Low back pain and headache as important aspects of chronic pain in primary health care in a community of the brazilian amazon region

A dor tem sido descrita como sendo uma experiência sensorial e emocional desagradável que é associada ou descrita em termos de lesão tecidual. Na atenção primária à saúde, a dor crônica atinge altos níveis de prevalência, especialmente devido aos quadros de lombalgia e de cefaléias. O objetivo do presente estudo foi investigar a prevalência de dor crônica na atenção primária à saúde na cidade de Buriticupu, localizada no estado do Maranhão, Brasil. Dentre todos os quadros clínicos, a dor crônica foi o diagnóstico mais prevalente entre os pacientes investigados, sendo encontrada em 539 pacientes (23,02%). Dor músculo-esquelética foi o quadro de dor crônica mais comum, atingindo 250 pacientes (10,62%), sendo que lombalgia foi o diagnóstico mais prevalente entre os quadros de dor músculo-esquelética, sendo encontrada em 120 pacientes (5,12%). Por outro lado, as cefaléias foram o segundo quadro de dor crônica mais comum, depois da dor músculo-esquelética, tendo sido diagnosticada em 212 pacientes (9,05%). Assim, 61,6% dos pacientes com dor crônica apresentavam lombalgia ou cefaléia. Análise estatística univariada encontrou associação entre gênero feminino e cefaléia, entre idade avançada e os principais tipos de dor crônica que foram avaliados neste estudo (músculo-esquelética, lombalgia e cefaléia), e entre índice de massa corpórea e dor músculo-esquelética e lombalgia. Quando a análise multivariada foi conduzida, as associações observadas com gênero feminino e idade avançada não mostraram alterações, mantendo os mesmos padrões de associação. No entanto, o índice de massa corpórea não apresentou mais associação com qualquer tipo de dor crônica.Pain has been described as an unpleasant sensory and emotional experience associated with actual or potential tissue damage or described in terms of such damage. In primary care health system, chronic pain reaches high levels of prevalence, mainly due to low back pain and headaches. The aim of the present study was to evaluate the prevalence of chronic pain in the primary healthcare system in the town of Buriticupu, located in the state of Maranhao, northeastern Brazil. Chronic pain disorders were the most prevalent medical diagnosis in the investigated sample, being found in 539 patients (23.02%). Musculoskeletal pain disorders were the most important etiology of the chronic pain, affecting 250 patients (10.62%), and among the musculoskeletal pain disorders, low back pain was the most prevalent one, observed in 120 (5.12%) patients. Headaches were the second most common cause of chronic pain, diagnosed in 212 (9.05%) patients. Thus, 61.6% of the chronic pain disorders were due to low back pain and headaches. The univariate statistical analysis demonstrated an association between female gender and headaches, between advanced age and all groups of chronic pain (musculoskeletal, low back pain and headaches), and between body mass index and musculoskeletal and low back pain. When the multivariate regression analysis was performed, the correlations between gender and age remained unaltered, maintaining the same patterns of association. However, body mass index no longer showed an association with any chronic pain disorder

Methadone in post-herpetic neuralgia: A pilot proof-of-concept study

OBJECTIVE: This research was designed as a pilot proof-of-concept study to evaluate the use of low-dose methadone in post-herpetic neuralgia patients who remained refractory after first and second line post-herpetic neuralgia treatments and had indications for adding an opioid agent to their current drug regimens. METHODS: This cross-over study was double blind and placebo controlled. Ten opioid naïve post-herpetic neuralgia patients received either methadone (5 mg bid) or placebo for three weeks, followed by a 15-day washout period and a second three-week treatment with either methadone or placebo, accordingly. Clinical evaluations were performed four times (before and after each three-week treatment period). The evaluations included the visual analogue scale, verbal category scale, daily activities scale, McGill pain questionnaire, adverse events profile, and evoked pain assessment. All patients provided written informed consent before being included in the study. ClinicalTrials.gov: NCT01752699 RESULTS: Methadone, when compared to placebo, did not significantly affect the intensity of spontaneous pain, as measured by the visual analogue scale. The intensity of spontaneous pain was significantly decreased after the methadone treatment compared to placebo on the category verbal scale (50% improved after the methadone treatment, none after the placebo, p = 0.031). Evoked pain was reduced under methadone compared to placebo (50% improved after the methadone treatment, none after the placebo, p = 0.031). Allodynia reduction correlated with sleep improvement (r = 0.67, p = 0.030) during the methadone treatment. The side effects profile was similar between both treatments. Conclusions: Methadone seems to be safe and efficacious in post-herpetic neuralgia. It should be tried as an adjunctive treatment for post-herpetic neuralgia in larger prospective studies

