Brazilian Journal of Anesthesiology
https://app.periodikos.com.br/journal/rba/article/doi/10.1590/S0034-70942010000200006
Brazilian Journal of Anesthesiology
Scientific Article

Perfil da dor Neuropática: a propósito do exame neurológico mínimo de 33 pacientes

Neuropathic pain profile: the basic neurological exam of 33 patients

Marco Antonio Cardoso de Resende; Osvaldo José Moreira Nascimento; Anna Amélia Silva Rios; Giseli Quintanilha; Luís Eduardo Sacristan Ceballos; Fernando Paiva Araújo

http://dx.doi.org/10.1590/S0034-70942010000200006 Braz J Anesthesiol, vol.60, n2, p.144-148, 2010
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Resumo

JUSTIFICATIVA E OBJETIVOS: Há poucos textos na literatura a lidar com o exame neurológico do paciente com dor neuropática (DN). O objetivo deste estudo foi avaliar o perfil de pacientes com DN através de exame clínico neurológico. MÉTODO: Em estudo observacional, uma série de casos de pacientes com DN foi acompanhada no período de um ano. A avaliação do exame neurológico foi efetuada durante visita ao ambulatório e através de análise prospectiva. Foram incluídos pacientes cuja intensidade da dor era igual ou maior que seis, segundo a Escala Analógica Visual. RESULTADOS: A dor em queimação predominou como descritor em 54,5% dos pacientes. A polineuropatia foi o padrão clínico-topográfico predominante (48%) com padrão distal e simétrico, em oposição a quadros de neuropatia multifocal (15,15%). As modalidades termoalgésica e tátil do exame de sensibilidade foram as mais comprometidas, logo acompanhadas por alterações motoras e reflexos profundos, enquanto modalidades de sensibilidade proprioceptiva vieram a seguir. Apesar de nenhum sinal ou sintoma ser específico de DN, a queimação como sintoma costuma ser atribuída ao acometimento de fibras finas, assim como o padrão típico destas é a alteração térmico-dolorosa. CONCLUSÕES: A história e os achados do exame físico são a chave para o diagnóstico de DN. O registro das alterações encontradas ao exame deve ressaltar o comprometimento observado e assim nortear a abordagem diagnóstica e terapêutica, se curativa ou paliativa.

Palavras-chave

EXAMES DIAGNÓSTICOS, DOR

Abstract

BACKGROUND AND OBJECTIVES: Very few texts in the literature approach the neurologic exam of patients with neuropathic pain (NP). The objective of this study was to evaluate the profile of patients with NP through the neurological exam. METHODS: This is an observational study that followed-up patients with NP for one year. The neurologic exam was evaluated at the outpatient clinic and through prospective analysis. Patients whose pain severity was equal or greater than six on the Visual Analogue Scale were included in this study. RESULTS: Burning pain predominated, affecting 54.5% of the patients. Unlike multifocal neuropathy (15.15%), distal and symmetrical polyneuropathy was the predominant clinical-topographic pattern (48%). The thermoalgic and tactile modalities of the sensorial exam were affected the most, followed by changes in motor function and deep tendon reflexes, and proprioception. Although NP does not have specific signs and symptoms, burning pain is attributed to the involvement of thin nerve fibers and thermoalgic pain is typical of those changes. CONCLUSIONS: History and physical exam findings are key factors in the diagnosis of NP. The log of changes in the physical exam should emphasize the involvement observed, guiding the diagnostic and therapeutic approach, curative or palliative.

Keywords

DIAGNOSTIC EXAMS, PAIN

Referencias

mith BH, Torrance N, Bennett MI. Health and quality of life associated with chronic pain of predominantly neuropathic origin in the community. Clin J Pain. 2007;23:143-149.

Eriksen J, Jensen MK, Sjogren P. Epidemiology of chronic nonmalignant pain in Denmark. Pain. 2003;106:221-228.

Kraychete DC, Gozzani JL, Kraychete AC. Dor Neuropática: Aspectos Neuroquímicos. Rev Bras Anestesiol. 2008;58:492-505.

Woolf CJ. Central sensitization: uncovering the relation between pain and plasticity. Anesthesiology. 2007;106:864-867.

Woolf CJ, Mannion RJ. Neuropathic pain: aetiology, symptoms, mechanisms, and management. Lancet. 1999;353:1959-1964.

Marquez JO. Exame Clínico. Dor Neuropática. 2005:97-103.

Amâncio EJ, Teixeira MJ. Dor Central. Dor Neuropática. 2005:199-230.

Campbell WW. De Jong, o Exame Neurológico. 2007.

Bennett MI, Attal N, Backonja MM. Using screening tools to identify neuropathic pain. Pain. 2007;127:199-203.

Treede RD, Jensen TS, Campbell JN. Neuropathic pain: redefinition and a grading system for clinical and research purposes. Neurology. 2008;70:1630-1635.

Scott J, Huskisson EC. Graphic representation of pain. Pain. 1976;2:175-184.

Ropper AH, Brown RH. Adams and Victors Principles of Neurology. 2005:1110-1177.

Fillingim RB. Sex, Gender and Pain: Progress in Pain Research and Management. 2000.

Hans G, Masquelier E, De Cock P. The diagnosis and management of neuropathic pain in daily practice in Belgium: an observational study. BMC Public Health. 2007;7.

Lachaine J, Gordon A, Choiniere M. Painful neuropathic disorders: an analysis of the Regie de l'Assurance Maladie du Quebec database. Pain Res Manag. 2007;12:31-37.

Helme RD, Gibson SJ. Pain in the elderly. Proceedings of the. 1997:919-44.

Boureau F, Doubrere JF, Luu M. Study of verbal description in neuropathic pain. Pain. 1990;42:145-152.

Bouhassira D, Attal N, Alchaar H. Comparison of pain syndromes associated with nervous or somatic lesions and development of a new neuropathic pain diagnostic questionnaire (DN4). Pain. 2005;114:29-36.

Gooch CL. Neuropathic Pain. Merritt's Neurology. 2005:545-551.

Mendell JR, Sahenk Z. Clinical practice: Painful sensory neuropathy. N Eng J Med. 2003;348:1243-1255.

Nascimento OJM. Polineuropatias Dolorosas. Dor Neuropática. 2005:159-170.

Martins RS, Siqueira MG, Tedesco-Marquese AJ. Neuroma sintomático do nervo sural: uma complicação rara após a retirada do nervo: relato de caso. Arq Neuropsiquiat. 2002;60(3-B):866-868.

Mendell JR, Kissel JT, Cornblath DR. Evaluation of the Patient with Peripheral Neuropathy: the Challenges. Diagnosis and Management of Peripheral Nerve Disorders. 2001:3-9.

Backonja MM. Defining neuropathic pain. Anesth Analg. 2003;97:785-90.

Schestatsky P, Nascimento OJM. O que os neurologistas gerais devem saber sobre dor neuropática?. Arq neuropsiquiatr. 2009;67(3a):741-749.

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