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Early Diagnosis of Peripheral Nervous System Involvement in Fabry Disease and Treatment of Neuropathic Pain: The Report of an Expert Panel

Burlina, Allesandro P; Sims, Katherine Bustin; Politei, Juan M; Bennett, Gary J; Baron, Ralf; Sommer, Claudia; Moller, Anette Torvin; Hilz, Max J
Fonte: BioMed Central Publicador: BioMed Central
Tipo: Artigo de Revista Científica
EN_US
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Background: Fabry disease is an inherited metabolic disorder characterized by progressive lysosomal accumulation of lipids in a variety of cell types, including neural cells. Small, unmyelinated nerve fibers are particularly affected and small fiber peripheral neuropathy often clinically manifests at young age. Peripheral pain can be chronic and/or occur as provoked attacks of excruciating pain. Manifestations of dysfunction of small autonomic fibers may include, among others, impaired sweating, gastrointestinal dysmotility, and abnormal pain perception. Patients with Fabry disease often remain undiagnosed until severe complications involving the kidney, heart, peripheral nerves and/or brain have arisen. Methods: An international expert panel convened with the goal to provide guidance to clinicians who may encounter unrecognized patients with Fabry disease on how to diagnose these patients early using simple diagnostic tests. A further aim was to offer recommendations to control neuropathic pain. Results: We describe the neuropathy in Fabry disease, focusing on peripheral small fiber dysfunction - the hallmark of early neurologic involvement in this disorder. The clinical course of peripheral pain is summarized, and the importance of medical history-taking...

Non-invasive Transcranial Magnetic Stimulation (TMS) of the Motor Cortex for Neuropathic Pain—At the Tipping Point?

Treister, Roi; Lang, Magdalena; Klein, Max M.; Oaklander, Anne Louise
Fonte: Rambam Health Care Campus Publicador: Rambam Health Care Campus
Tipo: Artigo de Revista Científica
EN_US
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The term “neuropathic pain” (NP) refers to chronic pain caused by illnesses or injuries that damage peripheral or central pain-sensing neural pathways to cause them to fire inappropriately and signal pain without cause. Neuropathic pain is common, complicating diabetes, shingles, HIV, and cancer. Medications are often ineffective or cause various adverse effects, so better approaches are needed. Half a century ago, electrical stimulation of specific brain regions (neuromodulation) was demonstrated to relieve refractory NP without distant effects, but the need for surgical electrode implantation limited use of deep brain stimulation. Next, electrodes applied to the dura outside the brain’s surface to stimulate the motor cortex were shown to relieve NP less invasively. Now, electromagnetic induction permits cortical neurons to be stimulated entirely non-invasively using transcranial magnetic stimulation (TMS). Repeated sessions of many TMS pulses (rTMS) can trigger neuronal plasticity to produce long-lasting therapeutic benefit. Repeated TMS already has US and European regulatory approval for treating refractory depression, and multiple small studies report efficacy for neuropathic pain. Recent improvements include “frameless stereotactic” neuronavigation systems...

No evidence of real progress in treatment of acute pain, 1993–2012: scientometric analysis

Correll, Darin J; Vlassakov, Kamen V; Kissin, Igor
Fonte: Dove Medical Press Publicador: Dove Medical Press
Tipo: Artigo de Revista Científica
EN_US
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Over the past 2 decades, many new techniques and drugs for the treatment of acute pain have achieved widespread use. The main aim of this study was to assess the progress in their implementation using scientometric analysis. The following scientometric indices were used: 1) popularity index, representing the share of articles on a specific technique (or a drug) relative to all articles in the field of acute pain; 2) index of change, representing the degree of growth in publications on a topic compared to the previous period; and 3) index of expectations, representing the ratio of the number of articles on a topic in the top 20 journals relative to the number of articles in all (>5,000) biomedical journals covered by PubMed. Publications on specific topics (ten techniques and 21 drugs) were assessed during four time periods (1993–1997, 1998–2002, 2003–2007, and 2008–2012). In addition, to determine whether the status of routine acute pain management has improved over the past 20 years, we analyzed surveys designed to be representative of the national population that reflected direct responses of patients reporting pain scores. By the 2008–2012 period, popularity index had reached a substantial level (≥5%) only with techniques or drugs that were introduced 30–50 years ago or more (epidural analgesia...

