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Objetivos: Este estudo objetivou construir e auferir evidências de validação de uma cartilha educativa para pessoas com doença falciforme, contendo oito práticas voltadas a promover a saúde visando a melhor qualidade de vida. Métodos: Trata-se de estudo metodológico realizado a partir da construção do material educativo, com posterior validação por juízes especialistas na área, e pelo público-alvo. Para estruturação do conteúdo, foi realizada revisão narrativa da literatura, bem como consulta a especialistas. O desenvolvimento e operacionalização do gênero textual levou em conta um modo lúdico e atrativo ao escolher o formato do produto educativo, elegendo-se o formato de história em quadrinhos. A validação de conteúdo foi estabelecida levando-se em conta o Content Validity Index (CVI) maior do que 80%. Resultados: Todos os juízes especialistas concordaram que a cartilha aborda hábitos que podem ser benéficos a indivíduos com doença falciforme. Foram aceitas as sugestões enviadas, como simplificação do vocabulário, troca do tipo de fonte, aumento da arte das hemácias e outras. Todos os itens foram avaliados como pertinentes, e o CVI alcançou média de 0,96. Após os ajustes sugeridos pelos juízes, o material foi apresentado a dez pessoas adultas com doença falciforme que o aprovaram. Conclusões: A cartilha foi considerada válida pela confiabilidade reconhecida por profissionais especializados em doença falciforme e em qualidade de vida quanto ao conteúdo, incluindo linguagem adotada, temas abordados e ilustrações. Sugere-se utilizar a história em quadrinhos nas redes sociais e por meio impresso para distribuição de profissionais de saúde e agentes comunitários.

Objectives. To assess the effectiveness of transcranial direct current stimulation (tDCS) for pain, fatigue, physical function, and health-related quality of life in patients with idiopathic inflammatory myopathy (IIM). Methods. This randomized, double-blind, sham-controlled, crossover clinical trial enrolled IIM patients with fatigue and pain who received tDCS (20 min, 2 mA) or sham stimulation for 10 daily sessions. Electrodes were placed according to the 10/20 EEG system. Both the groups underwent aerobic exercise training during the intervention period. The patients were evaluated for disease perception, pain, and fatigue using uni-multidimensional questionnaires and physical tests in the periods before and after the first and second interventions and after 12 weeks of follow-up. Results. After the tDCS intervention, a reduction in the general score of multidimensional pain of 32.0 (1.5-38.0) vs. 0.0 (0.0-13.4) with effect size (ES) of -0.78 was noted, and after sham intervention, a reduction of 26.0 (0.0-37.0) vs. 5.0 (0.0-19.2) with ES of -0.54 (P=0.047) was also noted. Similar results were evidenced with fatigue (22.5 (15.4-33.2) vs. 5.5 (0.0-14.6) with ES of -0.82) and sham intervention (21.0 (15.8-29.5) vs. 4.0 (4.0-17.5) with ES of -0.80 (P=0.012)). There were no differences in the domains of the fatigue and pain questionnaires. Adherence was observed in 88.8% of the patients without adverse events. Conclusion. The association of tDCS with aerobic training promoted additional effects in relation to the group subjected to placebo stimulation on general pain and fatigue scores, as well as on pain intensity, without changes in the subdomains of the pain and fatigue questionnaire. This trial is registered with NCT04678635.

ABSTRACT Background: Brazil has a top position regarding scientific production on noninvasive neuromodulation worldwide. Knowledge of scientometric phenomena involving Brazilian researchers who produce science on this theme may aid confidence in Brazilian clinical and research professionals. Objective: To investigate the scenario of research on the theme of noninvasive neuromodulation in Brazil. Methods: This was a scientometric study for mapping scientific production on this subject involving network phenomena, the professions of researchers, institutional affiliation, main research unit, total number of scientific articles on noninvasive neuromodulation published in journals, research sub-area and year of obtaining the PhD title. Public data from Lattes Platform curricula vitae and from VOSViewer© were used. Results: A total of 54 Brazilian researchers were identified, of whom 16 are research productivity fellows. Most of them are linked to institutions in southeastern Brazil, involving the professions of biology, biochemistry, physical education, physiotherapy, speech therapy, gerontology, medicine and psychology, with 1175 articles published in journals. These studies involve experimental animal and human models to account for mechanisms, observational studies, case reports, randomized clinical trials, systematic reviews, meta-analyses, product and process development, computer modeling and guidelines. Conclusions: Brazil occupies a prominent place in the world scenario of research on noninvasive neuromodulation, which is used by different professions for treatment of brain dysfunctions, with a trend towards expansion to other fields.

Chronic joint pain (CJP) is among the significant musculoskeletal comorbidities in sickle cell disease (SCD) individuals. However, many healthcare professionals have difficulties in understanding and evaluating it. In addition, most musculoskeletal evaluation procedures do not consider central nervous system (CNS) plasticity associated with CJP, which is frequently maladaptive. This review study highlights the potential mechanisms of CNS maladaptive plasticity related to CJP in SCD and proposes reliable instruments and methods for musculoskeletal assessment adapted to those patients. A review was carried out in the PubMed and SciELO databases, searching for information that could help in the understanding of the mechanisms of CNS maladaptive plasticity related to pain in SCD and that presented assessment instruments/methods that could be used in the clinical setting by healthcare professionals who manage chronic pain in SCD individuals. Some maladaptive CNS plasticity mechanisms seem important in CJP, including the impairment of pain endogenous control systems, central sensitization, motor cortex reorganization, motor control modification, and arthrogenic muscle inhibition. Understanding the link between maladaptive CNS plasticity and CJP mechanisms and its assessment through accurate instruments and methods may help healthcare professionals to increase the quality of treatment offered to SCD patients.

