This diploma thesis summarizes recent knowledge about body scheme, spatial orientation and their change in context of chronic pain. The purpose of this work is to find out if chronic pain negatively affects the body scheme and spatial orientation. The thesis includes a comparative analysis of experimental measurements between the patients with Failed Back Surgery Syndrome and healthy control group. The analysis compares tasks based on spatial orientation and body scheme tests. Results show the patients' group having lower results in body scheme related tests, showing a noticeable disparity compared to the control group's test scores. These results were further supported by portion of spatial orientation based tasks, where patients' group again performed at significantly lower level than the control group. In conclusion, our thesis, along with other academic works, states that there is a correlation between chronic pain, disrupted body scheme and spatial orientation. However, at the present time it could not be determined whether the pain precedes the effect of disrupted body scheme or vice versa. Powered by TCPDF (www.tcpdf.org)

Aim: The aim of this thesis is both evaluate a somatognosis quality and consider rate of personality dimensions in patients with FBSS. Methods: 30 patients with FBSS and 25 probands of healthy control group were examinated in laboratory of spatial cognition called Blue Velvet Arena. They underwent spatial navigation task and body scheme tests. We made comparative analysis of these measurements between groups. We evaluated personality dimensions in patients group, by using NEO personality inventory and Petrie test. Finally we consider relationships of these variables and another related factors. Results: Signicant difference between patient's group and control group was found both in spatial navigation task and body scheme tests. In spatial navigation task control group had lower results compared to the patient's group. In body scheme tests was found reverse results. We found high correlation of body scheme with age, pain duration and activity level. There was high percentage of underestimating probands and probands with high score of conscientiousness. Error rate (judgement out of tolerance zone) was higher in patient's group compared to the control group. Conclusions: Our results states that patients with FBSS have lower quality of somatognosis in light of body scheme. We hypothesise, that body...

This thesis describes coping in pacients with chronic musculoskeletal pain. It focuses especially on the cognitive evaluation of pain and coping strategies. Furthermore it deals with the emotional changes in chronic pain. The theoretical part consists of the development of access to pain and the overview of some current knowledge of biological and psychosocial determinant of pain. Emphasis is placed on a holistic, biopsychosocial approach to the issue. Empirical part consists of research aimed at assesing the important factors that contribute to cope life with pain, as in terms of personal dispositions of an individual, so in terms of environmental influence. The main aim of the research is to identity the most used coping strategies and to assess their effectiveness. Keywords: chronic disease, chronic pain, coping resources, coping strategies

Dans le présent travail, le rôle de la glie dans l’expression de la douleur cancéreuse et de la douleur neuropathique a été étudié de façon comparative. Le modèle animal de douleur cancéreuse a été obtenu par injection osseuse dans le tibia, chez la rate Sprague-Dawley, de cellules de carcinome mammaire de type MRMT-1. Le modèle de douleur neuropathique a été obtenu chez le rat Wistar par ligature des nerfs spinaux L5 et L6. Les données obtenues par l’analyse du comportement douloureux en réponse à la stimulation par des filaments de von Frey ont permis de quantifier l’allodynie et l’hyperalgésie mécaniques statiques. La douleur chronique, hors stimulation nociceptive, a été mesurée à l’aide d’un test d’impotence. Les agents pharmacologiques ont été administrés par voie intrapéritonéale ou par voie intrathécale, à l’aide d’un cathéter implanté de façon chronique. L’analyse des comportements nociceptifs après stimulation par filaments de von Frey montre que l’inhibition fonctionnelle transitoire de la glie spinale par le fluorocitrate est sans effet sur la douleur dans les deux modèles. Dans les deux modèles, l’expression des réponses douloureuses dépend de l’activation des récepteurs NMDA spinaux. L’administration par voie intrathécale d’une seule