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- ItemSomente MetadadadosAdjunct dipyrone in association with oral morphine for cancer-related pain: the sooner the better(Springer, 2007-11-01) Souza, Jose F. Duarte; Lajolo, Paula P.; Pinczowski, Helio; del Giglio, Auro; ABC Fdn Sch Med; Universidade Federal de São Paulo (UNIFESP); Albert Einstein HospIntroduction Adjunct nonopioid analgesics may improve pain control in patients with cancer needing morphine or its derivates. Dypirone is a cheap nonopioid analgesic widely used in many countries.Objective the objective of the study was to evaluate, whenever morphine was started, if associating dipyrone with it would improve pain control and if this effect was time dependent.Materials and methods This is a double-blind placebo-controlled randomized crossover study. Thirty-four ambulatory cancer patients experiencing cancer-related pain for which oral morphine was to be started at the dose of 10 mg orally (PO) every 4 h were randomized to take either dipyrone 500 mg PO every 6 h or placebo. After 48 h, patients would be switched from dipyrone to placebo and vice versa. Pain was the primary outcome and was measured using a visual analogue scale before starting medications, at 48 and 96 h.Results We randomized 16 patients to start with placebo (group 1) and 18 with dipyrone (group 2). Pain scores for groups 1 and 2 were at baseline: 7.31 +/- 0.29 vs 6.88 +/- 0.28 (p=0.3), at 48 h: 7.06 +/- 0.32 vs 5.5 +/- 0.31 (p=0.001), and at 96 h: 3.18 +/- 0.39 vs 1.94 +/- 0.37 (p=0.03). Both groups had significant improvements in pain scores after introducing dipyrone (p < 0.001, for both). Main toxicities were nausea, vomiting, epigastric pain, and myalgias. Twenty-eight patients chose dipyrone, four placebo, and two were indifferent.conclusions We conclude that dipyrone adds significantly to the analgesic effect of morphine and, when given at the time of starting morphine, results in better pain scores even after dipyrone is discontinued.
- ItemAcesso aberto (Open Access)Alterações posturais e dores musculoesqueléticas(Universidade Federal de São Paulo (UNIFESP), 2005-11-30) Faria, Ivan Barreira Cheida [UNIFESP]; Simões, Manuel de Jesus [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)Background: Good posture is the one that best fits our musculoskeletal system, balancing and distributing all the effort of our daily activities, encouraging the lowest overhead and helping to prevent pain. Objective: The purpose of this study was to verify the presence of musculoskeletal pain and postural deviations according to age and gender of visitors from the beaches of Santos and Guaruja cities. Methods: We evaluated 2394 subjects from 5 years of age being 43.27% males and 56.73% female. To determine the postural deviations and musculoskeletal pain were carried out data collection and assessment posture. Results: The total prevalence of pain and postural deviations were 64.66% and 63.28% respectively. The most affected area by pain was the backbone with 43.98% of the complaints, in which 17.04% of subjects evaluated cited as the lumbar region most affected. As for postural changes, the misalignment with scoliosis was the largest representation with 64.66%, followed by lumbar hyperlordosis with 38.18% and 30.03% with hyperkyphosis. Conclusion: It was concluded that the postural deviations and musculoskeletal pain have high prevalence among evaluated, especially in women and aged between 41 and 60 years, necessitating the implementation of programs aimed at prevention and correction of such findings.
- ItemAcesso aberto (Open Access)Analgesia com laser terapêutico após tonsilectomia(Sociedade de Pediatria de São Paulo, 2010-09-01) Neiva, Felipe Costa [UNIFESP]; Vieira, Fernando Mirage Jardim [UNIFESP]; Figueiredo, Claudia Regina [UNIFESP]; Stamm, Aldo Eden Cassol [UNIFESP]; Weckx, Luc Louis Maurice [UNIFESP]; Pignatari, Shirley Shizue Nagata [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)OBJECTIVE: The postoperative period of a tonsillectomy is usually very painful, requiring the use of pain-relieving drugs. The aim of this study was to evaluate the efficacy of low-level laser therapy in post-tonsillectomy pain control. METHODS: 18 children aged 5 to 15 years undergoing adenotonsillectomy between June 2005 and October 2006 were randomized to receive either local application of therapeutic laser immediately after surgery and 24 hours postoperatively (n=9) or routine analgesic drug therapy, if necessary. Pain was assessed by visual analog scale scores, need for analgesics, and acceptance of diet during the postoperative period. RESULTS: Patients undergoing laser applications had lower median pain scores and required less analgesic medication postoperatively than the control group. Acceptance of diet was similar in both groups. CONCLUSIONS: Preliminary results showed that low-level laser therapy is effective in the reduction of post-tonsillectomy pain, minimizing the need of analgesic medication in children and adolescents.