Ultrassonografia transcraniana na doença de Parkinson

Transcranial sonography has become a useful tool in the differential diagnosis of parkinsonian syndromes. This is a non-invasive, low cost procedure. The main finding on transcranial sonography in patients with idiopathic Parkinson's disease is an increased echogenicity of the mesencephalic substantia nigra region. This hyperechogenicity is present in more than 90% of cases, and reflects a dysfunction in the dopaminergic nigrostriatal pathway. This study discussed how the hyperechogenicity of the substantia nigra may facilitate the differential diagnosis of parkinsonian syndromes.A ultrassonografia transcraniana tem se tornado ferramenta útil no diagnóstico diferencial das síndromes parkinsonianas. Trata-se de um método não invasivo e de baixo custo. O principal achado da ultrassonografia transcraniana em pacientes com doença de Parkinson idiopática é o aumento da ecogenicidade, ou hiperecogenicidade, na região da substância negra mesencefálica, presente em mais de 90% dos casos, o que reflete disfunção da via dopaminérgica nigroestriatal. O presente trabalho abordou como a hiperecogenicidade da substância negra pode auxiliar no diagnóstico diferencial das síndromes parkinsonianas.Universidade de São Paulo Division of Clinical NeurosurgeryHospital Israelita Albert EinsteinUniversidade Federal de São Paulo (UNIFESP) Department of Neurology and NeurosurgeryHospital Israelita Albert Einstein Instituto do CérebroUNIFESP, Department of Neurology and NeurosurgerySciEL

Spontaneous S–Si bonding of alkanethiols to Si(111)–H: towards Si–molecule–Si circuits

We report the synthesis of covalently linked self-assembled monolayers (SAMs) on silicon surfaces, using mild conditions, in a way that is compatible with silicon-electronics fabrication technologies. In molecular electronics, SAMs of functional molecules tethered to gold via sulfur linkages dominate, but these devices are not robust in design and not amenable to scalable manufacture. Whereas covalent bonding to silicon has long been recognized as an attractive alternative, only formation processes involving high temperature and/or pressure, strong chemicals, or irradiation are known. To make molecular devices on silicon under mild conditions with properties reminiscent of Au–S ones, we exploit the susceptibility of thiols to oxidation by dissolved O2, initiating free-radical polymerization mechanisms without causing oxidative damage to the surface. Without thiols present, dissolved O2 would normally oxidize the silicon and hence reaction conditions such as these have been strenuously avoided in the past. The surface coverage on Si(111)–H is measured to be very high, 75% of a full monolayer, with density-functional theory calculations used to profile spontaneous reaction mechanisms. The impact of the Si–S chemistry in single-molecule electronics is demonstrated using STM-junction approaches by forming Si–hexanedithiol–Si junctions. Si–S contacts result in single-molecule wires that are mechanically stable, with an average lifetime at room temperature of 2.7 s, which is five folds higher than that reported for conventional molecular junctions formed between gold electrodes. The enhanced “ON” lifetime of this single-molecule circuit enables previously inaccessible electrical measurements on single molecules