dose de D-aminoacide oxydase, qui dégrade la D-sérine, co-agoniste endogène du récepteur NMDA, réduit l’allodynie et l’hyperalgésie chez les rats neuropathiques et l’allodynie chez les rats cancéreux. Les effets d’un traitement chronique par le fluoroacétate chez les rats neuropathiques sont réversés par l’administration intrathécale de D-sérine. La D-sérine altère légèrement le seuil nociceptif chez les rats cancéreux. Aucun des agents pharmacologiques utilisés ne réverse la réduction d’appui du membre lésé chez les rats cancéreux ou neuropathiques. Ces résultats montrent que, chez le rat, la douleur neuropathique comme la douleur osseuse cancéreuse dépend de la co-activation des récepteurs NMDA spinaux par un de ses ligands endogènes, la D-sérine, mais que seule la douleur neuropathique requiert une glie spinale fonctionnelle. Ils suggèrent donc un rôle différentiel de la glie dans la physiopathologie de ces deux types de douleur chronique / The present work has investigated the role of glia upon pain symptoms in a well established peripheral neuropathic pain model and a bone cancer pain model. The neuropathic pain model was obtained by right L5-L6 spinal nerve ligation in male Wistar rats. Bone cancer pain was induced by injecting MRMT-1 rat mammary gland carcinoma cells into the right tibia of Sprague-Dawley female rats. Mechanical allodynia and hyperalgesia were quantified using von Frey hairs and ambulatory incapacitance using dynamic weight bearing. Drugs were administered either acutely or chronically using osmotic pumps, through intrathecal catheters chronically implanted in experimental animals. Using von Frey hair stimuli, we found that transient inhibition of glia metabolism by intrathecal injection of fluorocitrate was ineffective in both models. In both models, pain symptoms required spinal NMDA receptor activation. Intrathecal administration of a single dose of D-aminoacid oxidase, which degrades D-serine, a co-agonist of NMDA receptors, reduced mechanical allodynia and hyperalgesia in neuropathic rats and allodynia in cancer rats. The effect of chronic fluoroacetate in neuropathic rats was reversed by acutely administered intrathecal D-serine, which had only a slight effect in cancer rats. None of these compounds altered the functional disability shown by neuropathic or cancer animals and measured by the dynamic weight bearing apparatus. These results show that neuropathic pain and cancer pains depend upon D-serine co-activation of spinal NMDA receptors but only neuropathic pain requires functional spinal cord glia in the rat. Glia may thus play different roles in the development and maintenance of chronic pain in these two situations.

A significant subset of mild traumatic brain injury (mild TBI) and chronic pain (CP) patients report, and sometimes show objective evidence of, persisting cognitive problems. Despite differences in injury mechanisms, there is considerable overlap in the types of persisting cognitive symptoms that are reported by the two populations. Psychogenic, rather than physiogenic, factors are thought to play an important role in the maintenance of these persisting symptoms. The current investigation examined the contributions somatization, depression, and anxiety had on an objective measure of “working attention.” In order to best elucidate the influences these psychological factors had on attentional performance, only individuals who passed well-validated and popular indicators of cognitive and self-report validity were included in the study. Two hundred and forty-nine individuals (n = 116 TBI; n = 133 CP) met the inclusionary criteria for the study. Psychological factors were assessed using Scales 1 (Hypochondriasis), 2 (Depression), 3 (Hysteria), and 7 (Psychasthenia) of the Minnesota Multiphasic Personality Inventory-II. “Working attention” was measured using the demographically-adjusted T-scores for the Working Memory and Processing Speed Indexes of the Wechsler Adult Intelligence Scale- 3. Results indicated that a high rate of psychological complications was observed in the mild TBI and CP groups but not the moderate-severe traumatic brain injury (M/S TBI) comparison group. Analysis indicated that psychological elevations were not significantly related to spontaneously-reported symptoms or working attention deficits for the mild TBI group but were for the CP and M/S TBI groups. The current results are important for understanding the psychological complications that may occur in individuals exhibiting persisting cognitive problems in these clinical populations.