- ItemSomente MetadadadosANGIOTENSIN (5-8) MODULATES NOCICEPTION AT the RAT PERIAQUEDUCTAL GRAY VIA the NO-sGC PATHWAY and AN ENDOGENOUS OPIOID(Elsevier B.V., 2013-02-12) Guethe, L. M.; Pelegrini-da-Silva, A.; Borelli, K. G.; Juliano, M. A. [UNIFESP]; Pelosi, G. G.; Pesquero, J. B. [UNIFESP]; Silva, C. L. M.; Correa, F. M. A.; Murad, F.; Prado, W. A.; Martins, A. R.; Universidade de São Paulo (USP); Univ Fed Triangulo Mineiro; Universidade Federal de São Paulo (UNIFESP); Universidade Federal do Rio de Janeiro (UFRJ); George Washington Univ; Universidade Estadual de Londrina (UEL)Angiotensins (Angs) modulate blood pressure, hydro-electrolyte composition, and antinociception. Although Ang (5-8) has generally been considered to be inactive, we show here that Ang (5-8) was the smallest Ang to elicit dose-dependent responses and receptor-mediated antinociception in the rat ventrolateral periaqueductal gray matter (vlPAG). Ang (5-8) antinociception seems to be selective, because it did not alter blood pressure or act on vascular or intestinal smooth muscle cells. the non-selective Ang-receptor (Ang-R) antagonist saralasin blocked Ang (5-8) antinociception, but selective antagonists of Ang-R types I, II, IV, and Mas did not, suggesting that Ang (5-8) may act via an unknown receptor. Endopeptidase EP 24.11 and amastatin-sensitive aminopeptidase from the vlPAG catalyzed the synthesis (from Ang II or Ang III) and inactivation of Ang (5-8), respectively. Selective inhibitors of neuronal-nitric oxide (NO) synthase, soluble guanylyl cyclase (sGC) and a nonselective opioid receptor (opioid-R) inhibitor blocked Ang (5-8)-induced antinociception. in conclusion, Ang (5-8) is a new member of the Ang family that selectively and strongly modulates antinociception via NO-sGC and endogenous opioid in the vlPAG. (c) 2012 IBRO. Published by Elsevier B.V. All rights reserved.
- ItemAcesso aberto (Open Access)ASSESSMENT of the EFFECTIVENESS of A FUNCTIONAL SPLINT for OSTEOARTHRITIS of the TRAPEZIOMETACARPAL JOINT of the DOMINANT HAND: A RANDOMIZED CONTROLLED STUDY(Foundation Rehabilitation Information, 2010-05-01) Carreira, Ana Claudia Gomes; Jones, Anamaria [UNIFESP]; Natour, Jamil [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)Objective: To assess the effectiveness of a functional splint for trapeziometacarpal osteoarthritis.Methods: Forty patients with a diagnosis of painful trapeziometacarpal osteoarthritis of the dominant hand were randomized into 2 groups. the study group received the splint at baseline and used it during activities of daily living for 180 days and the control group used the splint only during the evaluations for the first 90 days and during activities of daily living for the following 90 days. Pain, strength, hand function and dexterity (with and without splint) were measured by a blinded assessor at baseline, 45, 90 and 180 days.Results: the groups were homogenous at baseline for all outcomes evaluated. Pain without the splint was significantly different between groups over time; the study group experienced a decrease in pain beginning with the first evaluation (45 days), whereas the control group achieved a lower pain score only at the end of the study, after having used the splint for 90 days. No significant differences between groups were found for the other parameters.Conclusion: Splint use during activities of daily living for patients with trapeziometacarpal osteoarthritis reduces pain, but does not alter function, grip strength, pinch strength or dexterity.
