Orientador: Cláudia Herrera Tambeli / Dissertação (mestrado) - Universidade Estadual de Campinas, Faculdade de Odontologia de Piracicaba / Made available in DSpace on 2018-08-24T16:51:32Z (GMT). No. of bitstreams: 1 Miranda_Josiane_M.pdf: 1166629 bytes, checksum: b11fc8ed7e534b6c9265e384b6a80eef (MD5) Previous issue date: 2014 / Resumo: Neste estudo, foi testada a hipótese de que a transição da hiperalgesia aguda para a persistente e a hiperalgesia persistente reduzem a atividade e induzem alterações plásticas num circuito de analgesia endógena, o controle nociceptivo ascendente (CNA). Este circuito é de grande importância para mediar uma forma de analgesia endógena, conhecida como analgesia induzida por capsaicina, e é dependente de receptores µ-opióide no núcleo accumbens. Portanto, nós também investigamos se a transição da hiperalgesia mecânica aguda para a persistente e a hiperalgesia mecânica persistente altera a participação dos receptores µ-opióide intra-accumbens na analgesia induzida por capsaicina. No modelo animal de cronificação da dor utilizado, 14 dias consecutivos de injeções intraplantares de PGE2 na pata traseira de ratos (referido como o período de indução da hiperalgesia persistente), induz um estado permanente de sensibilização dos nociceptores (referido como o período de manutenção da hiperalgesia persistente), que se mantém por até 30 dias após a interrupção do tratamento com PGE2. A hipersensibilidade dos nociceptores foi medida pela diminuição do intervalo de tempo para o animal responder a uma leve estimulação mecânica na pata traseira. Para avaliar a expressão dos receptores µ-opióide no núcleo accumbens, foi utilizado o método de Western Blotting. Foi encontrada uma redução significativa na duração da analgesia induzida por capsaicina nos dias 7 e 14 do período de indução e nos dias 1, 7, 14 e 21 do período de manutenção da hiperalgesia mecânica persistente. A administração intra-accumbens do antagonista seletivo de receptor µ-opióide Cys2,Tyr3,Orn5,Pen7amide (CTOP), 10 minutos antes da injeção subcutânea de capsaicina na pata dianteira dos ratos, bloqueou a analgesia induzida por capsaicina. No entanto, não ocorreram alterações significativas na expressão dos receptores µ-opióide. Tomados em conjunto, estes resultados indicam que a transição da hiperalgesia aguda para a persistente e a hiperalgesia persistente reduzem a duração da analgesia induzida por capsaicina, sem afetar sua dependência de mecanismos mediados por receptores µ-opióide no núcleo accumbens. A atenuação da analgesia endógena durante a cronificação da dor e dor crônica sugerem que os circuitos endógenos de controle da dor desempenham um importante papel no desenvolvimento e manutenção da dor crônica / Abstract: In this study, we tested the hypothesis that the transition from acute to persistent hyperalgesia and persistent hyperalgesia reduces the activity and induces plastic changes in an endogenous analgesia circuit, the ascending nociceptive control (ANC). An important mechanism mediating this form of endogenous analgesia, referred as capsaicin-induced analgesia, is its dependence on nucleus accumbens µ-opioid receptor mechanisms. Therefore, we also investigated whether the transition from acute to persistent mechanical hyperalgesia and persistent mechanical hyperalgesia alters the requirement for nucleus accumbens µ-opioid receptor mechanisms in capsaicin-induced analgesia. We used an animal model of pain chronification in which daily intraplantar PGE2 injection into the rat's hind paw for 14 days, referred as the induction period of persistent hyperalgesia, induces a long lasting state of nociceptior sensitization referred as the maintenance period of persistent hyperalgesia, that lasts for at least 30 days following the cessation of the PGE2 treatment. The nociceptor hypersensitivity was measured by the shortening of the time interval for the animal to respond to a mechanical mild stimulation of the hind paw. Western blot analysis were used to evaluate the expression of µ-opioid receptors in nucleus accumbens. We found a significant reduction in the duration of capsaicin-induced analgesia at day 7 and 14th of the induction period and at days 1, 7, 14 and 21th of the maintenance period of persistent mechanical hyperalgesia. Intra-accumbens administration of the µ-receptor selective antagonist Cys2,Tyr3,Orn5,Pen7amide (CTOP) 10 min before the subcutaneous injection of capsaicin into the rat's fore paw blocked capsaicin-induced analgesia. However, no significant changes occurred in the expression of µ-opioid receptors. Taken together, these findings indicate that the transition from acute to persistent hyperalgesia and persistent hyperalgesia reduces the duration of capsaicin-induced analgesia, without affecting its dependence on nucleus accumbens µ-opioid receptor mechanisms. The attenuation of endogenous analgesia during pain chronification and chronic pain suggests that endogenous pain circuits play an important role in the development and maintenance of chronic pain / Mestrado / Fisiologia Oral / Mestra em Odontologia

