Cadasil em uma família catarinense: relato de caso e revisão da literatura.

Trabalho de Conclusão de Curso - Universidade Federal de Santa Catarina, Centro de Ciências da Saúde, Departamento de Clínica Médica, Curso de Medicina, Florianópolis, 200

Translation, Cross-Cultural Adaptation, and Validation of the Portuguese Version of the Rotterdam Elderly Pain Observation Scale

INTRODUCTION: This study reports on the translation, cultural adaptation, and validation of a Portuguese version of the Rotterdam Elderly Pain Observation Scale (REPOS), a Dutch scale to assess pain in patients who cannot communicate, with or without dementia. METHODS: This is a multicenter study in pain and neurological units involving Brazil (clinical phase) and the Netherlands (training phase). We performed a retrospective cross-sectional, 2-staged analysis, translating and culturally adapting the REPOS to a Portuguese version (REPOS-P) and evaluating its psychometric properties. Eight health professionals were trained to observe patients with low back pain. REPOS consists of 10 behavioral items scored as present or absent after a 2-min observation. The REPOS score of ≥3 in combination with the Numerical Rating Scale (NRS) of ≥4 indicated pain. The Content Validity Index (CVI) in all items and instructions showed CVI values at their maximum. According to the higher correlation coefficient found between NRS and REPOS-P, it may be suggested that there was an adequate convergent validity. RESULTS: The REPOS-P was administered to 80 patients with a mean age of 60 years (SD 11.5). Cronbach's alpha coefficient showed a moderate internal consistency of REPOS-P (α = 0.62), which is compatible with the original study of REPOS. All health professionals reached high levels of interrater agreement within a median of 10 weeks of training, assuring reproducibility. Cohen's kappa was 0.96 (SD 0.03), and the intraclass correlation coefficient was 0.98 (SD 0.02), showing high reliability of REPOS-P scores between the trainer (researcher) and the trainees (healthcare professionals). The Pearson correlation coefficient was 0.95 (95% confidence interval 0.94–0.97), showing a significant correlation between the total scores of REPOS-P and NRS. CONCLUSION: The REPOS-P was a valuable scale for assessing elderly patients with low back pain by different healthcare professionals. Short application time, ease of use, clear instructions, and the brief training required for application were essential characteristics of REPOS-P

Treating myofascial pain with dry needling: a systematic review for the best evidence-based practices in low back pain

Background Myofascial pain syndrome (MPS) is a common source of pain in primary care or pain clinics. There are many different ways to manage and treat MPS, such as physical exercise, trigger points massage, and dry needling

Relação entre cefaléia primária e fibromialgia: revisão de literatura Relationship between primary headache and fibromyalgia: literature review

OBJETIVO: conduzir uma revisão de literatura observando evidências sobre a relação entre fibromialgia (FM) e cefaléia. MÉTODO: uma busca em bancos de dados bibliográficos foi realizada utilizando as palavras-chave: fibromialgia, cefaléia, migrânea e cefaléia tensional. Foram selecionados resumos de estudos que preenchiam os critérios iniciais da seleção, sendo solicitadas cópias dos artigos originais. RESULTADO: sete estudos preencheram todos os critérios de inclusão. Foram diagnosticados como portadores de cefaléia 35% a 88,4% dos pacientes com fibromialgia, e 17,4% a 40% dos pacientes com cefaléia foram diagnosticados como portadores de fibromialgia. CONCLUSÃO: ainda não está claro se o diagnóstico de cefaléia é mais prevalente nos pacientes com FM. Contudo, pode-se observar que FM é muito mais prevalente em pacientes com cefaléia primária, especialmente na migrânea.<br>OBJECTIVE: to carry out a literature review of the evidence concerning the association of fibromyalgia and headache. METHOD: a search of databases was conducted using the keywords: fibromyalgia, headache, migraine, and tension-type headache. Abstracts which appeared to fulfill the initial selection criteria were selected and the original articles were retrieved. RESULT: seven studies met all inclusion criteria. Between 35% and 88.4% fibromyalgia patients were diagnosed as suffering of headache; 17.4% to 40% patients with headache were diagnosed as suffering of fibromyalgia. CONCLUSION: it is not clear if headache is more prevalent in fibromyalgia patients. However, fibromyalgia is more prevalent in primary headache patients, especially migraine

Comorbidities, medications and depressive symptoms in patients with restless legs syndrome and migraine