- ItemAcesso aberto (Open Access)Avaliação da imagem corporal, qualidade de vida, sensibilidade tátil e dor em mulheres com câncer de mama submetidas a intervenção cirúrgica(Universidade Federal de São Paulo (UNIFESP), 2015-11-27) Bueno, Juliana Nishimura [UNIFESP]; Nazario, Afonso Celso Pinto [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)Make a comparison between the preoperative and the 30th, 60th and 90th day postoperatively the surgical treatment of breast cancer, the image changes body, quality of life, sensitivity and presence and level of women's pain pesquisadas.A body image of the evaluated patients changed after surgery treatment of breast cancer. There was a worsening of the results of postoperative 30, 60 and 90 days before the preoperative evaluation. The quality of life had changes in some aspects assessed by questionnaire EORTC QLQ C30, physical function in postoperative evaluation 60 days significantly improved compared to the preoperative period and the evaluation of the emotional function in the postoperative 30, 60 and 90 days compared the preoperative. The assessment of cognitive function also showed improvement in 30 days after surgery compared to preoperatively. There was a significant deterioration in social function and loss of appetite in the postoperative period of 30 days in relation to pre operative, and also the symptoms of nausea and vomiting and constipation in the postoperative period 90 days. Body image when assessed by questionnaire EORTC QLQ BR23, was significantly worse in the evaluation of postoperative 30 days, as well as breast symptoms in the postoperative 30 and 60 days, and symptoms arm in all evaluated postoperatively. As for the function and satisfaction sexual significant improvement in postoperative 30 days, as well as prospects have improved in all investigated postoperative. The sensitivity and pain was noticeable worsening on all postoperative when compared to the preoperative evaluation.
- ItemSomente MetadadadosAvaliação do efeito analgésico da associação de magnésio com morfina na dor de pacientes com câncer: estudo clínico randomizado duplo-cego(Universidade Federal de São Paulo (UNIFESP), 2015-07-31) Baaklini, Luis Gustavo [UNIFESP]; Sakata, Rioko Kimiko Sakata [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)Objectives: The aim of this study was to evaluate if the association of Mg enhances the analgesic effect of morphine in cancer pain. Methods: The study was prospective, randomized, double-blinded, and comparative with placebo. There were studied 40 patients, with more than 18 years, of both genders, with cancer pain, using morphine (third analgesic step recommended by WHO). There were excluded patients with hypersensitivity to drugs, and pregnant. Group 1 patients received oral 656,6mg magnesium sulfate twice daily; group 2 patients received placebo twice a day, in identical capsules. All patients received morphine as needed. Acetaminophen was associated at doses of 2 to 3 g / day (every 4 to 6 h). Adjuvant drugs could be used when indicated. Pain intensity was evaluated by numerical scale from zero to 10 in the first consultation and after 1, 2, 3, and 4 wk. The patient noted the intensity of pain and side effects in a file. The functional performance of Karnofsky (KPS) and the quality of life by QLQ-C30 were evaluated in the 1st consultation and after 4 wk. Results: There was no difference between groups in pain intensity, doses of morphine, functional performance, quality of life and side effects. There was a significant reduction in pain intensity in both groups. There was a increased dose of morphine in G2. Conclusions: The association of magnesium sulfate (656,6mg) to morphine in cancer patients did not improve the analgesic effect, functional performance and quality of life; and did not reduce the side effects; but promoted less need to increase the dose of morphine.
- ItemAcesso aberto (Open Access)Cafeína para o tratamento de dor(Sociedade Brasileira de Anestesiologia, 2012-06-01) Tavares, Cristiane [UNIFESP]; Sakata, Rioko Kimiko [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)BACKGROUND AND OBJECTIVES: Caffeine is a widely used substance with effects on several systems, presenting characteristic of pharmacokinetic and pharmacodynamic which cause interactions with several drugs. This study's objective is to review the effects caused by caffeine. CONTENT: This review assesses the caffeine pharmacology, its action mechanisms, indications, contraindications, doses, interactions and adverse effects. CONCLUSIONS: There are insufficient double-blind randomized controlled studies that assess the analgesic effect of caffeine on several painful syndromes. Patients presenting chronic pain need caution when it comes to tolerance development, abstinence and drug interaction from chronic caffeine use.
