Nubia Verçosa Figueiredo

Uso de canabinóides na dor crônica e em cuidados paliativos

JUSTIFICATIVA Y OBJETIVOS: Muchos estudios han querido destacar la Cannabis sativa (Cs), por su potencial analgesico y por su capacidad de aliviar los sintomas relacionados con las enfermedades del sistema nervioso central. Sin embargo, la marihuana, como popularmente se conoce, por ser la mas popular de las drogas ilegales en todo el mundo, genera un prejuicio tanto entre los legos como entre los profesionales que actuan en el area de la salud. Se intento investigar el nivel de conocimiento actual y sus perspectivas de utilizacion para comprender mejor sus acciones y efectos en la investigacion experimental y en la practica medica en pacientes con enfermedades degenerativas neurologicas o en aquellos que esten fuera de posibilidades de cura, atendidos en programas de cuidados paliativos. CONTENIDO: Su uso terapeutico no es reciente. El presente estudio suministra una revision del historial y de la y farmacologia de la Cs, el desarrollo de su uso terapeutico a traves de los canabinoides sinteticos, el conocimiento cientifico actual, sus consecuencias organicas y psiquicas, demostrando sus opciones de uso clinico y perspectivas futuras. CONCLUSIONES: El delta-9-tetrahidrocanabinol (D9-THC) puro y sus analogos presentan aplicabilidad clinica, mostrando beneficios. El desarrollo de las sustancias sinteticas puras, buscando la atenuacion de efectos psicoactivos no deseados nos muestra perspectivas favorables para su utilizacion en el futuro. Estudios mas detallados deberan ser realizados. Debates amplios seran necesarios para crear normas de formulacion y disponibilidad con fines medicos, al tratarse de una sustancia que genera prejuicio por su comercializacion y utilizacion ilegal y porque tambien a su usoyse le achaca el misticismo.BACKGROUND AND OBJECTIVES Several studies have focused on Cannabis sativa (Cs) due to its analgesic potential and its ability to alleviate symptoms of disorders of the central nervous system. However, since marijuana, one of its popular names, is the most common illicit drug throughout the world, it breeds prejudice both among lay people and health care professionals. The objective of this study was to determine the current level of knowledge about this drug and the perspectives for its use, to better understand its actions and effects, both in experimental studies and clinical use, in patients with degenerative neurological disorders or in those who do not have the possibility of cure and are being followed by palliative care programs. CONTENTS The therapeutic use of Cannabis sativa is not recent. The present study presents the historical background and pharmacology of Cs, the development of its therapeutic use through synthetic cannabinoids, the current scientific knowledge, and its organic and psychological consequences, demonstrating the options for its clinical use and future perspectives. CONCLUSIONS Pure delta-9-tetrahydrocannabinol (Delta9-THC) and its analogues have clinical applicability, being beneficial in selected individuals. The development of pure synthetic substances, in an attempt to attenuate undesirable psychoactive effects, indicates that perspectives for its use in the future are favorable. More detailed studies should be undertaken. Ample debates will be necessary to create standards for its formulation and clinical availability, since it is a substance that generates prejudice, due to its illegal commercialization and use, and also because its use has been attributed to mysticism.

