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Reis PS, Kraychete DC, Pedreira EDM, Barreto ESR, Antunes Júnior CR, Alencar VB, Souza AKDN, Lins-Kusterer LEF, Azi LMTDA. Transdermal Opioids and the Quality of Life of the Cancer Patient: A Systematic Literature Review. Ann Pharmacother 2024:10600280241247363. [PMID: 38659244 DOI: 10.1177/10600280241247363] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/26/2024] Open
Abstract
OBJECTIVE This systematic literature review aims to evaluate the effectiveness of transdermal opioids in managing cancer pain and their impact on the quality of life (QoL) of patients. DATA SOURCES A systematic literature review conducted following the PRISMA protocol, focusing on randomized clinical trials found in the Lilacs, Embase, PubMed, and SciELO databases over the last 20 years. STUDY SELECTION AND DATA EXTRACTION We included randomized clinical trials, published in English, Portuguese, or Spanish, which assessed the impact of transdermal opioids on the QoL. Data extraction was facilitated using the Rayyan app. DATA SYNTHESIS Six articles meeting the inclusion and exclusion criteria were analyzed. These studies covered a population ranging from 24 to 422 cancer patients experiencing moderate to severe pain. The risk of bias was assessed in each study, generally being categorized as uncertain or high. RELEVANCE TO PATIENT CARE AND CLINICAL PRACTICE The findings indicate that the analgesic effectiveness and side effects of transdermal formulations (specifically buprenorphine and fentanyl) for managing moderate to severe cancer pain are comparable to, or in some cases superior to, those of oral opioids traditionally employed. CONCLUSIONS Transdermal therapy was suggested to have several advantages over oral opioid therapy in enhancing cancer patients' QoL. These benefits span various dimensions, including pain management, physical functioning, mental health, vitality, overall patient improvement, anger/aversion, strength/activity, general QoL, cognitive and emotional functions, fatigue, and insomnia.
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Pedreira EDM, Mineiro VBP, Knop LMPB, Lins-Kusterer LEF, Kraychete DC. Medication adherence in treating non-oncologic chronic pain: a problem to solve? Braz J Anesthesiol 2023; 73:827-828. [PMID: 37516355 PMCID: PMC10625146 DOI: 10.1016/j.bjane.2023.07.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Revised: 07/13/2023] [Accepted: 07/16/2023] [Indexed: 07/31/2023]
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de Barros GAM, Kraychete DC, Lineburger EB, Módolo NSP. Anesthesiology and pain medicine. Brazilian Journal of Anesthesiology (English Edition) 2022; 72:549-552. [PMID: 35914623 PMCID: PMC9515681 DOI: 10.1016/j.bjane.2022.07.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Amescua-Garcia C, Colimon F, Guerrero C, Jreige Iskandar A, Berenguel Cook M, Bonilla P, Campos Kraychete D, Delgado Barrera W, Alberto Flores Cantisani J, Hernandez-Castro JJ, Lara-Solares A, Perez Hernandez C, Rico MA, Del Rocio Guillen Nunez M, Sempertegui Gallegos M, Garcia JBS. Most Relevant Neuropathic Pain Treatment and Chronic Low Back Pain Management Guidelines: A Change Pain Latin America Advisory Panel Consensus. Pain Med 2019; 19:460-470. [PMID: 29025132 DOI: 10.1093/pm/pnx198] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Objective Chronic pain conditions profoundly affect the daily living of a significant number of people and are a major economic and social burden, particularly in developing countries. The Change Pain Latin America (CPLA) advisory panel aimed to identify the most appropriate guidelines for the treatment of neuropathic pain (NP) and chronic low back pain (CLBP) for use across Latin America. Methods Published systematic reviews or practice guidelines were identified by a systematic search of PubMed, the Guidelines Clearinghouse, and Google. Articles were screened by an independent reviewer, and potential candidate guidelines were selected for more in-depth review. A shortlist of suitable guidelines was selected and critically evaluated by the CPLA advisory panel. Results Searches identified 674 and 604 guideline articles for NP and CLBP, respectively. Of these, 14 guidelines were shortlisted for consensus consideration, with the following final selections made: "Recommendations for the pharmacological management of neuropathic pain from the Neuropathic Pain Special Interest Group in 2015-pharmacotherapy for neuropathic pain in adults: A systematic review and meta-analysis.""Diagnosis and treatment of low back pain: A joint clinical practice guideline from the American College of Physicians and the American Pain Society" (2007). Conclusions The selected guidelines were endorsed by all members of the CPLA advisory board as the best fit for use across Latin America. In addition, regional considerations were discussed and recorded. We have included this expert local insight and advice to enhance the implementation of each guideline across all Latin American countries.
