No description available.

The overall aim of this thesis was to examine the relationship between self-efficacy, individually tailored vocational rehabilitation and transition to work or studies. Study I was a cross-sectional study based on questionnaire- and registry data, investigating whether factors related to sick leave predict self-efficacy in women on long-term sick leave (n= 337) due to pain and/or mental illness. General self-efficacy was low. Anxiety and depression were the strongest predictors for low self-efficacy. Study II used longitudinal data from a randomised controlled trial, comprising partly the same women (n=401) as in Study I. Participants were allocated to either 1) assessment of multidisciplinary team and multimodal intervention (TEAM), 2) acceptance and commitment therapy (ACT), or 3) control group. Self-efficacy increased in the TEAM group in comparison with the control group. Study III had a descriptive qualitative design with individual interviews, studying participants’ (n=14) experiences with an individually tailored vocational rehabilitation project, and encounters with professionals working in it. The participants, who were on long-term sick leave due to mental illness or pain reported overall positive experiences with the project. The project was based on collaboration between authorities and motivational interviewing. The positive experiences were based on four categories: Opportunities for receiving various dimensions of support, Good overall treatment by the professionals, Satisfaction with the working methods of the project, and Opportunities for personal development. Study IV was a prospective cohort study investigating perceived self-efficacy in unemployed young adults (n= 249) aged 19-29 year with disabilities, and the association between self-efficacy and transition to work or studies. The study used questionnaire- and registry data from a vocational rehabilitation project. Higher levels of self-efficacy were associated with increased odds for ‘transition to work’. General self-efficacy was low, and young adults with lower self-efficacy reported worse self-rated health compared with those with higher self-efficacy. This thesis showed that multidisciplinary assessment with a multimodal intervention had positive effects on self-efficacy. Individually tailored vocational rehabilitation, based on cooperation and motivational interviewing, may be beneficial for individuals on long-term sick leave and the interactions between participants and the professionals may affect participants’ self-efficacy positively. Mental health needs to be considered when targeting self-efficacy in vocational rehabilitation. Furthermore, research is needed to a) clarify which components in the multidisciplinary team intervention can increase self-efficacy, b) study the effects of vocational rehabilitation based on an individual design, cooperation and motivational interviewing on self-efficacy, health and transition to work, and c) develop interventions that can increase self-efficacy and support transition to work/ studies in young adults with disabilities.

It is increasingly clear that pain and emotions are closely interconnected. Pain does not only cause psychological distress, but psychological distress also amplifies pain through neurological mechanisms. Treatment of both chronic and acute pain would benefit from acknowledging the psychological mechanisms of pain neurophysiology. Psychological acceptance predicts increased pain tolerance and decreased pain intensity and discomfort in experimentally induced pain and improved physical and psychosocial functioning for persons with chronic pain. The overall aim of this thesis was to evaluate acceptance-based interventions for persons suffering from pain. In Study I the effect of a manualised ACT-based self-help intervention for adults with chronic pain was evaluated in an RCT (n=90). The results showed improvements in satisfaction with life, physical functioning and pain intensity for the ACT group. Both the ACT and the control group improved regarding depression and anxiety. In Study II the mediating effect of acceptance for treatment change was evaluated, using data from Study I (n=64). The results showed indirect effects of treatment via acceptance for physical functioning but not for satisfaction with life. In Studies III and IV, instruments to measure psychological flexibility in relation to pain were developed for children with cancer, and their parents respectively, using factor analysis. The results showed that a two-factor solution for the child scale (n=61) and a three-factor solution for the parent scale (n=243), best represented the data. In Study V, an acceptance-based intervention was preliminarily evaluated in a single-subject study (n=5) for children reporting pain during cancer treatment. The intervention consisted of an approximately 15-minute long pain exposure exercise. All participants reported reduced discomfort of pain, and three of the participants reported reduced pain intensity. The results suggest that a manualised ACT-based self-help intervention is a valuable addition to the treatment repertoire for persons with chronic pain and that acceptance may mediate the effect of treatment on physical functioning. Furthermore, instruments to measure acceptance in the context of acute pain in children with cancer are now available, although further validation is needed. Lastly, the results indicate that an acceptance-based intervention may help children undergoing cancer treatment to cope with pain.

