Abordagem da Dor em Dermatologia (Parte II)
Resumo
A dor é um sintoma universal em Medicina; e na Dermatovenereologia é transversal ao seu domínio médico e cirúrgico. No domínio cirúrgico da especialidade temos a dor aguda peri-operatória, provavelmente mais frequente do que o esperado e cujo tratamento insuficiente implica morbilidade aguda e até potencialmente a longo prazo, dado o risco de cronificação. A dor crónica está associada a várias doenças cutâneas e é muitas vezes causa major de sofrimento para os doentes, dada a sua abordagem ser complexa, desafiante e por vezes infrutífera, agravada pela pouca evidência sobre como tratar apropriadamente o doente dermatológico com dor crónica. Este artigo é a segunda e última parte de uma revisão cujo objetivo é discutir os princípios gerais do tratamento da dor aguda peri- -operatória e crónica no contexto da especialidade. Neste segundo capítulo será abordada a dor relacionada com procedimentos terapêuticos específicos. Por último, será discutida a dor crónica associada a entidades dermatológicas com quadros álgicos significativos.
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Referências
Briggs M, Nelson EA, Martyn-St James M. Topical agents
or dressings for pain in venous leg ulcers. Cochrane Database
Syst Rev. 2012; 11 :CD001177.
Benedetto AV. A novel use of topical anesthetics to alleviate
the pain of cryotherapy. Skinmed. 2003; 2:307-8.
Gupta AK, Koren G, Shear NH. A double-blind, randomized,
placebo- controlled trial of eutectic lidocaine /
prilocaine cream 5% ( EMLA )@ for analgesia prior to
cryotherapy of warts in children and adults. Pediatr Dermatol.
; 15:129-33.
Mishra S. Safe and less painful injection of triamcenolone
acetonide into a keloid e A technique. Br J Plast Surg.
; 63:e205.
Ono N. Pain-free intralesional injection of triamcinolone
for the treatment of keloid. Scand J Plast Reconstr Hand
Surg. 1999; 33:89-91.
Azad A, Sacks L. Painless steroid injections for hypertrophic
scars and keloids. Br J Plast Surg. 2003; 56:534.
Park KY, Lee Y, Hong JY, Chung WS. Vibration anesthesia
for pain reduction during intralesional steroid injection for
keloid treatment. Dermatol Surg. 2017; 43:724-7.
Ericson MB, Wennberg A. Review of photodynamic therapy
in actinic keratosis and basal cell carcinoma. Ther Clin
Risk Manag. 2008; 4:1-9.
Wan MT, Lin JY. Current evidence and applications of photodynamic
therapy in dermatology. Clin Cosmet Investig
Dermatol. 2014; 7:145-63.
Karrer S, Kohl E, Feise K, Hiepe-Wegener D, Lischner S,
Philipp-Dormston W, et al. Photodynamic therapy for skin
rejuvenation: review and summary of the literature – results
of a consensus conference of an expert group for
aesthetic photodynamic therapy. J Dtsch Dermatol Ges.
:137-48.
Uebelhoer NS, Dover JS. Photodynamic therapy for cosmetic
applications. Dermatol Ther. 2005; 18:242-52.
Virgili A, Osti F, Maranini C, Corazza M. Photodynamic
therapy: parameters predictive of pain. Br J Dermatol.
; 162:460-1.
Waters A, Ibbotson S. Parameters associated with severe
pain during photodynamic therapy: results of a large Scottish
series. Br J Dermatol. 2011; 165:696-8.
Wang B, Shi L, Zhang YF, Zhou Q, Zheng J, Szeimies RM.
Gain with no pain? Pain management in dermatological
photodynamic therapy. Br J Dermatol. 2017; 177:656-
Arits A, van de Weert MM, Nelemans PJ, Kelleners-Smeets
NW. Pain during topical photodynamic therapy: uncomfortable
and unpredictable. J Eur Acad Dermatol Venereol.
; 12:1452-7.
Lindeburg KE, Brogaard HM, Jemec GB. Pain and photodynamic
therapy. Dermatology. 2007; 215:206-8.
Ang JM, Riaz IB, Kamal MU, Paragh G, Zeitouni NC. Photodynamic
therapy and pain: a systematic review. Photodiagnosis
Photodyn Ther. 2017; 19:308-44.
Berking C, Herzinger T, Flaig M, Brenner M, Borelli C,
Degitz K. The efficacy of photodynamic therapy in actinic
cheilitis of the lower lip: a prospective study of 15 patients.
Dermatol Surg. 2007; 33:825-30.
Manuscript A. Pain associated with aminolevulnic acid-
-photodynamic therapy of skin disease. J Am Acad Dermatol.
; 61:1033-3.
Greveling K, Prends E., Liu L, Van Doorn M. Non-invasive
anaesthetic methods for dermatological laser procedures
- a systematic review. J Eur Acad Dermatol Venereol.
;31:1096-110
Campos S. Manual de Anestesiologia Clínica.Lisboa:
Lidel; 2014.
