Investigações nos modelos de evolução dos processos de dor crônica sugerem que depressão, ansiedade, qualidade de sono e capacidade de enfrentamento da dor sejam importantes agentes de cronificação das disfunções temporomandibulares (DTM). Informações a respeito de dor temporomandibular crônica em uma população que busque atendimento psicológico são extremamente escassas. Este trabalho avaliou, em uma população em tratamento para distúrbios afetivos e de ansiedade, sinais e sintomas de DTM, sensibilidade à palpação das estruturas orofaciais, presença de cefaléia, presença de hábitos parafuncionais e prática de atividades físicas. Avaliou também a associação entre o grau de depressão, ansiedade, qualidade de sono e estratégias de enfrentamento com a presença de dor temporomandibular e sensibilidade à palpação. Cento e vinte e oito pacientes seqüenciais recém-admitidos no Ambulatório de Saúde Mental da Prefeitura Municipal de Bauru, SP foram avaliados pelo Research Diagnostic Criteria para DTM Eixos I e II, Craniomandibular Index, Índice de Qualidade de Sono de Pittsburgh, Inventário de Estratégias de Enfrentamento de Folkman e Lazarus e os Inventários de Depressão e Ansiedade de Beck, bem como por questionários de auto-relato para hábitos parafuncionais e prática de atividades físicas. Análises de correlação de Pearson determinaram a relação entre os fatores psicológicos e a presença de dor e sensibilidade à palpação. Um modelo de regressão logística foi construído para determinar a força de associação entre a presença de dor e fatores como depressão, ansiedade, qualidade de sono, enfrentamento, gênero e idade. Encontrou-se alta prevalência de dor temporomandibular persistente e idade média daqueles com dor superior à encontrada na população em geral. O auto-relato de cefaléia foi bastante frequente e associado a níveis elevados de depressão e ansiedade. Hábitos parafuncionais como apertamento dentário, bruxismo, morder tecidos moles intra-orais e objetos e apoiar a mandíbula nas mãos foram mais frequentemente encontrados em indivíduos com dor temporomandibular do que naqueles sem dor. O escore de sensibilidade à palpação correlacionou-se positivamente com depressão e ansiedade. Observou-se associações significantes entre presença de dor, o grau de severidade de depressão e ansiedade e qualidade de sono ruim, o que não ocorreu com as estratégias de enfrentamento. / Investigations on chronic pain evolution models have suggested that depression, anxiety, sleep quality and coping strategies are essential agents for temporomandibular disorders (TMD) chronicity. There is very few available data on temporomandibular chronic pain in a sample of population receiving treatment primarily for psychological disorders. This study assessed in a population in treatment for mood and anxiety disorders, signs and symptoms of TMD, tenderness to palpation of orofacial structures, and self-report of headache, parafunctional habits and physical exercises. It also assessed the association between depression, anxiety, sleep quality, coping strategies and temporomandibular pain and tenderness to palpation. One hundred and twenty eight sequential subjects referred to the Mental Health Institute, Bauru, SP were assessed according to the Research Diagnostic Criteria for TMD Axis I and II, Craniomandibular Index, Pittsburgh Sleep Quality Index, Coping Strategies Inventory of Folkman and Lazarus, and Beck Depression and Anxiety Inventories, as well as self-report questionnaires on parafunctional habits and physical exercises. Pearsons Correlation analyses calculated the relationship between the psychological factors and temporomandibular pain and tenderness to palpation. A logistic regression model was created to assess the strength of association between temporomandibular pain and depression, anxiety, sleep quality, coping strategies, gender and age. There was high prevalence of persistent temporomandibular pain and the mean age of the pain population was higher than among the general population. Selfreport of headache was frequent and associated to higher levels of depression and anxiety. Oral parafunctional habits as tooth clenching, tooth grinding, biting intra-oral tissues, and resting the jaw on the hand were more frequently found in pain subjects then in pain-free ones. Level of tenderness to palpation was positively correlated with depression and anxiety levels. There were significant and positive associations between temporomandibular pain and depression and anxiety severity, and poor quality of sleep

