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2.
Medicine (Baltimore) ; 99(5): e18919, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-32000401

RESUMO

Previous studies have suggested that patients with psychotic or mental disorders are relatively pain insensitive, resulting in difficulties in the diagnosis of acute intra-abdominal diseases requiring emergency surgeries. We aimed to evaluate whether central nervous system (CNS) or mental disorders are associated with perforated appendicitis in patients with acute appendicitis.We conducted a population-based case-control study using Taiwan's National Health Insurance Research database. Patients aged >18 years who had been hospitalized with a diagnosis of acute appendicitis between 2000 and 2013 were identified. After 1:1 matching for age and sex, 2792 patients with perforated appendicitis (case group) and 2792 patients with nonperforated appendicitis (control group) were included. CNS disorders, mental disorders, pain control medication, and several comorbidities were analyzed for the odds of appendiceal perforation with 95% confidence interval (CI) using the multivariable logistic regression model.Schizophrenia and dementia were associated with a high risk of appendiceal rupture in patients with acute appendicitis, with an adjusted odds ratio of 2.01 for dementia (95% CI: 1.19-3.39, P = .009) and 4.8 for schizophrenia (95% CI: 1.62-14.19, P = .005). Other factors, such as other CNS disorders, comorbidities, and pain control medication, were not associated with the risk of perforated appendicitis.Dementia and schizophrenia are associated with perforated appendicitis in patients with acute appendicitis. This might be owing to altered pain perception, difficult symptom expression, and delayed hospitalization. Further studies are still needed to determine the underlying mechanism and confirm the causality.


Assuntos
Apendicite/epidemiologia , Demência/epidemiologia , Esquizofrenia/epidemiologia , Adulto , Idoso , Estudos de Casos e Controles , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Percepção da Dor , Risco , Adulto Jovem
4.
Ann Otol Rhinol Laryngol ; 129(2): 175-180, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31625416

RESUMO

OBJECTIVES: The topic of prescription opioid overuse remains a growing concern in the United States. Our objective is to provide insight into pain perception and opioid use based on a patient cohort undergoing common otologic and neurotologic surgeries. STUDY DESIGN: Prospective observational study with patient questionnaire. SETTING: Single academic medical center. SUBJECTS AND METHODS: Adult patients undergoing otologic and neurotologic procedures by two fellowship trained neurotologists between June and November of 2018 were included in this study. During first postoperative follow-up, participants completed a questionnaire assessing perceived postoperative pain and its impact on quality of life, pain management techniques, and extent of prescription opioid use. RESULTS: A total of 47 patients met inclusion and exclusion criteria. The median pain score was 3 out of 10 (Interquartile Range [IQR] = 2-6) with no significant gender differences (P = .92). Patients were prescribed a median of 15.0 (IQR = 10.0-15.0) tablets of opioid pain medication postoperatively, but only used a median of 4.0 (IQR = 1.0-11.5) tablets at the time of first follow-up. Measured quality of life areas included sleep, physical activity, work, and mood. Sleep was most commonly affected, with 69.4% of patients noting disturbances. CONCLUSIONS: This study suggests that practitioners may over-estimate the need for opioid pain medication following otologic and neurotologic surgery. It also demonstrates the need for ongoing patient education regarding opioid risks, alternatives, and measures to prevent diversion.


Assuntos
Analgésicos Opioides , Uso de Medicamentos/estatística & dados numéricos , Procedimentos Cirúrgicos Otológicos , Manejo da Dor/métodos , Percepção da Dor , Dor Pós-Operatória/tratamento farmacológico , Analgésicos Opioides/administração & dosagem , Estudos de Coortes , Autoavaliação Diagnóstica , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Procedimentos Neurocirúrgicos , Procedimentos Cirúrgicos Otológicos/métodos , Medição da Dor , Estudos Prospectivos
5.
Schmerz ; 34(1): 74-78, 2020 Feb.
Artigo em Alemão | MEDLINE | ID: mdl-31784907

RESUMO

The effect of two-point discrimination described in this case report indicates a cortical reorganization through electrical stimulation of receptive fields. The "intervention units" compared to the "baseline" show clear effects. The pain behavior in both "intervention units" showed a clear change in the phantom phenomena, which in both "wash out" phases moved back towards "baseline". Thus, electrical stimulation of receptive fields could be another therapy for the treatment of phantom pain, given the change in two-point discrimination.


