | MEDLINE | ID: mdl-31181208

RESUMO

The role of spinal α5 subunit-containing GABAA (α5-GABAA) receptors in chronic pain is controversial. The purpose of this study was to investigate the participation of spinal α5-GABAA receptors in the reserpine-induced pain model. Reserpine administration induced tactile allodynia and muscle hyperalgesia in female and male rats. Intrathecal injection of L-655,708 and TB 21007 (7 days after the last reserpine injection) decreased tactile allodynia and, at a lesser extent, muscle hyperalgesia in female rats. The effects of these drugs produced a lower antiallodynic and antihyperalgesic effect in male than in female rats. Contrariwise, these drugs produced tactile allodynia and muscle hyperalgesia in naïve rats and these effects were lower in naïve male than female rats. Intrathecal L-838,417 prevented or reversed L-655,708-induced antiallodynia in reserpine-treated female rats. Repeated treatment with α5-GABAA receptor small interfering RNA (siRNA), but not scramble siRNA, reduced reserpine-induced allodynia in female rats. Accordingly, α5-GABAA receptor siRNA induced nociceptive hypersensitivity in naïve female rats. Reserpine enhanced α5-GABAA receptors expression in spinal cord and dorsal root ganglia (DRG), while it increased CD11b (OX-42) and glial fibrillary acidic protein (GFAP) fluorescence intensity in the lumbar spinal cord. In contrast, reserpine diminished K+-Cl- co-transporter 2 (KCC2) protein in the lumbar spinal cord. Data suggest that spinal α5-GABAA receptors play a sex-dependent proallodynic effect in reserpine-treated rats. In contrast, these receptors have a sex-dependent antiallodynic role in naïve rats.


Assuntos
Fibromialgia/complicações , Dor/complicações , Dor/tratamento farmacológico , Receptores de GABA-A/metabolismo , Reserpina/farmacologia , Animais , Astrócitos/efeitos dos fármacos , Astrócitos/patologia , Feminino , Gânglios Espinais/efeitos dos fármacos , Gânglios Espinais/metabolismo , Regulação da Expressão Gênica/efeitos dos fármacos , Hiperalgesia/tratamento farmacológico , Hiperalgesia/metabolismo , Masculino , Microglia/efeitos dos fármacos , Microglia/patologia , Dor/induzido quimicamente , Dor/patologia , Ratos , Ratos Wistar , Medula Espinal/efeitos dos fármacos , Medula Espinal/metabolismo , Simportadores/metabolismo
15.
Med Sci Monit ; 25: 4122-4129, 2019 Jun 03.
Artigo em Inglês | MEDLINE | ID: mdl-31155608

RESUMO

BACKGROUND This study aimed to compare the efficacy and safety of wrist arthroscopy, small incision surgery, and conventional open carpal tunnel release surgery for the treatment of carpal tunnel syndrome. MATERIAL AND METHODS Patients with carpal tunnel syndrome (n=111) were treated with wrist arthroscopy (n=33), small incision surgery (n=40), and conventional open carpal tunnel release surgery (n=38). Incision length, duration of surgery, degree of intraoperative bleeding, recovery time, and findings at postoperative follow-up at one month, three months, and six months after surgery were recorded. Assessment included the two-point discrimination test, the grip and pinch strength test, the visual analog scale (VAS) score for pain, the Levine questionnaire, and Kelly's therapeutic evaluation. RESULTS Incision length, duration of surgery, intraoperative bleeding, and recovery time were significantly reduced in the wrist arthroscopy group and the small incision surgery group compared with the conventional surgery group (p<0.05). There were no significant differences in the two-point discrimination or grip and pinch strength test (p>0.05). Postoperatively, at one month, the VAS score, Levine score, and Kelly's therapeutic evaluation in the wrist arthroscopy group and the small incision surgery group were significantly lower compared with the conventional surgery group (p<0.05). Scar length and scar tenderness in the conventional surgery group were significantly increased compared with the wrist arthroscopy group and the small incision surgery group (p<0.05). CONCLUSIONS Wrist arthroscopy, small incision surgery, and conventional open carpal tunnel release surgery were effective for the treatment of carpal tunnel syndrome, but conventional surgery resulted in more postoperative complications.


