Prevalence of chronic pain and its association with the sociodemographic situation and physical activity in leisure of elderly in Florianópolis, Santa Catarina: population-based study

Cortical Neurostimulation and N-Methyl-D-Aspartate Glutamatergic Receptor Activation in the Dysgranular Layer of the Posterior Insular Cortex Modulate Chronic Neuropathic Pain

BACKGROUND AND AIMS

The dysgranula parts of the posterior insular cortex (PIC) stimulation (PICS) has been investigated as a new putative cortical target for nonpharmacologic therapies in patients with chronic and neuropathic pain (NP). This work investigates the neural bases of insula neurostimulation-induced antinociception and glutamatergic neurochemical mechanisms recruited by the PICS in animals with neuropathy.

MATERIALS AND METHODS

Male Wistar rats were submitted to the von Frey and acetone tests to assess mechanical and cold allodynia after 21 days of chronic constriction injury (CCI) of the sciatic nerve or Sham procedure ("false operated"). Either the Cascade Blue 3000 MW lysine-fixable dextran (CBD) or the biotinylated dextran amine 3000 MW (BDA) neural tract tracer was microinjected into the PIC. The electrical PICS was performed at a low frequency (20 μA, 100 Hz) for 15 seconds by a deep brain stimulation device. PIC N-methyl-D-aspartate (NMDA) receptors (NMDAR) blockade with the selective antagonist LY235959 (at 2, 4, and 8 nmol/200 nL) followed by PICS was investigated in rats with CCI.

RESULTS

PIC sends projections to the caudal pontine reticular nucleus, alpha part of the parvicellular reticular nucleus, dorsomedial tegmental area, and secondary somatosensory cortex (S2). PICS decreased both mechanical and cold allodynia in rats with chronic NP. Blockade of NMDAR in the PIC with LY235959 at 8 nmol attenuated PICS-produced antinociception.

CONCLUSION

Neuroanatomic projections from the PIC to pontine reticular nuclei and S2 may contribute to chronic NP signaling. PICS attenuates the chronic NP, and the NMDA glutamatergic system in the PIC may be involved in PICS-induced antinociception in rodents with NP conditions.

Prevalence of chronic pain in Brazil: A systematic review and meta-analysis

OBJECTIVE

This review synthesized existing studies on the prevalence of chronic pain in Brazil and its associated factors to produce a recent estimation to guide public health politics.

METHODS

A search was carried out in the Ovid Medline, Embase, Web of Science, and BVS Regional/Lilacs databases to identify population-based cross-sectional studies from 2005 to 2020, which reported the prevalence of benign chronic pain in Brazil (more than three months). The risk of bias was assessed using design, sample size determination, and random selection as essential issues. Pooled prevalence estimates were calculated for chronic pain in the general and elderly populations. The protocol was registered on Prospero (CRD42021249678).

RESULTS

Of the 682 identified, 15 macheted the authors' inclusion criteria. Chronic pain prevalence in the general adult population ranged from 23.02% to 41.4% (pooled estimate 35.70%, 95% Cis 30.42 to 41.17) and was described as moderate to intense. It was associated with female sex, old age, lower education, intense professional activity, excessive alcohol consumption, smoking, central obesity, mood disorder, and sedentarism. The Southeastern and Southern regions presented a higher prevalence. The prevalence in the elderly population ranged from 29.3% to 76.2% (pooled estimate 47.32%, 95% Cis 33.73 to 61.11). In addition, this population visited doctors more frequently, had more sleep disorders, and was more dependent on daily living activities. Almost fifty percent of both populations with chronic pain reported pain-induced disability.

CONCLUSION

Chronic Pain is highly prevalent in Brazil and associated with significant distress, disability, and poorly controlled.

Living with opioids: A qualitative study with patients with chronic low back pain

BACKGROUND

Opioids are one of the most prescribed treatments for chronic pain (CP). However, their long-term use (>3 months) has been surrounded by controversy, due to loss of beneficial effects.

OBJECTIVE

To explore the experiences of people with chronic non-malignant low back pain in Spain undergoing long-term treatment with opioids.

DESIGN

Qualitative study.

SETTING AND PARTICIPANTS

We conducted 15 semi-structured interviews at the Pain Clinic with persons taking opioid treatment.

METHODS

The interviews were analysed by qualitative content analysis as described by Graneheim and Lundman, and developed categories and themes discussed in light of a biomedicalization framework.

MAIN RESULTS

We developed one overarching theme-Living with opioids: dependence and autonomy while seeking relief-and three categories: The long pathway to opioids due to the invisibility of pain; Opioids: from blind date to a long-term relationship; and What opioids cannot fix.

DISCUSSION

The long and difficult road to find effective treatments was a fundamental part of coping with pain, involving long-term relationships with the health system. This study reflects the benefits, and drawbacks of opioids, along with struggles to maintain autonomy and make decisions while undergoing long-term treatment with opioids. The paper also highlights the consequences of pain in the economy, family and social life of patients.

CONCLUSIONS

Patients' experiences should be considered to a greater extent by health-care professionals when giving information about opioids and setting treatment goals. Greater consideration of the social determinants of health that affect CP experiences might lead to more effective solutions to CP.