<p>Background: Sickle Cell Disease (SCD) is a genetic hematological disorder that affects more than 7 million people globally (NHLBI, 2009). It is estimated that 50% of adults with SCD experience pain on most days, with 1/3 experiencing chronic pain daily (Smith et al., 2008). Persons with SCD also experience higher levels of pain catastrophizing (feelings of helplessness, pain rumination and magnification) than other chronic pain conditions, which is associated with increases in pain intensity, pain behavior, analgesic consumption, frequency and duration of hospital visits, and with reduced daily activities (Sullivan, Bishop, & Pivik, 1995; Keefe et al., 2000; Gil et al., 1992 & 1993). Therefore effective interventions are needed that can successfully be used manage pain and pain-related outcomes (e.g., pain catastrophizing) in persons with SCD. A review of the literature demonstrated limited information regarding the feasibility and efficacy of non-pharmacological approaches for pain in persons with SCD, finding an average effect size of .33 on pain reduction across measurable non-pharmacological studies. Second, a prospective study on persons with SCD that received care for a vaso-occlusive crisis (VOC; N = 95) found: (1) high levels of patient reported depression (29%) and anxiety (34%), and (2) that unemployment was significantly associated with increased frequency of acute care encounters and hospital admissions per person. Research suggests that one promising category of non-pharmacological interventions for managing both physical and affective components of pain are Mindfulness-based Interventions (MBIs; Thompson et al., 2010; Cox et al., 2013). The primary goal of this dissertation was thus to develop and test the feasibility, acceptability, and efficacy of a telephonic MBI for pain catastrophizing in persons with SCD and chronic pain. </p><p>Methods: First, a telephonic MBI was developed through an informal process that involved iterative feedback from patients, clinical experts in SCD and pain management, social workers, psychologists, and mindfulness clinicians. Through this process, relevant topics and skills were selected to adapt in each MBI session. Second, a pilot randomized controlled trial was conducted to test the feasibility, acceptability, and efficacy of the telephonic MBI for pain catastrophizing in persons with SCD and chronic pain. Acceptability and feasibility were determined by assessment of recruitment, attrition, dropout, and refusal rates (including refusal reasons), along with semi-structured interviews with nine randomly selected patients at the end of study. Participants completed assessments at baseline, Week 1, 3, and 6 to assess efficacy of the intervention on decreasing pain catastrophizing and other pain-related outcomes. </p><p>Results: A telephonic MBI is feasible and acceptable for persons with SCD and chronic pain. Seventy-eight patients with SCD and chronic pain were approached, and 76% (N = 60) were enrolled and randomized. The MBI attendance rate, approximately 57% of participants completing at least four mindfulness sessions, was deemed acceptable, and participants that received the telephonic MBI described it as acceptable, easy to access, and consume in post-intervention interviews. The amount of missing data was undesirable (MBI condition, 40%; control condition, 25%), but fell within the range of expected missing outcome data for a RCT with multiple follow-up assessments. Efficacy of the MBI on pain catastrophizing could not be determined due to small sample size and degree of missing data, but trajectory analyses conducted for the MBI condition only trended in the right direction and pain catastrophizing approached statistically significance. </p><p>Conclusion: Overall results showed that at telephonic group-based MBI is acceptable and feasible for persons with SCD and chronic pain. Though the study was not able to determine treatment efficacy nor powered to detect a statistically significant difference between conditions, participants (1) described the intervention as acceptable, and (2) the observed effect sizes for the MBI condition demonstrated large effects of the MBI on pain catastrophizing, mental health, and physical health. Replication of this MBI study with a larger sample size, active control group, and additional assessments at the end of each week (e.g., Week 1 through Week 6) is needed to determine treatment efficacy. Many lessons were learned that will guide the development of future studies including which MBI strategies were most helpful, methods to encourage continued participation, and how to improve data capture.</p> / Dissertation

