Katia Nunes Sá

Electroencephalographic Patterns in Chronic Pain: A Systematic Review of the Literature

The main objective of this study is to review and summarize recent findings on electroencephalographic patterns in individuals with chronic pain. We also discuss recent advances in the use of quantitative Electroencephalography (qEEG) for the assessment of pathophysiology and biopsychosocial factors involved in its maintenance over time. Data collection took place from February 2014 to July 2015 in PubMed, SciELO and PEDro databases. Data from cross-sectional studies and longitudinal studies, as well as clinical trials involving chronic pain participants were incorporated into the final analysis. Our primary findings related to chronic pain were an increase of theta and alpha EEG power at rest, and a decrease in the amplitude of evoked potentials after sensory stimulation and cognitive tasks. This review suggests that qEEG could be considered as a simple and objective tool for the study of brain mechanisms involved in chronic pain, as well as for identifying the specific characteristics of chronic pain condition. In addition, results show that qEEG probably is a relevant outcome measure for assessing changes in therapeutic studies.

Effects of tDCS-induced motor cortex modulation on pain in HTLV-1: a blind randomized clinical trial

Objective:We aimed to evaluate the effects of transcranial direct current stimulation (tDCS) on chronic pain in human T-lymphotropic virus type I-infected patients. Materials and Methods:This is a sham-controlled randomized clinical trial. Twenty participants were randomized to receive active or sham anodal tDCS over the primary motor cortex (M1), with 2 mA, 25 cm2 electrodes, for 20 minutes on 5 consecutive days. Pain intensity was measured at baseline and after each day of treatment using a Visual Analog Scale. Associated factors such as pain components description, pressure pain threshold, and Timed Up and Go task were also assessed. Results:Mild adverse events were reported by 100% of patients in the tDCS group and 90% in the sham group. Comparison of daily Visual Analog Scale pain scores from both groups demonstrated a significant effect for the factor Time (P<0.001), but not for Group (P=0.13) or Time×Group interaction (P=0.06). There were 8 (80%) responders (reduction of 50% or more in pain intensity) in the tDCS group and 3 (30%) in the sham group (P=0.03). Both groups demonstrated improvements for most associated factors evaluated. However, there was no difference in between-groups comparison analyses. Conclusions:The analysis of the main outcomes in this study did not demonstrate a significant advantage of anodal tDCS applied to M1 in patients with human T-lymphotropic virus type I and chronic pain in comparison with sham tDCS, although secondary analysis suggests some superiority of active tDCS over sham. The large placebo effect observed in this study may explain the small differences between sham versus active tDCS.

Prevalence of chronic pain and associated factors in the population of Salvador, Bahia

OBJETIVO: Estimar a prevalencia de dor cronica, identificando os fatores associados. METODOS: Estudo transversal realizado em amostra populacional de 2.297 individuos com idade igual ou superior a 20 anos, em Salvador (BA), em 1999 e 2000. Aplicou-se em domicilio questionario padronizado para coleta de dados sobre dor e caracteristicas sociodemograficas e a medida da circunferencia abdominal. O criterio para classificacao de dor cronica foi duracao superior a seis meses. Foram estimadas as prevalencias de dor por razao de prevalencia ajustada com intervalo com 95% de confianca e valor de p<0,05 para as analises univariadas e regressao logistica. RESULTADOS: A presenca de dor cronica foi encontrada em 41,4% da populacao. Na analise bruta, os fatores associados mais frequentes foram: sexo, idade, situacao conjugal, fumo, consumo de alcool (p<0,05). Na analise multivariada, sexo feminino, idade, fumo e obesidade central foram preditores independentes enquanto consumo moderado de alcool e ser solteiro foram protetores. CONCLUSOES: A presenca de dor cronica predominou em mulheres, idosos, obesos, fumantes e ex-fumantes. Estrategias preventivas de saude publica sao sugeridas, visando a divulgacao dos riscos do tabagismo e da obesidade para o desenvolvimento de dor cronica, bem como o incentivo ao acompanhamento periodico da saude.OBJECTIVEnTo estimate the prevalence of chronic pain, identifying the associated factors.nnnMETHODSnA cross-sectional study was conducted in a population sample of 2,297 individuals aged 20 years or more, in Salvador, Northeastern Brazil, in 1999 and 2000. A standardized questionnaire was administered at the individuals home to collect data about pain, sociodemographic characteristics, and abdominal circumference measurement. The criterion for chronic pain classification was duration above six months. Prevalence of pain was estimated by adjusted prevalence ratio with confidence interval of 95% and p<0.05 for the univariate analyses and logistic regression.nnnRESULTSnThe presence of chronic pain was found in 41.4% of the population. In the gross analysis, the most frequent associated factors were: sex, age, marital status, smoking and alcohol consumption (p<0.05). In the multivariate analysis, female sex, age, smoking and presence of central obesity were independent predictors, while moderate consumption of alcohol and being single were protectors.nnnCONCLUSIONSnThe presence of chronic pain was predominant in women, elderly individuals, obese individuals, smokers and ex-smokers. Preventive public health strategies are suggested, aiming to disseminate the risks of smoking and obesity for the development of chronic pain. In addition, the periodic monitoring of health is encouraged.