Davis UC. Dermatology Online Journal UC Davis. Dermatol
Online J. 2013; 19:11.
Horvath B, Janse IC, Sibbald GR. Pain management in patients
with hidradenitis suppurativa. J Am Acad Dermatol.
; 73:47-51.
Ryder SA, Stannard CF. Treatment of chronic pain: antidepressant,
antiepileptic and antiarrhythmic drugs. Contin
Educ Anaesth Crit Care Pain. 2005; 5: 18-21.
Basra MK, Shahrukh M. Burden of skin diseases. Expert
Rev Pharmacoecon Outcomes Res. 2009; 9:271-83.
Von Der Werth J, Jemec G. Morbidity in patients with hidradenitis
suppurativa. Br J Dermatol. 2001; 144:809-
Miner A. Concern regarding the safety of tumor necrosis
factor-alfa antagonists in pregnancy. J Am Acad Dermatol.
; 62:706-9.
Gupta R. Post-herpetic neuralgia. Br J Anaesth. 2012;
:81-5.
Werner RN, Nikkels AF, Marinović B, Schäfer M, Czarnecka-
Operacz M, Agius AM, et al. European consensus-based
(S2k) Guideline on the Management of Herpes Zoster
- guided by the European Dermatology Forum (EDF) in
cooperation with the European Academy of Dermatology
and Venereology (EADV), Part 2: Treatment J Eur Acad
Dermatol Venereol. 2016; 31:20-9.
Gauthier A, Breuer J, Carrington D, Martin M, Remy V.
Epidemiology and cost of herpes zoster and post-herpetic
neuralgia in the United Kingdom. Epidemiol Infect. 2009;
:38-47.
Johnson RW, Rice AS. Clinical practice. Postherpetic neuralgia.
N Engl J Med. 2014;371: 1526-33.
Forbes HJ, Thomas SL, Smeeth L, Clayton T, Farmer R,
Bhaskaran K. A systematic review and meta-analysis
of risk factors for postherpetic neuralgia. Pain. 2016;
:30-54.
Sacks GM. Unmet need in the treatment of postherpetic
neuralgia. Am J Manag Care. 2013;19:3-10.
Haanpää M, Cruccu G, Nurmikko TJ, McBride WT, Docu
Axelarad A, et al. Capsaicin 8% patch versus oral pregabalin
in patients with peripheral neuropathic pain. Eur J
Pain. 2016; 20:316-28.
GERMI, Sociedade Portuguesa de Medicina Interna. Vacinação
da população idosa em Portugal: Recomendações
Europeias. [consultado jun 2017] Disponível em: http://
www.spmi.pt/wp-content/uploads/GERMI_37.pdf
Han Y, Zhang J, Chen N, He L, Zhou M, Zhu C. Corticosteroids
for preventing postherpetic neuralgia Cochrane
Database Syst Rev. 2013;3:CD005582.
Parra S, Lacouture P, Giles H. Chronic leg ulcer pain – a
need for effective topical analgesia. J Pain. 2015; 17:S13-
S14.
Green J, Jester R, Mckinley R, Pooler A, Care S. The impact
of chronic venous leg ulcers: a systematic review. J Wound
Care. 2013; 23:601-12.
Gonza RV. Quality of life in people with venous leg ulcers:
an integrative review. J Adv Nurs. 2011; 67:926-44.
Beiteke U, Bigge S, Reichenberger C, Gralow I. Pain and
pain management in dermatology. J Ger Soc Dermatol.2015:967-87.
Bastami S, Frödin T, Ahlner J, Uppugunduri S. Topical
morphine gel in the treatment of painful leg ulcers , a double-
blind , placebo-controlled clinical trial: a pilot study.
Int Wound J. 2012; 9:419-27.
Renner R, Seikowski K, Simon JC. Association of pain
level, health and wound status in patients with chronic leg
ulcers. Acta Derm Venereol. 2014; 94:50-3.
Kahle B, Hermanns H, Gallenkemper G. Evidence-based
treatment of chronic leg ulcers. Dtsch Arztebl Int. 2011;
:231-8.
Bigliardi-qi M, Sumanovski LT, Büchner S, Rufli T, Bigliardi
PL. Mu-opiate receptor and beta-endorphin expression in
nerve endings and keratinocytes in human skin. Dermatology.
; 209:183-9.
Vernassiere C, Cornet C, Trechot P, Alla F, Truchetet F, Cuny
JF, et al. Study to determine the efficacy of topical morphine
on painful chronic skin ulcers. J Wound Care. 2005;1
: 289-93.
Jansen MM, van der Horst JC, van der Valk PG, Kuks PF,
Zylicz Z, van Sorge AA. Pain-relieving properties of topically
applied morphine on arterial leg ulcers: a pilot study.
J Wound Care. 2004; 18:306-11.
Marcio L, Martin M, Barbosa LR. Hyperbaric oxygen therapy
as an adjuvant treatment for. An Bas Dermatol. 2011;
:1193-6.
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