L´existence d´état douloureux, chronique et sans substrat organique, de maladies de la douleur, sont signalés depuis le XIX siècle. La douleur, comme perception, est une expérience subjective qui intègre des sensations variées. Les différents syndromes de douleur chronique ont la douleur comme symptôme principal et se caractérisent par un ensemble de signes qui ne correspondent pas à un modèle de cause organiques non localisées. Alors que la douleur aigüe est un indicateur précieux dans l´établissement d´un diagnostic, la douleur chronique, pour avoir perdu son caractère de signald´alarme, nous renvoie à une multiplicité de déterminations d´ordre somatique, psychologique et/ou ambiant. L´apport de la psychanalyse, en partenariat avec la médecine se révèle utile dans l´appréhension du sens des symptômes dans laparticularité du cas et en relation avec la singularité du sujet. À la place de soutenir l´idée qu´il est nécessaire, à tout prix, d´éradiquer définitivement un syndrome douloureux quel qu´il soit et la souffrance psychique qui y est associée, il nous semble utile de prendre en considération ce qui est en jeu en termes structurel et inconscient. En d´autres mots, faire « parler » le corps, d´une douleur (psychique) impossible à symboliser. Possiblement, une douleur d´amour, c´est la supposition de base de notre hypothèse / The existence of painful condition, chronic and without organic substrate, disease of pain, are reported from the nineteenth century. Pain, such as perception, which is a subjective experience includes various sensations. Different chronic pain syndromes have pain as the main symptom and is characterized by a set of signs that do not correspond to a modelof organic causes unlocated. While acute pain is a valuable indicator in establishing a diagnosis, chronic pain, to have lost its character as a warning, we refer to a multiplicity of determinations order somatic, psychological and / or ambient. The contribution of psychoanalysis, in partnership with the medicine is useful in understanding the meaning of symptoms in the particularity of the case and in relation to the singularity of the subject. Instead of supporting the idea that it is necessary, at any cost, permanently eradicate a painful syndrome whatsoever and mental suffering associated with it, it is useful to consider what is involved in structural terms and unconscious. In other words, to "speak" the body, pain (psychic) Unable to symbolize. Possibly pain of love is the basic assumption of our hypothesis / A existência de condição dolorosa crônica e sem substrato orgânico , a doença de dor, são relatados a partir do século XIX. Dor, tais como percepção, que é uma experiência subjetiva inclui várias sensações . Diferentes síndromes de dor crônica tem a dor como o principal sintoma e é caracterizada por um conjunto de sinais que não correspondem a um modelo de causas orgânicas não localizados. Enquanto a dor aguda é um indicador valioso para estabelecer um diagnóstico, dor crônica, ter perdido seu caráter de advertência, nos referimos a uma multiplicidade de determinações ordem somática ,psicológica e / ou ambiente . A contribuição da psicanálise, em parceria com o medicamento é útil na compreensão do significado dos sintomas na particularidade do caso e em relação à singularidade do sujeito. Em vez de apoiar a ideia de que é necessário , a qualquer custo, eliminar permanentemente uma síndrome dolorosa que seja e sofrimento mental associado a ele, é útil considerar o que é envolvido em termos estruturais e inconsciente. Em outras palavras, para "falar" do corpo, dor ( psíquica ) Não é possível simbolizar . Possivelmente dor do amor é o pressuposto básico da nossahipótese

