BACKGROUND AND OBJECTIVES: Osteoarthritis (OA) is the most common arthropathy and one of the major causes of chronic pain in the elderly population, which may lead to major functional incapacity of these individuals. Aiming at treating pain of elderly patients with knee OA, we have used lysine clonixinate (LC) and have evaluated its effectiveness METHOD: Randomized, double-blind, placebo-controlled clinical trial with 109 elderly patients with knee OA-related pain. Participants were distributed in two groups: Group LC and Group P (placebo), who received tablets to be used three times a day for 30 days. Evaluations were performed initially, 15 days after and at study completion, as to pain intensity at rest, at initial movement, ambulation and joint compression; and the need for additional analgesia, morning stiffness; pain-related functional incapacity, adherence, tolerability and global treatment evaluation. RESULTS: LC has significantly decreased pain at initial movement and ambulation already in the first 15 days, with 30% decrease in protokinetic pain and 31.6% in ambulation, but best results were seen after 30 days, when reductions were 42.3% and 45.5%, respectively. Additional analgesia was significantly lower with LC: 2.6% and 9.5% for groups LC and P, respectively. There were no differences between groups in morning stiffness and functional incapacity. There has been major adherence and tolerability. Global evaluation was favorable to LC, being excellent or good for 50% of patients. CONCLUSION: Lysine clonixinate was effective to treat knee OA-related pain in elderly people.

JUSTIFICATIVA E OBJETIVOS: O programa de autogerenciamento da dor (AGD) inclui educação sobre dor, treinamento para identificação e modificação de pensamentos negativos, estabelecimento de metas, exercícios de relaxamento e terapias físicas com o objetivo de reduzir a dor, melhorar o humor e o funcionamento psicossocial. O objetivo foi avaliar o desenho metodológico e sua viabilidade em estudar a eficácia do AGD no tratamento da dor crônica em idosos e, secundariamente, avaliar sua eficácia comparando-o a um método educativo controle MÉTODO: Foram avaliados os aspectos sociodemográficos, aspectos sobre a dor crônica e sua mensuração, impacto em funcionalidade, qualidade de vida, cognição e emoção utilizando-se: avaliação sociodemográfica, escala analógica visual (EAV) de dor, "Geriatric pain measurement" (GPM), escala de Katz e de Lawton (avaliação de funcionalidade), mini-exame do estado mental (MEEM), Geriatric Depressive Scale (GDS) e SF-36. RESULTADOS: Foram incluídos 20 indivíduos (12 no G1/intervenção e 8 no G2/controle), todos do gênero feminino, com idade média 73,7 no G1 e 78,2 no G2. A intensidade média de dor ao início do estudo foi 18,6mm no G1, e 16,6mm no G2, quando utilizada a EAV e pontuação média de 21,8 no G1 e 19,7 no G2, utilizando-se o GPM. Ao final do estudo a intensidade média de dor segundo a EAV foi 16,7 mm no G1 (p = 0,342) e 41,2 mm no G2 (p = 0,006). A pontuação com o GPM foi 19,7 no G1 (p = 0,400) e 25,8 no G2 (p = 0,346). As pontuações pela escala Katz foi 5,8 no início e 5,9 no final do estudo no G1 com 5,4 no início e 5,6 no final no G2 (p = 0,198). Pela escala de Lawton houve melhora funcional estaticamente significante no G1 (p = 0,040), o mesmo não ocorrendo no G2 (p = 0,148) e a diferença entre os grupos foi significante (p = 0,032). Os valores médios obtidos com os tratamentos propostos pela SF-36 não diferiram significativamente entre os grupos. CONCLUSÃO: A intervenção de AGD melhorou a independência funcional do idoso, para as atividades instrumentais de vida diária, e demonstrou tendência em melhorar a intensidade da dor e qualidade de vida.