Do Diabetic Patients with Acute Coronary Syndromes Have a Higher Threshold for Ischemic Pain?

Nicolau, José Carlos; Barbosa, Carlos José Dornas Gonçalves; Franci, André; Baracioli, Luciano Moreira; Franken, Marcelo; Lima, Felipe Gallego; Giraldez, Roberto Rocha; Kalil Filho, Roberto; Ramires, José Antônio Franchini; Giugliano, Robert P.
Fonte: Sociedade Brasileira de Cardiologia Publicador: Sociedade Brasileira de Cardiologia
Tipo: Artigo de Revista Científica
EN_US
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Background: Data from over 4 decades have reported a higher incidence of silent infarction among patients with diabetes mellitus (DM), but recent publications have shown conflicting results regarding the correlation between DM and presence of pain in patients with acute coronary syndromes (ACS). Objective: Our primary objective was to analyze the association between DM and precordial pain at hospital arrival. Secondary analyses evaluated the association between hyperglycemia and precordial pain at presentation, and the subgroup of patients presenting within 6 hours of symptom onset. Methods: We analyzed a prospectively designed registry of 3,544 patients with ACS admitted to a Coronary Care Unit of a tertiary hospital. We developed multivariable models to adjust for potential confounders. Results: Patients with precordial pain were less likely to have DM (30.3%) than those without pain (34.0%; unadjusted p = 0.029), but this difference was not significant after multivariable adjustment, for the global population (p = 0.84), and for subset of patients that presented within 6 hours from symptom onset (p = 0.51). In contrast, precordial pain was more likely among patients with hyperglycemia (41.2% vs 37.0% without hyperglycemia, p = 0.035) in the overall population and also among those who presented within 6 hours (41.6% vs. 32.3%...

Qualidade de vida de mulheres com dor pélvica crônica; Quality of life of women with chronic pelvic pain

BARCELOS, Priscilla Rodrigues
Fonte: Universidade Federal de Goiás; BR; UFG; Mestrado em Ciências da Saúde; Ciências da Saúde - Medicina Publicador: Universidade Federal de Goiás; BR; UFG; Mestrado em Ciências da Saúde; Ciências da Saúde - Medicina
Tipo: Dissertação Formato: application/pdf
POR
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OBJECTIVES: to compare the quality of life (QOL) of women who have or do not have chronic pelvic pain (CPP) and to investigate the factors associated with QOL in women with CPP. METHODS: a cross-sectional study was performed, in which 30 women with CPP and 20 women without CPP were included. They were premenopausal women aged 18 to 50 years attending the gynecologic outpatient department of a tertiary care university hospital (Hospital das Clínicas, Universidade Federal de Goiás, Brazil). A CPP case was considered when presenting with recurrent or constant pelvic pain of at least six months` duration, unrelated to periods. Women who had been pregnant in the previous year or who had a history of malignant disease were excluded. Sociodemographic and clinical features were assessed. The Medical Outcomes Study 36-item Short-Form Health Survey (SF-36) questionnaire was used to investigate QOL. It provides an eight-scale profile of scores: physical functioning, role-physical, bodily pain, general health, vitality, social functioning, role-emotional and mental health. These eight domains can be summed up in two summary measures: physical component summary (PCS) and mental component summary (MCS). Pain intensity was evaluated using a mechanical visual analogue scale (VAS). Multiple regression analyses was used to compare QOL scores between women with and without CPP and to identify the factors associated with QOL in women with CPP. RESULTS: the mean age of women with and without CPP was 35.2±7.5 and 36±9.3 years...