- ItemSomente MetadadadosA case-control sleep study in children with polyarticular juvenile rheumatoid arthritis(J Rheumatol Publ Co, 2006-04-01) Passarelli, Cassia M.; Roizenblatt, Suely; Len, Claudio Arnaldo [UNIFESP]; Moreira, Gustavo A.; Lopes, Maria Cecília; Guilleminault, Christian; Tufik, Sergio [UNIFESP]; Hilário, Maria Odete Esteves [UNIFESP]; Universidade Federal de São Paulo (UNIFESP); Stanford UnivObjective. To investigate the relationship between clinical manifestations and sleep abnormalities in patients with juvenile rheumatoid arthritis (JRA).Methods. Twenty-one patients with active polyarticular JRA and 20 healthy controls were enrolled consecutively. Pain and functional impairment were assessed with standardized, validated Brazilian questionnaires. Sleep evaluation was based on parent reporting of their child's sleep habits and polysomnography subjects underwent an adaptation night in the sleep laboratory. Sleep architecture was analyzed and spectral analysis of non-rapid eye movement (REM) sleep was carried out by electroencephalography.Results. Patients with JRA exhibited higher indexes of periodic leg movements (PLM, p = 0.02). isolated leg movements (LM), and arousals, as well as increases in alpha activity in non-REM sleep (all p < 0.01), in spite of similar frequency of sleep complaints in comparison to controls. Among JRA patients, greater alpha activity in non-REM sleep was observed in the participants with greater joint involvement assessed by the Escola Paulista de Medicina-Pediatric Range of Motion Scale (p = 0.03) or joint count (p = 0.02). Correlation was observed between morning stiffness and PLM and/or LM (r(S) = 0.75, Sr = 0.74, p < 0.001 for both), and between self-rating scores of pain and alpha activity in non-REM sleep (r(S) = 0.74, p < 0.001).Conclusion. Pain symptoms and disability are related to sleep fragmentation in patients with active polyarticular JRA.
- ItemSomente MetadadadosClinical aspects and treatment of pain in children and adolescents with cancer(Wiley-Blackwell, 2005-12-01) Caran, EMM; Dias, C. G.; Seber, A.; Petrilli, A. S.; Universidade Federal de São Paulo (UNIFESP)Background. the aim of this study was to characterize the clinical aspects and the treatment of mild to severe pain in Brazilian children and adolescents with cancer. We evaluated the importance of classifying patients according to the phase of cancer treatment (diagnosis, treatment, recurrence, and end-of-life palliative care) and the opioid-related side effects.Methods. An institutional prospective study of 184 episodes of pain in children and adolescents with cancer was conducted. Pain was classified according to its cause, physiopathology and intensity. Treatment was based on the WHO guidelines for cancer pain relief.Results. Pain scales were completed by 77% of the patients. Numerical scales were used by 49% of them. Morphine was given in 111 episodes for 2,758 patient days. Morphine doses had to be escalated when it was given to patients during end-of-life palliative care. Opioids were well tolerated with no severe side effects. Psychological dependence on morphine was found in 2% (2/111) of the cases. Pain control was satisfactory in 97% of the episodes.Conclusions. the WHO guidelines for cancer pain relief were effective in controlling pain in children and adolescents with cancer. Despite their low socioeconomic level, patients were able to quantify their pain using rating scales.
