RESUMO
El dolor crónico constituye un reto terapéutico especial. Se presenta una revisión narrativa sobre el papel del tratamiento de oxigenación hiperbárica (TOHB) en el tratamiento del dolor neuropático, y sus aplicaciones en dolor crónico, síndromes neurosensitivos disfuncionales y oncodolor. El conocimiento de las indicaciones de TOHB en algiología y su aplicación en la práctica médica puede contribuir a mejorar la calidad de vida del paciente. (AU)
Chronic pain represents a special therapeutic challenge. We present a narrative review on the role of Hyperbaric Oxygen Therapy (HBOT) in the treatment of neuropathic pain, and its applications in chronic pain, dysfunctional neurosensitive syndromes and oncological pain. The knowledge of the indications of HBOT in algiology and its application in medical practice can contribute to improve the quality of life of the patient. (AU)
Assuntos
Dor Crônica/terapia , Oxigenoterapia Hiperbárica/métodos , Membro Fantasma/terapia , Qualidade de Vida , Distrofia Simpática Reflexa/terapia , Cefaleias Vasculares/terapia , Encefalopatias/terapia , Dor Facial/terapia , Fibromialgia/terapia , Causalgia/terapia , Neuropatias Diabéticas/terapia , Edema/terapia , Neuralgia Pós-Herpética/terapia , Dor Crônica/epidemiologia , Dor do Câncer/terapia , Oxigenoterapia Hiperbárica/tendências , Analgesia/métodos , Inflamação/terapia , Neuralgia/terapiaRESUMO
STUDY DESIGN: A controlled laboratory study. OBJECTIVE: The aim of this study was to analyze the effectiveness of hyperbaric therapy (HT) using mild and moderate models of spinal cord injury (SCI). SUMMARY OF BACKGROUND DATA: SCI can cause permanent impairment with socioeconomic consequences. The motor deficit occurs by two mechanisms: destruction of neuronal cells and local inflammatory response, resulting in hypoxia. HT acts by increasing oxygen in the injured area. METHODS: Thoracic laminectomy was performed in 72 female Wistar rats. The MASCIS impactor was used at 12.5âmm (nâ=â35) and 25âmm (nâ=â35) of height to perform, respectively, mild and moderate SCI. Muscle strength was assessed through the Basso, Beattie, and Bresnahan scale (BBB) on days 1, 7, 14, 21, and 28 after SCI. The animals were randomized into five subgroups with seven animals each: (1) control group had SCI without HT; (2) HT 30âminutes after SCI; (3) HT 30âminutes after SCI and daily for 7 days; (4) HT 12âhours after SCI; and (5) HT 12âhours after SCI and daily for 7 days. HT was performed at 2.5âatm for 1âhour. RESULTS: There was a linear relationship between injury severity and motor deficit until day 21, with similar BBB scores on day 28. A pattern of uniform lesions was observed in the mild SCI, with lower variation of BBB when compared with moderate SCI. All animals that underwent HT had significant improvement in motor function and histology when compared with control group. Regardless of the injury model, animals submitted to 7-day protocols had an early improvement in motor function and a smaller area of histological injury. CONCLUSION: The present study reported that the sooner HT is begun after mild and moderate SCI and the larger the number of sessions, the greater and earlier is the motor recovery and smaller is the tissue injury. LEVEL OF EVIDENCE: N/A.
Assuntos
Oxigenoterapia Hiperbárica/métodos , Atividade Motora/fisiologia , Recuperação de Função Fisiológica/fisiologia , Traumatismos da Medula Espinal/fisiopatologia , Traumatismos da Medula Espinal/terapia , Animais , Feminino , Oxigenoterapia Hiperbárica/tendências , Distribuição Aleatória , Ratos , Ratos Wistar , Traumatismos da Medula Espinal/patologia , Vértebras TorácicasRESUMO
Peripheral nerves are essential connections between the central nervous system and muscles, autonomic structures and sensory organs. Their injury is one of the major causes for severe and longstanding impairment in limb function. Acute peripheral nerve lesion has an important inflammatory component and is considered as ischemia-reperfusion (IR) injury. Surgical repair has been the standard of care in peripheral nerve lesion. It has reached optimal technical development but the end results still remain unpredictable and complete functional recovery is rare. Nevertheless, nerve repair is not primarily a mechanical problem and microsurgery is not the only key to success. Lately, there have been efforts to develop alternatives to nerve graft. Work has been carried out in basal lamina scaffolds, biologic and non-biologic structures in combination with neurotrophic factors and/or Schwann cells, tissues, immunosuppressive agents, growth factors, cell transplantation, principles of artificial sensory function, gene technology, gangliosides, implantation of microchips, hormones, electromagnetic fields and hyperbaric oxygenation (HBO). HBO appears to be a beneficial adjunctive treatment for surgical repair in the acute peripheral nerve lesion, when used at lower pressures and in a timely fashion (<6 hours).