A crença de auto-eficácia relaciona-se com a percepção da dor e com a funcionalidade física e psíquica dos doentes. Os objetivos deste estudo foram validar para a língua portuguesa a escala Chronic Pain Self-efficacy Scale e analisar as crenças de auto-eficácia de doentes com dor crônica. A amostra foi de 132 pacientes com dor crônica de etiologia variada (54,5% fibromialgia e 24,2% dor neuropática); 87,9% foram mulheres, a idade média foi de 46 anos (DP=12,6) e a escolaridade média de 10,1 anos. A média da intensidade da dor foi de 6,83 (DP=2,3) e o tempo médio de dor foi de 7,4 anos (DP=7,7). A validade da escala em língua portuguesa foi confirmada pela análise fatorial, que manteve os 3 domínios e os 22 itens da escala original; a variância explicada foi de 60,8%. A confiabilidade, analisada pelo alfa de Cronbach, variou entre 0,76 e 0,92 para os domínios e foi de 0,94 para a escala total. A validade convergente, verificada por meio da comparação entre os escores da Escala de Auto-Eficácia para Dor Crônica (AEDC) e os escores do Inventário de Depressão de Beck mostrou correlação negativa e estatisticamente significativa. As crenças de auto-eficácia foram analisadas em relação às variáveis sexo, idade, escolaridade, renda, intensidade da dor e tempo de dor. As variáveis escolaridade e intensidade da dor apresentaram associação com a auto-eficácia. Doentes com menor escolaridade relataram menor auto-eficácia, e naqueles com dor menos intensa, observou-se maior auto- eficácia. Este estudo disponibiliza para a língua portuguesa um instrumento válido e confiável para avaliar a auto-eficácia de pacientes com dor crônica. A validade da escala AEDC foi confirmada pela análise fatorial, análise da consistência interna e validade convergente. / The self-efficacy belief, relate to the pain perception and physical and psychiatric functionality. The goals of this study were to validate to the Portuguese language the Chronic Pain Self-efficacy Scale (CPSS) and analyze the self-efficacy beliefs of chronic pain patients. The subjects were 132 chronic pain patients with pain from diverse etiology (54,5% fibromyalgia, 24,2% neuropatic pain), 87,9% were women, the middle age were 46 years (SD=12,6) and educational level was 10,1 years. The pain intensity were 6,83 (SD=2,3) and the median time of pain were 7,4 years (SD=7,7). The scale validity in the Portuguese language was confirmed by factor analyzis, which maintained the 3 factors and 22 items of the original scale; the accounted variance was 60,8%. The reliability, analyzed by coefficient Cronbach´s alpha were 0,76 - 0,92 to the factors and 0,94 to the total scale. The convergent validity, verified by the comparison with the Escala de Auto-Eficácia para Dor Crônica (AEDC) scores and Beck Depression Inventory (BDI) scores showed significantly negative correlation. The self-efficacy beliefs were analyzed related to sex, age, educational level, income, pain intensity and pain chronicity. The educational level and pain intensity were related with self-efficacy. Subjects with lower educational level reported lower self-efficacy levels and those ones with lower pain levels, reported higher self-efficacy. This study became available to the Portuguese language a valid and reliable instrument to assess self-efficacy in chronic pain patients. The scale (AEDC) validity was confirmed by factor analyzis, internal consistency and convergent validity.