Introdução: Níveis elevados de ansiedade têm sido associados com intensidade e comportamento da dor em pacientes com dores aguda e crônica. Foi observado, em indíviduos com síndrome dolorosa miofascial (SDM), que o estresse e a ansiedade aumentam a predisposição para o desenvolvimento de pontos-gatilhos miofasciais. Adicionalmente a isto, existe a tendência do indivíduo experimentar emoções negativas em situações de estresse (neuroticismo), característica de personalidade associada ao traço de personalidade, que pode influenciar negativamente na experiência de dor. Indivíduos com alta ansiedade-traço são geralmente hipersensíveis a estímulos e psicologicamente mais reativos. É concebível supôr a coexistência de alteração na excitabilidade cortical, entre dor crônica e ansiedade nestes pacientes. Para melhorar a compreensão dos mecanismos centrais relacionados à ansiedade e à dor crônica, avaliou-se os parâmetros de excitabilidade cortical, usando estimulação magnética transcraniana (EMT), pulso único e pareado. Nossa hipótese é que a excitabilidade corticoespinhal seja modulada pela ansiedade favorecendo a perda de influxo inibitório descendente. Objetivos: O presente estudo teve como objetivo responder a três perguntas relacionadas à síndrome dolorosa miofascial (SDM): 1) A excitabilidade do córtex motor está relacionada com a ansiedade-traço? 2) A ansiedade-traço modula alterações da excitabilidade corticoespinhal, após dor evocada pelo Quantitative Sensory Testing (QST)? 3) A ansiedade-traço prevê resposta à dor evocada pelo QST, se receber simultaneamente um estímulo heterotópico [Conditioned Pain Modulation (CPM)]? Pacientes e métodos: Foram incluídas mulheres com SDM (n = 47) e controles saudáveis (n = 11), com idade entre 19 e 65 anos. A excitabilidade do córtex motor foi avaliada pela EMT, e a ansiedade foi avaliada com base no Inventário de Ansiedade Traço-Estado (IDATE). A incapacidade relacionada à dor foi avaliada pelo perfil da escala de dor crônica para a população brasileira (B:PCP:S), e as medidas psicofísicas da dor foram medidas pelo QST e CPM. Resultados: Nas pacientes, a ansiedade-traço foi positivamente correlacionada com a facilitação intracortical (FIC) no baseline e após a dor evocada pelo QST (β = 0,05 e β = 0,04, respectivamente) e negativamente relacionada com o período de silêncio cortical (PSC) no baseline e após a dor evocada pelo QST (β = -1,17 e β = -1,23, respectivamente) (P <0,05 para todas as comparações). Após dor evocada pelo QST, a incapacidade relacionada à dor crônica foi positivamente correlacionada com a FIC (β = 0,02) (P <0,05). Os escores de dor durante o CPM foram positivamente correlacionados com a ansiedadetraço, quando a incapacidade relacionada à dor crônica foi igualmente alta (β = 0,39, P = 0,02). A excitabilidade cortical das controles saudáveis permaneceu inalterada após o QST. Conclusões: Estes resultados sugerem que, na SDM, o desequilíbrio entre os sistemas excitatórios e inibitórios descendentes do trato corticoespinhal está associado concomitantemente a maiores níveis de ansiedade-traço e maiores níveis de incapacidade funcional ocasionados pela dor crônica. / Background: High levels of anxiety have been associated with the intensity and pain behavior in patients with acute and chronic pain. It was observed that in subjects with myofascial pain (SDM), stress and anxiety syndrome increase the predisposition for the development of myofascial trigger points. In addition to this, there is a tendency of individuals to experience negative emotions in stressful situations (neuroticism), personality characteristic associated with trait personality that may negatively influence in the experience of pain. Individuals with higher trait anxiety are usually hypersensitive to stimuli and more psychologically reactive. It is conceivable to assume the co-existence of change in cortical excitability, chronic pain and anxiety, in these patients. To improve the understanding of the central mechanisms related to anxiety and chronic pain, we assessed cortical excitability parameters by single and paired pulse transcranial magnetic stimulation (TMS). We hypothesize that corticospinal excitability is modulated by anxiety favoring loss of descendent inhibitory influx. Objectives: This study aimed to answer three questions related to chronic myofascial pain syndrome (MPS): 1) Is the motor cortex excitability, as assessed by transcranial magnetic stimulation parameters (TMS), related to state-trait anxiety? 2) Does anxiety modulate corticospinal excitability changes after evoked pain by Quantitative Sensory Testing (QST)? 3) Does the state-trait anxiety predict the response to pain evoked by QST if simultaneously receiving a heterotopic stimulus [Conditional Pain Modulation (CPM)]? Patient and methods: We included females with chronic MPS (n=47) and healthy controls (n=11), aged from 19 to 65 years. Motor cortex excitability was assessed by TMS, and anxiety was assessed based on the State-Trait Anxiety Inventory. The disability related to pain (DRP) was assessed by the Profile of Chronic Pain scale for the Brazilian population (B:PCP:S), and the psychophysical pain measurements were measured by the QST and CPM. Results: In patients, trait-anxiety was positively correlated to intracortical facilitation (ICF) at baseline and after QST evoked pain (β= 0.05 and β= 0.04, respectively) and negatively correlated to the cortical silent period (CSP) (β= -1.17 and β= -1.23, respectively) (P <0.05 for all comparisons). After QST evoked pain, the DRP was positively correlated to ICF (β= 0.02) (P<0.05). Pain scores during CPM were positively correlated with trait-anxiety when it was concurrently with high DRP (β= 0.39; P= 0.02). Controls’cortical excitability remained unchanged after QST. Conclusions: These findings suggest that, in chronic MPS, the imbalance between excitatory and inhibitory descending systems of the corticospinal tract is associated with higher trait-anxiety concurrent with higher DRP.