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Affiliation(s)
| | | | - Carlos Guerrero
- Hospital Universitario Fundacion Santa Fe de Bogota, Bogota, Colombia
| | | | | | | | | | | | | | | | - Argelia Lara-Solares
- Instituto Nacional de Ciencias Medicas y Nutricion Salvador Zubiran, Mexico City, Mexico
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Ahmedzai SH, Bautista MJ, Bouzid K, Gibson R, Gumara Y, Hassan AAI, Hattori S, Keefe D, Kraychete DC, Lee DH, Tamura K, Wang JJ. Optimizing cancer pain management in resource-limited settings. Support Care Cancer 2018; 27:2113-2124. [PMID: 30242544 PMCID: PMC6499735 DOI: 10.1007/s00520-018-4471-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2018] [Accepted: 09/10/2018] [Indexed: 12/11/2022]
Abstract
Purpose Adequate cancer pain management (CPM) is challenging in resource-limited settings, where current international guideline recommendations are difficult to implement owing to constraints such as inadequate availability and accessibility of opioids, limited awareness of appropriate opioid use among patients and clinicians, and lack of guidance on how to translate the best evidence into clinical practice. The multinational and multidisciplinary CAncer Pain managEment in Resource-limited settings (CAPER) Working Group proposes a two-step initiative to bridge clinical practice gaps in CPM in resource-limited settings. Methods A thorough review of the literature, a steering committee meeting in February 2017, and post-meeting teleconference discussions contributed to the development of this initiative. As a first step, we developed practical evidence-based CPM algorithms to support healthcare providers (HCPs) in tailoring treatment according to availability of and access to resources. The second part of the initiative proposes a framework to support an effective implementation of the CPM algorithms that includes an educational program, a pilot implementation, and an advocacy plan. Results We developed CPM algorithms for first-line use, breakthrough cancer pain, opioid rotation, and refractory cancer pain based on the National Comprehensive Cancer Network guidelines and expert consensus. Our proposed educational program emphasizes the practical elements and illustrates how HCPs can provide optimal CPM according to evidence-based guidelines despite varied resource limitations. Pilot studies are proposed to demonstrate the effectiveness of the algorithms and the educational program, as well as for providing evidence to support a draft advocacy document, to lobby policymakers to improve availability and accessibility of analgesics in resource-limited settings. Conclusions These practical evidence-informed algorithms and the implementation framework represent the first multinational step towards achieving optimal CPM in resource-limited settings. Electronic supplementary material The online version of this article (10.1007/s00520-018-4471-z) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Sam H Ahmedzai
- National Institute of Health Research Clinical Research Network for Cancer, Leeds, UK
| | | | - Kamel Bouzid
- Medical Oncology Department, Pierre & Marie Curie Center, Algiers, Algeria
| | - Rachel Gibson
- Division of Health Sciences, University of South Australia, Adelaide, Australia
| | - Yuddi Gumara
- National Cancer Center Dharmais Hospital, Jakarta, Indonesia
| | - Azza Adel Ibrahim Hassan
- Supportive & Palliative Care Section, Medical Oncology Department, National Center for Cancer Care and Research, Hamad Medical Corporation, Doha, Qatar.,Cancer Management & Research, Medical Research Institute, Alexandria University, Alexandria, Egypt
| | - Seiji Hattori
- Department of Cancer Pain Management, The Cancer Institute Hospital of JFCR, Tokyo, Japan
| | - Dorothy Keefe
- Department of Medicine, Faculty of Health Sciences, University of Adelaide, Adelaide, Australia
| | | | - Dae Ho Lee
- Department of Oncology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea
| | - Kazuo Tamura
- General Medical Research Center, Fukuoka University School of Medicine, Fukuoka, Japan
| | - Jie Jun Wang
- Department of Oncology, Shanghai Changzheng Hospital, Second Military Medical University, No. 64 He Tian Road, Shanghai, 200070, People's Republic of China.
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García CA, Santos Garcia JB, Rosario Berenguel Cook MD, Colimon F, Flores Cantisani JA, Guerrero C, Rocío Guillén Núnez MD, Hernández Castro JJ, Kraychete DC, Lara-Solares A, Lech O, Rico Pazos MA, Gallegos MS, Marcondes LP. Undertreatment of pain and low use of opioids in Latin America. Pain Manag 2018; 8:181-196. [PMID: 29774774 DOI: 10.2217/pmt-2017-0043] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
Pain is highly prevalent among the adult Latin American population. However, many patients with moderate to severe pain do not have access to effective pain management with opioids due to limited access to healthcare, overuse of nonopioid analgesics, regulatory barriers and lack of appropriate information about opioids. There is scarce training on use of opioids among physicians and other healthcare providers, which leads to misconceptions, mainly related to a fear of prescribing opioids. Although opioids are safe and effective drugs for the treatment of moderate to severe chronic pain, the use of opioids in Latin American nations is clearly below standards compared with developed countries.
