RESUMO
Many studies report on the incidence of chronic pain. However, deficiencies exist in prior research making it difficult to generalize results to trauma patients. This study evaluated the incidence of chronic pain in trauma patients at 4 months posttrauma and effect chronic pain has on life interference. The incidence of chronic pain was present in 79.2% of trauma patients 4 months posttrauma and a strong positive correlation (n = 80, r = 0.79, P < 0.001) existed between chronic pain severity and the effect on life interference. Chronic pain is prevalent and causes significant life interference in traumatically injured patients.
Assuntos
Dor Crônica/epidemiologia , Dor Crônica/etiologia , Traumatismo Múltiplo/complicações , Traumatismo Múltiplo/diagnóstico , Qualidade de Vida , Adolescente , Adulto , Distribuição por Idade , Análise de Variância , Distribuição de Qui-Quadrado , Dor Crônica/fisiopatologia , Avaliação da Deficiência , Estudos de Avaliação como Assunto , Feminino , Escala de Coma de Glasgow , Humanos , Incidência , Escala de Gravidade do Ferimento , Tempo de Internação , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Traumatismo Múltiplo/terapia , Medição da Dor , Estudos Prospectivos , Medição de Risco , Distribuição por Sexo , Fatores de Tempo , Adulto JovemRESUMO
BACKGROUND: Dimethyl fumarate (DMF) reduces absolute lymphocyte counts, CD4, and CD8 counts, without significantly affecting total white blood cell counts. However, the recovery rate of these cells after discontinuation of DMF is unknown. The effect of subsequent disease modifying therapies (DMTs) on re-population rate is also unknown. OBJECTIVES: 1. To study the re-population rate of absolute lymphocytes, CD4, and CD8 counts back to baseline after discontinuation of DMF. 2. To measure the effect of subsequent DMTs on the re-population rate of these cells after DMF therapy. 3. To study the effect of the duration of exposure to DMF on repopulation of these cells. METHODS: A retrospective chart review of subjects who had discontinued DMF and in whom, CBC with differential, CD4 and CD8 counts were available at baseline, discontinuation and at follow-up (n = 113). Linear mixed models were used to analyze and assess linear trends in lymphocyte counts after DMF had been discontinued. RESULTS: DMF causes a significant drop in absolute lymphocyte, CD4, and CD8 counts. Re-population of these cells after discontinuation of DMF is significantly delayed, irrespective of whether or not a subsequent DMT is used, although there is a difference in re-population rate among DMTs. The re-population rate is also dependent on the duration of time patients have been exposed to DMF; longer exposure was associated with more delayed recovery. CONCLUSION: During this 30 month study period, re-population rates were significantly delayed post-DMF, irrespective of what subsequent DMT the patients received. Furthermore, no recovery of lymphocyte counts occurred in patients who were started on fingolimod or alemtuzumab after DMF was discontinued; in fact there was a continued decline in all of the cell populations studied.