Assuntos
Estimulação Elétrica , Percepção da Dor , Córtex Somatossensorial , Humanos
6.
Br J Anaesth ; 124(3): 292-298, 2020 03.
Artigo em Inglês | MEDLINE | ID: mdl-31862159

RESUMO

BACKGROUND: Clinicians traditionally warn patients of pain before peripheral i.v. cannulation (PIVC). However, using words related to pain or undesirable experiences can result in greater pain and anxiety. The use of positive words can improve pain perception and subjective patient experience. We aimed to compare the effects of three types of communication, including hypnotic communication, on pain, comfort, and anxiety in patients during PIVC. METHODS: The Effect of Language and Confusion on Pain During Peripheral Intravenous Catheterization (KTHYPE) trial is a randomised, parallel, single-blind, multicentre study of patients undergoing PIVC on the dorsal face of the hand before surgery. Patients from three hospitals were randomly allocated to one of three groups: PIVC performed with a hypnosis technique (hypnosis group), negative connotation (nocebo group), and neutral connotation (neutral group). The primary outcome measure was the occurrence of pain measured with a 0-10 numerical rating scale just after PIVC. RESULTS: Of the 272 subjects analysed (hypnosis, n=89; nocebo, n=92; neutral, n=91), pain after PIVC was lower in the hypnosis group (mean [standard deviation]; range) (1.5 [1.9]; 0-5) compared with the neutral (3.5 [2.3]; 0-9; P<0.0001) and nocebo groups (3.8 [2.5]; 0-10; P<0.0001). Whilst anxiety was higher and comfort lower before PIVC in the hypnosis group, anxiety decreased and comfort perception increased after PIVC when hypnosis was used. CONCLUSIONS: This is one of the first well-designed RCTs showing a significant benefit of a hypnosis technique during a routine procedure, such as PIVC. The results could facilitate implementation of hypnosis in daily clinical care. CLINICAL TRIAL REGISTRATION: NCT02662322.


Assuntos
Ansiedade/prevenção & controle , Cateterismo Periférico/efeitos adversos , Comunicação , Hipnose/métodos , Dor/prevenção & controle , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Ansiedade/etiologia , Ansiedade/psicologia , Cateterismo Periférico/métodos , Escolaridade , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Dor/etiologia , Dor/psicologia , Medição da Dor/métodos , Percepção da Dor , Método Simples-Cego , Adulto Jovem
7.
J Sci Med Sport ; 23(1): 100-104, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31563440

RESUMO

OBJECTIVES: To determine whether pain perceptions and coping strategies are predictive of the following outcomes after knee surgery in athletes: (1) return to similar level of sport, (2) improvement in symptoms, and (3) improvement in kinesiophobia. DESIGN: Prospective cohort study. METHODS: 101 athletes (52 men, 49 women; mean age 32.7years) at mean 12.1months follow-up were included. Independent relationships between patient outcomes and pre-operative measures were determined: short form McGill Pain questionnaire (SF-MPQ), Pain Catastrophizing Scale (PCS), Pain Coping Measure (PCM), and the brief COPE subscales of acceptance, denial, positive reframing, and use of instrumental support. Adjustment was performed for length of follow-up, symptom duration, surgical history, age, activity level, and surgical procedure. RESULTS: Rate of return to similar level of sport was 73%; severe pain catastrophizers (PCS >36 points) had increased odds of not returning to similar level of sport (OR 11.3 CI 1.51, 236; p=0.02) whereas COPE-use of instrumental support was protective (per point increase: 0.72 CI 0.54, 0.94; p=0.02). Problem-focused coping positively correlated with improvement in IKDC-S scores (beta 0.032 SE 0.010; p=0.001). Improvement in kinesiophobia after surgery was less likely with higher pre-operative perceived pain frequency (OR 0.23 CI 0.06, 0.71; p=0.009) and higher COPE-denial scores (OR 0.43 CI 0.21, 0.88; p=0.02). CONCLUSIONS: Among athletes undergoing knee surgery, severe pain catastrophizing is negatively associated with return to similar level of sport. Instrumental support and problem-focused coping strategies are associated with improved outcomes. High preoperative pain scores are negatively associated with improvement in kinesiophobia after rehabilitation.


