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Background: There is limited evidence concerning the effect of intramuscular electrical stimulation (EIMS) on the neural mechanisms of pain and disability associated with chronic Myofascial Pain Syndrome (MPS).Objectives: To provide new insights into the EIMS long-term effect on pain and disability related to chronic MPS (primary outcomes). To assess if the neuroplasticity state at baseline could predict the long-term impact of EIMS on disability due to MPS we examined the relationship between the serum brain-derived-neurotrophic-factor (BDNF) and by motor evoked potential (MEP). Also, we evaluated if the EIMS could improve the descending pain modulatory system (DPMS) and the cortical excitability measured by transcranial magnetic stimulation (TMS) parameters.Methods: We included 24 right-handed female with chronic MPS, 19–65 years old. They were randomically allocated to receive ten sessions of EIMS, 2 Hz at the cervical paraspinal region or a sham intervention (n = 12).Results: A mixed model analysis of variance revealed that EIMS decreased daily pain scores by -73.02% [95% confidence interval (CI) = -95.28 to -52.30] and disability due to pain -43.19 (95%CI, -57.23 to -29.39) at 3 months of follow up. The relative risk for using analgesics was 2.95 (95% CI, 1.36 to 6.30) in the sham group. In the EIMS and sham, the change on the Numerical Pain Scale (NPS0-10) throughout CPM-task was -2.04 (0.79) vs. -0.94 (1.18), respectively, (P = 0.01). EIMS reduced the MEP -28.79 (-53.44 to -4.15), while improved DPMS and intracortical inhibition. The MEP amplitude before treatment [(Beta = -0.61, (-0.58 to -0.26)] and a more significant change from pre- to post-treatment on serum BDNF) (Beta = 0.67; CI95% = 0.07 to 1.26) were predictors to EIMS effect on pain and disability due to pain.Conclusion: These findings suggest that a bottom–up effect induced by the EIMS reduced the analgesic use, improved pain, and disability due to chronic MPS. This effect might be mediated by an enhancing of corticospinal inhibition as seen by an increase in IC and a decrease in MEP amplitude. Likewise, the MEP amplitude before treatment and the changes induced by the EIMS in the serum BDNF predicted it’s long-term clinical impact on pain and disability due MPS.The trial is recorded in ClinicalTrials.gov: NCT02381171.

OBJETIVO: Analisar fatores associados à Hipertensão Arterial Sistêmica (HAS) e sua relação com o estado nutricional de indivíduos hipertensos cadastrados no programa Hiperdia em um município do Rio Grande do Sul. MÉTODOS: Foram avaliados indivíduos hipertensos cadastrados no Hiperdia. Os dados referentes aos fatores associados à hipertensão foram coletados por meio de um questionário semiestruturado composto pelas seguintes variáveis: idade, escolaridade, exercício físico, tabagismo, medicamentos consumidos, herança genética, doenças crônicas, peso, altura e circunferência da cintura. RESULTADOS: Entre os 402 hipertensos estudados, 138 (34,3%) eram adultos e 264 (65,7%) eram idosos, sendo que a maioria era do gênero feminino. A prevalência de excesso de peso foi de 76,8% em adultos enquanto 35% dos idosos apresentaram peso normal. Quando comparadas as faixas etárias, 11% dos idosos estavam significativamente associados ao analfabetismo. Os adultos e idosos apresentaram média de circunferência da cintura e classificação do IMC acima dos níveis desejados. CONCLUSÃO: Neste estudo, a HAS foi associada a níveis pressóricos aumentados com o avanço da idade, excesso de peso, circunferência da cintura elevada, baixa escolaridade, fumo e consumo de bebida alcoólica. O excesso de peso configurou-se como um dos fatores mais agravantes nessa população.

