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

Dor musculoesquelética em membros inferiores de pacientes obesos antes e depois da cirurgia bariàtrica Musculoskeletal pain in lower limbs in obese patients before and after bariatric surgery

RACIONAL: A Organização Mundial da Saúde calcula que em 2015 haverá aproximadamente 2,3 bilhões de adultos com sobrepeso e mais de 700 milhões com obesidade no mundo. O excesso de peso pode levar a inúmeras complicações, dentre elas as doenças articulares degenerativas. OBJETIVO: Estimar a frequência e local da dor músculoesquelética em membros inferiores antes e depois da cirurgia bariátrica. MÉTODO: Estudo descritivo de corte transversal, composto por 22 indivíduos obesos que preencheram questionários antes e seis meses depois de submetidos à cirurgia bariátrica. Os dados foram expressos através de uma análise descritiva e avaliados estatiscamente com nível de significância de 5%. RESULTADOS: A dor foi referida pelos pacientes no pré-operatório em 87,5% no tornozelo e pé, 80% em joelho e 91,7% no quadril. No pós-operatório ela diminuiu para 12,5% no tornozelo e pé, 20% no joelho e 8,3% no quadril atingindo significância estatística (p<0,001). CONCLUSÃO: Indivíduos obesos submetidos à cirurgia bariátrica apresentaram acentuada redução tanto na frequência quanto na intensidade das dores músculoesqueléticas localizadas em ordem no quadril, tornozelo e pé e joelho.<br>BACKGROUND: The World Health Organization estimates that in 2015 there will be approximately 2.3 billion overweight adults and more than 700 million obese individuals worldwide. Excess weight can lead to several complications, such degenerative diseases. AIM: To estimate the frequency and local of musculoskeletal pain in the lower limbs before and after bariatric surgery. METHODS: Cross-sectional descriptive study consisting of 22 obese individuals who filled in questionnaires before and six months after undergoing bariatric surgery. Data were shown through a descriptive analysis. The statistical analysis was performed with significance level at 5%. RESULTS: Musculoskeletal pain in the lower limbs was placed preoperatively in 87.5% in the ankle and foot, knee 80% and 91.7% in the hip. Postoperative pain remained present in 12.5% in the ankle and foot, knee 20% and 8.3% in the hip, with statistical significance (p <0.001). CONCLUSION: Obese people who underwent bariatric surgery experienced a marked reduction in both frequency and intensity of musculoskeletal pain located in order in the hip, ankle and foot, and knee

Angioma em tufo e síndrome dolorosa miofascial Tufted angioma and myofascial pain syndrome

O Angioma em tufo é considerado um raro tumor vascular cutâneo adquirido. Caracteriza-se por máculas purpúrico-violáceas, dolorosas que podem evoluir para placas com pápulas angiomatosas. Tem natureza benigna, mas o envolvimento extenso é comum, gerando alteração funcional do membro afetado em caso de dor. Os autores relatam um caso de angioma em tufo associado à síndrome dolorosa miofascial, em que o elemento predisponente foi a presença deste tumor desde a infância. A dor local prejudicou a utilização da musculatura e possibilitou o surgimento da síndrome relatada. A realização de bloqueio anestésico de pontos-gatilhos no membro afetado, levou à melhora total dos sintomas.<br>Tufted angioma is a rare acquired vascular tumor. It is characterized by painful purplish macules that may progress to plaques containing angiomatous papules. The condition is benign; however, it often affects extensive areas of the skin, leading to functional disability of the affected limb if painful. The present report describes a case of a tufted angioma associated with myofascial pain syndrome in which the predisposing element was the presence of this tumor since childhood. Pain at the site of the lesion affected muscle use and led to the onset of the associated syndrome. Complete relief from symptoms was achieved by blocking the trigger points of the affected limb with anesthesia

Quality of life and prevalence of osteoarticular pain in patients submitted to bariatric surgery