Orientador: Celia Marisa Rizzatti Barbosa / Tese (doutorado) - Universidade Estadual de Campinas, Faculdade de Odontologia de Piracicaba / Made available in DSpace on 2018-08-26T10:35:22Z (GMT). No. of bitstreams: 1 Gama_MartaCristinadaSilva_D.pdf: 1662915 bytes, checksum: 18506169d934a9ebd8881f306afa48fb (MD5) Previous issue date: 2014 / Resumo: A Disfunção Temporomandibular (DTM) é uma condição de dor músculo-esquelética heterogênea. Recentemente, tem sido sugerida a distinção entre disfunção temporomandibular com dor localizada ou generalizada. O presente estudo teve como objetivo revisar o conhecimento atual sobre os achados clínicos relativos a avaliação funcional da mandíbula em pacientes com DTM, e avaliar a função mandibular e as características de dor facial entre subgrupos de pacientes com DTM, os quais foram classificados de acordo com a presença de dor localizada (DL) ou de dor generalizada (DG). Foram realizados dois estudos transversais e uma revisão da literatura. O questionário autoaplicável e os procedimentos de exame clínico do RDC / TMD foram aplicados em populações do Brasil (BR) e dos Estados Unidos da América (EUA). Os participantes foram classificados como controles sem queixas de DTM (BR=37, EUA=2,700), pacientes com DTM/DL (BR=43, EUA=463) e pacientes com DTM/DG (BR=33, EUA=569). Estes três grupos foram comparados em relação a cada medida de interesse, as quais foram obtidas a partir da avaliação clínica da dor facial e da função mandibular e de perguntas de auto-relato sobre dor facial, limitação funcional e hábitos parafuncionais. Além do exame clínico facial, a dor corporal e a presença de Bruxo-facetas também foram avaliadas na população dos EUA. Os resultados sugerem que os pacientes com DTM associada a DG apresentam uma forma mais grave de DTM do que pacientes com DL. Os pacientes com DTM diferem substancialmente dos controles com relação a todos os fatores de dor e quase todas as variáveis clínicas. Pacientes com DTM com dor generalizada relataram significativamente maior intensidade de dor facial e corporal, mais auto-relato de atividades parafuncionais orais, apresentaram maior frequência de dor moderada a severa à palpação, maior incapacidade relacionada à dor, maior número de sintomas orofaciais inespecíficos e maior limitação emocional e de comunicação do que os pacientes com dor localizada. Os pacientes com dor localizada apresentaram maior sobreposição incisal e maior presença de Bruxo-facetas, demonstrando que fatores locais podem contribuir para a dor na DTM localizada. Como conclusão, os subgrupos de DTM apresentam perfis distintos que foram mais relacionados com a presença de dor do que com limitação funcional mandibular. No entanto, a dor localizada da DTM parece ser mais influenciada por fatores locais, como a má oclusão e desgaste dentário. Mais estudos são necessários para uma melhor compreensão da função mandibular e dor em pacientes com diferentes perfis de DTM / Abstract: Temporomandibular Disorder (TMD) is a heterogeneous musculoskeletal pain condition. Recently, the distinction between temporomandibular disorders with localized or generalized pain has been suggested. The present study aimed to review the current knowledge about clinical findings concerning jaw functional assessments in patients with TMD, and to evaluate jaw function and facial pain characteristics among subgroups of TMD patients, which were classified according to the presence of localized pain (LP) or widespread pain (WP). Two cross-sectional studies and a literature review were conducted, and a self-administered questionnaires and clinical examination procedures from the RDC/TMD were applied in populations from Brazil (BR) and United States or America (USA). Participants were classified as controls free of TMD complaints (BR=37, USA=2700), TMD/LP patients (BR=43, USA=463) and TMD/WP patients (BR=33, USA=569). These