Physical activity level among older adultsover 70 years old and very old adults

Abstract Introduction: Physical activity (PA) is an effective strategy to ensure good health in older adults and mitigate the harmful effects of aging. Objective: To compare PA levels in people aged between 70 and 79 years and very old adults. Method: Quantitative, observational, descriptive cross-sectional study, with 343 individuals aged 70 years or older from a medium-sized municipality in western Santa Catarina state (SC). Data were collected using the MMSE, the Morais’ Questionnaire, and the IPAQ-SF. Data were analyzed using the Mann-Whitney U test, X² and Spearman’s correlation. Significance was set at p < 0.05. Results: The average physical activity level among 70 to 79-year-olds was 168.55 (± 146.81) minutes a week and 93.91 (± 122.66) in very old adults. IPAQ classification indicated that a higher percentage of very old adults were sedentary (79.5%), while 67.8% of 70 to 79-year-olds were categorized as active/very active. There was a statistically significant correlation between physical activity level, number of self-reported chronic diseases and number of medications. Conclusion: Older adults between 70 and 79 years old are more active than very old adults; older women are more active than their male counterparts; the increase in the number of chronic diseases and medications taken lowers physical activity level.

Chronic Pain and Frailty in Community-Dwelling Older Adults: A Systematic Review

OBJECTIVE

Our aim was to examine the relationship between chronic pain and frailty in community-dwelling older adults.

DESIGN

A systematic review method following the Joanna Briggs Institute Reviewers' Manual 2015.

DATA SOURCES

MEDLINE, Cochrane Library Plus, Science Direct, Scielo, LILACS, and the Joanna Briggs Institute database of systematic reviews and implementation reports were searched using different combinations of the terms "frail," "frailty," and "pain."

REVIEW/ANALYSIS METHODS

Original publications of nononcologic chronic pain and frailty status in community-dwelling older adults published in English or Spanish were included. Because of the heterogeneity of the studies, a narrative approach was used to summarize the results.

RESULTS

A total of 23 studies were finally selected for the systematic review. Most of them (n = 14) were cross-sectional studies, and there were also longitudinal studies (n = 4), cohort studies (n = 3), and randomized controlled trials (n = 2). Most of the studies found an association between chronic pain and frailty in terms of prevalence; approximately 45% of frail patients had chronic pain, and prevalence can reach 70%.

CONCLUSIONS

The studies analyzed suggest that chronic pain has a predictive effect for frailty in older adults compared with those reporting no pain. Higher pain intensity, chronic widespread pain, and higher pain interference were also related to frailty status. No specific interventions for managing chronic pain in frail or prefrail older adults were found.

Prevalence of Chronic Pain, Treatments, Perception, and Interference on Life Activities: Brazilian Population-Based Survey

Background and Objectives

Chronic pain affects between 30% and 50% of the world population. Our objective was to estimate the prevalence of chronic pain in Brazil, describe and compare differences between pain types and characteristics, and identify the types of therapies adopted and the impact of pain on daily life.

Methods

Cross-sectional study of a population-based survey with randomized sample from a private database. The interviews were conducted by phone. 78% of the respondents aged 18 years or more agreed to be interviewed, for a total of 723 respondents distributed throughout the country. Independent variables were demographic data, pain and treatment characteristics, and impact of pain on daily life. Comparative and associative statistical analyses were conducted to select variables for nonhierarchical logistic regression.

Results

Chronic pain prevalence was 39% and mean age was 41 years with predominance of females (56%). We found higher prevalence of chronic pain in the Southern and Southeastern regions. Pain treatment was not specific to gender. Dissatisfaction with chronic pain management was reported by 49% of participants.

Conclusion

39% of interviewed participants reported chronic pain, with prevalence of females. Gender-associated differences were found in intensity perception and interference of pain on daily life activities.

Depression and chronic pain in the elderly: links and management challenges

Aging is an inevitable process and represents the accumulation of bodily alterations over time. Depression and chronic pain are highly prevalent in elderly populations. It is estimated that 13% of the elderly population will suffer simultaneously from the two conditions. Accumulating evidence suggests than neuroinflammation plays a critical role in the pathogenesis of both depression and chronic pain. Apart from the common pathophysiological mechanisms, however, the two entities have several clinical links. Their management is challenging for the pain physician; however, both pharmacologic and nonpharmacologic approaches are available and can be used when the two conditions are comorbid in the elderly patients.

Upper and lower limb functionality and body mass index in physically active older adults

Abstract Introduction: Aging leads to sarcopenia and functional capacity decline, compromising upper (UL) and lower limb (LL) performance of activities. Body mass index (BMI) is an important parameter for the assessment of health conditions in older adults, especially with regard to obesity, since it leads to functional limitations in terms of mobility and task performance. Objective: To investigate the potential association between UL and LL functionality and BMI in physically active older adults; and to characterize this population with regard to BMI and UL and LL functionality. Methods: The data were collected between August 2013 and April 2014. The sample comprised 371 physically active older adults. This study used secondary data from the program “PET Saúde IPA/SMS”. The program interviewed older adults living in areas comprised by the Third Family Health Unit of a neighborhood in Porto Alegre/RS. This paper used questions from the “Instrumento de Avaliação Multidimensional Rápida da Pessoa Idosa” (Instrument for Rapid Multidimensional Assessment of Elderly People, in English) that had to do with UL and LL functionality, weight, height and BMI. Results and Conclusion: There was no association between UL and LL functionality and BMI in physically active older adults. More than half of the sample was overweight. Most participants had functional UL and LL. While occupation, self-perception of health as “good” and “very good”, and physical activity were found to be associated with LL functionality; regular physical exercise was found to be associated with UL and LL functionality.