INTRODUÇÃO: A dor, fenômeno multidimensional, é compreendida como experiência pessoal e subjetiva, influenciada por fatores que abrange o ser humano em sua totalidade e deve ser avaliada a fim de ser adequadamente manejada com excelência técnico-científica. OBJETIVOS: O objetivo geral deste estudo foi realizar adaptação transcultural da Escala Multidimensional de Avaliação de Dor (EMADOR) e os específicos foram traduzir a EMADOR para a língua inglesa; validar a EMADOR para a cultura americana na sua forma aparente e de conteúdo; aplicar a EMADOR adaptada e validada para a cultura americana em indivíduos com dor; aplicar a EMADOR em indivíduos brasileiros com dor; Descrever os dados sócios demográficos (idade e gênero) e clínicos (uso de medicamento e tipo de dor) das amostras norte americana e brasileira; Verificar o grau de atribuição dos descritores de dor crônica e de dor aguda da amostra americana; Verificar o grau de atribuição dos descritores de dor crônica e de dor aguda da amostra brasileira; Identificar as dimensões dos descritores atribuídos pelos participantes de ambas às amostras, norte americana e brasileira; Identificar semelhanças e diferenças da percepção da dor crônica e aguda entre as amostras norte americana e brasileira. MÉTODO: Realizou-se estudo de adaptação transcultural de instrumento, utilizando-se método proposto por Beaton e seus colaboradores, constituído pelas etapas de tradução, retrotradução, comitê de revisores, validação aparente e de conteúdo e teste piloto. Utilizou-se o método psicofísico de estimação de categoria na aplicação da EMADOR. A análise de dados foi realizada descritivamente. Foram calculados alpha de cronbach para analisar a fidedignidade da escala e o teste de Mann Whitney para verificar diferenças estatísticas entre as amostras. RESULTADOS: Na tradução, retrotradução e comitê de revisores os descritores de dor foram alterados de modo a manter o maior nível de similaridade entre as versões em português e em inglês (Multidimensional Pain Evaluation Scale - MPES). Na validação aparente e de conteúdo, os descritores de dor da MPES foram apresentados cardinalmente e algumas definições foram alteradas. A maioria dos participantes era do gênero feminino e grande parte fazia uso de medicação para alívio da dor. Quanto à aplicação da escala nos Estados Unidos, participaram 90 norte americanos, sendo 41 cuidadores de idosos e 49 estudantes universitários do curso de enfermagem, dos quais 49 (54,4%) apresentaram dor aguda e 41(45,6%) dor crônica. Os descritores de maior atribuição e suas respectivas dimensões para dor crônica foram \"Chata\" (Afetiva/Cognitiva), \"Incômoda\" (Afetiva/Cognitiva), \"Dolorosa\" (Afetiva/Sensitiva), \"Desagradável\" (Afetiva/Cognitiva) e \"Irritante\" (Afetiva/Cognitiva) e para dor aguda \"Dolorosa\" (Afetiva/Sensitiva), \"Irritante\" (Afetiva/Cognitiva), \"Desconfortável\" (Afetiva/Cognitiva), \"Desagradável\" (Afetiva/Cognitiva), \"Estafante\" (Afetiva/Cognitiva). Quanto à aplicação da escala no Brasil, participaram 97 brasileiros, sendo 28 cuidadores de idosos e 69 estudantes de graduação do curso de enfermagem, dos quais 39 (40,21%) apresentavam dor crônica e 58 (59,79%) dor aguda. Os descritores de maior atribuição e suas respectivas dimensões para dor crônica foram \"Desconfortável\" (Afetiva/Sensitiva), \"Incômoda\" (Afetiva/Cognitiva), \"Dolorosa\" (Afetiva/Sensitiva), \"Chata\" (Afetiva/Cognitiva) e \"Desagradável\" (Afetiva/Cognitiva) e para dor aguda \"Desconfortável\" (Afetiva/Cognitiva), \"Desagradável\" (Afetiva/Cognitiva), \"Importuna\" (Afetiva/Cognitiva), \"Irritante\" (Afetiva/Cognitiva) e \"Que Perturba\" (Afetiva/Cognitiva). CONSIDERAÇÕES FINAIS: A experiência dolorosa pode ser percebida em suas múltiplas dimensões, seja afetiva, cognitiva e sensitiva. Como experiência pessoal, é por meio da linguagem que as características das sensações dolorosas podem ser expressas, diferenciando-se, significativamente umas das outras. A adaptação transcultural da EMADOR/MPES para a cultura americana bem como sua aplicação nos Estados Unidos e no Brasil pode contribuir para enfermeiros e equipe de saúde em geral ter consciência da complexidade e da multidimensionalidade existente na dor em diferentes situações e perspectivas subjetivas, além de possibilitar avaliação fidedigna do fenômeno de modo a promover melhorias na assistência, e avanços na pesquisa e no ensino, propiciando manejos que respeitem o ser humano com dor. / INTRODUCTION: Pain, a multidimensional phenomenon, is understood as