Hip Dysfunction and Quality of Life in Patients With Sickle Cell Disease

Objective. To evaluate the influence of hip dysfunction on quality of life of pediatric patients with sickle cell disease (SCD). Methods. Clinical demographic, Charnley hip score, Barthel scale and Pediatric Quality of Life Inventory (PedsQL 4.0) questionnaires were used. Results. Seventeen patients were placed into the group “with hip dysfunction,” and 54 into the group “without hip dysfunction.” The group “with hip dysfunction” had a higher average age (P = .026), weight (P = .029), and height (P = .019) than the group “without hip dysfunction.” There was also a higher prevalence of hip trauma (P = .05) and pain (P = .00). The study demonstrated that hip dysfunction negatively influenced quality of life in the physical activity (P = .11) and psychosocial (P = .003) domains. Conclusion. Hip dysfunction and previous hip trauma negatively influenced quality of life, especially in the physical activity and psychosocial domains.

Analysis of the psychometric properties of the American Orthopaedic Foot and Ankle Society Score (AOFAS) in rheumatoid arthritis patients: application of the Rasch model

OBJECTIVEnTo tested the reliability and validity of Aofas in a sample of rheumatoid arthritis patients.nnnMETHODSnThe scale was applicable to rheumatoid arthritis patients, twice by the interviewer 1 and once by the interviewer 2. The Aofas was subjected to test-retest reliability analysis (with 20 Rheumatoid arthritis subjects). The psychometric properties were investigated using Rasch analysis on 33 Rheumatoid arthritis patients.nnnRESULTSnIntra-Class Correlation Coefficient (ICC) were (0.90<ICC<0.95; p<0.001) for intra-observer reliability and (0.75<ICC<0.91; p<0.001) for inter-observer reliability. Subjects separation rates were 1.9 and 4.75 for the items, showing that patients fell into three ability levels, and the items were divided into six difficulties levels. The Rasch analysis showed that eight items was satisfactory. One erroneous item have been identified, showing percentages above the 5% allowed by the statistical model. Further Rasch modeling suggested revising the original item 8.nnnCONCLUSIONSnThe results suggest that the Brazilian versions of Aofas exhibit adequate reliability, construct validity, response stability. These findings indicate that Aofas Ankle-Hindfoot scale presents a significant potential for clinical applicability in individuals with rheumatoid arthritis. Other studies in populations with other characteristics are now underway.

Neurodynamic Mobilization and Peripheral Nerve Regeneration: A Narrative Review

After a peripheral nerve injury, various aspects, including mechanical nerve properties, will influence regeneration. The reduction of nerve viscoelasticity, intraneural edema, mechanosensitivity, and adhesion of neural tissue to its interfaces may be a target to approaches that impose graded mechanical loads to the nerve. However, the effects of those treatments on peripheral nerve regeneration are not clear. Particularly neurodynamic mobilizations may be very useful. They consist of therapeutic maneuvers to assess nerve mechanical properties and restore their function through graded movements of the peripheral nerve attachments to bones and muscles. Here we discuss theoretical and experimental data regarding the effects of graded mechanical loads on peripheral nerve function and regeneration, and propose how neurodynamic mobilizations would interact with the peripheral nerve in order to promote regeneration. Those effects would influence the reduction of edema, normalization of axoplasmic flow, decrease nerve mechanosensitivity, and promotion of appropriate nerve mobility, increasing glial and neuronal activity.

Physiotherapy for human T-lymphotropic virus 1-associated myelopathy: review of the literature and future perspectives

Human T-lymphotropic virus 1 (HTLV-1) infection may be associated with damage to the spinal cord – HTLV-associated myelopathy/tropical spastic paraparesis – and other neurological symptoms that compromise everyday life activities. There is no cure for this disease, but recent evidence suggests that physiotherapy may help individuals with the infection, although, as far as we are aware, no systematic review has approached this topic. Therefore, the objective of this review is to address the core problems associated with HTLV-1 infection that can be detected and treated by physiotherapy, present the results of clinical trials, and discuss perspectives on the development of knowledge in this area. Major problems for individuals with HTLV-1 are pain, sensory-motor dysfunction, and urinary symptoms. All of these have high impact on quality of life, and recent clinical trials involving exercises, electrotherapeutic modalities, and massage have shown promising effects. Although not influencing the basic pathologic disturbances, a physiotherapeutic approach seems to be useful to detect specific problems related to body structures, activity, and participation related to movement in HTLV-1 infection, as well as to treat these conditions.