three groups were compared with respect to each measure of interest, which were obtained from the clinical assessment of facial pain and jaw function and from self-reported questions of facial pain, functional limitation and parafunctional habits. Add to clinical facial exam, body pain and the presence of bruxo-facets was assessed in USA population. The results suggest that TMD patients with WP have a more severe form of TMD than patients without WP. Patients with TMD differ substantially from controls with respect to all pain factors and almost all clinical variables. TMD patients with generalized pain reported significantly higher facial and body pain intensity and greater self-reported oral parafunctional activities, presented increased frequency of moderate/severe pain on palpation, higher pain-related disability, greater number of nonspecific orofacial symptoms, and greater emotional and communication limitation than the patients with localized pain. The patients with localized TMD presented higher incisal overlap and higher presence of bruxo-facets, demonstrating that local factors may contribute to localized TMD pain. As conclusion, TMD subgroups present distinct profiles which were more related with pain presence than with jaw functional limitation. However, localized TMD pain seems to be more influenced by local factors such as malocclusion and tooth wear. More studies are needed for a better understanding of jaw function and pain in patients with different profiles of TMD / Doutorado / Anatomia / Doutora em Biologia Buco-Dental

No description available.

α-Terpineol (TPN) is an alcoholic monoterpene present in the essential oil of oregano and thyme, having anticonvulsant, antinociceptive and anti-inflammatory properties. The TPN analgesic activity is associated with its actions in the central nervous system (CNS), what can suggest that TPN can act on dysfunctional chronic pain, such as fibromyalgia (FM). The FM is a chronic rheumatic disease with pathophysiology related to alterations in neurotransmission systems. The current therapy for FM is mainly characterized by pharmacotherapeutic conduct; however, there is significant drug resistance. Thus, the aim of this study was to evaluate the possible anti-hyperalgesic effect of an inclusion complex containing TPN and β-cyclodextrin (βCD) in the non-inflammatory chronic muscle pain model (considered to be a FM model) in rodents. The TPN-βCD complex was prepared and characterized by thermogravimetry (TG), absorption spectroscopy in the infrared Fourier transform (FTIR) and scanning electron microscopy (SEM). Albino Swiss mice were used, weighing between 20 and 30 g. The non-inflammatory chronic muscle pain model was induced by two injections of acid saline (pH 4.0 - 20 uL) into the left gastrocnemius, 5 days apart. After induction, the animals were treated with TPN-βCD (25, 50 or 100 mg/kg, p.o.), vehicle (0.9% saline, p.o.) or tramadol (5 mg/kg; i.p.) for 10 consecutive days. An hour after the treatment, it was measured the mechanical hyperalgesia through digital analgesimeter, the motor performance through the Rota-Rod and muscle strength through the Grip Strength Meter. In addition, it was tested the action of the administration of ondansetron and naloxone (opioid and serotonin antagonists, respectively) in the TPN analgesic action. The results were expressed as mean ± standard error and the differences between groups were analyzed using ANOVA followed by Tukey's test. After incorporation of TPN in βCD, the complexes were characterized physical chemically by different methods: TG, FTIR and SEM. These results together suggested the formation of TPN-βCD complex. The oral treatment with TPN-βCD, in all doses, produced a significant reduction (p <0.001) in the mechanical hyperalgesia without causing any changes in motor coordination. The muscle strength increased after