Introduction: Knowledge on the characteristics of neuropathic pain in people with sickle cell disease (SCD) may help to provide more effective treatment procedures. Objective: To describe the characteristics of neuropathic pain in patients with sickle cell disease and identify the impact on their quality of life. Method: A cross-sectional study (CAAE 57274516.8.0000.5544) was conducted at a reference center in Salvador, Bahia, Brazil. The instruments used were the Brief Pain Inventory (BPI), the Douleur Neuropatique Questionnaire (DN-4), the Anxiety and Depression Hospital scale (ADH) and the abbreviated version of the World Health Organization of Quality of Life questionnaire (WHOQOL-brief). The Mann-Whitney test was used to evaluate the association between the scores (5% alpha). Results: A total of 100 adults with SCD participated in the study, 69.7% of whom had neuropathic pain. Anxiety was present in 99% of the sample and depression, in 100%. Patients with neuropathic pain had worse scores in all domains of quality of life (p

Context: Thousands of people worldwide have been infected by the chikungunya virus (CHIKV), and the persistence of joint pain symptoms has been considered the main problem. Neuromodulation techniques such as transcranial direct current stimulation (tDCS) act on brain areas involved in the processing of chronic pain. It was previously demonstrated that tDCS for five consecutive days significantly reduced pain in the chronic phase of chikungunya (CHIK). Objective: To analyze the effect of alternate tDCS sessions on pain and functional capacity in individuals affected by CHIK. Methods: In a randomized clinical trial, 58 women in the chronic phase of CHIK were divided into two groups: active-tDCS (M1-S0, 2 mA, 20 min) and sham-tDCS. The Visual Analogue Scale (VAS) and the Brief Pain Inventory (BPI) were used to assess pain, while the Health Assessment Questionnaire (HAQ) assessed functional capacity. These scales were used before and after six sessions of tDCS in nonconsecutive days on the primary motor cortex, and at follow-up consultation 7 and 15 days after the last session. A repeated measures mixed-model ANOVA was used for comparison between groups (significant p-values

Introdução – Uma boa comunicação entre profissionais de saúde e pacientes favorece vínculos e transmissão de conhecimento. Os materiais socioeducativos podem ampliar essa comunicação, complementar informações, favorecer a autonomia e serem consultados inúmeras vezes. Objetivo – Identificar a metodologia utilizada para a elaboração de materiais de educação em saúde impressos para adultos. Métodos – Foi realizada uma revisão integrativa, de acordo com o PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analysis), por dois investigadores independentes nas bases de dados PubMed e SciELO. A seleção envolveu a leitura de títulos, resumos e textos completos. Foram incluídos estudos reprodutíveis, sem delimitação de tempo e idioma; e foram excluídos os materiais para educação profissional, de crianças e duplicados. Resultados – Foram selecionados treze artigos que envolveram a aproximação do público-alvo e/ou pesquisa do tema na literatura nas bases PubMed, SciELO, Lilacs e literatura cinzenta. Houve um consenso quanto à necessidade de linguagem clara e compreensível, ilustrações e diagramação para facilitar a compreensão. Conclusões – A metodologia para elaboração de materiais educativos em saúde é diversa, baseia-se em revisão da literatura, aproximação com o público-alvo, mas nem sempre avalia o nível de alfabetização em saúde do público-alvo.

BACKGROUND: The main symptoms of myelopathy associated with human T-cell lymphotropic virus type 1 or tropical spastic paraparesis (HAM / TSP) are the presence of high intensity pain in the lower back, spasticity and weakness in the lower limbs, loss of balance and difficulties in locomotion. Pulsed Transcranial Magnetic Stimulation (rTMS) has been able to influence cortical plasticity, decreasing spasticity, increasing motor performance and promoting analgesia in several similar conditions. OBJECTIVE: To analyze the effect of neuromodulation by pulsed transcranial magnetic stimulation (rTMS) on pain and functional mobility in individuals with HAM / TSP. METHODOLOGY: A randomized clinical trial will be conducted in a sample made up of 40 participants randomly allocated into two groups: Sham Group (SG) with 20 and Test Group (TG) with 20 patients. Individuals aged> 20 years, community walkers with or without orthosis, with chronic pain (? 6 months) in the lumbar region and / or lower limbs will be included. Individuals with epilepsy, cancer, pregnant women, patients with cardiac pacemakers, metallic implants in the brain or skull, users of illicit drugs and / or use of controlled medications in the last six months will be excluded. The protocol will be applied for 10 consecutive days with eight months of follow-up. Our hypothesis is that when using rTMs according to the proposed procedure, it will be possible to relieve pain and improve the functional mobility of these individuals with a long-lasting effect. CONCLUSION: We hope that rTMS is a promising treatment to reduce pain intensity and to improve functional mobility in individuals undergoing active modality. We declare this protocol a promising resource for the treatment of htlv-1 individuals in reducing pain and improving functional mobility. Yes, this protocol has already been applied to 6 patients. However, with the pandemic the study had to be discontinued. However, despite the small sample size and not being fully applied as suggested by the protocol, it was possible to notice a satisfactory result of the intervention. Thus, the application of this protocol can contribute to identify the result of this therapeutic modality in a safer way, as well as assist in the treatment of symptoms of this population, favoring a better quality of life.