Assuntos
Adaptação Psicológica , Catastrofização , Articulação do Joelho/cirurgia , Percepção da Dor , Volta ao Esporte , Adolescente , Adulto , Idoso , Atletas , Feminino , Humanos , Traumatismos do Joelho/psicologia , Traumatismos do Joelho/cirurgia , Masculino , Pessoa de Meia-Idade , Procedimentos Ortopédicos/psicologia , Estudos Prospectivos , Inquéritos e Questionários , Adulto Jovem
8.
Einstein (Sao Paulo) ; 18: eAO4916, 2020.
Artigo em Inglês, Português | MEDLINE | ID: mdl-31851226

RESUMO

OBJECTIVE: To investigate the prevalence and intensity of pain perception during diagnostic hysteroscopy in women and potential related factors. METHODS: A total of 489 women were investigated at an infertility clinic. Fluid diagnostic hysteroscopy was performed without analgesia or anesthesia by gynecologists with different levels of experience in operative hysteroscopy, using a 2.9mm rigid scope. The Visual Analog Scale was used to score pain intensity after vaginal speculum insertion and after hysteroscopy. Data collected included age, ethnicity, body mass index, history of infertility and endometrial surgery (curettage and/or hysteroscopy), smoking habits, and hysteroscopy diagnosis. Only the state of anxiety was assessed by the State-Trait Anxiety Inventory given to each patient before the procedure. RESULTS: Hysteroscopy median (25th to 75th) Visual Analog Scale scored 3.3 (3 to 5), and 41.7% of the women referred Visual Analog Scale score ≥4. Median (25th to 75th) State-Trait Anxiety Inventory score was 42 (38 to 45), and 58.3% of the women referred State-Trait Anxiety Inventory score >40. Hysteroscopy Visual Analog Scale score was significantly correlated to surgeon experience and to vaginal speculum insertion but not to State-Trait Anxiety Inventory score, ethnicity or abnormal hysteroscopic findings. CONCLUSION: Diagnostic hysteroscopy was mostly perceived as a mild discomfort procedure by most women. Nevertheless, in a considerable number of cases, women perceived hysteroscopy as painful. Pain perception was linked to individual pain threshold and surgeon experience, but not to pre-procedural anxiety state levels, ethnicity or abnormal hysteroscopic findings.


Assuntos
Histeroscopia/efeitos adversos , Medição da Dor/estatística & dados numéricos , Percepção da Dor , Dor Processual/epidemiologia , Dor Processual/etiologia , Adulto , Ansiedade/psicologia , Índice de Massa Corporal , Brasil/epidemiologia , Feminino , Humanos , Histeroscopia/psicologia , Pessoa de Meia-Idade , Medição da Dor/psicologia , Dor Processual/psicologia , Pólipos/cirurgia , Prevalência , Escalas de Graduação Psiquiátrica , Valores de Referência , Estatísticas não Paramétricas , Doenças Uterinas/cirurgia , Escala Visual Analógica , Adulto Jovem
10.
Artigo em Inglês | MEDLINE | ID: mdl-31847467

RESUMO

Resilience is an innate human capacity that holds the key to uncovering why some people rebound after trauma and others never recover. Various theories have debated the mechanisms underlying resilience at the psychological level but have not yet incorporated neurocognitive concepts/findings. In this paper, we put forward the idea that cognitive flexibility moderates how well people adapt to adverse experiences, by shifting attention resources between cognition-emotion regulation and pain perception. We begin with a consensus on definitions and highlight the role of cognitive appraisals in mediating this process. Shared concepts among appraisal theories suggest that cognition-emotion, as well as pain perception, are cognitive mechanisms that underlie how people respond to adversity. Frontal brain circuitry sub-serves control of cognition and emotion, connecting the experience of physical pain. This suggests a substantial overlap between these phenomena. Empirical studies from brain imaging support this notion. We end with a discussion of how the role of the frontal brain network in regulating human resilience, including how the frontal brain network interacts with cognition-emotion-pain perception, can account for cognitive theories and why cognitive flexibilities' role in these processes can create practical applications, analogous to the resilience process, for the recovery of neural plasticity.