Assuntos
Artroscopia/métodos , Síndrome do Túnel Carpal/cirurgia , Descompressão Cirúrgica/métodos , Adulto , China , Feminino , Força da Mão , Humanos , Masculino , Pessoa de Meia-Idade , Dor/complicações , Complicações Pós-Operatórias/etiologia , Período Pós-Operatório , Recuperação de Função Fisiológica , Estudos Retrospectivos , Inquéritos e Questionários , Resultado do Tratamento , Punho/cirurgia , Articulação do Punho/cirurgia
16.
Pain Manag ; 9(4): 355-359, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31215846

RESUMO

Aim: This pilot case series examined feasibility of anterior radiofrequency approach under combined ultrasound and fluoroscopy guidance to control pain from avascular necrosis of the hip. Patients & methods: Data on 11 consecutive patients were collected on longevity of cooled radiofrequency ablation (CRFA), pain relief and opioid use. Results: The average age was 56 (28-66), BMI 29.5 (16.5-34), in four women and three men. Their average opioid use was 92 mg MS04 equivalents (median 35 mg). The pain score decreased to 3.3 after the CRFA. Five patients claimed more than 50% of pain relief. The average time interval of greater than 50% of pain relief from the CRFA was 70-250 days. Conclusion: CRFA may be an effective treatment of chronic pain from avascular necrosis.


Assuntos
Osteonecrose/complicações , Osteonecrose/radioterapia , Manejo da Dor/métodos , Dor/complicações , Adulto , Idoso , Feminino , Fluoroscopia , Quadril , Humanos , Masculino , Pessoa de Meia-Idade , Medição da Dor , Projetos Piloto , Resultado do Tratamento , Ultrassonografia
17.
Pancreas ; 48(5): 690-697, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31091217

RESUMO

OBJECTIVES: Pancreatic duct stones contribute to pain in patients with chronic pancreatitis, and per-oral pancreatoscopy (POP) allows visualization, fragmentation, and removal of these stones. This study compared the safety and efficacy of endoscopic retrograde pancreatography (ERP) with and without POP. METHODS: This single-center retrospective review compared ERP with and without POP for treatment of main-duct pancreatic duct stones. The primary outcome was technical success, defined as partial or complete stone removal, which was compared between the 2 groups. RESULTS: In all, 223 patients underwent 549 ERPs with a technical success rate of 92.4% and complete stone clearance rate of 74.9%. Patients undergoing ERP with POP (n = 94) had higher technical success than patients undergoing ERP without POP (n = 129, 98.9% vs 87.6%, P < 0.001), but required more ERPs (3.1 vs 1.9, P = 0.02). Endoscopic retrograde pancreatography with POP was associated with larger stone size (8.9 vs 6.1 mm, P = 0.001), more stones per case (5+ stones: 33.8% vs 21.1%, P = 0.002), and more impacted stones (48.8% vs 10.3%, P < 0.001). CONCLUSIONS: Per-oral pancreatoscopy-guided lithotripsy permits effective stone removal in cases not amenable to standard ERP techniques, including those with larger or more numerous stones.


Assuntos
Colangiopancreatografia Retrógrada Endoscópica/métodos , Endoscopia Gastrointestinal/métodos , Litotripsia/métodos , Pancreatopatias/terapia , Ductos Pancreáticos/patologia , Cálculos Urinários/terapia , Dor Abdominal/diagnóstico , Dor Abdominal/etiologia , Adulto , Idoso , Colangiopancreatografia Retrógrada Endoscópica/efeitos adversos , Endoscopia Gastrointestinal/efeitos adversos , Feminino , Humanos , Litotripsia/efeitos adversos , Masculino , Pessoa de Meia-Idade , Dor/complicações , Dor/prevenção & controle , Pancreatite Crônica/complicações , Pancreatite Crônica/terapia , Estudos Retrospectivos , Resultado do Tratamento , Cálculos Urinários/complicações
18.
PLoS One ; 14(4): e0216108, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31039196

