Scielo RSS <![CDATA[Psychology & Neuroscience]]> vol. 7 num. 1 lang. es <![CDATA[SciELO Logo]]> <![CDATA[<b>The challenge of pain</b>]]> <![CDATA[<b>Contributions of four pain domains to the prediction of patient functioning and pain interference</b>]]> Pain is a multidimensional experience that can vary in intensity, quality and spatial and temporal characteristics. Although there is a great deal of research supporting the importance of pain intensity as a correlate of patient functioning, there is a lack of research examining the importance of the other components of pain, especially the temporal domain. The purpose of this study was to advance the understanding of the role of four pain domains in predicting both pain interference and psychological functioning in a sample of patients with multiple sclerosis. The findings confirmed the significant association between pain intensity and measures of pain interference and psychological functioning, providing additional support for the importance of assessing pain intensity as a key component of chronic pain assessment. None of the other domains showed statistically significant associations with either of the criterion variables. However, we did find non-significant trends for pain temporal patterns to be associated with depressive symptoms. Specifically, there was a trend for patients reporting constant pain to report more depression than those reporting intermittent and variable pain. This suggests the possibility that the temporal pattern of pain may play a role in the impact of pain on depression; however, more research is needed to confirm this finding. <![CDATA[<b>Fibromyalgia and the old dilemma</b>: <b>theory <i>vs.</i> practice</b>]]> The objective of this article is to review some aspects of the fibromyalgia syndrome and its mechanisms of development. We also discuss how to go from preclinical research to clinical practice. Fibromyalgia is a clinical syndrome whose main features include diffuse musculoskeletal pain, fatigue, sleep disturbances, and cognitive disorders. Russell & Larsson (2009) proposed "pronociceptive" and "antinociceptive" systems under normal conditions. Functional pain states such as fibromyalgia are derived from central disturbances in pain processing. The association with anxiety and depression is a negative prognostic factor. Distress is an important part of its physiopathology. The concomitance of other functional syndromes is a rule. The already known etiopathogenic mechanisms of fibromyalgia can be applied in clinical practice for diagnosis and rational therapeutic approaches. Pharmacological but mainly nonpharmacological measures must be applied. Although much information still needs to be obtained, the clinician presently has sufficient tools for efficiently treating fibromyalgia patients. An important aspect is that such knowledge needs to reach primary care physicians because the prevalence of fibromyalgia does not allow all patients to be treated by specialists. <![CDATA[<b>Geriatric pain management, pharmacological and nonpharmacological considerations</b>]]> Persistent pain is prevalent in the elderly population, although it is not an inevitable part of aging. It is important to understand how to manage pain effectively in old age, particularly because an increasing number of individuals are becoming older, or living longer. Several problems, less common in younger adults, may complicate the treatment of pain. An accurate pain assessment is required for the most efficient strategy of pain treatment. Challenges to an effective pain assessment include: pain underreporting by patients, atypical manifestations of pain in elderly, age-associated pharmacodynamic and pharmacokinetic changes to specific drugs, other general age-related changes, and misconceptions about tolerance or addiction to opioids. However, physicians are able to provide geriatric patients with appropriate analgesia by using comprehensive assessment involving a multidisciplinary approach, and the appropriate use of various treatment modalities. <![CDATA[<b>Pain in the treatment of vitreoretinal diseases</b>]]> Treatment of vitreoretinal diseases comprises a range of options that has increased in the past several years, allowing more individuals to benefit from new therapeutic approaches. The use of lasers in the retina, new surgical techniques, and intravitreal drug administration constitute common treatment options. These retinal and vitreal procedures have both benefits and drawbacks. Among the drawbacks is discomfort associated with the procedure, constituting a relevant issue because it can compromise adherence to treatment. We reviewed aspects of pain associated with vitreoretinal procedures and the available options for its control. With regard to vitreoretinal procedures, laser photocoagulation is associated with a higher pain score compared with vitrectomy and intravitreal injection using traditional anesthesia methods, suggesting that laser photocoagulation still needs to be improved with regard to comfort during the procedure. In some cases, a combination of analgesic options may be the best choice for pain-sensitive individuals. Individual differences