Fixed and on-demand regimens of acetaminophen in periodontal surgery: randomized clinical trial

Aim: to evaluate the clinical efficacy of an acetaminophen analgesic by comparing its prescription in fixed versus ondemand schedules after periodontal surgery. The hypothesis of the study was that the fixed regimen would be more effective than the on-demand regimen for postoperative analgesics following periodontal surgery. Methods: An open randomized clinical trial was conducted. The 68 patients who needed total flap surgery to restore supracrestal tissue attachment or surgical treatment of periodontitis were randomized". Visual Analogue Scale was used to assess pain. The fixed group (n = 34) received 500 mg of acetaminophen every 4 hours for 2 days. The on-demand group (n = 34) was instructed to use the acetaminophen "as needed," at intervals of no less than 4 hours between doses. Ibuprofen was the rescue medication for both groups. Pain scores and medication use were recorded 2, 6, 12, 24 and 48 hours after the surgical procedure. The study was registered at the Brazilian Registry of Clinical Trials under RBR-7wv259. Results: The two groups did not differ in relation to the frequency or the intensity of pain in a 48-hour period (n=20 in the fixed group, and n=22 in the on-demand group), or even in the intention-to-treat (n=34 in each group). Individuals who experienced moderate to severe pain used rescue medication more frequently in both groups. No adverse events were reported. Conclusion: Both regimens were effective in controlling postoperative pain after periodontal surgery

A national study on the use of opioid analgesics in dentistry

Abstract The aim of this study was to assess the frequency of opioid analgesics prescribed by Brazilian dentists, potential regional differences and their association with socioeconomic and health-related factors. Data for all opioid prescriptions by dentists was obtained from the 2012 database of the National Controlled Substances Management System, regulated by the Brazilian Health Surveillance Agency. The number of defined daily doses (DDD) and DDDs per 1,000 inhabitants per day for each Brazilian state were calculated as the primary outcomes. DDDs were compared by regions and Brazilian states. Spearman's rho correlation coefficient was used to determine the influence of the states' characteristics, such as the Human Development Index; poverty; education; number of dentists per 100,000 inhabitants; visit to the dentist; dental care plan; good or very good oral health; number of pharmaceutical establishments per 100,000/inhabitants; and ability to get all prescribed medications. Data analysis was performed using IBM SPSS Statistics 25.0. A total of 141,161 prescriptions for opioids analgesics by 36,929 dentists were recorded, corresponding to 658,855 doses of opioids dispensed in 2012. The most commonly dispensed opioids were codeine associated with paracetamol (83.2%; n = 117,493). The national DDDs per 1,000 inhabitants per day was 0.0093 (range: 0.0002-0.0216). DDD per 1,000 inhabitants per day was positively associated to visits to dentists (rs = 0.630; P < 0.001) and inversely associated to poverty (rs = -0.624; p = 0.001). There are significant differences in opioid prescriptions in dentistry among the Brazilian states. These differences may be associated with non-clinical factors.

Comparison of two combinations of opioid and non-opioid analgesics for acute periradicular abscess: a randomized clinical trial

Abstract Acute periradicular abscess is a condition characterized by the formation and propagation of pus in the periapical tissues and generally associated with debilitating pain. Objective: The aim of this study was to compare the overall analgesic effectiveness of two combinations of opioid and non-opioid analgesics for acute periradicular abscess. Material and Methods: This study included 26 patients who sought emergency care in a Brazilian dental school. The patients were randomly divided into two groups: Co/Ac - oral prescription of codeine (30 mg) plus acetaminophen (500 mg), every 4 h, for 3 days or Tr/Ac - oral prescription of tramadol hydrochloride (37.5 mg) plus acetaminophen (500 mg) on the same schedule. Two factors were evaluated: (1) pain scores recorded by the patients in a pain diary 6, 12, 24, 48, and 72 h after treatment, using the Visual Analogue Scale; and (2) the occurrence of adverse effects. Results: In both groups, there was a reduction in pain scores over time. For the Co/Ac group, there was a significant reduction in the scores 12, 24, 48, and 72 hours after treatment (P<0.05). In the Tr/Ac group, the scores significantly decreased over time from time point 6 h (P<0.05). Comparing the pain at each time point, the groups were not significantly different (P>0.05), i.e., both treatments were effective in controlling pain caused by APA; however, the combination of Tr/Ac caused more adverse reactions as two patients had to stop using the medication. Conclusion: This study suggests that, considering both analgesic efficacy and safety, the combination of codeine and acetaminophen is more effective to control moderate to severe pain from acute periradicular abscesses.