personal and subjective experience, influenced by factors that cover the whole human and must be evaluated in order to be adequately managed with technical and scientific excellence. OBJECTIVES: The general objective of this study was to perform transcultural adaptation of the Multidimensional Pain Evaluation Scale (MPES) and the specific ones were to translate the MPES into the English language; to validate the MPES for the north american culture in its apparent and content form; to apply the MPES adapted and validated for the north american culture in people with pain; to apply the MPES to brazilian people with pain; to describe the demographic data (age and gender) and clinical data (drug use and type of pain) of the north american and brazilian samples; to verify the degree of attribution of the chronic and acute pain descriptors of the north american sample; to verify the degree of attribution of chronic and acute pain descriptors of the brazilian sample; to identify the dimensions of the descriptors attributed by the participants of both samples, north american and brazilian; to identify similarities and differences in the perception of chronic and acute pain between the north american and brazilian samples. METHOD: A cross-cultural adaptation study was carried out using a method proposed by Beaton and his collaborators consisting of translation, retro-translation, review committee, apparent and content validation, and pilot testing. It was use the psychophysical method of category estimation in the MPES application. Data analysis was performed descriptively. Chronbach\'s alpha was calculated to analyze the reliability of the scale and the Mann Whitney test to verify statistical differences between the samples. RESULTS: In the translation, back-translation and review committee the pain descriptors were altered in order to maintain the highest level of similarity between the versions. In the apparent and content validation, the pain descriptors of the MPES were presented cardinally and some definitions were altered. The most of the participants were female and most of them used pain relief medication. As far as the application of the scale in the United States, 90 north americans were attended, 41 elderly caregivers and 49 undergraduate nursing students, of which 49 (54.4%) had acute pain and 41 (45.6%) had chronic pain. The descriptors of higher attribution and their respective dimensions for chronic pain were \"Annoyng\" (Affective / Cognitive), \"Disconforting\" (Affective / Cognitive), \"Painful\" (Affective / Sensitive), \"Unpleasant\" (Affective / Cognitive),\"Irritating \"(Affective / Cognitive) and to acute pain were \"Painful\" (Affective / Sensitive), \"Irritating\" (Affective / Cognitive), \"Uncomfortable\" (Affective / Cognitive), \"Unpleasant\" (Affective / Cognitive) and \"Exhausting\" (Affective / Cognitive) Regarding the application of the scale in Brazil, 97 Brazilians participated: 28 elderly caregivers and 69 nursing undergraduate students, of whom 39 (40.21%) had chronic pain and 58 (59.79%) had acute pain. The most attributable descriptors and their respective dimensions for chronic pain were \"Uncomfortable\" (Affective / Sensitive), \"Disconforting\" (Affective / Cognitive), \"Painful\" \"(Affective / Sensitive), \"Annoyng\" (Affective / Cognitive) and \"Unpleasant\" (Affective / Cognitive) and to acute pain were \"Uncomfortable\" (Affective / Cognitive), \"Unpleasant\" (Affective / Cognitive), \"Nagging\" (Affective / Cognitive), \"Irritating\" (Affective / Cognitive) and \"Disturbing\" (Affective / Cognitive). CONCLUSIONS: The painful experience can be perceived in its multiple dimensions, be it affective, cognitive and sensitive. As personal experience, it is through language that the characteristics of painful sensations can be expressed, differing significantly from one another. The cross-cultural adaptation of MPES to north american culture as well as its application in the United States and Brazil can contribute to nurses and health staff in general to be aware of the complexity and multidimensionality of pain in different situations and subjective perspectives, reliable in order to promote improvements in care, and advances in research and teaching, providing management that respects the human with pain.