Does ultrasound correlate with surgical or histologic findings in Greater Trochanteric Pain Syndrome? A pilot study

Fearon, A. M.; Scarvell, J. M.; Cook, J. L.; Smith, P. N.
Fonte: Springer Verlag Publicador: Springer Verlag
Tipo: Artigo de Revista Científica
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BACKGROUND Greater trochanteric pain syndrome can be severely debilitating. Ideal imaging modalities are not established, treatments are not reliably evaluated, and the underlying pathology is not well understood. QUESTIONS/PURPOSES Using surgical and histopathology findings as a gold standard, we therefore determined the positive predictive value of preoperative ultrasound assessment for greater trochanteric pain syndrome recalcitrant to nonoperative management. In addition, we report the outcomes of gluteal tendon reconstructive surgery using validated clinical and functional outcome tools and evaluate the contribution of the tendon and bursa to greater trochanteric pain syndrome. PATIENTS AND METHODS We reviewed 24 patients who had combined gluteal tendon reconstruction and bursectomy. Preoperative ultrasound imaging was compared with surgical findings. In the absence of a greater trochanteric pain syndrome specific outcome tool, surgical outcomes for pain and function were assessed via a 100-mm visual analog scale, the modified Harris hip score, and the Oswestry Disability Index. Strength also was measured. The tendon and bursa tissue collected at surgery was histopathologically reviewed. RESULTS In our small study, ultrasound had a high positive predictive value for gluteal tendon tears (positive predictive value = 1.0). Patients reported high levels of pain relief and function after surgery; tendon and bursa showed pathologic changes. CONCLUSIONS Ultrasound appears to be clinically useful in greater trochanteric pain syndrome; reconstructive surgery seems to relieve pain and the histopathologic findings show tendinopathy and bursa pathology coexist in greater trochanteric pain syndrome. LEVEL OF EVIDENCE Level IV...

The association between external weather conditions and pain and stiffness in women with rheumatoid arthritis

Drane, D.; Berry, G.; Bieri, D.; McFarlane, A.; Brooks, P.
Fonte: J RHEUMATOL PUBL CO Publicador: J RHEUMATOL PUBL CO
Tipo: Artigo de Revista Científica
Publicado em //1997 EN
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OBJECTIVE: To determine the self-reported prevalence of weather sensitivity in a sample of female patients with rheumatoid arthritis (RA), and to determine if there is objective evidence of associations between weather and pain and stiffness in female patients with RA. METHODS: Fifty-three female patients residing in the Sydney metropolitan area participated in a study on the psychological determinants of disability from 1985 to 1987. During the study, subjects recorded pain on a visual analog scale and duration of morning stiffness for 14 day periods at 3-4 monthly intervals over 1-3 years (X = 15.7 months). After completion of the study, data on weather conditions were collected from the Bureau of Meteorology for the days that pain and stiffness records were made. Descriptive statistics and autoregression were used to analyze the data. RESULTS: Sixty percent of subjects reported that they were sensitive to weather. Six weather variables made a statistically significant contribution to daily pain score (p < 0.0001). However, they accounted for only 2.5% of the variance. Two weather variables contributed to duration of morning stiffness (p < 0.0001), but again these variables accounted for only a small portion of the variance (1.1%). A separate analysis for pain was carried out on the data from subjects who reported being weather sensitive. The results were consistent with those of the other analyses...

