Therapeutic Approaches to Post-Mastectomy Pain Syndrome

Background: Breast cancer is increasingly common in society and post-mastectomy pain is a striking condition associated with surgery, both intra and postoperatively. The post-mastectomy syndrome is characterized by the persistence of pain for more than 3 months after the procedure. It is mostly of neuropathic origin and is highly refractory to treatments, which vary from clinical to surgical measures and alternative techniques. In this context, it is essential to understand the possible approaches to these patients. Objective: Understand alternatives for pain management in patients undergoing mastectomy, especially in those in whom pain persists for more than 3 months. Methods: Systematic literature review, conducted in the Virtual Health Library databases includes: Lilacs, SciELO, Medline, PubMed and Cochrane between 2018 and 2023, restricted to articles in English with the descriptors: Mastectomy, chronic Pain, Nerve Blocks and Breast Cancer. 317 articles were found involving the descriptors presented, all in English. After reading the abstracts, 28 articles were selected. Results: This review analyzed 28 scientific studies that rigorously met the previously established characteristics in the sample selection. The synthesis included the following aspects: author/year of publication, article title, objective, type of study and database. Conclusion: It was concluded that, according to the analyzed studies, post-mastectomy pain is a problem that has increased its incidence and that needs the attention of health professionals. The use of antineuropathic medications, nerve blocks, fat grafting, lymph node transplantation, therapy, physical activity and acupuncture are some examples of therapeutic approaches for these women. Therefore, the team must assist the patients, seeking to provide a better prognosis, quality of life and comfort.

Medical School Students’ Knowledge of Pain and Palliative Care: An Observational Study

Background: Pain and palliative care are a reality in daily routines of medical treatment. However, the theoretical-practical curricula of traditional medical school course still unsatisfactorily contemplate pain management, as well as the palliative care approach. Objective: To assess the knowledge of medical students about pain and palliative care, as well as to identify their perception of teaching these topics during hospitalization. Methods: A cross-sectional observational study, with a descriptive and exploratory approach, data collection for which was carried out between August and November 2020. The target population was medical students, who responded to an online survey of a quantitative, anonymous and follow-up nature. The survey study variables concerned knowledge about pain management and palliative care. Results: An expressive majority of academics showed difficulty in understanding the pathophysiology of pain related to prescribing drugs for pain management purposes, and all of them believe that it is necessary to acquire more knowledge about pain treatment. In parallel, only 9.3% report having received sufficient information regarding palliative care during medical school. Conclusion: The results suggest a certain lack of knowledge and insecurity among medical school students with respect to pain management and care for patients receiving palliative care. The didactical approach to this theme is still deficient in the medical curriculum and requires immediate improvement and new proposals that address the training of these professionals in a more specific and effective way.

Effects of Dexamethasone, Clonidine, Tramadol and Nalbuphine on Fentanyl-Induced Hyperalgesia in Rats

Opioids are drugs used to alleviate pain. However, studies have demonstrated that these drugs can cause an increase in pain sensitivity, which is called opioid-induced hyperalgesia. The objective of this study was to describe the effects of dexamethasone, clonidine, tramadol and nalbuphine on fentanyl-induced hyperalgesia in rats. After obtaining approval from the Committee for the Ethical Use of Animals (CEUA), 36 male Wistar rats were divided into 6 groups: Group 1 (GCSSL) wherein the rats received 1 ml 0.9% saline solution in two injections;Group 2 (GFTSL), received fentanyl at a dose of 100 ug·kg-1 followed by 1 ml 0.9% saline solution via intraperitoneal;the remaining groups (3, 4, 5, 6) received fentanyl at a dose of 100 ug·kg-1 following doses via intraperitoneal: Group 3 (GFTDX), dexamethasone at a dose of 1.0 mg·kg-1;Group 4 (GFTCL), clonidine at a dose of 20 mg·kg-1;Group 5 (GFTTR), tramadol at a dose of 50 mg·kg-1, and Group 6 (GFTNB), nalbuphine at a dose of 5 mg·kg-1. Under general anestesia using isoflurane, the animals were submitted to a surgical incision. Hyperalgesia was evaluated by applying Von Frey filaments at 2 hours after the incision and on the 1st, 3rd and 5th days afterward. At 2 hours after the surgical procedure, there was lower intensity of pain in the fentanyl group (GFTSL) compared to the other groups, and on the fifth day there were no significant differences for pain intensity between groups. The results suggest the presence of fentanyl-induced hyperalgesia and efficacy in its reduction by dexamethasone, clonidine, tramadol and nalbuphine.

