Brazilian Journal of Pain
https://brjp.org.br/article/doi/10.5935/2595-0118.20180005
Brazilian Journal of Pain
Original Article

Detection of pain with neuropathic characteristics in patients with diabetes mellitus assisted in primary care units

Detecção de dor com características neuropáticas em pacientes com diabetes mellitus atendidos na atenção básica

Francisca Lidiane Ximenes da Silva Aguiar; Luciana Fernandes Pastana Ramos; Cléa Nazaré Carneiro Bichara

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Abstract

BACKGROUND AND OBJECTIVES: There is a lack of epidemiological data on neuropathic pain in Brazil. Thus, the present study aimed to detect the presence of pain with neuropathic characteristics in people with diabetes mellitus, assisted by the Hiperdia program in Santarém-Pará.

METHODS: A cross-sectional study was carried out between April and November of 2016 in seven Primary Care Units of Santarém. Patients with types 1 and 2 diabetes mellitus enrolled in the Hiperdia program, who answered a clinical and sociodemographic questionnaire were included. All those who reported pain responded the Douleur Neuropathique 4 questions and the visual analog pain scale. Data were tabulated and statistically analyzed using the software Bioestat® 5.0.

RESULTS: The sample consisted of 129 patients, all of whom with type 2 diabetes mellitus. Of these, 67 (51.9%) reported pain. Of these, 34.1% were detected with pain of neuropathic characteristics, with a predominance of pain in lower limbs and moderate intensity. The most reported symptoms were: tingling, pinching/needling and numbness.

CONCLUSION: An expressive prevalence of people with neuropathic pain was obtained through the application of the Douleur Neuropathique 4 questions questionnaire, which proved to be an effective and easily applied tool. It is suggested that the neuropathic pain should be identified in the primary care unit and that studies with greater population coverage be performed in Santarém-Pará and in the Northern region, due to the scarcity of data in Brazil.

Keywords

Diabetes mellitus, Pain, Primary care

Resumo

JUSTIFICATIVA E OBJETIVOS: Há uma carência de dados epidemiológicos sobre dor neuropática no Brasil. Assim, o presente estudo teve por objetivo detectar a presença de dor com características neuropáticas em pessoas com diabetes mellitus, atendidos pelo programa Hiperdia, em Santarém-Pará.

MÉTODOS: Estudo transversal, realizado no período de abril a novembro de 2016, em sete Unidades Básicas de Saúde de Santarém. Foram incluídos pacientes com diabetes mellitus tipos 1 e 2, cadastrados no programa Hiperdia, que responderam a um questionário clínico e sociodemográfico. Todos que relataram dor responderam aos questionários Douleur Neuropathique4 questions e a escala analógica visual. Os dados foram tabelados e analisados estatisticamente através do software Bioestat® 5.0.

RESULTADOS: A amostra foi composta por 129 pacientes, os quais todos possuíam diabetesmellitus tipo 2. Dentre eles, 67 (51,9%) referiram dor. Desses, 34,1% foram detectados com dor de características neuropáticas, com seu predomínio nos membros inferiores e de intensidade moderada. Os sintomas mais relatados foram formigamento, alfinetada/agulhada e adormecimento.

CONCLUSÃO: Obteve-se uma prevalência expressiva de pessoas com dor de características neuropáticas, por meio da aplicação do questionário Douleur Neuropathique4 questions, que demonstrou ser um instrumento eficaz e de fácil aplicação. Sugere-se que seja feita a identificação da dor neuropática na atenção básica e que sejam realizados estudos de maior abrangência populacional em Santarém-Pará e na região norte, em razão da escassez de dados no Brasil.

Palavras-chave

Atenção básica, Diabetes mellitus, Dor

References

Treede RD, Jensen TS, Campbell JN, Cruccu G, Dostrovsky JO, Griffin JW. Neuropathic pain: redefinition and a grading system for clinical and research purposes. Neurology. 2008;70(18):1630-5.

Franco LC, Souza LA, Pessoa AP, Pereira LV. Terapias não farmacológicas no alívio da dor neuropática diabética: uma revisão bibliográfica. Acta Paul Enferm. 2011;24(2):284-8.

O'Connor AB. Neuropathic pain: quality-of-life impact, costs and cost effectiveness of therapy. Pharmacoeconomics. 2009;27(2):95-112.

The 2014-2015 Global Year Against Neuropathic Pain campaign. 2014.

IDF Diabetes Atlas. 2014.

