Fânia Cristina dos Santos

Pé doloroso do idoso associado à incapacidade funcional

BACKGROUND AND OBJECTIVES: Foot pain in elderly people may interfere with gait balance and cycle and may contribute for functional incapacity in the geriatric population. This study aimed at evaluating the frequency of functional incapacity associated to foot pain in elderly people. METHOD: Participated in this study 100 elderly people aged 60 years, with foot pain intensity of 30 mm by the pain visual analog scale (VAS). Types of feet and their injuries, types of shoes, falls, their circumstances and consequences were evaluated. Manchester Foot Pain Disability Index (MFPDI) and VAS at rest and movement, dynamic gait index and instrumental activity of daily life scale (IADL) were applied. Sperman and multiple regression tests were used for statistical analysis with significance level of 5% (p < 0.05). RESULTS: There has been prevalence of functional incapacity associated to foot pain above 50%. Univariate analysis has shown significant correlations of functional incapacity associated to foot pain and foot pain intensity at movement (p < 0.002), with the level of functional independence for IADL (p < 0.001), and with gait functionality, balance and risk for falls (p < 0.003), with significant association with the latter. The same correlations were significant in the multivariate analysis (p < 0.005). CONCLUSION: Functional incapacity associated to foot pain was highly prevalent in the elderly and was significantly correlated to foot pain intensity at movement, to the level of functional independence for IADL and to gait / balance functionality and risk for falls.

Comparison between intra-articular ozone and placebo in the treatment of knee osteoarthritis: A randomized, double-blinded, placebo-controlled study

Objective The aim of the trial was to determine the effectiveness of oxygen-ozone injections on knee osteoarthritis concerning pain reduction, joint functional improvement, and quality of life. Methods In this randomized, double-blinded, placebo controlled clinical trial, 98 patients with symptomatic knee osteoarthritis (OA) were randomized into two groups receiving intra-articular 20 μg/ml of ozone (OZ) or placebo (PBO) for 8 weeks. The efficacy outcomes for knee OA were the Visual Analogue Scale (VAS), Lequesne Index, Timed Up and Go Test (TUG Test), SF-36, Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), and Geriatric Pain Measure (GPM). Results After 8 weeks of treatment, ozone was more effective than the placebo: VAS [mean difference (MD) = 2.16, p < 0.003 (CI 95% 0.42–3.89)], GPM [MD = 18.94, p < 0.004 (CI 95% 3.43–34.44)], LEQ [MD = 4.05, p < 0.001 (CI 95% 1.10–7.00)], WOMAC (P) [median of diff = 9.999, p = 0.019 (CI 95% 0.000–15.000)], WOMAC (JS) [median of diff = 12.499, p < 0.001 (CI 95% 0.000–12.500)], WOMAC (PF) = [median of diff = 11.760, p = 0.003 (CI 95% 4.409–19.119)], TUG (no statistical difference) and SF-36 (FC) [(MD = -25.82, p < 0.001 (CI 95% 33.65–17.99)], SF-36 (PH) [MD = -40.82, p < 0.001 (CI 95% -54.48–27.17)], SF-36 (GSH) [MD = -3.38, p < 0.001 (CI 95% -4.83–1.93)], SF-36 (SA) [MD = 2.17, p < 0.001 (CI 95% -19.67–8.24), SF-36 (EA) [MD = -35.37, p < 0.001 (CI 95% -48.86–21.89)]. Adverse events occurred in 3 patients (2 in the placebo group and 1 in the ozone group) and included only puncture accidents. Conclusions The study confirms the efficacy of ozone concerning pain relief, functional improvement, and quality of life in patients with knee osteoarthritis. Trial registration International Standard Randomized Controlled Trial Number Register ISRCTNR55861167

Pain assessment in elderly with dementia: Brazilian validation of the PACSLAC scale

ABSTRACT Objective To validate the Pain Assessment Checklist for Seniors with Limited Ability to Communicate – Portuguese in demented elderly and to analyze its measurement properties. Methods We evaluated 50 elderly with dementia, residing in a nursing home and with limited communication ability, when exposed to potentially painful situations. The tool was applied at two different moments. First, two interviewers applied it simultaneously, and the intensity of pain was asked based on the caregiver’s opinion. After 14 days, with no analgesic intervention, one of the interviewers applied it again. Results The sample comprised more females, aged over 80 years, with dementia due to Alzheimer, presenting musculoskeletal pain of moderate to severe intensity. The psychometric properties of the tool demonstrated appropriate internal consistency (Cronbach’s alpha coefficient of 0.827). The scale had excellent reproducibility, according to the intraclass correlation coefficient, and the tool has been duly validated. Conclusion The Pain Assessment Checklist for Seniors with Limited Ability to Communicate – Portuguese had adequate measuring properties for use with elderly presenting limited communication.