Cannabinoids in chronic pain and palliative care

JUSTIFICATIVA Y OBJETIVOS: Muchos estudios han querido destacar la Cannabis sativa (Cs), por su potencial analgesico y por su capacidad de aliviar los sintomas relacionados con las enfermedades del sistema nervioso central. Sin embargo, la marihuana, como popularmente se conoce, por ser la mas popular de las drogas ilegales en todo el mundo, genera un prejuicio tanto entre los legos como entre los profesionales que actuan en el area de la salud. Se intento investigar el nivel de conocimiento actual y sus perspectivas de utilizacion para comprender mejor sus acciones y efectos en la investigacion experimental y en la practica medica en pacientes con enfermedades degenerativas neurologicas o en aquellos que esten fuera de posibilidades de cura, atendidos en programas de cuidados paliativos. CONTENIDO: Su uso terapeutico no es reciente. El presente estudio suministra una revision del historial y de la y farmacologia de la Cs, el desarrollo de su uso terapeutico a traves de los canabinoides sinteticos, el conocimiento cientifico actual, sus consecuencias organicas y psiquicas, demostrando sus opciones de uso clinico y perspectivas futuras. CONCLUSIONES: El delta-9-tetrahidrocanabinol (D9-THC) puro y sus analogos presentan aplicabilidad clinica, mostrando beneficios. El desarrollo de las sustancias sinteticas puras, buscando la atenuacion de efectos psicoactivos no deseados nos muestra perspectivas favorables para su utilizacion en el futuro. Estudios mas detallados deberan ser realizados. Debates amplios seran necesarios para crear normas de formulacion y disponibilidad con fines medicos, al tratarse de una sustancia que genera prejuicio por su comercializacion y utilizacion ilegal y porque tambien a su usoyse le achaca el misticismo.BACKGROUND AND OBJECTIVES Several studies have focused on Cannabis sativa (Cs) due to its analgesic potential and its ability to alleviate symptoms of disorders of the central nervous system. However, since marijuana, one of its popular names, is the most common illicit drug throughout the world, it breeds prejudice both among lay people and health care professionals. The objective of this study was to determine the current level of knowledge about this drug and the perspectives for its use, to better understand its actions and effects, both in experimental studies and clinical use, in patients with degenerative neurological disorders or in those who do not have the possibility of cure and are being followed by palliative care programs. CONTENTS The therapeutic use of Cannabis sativa is not recent. The present study presents the historical background and pharmacology of Cs, the development of its therapeutic use through synthetic cannabinoids, the current scientific knowledge, and its organic and psychological consequences, demonstrating the options for its clinical use and future perspectives. CONCLUSIONS Pure delta-9-tetrahydrocannabinol (Delta9-THC) and its analogues have clinical applicability, being beneficial in selected individuals. The development of pure synthetic substances, in an attempt to attenuate undesirable psychoactive effects, indicates that perspectives for its use in the future are favorable. More detailed studies should be undertaken. Ample debates will be necessary to create standards for its formulation and clinical availability, since it is a substance that generates prejudice, due to its illegal commercialization and use, and also because its use has been attributed to mysticism.

Hipotensão controlada induzida por halotano em coelhos

BACKGROUND: The authors describe haemodynamic changes secondary to controlled and induced hypotension during anesthesia with different halothane concentrations. METHODS: Twenty-nine New Zealand white rabbits (Oryctolagus cuniculus) were divided into four groups. A control group, composed by five animals, was compared to groups I, II, and III, with eight rabbits each one (n=8), that underwent anesthesia with halothane in concentrations of 1,0%, 1,5% and 2,0% respectively. Cardiac and respiratory rates, body temperature, average arterial blood pressure, pH values, arterial oxygen tension (PaO2), arterial carbon dioxide tension (PaCO2), bicarbonate concentrations (-HCO3), base excess (BE), and haemoglobin oxygen saturation (Sat O2) were studied. All parameters were registered before, during and after halothane anesthesia induced hypotension. Corneal and pupilary reflexes and cardiogram were followed continuously. RESULTS: Halothane resulted in hypotension and reduced heart rate. Rabbits have an alcaline blood pH. The metabolic acidosis trend observed was of transient character. Halothane did not modify SatO2.. CONCLUSION: Halothane is a safe and efficient anaesthetic to promote induced or controlled hypotension in rabbits.