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Affiliation(s)
| | | | | | - Frantz Colimon
- Centro Oncológico de Antioquia, Medellín, Antioquia, Colombia
| | | | - Carlos Guerrero
- Hospital Universitario Fundación Santa Fe, Bogotá. Universidad de los Andes, Colombia
| | | | | | - Durval Campos Kraychete
- Federal University of Bahia, Coordinator of the Pain Outpatient Clinic, Brazilian Society for the Study of Pain, Brazil
| | - Argelia Lara-Solares
- Department of Pain Medicine & Palliative Care, Instituto Nacional de Ciencias Médicas y Nutrición 'Salvador Zubirán', Mexico City, Mexico
| | - Osvandré Lech
- Orthopaedic Residency Program, UFFS-HSVP-IOT, Passo Fundo, Brazil
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Santos Garcia JB, Lech O, Campos Kraychete D, Rico MA, Hernández-Castro JJ, Colimon F, Guerrero C, Sempértegui Gallegos M, Lara-Solares A, Flores Cantisani JA, Amescua-Garcia C, Guillén Núñez MDR, Berenguel Cook MDR, Jreige Iskandar A, Bonilla Sierra P. The role of tramadol in pain management in Latin America: a report by the Change Pain Latin America Advisory Panel. Curr Med Res Opin 2017; 33:1615-1621. [PMID: 28696784 DOI: 10.1080/03007995.2017.1354821] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
OBJECTIVE Change Pain Latin America (CPLA) was created to enhance chronic pain understanding and develop pain management improving strategies in this region. During its seventh meeting (August 2016), the main objective was to discuss tramadol's role in treating pain in Latin America. Furthermore, potential pain management consequences were considered, if tramadol was to become more stringently controlled. METHODS Key topics discussed were: main indications for prescribing tramadol, its pharmacological characteristics, safety and tolerability, effects of restrictions on its availability and use, and consequent impact on pain care quality. RESULTS The experts agreed that tramadol is used to treat a wide spectrum of non-oncological pain conditions (e.g. post-surgical, musculoskeletal, post-traumatic, neuropathic, fibromyalgia), as well as cancer pain. Its relevance when treating special patient groups (e.g. the elderly) is recognized. The main reasons for tramadol's high significance as a treatment option are: its broad efficacy, an inconspicuous safety profile and its availability, considering that access to strong analgesics - mainly controlled drugs (classical opioids) - is highly restricted in some countries. The CPLA also agreed that tramadol is well tolerated, without the safety issues associated with long-term nonsteroidal anti-inflammatory drug (NSAID) use, with fewer opioid-like side effects than classical opioids and lower abuse risk. CONCLUSIONS In Latin America, tramadol is a valuable and frequently used medication for treating moderate to severe pain. More stringent regulations would have significant impact on its availability, especially for outpatients. This could cause regression to older and frequently inadequate pain management methods, resulting in unnecessary suffering for many Latin American patients.
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Affiliation(s)
| | - Osvandré Lech
- b Shoulder and Elbow Service , UFFS-HSVP-IOT , Passo Fundo , Brazil
| | | | | | | | - Frantz Colimon
- f Interventional Pain Management and Palliative Care Unit , Centro Oncológico de Antioquia , Colombia
| | - Carlos Guerrero
- g Hospital Universitario Fundación Santa Fe, Bogotá, Universidad de los Andes , Colombia
| | | | - Argelia Lara-Solares
- i Department of Pain Medicine & Palliative Care , Instituto Nacional de Ciencias Médicas y Nutrición 'Salvador Zubirán' , Mexico City , Mexico
| | - José Alberto Flores Cantisani
- j Programa Regional de Cuidados Paliativos , Unidad Médica de Alta Especialidad No. 25, IMSS , Monterrey NL , México
| | | | | | | | - Aziza Jreige Iskandar
- n Rehabilitation Residency Program , UCV, Unidad de Rehabilitación DM , Maracay , Venezuela
| | - Patricia Bonilla Sierra
- o Instituto Oncológico 'Luis Razetti', Pain Clinic & Palliative Care , Instituto Médico La Floresta , Caracas , Venezuela
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Lara-Solares A, Aguayo Zamora C, Amescua García C, Garcia JBS, Berenguel Cook MDR, Bonilla Sierra P, Campos Kraychete D, Flores Cantisani JA, Guerrero C, Guillén Núñez MDR, Hernández Castro JJ, Hernández Ortíz A, Jreige Iskandar A, Lech O, Macías Guerra J, Ramírez Samayoa G, Rangel Morillo E, Rico Pazos MA, Sempértegui Gallegos M. Latin-American guidelines for opioid use in chronic nononcologic pain. Pain Manag 2017; 7:207-215. [DOI: 10.2217/pmt-2016-0065] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
Aim: Latin-American experts in the use of opioids in patients with chronic nononcologic pain (CNOP) have updated existing recommendations to current Latin-American reality. Methods: Several key opinion leaders from Latin America participated in a face-to-face meeting in Guatemala (April 2015) to discuss the use of opioids in CNOP. Subgroups of experts worked on specific topics, reviewed the literature and shaped the final manuscript. Results: The expert panel developed guidelines taking into consideration the utility of both opioid and nonopioid analgesics and factors pertaining to their efficacy, safety, adherence, administration and risks for abuse/addiction. Conclusion: Latin-American guidelines for the use of opioids in CNOP should improve pain relief and patients’ quality of life by increasing access to these effective agents.
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Affiliation(s)
- Argelia Lara-Solares
- Instituto Nacional de Ciencias Médicas y Nutrición ‘Salvador Zubirán’, Mexico City, Mexico
| | | | | | | | | | - Patricia Bonilla Sierra
- Instituto Oncológico ‘Luis Razetti’, Pain clinic & Palliative Care, Instituto Médico La Floresta, Caracas, Venezuela
| | - Durval Campos Kraychete
- Federal University of Bahia, Coordinator of the Pain Outpatient Clinic, Brazilian Society for the Study of Pain, Brazil
| | | | - Carlos Guerrero
- Hospital Universitario Fundación Santa Fe, Bogotá. Universidad de los Andes, Colombia
| | | | | | - Andrés Hernández Ortíz
- Instituto Nacional de Ciencias Médicas y Nutrición ‘Salvador Zubirán’, Mexico City, Mexico
| | - Aziza Jreige Iskandar
- Rehabilitation Residency Program, UCV, Unidad de Rehabilitación DM, Maracay, Venezuela
| | - Osvandré Lech
- Orthopaedic Residency Program, UFFS-HSVP-IOT, Passo Fundo, Brazil
| | | | - Gerardo Ramírez Samayoa
- Hospital General San Juan de Dios, Universidad de San Carlos de Guatemala, HUMANA, Centro de Tratamiento e Investigación de Epilepsia en Guatemala
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Garcia JBS, Bonilla P, Kraychete DC, Flores FC, Valtolina EDPD, Guerrero C. [Optimizing post-operative pain management in Latin America]. Rev Bras Anestesiol 2017; 67:395-403. [PMID: 28410820 DOI: 10.1016/j.bjan.2016.04.011] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2016] [Accepted: 04/26/2016] [Indexed: 11/25/2022] Open
Abstract
Post-operative pain management is a significant problem in clinical practice in Latin America. Insufficient or inappropriate pain management is in large part due to insufficient knowledge, attitudes and education, and poor communications at various levels. In addition, the lack of awareness of the availability and importance of clear policies and guidelines for recording pain intensity, the use of specific analgesics and the proper approach to patient education have led to the consistent under-treatment of pain management in the region. However, these problems are not insurmountable and can be addressed at both the provider and patient level. Robust policies and guidelines can help insure continuity of care and reduce unnecessary variations in practice. The objective of this paper is to call attention to the problems associated with Acute Post-Operative Pain (APOP) and to suggest recommendations for their solutions in Latin America. A group of experts on anesthesiology, surgery and pain developed recommendations that will lead to more efficient and effective pain management. It will be necessary to change the knowledge and behavior of health professionals and patients, and to obtain a commitment of policy makers. Success will depend on a positive attitude and the commitment of each party through the development of policies, programs and the promotion of a more efficient and effective system for the delivery of APOP services as recommended by the authors of this paper. The writing group believes that implementation of these recommendations should significantly enhance efficient and effective post-operative pain management in Latin America.