Assuntos
Cognição , Emoções , Percepção da Dor , Resiliência Psicológica , Animais , Encéfalo/fisiologia , Humanos
11.
J Clin Neurophysiol ; 36(6): 430-436, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31688326

RESUMO

The diffuse noxious inhibitory control, which has been investigated extensively in animals, consists of the inhibitory modulation of pain pathways after heterotopic noxious stimulation. The subnucleus reticularis dorsalis, which lies in the caudal part of the medulla, together with its descending projections to the wide-dynamic-range neurones, is responsible for the diffuse noxious inhibitory control. Many studies have investigated the diffuse noxious inhibitory control phenomenon in humans. However, owing to the complexity of the effect of descending modulation on human pain perception, expert opinion has recommended the term "conditioned pain modulation" to describe the psychophysical paradigm in which a heterotopic noxious stimulus is used to affect pain pathways in humans. In this narrative review, we present the current knowledge on the mechanisms underlying the diffuse noxious inhibitory control in animals and show how this phenomenon can be investigated in humans by using the conditioned pain modulation paradigm. We also demonstrate the relevance of conditioned pain modulation to the pathophysiology of pain.


Assuntos
Controle Inibitório Nociceptivo Difuso/fisiologia , Percepção da Dor/fisiologia , Dor/fisiopatologia , Animais , Humanos
12.
JAMA Facial Plast Surg ; 21(6): 480-486, 2019 Dec 01.
Artigo em Inglês | MEDLINE | ID: mdl-31513234

RESUMO

Importance: Vibration has been shown to decrease injection site pain in patients; however, to date, this effect has not been assessed for patients who catastrophize pain (ie, patients who anticipate a higher pain level). The anticipation of a pain score greater than 4 on the 11-point Numeric Rating Scale (NRS) has been associated with an increase in a patient's perception of procedural pain. Objective: To assess the efficacy of vibration during cutaneous anesthetic injection for dermatologic surgery for patients who catastrophize pain (NRS score >4) and patients who do not (NRS score ≤4). Design, Setting, and Participants: Randomized, parallel-group clinical trial from June 19 to September 4, 2018, at a tertiary dermatologic surgery clinic among 87 adults undergoing cutaneous cancer removal surgery. Patients completed a preprocedural questionnaire detailing their baseline pain, anticipated pain, and drug use. Analysis was performed on an intent-to-treat basis. Interventions: Use of a vibratory anesthetic device (VAD) on the treatment site prior to anesthetic injection in the on (VAD ON) or off (VAD OFF) mode. Main Outcomes and Measures: Pain was reported using the 11-point NRS (where 0 indicates no pain and 11 indicates the worst pain imaginable). A minimum clinically important difference of 22% or more and a substantial clinically important difference of 57% or more were used to assess the efficacy of vibration in patient-reported NRS score during anesthetic injection (iNRS score). Results: A total of 87 patients were included, with 101 unique events reported (among the unique events, 37 were reported in women and 64 were reported in men; mean [SD] age, 66.0 [11.3] years). The mean (confidence level [CL]) iNRS score for patients who catastrophized pain was 2.27 (0.66) compared with 1.44 (0.39) for patients who did not (P = .03). A 38.9% decrease in mean (CL) iNRS score was reported with VAD ON compared with VAD OFF in all participants (1.24 [0.38] vs 2.04 [0.54]). Patients who catastrophized pain reported a 25.5% decrease in mean (CL) iNRS score with VAD ON vs VAD OFF (1.91 [0.99] vs 2.57 [0.98]), and patients who did not reported a 79.4% decrease (1.02 [0.40] vs 1.84 [0.66]). VAD ON was the only statistically significant variable to affect iNRS score (F statistic, 2.741; P = .03). Conclusions and Relevance: This trial demonstrates that those who catastrophize pain prior to a procedure report a higher perceived level of pain. The application of vibration during local anesthetic injection resulted in a minimum clinically important difference in pain level for patients who catastrophize pain and a substantial clinically important difference in pain level for patients who do not. Level of Evidence: 2. Trial Registration: ClinicalTrials.gov identifier: NCT03467685.