Orientador: Celia Marisa Rizzatti Barbosa / Tese (doutorado) - Universidade Estadual de Campinas, Faculdade de Odontologia de Piracicaba / Made available in DSpace on 2018-08-26T01:53:01Z (GMT). No. of bitstreams: 1 Gui-Demase_MaisaSoares_D.pdf: 1507199 bytes, checksum: e74dc0b6adb08a1d43ca0062c2db6cf7 (MD5) Previous issue date: 2014 / Resumo: A dor persistente relacionada às disfunções temporomandibulares (DTM) é reconhecida como a terceira condição de dor crônica mais prevalente em todo o mundo. Todavia, os fatores envolvidos na transição da fase aguda para a fase crônica ainda permanecem incertos. Além disso, há subgrupos de pacientes com DTM que são refratários ao tratamento. Um modelo heurístico de influências causais desta disfunção propôs que dois principais fenótipos intermediários: sofrimento psicológico e de amplificação da dor (hiperalgesia e alodinia), contribuiriam para o aparecimento e persistência das DTM. Além disso, no atendimento ao paciente crônico com DTM é difícil determinar especificamente o que pode ou não estar relacionado à dor para cada paciente individualmente. O conhecimento dos fatores persistentes e abordagens de tratamento que enfatizem a sua flexibilidade e que satisfaçam as necessidades individuais destes pacientes podem representar uma nova direção na pesquisa para o tratamento da dor crônica associada à DTM. Desse modo, o objetivo deste trabalho foi investigar fatores (de sofrimento psicológico e de amplificação da dor) relacionados ao processo de cronificação da dor facial nas DTM. Para tanto, após o levantamento bibliográfico elaborado no primeiro artigo, apresentamos também dois artigos desenvolvidos na Faculdade de Odontologia de Piracicaba e um artigo desenvolvido durante estágio no exterior na Universidade da Carolina do Norte (EUA), ambos com desenho de estudo transversal (caso-controle), os quais abordam fatores de sofrimento psicológico e qualidade do sono em pacientes com diferentes manifestações de dor relacionada à DTM. Nestes dois primeiros estudos de campo, comparamos subgrupos de DTM que foram classificados de acordo com a presença ou ausência de dor generalizada, a fim de avaliar, em primeiro lugar, os domínios de qualidade de vida e verificar quais os componentes que mais afetam a capacidade funcional dos pacientes com dor facial. Posteriormente investigamos também possíveis correlações entre a intensidade da dor facial com sintomas depressivos e de somatização. Para a obtenção dos dados utilizamos, respectivamente, o questionário de qualidade de vida SF-36 e o eixo II do questionário RDC-TMD. Os resultados mostraram que pacientes com dor localizada na face e pacientes com dores generalizadas pelo corpo compartilham prejuízos nos aspectos emocionais. A capacidade funcional em subgrupos de DTM só foi afetada pela dor e pela presença de dor generalizada. Além disso, independentemente dos grupos avaliados, houve uma correlação positiva, não só entre a dor facial e depressão, mas também com a somatização. No último estudo, nosso objetivo foi investigar associações entre a qualidade do sono e sinais de hiperalgesia e alodinia, em pacientes com DTM e controle, avaliados respectivamente pelo Índice de qualidade do sono de Pittsburgh e pelo Teste Sensorial Qualitativo. Foi encontrado que a má qualidade do sono está associada com estímulos dolorosos térmicos e mecânicos (hiperalgesia), mas não com alodinia. Portanto, conclui-se que os aspectos emocionais, a somatização, os sintomas depressivos e a baixa qualidade do sono podem estar relacionados ao desenvolvimento da dor crônica associada às DTM e à generalização da dor para outras regiões do corpo, a qual está também associada à incapacidade funcional / Abstract: Persistent pain related to temporomandibular disorders (TMD) is recognized as the third most prevalent chronic condition of pain in the world. However, the factors involved in the transition from the acute to the chronic phase remain uncertain. Furthermore, there are subgroups of patients with TMD that are noresponders to treatment. A heuristic model of causal influences of this dysfunction has proposed two major intermediate phenotypes: psychological distress and pain amplification (hyperalgesia and allodynia), contribute to the TMD onset and persistence. Furthermore, for chronic care of patient with TMD is difficult to determine specifically what can or cannot work for every patient individually. Knowledge of persistent factors and treatment approaches that emphasize the flexibility and satisfy the individual necessities of these patients may represent a new direction in research for the treatment of chronic pain associated with TMD. Thus, the aim of this study was to investigate factors (psychological distress and pain amplification) related to the process of TMD chronic facial pain development. To do so, first the literature review was presented in this study, then we present two articles developed at the Piracicaba Dental School and also an article during an exchange program at the University of North Carolina, both with cross-sectional design (case-control studies), which address psychological distress factors and sleep quality in patients with different manifestations of TMD-related pain. First two studies compared TMD subgroups that were classified according to the presence or absence of widespread pain in order to evaluate quality of life domains and which components most affect the functional capacity of facial pain patients. Later, we also investigated possible correlations between the intensity of facial pain and depressive symptoms, and also, somatization. For data collection we used, respectively, the ShortForm-36v2® Health Surveys and RDC/TMD axis II history questionnaire. The results showed that patients with localized facial pain and patients with generalized body pain share impairments on emotional aspects. Functional capacity was only affected by the pain and the presence of widespread pain. Moreover, regardless of the group assessed, there was a positive correlation not only between facial pain and depression, but also with somatization. In the latest study, our aim was to investigate associations between sleep quality and signs of hyperalgesia and allodynia in patients with TMD and controls, respectively evaluated by the Pittsburgh Sleep Quality Index and the Sensory Qualitative Test. Our findings showed that poor sleep quality is associated with noxious thermal and mechanical stimuli (hyperalgesia), but it is not associated with allodynia. Therefore, we could conclude that the emotional aspects, somatization, depressive symptoms and poor sleep quality could be related with the development of chronic pain associated with TMD and pain generalization to other body regions, which is also associated with disability / Doutorado / Anatomia / Mestra em Biologia Buco-Dental