- ItemSomente MetadadadosCo-occurrence of chronic physical pain and psychiatric morbidity in a community sample of older people(Wiley-Blackwell, 2007-09-01) Blay, Sergio Luis; Andreoli, Sergio Baxter; Dewey, Michael E.; Gastal, Fabio Leite; Universidade Federal de São Paulo (UNIFESP); Kings Coll LondonBackground Knowledge about co-occurrence of the most frequent chronic pain symptoms with psychiatric morbidity in older people is very limited. Objective To study the association of psychiatric morbidity and painful physical conditions in people aged 60 years and over. Method Population-based random sample of 7,040 household residents, aged 60 years and over, in Brazil. Results the overall prevalence of pain conditions is 76%. Age-sex specific prevalence of chronic pain conditions such as back pain,joint, abdominal, chest, headaches, reported by respondents ranged from 11.6% up to 5 1.1%. in logistic regression models, chest pain, head pain, back pain, joint pain and abdominal pain emerged as predictors of psychiatric morbidity. the odds of psychiatric morbidity are also affected by income, ethnicity, origin (urban/rural), and marital status. Conclusion the association of chronic painful conditions and psychiatric morbidity in late life is statistically strong in this surveyed population. Copyright (c) 2007 John Wiley & Sons, Ltd.
- ItemSomente MetadadadosCorrelação entre o limiar de dor à pressão e a intensidade de dor em individuos com disfunção temporomandibular submetidos a tratamento conservador(Universidade Federal de São Paulo (UNIFESP), 2014-12-18) Lalue, Monique [UNIFESP]; Alonso, Luis Garcia Alonso [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)Pain is a sensation or unpleasant emotional experience associated with actual or potential tissue damage, which features the most prevalent clinical symptoms in individuals with temporomandibular disorders (TMD). However, its quantification is still precarious regarding existing methods, because although they are well established are not very reliable to assess the clinical course of patients. Objective: To measure at different times, with a digital pressure algometer accuracy, the threshold of pain on pressure in masseter and temporalis muscles of TMD patients, who underwent conservative treatment. Methodology: To date were evaluated 27 individuals who had possessed DTM and tenderness in the masseter and temporalis muscles. After diagnostic measurements were performed pain threshold to pressure of these muscles on both sides of the head and the lateral pole of the temporomandibular joint, by placing the pressure algometer in the region being evaluated. For each individual, was established as a conservative treatment that included therapeutic and thermal therapy exercises. These individuals were reevaluated after 15 days and new measurements were obtained. Also will be evaluated after 45 and 75 days of starting treatment. Results: A total of 21 (77.8%) patients adhere to treatment. The Wilcoxon test to evaluate the improvement of the pain threshold to pressure in the first 15 days of treatment in each measured region, both on the right as on the left side of these patients showed statistically significant differences in the measurements. Right masseter Z = 2.24 (p = 0.0250), right temporal Z = 2.13 (p = 0.0325), for the right side Z = 2.55 (p = 0.0106), left masseter Z = 2.74 (p = 0.0060), left temporal Z = 2.27 (p = 0.0228) and left lateral pole Z = 3.43 (p = 0.0006). Conclusion: Based on these results we can infer that the imposition of a conservative treatment in patients with TMD shows positive results in increasing the pressure pain threshold.
- ItemSomente MetadadadosCuidados paliativos para pacientes com câncer de cabeça e pescoço: impacto no controle da dor e qualidade de vida(Universidade Federal de São Paulo (UNIFESP), 2014-09-24) Eugenio, Cecilia [UNIFESP]; Paiva, Marcos Bandiera Paiva [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)Objective: Evaluate whether there was a change in the quality of life and pain management in patients with malignant head and neck tumors referred to the Palliative Care Outpatient Clinic in the Department of Head and Neck Surgery, Federal University of São Paulo (UNIFESP) in a period of three months. Method: 44 patients with one of the following criteria were refered to the clinic: presence of distant metastasis, unresectable tumor, or inoperable patients due to lack of clinical conditions. 42 patients participated in the survey. In all 4 stages of the follow up (first office visit, 30, 60, and 90 days) the following survey was applied: the questionnaires on quality of life of the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire (EORTC QLQ) C30 (version 3.0) and EORTC QLQ-C15-PAL, hospital anxiety and depression scale (HADS), and verbal rating scale (VRS) to assess pain. Results: All patients were classified as stage IV and 78.6 % reported pain. There was improvement on pain management from the first return with p = 0.01, which was maintained in other queries. There was improvement in emotional function on the questionnaires on quality of life and reduction of anxiety on HADS after 60 days follow up. Conclusion: The intervention by a palliative care specialist team is able to better manage pain and emotional symptoms of patients with malignant head and neck tumors with advanced disease and no chance of cure.
