Randolfo dos Santos Junior

Uso de questionários para avaliar a multidimensionalidade e a qualidade de vida do fibromiálgico

Fibromyalgia syndrome (FMS) is a painful condition of unknown etiology, highly prevalent, and associated with other conditions, which causes great impact on daily life and quality of life. OBJECTIVE: To assess, due to the multifactorial character of the FMS, the discriminating power of instruments used to identify good indicators of self-assessment and self-knowledge. PATIENTS AND METHODS: This is a descriptive, exploratory, comparative, cross-sectional study with quantitative approach, and sample comprising a treatment group (T), diagnosed with FMS (n = 63) and a control group (C), undergoing interconsultation at the Pain Outpatient Clinic (n = 75). The following instruments were used: Fibromyalgia Impact Questionnaire (FIQ); visual analogue scale (VAS); McGill Pain Questionnaire; and the Post-Sleep Inventory (PSI). To evaluate the quality of life, Medical Outcomes Study 12-item Short-Form Health Survey (SF-12) was used. RESULTS: In the two groups, female gender predominated. The mean age of the sample was 42.3 ± 4.3 years, 45% were married, and the average schooling was 8 ± 3.5 years. The mean duration of pain was 3.2 years, and a mean time of two years were required for the clinical diagnosis of FMS in group T. Group T had higher levels of pain, anxiety, and depression, worse quality of sleep, less flexibility, and worse quality of life, although some of these symptoms were also present in group C. CONCLUSIONS: All instruments had good discriminating power (P < 0.05), especially FIQ, VAS and PSI, whose areas under the ROC curve were greater

Perfil sócio-demográfico e clínico de uma coorte de pacientes encaminhados a uma Clinica de Dor

BACKGROUND AND OBJECTIVES: There is little information in Brazil about the profile of Pain Clinic users and the impact of this demand on health services. This study aimed at identifying the profile of patients referred to a Pain Clinic using socio-demographic and clinical variables obtained by specific screening, correlating such variables to pain duration and intensity. METHOD: This is a cohort descriptive, transversal and exploratory study with 128 individuals seen by an outpatient setting specialized in pain management. Independent variables included age, gender, marital status, labor status, education, religiousness, ethnicity, clinic referring patients, original diagnosis, Pain Clinic diagnosis, pain duration and type. Evaluation tools were an electronic card and the physical evaluation performed by a pain specialist. Data were collected at first visit before the interaction with any health care provider. RESULTS: Pain was more prevalent among females (58.5%), married (66.4%), inactive (62.5%) and in those with mean school attendance of 6.8 ± 3.5 years. Most have religious beliefs (93.7%). Mean pain duration was 32.6 ± 21.9 months. There has been positive correlation between pain intensity and longer duration among females and educational level lower than 5 years. (p < 0.05). CONCLUSION: Chronic pain patients previously under the care of a different specialty and referred to a Pain Clinic supply data which may contribute to control pain with more effective therapeutic approaches, by the interaction of the knowledge of different professionals.

Melhora da qualidade de vida de pacientes com dor neuropática utilizando de monitorização ambulatorial contínua

JUSTIFICATIVA E OBJETIVOS: O manuseio da dor de paciente com dor cronica exige uma abordagem multifuncional, que implica fisica, psicologica, social e ocupacional. O entendimento da fisiopatologia da dor e sua avaliacao precisam otimizar o tratamento. O objetivo deste estudo foi avaliar de forma abrangente os mais fortes preditores de qualidade de vida atraves de registros semanais realizados em regime ambulatorial e domiciliar verificando atividades de vida pratica e diaria. METODO: Foram aplicados os instrumentos: Inventario de Dor de Wisconsin, Grafico de Humor, Questionario de Dor McGill, Protocolo Pos-Sono e Questionario generico de qualidade de vida (Whoqol-bref). RESULTADOS: A atividade fisica, o desempenho ocupacional e o padrao de sono prenunciaram melhor qualidade de vida. A sensibilidade a dor, evitar o medo, e dependencia de outra pessoa sao responsaveis por quantidade significativa da variacao nas atividades propostas. Estes achados sugerem que as fontes externas de reforco e orientacao podem servir para influenciar o comportamento fisico e social alem de pistas internas, tais como evitar o medo ou a dor. CONCLUSAO: A dor cronica neuropatica deve ser avaliada em suas particularidades de apresentacao clinica, comportamental e aspectos sociais, ja que tais elementos sao fundamentais para uma boa evolucao.

Psychological assessment of patients undergoing cardiac transplant in a teaching hospital (2004 to 2012)

Objective To analyze the psychological evaluations of patients with heart failure waiting for heart transplantation. Methods The data were obtained from patient records containing pre-surgery psychological evaluations performed by psychologists from the multidisciplinary cardiology team. The evaluation protocol included the Quality of Life Questionnaire (SF-36), Beck Depression Inventory, and an interview script. Results The results of psychological evaluations performed between 2004 and 2012 for 60 candidates for heart transplantation were analyzed: 43 men and 17 women aged between 16 and 66 years (Mean=45.18; SD=11.91), predominantly from the São José do Rio Preto area (São Paulo state, Brazil) (83%), with incomplete elementary education (68%), and who were in stable relationships (73%). Although women presented higher mean scores for depression (21.41) than men (14.61), there was no significant difference between genders. Womens quality of life was impaired in all domains compared to men (below 50%) and was significantly poorer in the physical functioning (P=0.01), vitality (P=0.00), emotional role functioning (P=0.04), and mental health (P=0.02) domains. Conclusion Patients with psychosocial vulnerability (e.g., depression) identified before transplantation should receive psychological treatment.