Background: The fibromyalgia (FM) physiopathology involves an intracortical excitability/inhibition imbalance as measured by transcranial magnetic stimulation measures (TMS). TMS measures provide an index that can help to understand how the basal neuronal plasticity state (i.e., levels of the serum neurotrophins brain-derived neurotrophic factor (BDNF) and S100-B protein) could predict the effect of therapeutic approaches on the cortical circuitries. We used an experimental paradigm to evaluate if pregabalin could be more effective than a placebo, to improve the disinhibition in the cortical circuitries in FM patients, than in healthy subjects (HS). We compared the acute intragroup effect of pregabalin with the placebo in FM patients and healthy subjects (HS) on the current silent period (CSP) and short intracortical inhibition (SICI), which were the primary outcomes. Pain scores and the pain pressure threshold (PPT) were secondary outcomes.Methods: This study included 27 women (17 FM and 10 HS), with ages ranging from 19 to 65 years. In a blinded, placebo-controlled clinical trial, participants were randomized to receive, in a cross-over manner, oral pregabalin of 150 mg or a placebo. The cortical excitability pain measures were assessed before and 90 min after receiving the medication.Results: A generalized estimating equation (GEE) model revealed that in FM, pregabalin increased the CSP by 14.34% [confidence interval (CI) 95%; 4.02 to 21.63] and the placebo reduced the CSP by 1.58% (CI 95%; −57 to 25.9) (P = 0.00). Pregabalin reduced the SICI by 8.82% (CI 95%, −26 to 46.00) and the placebo increased it by 19.56% (CI 95%; 8.10 to 59.45; P = 0.02). Pregabalin also improved the pain measures. In the treatment group, the BDNF-adjusted index was positively correlated and the serum S100-B negatively correlated with the CSP, respectively. However, in the HS, pregabalin and the placebo did not induce a statistically significant effect in either intracortical excitability or pain measures.Conclusion: These results suggest that pregabalin’s effect on cortical neural networks occurs, particularly under basal neuronal hyperexcitability, because its impact on the cortical excitability and the pain measures was observed only in the FM group. This indicates that pregabalin increased the CSP to induce inhibition in specific neural networks, while it increased the SICI to improve the excitability in other neurobiological systems. Trial registration in clinicaltrials.gov Identifier: NCT02639533.

ObjectiveChronic visceral pain (CVP) syndromes are persistently painful disorders with a remarkable lack of effective treatment options. This study aimed at evaluating the effects of different neuromodulation techniques in patients with CVP on cortical activity, through electreocephalography (EEG) and on pain perception, through clinical tests.DesignA pilot crossover randomized controlled study.SettingsOut-patient.SubjectsAdults with CVP (>3 months).MethodsParticipants received four interventions in a randomized order: (1) transcranial pulsed current stimulation (tPCS) and active transcranial direct current stimulation (tDCS) combined, (2) tPCS alone, (3) tDCS alone, and (4) sham condition. Resting state quantitative electroencephalography (qEEG) and pain assessments were performed before and after each intervention. Results were compared with a cohort of 47 healthy controls.ResultsWe enrolled six patients with CVP for a total of 21 visits completed. Compared with healthy participants, patients with CVP showed altered cortical activity characterized by increased power in theta, alpha and beta bands, and a significant reduction in the alpha/beta ratio. Regarding tES, the combination of tDCS with tPCS had no effect on power in any of the bandwidths, nor brain regions. Comparing tPCS with tDCS alone, we found that tPCS induced higher increase in power within the theta and alpha bandwidths.ConclusionThis study confirms that patients with CVP present abnormal EEG-indexed cortical activity compared with healthy controls. Moreover, we showed that combining two types of neurostimulation techniques had no effect, whereas the two interventions, when applied individually, have different neural signatures.

The central sensitization syndrome (CSS) encompasses disorders with overlapping symptoms in a structural pathology spectrum ranging from persistent nociception [e.g., osteoarthritis (OA)] to an absence of tissue injuries such as the one presented in fibromyalgia (FM) and myofascial pain syndrome (MPS). First, we hypothesized that these syndromes present differences in their cortical excitability parameters assessed by TMS, namely motor evoked potential (MEP), cortical silent period (CSP), short intracortical inhibition (SICI) and short intracortical facilitation (SICF). Second, considering that the presence of tissue injury could be detected by serum neurotrophins, we hypothesized that the spectrum of structural pathology (i.e., from persistent nociception like in OA, to the absence of tissue injury like in FM and MPS), could be detected by differential efficiency of their descending pain inhibitory system, as assessed by the conditioned pain modulation (CPM) paradigm. Third, we explored whether BDNF had an influence on the relationship between motor cortex excitability and structural pathology. This cross-sectional study pooled baseline data from three randomized clinical trials. We included females (n=114), aged 19 to 65 years old with disability by chronic pain syndromes: FM (n= 19), MPS (n=54), OA (n=27) and healthy subjects (n=14). We assessed the serum BDNF, the motor cortex excitability by parameters the TMS measures and the change on Numerical Pain Scale [NPS (0-10)] during CPM-task. The adjusted mean (SD) on the SICI observed in the absence of tissue injury was 56.36% lower than with persistent nociceptive input [0.31(0.18) vs. 0.55 (0.32)], respectively. The BDNF was inversely correlated with the SICI and with the change on NPS (0-10) during CPM-task. These findings suggest greater disinhibition in the motor cortex and the descending pain inhibitory system in FM and MPS than in OA and healthy subjects. Likewise, the inter-hemispheric disinhibition as well the dysfunction in the descending pain modulatory system is higher in chronic pain without tissue injury compared to a structural lesion. In addition, they highlight that a greater level of serum BDNF mediated the disinhibition of motor cortex excitability, as well the function of descending inhibitory pain modulation system, independently of the physiopathology mechanism of musculoskeletal pain syndromes.