Osteoartrite: fisiopatologia e tratamento medicamentoso / Osteoarthritis: physiopathology and drug treatment

A osteoartrite (OA) é a causa mais frequente de doença crônica musculoesquelética, sendo sem dúvida a maior causa de limitação das atividades diárias entre os idosos. Atualmente, cerca de 40% dos adultos com idade superior a 70 anos sofrem de OA do joelho; destes, 80% apresentam limitações de movimento e em 25% as atividades diárias estão comprometidas. Nas últimas décadas têm ocorrido avanços na terapêutica da osteoartrite

Osteoarthritis (OA) is the most common cause of chronic musculoskeletal disease and the most prevalent reason for the limitation of daily activities of the elderly population. Currently, about 40% of adults aged over 70 suffer from OA of the knee. Of these, 80% suffer from limitations in motion and 25% are engaged to carry out their daily activities. In recent decades there have been advances in the treatment of osteoarthritis

Removal of oral lichen planus by CO2 laser

The aim of this case report is to present a histologically diagnosed oral lichen planus excised by the CO2 laser. Oral lichen planus is a chronic inflammatory mucocutaneous disease of unknown etiology. Different treatments have been used to manage this condition. A 46 year-old female was referred to the Laser Clinic of the Dental School of the Federal University of Bahia to excise a lesion characterized by white patches on the oral mucosa, which was causing pain and burning sensation and had not respond to treatment with triamcinolone and corticosteroids for 3 months. CO2 laser was used to remove the lesion and the conclusive histopathological diagnosis was oral lichen planus. The patient was followed up over 1year with no signs of lesion recurrence. The use of the CO2 laser was found to be useful and effective to treat lichen planus.

O objetivo deste relato de caso é apresentar a remoção cirúrgica com o laser de CO2 de um líquen plano diagnosticado histologicamente. O líquen plano da cavidade oral é uma doença muco-cutânea crônica de etiologia desconhecida. Tratamentos diferentes têm sido usados para sua resolução. Uma paciente do sexo feminino de 46 anos de idade foi encaminhada para a Clinica de Laser da Faculdade de Odontologia da Universidade Federal da Bahia para a remoção de uma lesão na boca caracterizada pela presença de manchas brancas que estava causando dor e ardimento não havia respondido a tratamento com triamcinolone e corticoides durante 3 meses. O laser de CO2 foi utilizado para remover a lesão e o diagnóstico histopatológico conclusivo foi o de líquen plano de cavidade oral. A paciente foi acompanhada durante 1 ano sem sinal de recorrência da lesão. O uso do laser de CO2 foi considerado útil e efetivo no tratamento do líquen plano.

Caracterização da dor crônica e métodos analgésicos utilizados por idosos da comunidade / Characterization of chronic pain and analgesic approaches among community-dwelling elderly

OBJETIVO: Caracterizar a dor crônica e os métodos analgésicos utilizados por idosos residentes na área de abrangência de uma Unidade Básica de Saúde (UBS), localizada na região norte da cidade de Londrina (PR). MÉTODOS: Estudo transversal descritivo com todos os indivíduos com 60 anos ou mais residentes na área de abrangência da UBS, através de inquérito domiciliar. Utilizou-se como critério de dor crônica a dor de duração mínima de seis meses. Os idosos foram questionados sobre as características da dor quanto à localização, duração, freqüência, intensidade, fatores de melhora e de piora, assim como o impacto da dor na vida do indivíduo e descrição dos métodos analgésicos utilizados. RESULTADOS: Foram entrevistados 172 idosos (101 mulheres e 71 homens). A presença de dor crônica foi observada em 107 (62,21 por cento); no sexo feminino esta prevalência foi de 69,3 por cento e no masculino 52,1 por cento (p = 0,004). Os idosos mais velhos - 80 anos ou mais - apresentaram maior referência de dor crônica (p = 0,01), assim como os idosos com depressão (p<0,001). Os locais de maior prevalência de dor foram membros inferiores e região dorsal, com 31,25 por cento cada, sendo que grande número de idosos referiam dor diária, contínua e de alta intensidade. Em relação aos métodos analgésicos, houve predomínio dos métodos farmacológicos, referidos por 86 idosos (80,37 por cento), e com maior utilização de analgésicos simples (32,6 por cento). CONCLUSÃO: Os dados mostram que há uma grande prevalência de dor crônica nessa população de idosos, principalmente nas mulheres com 80 anos ou mais e nos indivíduos depressivos.