Assuntos
Anestésicos Locais/administração & dosagem , Injeções/efeitos adversos , Percepção da Dor , Dor/etiologia , Dor/prevenção & controle , Neoplasias Cutâneas/cirurgia , Vibração , Adulto , Idoso , Idoso de 80 Anos ou mais , Catastrofização , Procedimentos Cirúrgicos Dermatológicos , Humanos , Pessoa de Meia-Idade , Medição da Dor
13.
Anesth Prog ; 66(3): 119-132, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31545673

RESUMO

The focus of this systematic review is to assess the efficacy of several commonly utilized anesthetic techniques for reducing pain during the placement of mini-implants. An electronic search was conducted in the databases PubMed, Scopus, Web of Science, Medline Complete, Cochrane, Trials Central, and Clinical Trials, without limitations on year of publication or language. Randomized controlled trials (RCTs) and controlled clinical trials (CCTs) were considered. Two reviewers of articles independently evaluated the results of the study, and the risk of bias of included articles was evaluated according to the Cochrane Scale. Five eligible articles (3 RCTs and 2 CCTs) were included. The quality of the body of evidence was considered low because of the presence of multiple methodological problems, high risks of bias, and heterogeneity in the articles included. There was evidence that the efficacy of the analgesia of infiltrative anesthesia was most effective in promoting a lower perception of pain compared to the other anesthetic agents, although an injection was required. Among topical anesthetics, compound topical anesthetics with 20% lidocaine were more effective than compound topical anesthetics with low lidocaine concentration and conventional topical anesthetic with 20% benzocaine.


Assuntos
Anestésicos Locais , Lidocaína , Percepção da Dor , Anestésicos Locais/uso terapêutico , Humanos , Lidocaína/uso terapêutico , Dor , Medição da Dor , Ensaios Clínicos Controlados Aleatórios como Assunto
14.
Enferm. intensiva (Ed. impr.) ; 30(3): 99-107, jul.-sept. 2019. tab
Artigo em Espanhol | IBECS | ID: ibc-182968

RESUMO

Introducción: La evaluación y tratamiento del dolor es imprescindible para una atención de calidad, además de para mejorar la satisfacción del paciente y los resultados clínicos. Objetivos: 1) Describir la percepción de dolor de los pacientes posquirúrgicos ingresados en nuestra Unidad de Cuidados Intensivos (UCI). 2) Comparar la percepción del paciente con la valoración realizada por la enfermera. 3) Comparar los resultados de la encuesta International Pain Outcomes con los datos sociodemográficos. Metodología: Estudio descriptivo prospectivo observacional en la UCI de un hospital universitario de nivel terciario durante 3 meses. Se estudió la percepción del dolor en los pacientes posquirúrgicos, a las 24 h de ingreso en la unidad, a través de la encuesta International Pain Outcomes traducida al español. Resultados: La puntuación de mayor dolor registrada de los 109 pacientes fue 4,47 ± 2,75 y la de menor de 0,69 ± 1,25 frente a 5,59 ± 2,72 y 2,13 ± 2,03 que refirieron los pacientes, con diferencias significativas (p < 0,001). La puntuación del mayor de dolor registrado está relacionada con el tipo de cirugía (p = 0,027). Hay diferencias significativas en la valoración del menor dolor y la edad (p = 0,005 r = -0,270). Igualmente s22ucede con el sexo y la percepción de mayor dolor (p = 0,004). Los pacientes que refirieron que el dolor les hizo sentir muy ansiosos o indefensos fueron los que tuvieron las mayores puntuaciones en la percepción de mayor dolor, 7,35 ± 1,98 7,44 ± 1,85, respectivamente, con diferencias estadísticamente significativas (p = 0,001; p < 0,001). Con relación a la puntuación de menor dolor, se encuentra asociación con el sentimiento de ansiedad (p = 0,032) y no con el sentimiento de indefensión (p = 0,088). Conclusiones: Los pacientes posquirúrgicos refieren dolor durante las primeras 24 h de ingreso en la UCI (puntuación máx 5,59 ± 2,72). Las enfermeras infravaloran el dolor que el paciente refiere. Una formación adecuada ayudaría a dotar estrategias de valoración para un mejor tratamiento. La edad, el sexo, la ansiedad y la indefensión que el dolor provoca fueron variables que condicionaron el dolor de manera significativa