Safety and tolerability of controlled-release oxycodone on postoperative pain in patients submitted to the oncologic head and neck surgery

OBJECTIVE To evaluate the safety and tolerability of controlled-release oxycodone in the treatment of postoperative pain of head and neck oncologic resections. METHODS We conducted a prospective, observational and open study, with 83 patients with moderate to severe pain after head and neck oncological operations. All patients received general anesthesia with propofol, fentanyl and sevoflurane. Postoperatively, should they have moderate or severe pain, we began controlled-release oxycodone 20 mg 12/12 b.i.d on the first day and 10 mg b.i.d. on the second. We assessed the frequency and intensity of adverse effects, the intensity of postoperative pain by a verbal numeric scale and the use of rescue analgesia from 12 hours after administration of the drug and between 7 and 13 days after the last oxycodone dose. RESULTS The most common adverse events were nausea, vomiting, dizziness, pruritus, insomnia, constipation and urinary retention, most mild. No serious adverse events occurred. In less than 12 hours after the use of oxycodone, there was a significant decrease in the intensity of postoperative pain, which remained until the end of the study. The rescue medication was requested at a higher frequency when the opioid dose was reduced, or after its suspension. CONCLUSION Controlled release oxycodone showed to be safe and well tolerated and caused a significant decrease in post-operative pain.

Uso da metadona no tratamento da dor neuropática não-oncológica: relato de casos

BACKGROUND AND OBJECTIVES This report includes seven patients with chronic non-oncologic neuropathic pain who have not responded to classic approaches with tricyclic antidepressant and anticonvulsant drugs. Oral methadone, a synthetic opioid similar to morphine, is referred as alternative to treat neuropathic pain due to its non-competitive antagonist action on NMDA receptors. This study aimed at evaluating methadone to treat chronic non-oncologic neuropathic pain patients who have not responded to classic approaches. CASE REPORTS Seven cases in which methadone dose was titrated in subsequent visits are presented. Pain severity according to facial scale, side effects and improved functional capacity were evaluated 1, 7, 14, 30 and 180 days after treatment beginning. There has been decrease in pain severity and in the incidence of side effects, such as constipation, sedation, nausea, headache and insomnia. There has been no euphoria, sweating, myoclonia, urinary retention, decreased libido and respiratory depression. CONCLUSIONS Patients responded satisfactorily to low dose medication, side effects were controlled with simple measures and there has been significant functional capacity improvement. In the conditions of this study, methadone was an effective, safe and low-cost option to treat non-oncologic neuropathic pain.JUSTIFICATIVA E OBJETIVOS: O relato inclui sete casos de pacientes com dor neuropatica cronica nao-oncologica que nao haviam obtido resultados satisfatorios com os tratamentos classicos com antidepressivos triciclicos e anticonvulsivantes. O uso da metadona, opioide sintetico, semelhante a morfina, por via oral, e referido como alternativa no tratamento da dor neuropatica pela sua acao antagonista nao-competitiva sobre os receptores NMDA. Este estudo tem como objetivo avaliar o uso da metadona no tratamento de pacientes portadores de dores cronicas de origem neuropatica nao-oncologica que nao melhoraram com os tratamentos classicos. RELATO DOS CASOS: Sao apresentados sete casos nos quais a dose de metadona foi titulada em consultas subsequentes e as variaveis escore da intensidade algica segundo a escala de faces, efeitos colaterais e melhora da capacidade funcional foram analisados no 1o, 7o, 14o, 30o e 180o dias apos o inicio do uso da medicacao. Houve reducao do escore da intensidade algica e a ocorrencia de efeitos colaterais como constipacao, sedacao, nauseas, cefaleia e insonia. Nao foram observados efeitos colaterais do tipo euforia, sudorese, mioclonias, retencao urinaria, reducao de libido e depressao respiratoria. CONCLUSOES: Os pacientes apresentaram resposta que foi considerada satisfatoria ao uso da medicacao, em baixas doses; controle dos efeitos colaterais com medidas simples e melhora representativa da capacidade funcional. A inclusao da metadona, nas condicoes deste estudo, mostrou-se uma opcao eficaz, segura e de baixo custo, para o tratamento das dores de origem neuropaticas nao-oncologicas.