ABSTRACT Background: Central neuropathic pain (CNP) is often refractory to available therapeutic strategies and there are few evidence-based treatment options. Many patients with neuropathic pain are not diagnosed or treated properly. Thus, consensus-based recommendations, adapted to the available drugs in the country, are necessary to guide clinical decisions. Objective: To develop recommendations for the treatment of CNP in Brazil. Methods: Systematic review, meta-analysis, and specialists opinions considering efficacy, adverse events profile, cost, and drug availability in public health. Results: Forty-four studies on CNP treatment were found, 20 were included in the qualitative analysis, and 15 in the quantitative analysis. Medications were classified as first-, second-, and third-line treatment based on systematic review, meta-analysis, and expert opinion. As first-line treatment, gabapentin, duloxetine, and tricyclic antidepressants were included. As second-line, venlafaxine, pregabalin for CND secondary to spinal cord injury, lamotrigine for CNP after stroke, and, in association with first-line drugs, weak opioids, in particular tramadol. For refractory patients, strong opioids (methadone and oxycodone), cannabidiol/delta-9-tetrahydrocannabinol, were classified as third-line of treatment, in combination with first or second-line drugs and, for central nervous system (CNS) in multiple sclerosis, dronabinol. Conclusions: Studies that address the treatment of CNS are scarce and heterogeneous, and a significant part of the recommendations is based on experts opinions. The CNP approach must be individualized, taking into account the availability of medication, the profile of adverse effects, including addiction risk, and patients' comorbidities.

Abstract Background: Physical therapy has positive results in people with tropical spastic paraparesis (TSP). However, mobility and distance from rehabilitation centers limit the participation in outpatient programs. Objective: To evaluate the impact of a home exercise program on the posture and functional mobility of people with TSP. Methods: A randomized controlled trial comparing three groups of people who performed guided exercises from a guidebook for six months: supervised (SG), unsupervised (WG), and control (CG). Primary outcomes: postural angles (SAPO®) and functional mobility (TUG). Secondary outcomes: gait parameters (CVMob®). Results: The protocol described in the guidebook improved postural angles and functional mobility. There were also positive gait parameter effects (p

Abstract Transcranial Direct Current Stimulation (tDCS) is a non-invasive technique used to modulate neural tissue. Neuromodulation apparently improves cognitive functions in several neurologic diseases treatment and sports performance. In this study, we present a comprehensive, integrative review of tDCS for motor rehabilitation and motor learning in healthy individuals, athletes and multiple neurologic and neuropsychiatric conditions. We also report on neuromodulation mechanisms, main applications, current knowledge including areas such as language, embodied cognition, functional and social aspects, and future directions. We present the use and perspectives of new developments in tDCS technology, namely high-definition tDCS (HD-tDCS) which promises to overcome one of the main tDCS limitation (i.e., low focality) and its application for neurological disease, pain relief, and motor learning/rehabilitation. Finally, we provided information regarding the Transcutaneous Spinal Direct Current Stimulation (tsDCS) in clinical applications, Cerebellar tDCS (ctDCS) and its influence on motor learning, and TMS combined with electroencephalography (EEG) as a tool to evaluate tDCS effects on brain function.

INTRODUCTION: Temporomandibular disorder (TMD) is currently considered a central sensitization syndrome that belongs to the orofacial nociplastic pain group and offers great challenges for clinical practice. It can also be identified in individuals with sickle cell disease. Neuromodulation is a promising therapy that can help individuals with refractory chronic pain. To our knowledge, there is no treatment proposal for these individuals with chronic orofacial pain resulting from sickle cell disease. OBJECTIVE: This is a protocol of a randomized, double-blind, cross-over clinical trial. The purpose of this protocol is to investigate whether the immediate effect of transcranial direct current stimulation can be increased by adding the effect of peripheral sensory electrical stimulation. METHODS: Twenty women between 18 and 49 years of age will be screened to participate in this cross-over study where they will all receive the three types of protocol with a one-week washout. Active transcranial Direct Current Stimulation (tDCS) + active Peripheral Electrical Stimulation (PES); Active tDCS + PES sham and tDCS sham + PES sham. Stimulation with tDCS will be at 2 mA anodic over the motor cortex for 20 minutes ipsilateral to the most painful temporomandibular joint (TMJ). Peripheral electrical stimulation will be at 100 Hz over the most painful TMJ masseter muscle for 30 min. OUTCOME: The main outcome will be pain intensity assessed by VAS scale and by a pressure algometer in grams. In addition, endogenous pain modulation will be analyzed through the temporal summation of pain with Aesthesio precision tactile sensory filaments and conditioned pain modulation (CPM) evaluated by an algometer and thermal conditioned stimulus, as secondary outcomes. Data will be analyzed using ANOVA of repeated measures, controlling for confounding variables.