Hyperalgesia in Opioid-Managed Chronic Pain and Opioid-Dependent Patients

Hay, J.; White, J.; Bochner, F.; Somogyi, A.; Semple, T.; Rousefell, B.
Fonte: Churchill Livingstone Publicador: Churchill Livingstone
Tipo: Artigo de Revista Científica
Publicado em //2009 EN
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UNLABELLED: This observational study aimed to determine whether pain sensitivity in patients with noncancer chronic pain, taking either methadone or morphine, is similar to patients maintained on methadone for dependence therapy, compared with a control group. Nociceptive thresholds were measured on a single occasion with von Frey hairs, electrical stimulation, and cold pressor tests. In all subjects receiving methadone or morphine, nociceptive testing occurred just before a scheduled dose. Cold pressor tolerance values in patients with noncancer, chronic pain, treated with morphine and methadone, were 18.1 +/- 2.6 seconds (mean +/- SEM) and 19.7 +/- 2.3 seconds, respectively; in methadone-maintained subjects it was 18.9 +/- 1.9 seconds, with all values being significantly (P < .05) lower than opioid-naïve subjects (30.7 +/- 3.9 seconds). These results indicate that patients with chronic pain managed with opioids and methadone-maintained subjects are hyperalgesic when assessed by the cold pressor test but not by the electrical stimulation test. None of the groups exhibited allodynia as measured using the von Frey hairs. These results add to the growing body of evidence that chronic opioid exposure increases sensitivity to some types of pain. They also demonstrate that in humans...

Psychological predictors of substantial pain reduction after minimally invasive radiofrequency and injection treatments for chronic low back pain

van Wijk, R.; Geurts, J.; Lousberg, R.; Wynne, H.; Hammink, E.; Knape, J.; Groen, G.
Fonte: Wiley-Blackwell Publishing, Inc. Publicador: Wiley-Blackwell Publishing, Inc.
Tipo: Artigo de Revista Científica
Publicado em //2008 EN
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Objective. In this post hoc observational study, we investigated psychological predictors of outcome after radiofrequency and injection treatments, commonly performed in the management of chronic low back pain (CLBP). Design & Setting. Data, comprising 161 patients (29 eventually lost to follow-up), were obtained from two randomized controlled trials on efficacy of radiofrequency treatment for back pain and sciatica. Subsequently patients were additionally treated in an open prospective follow-up period. Although all groups presented a significant visual analog scale reduction after 3 and 12 months, no additional pain relief after radiofrequency compared with injection treatment was found. Both trial populations showed sufficient similarities. A principal component (factor) analysis was performed on baseline psychometric tests, SF-36, and physical activity variables. We constructed five clinically relevant psychological profiles: "psychologically negative,""adaptive manager,""rigid qualities,""supporting partner," and "strong ego." These were examined as possible predictors of significant pain relief using logistic regression analysis. Results. The "psychologically negative" dimension showed a negative and the "adaptive manager" dimension a positive prognostic effect on outcome. Conclusions. Minimally invasive treatment for CLBP leads to significant pain reduction...

Prevalence and correlates of shoulder pain and stiffness in a population-based study: the North West Adelaide Health Study

Hill, C.; Gill, T.; Shanahan, E.; Taylor, A.
Fonte: Wiley-Blackwell Publishing Asia Publicador: Wiley-Blackwell Publishing Asia
Tipo: Artigo de Revista Científica
Publicado em //2010 EN
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To determine the prevalence, correlates and impact of shoulder pain in a population-based sample. Methods: The North West Adelaide Health Study is a representative longitudinal cohort study of people aged 18 years and over. The original sample was randomly selected and recruited by telephone interview. Overall, 3206 participants returned to the clinic during the second stage (2004–2006) and were asked to report whether they had pain, aching or stiffness on most days in either of their shoulders. Data was also collected on body mass index; shoulder range of motion, lifestyle and socioeconomic factors; the Shoulder Pain and Disability Index and the Medical Outcomes Study Short Form 36 (SF36) was used. Results: Overall, 22.3% of participants indicated that they had pain, aching or stiffness in either of their shoulders. Women, those aged 50 years and over, current smokers and those classified as obese were all significantly more likely to report shoulder pain. Respondents with shoulder pain scored lower on all domains of the SF36. In those with shoulder symptoms, women had more severe pain and worse shoulder function than men, and older people had worse shoulder function than younger people. Conclusion: Shoulder pain affects almost a quarter of people in the Australian community...