Derivados canabinóides e o tratamento farmacológico da dor

JUSTIFICATIVA E OBJETIVOS: As propriedades medicinais da Cannabis sativa tem sido relatadas por muitos seculos para o tratamento de diversos disturbios e, mais recentemente, para o tratamento da dor. O objetivo deste estudo foi revisar os principais avancos na farmacologia do sistema endocanabinoide e no potencial uso terapeutico de alguns compostos canabinoides no tratamento de diversas formas de dor. CONTEUDO: Foi realizada uma busca nos bancos de dados Pubmed, Scielo e Lilacs, identificando-se estudos e revisoes da literatura sobre a farmacologia e o uso terapeutico de substâncias canabinoides em dor. Nessa busca foram utilizadas as seguintes palavras-chaves: Cannabis sativa, tetra-hidrocanabinol, canabidiol, sativex®, cannador®, canabinoides, endocanabinoide, dor e dor neuropatica. Os canabinoides sinteticos e os extratos de Cannabis sativa apresentaram efeito analgesico em diversos ensaios clinicos, sugerindo um potencial papel no tratamento da dor, em particular naquela de origem neuropatica. Os canabinoides sinteticos e os extratos de Cannabis sativatambem apresentaram efeitos ansioliticos quando usados como adjuvantes no tratamento da dor no câncer, na artrite reumatoide e na esclerose multipla. Porem, efeitos adversos significativos, como euforia, depressao e sedacao limitam o uso clinico desses agentes canabinoides. CONCLUSAO: Um melhor conhecimento sobre a farmacologia do sistema endocanabinoide, juntamente com os resultados dos estudos envolvendo o tratamento da dor com substâncias de natureza canabinoide, podem ser de grande valor para o desenvolvimento de farmacos que permitam um avanco significativo na terapeutica de pacientes portadores de sindromes dolorosas, em particular nos casos de dificil controle. Porem, mais estudos sao necessarios para confirmar esses resultados e determinar a seguranca desses compostos.BACKGROUND AND OBJECTIVES: Medical properties of Cannabis sativa have been reported for centuries for the treatment of different disorders and, more recently, to manage pain. This study aimed at reviewing major pharmacological advances of the endocannabinoid system and the potential therapeutic use of some cannabinoid compounds to manage different types of pain. CONTENTS: A search was carried out in Pubmed, Scielo and Lilacs databases to identify studies and literature reviews on the pharmacology and therapeutic use of cannabinoids for pain. The following keywords were used: Cannabis sativa, tetra-hydrocannabinol, cannabidiol, sativex®, cannador®, cannabinoids, endocannabinoid, pain and neuropathic pain. Synthetic cannabinoids and Cannabis sativa extracts have shown analgesic effects in several clinical trials, suggesting their potential role for pain management, especially neuropathic pain. Synthetic cannabinoids and CS extracts have also induced anxiolytic effects when used as adjuvants to treat cancer pain, rheumatoid arthritis and multiple sclerosis. However, significant adverse effects, such as euphoria, depression and sedation limit the clinical use of such cannabinoids. CONCLUSION: Further understanding of endocannabinoid system pharmacology, together with study results involving pain management with cannabinoid substances may be very useful for the development of drugs allowing a significant advance in the treatment of patients with painful syndromes, especially difficult to control. However, further studies are needed to confirm such findings and to determine the safety of such compounds.

