Neuropathic pain is a complex condition that is difficult to control and has a high impact on quality of life. 8% Capsaicin patch can be a therapeutic strategy in the treatment of peripheral ...neuropathic pain.
This study aims to (1) evaluate clinical efficacy and (2) tolerability of 8% capsaicin patch in a Pain Unit.
Retrospective observational study.
Portuguese Pain Unit.
A sample of 120 patients diagnosed with peripheral neuropathic pain, underwent treatment with the 8% capsaicin patch between February 2011 and February 2019 in a Portuguese Pain Unit. Patients were included in one of the following groups according to the etiology of pain: postherpetic neuralgia (PHN), chronic post-surgical pain (CPSP), post traumatic neuropathic pain (PTNP), diabetic neuropathy (DN), regional pain syndrome. complex I and II (CRPS I / II), HIV-associated neuropathy (HIVN), lumbar neuropathic pain (LNP), trigeminal neuralgia (TN) and other neuropathies (O). The evaluated parameters were: pain intensity according to unit protocol (numerical rating scale), pain characteristics, location, size of the painful area. The evolution of pain intensity after treatment (patients were considered as responders to therapy if the decrease in NRS was equal to or greater than 30%; patients with a decrease in NRS of 50% or more were also analyzed), the area of pain and the need for adjuvant analgesic therapy, as well as the tolerability to treatment and the identification of eventual predictors of its efficacy were evaluated, at 15 days, 8 weeks and 12 weeks after 8% capsaicin patch.
Of the 120 patients in the sample, 40.8% had a >= 30% decrease in basal pain intensity 15 days after treatment, 43.3% after 8 weeks and 45.0% after 12 weeks. 30.8% of patients had >= 50% decreased basal pain intensity 15 days after treatment, 27.5% after 8 weeks and 30.0% after 12 weeks. Pain area decreased in 36.7% of patients and 18.3% reduced chronic analgesic therapy within 12 weeks after 8% capsaicin patch application. There was only one case of intolerance to the treatment.
This study has the limitations inherent to a retrospective study. The study period was only 12 weeks and some diagnostic groups included a small number of patients.
Treatment of peripheral neuropathic pain with 8% capsaicin patch seem to be effective in the short and medium term, both in decreasing pain intensity and in reducing the painful area. Its application is tolerated by most patients.
Spasticity is a complex problem in patients with neurological disorders and may distress their quality of life. Intrathecal baclofen infusion pumps reduce spasticity with low doses and minimal side ...effects but are not free from complications. We aimed to evaluate the efficacy and safety of intrathecal baclofen infusion pumps as well as patients' satisfaction.
Retrospective cohort study including all intrathecal baclofen infusion pumps placed up to December 2015. Demographic characteristics, clinical diagnoses, date of placement or withdrawal/replacement of intrathecal baclofen infusion pumps, baclofen dosage and complications of intrathecal baclofen infusion pumps were collected. Assessments from the Ashworth and Penn's scales, Katz index and patients' global satisfaction were analysed.
In 19 years we placed 251 intrathecal baclofen infusion pumps in 155 patients. The mean age was 41.1 ± 15.8 years. The most frequent conditions were: trauma (34%), cerebral palsy (14%), multiple sclerosis (12%) and stroke (12%). Eighty-five patients (55%) required a second pump, and eleven (7%) a third one. The lifetime of the first pump was 72 (36 - 89) and the total follow-up time was 96 (9 - 132) months. The causes of withdrawal/replacement were: battery failure (57%), catheter migration/kinking (24%), infection (14%) and pump displacement/exteriorization (7%). The complication rate was 0.21 events/month. There was a significant improvement in the Ashworth and Penn's scales after the placemen of intrathecal baclofen infusion pumps (p < 0.001 for all diagnoses) and the patients were satisfied with the treatment.
The incidence of complications was within range of other international studies despite our long follow-up time. Events per month, loss to follow-up, re-intervention rate, incidence of infection and mortality were similar to other studies.
Intrathecal baclofen infusion pumps are safe and effective in the treatment of spasticity. Infusion pumps provide a high level of satisfaction regarding treatment and quality of life.
Objective
To evaluate the results of lumbar epiduroscopic adhesiolysis using mechanical methods and a radiofrequency catheter followed by epidural steroid and local anesthetic administration in ...patients with postoperative fibrosis and persistent or recurrent symptoms.
Study Design
Prospective study.
Methods
Patients with persistent or recurrent low back and/or lower limb pain after lumbar spine surgery, in whom no relevant findings were present on MR images besides epidural scar tissue, were submitted to epiduroscopic adhesiolysis. Patient‐reported outcomes including pain and disability were assessed in predefined time intervals and compared to baseline.
