[Compliance with chronic pain treatment: study of demographic, therapeutic and psychosocial variables]

Intervention Protocol Based on Transtheoretical Model of Behavior Change for Metabolic Syndrome

Abstract The present study is the translation and adaptation of an intervention based on the Transtheoretical Model of Change directed to patients at cardiovascular risk. The original 29-session manual was translated into Portuguese, extended to 36 sessions, and applied in a pilot study. The protocol was reduced to 12 sessions through the grouping based on the processes of change. The products of the present study were the processes in each behavior, the versatility of the protocol, the interdisciplinary work, the great cost-benefit, and the potential of effectiveness. Finally, the importance of consistent training in Motivational Interview, Transtheoretical Model and group management for proper use are highlighted, and the costs and benefits of protocols versus more flexible treatments are discussed.

Topical combinations aimed at treating microvascular dysfunction reduce allodynia in rat models of CRPS-I and neuropathic pain

Growing evidence indicates that various chronic pain syndromes exhibit tissue abnormalities caused by microvasculature dysfunction in the blood vessels of skin, muscle, or nerve. We tested whether topical combinations aimed at improving microvascular function would relieve allodynia in animal models of complex regional pain syndrome type I (CRPS-I) and neuropathic pain. We hypothesized that topical administration of either α(2)-adrenergic (α(2)A) receptor agonists or nitric oxide (NO) donors combined with either phosphodiesterase (PDE) or phosphatidic acid (PA) inhibitors would effectively reduce allodynia in these animal models of chronic pain. Single topical agents produced significant dose-dependent antiallodynic effects in rats with chronic postischemia pain, and the antiallodynic dose-response curves of PDE and PA inhibitors were shifted 2.5- to 10-fold leftward when combined with nonanalgesic doses of α(2)A receptor agonists or NO donors. Topical combinations also produced significant antiallodynic effects in rats with sciatic nerve injury, painful diabetic neuropathy, and chemotherapy-induced painful neuropathy. These effects were shown to be produced by a local action, lasted up to 6 hours after acute treatment, and did not produce tolerance over 15 days of chronic daily dosing. The present results support the hypothesis that allodynia in animal models of CRPS-I and neuropathic pain is effectively relieved by topical combinations of α(2)A or NO donors with PDE or PA inhibitors. This suggests that topical treatments aimed at improving microvascular function may reduce allodynia in patients with CRPS-I and neuropathic pain.

PERSPECTIVE

This article presents the synergistic antiallodynic effects of combinations of α(2)A or NO donors with PDE or PA inhibitors in animal models of CRPS-I and neuropathic pain. The data suggest that effective clinical treatment of chronic neuropathic pain may be achieved by therapies that alleviate microvascular dysfunction in affected areas.

Qualitative research as the basis for a biopsychosocial approach to women with chronic pelvic pain

Chronic pelvic pain (CPP) is a highly prevalent clinical condition and is recognized as a public health problem. Although the number of qualitative studies related to the topic is increasing, it is essential that this knowledge be presented in a synthesized manner, grounded in the context of the care provided to patients with CPP, in order to increase the clinical and research applicability of the findings. Little attention is given to CPP in undergraduate courses and in meetings for the continuing education of health professionals, the approach to CPP typically being based on the biomedical model. We believe that qualitative research can provide insights into CPP and form the basis for a biopsychosocial approach to the condition, which can in turn lead to better results, including resolution of the pain and greater patient/health professional satisfaction. Therefore, we conducted a metasynthesis of seven qualitative studies of CPP, the principal themes of which were as follows: (a) coping with CPP versus secondary gain; (b) the great importance of determining the cause of the pain; (c) expectations regarding the doctor-patient relationship; and (d) gender issues. We hope that the present study can aid in restoring the humanistic aspects of CPP treatment.

Evaluation of adherence to treatment by patients seen in a psychosocial care center in northeastern Brazil

In the treatment of mental disorders, nonadherence to medication, the main cause of psychiatric morbidity, is observed in about 50% of the cases and is responsible for numerous losses. This study evaluated adherence to drug treatment by patients seen in a Psychosocial Care Center (CAPS) in northeastern Brazil. Adherence to treatment was evaluated using the Haynes-Sackett and Morisky-Green-Levine tests. All patients registered in the CAPS were included in the study (n= 101). Only 11.88% of the patients adhered to drug treatment. The main reasons not to use medication were: oblivion (68.83%), feeling unwell after taking the medication (54.22%), not having money to buy the medication (43.83%), not finding the medication in the public health service (39.94%) and fear of harm that might be caused by the drug (28.90%). Furthermore, 85.1% of the patients did not know their diseases, 88.1% did not know their treatment, 86.4% did not feel good when they took their medication, and 88.1% took their medication incorrectly. The results revealed that the lack of information about diseases and drugs used, the nuisance posed by drug therapy and the low access to medications reduce adherence to treatment and, consequently, treatment effectiveness.