and the specific condition that is treated should be considered when deciding the best treatment option. <![CDATA[<b>Psychological adjustment in children with episodic migraine</b>: <b>a population-based study</b>]]> We investigated psychological adjustment in a preadolescent pediatric population as a function of headache diagnosis. Children from a city public education system were enrolled in this study. Parents were interviewed using validated headache questionnaires and the Strengths and Difficulties Questionnaire (SDQ), which measures psychological adjustment. Crude and adjusted prevalence ratios were obtained using a binary regression model. The relative risk [RR] of SDQ items and scores were modeled as a function of headache diagnosis in adjusted analyses. Multivariate models estimated determinants of psychological adjustment characteristics in children with migraine. The sample consisted of 846 children (65.9% of the target sample) from 5 to 12 years old (50.5% girls). Relative to children without headache, children with episodic migraine (EM) were more likely to have abnormal scores on the following SDQ scales: emotional symptoms (RR = 3.43, 95% confidence interval [CI] = 2.51-4.69), conduct problems (RR = 1.96, 95% CI = 1.37-2.79), total difficulties (RR = 2.23, 95% CI = 1.59-3.13), and total impact (RR = 2.85, 95% CI = 1.15-7.11). The multivariate analysis showed that total difficulties in psychological adjustment in children with EM were significantly influenced by headache frequency (p < .05), analgesic intake (p < .001), and the occurrence of nausea (p < .01) and vomiting (p < .05) in headache attacks. To the best of our knowledge, this is the first study reported in the literature to identify determinants of the association between migraine and difficulties in psychological adjustment in preadolescent children. Providers and educators should be aware of this association, and studies that address causality should be conducted. <![CDATA[<b>Assessment and management of pediatric pain based on the opinions of health professionals</b>]]> The present study characterized the opinions of health professionals about strategies for assessing and managing pediatric pain in a public teaching hospital. The sample consisted of 92 health professionals who worked in pediatric wards, pediatric intensive care, and neonatal intensive care. The sample included 45 doctors, 18 nurses, 16 psychologists, eight physiotherapists, and five occupational therapists. Data were collected through a self-administered questionnaire that included 22 open questions on the following topics: pain assessment, pharmacological management, and non-pharmacological interventions. Each area was analyzed with regard to actions, resources, gaps, and needs. The questionnaire was developed based on the principles of Strategic Planning. Two trained researchers analyzed the thematic content of all of the responses. With regard to actions and resources, 33% of the respondents mentioned the use of instruments for pain assessment, 73% reported that they prescribed pharmacological treatments for symptoms of pain, and 26% reported the use of non-pharmacological interventions for the relief of pain. The professionals predominantly reported a lack of training for pain assessment and management, standardized protocols, and human and material resources. Consequently, 96% of the professionals reported the necessity for educational training and standardized implementation guidelines for pain assessment services. These findings provide a baseline of the health professional's opinions of pain issues, which are essential for implementing and increasing pain assessment and management policies institutionally. <![CDATA[<b>Validity and reliability assessment of the Brazilian version of the Faces Pain Scale-Revised</b>]]> The Faces Pain Scale-Revised (FPS-R) is among the most commonly used measures of pain intensity in clinical and research settings. Little evidence exists about the Brazilian version of this scale. The purpose of the present study was to examine the validity and reliability of the Brazilian version of the FPS-R. The sample comprised 214 children, 6 to 10 years of age. In the first phase of the study, the children ranked the faces of the FPS-R according to pain intensity, and the faces were presented in all possible pair combinations (content validity). All six faces were correctly ranked by 47% of the younger children (6 to 7 years old) and 52% of the older children (8 to 10 years old). With regard to paired combinations, all of the pairs were correctly placed by 63% of the younger children and 67% of the older children. In the second phase, the children rated recalled experiences of pain using both the Brazilian version of the FPS-R and Coloured Analogue Scale (CAS; convergent validity). The children were retested 4 weeks later (test-retest reliability). The degree of agreement between the FPS-R and CAS was moderate, with a Kendall's tau-b (τ) of .49 (p < .01). The test-retest reliability coefficient was τ = .52 (p < .01). This study provides evidence of the validity and reliability of the FPS-R as a pain intensity measurement for use in Brazilian samples.