- ItemSomente MetadadadosDepression and anxiety in adults with sickle cell disease: the PiSCES project(Lippincott Williams & Wilkins, 2008-02-01) Levenson, James L.; McClish, Donna K.; Dahman, Bassam A.; Bovbjerg, Vjktor E.; Citero, Vanessa de A. [UNIFESP]; Penberthy, Lynne T.; Aisiku, Imoigele P.; Roberts, John D.; Roseff, Susan D.; Smith, Wally R.; Virginia Commonwealth Univ; Univ Virginia; Universidade Federal de São Paulo (UNIFESP)Objective: Depression and anxiety are common in sickle cell disease (SCD) but relatively little is known about their impact on SCD adults. This study measured prevalence of depression and anxiety in SCD adults, and their effects on crisis and noncrisis pain, quality-of-life, opioid usage, and healthcare utilization. Methods: the Pain in Sickle Cell Epidemiology Study-is a prospective cohort study in 308 SCD adults. Baseline variables included demographics, genotype, laboratory data, health-related quality-of-life, depression, and anxiety. Subjects completed daily diaries for up to 6 months, reporting sickle cell pain intensity, distress, interference, whether they were in a sickle cell crisis, as well as health care and opioid utilization. Results: Two hundred thirty-two subjects who completed at least 1 month of diaries were studied; 27.6% were depressed and 6.5% had any anxiety disorder. Depressed subjects had pain on significantly more days than nondepressed subjects (mean pain days 71.1% versus 49.6%, p < .001). When in pain on noncrisis days, depressed subjects had higher mean pain, distress from pain, and interference from pain. Both depressed and anxious subjects bad poorer functioning on all eight SF-36 subscales, even after controlling for demographics, hemoglobin type, and pain. the anxious subjects had more pain, distress from pain, and interference from pain, both on noncrisis pain days and on crisis days, and used opioids more often. Conclusions: Depression and anxiety predicted more daily pain and poorer physical and mental quality-of-life in adults with SCD, and accounted for more of the variance in all domains of quality-of-life than hemoglobin type.
- ItemSomente MetadadadosDevelopment of a tool for early referral of children and adolescents with signs and symptoms suggestive of chronic arthropathy to pediatric rheumatology centers(Wiley-Blackwell, 2006-06-15) Len, Claudio Arnaldo [UNIFESP]; Terreri, Maria Teresa Ramos Ascensão [UNIFESP]; Puccini, Rosana Fiorini [UNIFESP]; Wechsler, Rudolf [UNIFESP]; Silva, Edina Mariko Koga da [UNIFESP]; Oliveira, Leda Magalhães de [UNIFESP]; Barbosa, Cassia Maria Passarelli Lupoli [UNIFESP]; Pedroso, Glaura César [UNIFESP]; Hilário, Maria Odete Esteves [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)Objective. To develop an easy, time-efficient tool to identify children and adolescents with signs and symptoms suggestive of chronic arthropathies, and to evaluate its interobserver reproducibility and reliability.Methods. the instrument used standardized techniques as required for the development of health-related instruments, targeting parents of apparently healthy children and adolescents ages 1-16 years. A multidisciplinary team was involved in the design of the instrument.Results. Each health professional generated 10-15 questions addressing musculoskeletal complaints that they considered to be the most relevant. A total of 60 questions were listed. During the reduction step, each health professional scored questions from 1 to 4 according to the question's relevance. the tool comprised 12 questions and was administered to the parents of 3 groups: patients with juvenile idiopathic arthritis (JIA; n = 48), children with diffuse musculoskeletal pain (n = 39), and a healthy control group (n = 42). the JIA group achieved the highest scores, followed by the diffuse musculoskeletal pain group and the control group. Nine (18.7%) of 48 patients with JIA and 2 (5.1%) of 39 children with musculoskeletal pain had a score of 5. the interobserver reproducibility was confirmed. All 12 questions were included in the final version of the instrument. We determined that children and adolescents with a score >= 5 should be referred for a rheumatologic evaluation (cluster analysis and logistic regression).Conclusion. Our questionnaire seems to be a useful tool for the early detection of musculoskeletal problems in children that may need a referral for a rheumatologic evaluation.