JUSTIFICATIVA E OBJETIVOS: Pouquíssimas são as publicações sobre a síndrome de amplificação dolorosa no idoso (SAD), a despeito da sua importância para aqueles indivíduos, pois pode ter múltiplas consequências no envelhecimento. O objetivo deste estudo foi relatar um caso de SAD no idoso; representada pela fibromialgia (FM), descrevendo sua abordagem diagnóstica e seu manuseio terapêutico, bem como apresentar uma revisão bibliográfica do assunto. RELATO DO CASO: Paciente do gênero feminino, 73 anos, há 4 anos iniciando um quadro de moderada dor muscular difusa, rigidez matinal fugaz, anedonia, tristeza, ansiedade, importante fadiga e distúrbio do sono. Inicialmente, diagnosticada polimialgia reumática, assim, vinha fazendo uso regular de prednisona, apesar de progressiva piora da sua capacidade funcional e qualidade de vida (QV). Há um ano, no nosso serviço, foi revisto o diagnóstico, e verificado tratar-se de SAD, espectro da FM. Suspendeu-se, então, a prednisona e orientado terapia não farmacológica com programa de autogerenciamento em dor, e farmacológica multimodal com analgésicos não opioide o clonixinato de lisina e opioide o tramadol, e um modulador da dor, a duloxetina. Após 6 meses de tratamento verificou-se grande melhora na dor, sono, depressão, ansiedade, capacidade funcional e QV. CONCLUSÃO: É de suma importância o diagnóstico correto e uma intervenção terapêutica adequada nos casos de SAD, especialmente tratando-se da população idosa e da FM, a qual apresenta características peculiares naquela população. Há grandes probabilidades de melhora sintomática, funcional, e na QV dos idosos com SAD ao se atentar aos diagnósticos diferenciais, bem como ao se introduzir terapêuticas adequadas.

ABSTRACT BACKGROUND AND OBJECTIVES: Chronic pain considerably worsens quality of life of the elderly, giving relevance to studies addressing it in such individuals, especially those long-lived. Recently, vitamin D deficiency, very prevalent among the elderly, has been correlated to chronic pain. This study aimed at estimating the prevalence of chronic pain among community long-lived elderly with functional independence, at evaluating its characteristics and at correlating this pain to serum vitamin D levels. METHODS: Cross-sectional study of the “Long-Lived Project”, with elderly aged 80 years or above, of both genders, with functional independence. Socio-demographic data were collected, referred chronic pains were measured and serum vitamin D levels were obtained. RESULTS: We have evaluated 330 participants of the “Long-Lived Project” and pain prevalence was 20.9%, especially nociceptive, continuous, moderate to severe and lumbar pain. Among pain intensity measurement tools, faces and verbal numeric scales were preferred. There has been high prevalence of vitamin D deficiency among long-lived elderly with chronic pain (87%); deficiency and insufficiency levels were 49 and 38%, respectively, however such levels were not significantly correlated to chronic pain. CONCLUSION: There has been high prevalence of chronic pain among the elderly. Moderate to severe and low back pain were the most frequent. There has been high prevalence of vitamin D deficiency among studied long-lived elderly; however there has been no significant correlation between low serum vitamin D levels and chronic pain.

ABSTRACT Objective: The term Locomotive Syndrome refers to conditions in which the elderly are at high risk of inability to ambulate due to problems in locomotor system. For Locomotive Syndrome screening, the 25-Question Geriatric Locomotive Function Scale was created. The objective here was to translate, adapt culturally to Brazil, and study the psychometric properties of 25-Question Geriatric Locomotive Function Scale. Method: The translation and cultural adaptation of 25-Question Geriatric Locomotive Function Scale were carried out, thus resulting in GLFS 25-P, whose psychometric properties were analyzed in a sample of 100 elderly subjects. Sociodemographic data on pain, falls, self-perceived health and basic and instrumental functionalities were determined. GLFS 25-P was applied three times: in one same day by two interviewers, and after 15 days, again by the first interviewer. Result: GLFS 25-P showed a high internal consistency value according to Cronbach's alpha coefficient (0.942), and excellent reproducibility, according to intraclass correlation, with interobserver and intraobserver values of 97.6% and 98.4%, respectively (p < 0.01). Agreements for each item of the instrument were considerable (between 0.248 and 0.673), according to Kappa statistic. In its validation, according to the Pearson's coefficient, regular and good correlations were obtained for the basic (BADL) and instrumental (IADL) activities of daily living, respectively (p < 0.01). Statistically significant associations with chronic pain (p < 0.001), falls (p = 0.02) and self-perceived health (p < 0.001) were found. A multivariate analysis showed a significantly higher risk of Locomotive Syndrome in the presence of chronic pain (OR 15.92, 95% CI 3.08–82.27) and with a worse self-perceived health (OR 0.23, 95% CI 0.07–0.79). Conclusion: GLFS 25-P proved to be a reliable and valid tool in Locomotive Syndrome screening for the elderly population.