Uso de canabinoides en el dolor crónico y en cuidados paliativos

JUSTIFICATIVA Y OBJETIVOS: Muchos estudios han querido destacar la Cannabis sativa (Cs), por su potencial analgesico y por su capacidad de aliviar los sintomas relacionados con las enfermedades del sistema nervioso central. Sin embargo, la marihuana, como popularmente se conoce, por ser la mas popular de las drogas ilegales en todo el mundo, genera un prejuicio tanto entre los legos como entre los profesionales que actuan en el area de la salud. Se intento investigar el nivel de conocimiento actual y sus perspectivas de utilizacion para comprender mejor sus acciones y efectos en la investigacion experimental y en la practica medica en pacientes con enfermedades degenerativas neurologicas o en aquellos que esten fuera de posibilidades de cura, atendidos en programas de cuidados paliativos. CONTENIDO: Su uso terapeutico no es reciente. El presente estudio suministra una revision del historial y de la y farmacologia de la Cs, el desarrollo de su uso terapeutico a traves de los canabinoides sinteticos, el conocimiento cientifico actual, sus consecuencias organicas y psiquicas, demostrando sus opciones de uso clinico y perspectivas futuras. CONCLUSIONES: El delta-9-tetrahidrocanabinol (D9-THC) puro y sus analogos presentan aplicabilidad clinica, mostrando beneficios. El desarrollo de las sustancias sinteticas puras, buscando la atenuacion de efectos psicoactivos no deseados nos muestra perspectivas favorables para su utilizacion en el futuro. Estudios mas detallados deberan ser realizados. Debates amplios seran necesarios para crear normas de formulacion y disponibilidad con fines medicos, al tratarse de una sustancia que genera prejuicio por su comercializacion y utilizacion ilegal y porque tambien a su usoyse le achaca el misticismo.BACKGROUND AND OBJECTIVES Several studies have focused on Cannabis sativa (Cs) due to its analgesic potential and its ability to alleviate symptoms of disorders of the central nervous system. However, since marijuana, one of its popular names, is the most common illicit drug throughout the world, it breeds prejudice both among lay people and health care professionals. The objective of this study was to determine the current level of knowledge about this drug and the perspectives for its use, to better understand its actions and effects, both in experimental studies and clinical use, in patients with degenerative neurological disorders or in those who do not have the possibility of cure and are being followed by palliative care programs. CONTENTS The therapeutic use of Cannabis sativa is not recent. The present study presents the historical background and pharmacology of Cs, the development of its therapeutic use through synthetic cannabinoids, the current scientific knowledge, and its organic and psychological consequences, demonstrating the options for its clinical use and future perspectives. CONCLUSIONS Pure delta-9-tetrahydrocannabinol (Delta9-THC) and its analogues have clinical applicability, being beneficial in selected individuals. The development of pure synthetic substances, in an attempt to attenuate undesirable psychoactive effects, indicates that perspectives for its use in the future are favorable. More detailed studies should be undertaken. Ample debates will be necessary to create standards for its formulation and clinical availability, since it is a substance that generates prejudice, due to its illegal commercialization and use, and also because its use has been attributed to mysticism.

Uso de la metadona en el tratamiento del dolor neuropático no oncológico: relato de casos

BACKGROUND AND OBJECTIVES This report includes seven patients with chronic non-oncologic neuropathic pain who have not responded to classic approaches with tricyclic antidepressant and anticonvulsant drugs. Oral methadone, a synthetic opioid similar to morphine, is referred as alternative to treat neuropathic pain due to its non-competitive antagonist action on NMDA receptors. This study aimed at evaluating methadone to treat chronic non-oncologic neuropathic pain patients who have not responded to classic approaches. CASE REPORTS Seven cases in which methadone dose was titrated in subsequent visits are presented. Pain severity according to facial scale, side effects and improved functional capacity were evaluated 1, 7, 14, 30 and 180 days after treatment beginning. There has been decrease in pain severity and in the incidence of side effects, such as constipation, sedation, nausea, headache and insomnia. There has been no euphoria, sweating, myoclonia, urinary retention, decreased libido and respiratory depression. CONCLUSIONS Patients responded satisfactorily to low dose medication, side effects were controlled with simple measures and there has been significant functional capacity improvement. In the conditions of this study, methadone was an effective, safe and low-cost option to treat non-oncologic neuropathic pain.JUSTIFICATIVA E OBJETIVOS: O relato inclui sete casos de pacientes com dor neuropatica cronica nao-oncologica que nao haviam obtido resultados satisfatorios com os tratamentos classicos com antidepressivos triciclicos e anticonvulsivantes. O uso da metadona, opioide sintetico, semelhante a morfina, por via oral, e referido como alternativa no tratamento da dor neuropatica pela sua acao antagonista nao-competitiva sobre os receptores NMDA. Este estudo tem como objetivo avaliar o uso da metadona no tratamento de pacientes portadores de dores cronicas de origem neuropatica nao-oncologica que nao melhoraram com os tratamentos classicos. RELATO DOS CASOS: Sao apresentados sete casos nos quais a dose de metadona foi titulada em consultas subsequentes e as variaveis escore da intensidade algica segundo a escala de faces, efeitos colaterais e melhora da capacidade funcional foram analisados no 1o, 7o, 14o, 30o e 180o dias apos o inicio do uso da medicacao. Houve reducao do escore da intensidade algica e a ocorrencia de efeitos colaterais como constipacao, sedacao, nauseas, cefaleia e insonia. Nao foram observados efeitos colaterais do tipo euforia, sudorese, mioclonias, retencao urinaria, reducao de libido e depressao respiratoria. CONCLUSOES: Os pacientes apresentaram resposta que foi considerada satisfatoria ao uso da medicacao, em baixas doses; controle dos efeitos colaterais com medidas simples e melhora representativa da capacidade funcional. A inclusao da metadona, nas condicoes deste estudo, mostrou-se uma opcao eficaz, segura e de baixo custo, para o tratamento das dores de origem neuropaticas nao-oncologicas.