We will study the influence of low intensity and frequency surface peripheral electrical stimulation (PES) on nerve regeneration of digital nerve injuries of the hand after its surgical repair in humans. Participants will be patients with acute traumatic peripheral nerve injury referred to the Hand Surgery Service of the General Hospital of the State of Bahia, a reference service in the state. These patients will undergo surgery followed by PES in the immediate postoperative period. After hospital discharge, they will be followed up on an outpatient basis by researchers, who will remotely supervise a physiotherapy program. Our hypothesis is that PES will positively influence the recovery of sensory function in patients undergoing neurorrhaphy of digital nerves of the hand. ReBEC registration: U1111-1259-1998 (12/18/2020)

Background: Novel coronavirus disease (COVID-19) morbidity is not restricted to the respiratory system, but also affects the nervous system. Non-invasive neuromodulation may be useful in the treatment of the disorders associated with COVID-19.Objective: To describe the rationale and empirical basis of the use of non-invasive neuromodulation in the management of patients with COVID-10 and related disorders.Methods: We summarize COVID-19 pathophysiology with emphasis of direct neuroinvasiveness, neuroimmune response and inflammation, autonomic balance and neurological, musculoskeletal and neuropsychiatric sequela. This supports the development of a framework for advancing applications of non-invasive neuromodulation in the management COVID-19 and related disorders.Results: Non-invasive neuromodulation may manage disorders associated with COVID-19 through four pathways: (1) Direct infection mitigation through the stimulation of regions involved in the regulation of systemic anti-inflammatory responses and/or autonomic responses and prevention of neuroinflammation and recovery of respiration; (2) Amelioration of COVID-19 symptoms of musculoskeletal pain and systemic fatigue; (3) Augmenting cognitive and physical rehabilitation following critical illness; and (4) Treating outbreak-related mental distress including neurological and psychiatric disorders exacerbated by surrounding psychosocial stressors related to COVID-19. The selection of the appropriate techniques will depend on the identified target treatment pathway.Conclusion: COVID-19 infection results in a myriad of acute and chronic symptoms, both directly associated with respiratory distress (e.g., rehabilitation) or of yet-to-be-determined etiology (e.g., fatigue). Non-invasive neuromodulation is a toolbox of techniques that based on targeted pathways and empirical evidence (largely in non-COVID-19 patients) can be investigated in the management of patients with COVID-19.

Abstract INTRODUCTION: A good rating of the device in people with HTLV-1 in this population is essential for accuracy in prescribing data (walking). Thus, this study aimed to analyze the counterpart assessment methods that are best suited to patients with human T-cell lymphotropic virus (HTLV)-1 associated myelopathy or tropical spastic paraparesis (HAM/TSP). METHODS: This cross-sectional study related stabilometric and kinematic variables of postural oscillations with Berg’s balance scale (BBS) and Timed Up and Go (TUG) in subjects with HAM/TSP compared to asymptomatic subjects. To assess the posterior and lateral postural projection, baropodometry and the Footwork® system was used, and the CVMob system was applied to kinematic parameters. The means comparison tests and correlations were applied with an alpha of 5%. RESULTS: Thirty-nine subjects (predominantly female) made up the sample. There was an increase in barodopometric oscillations, in the total oscillation area (p = 0.004), in the anteroposterior oscillation in the left (p = 0.015) and right views (p = 0.036), and in the lateral oscillation (p = 0.039) in the HAM/TSP group. Moderate correlations were found between oscillation baropodometry and the angular variation of the ankle, as well as with the BBS in the three angles and the TUG for lateral oscillation (p = 0.406). CONCLUSIONS: Each method has advantages and disadvantages, including cost accuracy. The best resources available at no additional cost for outpatient to use are the kinematic evaluation using a simple smartphone camera and free analysis software, and the TUG.

The coronavirus disease 19 (COVID-19) pandemic has resulted in the urgent need to develop and deploy treatment approaches that can minimize mortality and morbidity. As infection, resulting illness, and the often prolonged recovery period continue to be characterized, therapeutic roles for transcranial electrical stimulation (tES) have emerged as promising non-pharmacological interventions. tES techniques have established therapeutic potential for managing a range of conditions relevant to COVID-19 illness and recovery, and may further be relevant for the general management of increased mental health problems during this time. Furthermore, these tES techniques can be inexpensive, portable, and allow for trained self-administration. Here, we summarize the rationale for using tES techniques, specifically transcranial Direct Current Stimulation (tDCS), across the COVID-19 clinical course, and index ongoing efforts to evaluate the inclusion of tES optimal clinical care.

Abstract. Chronic pain (CP) is prevalent worldwide. Current reports on its prevalence in developing countries are heterogeneous, and to date, there is no quantitative synthesis providing a general estimation of its magnitude in the developing world. The goal of this study was to estimate the pooled prevalence of CP in the general population in developing countries. This was a PROSPERO-registered CRD42019118680 systematic review including population-based cross-sectional studies on CP from countries with ≤0.8 human developing index. We calculated prevalence using both random effects and fixed effects. Heterogeneity was calculated by the Cochran Q test and the I2 statistic. Publication bias was evaluated by visual inspection of the Egger funnel plot, as well as by the Begg rank test and the Egger linear test. Sources of heterogeneity were also explored in subgroup analyses. Twelve studies with a total of 29,902 individuals were included in this meta-analysis, of which 7263 individuals were identified with CP. The overall pooled prevalence of CP after correction for publication bias was 18% (95% confidence interval: 10%–29%), the sample presenting significant heterogeneity (I2 = 100%, P < 0.001). Subgroup analyses demonstrated that year of publication and the adopted threshold for pain chronicity could partially explain the observed heterogeneity (P < 0.05). The proportion of individuals with CP in the general population of developing countries was 18%. However, reports of prevalence have high variability, especially related to year of publication and the threshold level adopted for pain chronicity.