Results
Twenty‐four patients were enrolled. It was possible to elicit the patient's usual pain by probing the epidural scar tissue in all patients. Statistically significant improvement in low back and lower limb pain was observed in all assessment periods up to 12 months. A pain relief over 50% was achieved in 71% of the patients at 1 month, 63% at 3 and 6 months, and 38% at 12 months. Disability scores significantly improved for around 6 months. Mean patient satisfaction rates were 80% at 1 month, 75% at 3 months, 70% at 6 months, and 67% 1 year after intervention. Only 1 transient postprocedural complication was detected.
Conclusion
Endoscopic adhesiolysis is a potentially useful treatment for the relief of chronic intractable low back and lower limb pain in patients with previous lumbar spine surgery and epidural fibrosis. The use of larger volumes of saline during endoscopy and the employment of radiofrequency for the lysis of epidural adhesions are safe procedures, which may provide an additional benefit to the intervention.
Chronic neuropathic pain is estimated to affect 3-4.5% of the worldwide population, posing a serious burden to society. Deep Brain Stimulation (DBS) is already established for movement disorders and ...also used to treat some "off-label" conditions. However, DBS for the treatment of chronic, drug refractory, neuropathic pain, has shown variable outcomes with few studies performed in the last decade. Thus, this procedure has consensus approval in parts of Europe but not the USA. This study prospectively evaluated the efficacy at three years of DBS for neuropathic pain.
Sixteen consecutive patients received 36 months post-surgical follow-up in a single-center. Six had phantom limb pain after amputation and ten deafferentation pain after brachial plexus injury, all due to traumas. To evaluate the efficacy of DBS, patient-reported outcome measures were collated before and after surgery, using a visual analog scale (VAS) score, University of Washington Neuropathic Pain Score (UWNPS), Brief Pain Inventory (BPI), and 36-Item Short-Form Health Survey (SF-36).
Contralateral, ventroposterolateral sensory thalamic DBS was performed in sixteen patients with chronic neuropathic pain over 29 months. A postoperative trial of externalized DBS failed in one patient with brachial plexus injury. Fifteen patients proceeded to implantation but one patient with phantom limb pain after amputation was lost for follow-up after 12 months. No surgical complications or stimulation side effects were noted. After 36 months, mean pain relief was sustained, and the median (and interquartile range) of the improvement of VAS score was 52.8% (45.4%) (p = 0.00021), UWNPS was 30.7% (49.2%) (p = 0.0590), BPI was 55.0% (32.0%) (p = 0.00737), and SF-36 was 16.3% (30.3%) (p = 0.4754).
DBS demonstrated efficacy at three years for chronic neuropathic pain after traumatic amputation and brachial plexus injury, with benefits sustained across all pain outcomes measures and slightly greater improvement in phantom limb pain.
Fifteen hundred patients have received deep brain stimulation (DBS) to treat neuropathic pain refractory to pharmacotherapy over the last half-century, but few during the last decade. Deep brain ...stimulation for neuropathic pain has shown variable outcomes and gained consensus approval in Europe but not the US. This study prospectively evaluated the efficacy at 1 year of DBS for phantom limb pain after amputation, and deafferentation pain after brachial plexus avulsion (BPA), in a single-center case series.
Patient-reported outcome measures were collated before and after surgery, using a visual analog scale (VAS) score, 36-Item Short-Form Health Survey (SF-36), Brief Pain Inventory (BPI), and University of Washington Neuropathic Pain Score (UWNPS).
Twelve patients were treated over 29 months, receiving contralateral, ventroposterolateral sensory thalamic DBS. Five patients were amputees and 7 had BPAs, all from traumas. A postoperative trial of externalized DBS failed in 1 patient with BPA. Eleven patients proceeded to implantation and gained improvement in pain scores at 12 months. No surgical complications or stimulation side effects were noted. In the amputation group, after 12 months the mean VAS score improved by 90.0% ± 10.0% (p = 0.001), SF-36 by 57.5% ± 97.9% (p = 0.127), UWNPS by 80.4% ± 12.7% (p < 0.001), and BPI by 79.9% ± 14.7% (p < 0.001). In the BPA group, after 12 months the mean VAS score improved by 52.7% ± 30.2% (p < 0.001), SF-36 by 15.6% ± 30.5% (p = 1.000), UWNPS by 26.2% ± 40.8% (p = 0.399), and BPI by 38.4% ± 41.7% (p = 0.018). Mean DBS parameters were 2.5 V, 213 microseconds, and 25 Hz.
Deep brain stimulation demonstrated efficacy at 1 year for chronic neuropathic pain after traumatic amputation and BPA. Clinical trials that retain patients in long-term follow-up are desirable to confirm findings from prospectively assessed case series.