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Affiliation(s)
- João Batista Santos Garcia
- Universidade Federal do Maranhão (UFMA), Departamento de Anestesiologia, Dor e Cuidados Paliativos, São Luís, MA, Brasil.
| | - Patricia Bonilla
- Instituto Oncológico Luis Razetti, Departamento de Medicina Paliativa, Caracas, Venezuela
| | - Durval Campos Kraychete
- Universidade Federal da Bahia (UFBA), Departamento de Anestesiologia e Cirurgia, Bahia, BA, Brasil
| | - Fernando Cantú Flores
- Hospital Zambrano-Hellion TEC Salud, Departamento de Anestesia/Tratamento da Dor do Instituto de Dor, San Pedro Garza García, México
| | | | - Carlos Guerrero
- Hospital Universitario Fundacion Santa Fe, Departamento de Anestesia - Clínica de Dor, Bogotá, Colômbia
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Castro APCRD, Kraychete DC. Subarachnoid and epidural administration in postoperative analgesia. Revista Dor 2017. [DOI: 10.5935/1806-0013.20170072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Kraychete DC, Castro APCR, Miranda LLD. Peripheral sensitization, central sensitization and postoperative pain
chronifcation. Revista Dor 2017. [DOI: 10.5935/1806-0013.20170041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Kraychete DC, Siqueira JTTD, Garcia JB, Sakata RK, Sousa ÂM, Andrade DCD, Zakka TRM, Teixeira MJ. Clinical evidence on visceral pain. Systematic review. Revista Dor 2017. [DOI: 10.5935/1806-0013.20170014] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Barros-Neto JA, Souza-Machado A, Kraychete DC, de Jesus RP, Cortes ML, Lima MDS, Freitas MC, Santos TMDM, Viana GFDS, Menezes-Filho JA. Selenium and Zinc Status in Chronic Myofascial Pain: Serum and Erythrocyte Concentrations and Food Intake. PLoS One 2016; 11:e0164302. [PMID: 27755562 PMCID: PMC5068745 DOI: 10.1371/journal.pone.0164302] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2016] [Accepted: 09/22/2016] [Indexed: 12/31/2022] Open
Abstract
INTRODUCTION Nutritional disorders have been reported to be important causal factors that can intensify or cause a painful response in individuals with chronic musculoskeletal pain. AIM To assess the habitual intake of and the serum and erythrocyte levels of selenium and zinc in patients with chronic myofascial pain. MATERIALS AND METHODS A case-control study of 31 patients with chronic myofascial pain (group I) and 31 subjects without pain (group II). Dietary record in five days for assessing food intake were used. The serum and erythrocyte concentrations of selenium and zinc were analyzed using an atomic absorption spectrophotometry. Pain intensity was assessed using a visual analog scale. RESULTS The group of patients with chronic myofascial pain, compared with the control group, showed a lower erythrocyte concentration of selenium (79.46 ± 19.79 μg/L vs. 90.80 ± 23.12 μg/L; p = 0.041) and zinc (30.56 ± 7.74 μgZn/gHb vs. 38.48 ± 14.86 μgZn/gHb, respectively; p = 0.004). In this study, a compromised food intake of zinc was observed in the majority of the subjects in both groups. The selenium intake was considered to be safe in 80% of the subjects in both groups; however, the likelihood of inadequate intake of this mineral was twice as high in group I (49.5% vs. 24.4%, respectively). In the logistic regression analysis, the erythrocyte concentration of zinc was associated with the presence of pain. In each additional 1 mg of Zn2+ per gram of hemoglobin, a reduction of 12.5% was observed in the risk of the individual having chronic myofascial pain (B = -0.133; adjusted OR = 0.875, 95% CI = 0.803 to 0.954, Wald = 9.187, standard error = 0.044, p = 0.002). Physical inactivity and obesity were noted more commonly in group I compared with the control group. CONCLUSION In this study, patients with chronic myofascial pain showed lower intracellular stores of zinc and selenium and inadequate food intake of these nutrients.