Abstract Background Knee 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. Methods Patients 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. Discussion The 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 registration ID: RBR-9D7C7B . Registered on 29 February 2016.

ABSTRACT BACKGROUND AND OBJECTIVES: Chronic pain is considered a public health problem. The best way to deal with it is still a challenge. However, socio-educational interventions have been recommended in national and international guidelines that deal with it. The objective of this study was to develop an educational booklet written in the Brazilian Portuguese language for people who face the problem of chronic pain. METHODS: This study on the development of a light technology was conducted in three phases: the narrative of the literature review to identify the appropriate content; the approach of target audience through structured interviews; and the elaboration of a booklet by professionals specialized in the treatment of chronic pain. RESULTS: The study resulted in the production of a booklet named “EducaDor,” ludically illustrated with 18 pages, divided into the following sections: 1. What is pain? 2. Acute pain: useful pain; 3. Chronic pain: the persistent pain; 4. Living with the pain; 5. False ideas about chronic pain, do not believe them; 6. Strategies to deal with the pain. Using plain language, the booklet provides data on neurophysiology and psychological and behavioral aspects related to chronic pain. The booklet can contribute to modifying misbeliefs about pain and bad behaviors, as well as to provide strategies to cope with chronic pain. CONCLUSION: This study has successfully developed a light health technology which offers inputs for socio-educational programs to handle chronic pain.

Objective: To describe the pain in patients infected with human T-cell lymphotropic virus type 1, clinically and epidemiologically. Methods: This systematic review was based on The PRISMA Statement. Four reviewers searched PUBMED, SciELO, LILACS and BIREME for data from observational studies and clinical trials (n ≥ 30) regarding pain prevalence, characteristics, and associated factors in patients with human T-cell lymphotropic virus type 1. No limits on publication date or language were established. Studies that did not have pain as an outcome measure or not involving human T-cell lymphotropic virus type 1 infected patients were excluded. Results: A total of 3013 articles (including duplicates) were found of which seven met the predetermined criteria. The most common pain region was the lower back (53.0%). Non-neuropathic type (ranging from 52.6% to 86.8%) was more frequent in human T-cell lymphotropic virus type 1-associated myelopathy/tropical spastic paraparesis participants, and neuropathic pain was more common in human T-cell lymphotropic virus type 1 carriers (53.1%). The pain was mostly reported as moderate or severe. One study showed that chronic pain was negatively associated with quality of life. Discussion: Pain is a common complaint in human T-cell lymphotropic virus type 1 infected patients, with lower back pain as the most frequent site. Pain can either be nociceptive, neuropathic, or both, is frequently severe, and negatively affects quality of life. Only studies of two countries were included in this review, limiting the external validity of the conclusions. The heterogeneity of variables prevented us from implementing a meta-analysis. Further research should better characterize the pain and explore its impact on quality of life, especially using longitudinal study design. Keywords: HTLV-1, HAM/TSP, Pain, Prevalence

Abstract INTRODUCTION: Human T-cell lymphotropic virus type 1-associated myelopathy or tropical spastic paraparesis (HAM/TSP) causes, among other abnormalities, chronic pain that may impair quality of life (QOL). Home protocols can help those who have difficulty attending rehabilitation centers. This study aimed to evaluate the impact of a home-based exercise protocol on pain and QOL in people with HAM/TSP. METHODS: A randomized clinical trial of people with HAM/TSP (World Health Organization criteria) classified as probable or definite. The supervised group (SG) underwent training for 12 weeks and continued the protocol at home for another 12 weeks; the unsupervised group (UG) performed the same protocol at home without physical therapist supervision for 24 weeks; and the control group (CG) maintained the usual care. QOL was assessed by the Short Form-36 health survey and the pain condition by the Brief Pain Inventory (BPI). The Chi-square, analysis of variance, Kruskal-Wallis, and Friedman tests (5% alpha) were used for the analyses. The intention-to-treat method was adopted in case of follow-up losses. Record number RBR-849jyv/UTN: U1111-1176-2858. RESULTS: Of 56 participants, 49 completed the protocol. Mean pain was moderately reduced (>30%) in the UG and CG and mildly reduced (20%) in the SG. Loss in the vitality score of QOL in the CG was noted. CONCLUSIONS: The protocol generated mild and moderate pain relief and reduced losses in the functional QOL in the treatment groups.