the administration of the highest dose. The analgesic time effect in animals treated with TPN-βCD complex was over four hours to the free αTPN, being these difference statistically significant (p <0.01). The analgesic effect observed was reversed by systemic administration of naloxone or ondansetron. Corroborating these findings, the "docking" study confirmed the possible interaction of αTPN with opioid (mu, kappa, delta) and serotonin receptors. Thus, it can be concluded that the TPN-βCD complex reduced the mechanical hyperalgesia in the chronic muscle pain model, probably due to activation of CNS areas, possibly acting on opioid and serotonin receptors. / O α-terpineol (TPN) é um monoterpeno alcoólico presente no óleo essencial de orégano e tomilho com propriedades anticonvulsivantes, antinociceptiva e anti-inflamatória. As propriedades analgésicas do TPN estão associadas a suas ações no sistema nervoso central (SNC), sendo sugestivo seu efeito sobre dores crônicas conhecidas como disfuncionais, tais como a fibromialgia (FM). A FM é uma doença reumatológica crônica de fisiopatologia relacionada a alterações em sistemas de neurotransmissão e sua terapia atual é caracterizada principalmente pela conduta farmacoterapêutica, contudo, com significativa farmacoresistência terapêutica. Dessa forma, o objetivo do trabalho foi avaliar a possível efeito anti-hiperalgésico do complexo de inclusão contendo TPN e β-ciclodextrina (βCD) no modelo de dor muscular crônica não inflamatória (considerado ser um modelo experimental de FM) em roedores. O complexo TPN-βCD foi preparado e caracterizado por termogravimetria (TG), espectroscopia de absorção na região do infravermelho com transformada de Fourier (FTIR) e microscopia eletrônica de varredura (MEV). Foram utilizados camundongos Swiss albinos machos pesando de 20 a 30 g. O modelo de hiperalgesia muscular crônica não inflamatória foi induzida por duas injeções de solução salina (pH 4,0 - 20 μL) no gastrocnêmio esquerdo, sendo a primeira no dia 0 e a segunda no dia 5. Após a indução da hiperalgesia, os animais foram tratados com αTPN-βCD (25, 50 ou 100 mg/kg; v.o.), veículo (salina 0.9%, v.o.) ou Tramadol (4 mg/kg; i.p.) durante 10 dias consecutivos. Uma hora após analise da hiperalgesia mecânica, avaliou-se o desempenho motor no teste do Rota-Rod e a força muscular no Grip Strength Meter. Além disso, foi testado o possível antagonismo da ação analgésica pela administração de naloxona e ondansetrona (antagonistas de receptores opióides e serotoninergico, respectivamente). Os resultados foram expressos como média ± erro padrão da média e as diferenças entre os grupos foram analisadas por meio do teste de variância ANOVA, seguido pós-teste de Tukey. Após incorporação do αTPN na βCD, os complexos foram caracterizados fisico-quimcamente por diferentes métodos: TG, FTIR e MEV, e o conjunto dos resultados obtidos sugerem a formação do complexo αTPN-βCD. O tratamento oral com αTPN-βCD, em todas as doses testadas, produziu uma redução estatisticamente significativa (p<0,001), na hiperalgesia mecânica, sem causar alterações na coordenação motora e aumentando a força muscular na maior dose testada. A duração do efeito analgésico nos animais tratados com complexo αTPN-βCD foi quarto horas superior ao tempo de analgesia causada pela αTPN livre, diferença estatisticamente significativa quanto a comparação desses dois grupos (p<0,01). O efeito analgésico foi revertido pela administração sistêmica de naloxona ou ondansetrona. Corroborando com esses resultados, o estudo de “docking” confirmou a possível interação do αTPN com receptores Opióides (MU, Kappa, Delta) e Serotonina. Assim, pode-se concluir que o complexo αTPN-βCD reduziu a hiperalgesia mecânica no modelo de nocicepção muscular crônica, provavelmente por ativação de áreas do SNC, agindo, possivelmente, nos receptores opióides e serotoninérgicos.