RESUMO

BACKGROUND: Few studies have investigated the associations of comorbid migraine with other painful physical symptoms (PPS) in patients with major depressive disorder (MDD) at the two-year follow-up point. This study aimed to investigate this issue. METHODS: At baseline, 155 outpatients with MDD were enrolled. Migraine was diagnosed at baseline according to the International Classification of Headache Disorders. At follow-up, data of 101 subjects were analyzed. The average intensities of head, bone and/or joints, back, chest, abdomen, neck and/or shoulder, general muscle, and limb pain in the past week were evaluated using a visual analog scale (VAS). At follow-up, active headache was defined as a score on the VAS > 3. Multiple linear regressions were used to investigate the associations of migraine at baseline with other PPS at follow-up. RESULTS: Compared with the migraine with inactive headache group and the non-migraine group, patients with migraine with active headache had significantly higher intensities of other PPS and a lower remission rate of depression. There were no significant differences in the pain intensities of the other seven PPS between the migraine with inactive headache group and the non-migraine group. Headache intensity was significantly correlated with the intensities of other PPS at baseline and follow-up. Migraine with active headache independently predicted other PPS after controlling for depression and anxiety at baseline. CONCLUSIONS: Migraine with active headache among MDD patients could predict other PPS. Prevention and treatment of headache might help to decrease other PPS and improve the prognosis of depression. Integration of treatment for depression and headache is indicated.


Assuntos
Transtorno Depressivo Maior/complicações , Cefaleia/complicações , Transtornos de Enxaqueca/complicações , Dor/complicações , Adulto , Feminino , Seguimentos , Humanos , Masculino , Psicometria
19.
Support Care Cancer ; 27(8): 2755-2756, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31053971

RESUMO

This commentary deals with the need of an early integration between hematologist and palliative care specialists as well as pain therapists as a routine basis in order to ensure the best management of patients affected by acute leukemia from the onset of the disease and in the stages of causal therapy. This strategy could limit the burden of painful symptoms and, in addition, avoid unnecessary suffering to patients, ensuring the best conditions for optimal outcome of these patients with extremely high clinical complexity and symptomatology who receive intensive treatments or who are managed with novel treatment approaches.


Assuntos
Dor do Câncer/complicações , Dor do Câncer/terapia , Hematologia/métodos , Leucemia Mieloide Aguda/terapia , Oncologia/métodos , Manejo da Dor/métodos , Cuidados Paliativos/métodos , Dor do Câncer/epidemiologia , Hematologia/organização & administração , Hematologia/normas , Humanos , Comunicação Interdisciplinar , Leucemia Mieloide Aguda/complicações , Oncologia/organização & administração , Oncologia/normas , Dor/complicações , Dor/etiologia , Manejo da Dor/efeitos adversos , Equipe de Assistência ao Paciente/organização & administração , Equipe de Assistência ao Paciente/normas
20.
BMC Neurosci ; 20(1): 17, 2019 04 24.
Artigo em Inglês | MEDLINE | ID: mdl-31014242

RESUMO

BACKGROUND: Reports show that stressful events before injury exacerbates post-injury pain. The mechanism underlying stress-induced heightened thermal pain is unclear. Here, we examined the effects of chronic intermittent stress (CIS) on nociceptive behaviors and brain-derived nerve growth factor (BDNF) system in the prefrontal cortex (PFC) and hypothalamus of rats with and without thermal injury. RESULTS: Unstressed rats showed transient mechanical allodynia during stress exposure. Stressed rats with thermal injury displayed persistent exacerbated mechanical allodynia (P < 0.001). Increased expression of BDNF mRNA in the PFC (P < 0.05), and elevated TrkB and p-TrkB (P < 0.05) protein levels in the hypothalamus were observed in stressed rats with thermal injury but not in stressed or thermally injured rats alone. Furthermore, administration of CTX-B significantly reduced stress-induced exacerbated mechanical allodynia in thermally injured rats (P < 0.001). CONCLUSION: These results indicate that BDNF-TrkB signaling in PFC and hypothalamus contributes to CIS-induced exacerbated mechanical allodynia in thermal injury state.


Assuntos
Fator Neurotrófico Derivado do Encéfalo/metabolismo , Hiperalgesia/metabolismo , Dor/fisiopatologia , Estresse Fisiológico/fisiologia , Animais , Queimaduras/complicações , Queimaduras/fisiopatologia , Hiperalgesia/complicações , Hiperalgesia/fisiopatologia , Hiperalgesia/prevenção & controle , Hipotálamo/metabolismo , Masculino , Dor/complicações , Peptídeos Cíclicos/farmacologia , Fosforilação , Córtex Pré-Frontal/metabolismo , Ratos , Receptor trkB/metabolismo
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