A survey of musculoskeletal pain / discomfort and organisational factors in South Australian workplaces

Doda, D.; Pisaniello, D.; Rothmore, P.; Mahmood, M.; Hiller, J.; Winefield, H.; Boucaut, R.; Stewart, S.
Fonte: NZ Ergonomics Society Inc; NZ Publicador: NZ Ergonomics Society Inc; NZ
Tipo: Conference paper
Publicado em //2010 EN
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OBJECTIVE: Musculoskeletal disorders (MSD) represent the largest injury cost burden in workplaces. A baseline survey in South Australian workplaces was conducted as the first element of a randomised controlled trial of MSD preventative interventions based on stage of change (SOC). The purpose of this preliminary study was to determine the prevalence of musculoskeletal pain/discomfort and its association with worker and organisational characteristics. METHOD: Twenty three companies and 406 workers in a wide range of industries were surveyed. Data on worker characteristics, pain / discomfort in the last 7 days, SOC, job satisfaction, and safety climate were collected using previously published questionnaire survey instruments. Workload and vibration were classified by an experienced ergonomist. RESULTS: In this sample (mean age 39 years, 49% male), 40% reported musculoskeletal pain/discomfort (MSPD) and 15% reported severe pain (rating of 5 or more out of 7). In bivariate analyses, age, length of employment, safety climate (supportive environment), and job satisfaction were significantly associated with categories of pain (MSPD and severe pain).In a logistic regression model, job satisfaction (odds ratio 2.72), length of employment (1.78)...

(+)-Naloxone, an opioid-inactive toll-like receptor 4 signaling inhibitor, reverses multiple models of chronic neuropathic pain in rats

Lewis, S.; Loram, L.; Hutchinson, M.; Li, C.M.; Zhang, Y.; Maier, S.; Huang, Y.; Rice, K.; Watkins, L.
Fonte: Churchill Livingstone Publicador: Churchill Livingstone
Tipo: Artigo de Revista Científica
Publicado em //2012 EN
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UNLABELLED: Previous work demonstrated that both the opioid antagonist (-)-naloxone and the non-opioid (+)-naloxone inhibit toll-like receptor 4 (TLR4) signaling and reverse neuropathic pain expressed shortly after chronic constriction injury. The present studies reveal that the TLR4 contributes to neuropathic pain in another major model (spinal nerve ligation) and to long established (2-4 months) neuropathic pain, not just to pain shortly after nerve damage. Additionally, analyses of plasma levels of (+)-naloxone after subcutaneous administration indicate that (+)-naloxone has comparable pharmacokinetics to (-)-naloxone with a relatively short half-life. This finding accounts for the rapid onset and short duration of allodynia reversal produced by subcutaneous (+)-naloxone. Given that toll-like receptor 2 (TLR2) has also recently been implicated in neuropathic pain, cell lines transfected with either TLR4 or TLR2, necessary co-signaling molecules, and a reporter gene were used to define whether (+)-naloxone effects could be accounted for by actions at TLR2 in addition to TLR4. (+)-Naloxone inhibited signaling by TLR4 but not TLR2. These studies provide evidence for broad involvement of TLR4 in neuropathic pain, both early after nerve damage and months later. Additional...

Contextual and individual assessment of dental pain period prevalence in adolescents: a multilevel approach

De Anselmo Peres, M.; Glazer De Anselmo Peres, K.; Frias, A.; Antunes, J.
Fonte: BioMed Central Ltd. Publicador: BioMed Central Ltd.
Tipo: Artigo de Revista Científica
Publicado em //2010 EN
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BACKGROUND Despite evidence that health and disease occur in social contexts, the vast majority of studies addressing dental pain exclusively assessed information gathered at individual level. OBJECTIVES To assess the association between dental pain and contextual and individual characteristics in Brazilian adolescents. In addition, we aimed to test whether contextual Human Development Index is independently associated with dental pain after adjusting for individual level variables of socio-demographics and dental characteristics. METHODS The study used data from an oral health survey carried out in São Paulo, Brazil, which included dental pain, dental exams, individual socioeconomic and demographic conditions, and Human Development Index at area level of 4,249 12-year-old and 1,566 15-year-old schoolchildren. The Poisson multilevel analysis was performed. RESULTS Dental pain was found among 25.6% (95%CI = 24.5-26.7) of the adolescents and was 33% less prevalent among those living in more developed areas of the city than among those living in less developed areas. Girls, blacks, those whose parents earn low income and have low schooling, those studying at public schools, and those with dental treatment needs presented higher dental-pain prevalence than their counterparts. Area HDI remained associated with dental pain after adjusting for individual level variables of socio demographic and dental characteristics. CONCLUSIONS Girls...