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Affiliation(s)
| | | | | | | | - Matheus Lopes Cortes
- Multidisciplinary institute in health, Federal University of Bahia, Vitória da Conquista, Bahia, Brazil
| | - Michele dos Santos Lima
- Multidisciplinary institute in health, Federal University of Bahia, Vitória da Conquista, Bahia, Brazil
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Rico MA, Kraychete DC, Iskandar AJ, Colimon F, Lara-Solares A, Cantisani JAF, Amescua-García C, Núñez MDRG, Bonilla P, Lech O, Hernández-Castro JJ, Guerrero C, Barrera WD, Gallegos MS, Cook MB, Garcia JBS, Hernández CP. Use of Opioids in Latin America: The Need of an Evidence-Based Change. ACTA ACUST UNITED AC 2016; 17:704-16. [PMID: 26700728 DOI: 10.1111/pme.12905] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2015] [Accepted: 07/28/2015] [Indexed: 12/01/2022]
Abstract
OBJECTIVE The subject of this publication has been focused on local considerations for facilitating regional best practice, including identifying and uniformly adopting the most relevant international guidelines on opioid use (OU) in chronic pain management. DESIGN AND SETTING The Change Pain Latin America (CPLA) Advisory Panel conducted a comprehensive, robust, and critical analysis of published national and international reviews and guidelines of OU, considering those most appropriate for Latin America. METHODS A PubMed search was conducted using the terms "opioid," "chronic," and "pain" and then refined using the filters "practice guidelines" and "within the last 5 years" (2007-2012). Once the publications were identified, they were selected using five key criteria: "Evidence based," "Comprehensive," "From a well-recognized source," "Current publications," and "Based on best practice" and then critically analyzed considering 10 key criteria for determining the most relevant guidelines to be applied in Latin America. RESULTS The initial PubMed search identified 177 reviews and guidelines, which was reduced to 16 articles using the five preliminary criteria. After a secondary analysis according to the 10 key criteria specific to OU in Latin America, 10 publications were selected for critical review and discussion. CONCLUSIONS The CPLA advisory panel considered the "Safe and effective use of opioids for chronic non-cancer pain" (published in 2010 by the NOUGG of Canada) to be valid, relevant to Latin America, practical, evidence-based, concise, unambiguous, and sufficiently educational to provide clear instruction on OU and pain management and, thus, recommended for uniform adoption across the Latin America region.
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Affiliation(s)
- María Antonieta Rico
- *Facultad de Medicina Clínica Alemana/Universidad del Desarrollo, Santiago, Chile
| | - Durval Campos Kraychete
- Clínica del Dolor y Departamento de Anestesiología y Cirugía de la Universidade Federal da Bahia, Brazil
| | | | - Frantz Colimon
- Medicina del Dolor y Cuidados Paliativos, Clínica el Rosario, Medellín, Colombia
| | - Argelia Lara-Solares
- Clínica del Dolor y Cuidados Paliativos, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico, DF, Mexico
| | | | | | | | | | - Osvandré Lech
- Servicio de Ortopedia, Instituto de Ortopedia e Traumatologia, Hospital Sao Vicente de Paulo, Passo Fundo, Brazil
| | - John Jairo Hernández-Castro
- ***Unidad de Neurociencias de la Universidad del Rosario, Centro de Cuidados Paliativos y Medicina del Dolor en Hospital Universitario Mederi, Bogotá, Colombia
| | - Carlos Guerrero
- Departamento de Anestesia y Clínica de Dolor, Hospital Universitario Fundación Santa Fe de Bogotá, Colombia
| | | | - Manuel Sempértegui Gallegos
- Facultad de Ciencias de la Salud de la Universidad Tecnológica Equinoccial, Clínica del Dolor Hospital Metropolitano, Quito, Ecuador
| | - María Berenguel Cook
- Departamento de Dolor y Cuidados Paliativos, TotalCare-Oncosalud-Auna, San Borja-Lima, Peru
| | - João Batista Santos Garcia
- ****Departamento de Anestesiología, Dolor y Cuidados Paliativos de la Universidad Federal do Maranhao (UFMA), Brazil
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Kraychete DC. Clinical listening of painful patients and its importance in the daily life of
pysicians. Revista Dor 2016. [DOI: 10.5935/1806-0013.20160080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Kraychete DC, Palladini MC, Castro APCR. Topic drug therapy for neuropathic pain. Revista Dor 2016. [DOI: 10.5935/1806-0013.20160058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Kraychete DC. Revista Dor and the challenge for new indexations. Revista Dor 2016. [DOI: 10.5935/1806-0013.20160001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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de Miguel M, Kraychete DC, Meyer Nascimento RJ. Chronic pain: cytokines, lymphocytes and chemokines. ACTA ACUST UNITED AC 2015; 13:339-49. [PMID: 25587846 DOI: 10.2174/1871528114666150114170004] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2014] [Revised: 12/30/2014] [Accepted: 01/11/2015] [Indexed: 11/22/2022]
Abstract
Chronic pain is a debilitating condition and, in most cases, difficult to treat. A prominent example of this is neuropathic pain. Understanding pathophysiological mechanisms of pain and, therefore, making this knowledge into an effective treatment is still a challenge to experts. Pain can now be considered as a neuro-immune disorder, since recent data indicate critical involvement of innate and adaptive immune responses following injury, and this interaction plays an important role in the onset and perpetuation of chronic pain. The aim of this article is to review the relationship between immune system and chronic pain, especially about neuropathic pain, and focusing on cytokines, chemokines and lymphocytes.