Introduction: Pain assessment and treatment are essential for ensuring quality of care as well as for improving patient's satisfaction and clinical outcomes. Objectives: 1) To describe pain perception of surgical patients admitted to our Intensive Care Unit(ICU). 2) To compare the patients' pain perception with the assessment carried out by nurses. 3) To correlate International Pain Outcomes Questionnaire results with socio-demographical data. Methodology: A prospective descriptive observational study was carried out in the ICU of a third level university hospital over a period of 3 months. Surgical patients' pain-perception was assessed 24hours after their admission to the ICU using the Spanish translation of International Pain Outcomes Questionnaire. Results: The highest pain score recorded among 109 patients by nurses was 4.47 ± 2.75, while, the lowest was .69 ± 1,25. However, the highest and lowest pain scores reported by patients were 5.59 ± 2.72 and 2.13 ± 2.03, which showed significant differences (P < 0.001). The highest pain score seemed to be related to the type of surgery (P < 0.027). There are significant variations in the lowest pain score depending on age (P = 0.005 r= -0.270). Likewise, the worst pain score correlated with the patients' sex (P = 0.004). Patients who reported that pain made them feel very anxious or helpless scored highest with the worst pain, 7.35±1.98, 7.44±1.85 respectively. These differences were statistically significant (P = 0.001, P < 0.001). Regarding to the score of less pain, there is an association with feeling anxiety (P = 0.032) and not with feeling helpless (P = -0.088). Conclusions: The post-surgical patients reported pain during the first 24 hours following admission to ICU (max score 5.59 ± .26). The nurses underestimated the patients' reported pain. Improving nurses' education would provide them with assessment strategies for better pain management. Age, sex, anxiety and helplessness caused by pain, were variables that significantly influenced pain


Assuntos
Humanos , Masculino , Feminino , Pessoa de Meia-Idade , Idoso , Percepção da Dor , Unidades de Terapia Intensiva/estatística & dados numéricos , Dor/diagnóstico , Manejo da Dor , Avaliação em Enfermagem , Cuidados Pós-Operatórios , Satisfação do Paciente , Estudos Prospectivos , Medição da Dor , Hospitais Universitários , Inquéritos e Questionários , Análise de Dados , Análise de Variância
15.
Biol Sex Differ ; 10(1): 39, 2019 08 07.
Artigo em Inglês | MEDLINE | ID: mdl-31391124

RESUMO

BACKGROUND: The incidence and prevalence of musculoskeletal disorders (MSDs) is about twice as high in women compared to men, and those of the neck/shoulder region are particularly high among women. Fatigue and responses towards pain are known risk factor for MSDs. However, women have been shown to be less fatigable than men, but more sensitive to experimental pain. From a general standpoint, sex differences in the relationships between the fatigue and pain pathways are poorly understood. This may be due to differences in how men and women conceptually define the sensations of fatigue and pain. The objective of this study was to compare physical and verbal descriptors of fatigue and pain between men and women undergoing an experimental protocol where fatigue and pain were manipulated. METHODS: Healthy adult volunteers (14 men and 14 women) underwent experimental pain tests to identify pressure pain threshold (PPT) at biceps brachii (BIC), anterior deltoid (AD), and upper trapezius (UT) followed by the Short-form McGill Pain Questionnaire (SF-MPQ) and Pain Catastrophizing Scale (PCS) before and after a repetitive arm task performed at shoulder height until reaching a rating of neck/shoulder perceived exertion, using the Borg Category Ratio 10 (CR10), greater than 8/10. PPT and MPQ data were analyzed using repeated measures analyses of variance (ANOVA) (time × sex). Correlational analyses were used to investigate relationships between pain measures with time and fatigue. RESULTS: UT PPT was reduced following the fatiguing task (p ≤ 0.01). Men overall reported higher AD PPT levels compared to women (p ≤ 0.05). MPQ and PCS magnification scores were significantly higher after the fatiguing task (p ≤ 0.05), with no sex differences. Time to fatigue correlated with changes in AD PPT in men and with PCS scores in women. CONCLUSIONS: Findings suggest that mechanisms underlying the sensation of acute pain following a repetitive shoulder height task are closely linked with PPT changes in shoulder stabilizers (UT) irrespective of sex, and more so with physical pain responses in men and in attitudes towards pain in women. Sex differences in pain perception may contribute to a better understanding of sex-specific mechanisms underlying neck/shoulder MSDs.


