Massako Okada

Burning mouth complaints: clinical characteristics of a Brazilian sample

OBJECTIVE Evaluation of the clinical characteristics of burning mouth complaints (BMC) in a series of Brazilian patients referred to a large teaching hospital. MATERIALS AND METHODS 66 patients with burning mouth complaints were evaluated through a standardized protocol. RESULTS 56 women and 10 men were examined, ranging in age from 35-83 years. The primary location of the complaints was reported to be the tongue. Thirty-six patients reported a precipitating event. The mean VAS pain levels were 7.5 in women and 6.11 in men. The average estradiol levels in women were low (<13 pg/ml); 80% of all patients reported a concomitant chronic disease, 55% of all patients wore total dentures, 54% of all patients reported subjective xerostomia, 48% of all patients reported sleep disturbances and 66% reported phantom taste. No statistical differences were found between groups with or without a precipitating event in VAS: (p=0.139), in the Number of Words Chosen (NWC) (p=0.259) and Pain Rating Index (PRI) (p=0.276) sections of the McGill Pain Questionnaire (MPQ). CONCLUSION The existence of systemic comorbidities, self-reported sleep disturbances and taste alterations indicates possible correlations and the need for a careful systemic evaluation of each patient; there were no differences between patients with and without precipitating events.

Beyond neuropathy in hereditary sensory and autonomic neuropathy type V : cognitive evaluation

Background and purpose:  Hereditary sensory and autonomic neuropathy (HSAN) type V is a very rare disorder. It is characterized by the absence of thermal and mechanical pain perception caused by decreased number of small diameter neurons in peripheral nerves. Recent genetic studies have pointed out the aetiological role of nerve growth factor beta, which is also involved in the development of the autonomic nervous system and cholinergic pathways in the brain. HSAN type V is usually reported not to cause mental retardation or cognitive decline. However, a structured assessment of the cognitive profile of these patients has never been made.

Use of low intensity laser treatment in neuropathic pain refractory to clinical treatment in amputation stumps

Debilitating stump pain following amputation surgery is a major problem when it affects the patient’s quality of life, often making the patient totally dependent on others for their day-to-day care. Attempts have been made to treat those patients through pharmacological, psychological, and physical therapies, but in many cases these fail to relieve the pain. This article focuses on three patients with chronic, intense, and debilitating stump pain who were previously treated with pain medications, but with little success. These patients underwent nine sessions of low-intensity laser therapy (LILT) to the stump – this is a new treatment that has been used to treat other pain disorders. All patients reported a decrease in the intensity of their pain and increased ability to perform daily living activities during a 4-month follow-up.

Facial sensibility of patients with trigeminal neuralgias

OBJECTIVES Idiopathic trigeminal neuralgia (ITN) is an excruciating shock-like paroxysmal pain restricted to the trigeminal area of innervation, with discrete loss of sensibility (thermal, tactile and painful). Trigeminal postherpetic neuralgia (PHN) is a neuropathic pain at the trigeminal territory that persists after Herpes zoster infection, which also is associated to sensorial compromise. The objective of this study was to evaluate the somesthetic facial sensibility (pain, thermal and tactile) and to compare the findings between PHN and ITN. METHODS 18 patients with PHN and 26 patients with ITN were diagnosed by the IASP criteria. They were evaluated with a systematic approach, which included mechanical, thermal (cold and warm) and painful stimuli. RESULTS We found statistical significance at the ophthalmic branch of PHN in pain (p=0.001), tactile (p=0.002), cold (p=0.016) and warm (p=0.013); in ITN, the maxillary branch had higher threshold with pinpricks (p=0.016) and the mandibular branch had higher tactile threshold. CONCLUSIONS The trigeminal area affected by the disease had the higher sensorial losses (ophthalmic branch in PHN and maxillary/mandibular branches in ITN). PHN patients had losses in large and small fibers; therefore, ITN patients had the losses mostly in large fibers, which support different peripheral neural mechanisms for these neuropathic diseases.