- ItemSomente MetadadadosDiferenças na expressão de dor entre recém-nascidos a termo do sexo feminino e masculino diante de estímulo nociceptivo agudo(Universidade Federal de São Paulo (UNIFESP), 2014-12-16) Arias, Maria Carmenza Cuenca [UNIFESP]; Guinsburg, Ruth Guinsburg [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)Neonatal exposure to noxious stimuli during their stay in intensive care unit has the potential to alter neurodevelopment and cause permanent changes in somatosensory processing of pain. The consequences of nociception in both the short and long term are known to be affected by variables such as gestational age and newborn morbidity. Furthermore, sex-related differences in the structure and functionality of the brain can also affect its susceptibility to nociceptive stimulus during the neonatal period. However, the impact of sex in the response to an acute nociceptive stimulus in newborn infants remains to be elucidated. In this context the objective of this study was to analyze the differences in the expression of pain in newborns (NB) females and males in response to acute noxious stimulation in the first hours of life. For this purpose, we performed a cross-sectional and blinded study with prospective data collection of 400 infants (200 / sex) healthy, full-term, in the first 6 hours of life, who underwent intramuscular injection of Vitamin K. Heart rate (HR), oxygen saturation (SpO2) and three validated scales for assessing neonatal pain (neonatal Facial Coding System (NFCS), Behavioral Indicators of Infant Pain (BIPP) and Premature Infant pain Profile (PIPP)) were assessed before the procedure, during antisepsis, during injection and two minutes afterwards. The results for both sexes were compared with repeated measures (RM) ANOVA adjusted for gestational age (GA), hours of age, 5-minute Apgar. p <0.05 was considered significant. The studied population had an average or mean GA 39 ± 1 week, birth weight 3169 ± 316g, postnatal age 67 ± 45 minutes, 65% were born by cesarean section and the median Apgar score at 5 minutes was 10. RM-ANOVA adjusted HR, SpO2, BIPP and PIPP were significant for time effect, but not for sex or for the interaction of time and sex. NFCS as to the time effects (p <0.001), gender (p <0.05) and time and sex interaction (p <.03) were significant. Further, construction of contrasts analysis showed that this difference occurred during injection. Therefore, our findings indicate that the newborn full-term healthy females express more facial movements related to pain during an acute nociceptive stimulus in the first 6 hours of life, compared to males.
- ItemSomente MetadadadosDistúrbios de sono causam impacto na qualidade de vida de mulheres com lúpus eritematoso sistêmico (les)(Universidade Federal de São Paulo (UNIFESP), 2015-08-31) Reis, Lilian Karla Cunha dos [UNIFESP]; Trevisani, Virginia Fernandes Moca Trevisani [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)Despite the small number of studies regarding sleep disorders, they are a frequent complaint of patients with SLE (62 to 80%) and are related to fatigue, pain, and decreased quality of life (Qol). Objective: To assess the impact of sleep disorders in Qol, pain, and fatigue in women with SLE. Methods: We used the following questionnaires, scales and indices: actigraphy to assess sleeping habits of women with SLE, the Pittsburgh Sleep Quality lndex (PSQI) questionnaire, Medical Outcomes short form 36 (SF-36), the Fatigue Severity Scale (FSS), the Visual Analogue Scale (VAS), the Systemic Lupus Erythematosus Disease Activity Index (SLEDAI), and the Systemic Lupus International Collaboration Clinics (SLICC). The software used for data analysis was Minitab version 16.1, with a significance level of 5%. Results: We studied 46 women with SLE, who had subjective complaints of bad sleep (PSQI). When we related the PSQI data with the questionnaires, we observed associations with (FSS) (p=0.048), pain (VAS) (p=0.028), the role-physical (RP) (p = 0.017), the role emotional (RE) (p=0.006), and mental health (MH) scales (SF-36) (p = 0.034). In terms of correlation of the actigraphy variables with the scores of the questionnaires, we observed statistical significance correlation with the SF-36 data in the RE scale, as follows: with sleep latency (SL) (p=0.005), number of wake ups after sleep onset (p=0.038) and sleep efficiency (p=0.046). In the use of drugs: yes or no, the only association that we observed was the use of antimalarial drugs and greater SL (p=0.032). The association of the use of prednisone (PDN) and less total sleep time (TST) almost reached significant value (p=0.056). Conclusion: Our study indicates that patients with SLE and sleep disorders experience a negative impact in terms of fatigue, pain, and some scales of Qol (in the RP, RE and MH scales), particularly role emotional, with increased latency and wake ups after sleep onset, reducing sleep efficiency; in addition to the influence of corticoids and antimalarial drugs over these alterations. We also observed consistency in both evaluation methods (actigraphy and PSQI) in sleep latency. We have no conflict of interest in this study.
