Geana Paula Kurita

Adesão ao tratamento da dor crônica: estudo de variáveis demográficas, terapêuticas e psicossociais

The aims of this study were to identify the prevalence of compliance with drug therapy in patients with chronic pain and analyze the relationships between compliance and characteristics of drug therapy and psychosocial factors (beliefs regarding pain, health locus of control and depression). Thirty patients were evaluated 5 times over a period of 6 months. Total compliance occurred in 43.3% to 56.7% of the patients. Partial compliance and non-compliance were high (40.0%-56.7%). The index of compliance did not vary over the six months. Low compliance related to occurrence of side effects and beliefs that the control of health depended on the patient, pain is a disability, that pain means the presence of physical injury and solicitous behavior of others is desirable when there is manifestation of pain. Knowing the factors involved in compliance enables us to test interventions that optimize it.

Cognitive function in patients with chronic pain treated with opioids: characteristics and associated factors

The paucity of studies regarding cognitive function in patients with chronic pain, and growing evidence regarding the cognitive effects of pain and opioids on cognitive function prompted us to assess cognition via neuropsychological measurement in patients with chronic non‐cancer pain treated with opioids.

Dor crônica em pacientes esquizofrênicos: prevalência e características

Chronic pain may be at least as prevalent in psychiatric patients as in the general population. To estimate the prevalence of chronic pain in schizophrenic patients, compare the groups with and without chronic pain, and characterize the pain, a cross-sectional study was performed on a probabilistic sample of 205 adult patients with a diagnosis of schizophrenia (mean age 37 years; 65% men; mean schooling nine years; 87% single; 65% living with parents), treated at a public hospital in the city of Sao Paulo, Brazil. Prevalence of pain was 36.6%, and the most frequent sites were abdomen (30.7%), head, face, and mouth (24%), and lower back (14.7%). Twenty-four percent of patients reported feeling pain every day. Mean duration of pain was 41 months, with moderate intensity. Prevalence of chronic pain in schizophrenic patients was similar to that in the general population, and the clinical course was significant in terms of duration, intensity, and frequency.

65 CHRONIC PAIN AND QUALITY OF LIFE IN SCHIZOPHRENIC PATIENTS

from the opioids. It is highly likely that the potentiation in synaptic strength translates into enhanced pain behaviour: 1. Induction protocols leading to LTP also cause hyperalgesia in behaving animals and in human subjects. 2. Postsynaptic lamina I neurons that express LTP are indispensable for full expression of hyperalgesia and 3. Signalling pathways and pharmacological profiles of LTP at C-fibre synapses and hyperalgesia largely overlap. Thus, plasticity at the first synapse in pain pathways is a promising target for the prevention and treatment of hyperalgesia of various origins.

467 FATIGUE AND DISABILITY IN CHRONIC LOW BACK PAIN

and treatment, CT and MRI scan findings and neurological outcome were collected. Results: A 28 year old male treated with lumbar epidural steroid infiltrations, a 49 year old female with a dropfoot and a 72 year old female with pyelonephritis developed each a different presentation of CES which existed at least 24 hours up to 5 days before decompression was performed. Lasting neurological deficits ranged from sensory loss at the buttocks to urine incontinence. Conclusion: A CES remains a neurological emergency, both diagnostic and surgical. Early recognition of the severity of the situation is difficult, since there is no classical presentation of CES. Delay in diagnosis and treatment can worsen the outcome with potentially irreversible injury. Early surgical decompression has to be performed. Consequently, in every evolving lumbar radicular pain syndrome, a CES must be excluded.

87 ATTITUDES AND DISABILITY IN LOW BACK PAIN PATIENTS

Introduction: Determining predicting factors of disability in low back pain patients may help proposing preventive and rehabilitative interventions. Aims: To identify independent predictors of disability in low back pain patients. Methods: Cross-sectional study with 215 adults (outpatients and workers) recruited in São Paulo (Brazil). Participants (age 44.7±11.1 years, 65.1% female, schooling 11.2±3.5 years) filled out Socio Demographic and Clinic Profile, Oswestry Disability Index (ODI), Chronic Pain Self-Efficacy Scale, Tampa Scale for Kinesiophobia, Beck Depression Inventory, Piper Fatigue Scale and Baecke Physical Activity Questionnaire. Disability patients presented moderate or severe scores in ODI (>21) and 30 days or more of sick listed/last year. Results: Disability was observed in 53.5% (95%IC 46.6–60.3). Logistic regression identified six predictors, adjusted by sex: pain intensity (OR: 7.5; 95%CI 1.8–31.3, p = 0.005), self-efficacy (OR=5.1; 95%CI 2.3–11.4, p < 0.001), pain fear and avoidance (OR: 3.4; 95%CI 1.5–7.5, p = 0.002), depression (OR: 3.4; 95%CI 1.4–8.3, p = 0.005), age (OR: 2.8; 95%CI 1.3–6.2, p = 0.007), and marital status (OR: 2.3; 95%CI 1.0–5.3, p = 0.047). Body mass, physical activity and fatigue do not showed significance in multiple regression analyses. Conclusions: Different beliefs and psychosocial variables were predictors of disability and it is relevant because these aspects can be changed.

839 THE COGNITIVE EFFECTS OF OPIOIDS IN CHRONIC NON‐CANCER PAIN: A SYSTEMATIC REVIEW

Background and Aim: Given the marked increase in the use of opioids in chronic non-cancer pain, better understanding of their effects on cognitive function would be useful. This systematic review aimed to investigate the evidence for the effects of opioids on cognition in patients with chronic non-cancer pain. Methods: Search strategies in Nov/2008 for PubMed, EMBASE, PsycInfo, CINAHL, Lilacs and Cochrane used terms related to pain, opioid, cognition. Inclusion criteria: chronic non-cancer pain, controlled studies, neuropsychological tests, English language. Studies were classified by design, Jadad Scale, Oxford level of evidence (1–5, a–c) and grade of recommendation (A–D), which reflect the study quality. Results: Fifteen studies were analyzed; four randomized trials (RT), two non-randomized trials (NT) and nine outcomes research. One RT scored maximum on Jadad Scale. Five studies had high level of evidence (2b), 9 studies had level 2c (moderate grade of recommendation-B), one was level 4 (weak grade of recommendation). No significant differences in cognitive function were reported in 7 studies (2b, 2c, 4). Improvements in attention, psychomotor speed and short-term memory were shown in 4 studies (2b, 2c). Worse test results were shown in 4 outcome researches (2c). Five studies found no significant correlations between opioid dose/plasma level and cognitive performance. Conclusion: High quality studies about opioids effects on cognition showed no difference or improved cognitive function. However, the number of studies was small with important methodological limitations. Therefore, evidence for the effects of opioids on cognitive function in chronic non-cancer pain patients is limited.