Pharmaceutical assistance concerns actions developed by the pharmacist and other professionals with the purpose of promoting, protecting and restoring health. Medications are an essential tool in this process that focuses on the access to, and the rational use of, drugs. This study is aimed at evaluating the Pharmaceutical Assistance provided by Municipal Health Offices in the Taquari Valley, Rio Grande do Sul. For this purpose, 2,794 users of public pharmacies were interviewed and data was analyzed using descriptive statistics. The users of the public pharmacies were mainly female and individuals with low educational level and income. On average, 2.41 drugs were prescribed per medical prescription and 1.72 of these were procured. Out of the total medicines prescribed, 76.5% were listed in the municipal standard drug list (SDL). Medication was prescribed by its generic name in 81.8% of the prescriptions. Antibiotics and injections were prescribed in 11.9% and 4.0% of the prescriptions, respectively. Users' access to information is partial, which can impair adherence to the treatment. Thus, it is possible to conclude that review of the service is necessary for it to be effective.A Assistência Farmacêutica se preocupa com ações desenvolvidas pelo farmacêutico ou outros profissionais com o propósito de promover, proteger e restaurar a saúde. Medicamentos são ferramentas essenciais nesse processo, que se concentra no acesso e no uso racional de fármacos. Este estudo objetivou a avaliação da Assitência Farmacêutica suprida pela Secretaria Municipal da Saúde no Vale do Taquari, no Rio Grande do Sul. Com esse propósito, 2.794 usuários das farmácias públicas foram entrevistados e analisaram-se os dados usando estatística descritiva. Os usuários das farmácias públicas eram, principalmente, mulheres e indivíduos com baixo nível educacional e financeiro. Na média, 2,41 fármacos eram prescritos por prescrição médica e 1,72 destes foram obtidos. Do total de medicamentos prescritos, 76,5% estava inscritos na lista de medicamentos padrão do município (SDL). A medicação foi prescrita pelo nome genérico em 81,8% dos casos. Antibióticos e injeções foram prescritas em 11,9% e 4,0% das prescrições, respectivamente. O acesso dos usuários à informação é parcial, o que pode prejudicar a adesão ao tratamento. Dessa forma, é possível concluir que a revisão do serviço é necessária para que seja eficaz.

Objetivo: Analisar os indicadores propostos pela Organização Mundial de Saúde (OMS) em prescrições médicas fornecidas a pacientes atendidos em Centro de Saúde do município de Lajeado – RS. Métodos: Foi realizado estudo transversal, que avaliou dados relativos ao padrão de prescrição em Sistema Único de Saúde (SUS). Resultados: Foram analisadas 292 prescrições médicas. Destas, 282 continham o nome do paciente, mas em apenas três havia o seu endereço. Em 243 prescrições, constava o nome do médico, e, em 227, havia o número de inscrição no Conselho de Medicina. Foram identificados 713 medicamentos, com média de 2,44 por prescrição, sendo aqueles com ação em sistema cardiovascular os mais prevalentes. Observou-se, ainda, que 611 medicamentos constavam da Relação Nacional de Medicamentos Essenciais (RENAME), 509 constavam da Relação Municipal de Medicamentos Essenciais (REMUME) e 489 constavam da Lista Modelo da OMS. Conclusão: A maioria dos indicadores de prescrição avaliados apresentou adequação ao que é proposto pela OMS. No entanto, ainda há dificuldades, como aquelas referentes a itens faltantes nas prescrições médicas, o que pode interferir no uso racional de medicamentos.

Objetivo: Analisar os indicadores propostos pela Organização Mundial de Saúde (OMS) em prescrições médicas fornecidas a pacientes atendidos em Centro de Saúde do município de Lajeado – RS. Métodos: Foi realizado estudo transversal, que avaliou dados relativos ao padrão de prescrição em Sistema Único de Saúde (SUS). Resultados: Foram analisadas 292 prescrições médicas. Destas, 282 continham o nome do paciente, mas em apenas três havia o seu endereço. Em 243 prescrições, constava o nome do médico, e, em 227, havia o número de inscrição no Conselho de Medicina. Foram identificados 713 medicamentos, com média de 2,44 por prescrição, sendo aqueles com ação em sistema cardiovascular os mais prevalentes. Observou-se, ainda, que 611 medicamentos constavam da Relação Nacional de Medicamentos Essenciais (RENAME), 509 constavam da Relação Municipal de Medicamentos Essenciais (REMUME) e 489 constavam da Lista Modelo da OMS. Conclusão: A maioria dos indicadores de prescrição avaliados apresentou adequação ao que é proposto pela OMS. No entanto, ainda há dificuldades, como aquelas referentes a itens faltantes nas prescrições médicas, o que pode interferir no uso racional de medicamentos.