Chronic pelvic pain: multifactorial influences

RATIONALE

Chronic pelvic pain (CPP) is a common and complex disease whose cause is often clinically inexplicable, with diagnosis and treatment being more difficult. From a clinical viewpoint, CPP is defined as non-cyclic, non-menstrual pain lasting at least 6 months and sufficiently severe to interfere with habitual activities and requiring clinical or surgical treatment. Thus, CPP is a syndrome resulting from a complex interaction of the nervous, musculoskeletal and endocrine systems and also influenced by psychological and sociocultural factors. CPP is influenced by emotional aspects with an impact on quality of life, and involving high costs for health services. Its aetiology is not always clear and a cure or significant improvement of symptoms is not always obtained with the treatments employed, with constant frustration of the professionals involved. It can be seen that its treatment is often unsatisfactory, simply providing temporary relief of symptoms.

METHODS

In the present study, we reviewed the bibliography regarding pelvic pain, with emphasis on emotional aspects and on the importance of a multidimensional approach to the care for these patients.

RESULTS AND CONCLUSIONS

New investigations are needed to clarify these relations and interventions in a more effective manner. Interdisciplinary care can minimize the impact of the disease, helping the patients to cope with symptoms and improving their quality of life.

Fisiomotricidade e limiares de dor: efeitos de um programa de exercícios na autonomia funcional de idosas osteoporóticas

INTRODUÇÃO: A atividade física é importante para a manutenção da autonomia funcional do homem e crucial em idosos. Todavia, alguns fatores, como a dor, limitam a participação deles em programas de atividade física. OBJETIVO: Investigar se, em função de um programa de atividades físicas estruturado de maneira a limitar a dor, poder-se-ia garantir a aderência de idosas sofrendo de osteoporose/osteopenia e, dessa forma, promover melhoras na autonomia funcional destas. DESENVOLVIMENTO: A amostra foi composta por 30 mulheres, entre 65 e 70 anos, divididas em dois grupos definidos em função de um diagnóstico de dor. MATERIAIS E MÉTODOS: Aplicou-se um programa definido pelo termo fisiomotriz, de baixo impacto, caracterizado por lentidão nas mudanças articulares, progredindo em quatro níveis que foram distribuídos em 48 encontros. Os dados da dor e da autonomia funcional, obtidos por meio do teste de dor em escala analógica visual e do protocolo de GDLAM foram estudados por estatística descritiva e inferencial, com o índice ALFA ± 0,05. O instrumento foi uma Análise de Variância de Kruskal Wallis com índice Qui-quadrado (Chi²). RESULTADOS: Os resultados revelaram melhora da autonomia funcional e diminuição de dor relatada pelas participantes, fato que consequentemente implementou a aderência destas até ao final do programa. CONCLUSÃO: Conclui-se que o programa fisiomotriz, aplicado em idosas com osteopenia e/ou osteoporose, foi uma forma eficaz na promoção da melhora de sua autonomia funcional, que pode ser atribuída, pelo menos em parte, à diminuição de dor antes relatada pelas idosas.

Sleep patterns and symptoms of anxiety and depression in patients with chronic pain

BACKGROUND

Sleep disturbances and symptoms of anxiety and depression have been shown to be involved in the genesis and perpetuation of chronic pain.

OBJECTIVE

To evaluate sleep patterns and the prevalence of symptoms of anxiety and depression in patients with chronic pain.

METHOD

Four hundred consecutive patients referred to a chronic pain outpatient clinic were investigated using patient charts, the numerical Visual Analogue Scale for the evaluation of pain, the Hospital Anxiety and Depression scale and the Mini-Sleep Questionnaire.

RESULTS

The mean age of patients was 45.6+/-11.4 years. The most frequent medical diagnosis was myofascial pain followed by neuropathic pain. The prevalence of symptoms of anxiety was 72.8%, depression 93% and altered sleep patterns 93%.

CONCLUSION

This study revealed a high prevalence of symptoms of depression and anxiety and alterations in sleep patterns in patients with chronic pain, justifying investigation into these disturbances in this group of patients.