The effects of a computer program (Health Imagery Technology Systems, HITS) designed to promote attitude and cognitive changes through elicitation of evoked response potentials were evaluated with chronic pain patients. A treatment and control group were used for comparison (52 patients, 22 females, 32 males, mean ages 47). Wechsler Adult Intelligence Scale-Revised subtests, a Semantic Differential scale, the Health Attribution Test, an imagery protocol, the McCoy-Lawlis Pain Drawing, and the Zung Depression scale were used at admission and discharge to measure change. A pre- post-mood thermometer was used with the treatment group. The hypotheses that the treatment group would show significant changes on these measures were tested with a two group repeated measures analysis of variance design. No significant changes were noted for either group on the intellectual measures, on health attitudes, or reports of pain. The similarities subscale showed significant within group variance (F = 5.46, p < .023). One bipolar adjective pair indicated significant differences (F = 4.79, p < .035), possibly a result of chance. One of seven imagery measures suggested a significant improvement in strength of imagery for the treatment group (F = 18.2, p < .00008). Both groups showed significantly improved imagery of body defenses (F = 4.58, £ < .037) and significantly reduced depression scores (F = 15.93, p < .000021). A mood thermometer was measured for the treatment group alone and five situational mood changes were significant in predicted directions. Post hoc discriminant analysis showed significant differences only on one adjective pair (F = 9.75, p < .0029). No combination of variables added to the prediction of group membership. Overall, the effects of the HITS program did not seem strong enough to indicate its value as a treatment modality in chronic pain populations beyond current treatment. It did indicate some significant situational mood effects in positive directions.

Doctorat en sciences psychologiques / info:eu-repo/semantics/nonPublished

Suffering is a fundamental experience of the human condition. Whereas the arts and humanities have struggled to make sense of this condition, no concerted effort has taken place in nursing. Suffering is painfully absent within the cancer nursing research literature, a place where suffering should be conspicuous. The purpose of this study was to explore suffering inherent in the cancer experience. The concurrent use of Travelbee's Human-To-Human Relationship Model and narrative theory provided the conceptual underpinning for this prospective ethnography. Narratives of suffering were explored among seven patients diagnosed with cancer (breast, n = 4; brain; malignant melanoma; and ovarian cancer). Five women and two men were interviewed weekly (N = 89 interviews) for a period of up to five months. Participant observation supplemented the interview data. Seven richly textured narratives revealed the suffering endured in the living-of-cancer. The narratives also detailed the informant as person, the cancer trajectory, and explanatory models of cancer causation. A second level analysis of the narratives provided an intra-group comparison of suffering. "Cascade of losses" was the overarching theme. The undermining of personhood, and a loss of faith and trust in the medical system characterized this cascade of losses. Losses were further encountered: the dismissal of symptoms presented to physicians, the failure of treatment as cure, the death of other cancer patients, and the false reassurance that "cancer can be beaten". The remaining themes were "cancer as torture" and "the work of suffering--the beauty of cancer". The findings of this study suggest that nurses may not be capable of alleviating patient suffering. Patients' lives intersect at the suffering experience; their suffering is shaped by the past, present, and future. Nurses may influence these intersections of suffering to some extent, however, it is the individual who ultimately determines the living and outcome (if any) of their suffering. In the lives of the informants, it was the love of spouses and children, faith and trust in God, and satisfaction with life's accomplishments which permitted the endurance of suffering. Competent, comfort-care provided by compassionate nurses is needed by patients who suffer with cancer.

It is believed by many researchers that little attention has been given to patients' perceptions of the impact of chronic pain on their lives. In recognition of this need, G. Frank Lawlis, C. Edward McCoy, and David K. Selby developed the Dallas Pain Questionnaire (DPQ) to assess the amount of chronic pain that affects four aspects (daily activities, work-leisure activities, anxiety-depression, and social interest) of the patients' lives. The present study, conducted to validate the DPQ's statistical properties, first reviews the literature addressing the various theories and varieties of pain, its opiates, and the two current approaches to quantify pain. This study included a total of 143 subjects. Clinical subjects were 104 inpatients in the Spinal and Chronic Pain Center at Medical Arts Hospital and 15 chronic pain outpatients released to work. Normal subjects consisted of staffing personnel (n = 13) and flight assistance employees (U = 11)- Both clinical and normal groups completed the DPQ. The Minnesota Multiphasic Personality Inventory (MMPI) was administered only to the clinical population. Results suggest that the DPQ is both externally reliable (stability reliability coefficient of .970) as well as an internally consistent instrument. Two factors emerged from factor structure analysis. Factor one (63.2% of variance) represents functional activities. Factor two (8.3% of variance) represents emotional capacities. A correlation analysis suggests the concurrent validity of the psychological and functional factors of the DPQ. A t-test demonstrated that chronic pain patients have significantly higher DPQ's scores than normals. Because these findings support its psychometric properties, the DPQ appears to have utility for clinical and research purposes. The findings, limitations, and implications of this study are detailed, as are suggestions for future research.