Made available in DSpace on 2017-06-01T18:08:29Z (GMT). No. of bitstreams: 1 dissertacao_maria_do_socorro.pdf: 18486072 bytes, checksum: a3368ec9c3928dfeadbdfb93f006a4fb (MD5) Previous issue date: 2010-05-31 / Chronicle pain is an important contemporary public health problem, as well as the increasing demand for health care services and technological resources to improve the approach of several factors involved in the consequential incapacity and suffering. In the last years, the study of pain and depression has contributed to deep changes in the comprehension of the nervous system dynamics and complexity; it has raised the recognition of the importance of social, cultural and psychological factors for the experience and expression of pain, and, besides that, it has diversified therapeutic care resources. This exciting reality has raised the interest to deepen the knowledge in this area and, therefore, the research had as main objective to investigate chronicle pain and its relation to depressive symptoms in the contemporary context. For fieldwork, we have elected five patients with chronicle pain and depression diagnosis, who were sent by the medical team of a Pain Clinic in João Pessoa city, Paraíba state. They were monitored through a therapeutic listening weekly, with fifty minutes for each session, for up to ten months. Collected data were analyzed and interpreted from a psychoanalytical perspective, considering the body somatic language in chronicle pain and in depression, trying to understand psychological factors in the context of these people s life stories. Among several results, it is possible to highlight feelings of abandonment and the need for care, the involvement of the body in the process of psychological elaboration, the need for recognition through the experience of pain, marked losses, interferences in family dynamics and secondary benefits of painful symptoms. The depressive trace and the paralyzing character of pain were present in all participants, identified through aspects such as social isolation, unproductiveness, and feelings of emptiness, death drive, low self-esteem, hopelessness and acceptance of the sick person role as characteristic of self-identification. In this way, we expect to contribute to deepen this thematic and we can conclude that, despite the chronicle pain/depressive body controversial relation, pain has always been associated to/with depression / A dor crônica é um importante problema de saúde pública contemporâneo, assim como a crescente demanda por serviços de saúde e recursos tecnológicos para a abordagem das diversas dimensões envolvidas na incapacidade e no sofrimento resultante. Nos últimos anos, o estudo da dor e da depressão tem contribuído com mudanças profundas na compreensão da dinâmica e complexidade do sistema nervoso; tem impulsionado o reconhecimento da importância das dimensões sócio-culturais e psíquicas na experiência e expressão do fenômeno doloroso, além de ter proporcionado a diversificação de recursos terapêuticos mobilizados nesse cuidado. Essa realidade instigadora foi despertando o interesse em aprofundar os conhecimentos nessa área, de modo que a realização desta pesquisa teve como objetivo geral investigar a dor crônica no contexto contemporâneo e sua relação com sintomas depressivos. Para a pesquisa de campo, elegemos cinco pacientes diagnosticados como portadores de dor crônica e depressão, encaminhados pela equipe médica de uma Clínica da Dor da cidade de João Pessoa, Paraíba, os quais foram acompanhados através da escuta terapêutica, com um encontro semanal, com duração de cinqüenta minutos, por um período de até dez meses. Os dados coletados foram analisados e interpretados, a partir do referencial psicanalítico, considerando a relação entre a linguagem somática do corpo na dor crônica e na depressão, compreendendo sua dimensão psíquica no contexto de suas histórias de vida. Entre os resultados encontrados, destacaram-se o sentimento de desamparo e a demanda por cuidado, a convocação do corpo no processo de elaboração psíquica, a necessidade de reconhecimento através da experiência dolorosa, as vivências marcantes de perdas, interferências na dinâmica familiar e os benefícios secundários dos sintomas dolorosos. O traço depressivo e o caráter paralisante da dor estiveram presentes em todos os participantes, identificados através de aspectos como isolamento social, improdutividade, sentimento de vazio, pulsão de morte, baixa auto-estima, sentimento de desesperança e aceitação do papel de ser doente como característica de sua auto-identificação. Dessa forma, esperando ter contribuído para o aprofundamento da temática abordada, podemos concluir que, apesar das controvérsias na relação dor crônica/corpo deprimido, a dor esteve sempre associada à depressão