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de Souza MF, Kraychete DC. A ação analgésica da lidocaína intravenosa no tratamento da dor crônica: uma revisão de literatura. Revista Brasileira de Reumatologia 2014; 54:386-92. [DOI: 10.1016/j.rbr.2014.01.010] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2013] [Revised: 11/23/2013] [Accepted: 01/28/2014] [Indexed: 11/26/2022] Open
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Kraychete DC, Siqueira JTTD, Garcia JBS, Especialistas GD. Recommendations for the use of opioids in Brazil: Part II. Use in children and the elderly. Revista Dor 2014. [DOI: 10.5935/1806-0013.20140015] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Kraychete DC, Siqueira JTTD, Zakka TRM, Garcia JBS. Recommendations for the use of opioids in Brazil: Part III. Use in special situations (postoperative pain, musculoskeletal pain, neuropathic pain, gestation and lactation). Revista Dor 2014. [DOI: 10.5935/1806-0013.20140030] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Cortes ML, Castro MMC, Jesus RPD, Barros Neto JAD, Kraychete DC. Uso de terapêutica com ácidos graxos ômega-3 em pacientes com dor crônica e sintomas ansiosos e depressivos. Rev dor 2013. [DOI: 10.1590/s1806-00132013000100012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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Castro MMC, Daltro C, Kraychete DC, Lopes J. The cognitive behavioral therapy causes an improvement in quality of life in patients with chronic musculoskeletal pain. Arq Neuro-Psiquiatr 2012; 70:864-8. [DOI: 10.1590/s0004-282x2012001100008] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/29/2012] [Accepted: 07/26/2012] [Indexed: 11/22/2022]
Abstract
Chronic pain causes functional incapacity and compromises an individual's affective, social, and economic life. OBJECTIVE: To study the cognitive behavioral therapy (CBT) effectiveness in a group of patients with chronic pain. METHODS: A randomized clinical trial with two parallel groups comprising 93 patients with chronic pain was carried out. Forty-eight patients were submitted to CBT and 45 continued the standard treatment. The visual analogue, hospital anxiety and depression, and quality of life SF-36 scales were applied. Patients were evaluated before and after ten weeks of treatment. RESULTS: When the Control Group and CBT were compared, the latter presented reduction of depressive symptoms (p=0.031) and improvement in the domains 'physical limitations' (p=0.012), 'general state of health' (p=0.045), and 'limitations by emotional aspects' (p=0.025). CONCLUSIONS: The CBT was effective and it has caused an improvement in more domains of quality of life when compared to the Control Group, after ten weeks of treatment.
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Affiliation(s)
- Martha M. C. Castro
- Universidade Federal da Bahia (UFBA), Brazil; Universidade Federal da Bahia (UFBA), Brazil
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Kraychete DC, Sakata RK. Uso e rotação de opioides para dor crônica não oncológica. Rev Bras Anestesiol 2012. [DOI: 10.1590/s0034-70942012000400010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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Minson FP, Abrão MS, Sardá Júnior J, Kraychete DC, Podgaec S, Assis FD. [Importance of quality of life assessment in patients with endometriosis]. Rev Bras Ginecol Obstet 2012; 34:11-15. [PMID: 22358342] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2011] [Accepted: 12/12/2011] [Indexed: 05/31/2023] Open
Abstract
PURPOSE The present study examined the relationship between some clinical variables and quality of life in a group of patients with endometriosis. METHODS A total of 130 women seen at a multidisciplinary center specializing in gynecology endometriosis in 2008 participated in the study. This was a cross-sectional study conducted with a convenience sample. The diagnosis of endometriosis was performed by biopsy according to the criteria of the American Society for Reproductive Medicine. The clinical and demographic data were collected from the patients' records. Pain intensity was assessed by a visual numerical scale (0-10), and data on the quality of life were collected using the SF-36. Data analysis consisted of descriptive and inferential statistical tests, Spearman correlation coefficient and Kruskal-Wallis test to compare scores between groups. Nonparametric tests were used for analysis because data were not normally distributed. RESULTS The patients were 21 to 54 years of age or 34, standard diversion (SD)=6.56], 87% had a university degree, and 75% were married. Seventeen percent reported cases of endometriosis in the family. The average time of onset of symptoms was 4.5 years (SD=6.6), 63% of patients were in stage 3 or 4 of endometriosis 36% of patients had severe or disabling dysmenorrhea and the average intensity of pain according to a visual numerical scale was of 5.6 (SD=3.5). Results suggest that the staging of the disease did not determine the intensity of pain. The time of onset of symptoms also showed no relationship to pain intensity and SF-36 scores. On the other hand, the intensity of pain was associated with lower scores on some scales of the SF-36. CONCLUSION Patients with endometriosis had lower scores of quality of life than the general population and lower than those of some other diseases.