Validade e confiabilidade do Inventário de Atitudes frente à Dor Crônica (IAD-28 itens) em lingua portuguesa

Trata-se da reavaliação da confiabilidade e validade do Inventário de Atitudes frente à Dor Crônica-versão breve, (IAD-breve) com 183 pacientes com dor crônica não oncológica. O IAD-breve 28 itens avalia as crenças sobre dor crônica relacionadas ao controle, emoção, solicitude, cura médica, dano físico, incapacidade e medicação. A análise mostrou sete domínios e 28 itens. Houve diferenças na alocação de dois itens e, após análises, optou-se por retirá-los. Quatro domínios apresentaram valores de alfa de Cronbach considerados bons (entre 0,74 e 0,85) e em três, foram moderados (entre 0,58 e 0,65). O IAD-breve 28 itens em língua portuguesa é superior à primeira versão.

High levels of anxiety and depression have a negative effect on quality of life of women with chronic pelvic pain

BACKGROUND

Chronic pelvic pain (CPP) is a common and complex disease whose cause is often clinically inexplicable, with consequent difficulty in diagnosis and treatment. Patients with CPP have high levels of anxiety and depression, with a consequent impairment of their quality of life.

AIMS

The objective of this study was to determine the prevalence of anxiety and depression and their impact on the quality of life of women with CPP.

MATERIALS AND METHODS

A cross-sectional controlled study was conducted on 52 patients with CPP and 54 women without pain. Depression and anxiety were evaluated by the Hospital Anxiety and Depression Scale, and quality of life was evaluated by the World Health Organization Quality of life Whoqol-bref questionnaire. Data were analysed statistically by the Mann-Whitney U-test, the Fisher exact test, chi-square test and Spearman correlation test.

RESULTS

The prevalence of anxiety was 73% and 37% in the CPP and control groups, respectively, and the prevalence of depression was 40% and 30% respectively. Significant differences between groups were observed in the physical, psychological and social domains. Patients with higher anxiety and depression scores present lower quality of life scores.

DISCUSSION

The fact that DPC is a syndromic complex, many patients enter a chronic cycle of search for improvement of medical symptoms. The constant presence of pain may be responsible for affective changes in dynamics, family, social and sexual. Initially the person is facing the loss of a healthy body and active, to a state of dependence and limitations. In this study, patients with higher scores of anxiety and depression scores had lower quality of life and patients with lower scores of anxiety and depression had scores of quality of life. These results show that perhaps the depression and anxiety may be related to the negative impact on quality of life of these patients.

CONCLUSION

In view of this association, we emphasise the importance of a specific approach to the treatment of anxiety and depression together with clinical treatment to improve the quality of life of these patients.

Atendimento psicológico a pacientes com insuficiência renal crônica: em busca de ajustamento psicológico

As doenças crônicas, entre elas a insuficiência renal crônica, têm recebido grande atenção dos profissionais de saúde nas últimas décadas devido ao importante papel desempenhado na morbimortalidade da população mundial. Este trabalho pretende apresentar um relato de experiência sobre o atendimento psicológico, realizado numa clínica de hemodiálise, de 26 pacientes com idades entre 15 e 80 anos, a maioria mulheres (69,2%), casados (53,8%), que não trabalham (92,3%) e aposentados (57,7%), fazendo hemodiálise três vezes por semana. No lugar de reagir passivamente a eventos negativos, indivíduos podem se comportar de modos que aumentem seu bem-estar em tempos de desafios e mudanças, como no caso de se ter uma insuficiência renal crônica. A forma como as pessoas lidam com o sofrimento e seus benefícios pode trazer possibilidades de ajustamento e crescimento pessoal frente à adversidade.

Adesão de mulheres mastectomizadas ao início precoce de um programa de reabilitação

OBJETIVOS: Verificar a adesão de mulheres mastectomizadas ao início precoce de um programa de reabilitação da amplitude de movimento do ombro homolateral à cirurgia e identificar as dificuldades na realização dos exercícios e das atividades de vida diária. MÉTODOS: Estudo prospectivo desenvolvido no Ambulatório de Oncomastologia do Hospital São Paulo/Universidade Federal de São Paulo, no período de 2003 a 2004. A amostra constitui-se de 28 mulheres mastectomizadas que aceitaram participar do programa de reabilitação, desde a alta hospitalar até o primeiro retorno ambulatorial. RESULTADOS: Aderiram ao programa 64,2% das pacientes e 82,1% referiram dificuldade para execução dos exercícios, principalmente devido à dor. A maioria realizou as atividades de vida diária sem dificuldades. CONCLUSÃO: Faz-se necessário um melhor controle da dor pós-operatória e reforço das orientações para incrementar a adesão das pacientes ao programa de reabilitação.