Aslam A, Singh J, Rajbhandari S. Pathogenesis of painful diabetic neuropathy. Pain Res Treat. 2014;2014:412041.

Palladini MC. Diabetes na prática clínica: Dor neuropática, diagnóstico e tratamento [E-Book 2.0. 2014.

Haanpää M, Attal N, Backonja M, Baron R, Bennett M, Bouhassira D. NeuPSIG guidelines on neuropathic pain assessment. Pain. 2011;152(1):14-27.

Miranda CC, Seda JL, Pelloso LR. Nova classificação fisiológica das dores: o atual conceito de dor neuropática. Rev Dor. 2016;17(Suppl 1):S2-4.

Política Nacional de Atenção Básica. 2012.

Haanpää ML, Backonja M, Bennett MI, Bouhassira D, Cruccu G, Hansson PT. Assessment of neuropathic pain in primary care. Am J Med. 2009;122(10 Suppl):S13-21.

Atenção Básica: saúde da família. 2011.

Portaria nº 2.488, de 21 de outubro de 2011. Aprova a Política Nacional de Atenção Básica, estabelecendo a revisão de diretrizes e normas para a organização da atenção básica, para a Estratégia Saúde da Família (ESF) e o Programa de Agentes Comunitários de Saúde (PACS). 2011.

Carvalho Filha FS, Nogueira LT, Viana LM. Hiperdia: adesão e percepção de usuários acompanhados pela Estratégia Saúde da Família. Rev Rene. 2011;12(no esp):930-6.

Portaria nº 1083, de 02 de outubro de 2012. Aprova o Protocolo Clínico e Diretrizes Terapêuticas da Dor Crônic. 2012.

Resolução nº 196 de 10 de outubro de 1996. Aprova diretrizes e normas regulamentadoras de pesquisa envolvendo seres humanos. 1996.

Bouhassira D, Attal N, Alchaar H, Boureau F, Brochet B. Comparison of pain syndromes associated with nervous or somatic lesions and development of a new neuropathic pain diagnostic questionnaire (DN4). Pain. 2005;114(1):29-36.

Sousa FA. Dor: o quinto sinal vital. Rev Lat Am Enfermagem. 2002;10(3):446-7.

Spallone V, Morganti R. Validation of DN4 as a screening tool for neuropathic pain in painful diabetic polyneuropathy. Diabet Med. 2012;29(5):578-85.

Celik S, Yenidunya G, Temel E, Purisa S, Uzum AK, Gulum N. Utility of DN4 questionnaire in assessment of neuropathic pain and its clinical correlations in Turkish patients with diabetes mellitus. Prim Care Diabetes. 2016;10(4):259-64.

Gore M, Brandenburg NA, Hoffman DL, Tai KS, Stacey B. Burden of illness in painful diabetic peripheral neuropathy: the patients' perspectives. J Pain. 2006;7(12):892-900.

National Diabetes Statistics Report: Estimates of Diabetes and Its Burden in the United States, 2014. 2014.

Davies M, Brophy S, Williams R, Taylor A. The prevalence, severity, and impact of painful diabetic peripheral neuropathy in type 2 diabetes. Diabetes Care. 2006;29(7):1518-22.

Jacovides A, Bogoshi M, Distiller LA, Mahgoub EY, Omar MKA, Tarek IU. An epidemiological study to assess the prevalence of diabetic peripheral neuropathic pain among adults with diabetes attending private and institutional outpatient clinics in South Africa. J Int Med Res. 2014;42(4):1018-28.

Aslam A, Singh J, Rajbhandari S. Prevalence of painful diabetic neuropathy using the self-completed leeds assessment of neuropathic symptoms and signs questionnaire in a population with diabetes. Can J Diabetes. 2015;39(4):285-95.

Ojo OO, Odeniyi IA, Iwuala SO, Oshinaike OO, Okubadejo NU, Fasanmade OA. Frequency of neuropathic pain in type 2 diabetes mellitus at the Lagos University Teaching Hospital: a questionnaire-based outpatient survey. J Clin Sci. 2016;13(2):46-50.

Cortez J, Reis C, Cardoso Y, Onofre A, Piovezan AP. Prevalence of neuropathic pain and associated factors in diabetes mellitus type 2 patients seen in outpatient setting. Rev Dor. 2014;15(4):256-9.