Resumo Em indivíduos com dor crónica (DC), as emoções têm um papel preponderante, podendo interferir na perceção de intensidade e a nível cognitivo, com a presença de crenças disfuncionais e, por ...vezes, ausência da confiança de que é possível ultrapassar o momento doloroso. Assim, os objetivos do estudo são: caracterizar a inteligência emocional (IE) e a autoeficácia (AE) de indivíduos com DC; e explorar a relação entre IE e AE em função da DC. Responderam presencialmente a um Questionário Sociodemográfico e Clínico desenvolvido para o efeito, ao Questionário de Regulação Emocional, à General Self-Efficacy Scale e ao Módulo de AE para a Dor, elaborado para este estudo, 120 pacientes adultos da consulta de Psicologia-Dor de um Hospital público (estudo transversal). A reavaliação cognitiva (RC) e a supressão emocional (SE) apresentaram valores médios superiores aos descritos na literatura. A AE da amostra encontrava-se em níveis inferiores ao estado da arte e à média da população portuguesa. A AE demonstrou uma relação com a SE em indivíduos com dor moderada e com a RC na dor intensa. Os resultados reforçam a pertinência de focar a IE e a AE na intervenção junto de indivíduos com DC.
O presente trabalho visa a análise de correspondências entre organizações sociais, colónias de formigas, organizações humanas e a cibenética.As colónias de formigas, as organizações empresariais, ...funcionam como sistemas, capazes de se adaptar e colaborar, com a capacidade de se auto-organizarem, o que leva a uma aproximação teórica destes sistemas, que pode resultar numa nova luz para as estratégias das empresas.Em suma, pode-se afirmar que as Teorias da Complexidade, ajudam a compreender a envolvente organizacional e promovem um novo modelo de pensamento estratégico, holístico e interdisciplinar.A complexificação das instituições e das tecnologias exigem soluções alternativas de gestão, das quais não pode ser dissociada a biologia como elemento diferenciados e determinante nas estratégias organizacionais.
Este estudo visou avaliar a qualidade de vida em 60 mulheres com diagnóstico de cancro da mama, já submetidas a cirurgia (mastectomia ou tumorectomia) e, presentemente, em tratamento de ...quimioterapia, no Hospital de S. João (Porto, Portugal). Foram administrados o European Organization for Research and Treatment of Cancer Quality of Life Questionnaire (EORTC QLQ-C30) e o Supplementary Questionnaire Breast Cancer Module (QLQ-BR23). Observou-se que as mulheres submetidas a tumorectomia evidenciavam uma "percepção da imagem corporal" (BRBI) mais negativa e uma maior "preocupação com a queda do cabelo" (BRHL) do que as mulheres mastectomizadas (sub-escalas do QLQ-BR23). O grupo submetido ao esquema de tratamento quimioterapêutico FEC evidenciava mais problemas físicos, em várias sub-escalas do EORTC QLQ-C30 e QLQ-BR23, comparativamente com o grupo que estava a realizar o esquema de tratamento CMF. As mulheres mais velhas apresentavam melhor qualidade de vida que as mais jovens, traduzida pela avaliação do "funcionamento físico" (PF2), do "funcionamento sexual" (BRSEF) e "prazer sexual" (BRSEE). Verificou-se, também que as mulheres casadas revelavam mais problemas ao nível do "funcionamento físico" (PF2) e sintomas como "diarreia" (DI). Por seu lado, as mulheres não casadas apresentavam mais preocupações com a sua saúde no futuro e um melhor "funcionamento sexual" (BRSEF).
The use of castor oil in producing polyurethane resins has been identified as one of the most promising options for the industry. The piassava fibers waste generated by the industry on a large scale ...presents excellent properties as a reinforcing agent due to its high lignin content characterized by chemical tests and FTIR. Composite boards consisting of a higher content of mercerized piassava fibers (10 mm, 85 wt.%) reinforced polyurethane castor oil-based resin (prepolymer (PP) and polyol (OM)) exhibited excellent performance. Composites with these properties have strong potential for medium-density applications ranging from biomedical prosthetics to civil partition walls and insulation linings. Alkali treatment removed the superficial impurities of piassava fibers, activating polar groups, and physical characterization reported excellent performance for all composites. Among the composites, the CP3 sample (composite reinforced with piassava fibers (85 wt.% fibers; 1.2:1-PP:OM)) stood out with higher density and lower swelling and water absorption percentage than other composites. FTIR results indicated NCO traces after the resin cured in the PU3 (1.2:1-PP:OM), possibly contributing to the interaction with the fibers. DMA results reported relevant information about more flexibility to CP1 (composite reinforced with piassava fibers (85 wt.% fibers; 0.8:1-PP:OM)) and CP3 than CP2 (composite reinforced with piassava fibers (85 wt.% fibers; 1:1-PP:OM)). The results suggest that the proper combination with natural products must lead to composites with potential applications as engineering materials.
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