Methadone in post-herpetic neuralgia: A pilot proof-of-concept study

OBJECTIVE: This research was designed as a pilot proof-of-concept study to evaluate the use of low-dose methadone in post-herpetic neuralgia patients who remained refractory after first and second line post-herpetic neuralgia treatments and had indications for adding an opioid agent to their current drug regimens. METHODS: This cross-over study was double blind and placebo controlled. Ten opioid naïve post-herpetic neuralgia patients received either methadone (5 mg bid) or placebo for three weeks, followed by a 15-day washout period and a second three-week treatment with either methadone or placebo, accordingly. Clinical evaluations were performed four times (before and after each three-week treatment period). The evaluations included the visual analogue scale, verbal category scale, daily activities scale, McGill pain questionnaire, adverse events profile, and evoked pain assessment. All patients provided written informed consent before being included in the study. ClinicalTrials.gov: NCT01752699 RESULTS: Methadone, when compared to placebo, did not significantly affect the intensity of spontaneous pain, as measured by the visual analogue scale. The intensity of spontaneous pain was significantly decreased after the methadone treatment compared to placebo on the category verbal scale (50% improved after the methadone treatment, none after the placebo, p = 0.031). Evoked pain was reduced under methadone compared to placebo (50% improved after the methadone treatment, none after the placebo, p = 0.031). Allodynia reduction correlated with sleep improvement (r = 0.67, p = 0.030) during the methadone treatment. The side effects profile was similar between both treatments. CONCLUSIONS: Methadone seems to be safe and efficacious in post-herpetic neuralgia. It should be tried as an adjunctive treatment for post-herpetic neuralgia in larger prospective studies.

Liposomal topical capsaicin in post-herpetic neuralgia: a safety pilot study

UNLABELLED Topical treatments have gained popularity for general use as an adjunct to systemic drugs in neuropathic pain, but their use produces variable clinical results and local adverse events. OBJECTIVE To evaluate the safety and analgesic effect of a formulation of liposomal capsaicin (LC) (0.025%) in patients with post herpetic neuralgia (PHN). METHOD Patients who remained symptomatic after first-and second-line treatment were randomized to receive LC for six weeks in a placebo-controlled, crossover design study. Clinical assessment was performed at baseline, in the second, fourth and sixth week of treatment. RESULTS Thirteen patients completed both treatment periods. Visual Analog Scale (VAS) was significantly decreased after the end of the study (p = 0.008), however the effect of treatment was not significant (p = 0.076). There was no difference on global impression of change and other pain characteristics. LC was safe and well tolerated. However, at the concentration used, its analgesic effects were marginal and not significant.

Liga de dor: uma experiência de ensino extracurricular

Os objetivos deste estudo foram descrever um programa extracurricular de educacao em dor, organizado na forma de Liga, e identificar a opiniao dos alunos sobre esse modelo de ensino. O Estatuto e o Regimento Interno da Liga de Dor foram as fontes e dados para a descricao da sua organizacao e funcionamento. Todos os alunos que frequentaram a Liga de Dor nos anos de 1995 e 1996 foram solicitados a responder um questionario sobre suas experiencias na Liga. A Liga de Dor foi organizada sob o patrocinio do Centro Academico Osvaldo Cruz, da Faculdade de Medicina da USP, e Centro Academico XXXI de Outubro, da Escola de Enfermagem da USP, em 1995. E composta por alunos dessas duas faculdades e profissionais enfermeiros e medicos, de varias especialidades. Todas as atividades sao voluntarias, desenvolvidas em periodo extracurricular e os estudantes dirigem a Liga. Os objetivos da Liga sao: melhorar a qualidade do ensino sobre dor nas escolas medica e de enfermagem, desenvolver pesquisas relativas a epidemiologia, clinica e controle da dor e promover modelo de assistencia multidisciplinar e multiprofissional. A maioria dos alunos expressou ter alcancado seus objetivos, total ou parcialmente; ter aumentado seu conhecimento sobre as sindromes algicas e sobre o manejo do doente com dor; sentir-se gratificado com sua atividade; que o tema dor deveria ser incluido no curriculo de modo mais especifico e que recomendaria a outros colegas a participacao na Liga de Dor. As opinioes dos estudantes mostraram que a Liga de Dor pode ser um modelo util para a introducao do ensino da dor nos cursos de graduacao e enfermagem e de medicina.

903 ANALGESIC EFFECTS OF EPIDURAL MORPHINE IN THE TREATMENT OF REFRACTORY NEUROPATHIC PAIN RELATED TO BRACHIAL PLEXUS AVULSION

challenging. We wanted to find out the efficacy of 500mcg intrathecal diamorphine. We also wanted to know the common side effects or complications after intrathecal diamorhine. Methods: We conducted a prospective audit of 25 patients undergoing elective revision hip surgery. All the patients had standard General Anaesthetic with invasive monitoring. Patients were given prophylactic Ondansatron and dexamthesone as antiemetics. All patients had intrathecal diamorphine 500mcg.for post-operative pain relief and were also prescribed morhine PCA. Patients were monitored for 24 hrs on post-operative surgical unit. Pain was assessed at regular intervals by using VAS scale. Results: Our study group patients had male:female ratio 56:44. Agerage age was 62 years. All patients had VAS pain score of <1. Average duration of pain relief prior to use of morphine PCA was 11.2 hrs. Common side effects were nausea/vomiting (28%) and pruritus (16%). None of our patient had respiratory depression or sedation score of more than 1. Conclusion: Intrathecal diamorphine 500mcg can be safely used for the post-operative pain relief after revision hip surgery. Nausea/vomiting remains commonly occuring problem despite prophylactic antiemetics.