A incapacidade relacionada à dor lombar crônica (DLC) é um fenômeno complexo e multifatorial. O objetivo desse estudo foi identificar a prevalência e os fatores associados à incapacidade em pacientes com dor lombar crônica. Estudo transversal com amostra composta por 177 pacientes com DLC, de três serviços de saúde; que responderam ao formulário com dados demográficos, ao Inventário de Depressão de Beck, às Escalas Oswestry Disability Index, de autoeficácia para dor crônica, Tampa de Cinesiofobia e de Fadiga de Piper. A prevalência de incapacidade foi de 65% (IC95%: 57,5 - 72,0) e era de moderada a grave em 80,7% dos pacientes. O modelo de regressão múltipla identificou três fatores independentemente associados à incapacidade: ausência de trabalho remunerado, autoeficácia baixa e depressão. Os fatores associados à incapacidade identificados são modificáveis. Intervenções como recolocação no trabalho, tratamento para a depressão e reconceitualização da crença de autoeficácia podem ter um impacto importante na prevenção e redução de incapacidade.

Sex- and/or ethnic-appropriate echocardiographic reference values are indicated for many measurements of LA and LV size, LV mass, and EF. Reference values for LV volumes and mass also differ across the age range.

OBJECTIVE Analyzing the evidence of the effects of dignity therapy onterminally ill patients. METHOD A Systematic review of the literature conducted using the search strategy in six databases. Inclusion criteria were primary studies, excluding literature reviews (systematic or not) and conceptual articles. RESULTS Ten articles were analyzed regarding method, results and evidence level. Dignity therapy improved the sense of meaning andpurpose, will to live, utility, quality of life, dignity and family appreciationin studies with a higher level of evidence. The effects are not well established in relation to depression, anxiety, spirituality and physical symptoms. CONCLUSION Studies with a moderate to high level of evidence have shown increased sense of dignity, will to live and sense of purpose. Further studies should be developed to increase knowledge about dignity therapy.

No abstract

Abdominal pain is an important symptom in most patients with pancreatic ductal adenocarcinoma (PDAC). Adequate control of pain is often unsatisfactory due to limited treatment options and significant variation in local practice, emphasizing the need for a multidisciplinary approach. This review contends that improvement in the management of PDAC pain will result from a synthesis of best practice and evidence around the world in a multidisciplinary way. To improve clinical utility and evaluation, the evidence was rated according to the GRADE guidelines by a group of international experts. An algorithm is presented, which brings together all currently available treatment options. Pain is best treated early on with analgesics with most patients requiring opioids, but neurolytic procedures are often required later in the disease course. Celiac plexus neurolysis offers medium term relief in a substantial number of patients, but other procedures such as splanchnicectomy are also available. Palliative chemotherapy also provides pain relief as a collateral benefit. It is stressed that the assessment of pain must take into account the broader context of other physical and psychological symptoms. Adjunctive treatments for pain, depression and anxiety as well as radiotherapy, endoscopic therapy and neuromodulation may be required in selected patients. There are few comparative studies to help define which combination and order of these treatment options should be applied. New pain therapies are emerging and could for example target neural transmitters. However, until better methods are available, management of pain should be individualized in a multidisciplinary setting to ensure optimal care.

BACKGROUND AND OBJECTIVES: Inflammation is a defense response of the body to a cellular damage caused by physical, chemical or biological agents, which triggers, among other factors, pain. Although inflammation plays an important role in the protection and regeneration of tissue injury, inflammatory pain results in decreased quality of life. In view of this, the development of safe and less invasive forms for the treatment of inflammatory pain is of great importance. The objective of this study was to evaluate the antihyperalgesic potential of the culture supernatant of keratinocytes and human fibroblasts in an experimental model of inflammatory hyperalgesia. METHODS: Evaluation of carrageenan induced inflammatory hyperalgesia through the use of electronic von Frey in animal models treated with culture supernatant of keratinocytes and fibroblasts. RESULTS: Local administration of naloxone, a nonselective opioid antagonist, in peripheral tissue, has been observed to inhibit the antihyperalgesic effect of the keratinocyte culture supernatant. Fibroblast culture supernatant on days 1 and 3 reverses for 2 hours the carrageenan induced inflammatory hyperalgesia, which is mediated by µ opioid agonist. CONCLUSION: This study indicates that culture supernatant of fibroblasts and keratinocytes is capable of inducing antinociception in inflammatory hyperalgesia, mediated by the release of Evaluation of the keratinocytes or fibroblasts culture supernatant in an inflammatory hyperalgesia model Avaliação do sobrenadante da cultura de queratinócitos ou fibroblastos em modelo de hiperalgesia inflamatória

O tratamento de doentes com dor crônica inclui a modificação de crenças, atitudes, valores e com-portamentos pouco adaptativos. Crenças disfuncionais podem se tornar o problema central e determinar os resultados do tra-tamento. Dentre as crenças importantes para a vivência e manejo da dor crônica, a de auto-eficácia merece destaque. Auto-eficácia, de acordo com Bandura, é a crença sobre a habilidade pessoal de desempenhar com sucesso determinadas tarefas ou comportamentos para produzir um resultado desejável. Este estudo é uma revisão crítica da literatura sobre a crença de auto-eficácia relacionada à dor crônica e sobre os métodos para sua avaliação. Estudos existentes nas ba-ses Medline (1992 a 2002), Lilacs e Dedalus (toda a base) foram analisados. Os descritores utilizados foram pain and self-efficacy, dor e auto-eficácia.

ResumoA crença de auto-eficácia relaciona-se com a percepção da dor e com a funcionalidade física e psíquica dos doentes. O objetivo deste estudo foi validar para a língua portuguesa a Chronic Pain Self-efficacy Scale. A amostra foi de 132 pacientes com dor crônica de etiologia variada. A validade da escala em língua portuguesa foi confirmada pela análise fatorial, que manteve os três domínios e os 22 itens da escala original; a variância explicada foi de 60,8%. A confiabilidade, analisada pelo alfa de Cronbach, variou entre 0,76 e 0,92 para os domínios e foi de 0,94 para a escala total. A validade convergente, verificada por meio da comparação entre a Escala de Auto-Eficácia para Dor Crônica (AEDC) e o Inventário de Depressão de Beck (IDB) mostrou correlação negativa e estatisticamente significativa. Este estudo disponibiliza para a língua portuguesa um instrumento válido e confiável para a avaliação da auto-eficácia de pacientes com dor crônica.Palavras-chave: Auto-eficácia, dor (controle), dor crônica, crença, psicometria, cognição. AbstractThe self-efficacy belief relates to pain perception and physical and psychiatric functionality. The goal of this study was to validate to the Portuguese language the Chronic Pain Self-efficacy Scale (CPSS). The subjects were 132 chronic pain patients with pain from several etiologies. The scale validity in the Portuguese language was confirmed by factor analyzis, which maintained the 3 factors and 22 items of the original scale; the accounted variance was 60,8%. The reliability, analyzed by Cronbach´s alpha coefficient, were 0,76 -0,92 to the factors and 0,94 to the total scale. The convergent validity, verified by the comparison with the Portuguese version of the Chronic Pain Self-efficacy Scale and Beck Depression Inventory (IDB) showed significantly negative correlation. This study made available to the Portuguese language a valid and reliable instrument to assess self-efficacy in chronic pain patients.