Quality of life and pain multidimensional aspects in individuals with HTLV-1

HTLV-1 creates a chronic health condition that involves moderate to severe pain with a negative impact on quality of life (QoL). There is no consensus on which attitudes to pain are more related to the worsening of QoL in HTLV-1 infected patients. The aim of this study was to investigate the correlation between QoL and multidimensional aspects of pain in patients with HTLV-1. A cross-sectional study was conducted in Salvador, Bahia, Brazil. The study included individuals diagnosed with HTLV-1. The Short Form 36 Questionnaire was used to analyze QoL, and the Brief Pain Inventory was used to assess multidimensional aspects of pain. The mean pain intensity was 4.88±3.06 on the visual pain scale, and the average impact on QoL corresponded to a loss of approximately 40%. Moderate to high correlations between pain intensity and all domains of QoL were observed and compared reaction attitudes for general activity, mood, ability to walk, ability to work, relationships, sleep, and ability to enjoy life (r>0.40; p<0.05). Moderate correlations were found between all domains of QoL, pain intensity, and reactive attitudes to pain. The greatest pain intensity impacts involved difficulty to walk and to work, and interpersonal relationships in the emotional aspect of QoL.

Electromyographic Biofeedback in Motor Function Recovery After Peripheral Nerve Injury: An Integrative Review of the Literature

Electromyographic biofeedback (EMG-BF) has been applied to treat different types of peripheral nerve injuries (PNI). However, despite the clinical practice widespread use its evidence is controversial. With the objective of summarize the available evidence on the electromyographic biofeedback effectiveness and efficacy to help motor function recovery after PNI an integrative review was performed. A secondary objective was to identify the conceptual framework and strategies of EMG-BF intervention, and the quality of technical description of EMG-BF procedures. To conduct this integrative review a systematic search of the literature was performed between October 2013 and July 2018, in PUBMED, ISI and COCHRANE databases for EMG-BF original studies in PNI patients of any etiology, in English, Portuguese, Spanish or French, published after 1990. Exclusion criteria were poor description of EMG-BF treatment, associated treatment that could impair EMG-BF effect, inclusion of non-PNI individuals and case studies design. The PEDro scale was used to evaluate study quality of randomized clinical trials (RCTs) included. This resulted in 71 potential articles enrolled to full reading, although only nine matched the inclusion criteria. PNI included facial paralysis, acute sciatic inflammation and carpal tunnel syndrome. The average quality score of the included RCTs was five, corresponding to low methodological quality. Due to the small number of included articles, low qualityxa0studies and heterogeneity of interventions, outcomes and population we concluded that there is limited evidence of EMG-BF effectiveness and efficacy for motor function recovery in PNI patients.

Additive effect of tDCS combined with Peripheral Electrical Stimulation to an exercise program in pain control in knee osteoarthritis: study protocol for a randomized controlled trial

BackgroundKnee osteoarthritis (OA) has been linked to maladaptive plasticity in the brain, which may contribute to chronic pain. Neuromodulatory approaches, such as Transcranial Direct Current Stimulation (tDCS) and Peripheral Electrical Stimulation (PES), have been used therapeutically to counteract brain maladaptive plasticity. However, it is currently unclear whether these neuromodulatory techniques enhance the benefits of exercise when administered together. Therefore, this protocol aims to investigate whether the addition of tDCS combined or not with PES enhances the effects of a land-based strengthening exercise program in patients with knee OA.MethodsPatients with knee OA (n = 80) will undertake a structured exercise program for five consecutive days. In addition, they will be randomized into four subgroups receiving either active anodal tDCS and sham PES (group 1; n = 20), sham tDCS and active PES (group 2, n = 20), sham tDCS and PES (group 3, n = 20), or active tDCS and PES (group 4, n = 20) for 20 min/day for five consecutive days just prior to commencement of the exercise program. The primary outcomes will be subjective pain intensity (VAS) and related function (WOMAC). Secondary outcomes will include quality of life (SF-36), anxiety and depression symptoms (HAD), self-perception of improvement, pressure pain thresholds over the knee, quadriceps strength, and quadriceps electromyographic activity during maximum knee extension voluntary contraction. We will also investigate cortical excitability using transcranial magnetic stimulation. Outcome measures will be assessed at baseline, 1 month after, before any intervention, after 5 days of intervention, and at 1 month post exercise intervention.DiscussionThe motor cortex becomes less responsive in knee OA because of poorly adapted plastic changes, which can impede exercise therapy benefits. Adding tDCS and/or PES may help to counteract those maladaptive plastic changes and improve the benefits of exercises, and the combination of both neuromodulatory techniques must have a higher magnitude of effect. Trial registration: Brazilian Registry on Clinical Trials (ReBEC) – Effects of electrical stimulation over the skull and tight together with exercises for knee OA; protocol number RBR-9D7C7B.Trial registrationID: RBR-9D7C7B. Registered on 29 February 2016.