Fibromyalgia is a chronic pain disorder. It affects muscles and connective tissue. It's a very complex disorder that has no adequate treatment or cure. The research has progressed but there are still some questions to be answered. Quality of life for these patients is decreased and leads to suffering. Aim: The aim of this study was to illuminate patients' experiences of living with fibromyalgia. Method: A literature overview where nine different qualitative studies between the years 1998-2012 were analyzed. Results: The analysis of the articles lead to six subthemes "Accepted and adapted to the new life", "Experienced a new I", "Experienced changes in the work situation", Experienced changes in privacy", Experienced ignorance" and "Experienced incomprehension" which lead to three main themes "Experienced an identity change", "Experienced a sense of isolation" and "Felt frustration in meeting with health care" Conclusion: The disorder affects the patients both mentally and physically. More research needs to be done for more knowledge about the disorder in order to improve patients care and quality of life

The purpose of the present study was to determine specific psychotic factors associated with environmental sensitivities, the changes in those tendencies occurring with ecological treatment and the extent to which those behaviors could be attributed to the chronicity of the illness. An inpatient group of 42 environmental patients was compared to an inpatient population of 20 chronic spinal pain patients. Instruments utilized in the study included the Bender Gestalt Test of Motor Ability, the Minnesota Multiphasic Personality Inventory (MMPI) with the Harris and Lingoe subscales, and three subtests of the Wechsler Adult Intelligence Scale-Revised, Digit Symbol, Object Assembly, and Block Design. Data was analyzed via multivariate analysis of covariance, analysis of covariance, canonical analysis, and t tests for related and independent means.

Background. Pain is the most commonly reported symptom in primary care and is estimated to affect over 110 million people in the United States. Increased pain severity and occurrence and inadequate treatment of pain is linked to being a minority, healthcare access, socioeconomic status, age and gender. Outcomes of pain include costs, healthcare utilization, functional changes, and quality of life. Gaps in knowledge exist regarding the American Indian (AI) chronic non-malignant pain experience, management and outcomes. Objective. The purpose of this research is to describe Northern New Mexico (NNM) AIs chronic pain experience, intervention strategies, and outcomes. Methods. This study utilized a qualitative descriptive (QD) design, with in-depth, one-on-one interviews with semi-structured interview questions. A sample of 14 Native Americans were interviewed for this study. A questionnaire was used to collect demographic data. Domain, taxonomic and content analyses were utilized to gain a highly nuanced description of the research topic. Results. The participants provided rich qualitative data regarding chronic pain experience, management strategies and outcomes. Frequent pain experiences included the body as a confining entity, body awareness, unpredictability of pain, and psychological outcomes. AIs in the study utilize a variety of biomedical, professional and self-care interventions. Outcomes discussed were functional status, costs, healthcare utilization, and quality of life. Outcomes. The goal of this research is increased understanding of the chronic pain experience through the perspective of those experiencing it. Findings will be submitted to the University of Arizona dissertation library, disseminated across relevant peer-reviewed journals focused on pain and pain management, and presented to appropriate groups and organizations.

No description available.

The purpose of this study was to analyze the factor structure of items pertaining to health on the Minnesota Multiphasic Personality Inventory (MMPI2) for chronic back pain patients in comparison to a control group. The results may be used as groundwork for developing an MMPI2 subscale to describe this population. The groups differed in the sequence of the resulting factors and the percentage of variance accounted for by each factor. The factors extracted when evaluating the control group were titled in order: Poor Physical Health, Digestive Difficulties, Equilibrium, Depression/Malaise, and Multiple Somatic Complaints. Resulting factors for the pain group were: Depression/Malaise, Digestive Difficulties, Multiple Somatic Complaints, Headaches/Dizziness, and Neurological Reaction/Poor Physical Health.

Class of 2006 Abstract / Objectives: To determine acceptance rate of pharmacist recommendation in an interdisciplinary chronic pain clinic. Subjects: Veterans enrolled in the Southern Arizona Veterans Administration Health Care System (SAVAHCS) Methods: The study will be a retrospective chart review. Data will be collected from electronic medical records. Included in this database are demographics, consult notes, medication history, and physician visits. Information unavailable will be medical care received outside the SAVAHCS closed system that is not disclosed by the patient. Number and types of recommendations, as well as acceptance of these options by the primary care provider will be calculated. Results: The number and type of recommendations initiated within 30 days will be calculated; and acceptance rates will be compared pre and post changes in the format of relaying these recommendations. Implications: The results will determine whether changing how the recommendation is presented to patients primary care providers (by the pharmacist) will affect acceptance rate.

No description available.