Abstract. Introduction:. Chronic pain (CP) is highly prevalent and generally undertreated health condition. Noninvasive brain stimulation may contribute to decrease pain intensity and influence other aspects related to CP. Objective:. To provide consensus-based recommendations for the use of noninvasive brain stimulation in clinical practice. Methods:. Systematic review of the literature searching for randomized clinical trials followed by consensus panel. Recommendations also involved a cost-estimation study. Results:. The systematic review wielded 24 transcranial direct current stimulation (tDCS) and 22 repetitive transcranial magnetic stimulation (rTMS) studies. The following recommendations were provided: (1) Level A for anodal tDCS over the primary motor cortex (M1) in fibromyalgia, and level B for peripheral neuropathic pain, abdominal pain, and migraine; bifrontal (F3/F4) tDCS and M1 high-definition (HD)-tDCS for fibromyalgia; Oz/Cz tDCS for migraine and for secondary benefits such as improvement in quality of life, decrease in anxiety, and increase in pressure pain threshold; (2) level A recommendation for high-frequency (HF) rTMS over M1 for fibromyalgia and neuropathic pain, and level B for myofascial or musculoskeletal pain, complex regional pain syndrome, and migraine; (3) level A recommendation against the use of anodal M1 tDCS for low back pain; and (4) level B recommendation against the use of HF rTMS over the left dorsolateral prefrontal cortex in the control of pain. Conclusion:. Transcranial DCS and rTMS are recommended techniques to be used in the control of CP conditions, with low to moderate analgesic effects, and no severe adverse events. These recommendations are based on a systematic review of the literature and a consensus made by experts in the field. Readers should use it as part of the resources available to decision-making.

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

Resumo Objetivo: Testar a confiabilidade e a validade do escore Aofas em uma amostra de pacientes com artrite reumatoide. Métodos: A escala foi aplicada a pacientes com artrite reumatoide, duas vezes pelo entrevistador 1 e uma vez pelo entrevistador 2. O Aofas foi submetido a exame de confiabilidade teste-reteste (com 20 indivíduos com artrite reumatoide). As propriedades psicométricas foram investigadas pela análise Rasch em 33 pacientes com artrite reumatoide. Resultados: O coeficiente de correlação intraclasse (CCI) foi de 0,90 < CCI < 0,95 (p < 0,001) para a confiabilidade intraexaminador e 0,75 < CCI < 0,91 (p < 0,001) para a confiabilidade interexaminador. O índice de separação dos indivíduos foi de 1,9 e 4,75 para os itens. Isso demonstra que os pacientes se dividiam em três níveis de habilidade e os itens foram divididos em seis níveis de dificuldades. A análise Rasch mostrou que oito itens foram satisfatórios. Foi identificado um item errôneo, que mostrou percentuais acima dos 5% permitidos pelo modelo estatístico. Além disso, o modelo Rasch sugeriu a revisão do item 8 original. Conclusões: Os resultados sugerem que a versão brasileira do Aofas apresenta confiabilidade adequada, validade de constructo e estabilidade de resposta. Esses resultados indicam que a escala de tornozelo-retropé Aofas apresenta um potencial significativo de aplicabilidade clínica em indivíduos com artrite reumatoide. Outros estudos em populações com outras características já estão em andamento.

Objetivo Traduzir e adaptar culturalmente o Shoulder Rating Questionnaire (SRQ) para o idioma português do Brasil, e determinar sua validade, confiabilidade e sensibilidade à mudança em pacientes com comprometimento funcional do ombro. Métodos Em seguida à tradução e retro-tradução da versão original por quatro tradutores independentes, o instrumento foi revisado por uma comissão de especialistas, tendo sido subsequentemente aplicado a oito pacientes com lesão do ombro (público-alvo) para a produção da versão em português. Em seguida, essa versão foi aplicada a 102 pacientes selecionados de nossos centros de referência para tratamento funcional do ombro, exibindo diagnósticos clínicos, níveis educacionais e bases socioeconômicas e culturais diversas. A avaliação foi realizada duas vezes com um intervalo de quatro semanas entre aplicações. Resultados A versão brasileira do SRQ foi equivalente em termos de semântica, tendo demonstrado bons níveis de confiabilidade (Alfa de Cronbach=0,89 e Coeficiente de Correlação Intraclasse [CCI]=0,83). A reprodutibilidade foi alta (Coeficiente de Correlação de Spearman=0,82) e a validade dos itens, que variou de 0,54 até 0,99, foi considerada excelente. Os testes d de Cohen e T para medidas repetidas demonstraram que o instrumento é capaz de monitorar e acompanhar melhoras na função do ombro. Conclusão Os critérios psicométricos foram atendidos, o que justifica a aplicabilidade da versão brasileira do SRQ em indivíduos com comprometimento funcional do ombro.

Patients with chronic pain due to neuropathy or musculoskeletal injury frequently exhibit reduced alpha and increased theta power densities. However, little is known about electrical brain activity and chronic pain in patients with rheumatoid arthritis (RA). For this purpose, we evaluated power densities of spontaneous electroencephalogram (EEG) band frequencies (delta, theta, alpha, and beta) in females with persistent pain due to RA. This was a cross-sectional study of 21 participants with RA and 21 healthy controls (mean age = 47.20; SD = 10.40). EEG was recorded at rest over five minutes with participant's eyes closed. Twenty electrodes were placed over five brain regions (frontal, central, parietal, temporal, and occipital). Significant differences were observed in depression and anxiety with higher scores in RA participants than healthy controls (p = .002). Participants with RA exhibited increased average absolute alpha power density in all brain regions when compared to controls (F (1.39) = 6.39, p = .016), as well as increased average relative alpha power density (F (1.39) = 5.82, p = .021) in all regions, except the frontal region, controlling for depression/anxiety. Absolute theta power density also increased in the frontal, central, and parietal regions for participants with RA when compared to controls (F(1,39) = 4.51, p = .040), controlling for depression/anxiety. Differences were not exhibited on beta and delta absolute and relative power densities. The diffuse increased alpha may suggest a possible neurogenic mechanism for chronic pain in individuals with RA.