Methadone to treat non-oncologic neuropathic pain: case reports

BACKGROUND AND OBJECTIVES This report includes seven patients with chronic non-oncologic neuropathic pain who have not responded to classic approaches with tricyclic antidepressant and anticonvulsant drugs. Oral methadone, a synthetic opioid similar to morphine, is referred as alternative to treat neuropathic pain due to its non-competitive antagonist action on NMDA receptors. This study aimed at evaluating methadone to treat chronic non-oncologic neuropathic pain patients who have not responded to classic approaches. CASE REPORTS Seven cases in which methadone dose was titrated in subsequent visits are presented. Pain severity according to facial scale, side effects and improved functional capacity were evaluated 1, 7, 14, 30 and 180 days after treatment beginning. There has been decrease in pain severity and in the incidence of side effects, such as constipation, sedation, nausea, headache and insomnia. There has been no euphoria, sweating, myoclonia, urinary retention, decreased libido and respiratory depression. CONCLUSIONS Patients responded satisfactorily to low dose medication, side effects were controlled with simple measures and there has been significant functional capacity improvement. In the conditions of this study, methadone was an effective, safe and low-cost option to treat non-oncologic neuropathic pain.JUSTIFICATIVA E OBJETIVOS: O relato inclui sete casos de pacientes com dor neuropatica cronica nao-oncologica que nao haviam obtido resultados satisfatorios com os tratamentos classicos com antidepressivos triciclicos e anticonvulsivantes. O uso da metadona, opioide sintetico, semelhante a morfina, por via oral, e referido como alternativa no tratamento da dor neuropatica pela sua acao antagonista nao-competitiva sobre os receptores NMDA. Este estudo tem como objetivo avaliar o uso da metadona no tratamento de pacientes portadores de dores cronicas de origem neuropatica nao-oncologica que nao melhoraram com os tratamentos classicos. RELATO DOS CASOS: Sao apresentados sete casos nos quais a dose de metadona foi titulada em consultas subsequentes e as variaveis escore da intensidade algica segundo a escala de faces, efeitos colaterais e melhora da capacidade funcional foram analisados no 1o, 7o, 14o, 30o e 180o dias apos o inicio do uso da medicacao. Houve reducao do escore da intensidade algica e a ocorrencia de efeitos colaterais como constipacao, sedacao, nauseas, cefaleia e insonia. Nao foram observados efeitos colaterais do tipo euforia, sudorese, mioclonias, retencao urinaria, reducao de libido e depressao respiratoria. CONCLUSOES: Os pacientes apresentaram resposta que foi considerada satisfatoria ao uso da medicacao, em baixas doses; controle dos efeitos colaterais com medidas simples e melhora representativa da capacidade funcional. A inclusao da metadona, nas condicoes deste estudo, mostrou-se uma opcao eficaz, segura e de baixo custo, para o tratamento das dores de origem neuropaticas nao-oncologicas.