<p>Brazilian population is fastly growing older, and it is being foreseen that, in 2020, the elderly population will reach 16,2 million. The event of fall in those individuals can mean a great decline in functional independence and great losses in In their life quality. About 28% to 35% of the aged ones above of 65 years had suffered, at least, one fall in the period of one year. The etiologies generally are multifactorial; extrinsic and intrinsic factors, being these last one related to the static disequilibrium, difficulty of postural, dynamic control, deficit of muscular force and power.<br> Some studies suggest that training programs of muscular force or balance can reduce, the risk of falling, while others suggest that only multifactorial programs are effective in this reduction. Objectifying to evaluate the effect of the physical resisted exercises and/or muscular force training as an only intervention in the improvement of the balance and the prevention of fall in aged people, a bibliographical revision of current literature was done.<br> The only intervention with resisted exercise traditional showed to improve the muscular force in aged people, however, it had a limited effect in the improvement of balance, and also, in their functional capacity; this way, it had a limited effect in the reduction of the risk of falling. However, in recent studies, the training of muscular power shows benefits for balance and functional capacity in aged people.Thus, it is suggested that programs that promote balance and prevent falls in aged people must be multisensorial, enclosing the multiples and important factors important factors of the risk of falling population.</p>

ABSTRACT Objective To determine the frequency with which physicians address their older adult patients with chronic pain about the issue of sexuality. Methods It is a cross sectional, descriptive, analytical study in which physicians answered a questionnaire comprising questions related to addressing the issue of sexuality during appointments. Results A sample of 155 physicians was obtained, 63.9% stated they did not address sexuality in medical interviews and 23.2% did it most of the time. The main reasons for not addressing were lack of time, fear of embarrassing the patient and technical inability to address the issue. Conclusion There is a need to develop strategies to increase and improve addressing of sexuality in elderly patients with chronic pain, in order to have better quality of life.

JUSTIFICATIVA E OBJETIVOS: A dor crônica é queixa muito frequente nas consultas, principalmente entre os idosos. Na tentativa de buscar terapêuticas mais eficazes e com menos efeitos adversos, nessa população, especialmente considerando idosos com dor neuropática e musculoesquelética, tem-se observado estudos que vêm relacionando a vitamina D a quadros dolorosos, o que poderia propô-la como uma alternativa analgésica. O objetivo deste estudo foi rever, na literatura, o papel da vitamina D na dor crônica neuromusculoesquelética em idosos. CONTEÚDO: Realizada a revisão bibliográfica na base de dados do Pubmed, Medline, LILACS, Biblioteca Cochrane e Scielo, contemplando os últimos 10 anos, títulos em português e inglês. Os descritores usados na busca inicial foram "vitamina D" e "dor crônica", resultando 220 artigos, dos quais apenas os que se tratavam de dor neuromusculoesquelética em idosos foram utilizados. Destes, somente 10 preenchiam os critérios estabelecidos e foram analisados, resultando: um estudo de revisão sistemática, cinco estudos analíticos transversais, dois estudos retrospectivos do tipo série de casos, um estudo observacional prospectivo e um trial clínico randomizado e controlado. Observou-se em cinco estudos uma relação significativa entre a hipovitaminose D e dor crônica musculoesquelética, em três estudos uma melhora da dor após suplementação com vitamina D, e, em outros dois, não haver melhora da dor com esta suplementação. CONCLUSÃO: Os estudos relacionando a vitamina D e a dor crônica em idosos ainda são escassos e bastante heterogêneos. A avaliação do déficit de vitamina D deveria estar mais presente nas consultas geriátricas, pois este tem sido correlacionado com certas síndromes dolorosas e sua adequação poderia trazer beneficio terapêutico em alguns casos.