The purpose of the present study was to investigate cognitive functioning in a group of 30 chronic pain patients (CPG) as compared to a group of 39 acute pain patients (APG). In order to assess cognitive performance, certain subtests were selected from the McCarron-Dial System (MDS) of Neuropsychological Evaluation. Specifically, a measure of haptic discrimination was used along with the Bender Visual Motor Gestalt Test. As such, completion of these subtests required a cortically mediated, central nervous system processing of sensory information. This particular method of assessment was chosen because it provided a nonverbal measure of higher-order cognitive performance. Additionally, the haptic measure provided separate scores for right and left hemispheric functioning. Data analysis revealed significantly poorer Bender performance among CPG members (t(69) = -5.09, E - •0004, two tailed). Further data analysis revealed that the CPG performed significantly poorer on certain of the haptic discrimination subtests. Specifically, both texture and configuration scores for the right hemisphere were significantly lower among CPG members (texture, p = -042 and configuration, p = .002). Subsequent analyses were conducted to determine predictive relationships between important variables. These data are discussed in terms of their clinical significance and importance for future research.

"December, 2003" / Bibliography: leaves 283-311. / xiv, 311 leaves : ill. ; 30 cm. / Title page, contents and abstract only. The complete thesis in print form is available from the University Library. / Thesis (Ph.D.)--University of Adelaide, School of Medicine, Dept. of Psychology, 2005

One of the primary goals of palliative care is management of symptoms such as pain. Palliative clinicians experience difficulty in severe pain management (SPM) and therefore there is a need for enhanced approaches to SPM. This dissertation attempts to fulfill that need by applying informatics based approaches to SPM. The dissertation was done in three phases: conceptualization, construction and testing. Conceptualization developed a practice support framework and set of informatics based tools for palliative SPM, construction implemented the informatics based tools as a computer based practice support tool and testing performed usability testing on the computer based tool. The results show that qualitative methods can be used to capture and understand the practice support needs for palliative SPM, which include a number of processes and information to support SPM. The practice support needs were then used to develop a set of informatics based solutions consisting of an ontology, a set of problem solving methods and an empirically derived vocabulary for palliative SPM. The informatics based solutions then became the design requirements for a computer based tool that provided comprehensive practice support for palliative SPM. The testing phase of the research used usability testing to test the functionality of the computer based tool. Usability testing was favorable to the question of how well does the computer based tool provide practice support for palliative SPM. This dissertation makes contributions to the fields of health informatics and palliative care. For health informatics it illustrates how to apply qualitative research methods to capture and organize knowledge around a complex healthcare domain area. The dissertation also illustrates how to use that knowledge to extend existing work on ontology based information system (IS) design by using that knowledge to develop a set of empirically derived informatics based solutions and then implementing the solutions as a computer based tool. The dissertation makes a contribution to palliative SPM by identifying practice support needs for SPM including linkages between research and practice, promotion of a common SPM vocabulary, and an approach to information handling to help manage the complexity of SPM.

Thesis (M.S.)--University of Florida, 2004. / Typescript. Title from title page of source document. Document formatted into pages; contains 33 pages. Includes Vita. Includes bibliographical references.