OBJECTIVE: To characterize chronic pain and analgesic approaches in community- dwelling elderly of the northern district of Londrina - Brazil. METHODS: Cross-sectional study with individuals 60 years old and more, resident in the local area of a Basic Health Unit (UBS) of Londrina, by home inquiry. Chronic pain was defined as pain lasting for six months or more. The elderly with pain, were questioned about characteristics of the pain as regards location, duration, frequency, intensity, improvement and worsening situations, as well as the impact of pain in the quality of life and also about analgesic approaches. RESULTS: One hundred and seventy two elderly were interviewed (101 women and 71 men). Presence of chronic pain was observed in 107 (62. percent) of these 69.3 percent were female and 52.1 percent male (p = 0.004). The very old people, 80-year-old or more (p=0.01) and the depressive elderly (p=0.0008) presented higher frequency of chronic pain. Most prevalent pains were in the legs and back, with 31.2 percent each, and the majority of elderly referred to continuous, daily high intensity pain. Regarding analgesic approaches, the pharmacologic method was mentioned by 86 elderly (80.4 percent) and simple analgesic (32.6 percent) was the most used. CONCLUSION: Facts show that there is a high predominance of chronic pain in the population of elderly, mainly in women, in very old people and in depressive individuals.

Analgésicos no opioides en dolor postoperatorio pediátrico / Analgesic not opioids in pediatric postoperative pain

El dolor postoperatorio es todavía subvalorado en la población pediátrica. Por otro lado, entre las publicaciones que abordan el tema del dolor postoperatorio solo un 10 por ciento de ellas incluye a la población menor de 15 años. Las alternativas terapéuticas en base a analgésicos no opiaceos es restringida en niños, ya que sólo un 20 por ciento del total de las drogas disponibles en el mercado ha probado su eficacia y seguridad en esta población. un analgésico antiguo es el acetaminofeno, acumulando la mayor cantidad de estudios. Los antinflamatorios no esteriodales (AINEs) han ganado popularidad en el manejo del dolor postoperatorio pediátrico. El objetivo de esta revision es determinar cuáles son las indicaciones y las dosis mas racionales y seguras para el tratamiento del dolor agudo en niños.

Postoperatory pain is still subvaluated in pediatric population. On the other hand, only 10 percent of publications discussing postoperatory pain subjects includes a population under age 15. Therapeutic alternatives based on nonopiate analgesics are restrained for children as only 20 percent of the total available drugs in the market has proven their efficacy and safety in children. An old analgesic is acetaminophen, which accumulates most part of studies. Nonsteroidal antinflammarory drugs (NSAI) are gaining popularity to manage postoperatory pain in children. The objective of this revision is to determine the most rational and safest indications and dosages when treating acute pain in children.

Avaliação clínica da eficácia da combinação paracetamol e cafeína no tratamento da cefaléia tipo tensão / Clinical evaluation of the efficacy of the paracetamol and caffeine combination in the treatment of tension headache

A cefaléia tipo tensão em suas duas modalidades, episódica e crônica, é a forma mais comum de dor de cabeça na população. O tratamento é feito com medidas não farmacológicas e farmacológicas, tanto para o ataque como profilaxia das crises. Este estudo foi realizado com 5490 pacientes, que procuraram ambulatórios e consultórios médicos em várias regiões do Brasil. Cerca de 95 por cento apresentavam cefaléia tipo tensão episódica e 5 por cento cefaléia tipo tensão crônica. A maioria dos pacientes apresentou crises de intensidade moderada (62,19 por cento). Em 5419 pacientes uma crise de cefaléia tipo tensão foi tratada com 1000 mg de paracetamol e 130 mg de cafeína. Em 93,98 por cento início de melhora foi observado em até 2 horas após a ingestão da medicação. Em 77,61 por cento houve reversão completa da crise em até 2 horas. Avaliação da eficácia boa/excelente foi observada em 51,93 por cento/37,80 por cento dos casos quando feita pelos médicos e em 48,51 por cento/40,29 quando pelos pacientes. Efeitos adversos, em geral manifestações gastrointestinais, foram observados em 5,57 por cento. Este estudo representa uma experiência brasileira no tratamento de ataque da cefaléia tipo tensão, demonstrando eficácia e segurança no uso da combinação paracetamol-cafeína.