Kortikale Reorganisation beim Komplexen Regionalen Schmerzsyndrom (CRPS): Diagnostische und therapeutische Untersuchung mit transkranieller Gleichstrom- und Magnetstimulation; Cortical reorganization in Complex Regional Pain Syndrom (CRPS): Diagnostic and therapeutic study with transcranial direct current - and magnetic stimulation

Schmid, Anne-Christine
Fonte: Universidade de Tubinga Publicador: Universidade de Tubinga
Tipo: Dissertação
DE_DE
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Jährlich werden deutschlandweit 15.000 neue Fälle bekannt, bei denen Patienten am Komplexen Regionalen Schmerzsyndrom (CRPS) leiden. Es ist immer noch nicht geklärt, welche Auslöser zum Auftreten eines CRPS und den Veränderungen im Kortex führen. Eine mögliche Erklärung könnten veränderungen in der Vulnerabilität für Neuroplastizität sein. CRPS Patienten zeigen eine kortikale Reorganisation im primären somatosensorischen (S1) und primären motorischen (M1) Kortex in Form einer Verkleinerung des Handrepräsentationsareals der betroffenen Hand. In Studien bei Phantomschmerzpatienten wird nachgewiesen, dass es eine Verbindung zwischen der Stärke der chronischen Schmerzen und der Größe der kortikalen Reorganisation gibt. Wenn die originäre Repräsentation der Hand wieder hergestellt werden kann, werden die Schmerzen bis hin zur Schmerzfreiheit reduziert. Bei Brailleschrift-Lesern oder Musikern ist aus Studien bekannt, dass ein sinnvolles Training zu einer Vergrößerung der kortikalen Handrepräsentation führt. Mit einem speziellen, von unserer Arbeitsgruppe entwickelten, sensomotorischen Handtraining haben drei CRPS-Patienten in einer Pilotstudie zwei Wochen trainiert. Eine Annäherung an die ursprüngliche Organisation in S1 kontralateral zur betroffenen Hand konnte erreicht werden...

Suicidal ideation and the risk of suicide in patients with fibromyalgia: a comparison with non-pain controls and patients suffering from low-back pain

Jim??nez-Rodr??guez, Irene; Garc??a-Leiva, Juan Miguel; Jim??nez-Rodr??guez, Beatriz M.; Cond??s-Moreno, Emilia; Rico-Villademoros, Fernando; Pita Calandre, Elena
Fonte: Dove Press Publicador: Dove Press
Tipo: Artigo de Revista Científica
ENG
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Fibromyalgia is associated with an increased rate of mortality from suicide. In fact, this disease is associated with several characteristics that are linked to an increased risk of suicidal behaviors, such as being female and experiencing chronic pain, psychological distress, and sleep disturbances. However, the literature concerning suicidal behaviors and their risk factors in fibromyalgia is sparse. The objectives of the present study were to evaluate the prevalence of suicidal ideation and the risk of suicide in a sample of patients with fibromyalgia compared with a sample of healthy subjects and a sample of patients with chronic low-back pain. We also aimed to evaluate the relevance of pain intensity, depression, and sleep quality as variables related to suicidal ideation and risks. Logistic regression was applied to estimate the likelihood of suicidal ideation and the risk of suicide adjusted by age and sex. We also used two logistic regression models using age, sex, pain severity score, depression severity, sleep quality, and disease state as independent variables and using the control group as a reference. Forty-four patients with fibromyalgia, 32 patients with low-back pain, and 50 controls were included. Suicidal ideation...