OBJECTIVE: To analyze quality of life and observe the prevalence of musculoskeletal pain in patients submitted to bariatric surgery. METHODS: A prospective, observational and comparative study with 26 individuals aged 18 to 60 years, 25 women, which included two evaluations, one preoperative and the other approximately 42 months after surgery. The Medical Outcomes Study 36-Item Short Form Health Survey (SF-36) and the Human Body Diagram with Visual Analogue Scale were employed. RESULTS: The individual samples showed grade III obesity, with a predominance of postoperative overweight, hypertension and diabetes in 65.4% and 42.3% of the samples, with remission of hypertension in 50% and of diabetes mellitus in 38.5% (p<0.001). The SF-36 demonstrated improved quality of life, especially in aspects related to motricity; vitality and mental health showed no significant changes. Osteoarticular pain was reported and identified in various sites by the subjects; however, 87.5% of patients in the preoperative period and 88.5% in the postoperative period reported not having any physical therapy orientation, while 65.4% reported being engaged in some type of regular physical activity after surgery (p<0.001). CONCLUSION: Morbidly obese individuals have a high probability of suffering from clinical, psychic, and musculoskeletal alterations, compromising their quality of life and showing improvement after bariatric surgery; on the other hand, the psycho-emotional manifestations did not progress in the same way

Queixas osteomusculares relacionadas ao trabalho relatadas por mulheres de centro de ressocialização Work-related musculoskeletal complaints by women in a social rehabilitation center

Considerando as queixas de origem laboral um problema de saúde pública, objetivou-se, com o presente estudo, analisar a freqüência da população que refere queixas osteomusculares e a associação de ocorrência e severidade destas às variáveis antropométricas e de trabalho. Tomou-se 146 mulheres de um centro de ressocialização feminino, que responderam a um questionário validado contendo informações sobre dados antropométricos e queixas osteomusculares relacionadas ao trabalho. O estudo da associação entre e dentro das variáveis foi feito pelo teste de Goodman. Observou-se elevada freqüência de ocorrência de queixas após início de atividade laboral (94,19%). As participantes com necessidade de afastamento apresentaram maiores valores em idade e peso. Queixa acentuada foi mais referida na coluna do tronco. Afastamento foi mais referido para as que trabalhavam há mais tempo. Concluiu-se que é alta a freqüência de queixas relacionadas ao trabalho e que há associação entre maiores valores de peso e de estatura e nível de severidade acentuado; maiores valores de idade e de peso e necessidade de afastamento; níveis acentuados de queixas e região da coluna e entre maior tempo de serviço e necessidade de afastamento.<br>Considering work-related complaints as a public health problem, the current study aimed to analyze the frequency of musculoskeletal complaints and the association between their occurrence and severity and anthropometric and work variables. The sample included 146 women from a social rehabilitation center who answered a validated questionnaire with anthropometric data and history of work-related musculoskeletal complaints. The Goodman test was used to analyze the association between and within variables. We observed a high rate of complaints after beginning work activity (94.19%). Subjects that required sick leave showed higher mean age and weight. The most severe complaints related to back pain. Sick leave was more common among women who had worked longer. The study concluded that there was a high frequency of work-related complaints and an association between: higher weight and height values and severity; higher age and sick leave; more serious complaints and back pain; and longer time on the job and need for sick leave

Mean intrasellar pressure, visual field, headache intensity and quality of life of patients with pituitary adenoma Pressão intra-selar média, campo visual, intensidade de cefaléia e qualidade de vida em portadores de adenoma hipofisário

Intrasellar pressure (ISP) measurement technique has recently opened a new line of research in neuroendocrinology. The absolute and mean ISP values were investigated in 25 patients consecutively operated at the Brasilia University Hospital (DF). These data were correlated with serum prolactin levels, number of visual quadrant affected, tumor size, quality of life (measured through the SF-36 scale) and graded headache (measured through the HIT-6 scale). No correlation was observed. The p values were 0.887; 0.137; 0.892; 0.812 and 0.884; respectively. The HIT-6 values were inversely and moderately correlated with total RAND SF-36 and its mental and physical dimensions.<br>A técnica da medida da pressão intra-selar (PIS) abriu, recentemente, uma nova linha de pesquisa em neuroendocrinologia. O objetivo deste estudo foi aferir os valores absolutos da PIS e calcular a pressão intra-selar média (PIM) em uma população de 25 pacientes operados consecutivamente no Hospital Universitário de Brasília (DF). Não se observou correlação significativa entre a PIM e o número de quadrantes visuais comprometidos (p=0,137), área do tumor (p=0,892), nível de qualidade de vida mensurado pela escala SF-36 (p=0,812) e a presença e a intensidade da cefaléia mensurada pela escala HIT-6 (p=0,884). Contudo, o HIT-6 correlacionou-se de forma inversa e intensidade moderada com os valores de HIT-6 e suas dimensões mental e física