Opiáceo intratecal na dor crônica não neoplásica: alívio e qualidade de vida

Abstract

RESUMO -O uso de agentes morfínicos para o controle da dor crônica não relacionada a câncer é controverso. Este estudo aferiu o alívio da dor e as mudanças nas atividades de 11 doentes com dor crônica não associada ao câncer, tratados pela infusão intratecal de fármacos morfínicos através de bombas implantáveis. A dor era neuropática em 5 doentes e miofascial em 6. A duração média da queixa álgica foi 5,3 anos. A média da intensidade da dor antes da infusão foi 8,6. Sete doentes apresentavam dor durante 6 ou mais horas por dia. Após o tratamento, a média de intensidade da dor reduziu-se para 3,9. Somente 1 doente manteve dor com duração superior a 6 horas. O tratamento melhorou o desempenho de 36,36% dos aspectos funcionais avaliados. O tempo médio de tratamento foi 19,6 meses. A infusão crônica de agentes morfínicos por via intratecal proporcionou alívio da dor, mas não melhorou a funcionalidade com a mesma magnitude. PALAVRAS-CHAVE: dor, dor crônica, opióides, morfínicos, dor neuropática, dor miofascial. Intrathecal opioids for treatment of intractable non-malignant painThe use of opioids for treatment of non-malignant pain is controversial. The evaluation of pain relief and of the quality of life of 11 severely incapacitated chronic non-cancer pain patients treated with long term intrathecal infusion of opioids trought implantable pumps was performed. The mean duration of pain complaints was 5.3 years. The mean pain intensity was 8.6. In 7 patients, pain episodes lasted at least 6 hours daily. The mean duration of the therapy was 19.6 months. After the treatment the mean pain score became 3.9. In only 1 patient, the duration of pain episodes was still longer than 6 hours. Quality of life improved in 36.36% of the cases. The long term spinal opioids through implantable pumps for non-malignant pains results in pain relief but not necessarily improves the quality of life.KEY WORDS: pain, chronic pain, opioids, pain relief, neurophatic pain, miofascial pain.A dor crônica neuropática e a dor por afecções do aparelho locomotor são frequentemente rebeldes ao tratamento. As estratégias terapêuticas devem ser adaptadas à condição nosológica, à localização das condições álgicas, à magnitude do sofrimento, ao comprometimento funcional e às perspectiva de vida dos doentes. A utilização de agentes morfínicos em doentes com dor crônica não

Chronic Pain - Perceptions, Limitations and Implications. A Social Perspective

“…Pain is usually associated with illness, physical disability or highly significant losses such as body image. It is a very personal feeling that is hard to describe and measure, despite being experienced by [39] most people . responsabilidades profissionais, mudança de profissão/trabalho, reforma antecipada, baixa médica [26] de longo prazo .…”

“…Three inhibiting factors were identified: social barriers (OD intake is connected to a negative image linked to illegality); health professionals lack of knowledge about treatment of painful syndromes( this includes a lack of knowledge about physical and chemical dependence, or tolerance, which are not synonymous and are visibly distinct from each other); and the legal system ( on the one hand the law is vague and ambiguous and doctors are afraid when giving instructions; they therefore prescribe minimum doses and use it only as a last resort; on the other hand, the government's disinterest and misinformation allows for the provision of OD for the [40] relief of pain) . Thus, the use of OD as a pain control mainly for CP, is conditioned by social, economical, legal, education, ethical and political issues, and this [39,40] contribute to its prevalence . Nevertheless it is assumed that, at present, in addition to pharmacological interventions, there are nonpharmacological interventions that can be used in pain relief and control which take into account the physical, [8] psychological and social aspects of the individual .…”