Base Teórica: A prevalência de dor crônica na infância é bem documentada e estima-se que atinja entre 20 a 35% da população pediátrica, podendo causar enorme sofrimento em seus portadores, inaptidões pessoais e ser acompanhada de sintomas emocionais importantes. O manejo dessas criancas inclui a compreensão dos fatores biomecânicos, psicológicos e socioculturais associados ao seu contexto. Dentre os fatores psíquicos o pensamento catastrófico sobre a dor, definido como uma resposta negativa exagerada a mesma, tem sido identificado como uma estratégia adaptativa às circunstâncias. A escala de avaliação do pensamento catastrófico em crianças - Pain Catastrophizing Scale – child version (PCS-C), adaptada da escala para adultos, já está validada em diferentes línguas, no entanto, pouco se sabe sobre o catastrofismo em crianças brasileiras. Objetivos: O objetivo desse estudo é validar e adaptar a PCS-C para o português do Brasil, examinar as propriedades psicométricas, bem como a estrutura fatorial da escala, e sua correlação com a dor e suas consequências em crianças com e sem dor crônica. Métodos: A versão em português do Brasil foi modificada por um grupo de especialistas a fim de torná-la apropriada para aplicação em crianças entre 7-12 anos. Para avaliar as propriedades psicométricas, 100 crianças (44 com dor crônica e 56 saudáveis) responderam a versão brasileira da PCS-C (BPCS-C). Também foram questionadas quanto aos níveis de dor e quanto à capacidade funcional durante atividades da prática de educação física na escola. Ainda, amostras de saliva foram passivamente coletadas a fim de se medir o fator neurotrófico derivado do cérebro (BDNF). O subgrupo de crianças com dor crônica foi recrutado dos ambulatórios de gastro pediatria, oncologia e reumatologia do Hospital de Clínicas de Porto Alegre e o subgrupo de crianças saudáveis foi recrutado de uma escola pública. Resultados: O estudo mostrou uma boa consistência interna do instrumento (alfa de Crombach: 0,81 para o escore total da BPCS-C). Tanto a análise paralela, quanto a análise fatorial exploratória identificaram 2 dimensões (fatores) no instrumento. A análise fatorial confirmatória apresentou os melhores valores de ajustamento (CFI, confirmatory fit-index) quando comparada a outros modelos já existentes. Os escores totais da BPCS-C não diferiram entre as crianças com dor crônica e as saudáveis. No entanto, a dificuldade progressiva de realizar as atividades da Educação Física na escola foi associada com o catastrofismo (p=0,019) nos pacientes com dor crônica. BDNF salivar apresentou fraca associação (r=0,27 p=0,012) com o catastrofismo. Conclusão: Os resultados suportam a validade e confiabilidade da BPCS-C. A estrutura de 2 fatores apresentou adequado ajustamento podendo ser usada, mesmo que diferindo do número de fatores da escala original, pois escore total é o valor mais utilizado para composição do diagnóstico. A ausência de diferença entre os escores nas crianças doentes e saudáveis sugere a necessidade de estudos mais profundos sobre a catastrofização em crianças e a necessidade de instrumentos específicos, e não apenas adaptação daqueles utilizados em adultos. / Introduction: The prevalence of chronic pain in childhood is well documented and is estimated to reach 20 and 35% of the pediatric population. Chronica pain can cause enormous suffering, personal miscarriages and it can be accompanied by important emotional symptoms. The management of these children includes understanding the biomechanical, psychological and sociocultural factors associated in this context. Among the psychic factors, catastrophic thinking about pain is identified as an adaptive strategy to the circumstances. The instrument for catastrophic thinking evaluation in children - Pain Catastrophizing Scale - child version (PCS-C), adapted from the scale for adults, is already validated in different languages, however little is known about catastrophism in Brazilian children. Objectives:. With this cross-sectional study, we aim to adapt the Brazilian version of the PCS-C (BPCS-C) and to examine the psychometric properties and factorial structure of the scale for children with and without chronic pain. Methods: The Brazilian version of the PCS-C was modified by a group of experts to appropriate it for children between 7-12 years. To asses the psychometric properties of the version, 100 children (44 with chronic pain and 56 healthy children) answered the BPCS-C, the visual analog scale and one functional school activity question. It was also collected a passive salivary sample to measure BDNF. The chronic pain children sample was recruited from the gastropediatric, oncologic, and reumatologic ambulatories at a tertiary hospital and the healthy children from a fifth grade public school. Results: We observed good internal consistency (Cronbach’s value of 0.81 for the total BPCS-C). Both parallel analysis and exploratory factorial analysis retained 2 factors for instrument dimensions. The confirmatory factorial analysis presented the best adjustment values (CFI, confirmatory fit-index) when compared to other existing pre-existing models. BPCS-C total scores were not diferente between chronic pain and healthy children. However, the progressive difficulty of performing physical education activities at school was associated with catastrophism (p = 0.019) in patients with chronic pain. 6 Salivary BDNF presented a weak association (r = 0.27 p = 0.012) with catastrophism. Discussion: The results support the validity and reliability of BPCS-C. The 2-factors structure presented an adequate adjustment and can be used for brazilian children population. Although different from the number of factors of the original scale, the instrument measured the most used value for diagnosis, total score. The lack of difference between scores in chronic pain and healthy children suggests the necessity of further studies on catastrophizing in children, as well as for specific instruments, instead of simple adaptation of those used in adults.

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