Orientador: Maria da Consolação Gomes Cunha Fernandes Tavares / Tese (doutorado) - Universidade Estadual de Campinas, Faculdade de Educação Fisica / Made available in DSpace on 2018-08-12T05:58:53Z (GMT). No. of bitstreams: 1 Marcelino_VagnerReolon_D.pdf: 534331 bytes, checksum: 356a87c3be243fff9f823ff8c666387d (MD5) Previous issue date: 2008 / Resumo: No processo do envelhecimento ocorre alta incidência de doenças crônicas e degenerativas que, muitas vezes, resultam em elevada dependência. A dor crônica é a principal queixa do idoso, fato que pode interferir de modo significativo na estrutura da sua identidade corporal. Ultimamente a disseminação da prática de atividade física para idosos vem sendo preconizada como uma intervenção importante para garantir um envelhecimento saudável. Acreditamos que é importante disponibilizar ao professor de Educação Física informações que permita realizar a abordagem do idoso com dor crônica durante a prática de atividade física considerando suas necessidades especiais. Dessa forma o objetivo deste trabalho foi verificar se a intervenção da prática de atividade física sistematizada com exercícios resistidos e exercícios recreativos poderia intervir na auto-imagem e na auto-estima e na percepção da dor em pessoas idosas com dores crônicas. A amostra foi constituída por idosos pertencentes ao projeto de extensão da Faculdade de Americana, denominado musculação para idosos, sendo divididos em dois grupos: um grupo com atividade física - GCAF (n=13) e um grupo sem atividade física - GSAF (n=12). A auto-imagem a auto-estima foi determinada por meio de aplicação do questionário proposto por Steglich(1978) e a percepção de dor foi avaliada através da escala analógica visual de dor - EVA. O grupo com atividade física - GCAF foi submetido a um programa de exercícios resistidos e exercícios recreativos durante três meses. O grupo sem atividade física - GSAF realizou encontros quinzenais com o pesquisador/responsável realizando atividades de sociabilização durante três meses. Como resultados observou-se que a auto-imagem do grupo sem atividade física - GSAF para o antes e depois do período proposto de encontros não alterouse. Com relação à auto-estima ocorreu uma pequena diferença após o programa. O grupo com atividade física - GCAF não apresentou alterações na variável auto-estima. Quando comparados os dados antes e depois após o programa de atividade física na variável da auto-imagem não ocorreu diferenças. A percepção de dor do grupo com atividade física - GCAF para o grupo sem atividade física - GSAF houve diferença da percepção de sensibilidade de dor para ambos os grupos. O grupo com atividade física - GCAF antes das intervenções dos programas de atividades físicas mostrava uma sensibilidade significativa conforme a Escala EVA, após as atividades físicas o mesmo grupo apontava uma sensibilidade menor com a apresentada anteriormente. O grupo sem atividade física - GSAF também mostrou uma diminuição na sensibilidade de dor, conforme a escala EVA. Mas, não estatisticamente conforme o grupo com atividade física - GCAF. A reflexão neste trabalho nos leva a valorizar a formação abrangente do profissional de Educação Física, reconhecendo o mesmo como professor qualificado e apto a lidar com o complexo do valor humano, no contexto da formação da área em educação física. / Abstract: A high incidence of chronic and degenerative diseases occurs in the aging process, which, many times, results in a state of high dependence. Chronic pain is the main complaint of the aged, a fact which can significantly interfere in the structure of their corporal identity. Lately, physical activity practice for the aged is recommended, as an important intervention to guarantee a healthy aging process. We believe it is important to offer the Physical Education professor information which would allow him (her) to approach the aged who have chronic pain while practicing physical activity, considering their special needs. In this manner, the aim of this paper was to verify if an intervention in the practice of systematic physical activity with resisted and recreative exercises could intervene in the self image and self esteem and in the perception of chronic pain of the aged. The sample was composed of aged belonging to the extension project of the Americana School (Faculdade de Americana), named Muscle Building for the Aged, divided into two groups: a group with physical activity - GCAF (n=13) and a group with no physical activity - GSAF (n=12). Self image and self esteem were determined by applying the questionnaire proposed by Steglich (1978) and the perception of pain was evaluated through the visual analogical scale - EVA. The group with physical activity - GCAF was submitted to a resisted and recreative exercise program for three months. The group with no physical activity - GSAF participated in fortnightly meetings with the researcher/person responsible, performing socializing activities for three months. The results showed that the self image of the group with no physical activity - GSAF, before and after the period of the meetings proposed, did not change. In relation to self esteem, there was a small difference, after the program. The group with physical activity - GCAF did not show alterations in the self esteem variable. When the data before and after the physical activity program was compared, no alterations occurred in the self image variable. There was a difference in the sensitivity to pain for both groups. The group with physical activity - GCAF showed a significant sensitivity before the interventions of the physical activity programs, according to the EVA scale; after the physical activities, the same group pointed to a lower sensitivity than that previously seen. The group with no physical activity - GSAF also showed lower sensitivity to pain, according to the EVA scale, but not statistically, as in the group with physical activity - GCAF. Pondering the data raised in this paper leads us to valorize the comprehensive formation of the Physical Education professional, recognizing him (her) as a qualified professor and apt to deal with the complex value of the human being, in the context of formation in the area of physical education. / Doutorado / Atividade Fisica, Adaptação e Saude / Doutor em Educação Física