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Kraychete DC. Vencemos mais uma etapa, conseguimos a indexação na base de dados SciELO. Rev dor 2011. [DOI: 10.1590/s1806-00132011000200001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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Castro MMC, Quarantini LC, Daltro C, Pires-Caldas M, Koenen KC, Kraychete DC, Oliveira IRD. Comorbidade de sintomas ansiosos e depressivos em pacientes com dor crônica e o impacto sobre a qualidade de vida. ACTA ACUST UNITED AC 2011. [DOI: 10.1590/s0101-60832011000400002] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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Kraychete DC, Sakata RK, Issy AM, Bacellar O, Santos-Jesus R, Carvalho EM. Serum cytokine levels in patients with chronic low back pain due to herniated disc: analytical cross-sectional study. SAO PAULO MED J 2010; 128:259-62. [PMID: 21181064 PMCID: PMC10948061 DOI: 10.1590/s1516-31802010000500003] [Citation(s) in RCA: 57] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2007] [Revised: 11/23/2007] [Accepted: 09/08/2010] [Indexed: 11/22/2022] Open
Abstract
CONTEXT AND OBJECTIVE the role of immune response and proinflammatory cytokines in the pathogenesis of chronic pain has been of growing interest. In order to evaluate whether there is any association between disc herniation and elevated cytokine levels, we measured cytokine levels in patients with chronic low back pain and in healthy subjects. DESIGN AND SETTING analytical cross-sectional study at the Pain Clinic of Universidade Federal da Bahia (UFBA). METHODS cytokine levels were measured using the enzyme-linked immunosorbent assay (ELISA) technique on 23 patients with low back pain (G1) and on 10 healthy subjects (G2). RESULTS the levels of tumor necrosis factor-alpha [TNF-alpha] (G1 = 5.6 ± 2.3 pg/ml; G2 = 1.6 ± 0.5 pg/ml; P = 0.01) and interleukin-6 [IL-6] (G1 = 4.1 ± 3.0 pg/ml; G2 = 0.9 ± 0.4 pg/ml; P = 0.01) were higher in G1. There were no statistically significant differences in relation to interleukin-1 [IL-1] (G1 = 0.5 ± 0.3 pg/ml; G2 = 0.5 ± 0.1 pg/ml; P = 1) or soluble tumor necrosis factor receptor [sTNF-R] (G1 = 572 pg/ml ± 36; G2 = 581 ± 50 pg/ml; P = 0.87). CONCLUSION The patients with chronic low back pain due to disc herniation presented higher levels of TNF-alpha and IL-6, but not of IL-1 or sTNF-R.
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Affiliation(s)
- Durval Campos Kraychete
- MD, PhD. Assistant professor, Universidade Federal da Bahia (UFBA), Bahia, Salvador, Brazil.
| | - Rioko Kimiko Sakata
- MD, PhD. Associate professor, anesthetist and coordinator of the Pain Clinic, Department of Anesthesia, Universidade Federal de São Paulo (Unifesp), São Paulo, Brazil.
| | - Adriana Machado Issy
- PhD. Assistant professor and pharmacologist, Department of Anesthesia, Universidade Federal de São Paulo (Unifesp), São Paulo, Brazil.
| | - Olívia Bacellar
- PhD. Immunologist, Department of Immunology, Universidade Federal da Bahia (UFBA), Salvador, Brazil.
| | - Rogério Santos-Jesus
- MD. Psychiatrist and Statistician, Department of Medicine, Universidade Federal da Bahia (UFBA), Salvador, Brazil.
| | - Edgar Marcelino Carvalho
- MD. Psychiatrist and Statistician, Department of Medicine, Universidade Federal da Bahia (UFBA), Salvador, Brazil.
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Rocha APC, Kraychete DC, Lemonica L, de Carvalho LR, de Barros GAM, Garcia JBDS, Sakata RK. Pain: current aspects on peripheral and central sensitization. Rev Bras Anestesiol 2009; 57:94-105. [PMID: 19468623 DOI: 10.1590/s0034-70942007000100011] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2006] [Accepted: 09/07/2006] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Current research has focused on the biochemical and structural plasticity of the nervous system secondary to tissue injury. The mechanisms involved in the transition from acute to chronic pain are complex and involve the interaction of receptor systems and the flow of intracellular ions, second messenger systems, and new synaptic connections. The aim of this article was to discuss the new mechanisms concerning peripheral and central sensitization. CONTENTS Tissue injury increases the response of nociceptors, known as sensitization or facilitation. These phenomena begin after the local release of inflammatory mediators and the activation of the cells of the immune system or specific receptors in the peripheral and central nervous system. CONCLUSIONS Tissue and neuronal lesions result in sensitization of the nociceptors and facilitation of the central and peripheral nervous conduction.
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Abstract
BACKGROUND AND METHODS Chronic pain after spinal cord injury is a highly prevalent clinical condition, which is difficult to treat. Therefore, it is important to know its clinical characteristics and causes for a better diagnostic and therapeutic approach. The objective of this study was to review the literature on pain in patients with spinal cord injury and the possible association with physical (level of the injury, completeness of lesion, pain duration) and psychological (mood and quality of life) factors. CONTENTS Original studies in the Medline database with patients older than 18 years and published over the last six years were reviewed. The clinical characteristics of pain in patients with spinal cord injury are discussed, and the works of several authors are compared. CONCLUSIONS Despite conceptual and methodological differences among the studies, the prevalence of pain in patients with spinal cord injury was high, varying from 64% to 82%. Neuropathic pain at the level of the injury has an early onset (days or weeks), while that below the level of the injury has a late onset (months or years). An association between pain and integrity of the lesion is not observed, and the percentage of patients who complain of severe pain varies from 21% to 39%. It was not possible to conclude which is the relationship between pain and level of spinal cord injury. However, pain can have a negative influence on mood and in the capacity to perform cognitive, social, recreational, and work-related activities.