Tratamento da dor associada à osteoartrose de joelho em idosos: um ensaio clínico aleatório e duplamente encoberto com o clonixinato de lisina

JUSTIFICATIVA E OBJETIVOS: A osteoartrose (OA) e a artropatia mais comum e uma das principais causas de dor cronica na populacao idosa, podendo levar a grande incapacidade funcional nestes individuos. Objetivando o tratamento da dor em idosos com OA de joelho utilizou-se o clonixinato de lisina (CL) e avaliou-se a sua efetividade. METODO: Estudo clinico e duplamente encoberto, aleatorio e placebo controlado com 109 idosos com dor associada a OA de joelho. Os participantes foram divididos em dois grupos: Grupo CL e P (placebo) que receberam comprimidos para uso tres vezes ao dia por 30 dias. Realizadas avaliacoes iniciais, apos 15 dias e ao final do estudo, quanto a intensidade de dor em repouso, ao movimento inicial, a deambulacao e a compressao articular; necessidade de analgesia complementar, rigidez matinal; incapacidade funcional associada a dor, aderencia, tolerabilidade e avaliacao global do tratamento. RESULTADOS: O CL reduziu significantemente a dor ao inicio do movimento e a deambulacao ja nos primeiros 15 dias, reducao de 30% da dor protocinetica e de 31,6% a deambulacao, mas os melhores resultados ocorreram com 30 dias, quando as reducoes foram de 42,3% e 45,5%, protocinetica e a deambulacao, respectivamente. A analgesia complementar foi significantemente menor com o CL: 2,6% e 9,5%, grupos CL e P, respectivamente. Nao ocorreram diferencas entre os grupos para rigidez matinal e incapacidade funcional. Houve grande aderencia e tolerabilidade. A avaliacao global foi favoravel para o CL, sendo excelente ou boa em 50%. CONCLUSAO: O clonixinato de lisina foi efetivo no tratamento da dor associada a osteoartrite de joelho em idosos.

O uso de vitaminas do complexo B em terapêutica analgésica

BACKGROUND AND OBJECTIVES: The B complex vitamins have been used as single therapy or combined to other drugs, such as anti-inflammatory drugs, in different clinical situations, such as degenerative spinal diseases, rheumatologic diseases, polyneuropathies and in different postoperative situations. This study aimed at identifying in the scientific literature most recent evidences of the use of B complex vitamins as analgesic therapy and at describing clinical situations where their analgesic action could be observed. CONTENTS: A search was carried out in Pubmed, Medline, LILACS, Cochrane Library and Scielo databases, contemplating the last 10 years and titles in Portuguese, Spanish and English.

Assessment of physicians’ addressing sexuality in elderly patients with chronic pain

ABSTRACT Objective To determine the frequency with which physicians address their older adult patients with chronic pain about the issue of sexuality. Methods It is a cross sectional, descriptive, analytical study in which physicians answered a questionnaire comprising questions related to addressing the issue of sexuality during appointments. Results A sample of 155 physicians was obtained, 63.9% stated they did not address sexuality in medical interviews and 23.2% did it most of the time. The main reasons for not addressing were lack of time, fear of embarrassing the patient and technical inability to address the issue. Conclusion There is a need to develop strategies to increase and improve addressing of sexuality in elderly patients with chronic pain, in order to have better quality of life.

Sexuality and chronic pain in long-lived females: description of interferential factors

BACKGROUND AND OBJECTIVES: Approximately 60% of chronic pain individuals complain of sexual dysfunction, the prevalence of which varies from 20 to 88%. Among sexual complaints most reported by elderly females there are low interest, difficult vaginal lubrication and inability to reach orgasm. This study aimed at checking the prevalence of sexual dysfunction among long-lived females with chronic pain and at describing interfering factors. METHODS: This was a descriptive, analytical and cross-sectional study with females above 80 years of age. Data were collected on demographics, comorbidities and use of drugs, in addition to chronic pain evaluation and measurement and identification of sexual dysfunctions by the Short Personal Experiences Questionnaire. RESULTS: Participated in the study 32 elderly females, with mean age of 87 years, most of them widows, with less than 4 years of education, good self-reported health, without sexual partner and with primarily osteoarthritis-induced nociceptive pain.The prevalenceof sexual dysfunctionwasfoundtobe 78% ofelderlywithchronicpainwith a mean score of7. Major reason for sexual inactivity was lack of a partner. In approximately 28.1% it was observed that chronic pain would interfere with sexuality. It was also observed that no elderly female had been previously addressed as to their sexuality, although 68.8% have stated that would have liked to be addressed. CONCLUSION: Chronic pain was considered a factor interfering with sexual practices of studied long-lived females, suggesting that this symptom may impair sexuality during aging.

Síndrome de amplificação dolorosa no idoso: relato de caso e revisão da literatura

BACKGROUND AND OBJECTIVES: There are very few publications on pain amplification syndrome in the elderly (PAS), in spite of its importance for them, because it may have multiple consequences during aging. This study aimed at reporting a case of PAS in the elderly represented by fibromyalgia (FM), describing its diagnostic approach and therapeutic management, and at presenting a literature review on the subject. CASE REPORT: Female patient, 73 years old, with moderate diffuse muscle pain, fleeting morning stiffness, anhedonia, sadness, anxiety, major fatigue and sleep disorders for four years. She was initially diagnosed as rheumatic polymyalgia and was under regular prednisone in spite of the progressive worsening of her functional capacity and quality of life (QL). One year ago her diagnosis was reviewed by our service and we confirmed it was PAS, spectrum of FM. Prednisone was then withdrawn and non-pharmacological therapy was indicated with pain self-management program; multi-176 modal pharmacological therapy was also instituted with non-opioid (lysine clonixinate) and opioid (tramadol) analgesics and a pain modulator (duloxetine). Six months later there has been major pain, sleep, depression, anxiety, functional capacity and QL improvement. CONCLUSION: Accurate diagnosis and adequate therapeutic intervention are paramount for PAS cases, especially in the elderly population with FM, which has unique characteristics in such population. There are major probabilities of symptomatic, functional and QL improvement in the elderly with PAS if we pay attention to differential diagnoses and introduce adequate therapies.