Tratamento farmacológico da dor musculoesquelética

Várias classes de fármacos são utilizadas com finalidade analgésica. A dor deve ser tratada segundo escala ascendente de potência analgésica. Os analgésicos antiinflamatórios e os psicotrópicos associados ou não aos opióides de baixa e/ou elevada potência e/ou aos miorrelaxantes são as classes medicamentosas mais utilizadas no tratamento da dor musculoesquelética. Oscorticosteróides, os anticonvulsivantes, os bloqueadores da atividade osteoclástica e os tranqüilizantes menores são indicados em casos especiais. A prescrição deve ser adequada às necessidades e respeitar a farmacodinâmica e a farmacocinética de cada agente e as contra-indicações peculiares a cada caso. As medicações devem ser preferencialmente de baixo custo e de fácil aquisição. Aadministração deve ser regular e não apenas quando necessário. A via enteral, preferentemente à oral, deve ser priorizada. Alguns efeitos colaterais são dependentes da dose dos agentes, outros de sua natureza; alguns desses efeitos podem ser minimizados com medidas medicamentosas ou físicas específicas. O tratamento antiálgico deve ser instituído imediatamente após as primeiras manifestações da condição dolorosa, pois não compromete o resultado da semiologia clínica ou armada e previne a cronificação da dor. A descoberta de analgésicos antiinflamatórios que inibem seletiva ou especificamante a COX-2, de antidepressivos que atuam seletivamente na recaptura de serotonina e noradrenalina de neurolépticos mais específicos, de miorrelaxantes de ação prolongada e o desenvolvimento de apresentações de derivados opióides de ação ou liberação prolongada são avanços que tornaram a analgesia mais eficaz e segura em doentes com afecções álgicas musculoesqueléticas

Prevalence of temporomandibular disorder in patients with fibromyalgia: a systematic review / Prevalência de distúrbio temporomandibular em pacientes com fibromialgia: uma revisão sistemática

INTRODUCTION: Temporomandibular Disorders (TMDs) and Fibromyalgia (FM) may share similar signs and symptoms. Among them, muscle pain may be involved and significantly reduce the quality of life of these patients. AIM: The aim of this systematic review was to determine the prevalence of TMD in patients with FM.MATERIALS AND METHODS: In this systematic review six electronic databases (LILACS, LIVIVO, PubMed, ScienceDirect, PsycINFO, and Web of Science), as well as three grey literature databases (Google Scholar, Open Grey, and ProQuest) were searched. Cross-sectional studies were selected by two independent reviewers and analyzed in two-phases, following the PRISMA statement. Risk of bias was assessed through the MASTARI (Meta-Analysis of Statistics Assessment and Review Instrument for observational studies from the Joana Briggs Institute).RESULTS: From 660 articles, 51 were eligible for full-text reading and six were finally included. None of the articles met all quality methodological criteria. Therefore, considering the overall risk of bias, one article was judged with moderate risk and five with low risk of bias. A heterogeneity was considered high; thus, a meta-analysis was not performed. From the qualitative analysis it was possible to determine that between 13% to 87.1% of patients with FM can present TMD.CONCLUSION: The prevalence of TMD in patients with FM ranged from 13% to 87.1%. It is suggested that further studies be carried out, mainly with longitudinal design and better quality methodology to help answer whether fibromyalgia is a risk factor for the development of TMDs

The contribution of concentric electrode-evoked potentials and nociceptive withdrawal reflex to the routine neurophysiological assessment of neuropathic pain:cross-sectional study

BACKGROUND AND OBJECTIVES:Conventional electrodiagnostic studies (EDX) are frequently used to support the diagnosis of peripheral neuropathic pain. However, routine EDX has poor diagnostic yield for identifying small fiber neuropathy, which may be cause of neuropathic pain in some patients. This study aimed to assess the gain in diagnostic yield brought by adding pain-related evoked potentials with concentric electrode (CN-PREP) and nociceptive withdrawal reflex (NWR) assessments to EDX.METHODS:Transversal observational accuracy study which included patients referred to routine EDX in a tertiary-care hospital who reported chronic neuropathic pain in their lower limbs. Besides routine EDX, subjects underwent CN-PREP and NWR assessments. Diagnostic yield and tolerability were examined and compared between test studies.RESULTS:The study enrolled 100 patients (54% female), with 57 ± 12 years. EDX was altered in 47% of all patients. The addition of CN-PREP alone, and NWR combined with CN-PREP increased diagnostic yield to 69% and 72%, respectively. CN-PREP proved to be well tolerable, while NWR was associated with higher test-related pain intensity and discontinuation rate (9% vs. 0%). Considering EDX as the reference test, CN-PREP sensitivity was 85.1% and specificity 58.5%.CONCLUSION:Combining CN-PREP with the routine EDX for patients with neuropathic pain is feasible and results in increased diagnostic yield. Conversely, the addition of NWR to the aforementioned tests provides little improvement to this yield and is less tolerable to the patient. Further studies are needed to determine the actual sensitivity and specificity of CN-PREP when compared to the gold-standard for small fiber neuropathy diagnosis, i.e. intraepidermal nerve fiber density assessment