- ItemAcesso aberto (Open Access)Dor musculoesquelética idiopática difusa na infância e na adolescência(Sociedade de Pediatria de São Paulo, 2011-06-01) Molina, Juliana [UNIFESP]; Silva, Simone Guerra Lopes da [UNIFESP]; Teles, Fernanda Moreira [UNIFESP]; Fraga, Melissa Mariti [UNIFESP]; Paulo, Luciana Tudech Salgueiro Pedro [UNIFESP]; Bugni, Vanessa [UNIFESP]; Terreri, Maria Teresa Ramos Ascensão [UNIFESP]; Hilário, Maria Odete Esteves [UNIFESP]; Len, Claudio Arnaldo [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)OBJECTIVE: Persistent or intermittent diffuse idiopathic musculoskeletal pain is defined by the presence of pain over three months with no apparent etiology. The diagnosis of this condition in children and adolescents is increasing. The objective of this study was to report the cases of two patients with disabling pain that received multidiscipli-nary treatment and to review the current literature about this subject. CASE DESCRIPTION: The first patient is a nine-year old girl with history of headache, musculoskeletal pain and abdominal pain for two years. During this period she had four episodes of absence of gait with no apparent organic cause. The second patient is a 14-year girl with severe daily low back pain for 14 months, followed by headache and fatigue. Both patients presented a normal physical examina-tion, except for allodynia (case 1) and fibromyalgia tender points (case 2). All tests resulted negative regarding the search for organic reasons for pain complaints. Significant clinical improvement was observed with a multidisciplinary approach offered by pediatricians, psychologists, physical therapists, and nutritionists. Both patients resumed their daily regular activities. COMMENTS: Team integrated performance in a short-term period can provide the attenuation of pain symptoms since emotional, physical and nutritional factors are related to the pain expressed by the patients.
- ItemAcesso aberto (Open Access)Dor pós-operatória em craniotomia(Escola de Enfermagem de Ribeirão Preto / Universidade de São Paulo, 2005-08-01) Peón, Andréa Ungaro; Diccini, Solange [UNIFESP]; Hospital Israelita Albert Einstein; Universidade Federal de São Paulo (UNIFESP)In the postoperative period, 47% to 75% of the patients report some degree of pain. This study aimed to evaluate pain in the pre and postoperative period of patients submitted to craniotomy. This prospective research was carried out at the neurosurgery unit of a large Brazilian hospital. For a quantitative evaluation of pain, the verbal numeric 0 - 10 rating scale was used. Forty patients with a mean age of 36 years were evaluated. In the preoperative period, 34 (85%) patients indicated headache as the main cause of pain. In the postoperative period, 37 (93%) patients complained of pain while three (7%) reported absence of pain. Pain peaks were observed on the 2nd postoperative day, when 12 (32%) of the patients reported severe pain and 10 (27%) moderate pain. Absence of severe pain occurred after the 8th postoperative day. It was concluded that protocols of analgesia in craniotomy are needed, such as training nurses to better evaluate and handle pain.
- ItemAcesso aberto (Open Access)A dor, o indivíduo e a cultura(Faculdade de Saúde Pública, Universidade de São Paulo.Associação Paulista de Saúde Pública., 2001-07-01) Sarti, Cynthia Andersen [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)In the pain, the relation between the individual and society appears clearly. The way in which pain is felt and expressed is ruled by cultural codes and pain itself is constituted, as a human fact, by the meanings given to it by society, that sanctions the ways to demonstrate feelings. Although pain is a singular experience for the one who feels it, it happens within a symbolic system, making it a cultural fact.
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