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

Analysis of cerebral perfusion through SPECT in patients with low back pain due to disc herniation before and after treatment with gabapentin

Dor lombar crônica (DLC) é causa de incapacidade para o trabalho e prejuízo econômico para a sociedade. Quando decorre do comprometimento de estruturas do sistema nervoso (dor neuropática), seu manejo é difícil e exige expertise do profissional que a acompanha. A gabapentina emerge nesse cenário como uma possibilidade terapêutica eficaz, estando indicada em diversas diretrizes para o tratamento de dor neuropática como medicação de primeira linha. Este estudo propõe analisar qual o padrão de perfusão cerebral de pacientes com dor lombar crônica secundária à hérnia discal e avaliar se há mudanças nesse padrão após o tratamento com gabapentina utilizando SPECT cerebral. Baseamos a comparação na medida da intensidade da dor pela Escala Visual Numérica (EVN) antes e após o tratamento, além de sua correlação com aspectos biopsicossociais que estão envolvidos na dor crônica (ansiedade, depressão, catastrofização e qualidade de vida). Foram selecionados 13 pacientes portadores de dor crônica secundária à hérnia discal lombar, com média de idade de 41 anos e intensidade de dor de 5,92 pontos medida pela EVN. Os resultados mostraram que portadores de DLC possuem aumento da perfusão cerebral no córtex pré-frontal dorsolateral, lobo occipital direito e córtex cingulado posterior em relação aos voluntários saudáveis. Após o uso da gabapentina, houve hiperperfusão no lobo límbico bilateral e hipoperfusão na substância cinzenta periaquedutal em comparação aos voluntários saudáveis. Entre os pacientes que não apresentaram melhora clínica com o uso da gabapentina houve hipoperfusão biparietal em comparação aos voluntários saudáveis e hiperperfusão no cíngulo anterior esquerdo em comparação à imagem de SPECT antes do uso da gabapentina. Não houve correlação estatística significativa entre o uso da gabapentina e melhora de sintomas associados à dor como depressão, ansiedade, catastrofização e percepção de qualidade de vida.Chronic low back pain (LBP) is a cause of disability for work and economic harm to society. When it is due to the compromise of structures of the nervous system (neuropathic pain), its handling is difficult and requires the expertise of the professional who accompanies it. Gabapentin emerges in this scenario as an effective therapeutic possibility and is indicated in several guidelines for the treatment of neuropathic pain as first-line medication. This study proposes to analyze the pattern of cerebral perfusion of patients with chronic low back pain secondary to the herniated disc and to evaluate if there are changes in this pattern after the treatment with gabapentin using cerebral SPECT. We base the comparison in the pain intensity measurement by the Visual Numerical Scale (VNS) before and after the treatment, in addition to its correlation with biopsychosocial aspects that are involved in chronic pain (anxiety, depression, catastrophization and quality of life). We selected 13 patients with chronic pain due to lumbar disc herniation, with a mean age of 41 years and pain intensity of 5.92 points measured by VNS. The results showed that LBP patients had increased cerebral perfusion in the dorsolateral prefrontal cortex, right occipital lobe and posterior cingulate cortex compared to healthy volunteers. After gabapentin use, there was hyperperfusion in the bilateral limbic lobe and hypoperfusion in periaqueductal gray matter compared to healthy volunteers. Among patients who did not show clinical improvement with gabapentin, there was biparietal hypoperfusion compared to healthy volunteers and hyperperfusion in the left anterior cingulate cortex compared to SPECT before gabapentin. There was no significant statistical correlation between the use of gabapentin and improvement of symptoms associated with pain such as depression, anxiety, catastrophization and perception of quality of life