Assuntos
Fadiga Muscular , Medição da Dor , Percepção da Dor/fisiologia , Limiar da Dor/fisiologia , Adulto , Feminino , Humanos , Masculino , Caracteres Sexuais , Adulto Jovem
16.
Artigo em Inglês | MEDLINE | ID: mdl-31395808

RESUMO

Chronic joint pain is associated to an increase in the consumption of medication and decrease in life quality in elderly people, which requires developing non-pharmacological treatments. The aim of this study was to evaluate the effectivity of a group intervention, based on animal-assisted therapy and applied to elderly people with chronic joint pain and polymedication, regarding the decrease of chronic pain, use of analgesics and improvement of life quality. A randomized controlled trial, two arms and open-label was conducted in a Primary Health Center. Twelve weekly sessions of kinesitherapy; in the EG, these exercises were performed with the additional assistance of the therapy dog. A total of 52 participants (22 Control Group (CG), 30 EG), average age 77.50 (±7.3), women 90.4%. A significant reduction on post-intervention values of pain ß = -0.67(-1.27, -0.08), p = 0.03 and pain induced insomnia ß = -0.53(-1.01, -0.05), p = 0.03 was found in EG for increasing baseline values. Animal-assisted therapy leads to an additional reduction in the perception of pain and pain induced insomnia in individuals with higher baseline severity. The presence of the dog improves the attachment to intervention and the satisfaction of the participants.


Assuntos
Terapia Assistida por Animais , Artralgia/terapia , Dor Crônica/terapia , Percepção da Dor , Polimedicação , Idoso , Idoso de 80 Anos ou mais , Animais , Cães , Terapia por Exercício , Feminino , Humanos , Masculino , Qualidade de Vida
18.
Biomed Res Int ; 2019: 9073073, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31380442

RESUMO

The study investigated touch and pain sensations and the correlation between them in diadynamic current (DD) and transcutaneous electrical nerve stimulation (TENS), electrotherapies commonly applied in musculoskeletal disorders and occupational rehabilitation medicine. Forty healthy subjects were treated with either DD (n=20) or TENS (n=20). Each treatment consisted of three sessions with one-week interval. Touch sensation was determined with the JVP Domes esthesiometer, pain sensation with pressure pain threshold (PPT), and pressure pain tolerance threshold (PPTO) by an algometer. During each session the measurements were performed before the application of the procedure (T0), immediately after it (T1), and 30 minutes after the end of the procedure (T2). Both DD and TENS increased touch sensation (p<0.01) and did not significantly alter PPT and PPTO (p>0.05). No statistically significant differences in short-term effects, i.e., 3 weeks of the trial, were noted between DD and TENS in their influence on touch and pain sensations (p>0.05). There was a high significant correlation between touch and pain sensations in DD (r=0.86). TENS and DD caused similar analgesic effects. DD, which is shorter in the duration of the treatment, may comprise a realistic alternative to TENS in clinical practice of pain management.


Assuntos
Terapia por Estimulação Elétrica , Manejo da Dor/métodos , Tato/fisiologia , Estimulação Elétrica Nervosa Transcutânea/métodos , Adulto , Feminino , Humanos , Masculino , Medição da Dor/métodos , Percepção da Dor/fisiologia , Adulto Jovem
19.
Science ; 365(6454): 641-642, 2019 08 16.
Artigo em Inglês | MEDLINE | ID: mdl-31416950
20.
Science ; 365(6454): 695-699, 2019 08 16.
Artigo em Inglês | MEDLINE | ID: mdl-31416963

RESUMO

An essential prerequisite for the survival of an organism is the ability to detect and respond to aversive stimuli. Current belief is that noxious stimuli directly activate nociceptive sensory nerve endings in the skin. We discovered a specialized cutaneous glial cell type with extensive processes forming a mesh-like network in the subepidermal border of the skin that conveys noxious thermal and mechanical sensitivity. We demonstrate a direct excitatory functional connection to sensory neurons and provide evidence of a previously unknown organ that has an essential physiological role in sensing noxious stimuli. Thus, these glial cells, which are intimately associated with unmyelinated nociceptive nerves, are inherently mechanosensitive and transmit nociceptive information to the nerve.


Assuntos
Percepção da Dor/fisiologia , Células de Schwann/fisiologia , Pele/inervação , Animais , Feminino , Masculino , Mecanorreceptores/fisiologia , Camundongos , Camundongos Endogâmicos C57BL , Nociceptores/fisiologia , Optogenética , Limiar da Dor , Fatores de Transcrição SOXE/genética , Fatores de Transcrição SOXE/metabolismo , Células de Schwann/metabolismo , Termorreceptores/fisiologia
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