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Affiliation(s)
- Marcia de Miguel
- Especialista em Dor - Universidade Salvador (UNIFACS); Farmacêutica Hospitalar - Rede SARAH de Hospitais de Reabilitação. marciademiguel @ sarah.br
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Kraychete DC, Sakata RK, Issy AM, Bacellar O, Jesus RS, Carvalho EM. Proinflammatory Cytokines in Patients with Neuropathic Pain Treated with Tramadol. Rev Bras Anestesiol 2009; 59:297-303. [DOI: 10.1590/s0034-70942009000300004] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2008] [Accepted: 01/20/2009] [Indexed: 12/31/2022] Open
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Cardoso HEDDP, Kraychete DC, Lima Filho JA, Garrido LS, Rocha APC. Disfunção temporária do nervo lingual após uso de máscara laríngea: relato de caso. Rev Bras Anestesiol 2007; 57:410-3. [DOI: 10.1590/s0034-70942007000400009] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2006] [Accepted: 04/18/2007] [Indexed: 12/22/2022] Open
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Kraychete DC, Rocha APC, Castro PACRD. [Psoas muscle abscess after epidural analgesia: case report.]. Braz J Anesthesiol 2007; 57:195-8. [PMID: 19466354 DOI: 10.1590/s0034-70942007000200009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2006] [Accepted: 11/27/2006] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Psoas muscle abscess is a rare complication of epidural analgesia. The adequate approach to this complication is fundamental for a good resolution. The objective of this report was to discuss the diagnosis and treatment of psoas muscle abscess. CASE REPORT A female patient, 65 years old, with neuropathic pain in the lower limbs, difficult to control with systemic drugs. The patient was treated with epidural opioid and local anesthetic as an alternate treatment. Twenty days after the continuous epidural administration, the patient complained of lumbar pain, headache, and fever. A CT scan of the pelvis showed an abscess of the psoas muscle, thus, closed drainage and antibiotics were indicated. CONCLUSIONS An adequate, continuous supervision of the patient is necessary when an epidural catheter is placed, and it should continue after its removal.
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Castro MMC, Quarantini L, Batista-Neves S, Kraychete DC, Daltro C, Miranda-Scippa Â. Validade da escala hospitalar de ansiedade e depressão em pacientes com dor crônica. Rev Bras Anestesiol 2006; 56:470-7. [DOI: 10.1590/s0034-70942006000500005] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2005] [Accepted: 06/02/2006] [Indexed: 11/22/2022] Open
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Magalhães E, Mascarenhas AM, Kraychete DC, Sakata RK. Gabapentina no tratamento da dor decorrente de cistos perineurais sacrais: relato de caso. Braz J Anesthesiol 2004. [DOI: 10.1590/s0034-70942004000100010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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Magalhães E, Mascarenhas AM, Kraychete DC, Sakata RK. Gabapentin to treat sacral perineural cyst-induced pain. Case report. Rev Bras Anestesiol 2004; 54:73-77. [PMID: 19471713] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2003] [Accepted: 06/03/2003] [Indexed: 05/27/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Perineural cysts may induce difficult to control neuropathic pain. Anticonvulsivants are used to treat such pain. This report aimed at presenting a case of total pain remission with gabapentin after failure of all other therapeutic alternatives used. CASE REPORT Female, diabetic patient, 67 years old, complaining of lumbosacral pain for two months, with the following characteristics: daily, sharp and burning pain of mild to moderate intensity irradiating to posterior thigh. Pain would worsen with movement and in the standing position. Six months before she had had a similar pain episode which improved with steroids. Lumbosacral spine MRI showed 2.5 cm sacral perineural cyst injuries at S1, S2 and S3, compressing the dural sac and associated to bone erosion. Gabapentin was introduced in progressive doses until 900 mg/day, with complete pain relief. CONCLUSIONS Tarlov's cyst neuropathic pain may be adequately controlled with gabapentin.
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Affiliation(s)
- Elza Magalhães
- Ambulatório de Dor do Hospital Universitário Prof. Edgard Santos (HUPES)-UFBA, Pós-Graduação em Dor, UNIFACS, Salvador, BA.
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Kraychete DC, Guimarães AC, Carvalho MG, Carvalho EMD. Papel da lidocaína por via venosa no tratamento da dor na esclerodermia: relato de caso. Rev Bras Anestesiol 2003; 53:797-801. [DOI: 10.1590/s0034-70942003000600010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2003] [Accepted: 04/22/2003] [Indexed: 11/22/2022] Open
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Kraychete DC, Guimarães AC. [Visceral hyperalgesia and chronic abdominal pain: diagnostic and therapeutic approach.]. Rev Bras Anestesiol 2003; 53:833-53. [PMID: 19471702 DOI: 10.1590/s0034-70942003000600014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2003] [Accepted: 04/22/2003] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Chronic abdominal pain is one of the most frequent reasons for medical consultation. There is, however, no well-established protocol for its diagnostic approach and, most of the times, investigation becomes an expensive and invasive medical practice. This review aimed at explaining visceral pain pathophysiology and establishing diagnostic and therapeutic goals for these patients, based on specific criteria. CONTENTS Chronic nonspecific or functional abdominal pain is a complex interaction among impaired motility, visceral hypersensitivity and inadequate neuroendocrine and psychosocial responses. Peripheral and central nociception mechanisms seem to be involved in visceral hyperalgesia. Diagnosis requires detailed history and clinical evaluation, taking into consideration Rome II criteria. Based on known or assumed pathophysiological mechanisms, new drugs have been researched, and some have been more recently used to control abdominal pain, such as 5-HT4 receptor agonists and sodium channel blockers. CONCLUSIONS Chronic pathophysiological abdominal pain mechanisms are still not well understood. Therapy and diagnosis require the understanding of such mechanisms, as well as of Rome II criteria. On the other hand, good patient-physician relationship and multidisciplinary teams performance seem to be critical in improving treatment response and patients quality of life.
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