Refinement and partial validation of the UNESP-Botucatu multidimensional composite pain scale for assessing postoperative pain in horses

Taffarel, Marilda Onghero; Luna, Stelio Pacca Loureiro; Oliveira, Flavia Augusta de; Cardoso, Guilherme Schiess; Alonso, Juliana de Moura; Pantoja, José Carlos; Brondani, Juliana Tabarelli; Love, Emma; Taylor, Polly; White, Kate; Murrell, Joanna C.
Fonte: Biomed Central Ltd Publicador: Biomed Central Ltd
Tipo: Artigo de Revista Científica Formato: 1-12
ENG
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Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP); Processo FAPESP: 2010/00786-6; Processo FAPESP: 2010/08967-0; Background: Quantification of pain plays a vital role in the diagnosis and management of pain in animals. In order to refine and validate an acute pain scale for horses a prospective, randomized, blinded study was conducted. Twenty-four client owned adult horses were recruited and allocated to one of four following groups: anaesthesia only (GA); pre-emptive analgesia and anaesthesia (GAA,); anaesthesia, castration and postoperative analgesia (GC); or pre-emptive analgesia, anaesthesia and castration (GCA). One investigator, unaware of the treatment group, assessed all horses at time-points before and after intervention and completed the pain scale. Videos were also obtained at these time-points and were evaluated by a further four blinded evaluators who also completed the scale. The data were used to investigate the relevance, specificity, criterion validity and inter-and intra-observer reliability of each item on the pain scale, and to evaluate construct validity and responsiveness of the scale.Results: Construct validity was demonstrated by the observed differences in scores between the groups, four hours after anaesthetic recovery and before administration of systemic analgesia in the GC group. Inter-and intra-observer reliability for the items was only satisfactory. Subsequently the pain scale was refined...

Increased multiple sclerosis relapses related to lower prevalence of pain

Silva,José Vinícius Martins da; Oliveira,Beatriz Fátima Alves de; Nascimento,Osvaldo José Moreira do; Farinhas,João Gabriel Dib; Cavaliere,Maria Graziella; Cal,Henrique de Sá Rodrigues; Matta,André Palma da Cunha
Fonte: Academia Brasileira de Neurologia - ABNEURO Publicador: Academia Brasileira de Neurologia - ABNEURO
Tipo: Artigo de Revista Científica Formato: text/html
Publicado em 01/07/2015 EN
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Objective The study aims to investigate the presence of pain amongst multiple sclerosis (MS) patients. Method One hundred MS patients responded to questionnaires evaluating neuropathic and nociceptive pain, depression and anxiety. Statistical analysis was performed using the Mann–Whitney U, Chi-Square and two-tailed Fisher’s exact tests and multivariate logistic regression. Results Women had a statistically higher prevalence of pain (p = 0.037), and chances of having pain after the age of 50 reduced. Women with pain had a statistically significant lower number of relapses (p = 0.003), restricting analysis to those patients with more than one relapse. After the second relapse, each relapse reduced the chance of having pain by 46%. Presence of pain was independent of Expanded Disability Status Scale (EDSS) anxiety, and depression. Conclusion Our findings suggest a strong inverse association between relapses and pain indicating a possible protective role of focal inflammation in the control of pain.