OBJECTIVE: The pathophysiology of migraine and restless legs syndrome (RLS) seems to involve inherited mechanism and dysfunction of the dopaminergic system. Previous articles have shown that the frequency of RLS is higher in migraine patients than in controls. We conducted a study to evaluate comorbidities, medication used and depressive symptoms that can explain the relation between migraine and RLS. METHODS: A case-control study was performed in which patients with migraine (n=72) and a control group without migraine (n=72) were interviewed. Data including RLS diagnosis, depressive symptoms, comorbidities and drugs used were evaluated. RESULTS: There was a significant association between migraine and RLS (p=0.01), but comorbidities such as diabetes, hypertension, anemia and drugs used did not explain this association. Depression scores, as measured by the Beck Depression Inventory, were higher in migraine patients with RLS (p =0.04). CONCLUSION: No specific factors explaining the association between migraine and RLS were found. Symptoms of depression were more frequent in patients with migraine and RLS

Therapeutic drug monitoring of gabapentin: the applicability in patients with neuropathic pain

Gabapentin is an antiepileptic drug prescribed for several neuropathic pain conditions. This study aimed to evaluate gabapentin (GAB) trough plasma concentration range and the applicability of therapeutic drug monitoring in patients with neuropathic pain. Fifty-three patients with neuropathic pain, aged 20 to 75, received gabapentin as treatment for at least 7 days. Gabapentin plasma concentration was sampled before GAB administration and quantified by liquid chromatography with a UV detector. GAB trough plasma concentration ranged between 0.40 and 11.94 µg/mL in patients with chronic neuropathic pain. No differences were observed in terms of GAB plasma concentrations between responsive and non-responsive patients. Our data suggest that the reference ranges suggested in the literature for patients with epilepsy should not be used for patients with neuropathic pain. Therapeutic drug monitoring of GAB was shown to be an important tool to assess treatment adherence

SUNCT syndrome: report of a possible symptomatic case Síndrome SUNCT: relato de caso possivelmente sintomático

SUNCT is one of the rarest and least known primary headache disorders. Although its pathogenesis has been partially understood by functional neuroimaging and reports of secondary cases, there is limited understanding of its cause. We report a case of SUNCT in a 54-years-old man, that could not be strictly classified as secondary SUNCT; however, the time lag of pain onset suggests a new theory in which neuroplasticity could be involved in the origin and duration of the pain in SUNCT syndrome.<br>SUNCT é uma das mais raras e menos conhecidas cefaléias primárias. Embora sua patogênese esteja parcialmente compreendida por neuroimagem funcional e relatos de casos secundários, há insuficiente conhecimento a respeito de sua causa. Nós relatamos um caso de SUNCT em um homem de 54 anos, que não poderia ser estritamente classificado como SUNCT secundário; entretanto, o lapso de tempo para o início da dor sugere uma nova hipótese na qual a neuroplasticidade possa esta envolvida na origem e duração da dor na síndrome SUNCT

Body posture changes in women with migraine with or without temporomandibular disorders

Background: Migraine and temporomandibular disorders (TMDs) are reported to be associated. However, there are no reports on the association among migraines, TMDs and changes in body posture. Objectives : To assess changes in body posture in women suffering migraines with or without TMD compared with a control group. Method: Sixty-six women with a mean age of 18 to 45 years participated in this study. The groups were composed of 22 volunteers with migraine and TMD (MTMD), 22 volunteers with migraines without TMD (MG) and 22 women in the control group (CG). Static posture was assessed by photogrammetry, and 19 angles were measured. Results: Postural asymmetry was observed in the face for 4 angles measured on the frontal plane in the MG group and for 4 angles of the trunk in the MG and MTMD groups with respect to CG. However, for comparisons between MTMD and CG, clinical relevance was identified for two angles of the sagittal plane (Cervical and Lumbar Lordosis, Effect Size - ES - moderate: 0.53 and 0.60). For comparisons between the MG and CG, the clinical relevance/potential was verified for three angles with moderate ES (ES>0.42). The clinical relevance when comparing MTMD and CG was identified for four angles of facial symmetry head inclination (ES>0.54) and for two angles between MG and CG (ES>0.48). Conclusion : The results demonstrated the presence of postural changes compared with a control group in women with migraines with or without TMD, and there were similar clinically relevant postural changes among the patients with migraines with and without TMD