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.

OBJECTIVE: To assess the quality of life (QoL) of patients with HTLV-I-associate myelopathy/tropical spastic paraparesis (HAM/TSP) and to correlate it with specific aspects of the disease. METHODS: Fifty-seven HAM/TSP patients completed the SF-36 QoL questionnaire. They were also asked about common complaints related to the disease, and we looked for associations between QoL and these complaints. RESULTS: Patients with HAM/TSP showed a strong negative association to QoL. Pain was the condition which most affected their QoL. The practice of physical activity is associated with better QoL in five out of eight domains of the scale. CONCLUSION: HAM/TSP leads to a poor QoL, mostly influenced by pain. Physical activity may have a positive association to QoL of these patients.OBJETIVO: Avaliar a qualidade de vida (QV) em pacientes com mielopatia associada ao HTLV-I/paraparesia espástica tropical (MAH/PET) e correlacioná-la com aspectos específicos da doença. MÉTODOS: Cinquenta e sete pacientes com MAH/PET completaram o questionário de qualidade de vida SF-36. Também foram feitas perguntas sobre queixas comuns relacionadas à doença e investigadas posteriormente associações entre QV e essas queixas. RESULTADOS: Pacientes com MAH/PET apresentaram uma associação negativa com a QV. A dor foi a condição que mais afetou a QV. A prática de atividade física foi associada a uma melhor QV em cinco dos oito domínios da escala. CONCLUSÃO: MAH/PET leva a uma pior QV, principalmente influenciada pela dor. A atividade física pode estar positivamente associada à QV destes pacientes.

OBJETIVO: Estimar a prevalência de dor crônica, identificando os fatores associados. MÉTODOS: Estudo transversal realizado em amostra populacional de 2.297 indivíduos com idade igual ou superior a 20 anos, em Salvador (BA), em 1999 e 2000. Aplicou-se em domicílio questionário padronizado para coleta de dados sobre dor e características sociodemográficas e a medida da circunferência abdominal. O critério para classificação de dor crônica foi duração superior a seis meses. Foram estimadas as prevalências de dor por razão de prevalência ajustada com intervalo com 95% de confiança e valor de pOBJETIVO: Estimar la prevalencia de dolor crónico, identificando los factores asociados. MÉTODOS: Estudio transversal realizado en muestra poblacional de 2.297 individuos con edad igual o superior a 20 años, en Salvador (Noreste de Brasil), en 1999 y 2000. Se aplicó en domicilio cuestionario estandarizado para colectar datos sobre dolor y características sociodemográficas y la medida de la circunferencia abdominal. El criterio para clasificación de dolor crónico fue duración superior a seis meses. Fueron estimadas las prevalencias de dolor por razón de prevalencia ajustada con intervalo con 95% de confianza y valor de pOBJECTIVE: To estimate the prevalence of chronic pain, identifying the associated factors. METHODS: A 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

Current standardized treatments for cognitive impairment in attention-deficit/hyperactivity disorder remain limited and their efficacy restricted. Transcranial direct current stimulation (tDCS) is a promising tool for enhancing cognitive performance in several neuropsychiatric disorders. Nevertheless, the effects of tDCS in reducing cognitive impairment in patients with attention-deficit/hyperactivity disorder (ADHD) have not yet been investigated.A parallel, randomized, double-blind, sham-controlled trial was conducted to examine the efficacy of tDCS on the modulation of inhibitory control in adults with ADHD. Thirty patients were randomly allocated to each group and performed a go/no-go task before and after a single session of either anodal stimulation (1 mA) over the left dorsolateral prefrontal cortex or sham stimulation.A nonparametric two-sample Wilcoxon rank-sum (Mann-Whitney) test revealed no significant differences between the two groups of individuals with ADHD (tDCS vs. sham) in regard to behavioral performance in the go/no go tasks. Furthermore, the effect sizes of group differences after treatment for the primary outcome measures-correct responses, impulsivity and omission errors--were small. No adverse events resulting from stimulation were reported.According to these findings, there is no evidence in support of the use of anodal stimulation over the left dorsolateral prefrontal cortex as an approach for improving inhibitory control in ADHD patients. To the best of our knowledge, this is the first clinical study to assess the cognitive effects of tDCS in individuals with ADHD. Further research is needed to assess the clinical efficacy of tDCS in this population.ClinicalTrials.gov NCT01968512.