Locus of control in active physical therapy treatment for non-specific chronic low back pain

Batista,Alexandre Apolinário de Souza; Diniz,Leandro Silva Rezende; Oliveira,Vinícius Cunha; Venturini,Claudia
Fonte: Pontifícia Universidade Católica do Paraná Publicador: Pontifícia Universidade Católica do Paraná
Tipo: Artigo de Revista Científica Formato: text/html
Publicado em 01/09/2015 EN
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AbstractIntroduction The health locus of control is defined as the perception of individuals in relation to whom they believe to be responsible for their health condition, including low back pain.Objective To identify whether individuals suffering from chronic low back pain in active physical therapy treatment believe they are responsible for their own condition.Material and methods Cross-sectional study involving 28 patients under active physical therapy treatment for non-specific chronic low back pain. Sociodemographic data and low back characteristics — including disability and pain severity — were collected. The Multidimensional Health Locus of Control (MHLC) scale was used to assess the health locus of control.Results Participants undergoing active low back pain treatment presented a mean (SD) of 26 points (11.40) in a 0–100 point scale for disability and 6.39 points (2.24) on a 0–10 scale for pain. In relation to the health locus of control, the means (SD) for internal, external and chance subscales were, respectively: 29.32 (3.98), 24.75 (3.58), and 13.71 (6.67). 82.1% of the participants presented higher rates for internal locus of control.Conclusion Patients undergoing active treatment for chronic low back pain believe they are responsible for their own condition. Further longitudinal studies may determine whether active treatments affect the beliefs of low back pain patients.

Why is pain still under-treated in the emergency department? Two new hypotheses

Carter, D.A.; Sendziuk, P.; Eliott, J.A.; Braunack-Mayer, A.
Fonte: Wiley Publicador: Wiley
Tipo: Artigo de Revista Científica
Publicado em //2015 EN
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Across the world, pain is under-treated in emergency departments (EDs). We canvass the literature testifying to this problem, the reasons why this problem is so important, and then some of the main hypotheses that have been advanced in explanation of the problem. We then argue for the plausibility of two new hypotheses: pain’s under-treatment in the ED is due partly to (1) an epistemic preference for signs over symptoms on the part of some practitioners, and (2) some ED practices that themselves worsen pain by increasing patients’ anxiety and fear. Our argument includes the following logic. Some ED practitioners depart from formal guidance in basing their acute pain assessments on observable features rather than on patient reports of pain. This is potentially due to an epistemic preference for signs over symptoms which aims to circumvent intentional and/or unintentional misrepresentation on the part of patients. However, conducting pain assessments in line with this epistemic preference contributes to the undertreatment of pain in at least three respects, which we detail. Moreover, it may do little to help the practitioner circumvent any intentional misrepresentation on the part of the patient, as we explain. Second, we examine at least four ED practices that may be contributing to the under-treatment of pain by increasing patient anxiety and fear...

Six month post-treatment deterioration in acceptance (CPAQ-8) and cognitions following multidisciplinary pain treatment

Baranoff, J.; Hanrahan, S.J.; Kapur, D.; Connor, J.P.
Fonte: Springer Publicador: Springer
Tipo: Artigo de Revista Científica
Publicado em //2014 EN
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Pain acceptance contributes significantly to the effectiveness of pain treatment outcomes. Nevertheless, little research has been conducted to examine whether a decrease in acceptance contributes to a deterioration in post treatment functioning. The aim of this study was to assess the role of pain acceptance in relation to process and outcome variables in the six-months following the conclusion of a pain program. Adults with chronic pain (N = 120) completed assessments at the completion of a 3-week multidisciplinary treatment program and 6-months post-treatment. Process measures included the Chronic Pain Acceptance Questionnaire-8 (CPAQ-8); the catastrophizing scale of the Pain Response Self-Statement Scale; the coping cognitions scale of the Pain Response Self-Statement Scale; and the Tampa Scale of Kinesiophobia. Outcome measures included the Roland Morris Disability Questionnaire; the depression scale of the Depression Anxiety and Stress Scale; and two measures of physical functioning. Deterioration in acceptance of pain was significantly associated with deterioration in depression and disability, even when catastrophizing cognitions and kinesiophobia were accounted for. Decrease in acceptance was the strongest predictor of reliable deterioration in depression and disability. Results indicated the CPAQ-8 has utility as a measure for monitoring patient functioning post-treatment.; John Baranoff...