Introdução: A osteoartrite (OA) do quadril manifesta-se clinicamente pela dor e o comprometimento da amplitude de movimento articular. Quando há falha no tratamento clínico, fundamentado no controle de sintomas e na recuperação da funcionalidade, pode ser indicada a artroplastia de quadril. Em paciente sem condições clínicas ou socioeconômicas para a realização cirúrgica, ou para os pacientes que estão em reabilitação, uma alternativa para o gerenciamento dos sintomas é o bloqueio do ramo anterior do nervo obturatório (RAO), que pode ser realizado com lidocaína ou fenol. Devido às suas características farmacológicas, acredita-se que o efeito do bloqueio com fenol pode ter uma duração maior e ser clinicamente mais vantajoso. Objetivos: Comparar os resultados do bloqueio do RAO com fenol versus lidocaína para o tratamento da dor e melhora da funcionalidade em pacientes com osteoatrite grave do quadril que apresentaram falhas no tratamento conservador. Metodologia: 44 pacientes com OA grave do quadril e indicação de artroplastia total dessa articulação foram aleatorizados em dois grupos e submetidos ao bloqueio do RAO guiado por eletroestimulação com fenol 5% (GF) ou lidocaína 2% (GL). Os pacientes foram avaliados por meio da escala visual analógica (EVA), Western Ontario andMcMasterUniversitiesOsteoarthritis Index (WOMAC), e dolorimetria de pressão no imediatamente antes do bloqueio e ao final de um e de quatro meses. Resultados: No GF o valor médio inicial de dor antes do bloqueio (8,8± 1,5) evoluiu para 5,8±2,9 em um mês e 5,9±2,9 após quatro meses, enquantopara o GL a evolução foi de 9,0±1,2 para 7,0±2,8 e finalmente para 6,0±3,2. Assim como para os outros parâmetros (WOMAC e dolorimetria), a redução dos valores ao final de quatro meses foram estatisticamente significantes, mas não houve diferenças entre os grupos. Dez pacientes relataram valores de dor EVA < 3 até o quarto mês de observação e um paciente tornou-se completamente sem dor nesse período. Três pacientes não relataram melhora alguma da dor ou da funcionalidade. Não ocorreram efeitos colaterais como sangramentos, dor pelo procedimento ou do tipo neuropática. Conclusão: O uso de lidocaína ou fenol para o bloqueio do RAO é igualmente eficaz no tratamento da dor crônica na OA de quadril por até quatro meses, podendo resultar em melhora da funcionalidade. Não ocorreram efeitos adversos com o procedimento / Introduction: Hip osteoarthritis (OA) is clinically manifested by pain and reduced joint range of motion. When conservative treatment based on symptom control and functional recovery fails, hip arthroplasty may be indicated. In a patient without clinical or socioeconomic conditions for the surgical treatment, or under rehabilitation interventions, an alternative for the management of the symptoms is the blockage of the anterior branch of obturator nerve (ABO), which can be performed with lidocaine or phenol. Due to its pharmacological characteristics, the effect of phenol blockade may last longer and be clinically more advantageous. Objectives: To compare the results of ABO blockade with phenol versus lidocaine for the treatment of pain and improvement of functioning in patients with severe hip osteoarthritis who presented with failures in conservative treatment. Method: 44 patients scheduled for total hip replacement due to severe hip OA were randomized into two groups for ABO blockade guided by electrostimulation with phenol 5% (GF) or 2% lidocaine (GL). Patients were evaluated using visual analogue scale (VAS), Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), and pressure pain dolorimetry immediately before the blockade and at the end of one and four months. Results: In the GF, initial mean VAS was 8.8 ± 1.5 and evolved to 5.8 ± 2.9 in one month and 5.9 ± 2.9 after four months, whereas for GL VAS evolved from 9.0 ± 1.2 to 7.0 ± 2.8 and finally to 6.0 ± 3.2. As for the other parameters (WOMAC and painimetry), the reduction of the values at the end of four months were statistically significant, but there were no differences between the groups. Ten patients reported VAS < 3 duringthe four months of observation and one patient became completely painless. However, three patients reported no improvement in pain or functioning. There were no side effects such as bleeding, inflammatory or neuropathic pain. Conclusion: The use of lidocaine or phenol for ABO blockade is equally efficient in the treatment of chronic hip pain in OA for up to four months and may result in improved functioning. There were no adverse effects with the procedure

No description available.