ABSTRACTBACKGROUND AND OBJECTIVES:Chronic pain affects thousands of people, changing their functionality and emotional status. The Brief Pain Inventory has not been used in populational studies and may be a relevant tool. This study aimed at characterizing chronic pain sensory aspects and their influence on daily life activities.METHODS:This is a cross-sectional populational study carried out in a Family Health Unit (Salvador/BA/Brazil). Participated in the study 191 individuals aged 20 years or above, with pain for six months or longer. Brief Pain Inventory was used as evaluation tool because it has sensory aspects as predicting variables and reactive aspects as outcome variables. Chi-square test was used for proportional analysis and Spearman correlation test was used for intergroup comparisons.RESULTS:Sample was made up of 86.4% females, single (48.7%), non white (49.7%), low education (46.6%) and low socio-economic level (100.0%). Most participants (46.8%) have reported pain for at least five years, with predominance of knees (46.1%) and lumbar spine (42.4%), being that 77.5% of the population made systematic use of some painkiller. There has been negative correlation between sensory and reactive variables: general activities (p

ABSTRACT Objective: To check sensitivity and specificity of assessment instruments of QoL in patients with rheumatoid arthritis (RA). Methodology: Accuracy study in a sample consisting of patients with confirmed diagnosis of RA. QoL questionnaires QV SF-36 (Gold Standard), HAQ and NHP were applied. The Pearson correlation coefficient, ROC curve, AUC and Youden Index (J) were used to analyze the data. Results: This study enrolled 97 individuals with RA. The functional capacity estimated by SF-36 was correlated with the total score of HAQ (r = −0.666; p < 0.001; J = 0.579), while the emotional aspects of SF-36 were correlated with the emotional reactions domain of NHP (r = −0.316; p = 0.005; J = 0.341). The vitality domain of SF-36 was correlated with the level of energy of NHP (r = −0.362; p = 0.001; J = 0.302). For the evaluation of functional capacity (AUC = 0.839; p < 0.001) and physical aspect (AUC = 0.755; p < 0.001) the most accurate instrument was the HAQ. For evaluation of the impact of vitality, sleep (AUC = 0.679; p = 0.007), emotional reactions (AUC = 0.674; p = 0.009) and level of energy in QoL, the NHP (AUC = 0.633; p = 0.045) was the most specific and sensitive. In the evaluation of the emotional aspect domain, the most accurate instrument was the NHP in the “emotional reaction” score (AUC = 0.699; p = 0.003). The evaluation of pain was limited in the three instruments and SF-36 was the only one in assess of the domains of social aspects and general health status. Conclusion: For evaluation of the physical aspects in patients with RA, the HAQ is the most accurate. For evaluation of emotional aspects the NHP is the most indicated, although the SF-36 was the only one in the evaluation of general domains.

ABSTRACT BACKGROUND AND OBJECTIVES: To introduce the curriculum in Pain for Graduation in Physiotherapy, suggesting its use for academic training in Brazil. CONTENTS: Considering that physiotherapists should be prepared to engage in the health care professional team assisting patients with different kinds of pain understanding the role of each professional, a group of physiotherapists with academic and clinical experience in pain treatment has developed, after consensus, this curriculum of pain for physiotherapy, which highlights the role of this professional in the health care team and the development of a therapeutic relationship with patients, favoring patients' autonomy and education, as well as the strategies for pain evaluation and management. CONCLUSION: The specific content of this pain curriculum can be integrated into different programs/courses, using the most adequate structure and educational method with regard to professional needs and their demands. Physical therapy, pain and models of academic training in health are discussed.

ABSTRACT BACKGROUND AND OBJECTIVES: Neuropathic pain is disabling, decreases quality of life, impairs professional performance, and limits social participation of patients living with excruciating pain. In this context, it is easy to see physical rehabilitation as facilitator of autonomy and mobility. However, therapeutic action goes beyond these actions. With technological advances, new approaches are proposed and it now it is possible to measure the performance of physical methods for pain modulation. CONTENTS: The innovative potential of physical rehabilitation to treat neuropathic pain is discussed. Reflections are made on therapeutic options such as: electrothermotherapy, manual therapy, physical exercise, transcranial stimulation with constant current, repetitive transcranial magnetic stimulation, visual mental exercises and mirror therapy, among others. Therapeutic modalities shall be addressed according to some neuropathic pain conditions, so the authors propose a parallel between specific pathologic mechanism of some neuropathic pain conditions and the neurophysiologic mechanism of the proposed therapeutic modality. CONCLUSION: In spite of different pathological mechanisms and different ways of physical and mental approach with patients, the importance of active participation of patients during the rehabilitation process has to be stressed.

Resumo: O objetivo deste estudo foi identificar perfis de resiliência em paciente com dor crônica. Utilizando a Análise de Classes Latentes, em uma amostra de 414 pacientes com dor crônica musculoesquelética, foram identificados três perfis: resiliência primária (40%), composto por indivíduos de até 40 anos, que têm alta escolaridade, buscam os cuidados médicos, não trabalham e não apresentam sintomas de estresse psicológico; resiliência secundária (30%), composto por mulheres com mais de 54 anos, que têm baixo nível de escolaridade, buscam cuidados médicos, não trabalham e apresentam baixa probabilidade de experimentar sintomas de estresse psicológico; resiliência terciária (29%), composto por mulheres com médio nível de escolaridade, idade entre 40 e 54 anos, que trabalham, não buscam cuidados médicos e têm alta probabilidade de experimentar sintomas de estresse psicológico. Os três perfis revelam caminhos distintos de resiliência na dor crônica com relevância para prática clínica, destacando a atuação multidisciplinar nos cuidados ao paciente com dor crônica.