ABSTRACT BACKGROUND AND OBJECTIVES: The "Geriatric Pain Measure" was developed for multidimensional pain evaluation in the elderly, being easy to apply and understand. It has already been translated and transculturally adapted to Brazil (Geriatric Pain Measure-P). This study aimed at evaluating its psychometric properties, checking whether they are adequate. METHODS: Participated in the study 70 community elderly, aged 60 years or above, of both genders, with chronic pain (three months or longer), with intensity equal to or higher than 30 mm according to the pain visual analog scale. Socio-demographic characteristics, pain duration and intensity were evaluated. For reliability and validity, two interviewers have applied the Geriatric Pain Measure and, in up to 14 days, a single interviewer has reapplied it. For validity, the Geriatric Pain Measure-P "Total Adjusted Score" and its questions related to pain intensity (Q 19 and 20) were correlated to the visual analog scale and, in a subsample, the Geriatric Pain Measure-P "Total Adjusted Score" was correlated to daily life functionality. RESULTS: Sample was made up especially of long-lived elderly females, widows, with low education and moderate to severe pain. Internal consistency was adequate (Cronbach’s alpha= 0.729) and reproducibility was satisfactory (low variability without statistically significant differences). The Geriatric Pain Measure-P "Total Adjusted Score" and the visual analog scale had low correlation but it was regular for Q19 and Q20 of the Geriatric Pain Measure-P and for the visual analog scale (19 r=45.5%, 20 r=51.9%; p<0.05). CONCLUSION: The Geriatric Pain Measure-P had its psychometric properties analyzed and adequate reliability and validity were found. It was easy to apply and understand, demanding a short period of time.

RESUMO JUSTIFICATIVA E OBJETIVOS: As vitaminas do complexo B têm sido utilizadas em monoterapia ou combinada a outros fármacos, como os anti-inflamatórios, em diversas situações clinicas, como por exemplo, nas doenças degenerativas da coluna, doenças reumatológicas, polineuropatias e nos pós-operatórios diversos. O objetivo deste estudo foi identificar na literatura científica as evidências mais recentes do uso de vitaminas do complexo B como terapia analgésica e descrever as situações clínicas em que se pode verificar a sua ação analgésica. CONTEÚDO: Realizada a revisão bibliográfica na base de dados do Pubmed, Medline, LILACS, Biblioteca Cochrane e Scielo, contemplando os últimos 10 anos, títulos em português, espanhol e inglês. Os descritores utilizados foram: "Dor", "vitaminas do complexo B", "tratamento", "vitamina B1", "vitamina B6", "vitamina B12", "tiamina", "piridoxina" e "cianocobalamina". Dentre os 40 estudos encontrados selecionaram-se apenas os trials em dor musculoesquelética e neuropática com seres humanos, e em que as vitaminas do complexo B configuraram-se como agentes analgésicos. Foram selecionados então 13 estudos que satisfizeram esses critérios de inclusão. Em todos eles as vitaminas do complexo B desempenharam papéis na analgesia, inclusive quando em monoterapia. As vitaminas do complexo B também apresentaram ação anti-inflamatória, anti-pruriginosa, na funcionalidade e na qualidade de vida. CONCLUSÃO: Os estudos existentes, apesar de heterogêneos, demonstraram que as vitaminas do complexo B possuem efeito analgésico em síndromes dolorosas neuropática e nociceptiva, e que por serem esses fármacos seguros e de baixos custos poderiam representar boas opções na terapêutica analgésica no nosso meio.