Kim SS, Won JC, Kwon HS, Kim CH, Lee JH, Park TS. Prevalence and clinical implications of painful diabetic peripheral neuropathy in type 2 diabetes: Results from a nationwide hospital-based study of diabetic neuropathy in Korea. Diabetes Res Clin Pract. 2014;103(3):522-9.

Chiang SS, Lee CL, Liu HC, Wang JS, Lee IT, Song YM. Physical activity and albuminuria were associated with painful diabetic polyneuropathy in type 2 diabetes in an ethnic Chinese population. Clin Chim Acta. 2016;462:55-9.

Halawa MR, Karawagh A, Zeidan A, Mahmoud AE, Sakr M, Hegazy A. Prevalence of painful diabetic peripheral neuropathy among patients suffering from diabetes mellitus in Saudi Arabia. Curr Med Res Opin. 2010;26(2):337-43.

Diretrizes da Sociedade Brasileira de Diabetes (2015-2016). 2016.

Posso IP, Palmeira CC, Vieira EB. Epidemiologia da dor neuropática. Rev Dor. 2016;17(Suppl 1):S11-4.

Dobrota VD, Hrabac P, Skegro D, Smiljanic R, Dobrota S, Prkacin I. The impact of neuropathic pain and other comorbidities on the quality of life in patients with diabetes. Health Qual Life Outcomes. 2014;12(1):1-8.

Veves A, Backonja M, Malik RA. Painful diabetic neuropathy: epidemiology, natural history, early diagnosis, and treatment options. Pain Med. 2008;9(6):660-74.

Abbott CA, Malik RA, Ross ER, Kulkarni J, Boulton AJM. Prevalence and characteristics of painful diabetic neuropathy in a large community-based. Diabetic population in the U.K. Diabetes Care. 2011;34(10):2220-4.

Hoffman Dl, Sadosky A, Alvir J. Cross-national burden of painful diabetic peripheral neuropathy in Asia, Latin America, and the Middle East. Pain Pract. 2009;9(1):35-42.

Bouhassira D, Letanoux M, Hartemann A. Chronic pain with neuropathic characteristics in diabetic patients: a French cross-sectional study. PLoS One. 2013;8(9).

Goldenberg P, Schenkman S, Franco LJ. Prevalência de diabetes mellitus: diferenças de gênero e igualdade entre os sexos. Rev Bras Epidemiol. 2003;6(1):18-28.

Schmader KE. Epidemiology and impact on quality of life of postherpetic neuralgia and painful diabetic neuropathy. Clin J Pain. 2002;18(6):350-4.

Cheng YJ, Imperatore G, Geiss LS, Wang J, Saydah SH, Cowie CC. Secular changes in the age-specific prevalence of diabetes among U.S. adults: 1988-2010. Diabetes Care. 2013;36(9):2690-6.

Silva TS. Caracterização e identificação de dor associada à polineuropatia diabética distal em atenção primária. 2013.

. 2010.

Fernandes LC, Bertoldi AD, Barros AJ. Health servisse use in population covered by the Estratégia de Saúde da Família (Family Health Strategy). Rev Saude Publica. 2009;43(4):595-603.

Freitas LR, Garcia LP. Evolução da prevalência do diabetes e deste associado à hipertensão arterial no Brasil: análise da Pesquisa Nacional por Amostra de Domicílios, 1998, 2003 e 2008. Epidemiol Serv Saúde. 2012;21(1):7-19.

Erbas T, Ertas M, Yucel A, Keskinaslan A, Senocak M. Prevalence of peripheral neuropathy and painful peripheral neuropathy in Turkish diabetic patients. J Clin Neurophysiol. 2011;28(1):51-5.

Lopes JM. Dores Neuropáticas. 2007.

Goren A, Gross HJ, Fujii RK, Pandey A, Mould-Quevedo J. Prevalence of pain awareness,treatment, and associated health outcomes across different conditions in Brazil. Rev Dor. 2012;13(4):308-19.

Peacock S, Patel S. Cultural influences on pain. Br J Pain. 2008;1(2):6-9.

Costa MC, Alves Neto O. Dor neuropática. Dor: Princípios e prática. 2009.

Soyannwo OA. Improved neuropathic pain treatment in developing countries-a critical review of WHO essential list. Pain. 2015;156(5):763-4.

Kamerman PR, Wadley AL, Davis KD, Hietaharju A, Jain P, Kopf A. World Health Organization (WHO) essential medicines lists. Pain. 2015;156(5):793-7.


Submitted date:
05/06/2017

Accepted date:
01/08/2018

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