Effects of Ketoprofen, Ketamine, Lidocaine and Propofol on Fentanyl-Induced Hyperalgesia in Rats

Opioid-induced hyperalgesia negatively affects physiological pain management and presents a complex causal mechanism, involving, pharmacodynamic and pharmacokinetic factors of interactions with receptors, opioid-independent ascending systems and with pro-nociceptive systems. After approval by the CEUA, 42 male Wistar rats were divided into 7 groups: In group 1 (GCSSL) the animals received 1 ml of 0.9% saline solution intraperitoneally (IP);in group 2 (GFTSL), they received fentanyl at a dose of 100 ug·kg-1 IP;in the remaining groups (3, 4, 5, 6 and 7) the animals received IP, fentanyl at a dose of 100 ug·kg-1 followed also by IP route of: group 3 (GFTKP) ketoprofen at a dose of 5 mg·kg-1;group 4 GFTKT), ketamine up to a dose of 10.0 mg·kg-1;group 5 (GFTLI), incisional lidocaine up to a dose of 10 mg·kg-1;group 6 (GFTLP), intraperitoneal lidocaine up to a dose of 10 mg·kg-1 and group 7 (GFTPP), propofol up to a dose of 60 mg·kg-1. Under general anesthesia, all animals with a plantar surgical incision. Hyperalgesia was evaluated by applying Von Frey filaments on the 2nd, 1st, 3rd and 5th days after treatment. In the 2nd hour and on the 5th day after the procedure, there was no hyperalgesia associated with the use of fentanyl, however, on the 1st and 3rd postoperative days there was hyperalgesia that was attenuated by ketoprofen, ketamine, lidocaine infiltrated in the incision and intraperitoneally, an effect not observed with the use of propofol. The results suggest fentanyl-induced hyperalgesia and the efficacy of ketoprofen, ketamine, incisional lidocaine and intraperitoneal lidocaine in reducing this effect.

Approach to Pain in Endometriosis Patients: Systematic Literature Review

Background: Endometriosis is a gynecological, multifactorial condition that affects women’s life quality, especially due to the pain inherent to it. Pain is caused by physical and psychological aspects;therefore, several factors must be analyzed, aiming to treat the whole. Conventional, drug or surgical treatments are the most used;however, the search for alternative therapeutic methods is growing. Objective: To analyze the approach to pain in women with endometriosis, seeking a better understanding of the pathophysiological mechanisms of this disease, its impact on life quality, as well as the means of treatments in use and innovations in this field. Methods: Systematic literature review, conducted in the Virtual Health Library databases between 2010 and 2021, restricted to articles in English and Portuguese with the descriptors: Endometriosis, Pain, and Treatment. After reading the abstracts, 197 articles were found, and, after reading them, 59 articles were selected. Results: This review analyzed 59 scientific studies that rigorously met the previously established characteristics in the sample selection. The synthesis included the following aspects: author/year of publication, article title, objective, type of study and database. Related factors such as acute or chronic pain, late diagnosis, discrediting symptomatic complaints and trivialization by health professionals have a profound impact on the physical and mental health of women with endometriosis. On the other hand, there are several classes of drugs, surgical procedures, and alternative therapies available for pain management. Conclusion: Given the context addressed, a certain need is suggested for health professionals to better understand the disease and adopt new behaviors or improve existing ones, such as reception, active listening, early diagnosis and comprehensive and individualized treatment. In addition, further studies are needed regarding alternative therapies, seeking to expand the scientific evidence of their benefits.

Musculoskeletal Pain in Medical Students Subject to Remote Teaching during the COVID-19 Pandemic

Musculoskeletal pain is a consequence of repetitive strain, overuse, and work-related musculoskeletal disorders. In 2020, due to the new coronavirus pandemic, social isolation started, and so did online classes in a remote study strategy to replace classroom-based study routines. Thus, students adopted a different physical posture from the usual one for a longer time than usual, representing a possible risk factor for musculoskeletal pain. In this sense, this research aimed to identify the occurrence of musculoskeletal pain in medical students subject to distance learning during the COVID-19 pandemic. A cross-sectional, descriptive and exploratory study was applied through an online questionnaire, using the Google Forms application, to 154 students from the first to the fourth year of the medical course at a university in the countryside of the state of S?o Paulo. Among the participants, 99 (64.3%) were female, and 54 (35.7%) were male individuals with ages ranging from 18 and 34. In regards to the daily study time in sitting position, 83 (55.0%) reported staying more than 4 hours, 39 (25.8%) between 2 and 4 hours, and 29 (19.2%) less than 2 hours still. As for musculoskeletal pain before the pandemic;98 (63.6%) reported not feeling it, while 56 (36.4%) reported being affected by this type of pain. However, after the pandemic, 51 respondents (33.1%) continued not to feel anything, whereas 103 (66.9%) kept on having some type of musculoskeletal pain. The results obtained suggest an increase in musculoskeletal pain during the pandemic however other studies may confirm these findings.

Tracheal Intubation Difficulties: Systematic Literature Review

Background: Tracheal intubation is a common procedure in medical practice, being performed mainly in surgical centers and emergencies in trauma patients. Objective: This systematic literature review aims to understand the main difficulties and complications related to tracheal intubation. Methods: Systematic literature review, conducted in the Virtual Health Library databases between 2016 and 2021, restricted to articles in English and Portuguese with the descriptors: Airway, Difficult intubation, and Complications. After reading the abstracts, 34 articles were found, and, after reading them, 9 articles were selected. Results: This review analyzed 9 scientific studies that rigorously met the previously established characteristics in the sample selection. The synthesis included the following aspects (author/year of publication, article title, objective, type of study, and database. Discussion: Several factors that influence the success of intubation were identified, such as technical, professional, and patient issues. In addition, measures to minimize the risks involving the procedure were highlighted. Conclusion: Tracheal intubation is a common procedure in surgical centers and emergencies. However, its risks, while low, should not be ignored. Unsuccessful procedures can occur and have consequences for the patient, such as trauma to the upper airway.