A comunicação na transição para os cuidados paliativos: artigo de revisão

Upon receiving the diagnosis of an incurable disease and experiencing the threat or reality of losses inherent to this new condition, patients and their families experience a crisis, going through certain phases or psychological states to which the health professional must be alert in order to guide them and meet their needs. With the currently increasing demand and supply of palliative care, this study aims to present a brief review of Brazilian and foreign literature regarding communication in the transition from curative care to palliative care in oncology. A bibliographical survey was conducted and articles were analyzed from the SciELO and Medline databases from 2006 to 2013, using the keywords: Palliative care and Breaking bad news. In total, thirty-two studies deemed relevant to the topic were found and included. Of those, twenty-four were used and subdivided into the following categories: communication skills training, workshops, studies on the quality of communication, and protocols for communication in palliative care.

Self-perception of quality of life and identification of alexithymia in failed back surgery syndrome patients

JUSTIFICATIVA E OBJETIVOS: A sindrome da falha cirurgica e uma das mais frequentes entidades nosologicas em uma Clinica de Dor e caracteriza-se pela manutencao persistente de queixas algicas lombares e/ou nos membros inferiores em individuos ja submetidos a cirurgia vertebral lombar. O objetivo deste estudo foi avaliar a qualidade de vida e investigar a presenca de alexitimia em uma amostra de individuos com sindrome da falha cirurgica, e analisar as correlacoes entre intensidade de dor e presenca de sintomas de ansiedade e depressao. METODOS: Trata-se de um estudo descritivo, exploratorio, comparativo, de corte transversal com abordagem quantitativa em uma amostra composta de individuos com diagnostico de sindrome da falha cirurgica (G1) (n=38) e um grupo com dor lombar e sem intervencao cirurgica (G2) (n=42) pertencentes a uma Clinica da Dor de um hospital escola. Os participantes foram avaliados pelo Inventario Breve de Dor e a escala de Alexitimia de Toronto. Fatores emocionais como ansiedade e depressao foram avaliados pelas escalas Beck e, a qualidade de vida pelo questionario generico WHOQOL-BREF. RESULTADOS: Apontaram escores medios significativamente mais elevados de alexitimia, ansiedade e depressao no G1 e pior qualidade de vida em todos os dominios, se comparado ao G2. Correlacoes significativas entre alexitimia e depressao (p<0,01) e qualidade de vida (exceto no dominio ambiente) e ansiedade/ depressao (p<0,001). CONCLUSAO: Os resultados destacam o impacto negativo que as variaveis psicologicas, frequentemente subdiagnosticadas, tem na qualidade vida. A melhor compreensao dessas reacoes emocionais pode promover uma atuacao mais eficaz do profissional de saude.

IMPACTO FUNCIONAL NA QUALIDADE DE VIDA DE INDIVÍDUOS COM SÍNDROME DOLOROSA PÓS-LAMINECTOMIA

Introduction: Post- laminectomy syndrome (FBSS) or pain after surgical proceedings of the lumbar column cause a significant impact in the individual and in the society. It is often under treated. Objective: Evaluate the function, quality of life, fear of movement, and anxiety and depression symptoms in these patients. Patients and Method: This is a descriptive, exploratory, cross-sectional study using a quantitative approach with post laminectomy patients (n = 18) attended at a Pain Clinic. The instruments used were the Roland-Morris Questionnaire, the Beck Anxiety Inventory (BAI) and the Beck Depression Inventory (BDI). To assess the quality of life, we used the Whoqol-bref (a short version) and the Tampa Scale for kinesiophobia (KTS) for measure fear of movement. Results: The sample was predominantly female with a mean age of 42.3 ± 5.8 years, 43% married and mean schooling of 7 ± 4.5 years. It was reported an average time of pain of 8 ± 6.8 months, as well as high levels of anxiety, depression, and kinesiophobia. Conclusion: This study demonstrates the great inconvenience that this syndrome causes in patients. It provokes disability, pain, poor quality of life, and it impairs emotional and physical situations as well. This study depicts the great inconvenience that this syndrome causes in patients. It provokes disability, pain, poor quality of life, and it impairs emotional and physical situations as well. There is the need to make changes in the treatment of this particularly vulnerable population. Descriptors: Laminectomy; Quality of life; Chronic Pain.

Tratamento da hepatite C: impacto sobre o cuidador

The purpose of this study was to identify levels of stress, symptoms of depression, burden and coping strategies among caregivers of patients undergoing treatment for Hepatitis C at the Hospital de Base, Sao Jose do Rio Preto, Sao Paulo. Participants were 43 caregivers assessed before, during and after treatment with the Stress Symptoms Inventory (ISSL), the Beck Depression Inventory, the Ways of Coping Scale and the Burden Interview. Caregivers were mostly women (n = 31), adults and family members. Mean burden scores were 22.2 (SD = 9.2). There was an increase of patients with stress and with depression symptoms during the treatment (p = 0.03). Caregivers used more problem focused coping.