Aula 3 Dor e Termoterapia

Esta é uma pré-visualização de arquivo. Entre para ver o arquivo original

Fisiologia da Dor
1
This slide illustrates three broad categories of Pain: neuropática (pathologic), nociceptiva (physiologic), and mixed Pain states that encompass both nociceptiva and neuropática components, with examples of common causes of each type of Pain.
The key talking points on this slide are as follows:
neuropathic pain has been defined by the International Association for the Study of Pain as ‘initiated or caused by a primary lesion or dysfunction in the nervous system’.1 Depending on where the lesion or dysfunction occurs within the nervous system, neuropathic pain can be peripheral or central in origin. 
 Causas of neuropathic pain periférica include nevralgia pós-herpética (PHN) and neuropatia diabética periférica (DPN). Due to the prevalence and characteristics of PHN and DPN, these states may be considered representative of neuropathic pain periférica.
Nociceptive Pain is an appropriate physiologic response that occurs when specific peripheral sensory neurons (nociceptors) respond to noxious stimuli. Nociceptive Pain has a protective role because it elicits reflex and behavioral responses that keep tissue damage to a minimum.
Acute Pain, such as that seen with tissue inflamação and chronic Pain, such that accompanying osteoarthritis, are examples of nociceptiva Pain.
Although there are no specific descriptors for each type of Pain, neuropathic pain is frequently described as ‘queimadura or formigueiro’ in quality, while nociceptiva Pain is often described as ‘aching or throbbing’.
There are cases in which an individual experiences Pain sensations that are a blend of Pain having a nociceptiva and a neuropática origin. For example, in carpal tunnel syndrome, it is common experience to have nociceptiva Pain, felt around the wrist, and neuropathic pain, felt in the distribution territory of the median nerve (fingers). 
References
International Association for the Study of Pain. IASP Pain Terminology.
Raja et al. in Wall PD, Melzack R (Eds). Textbook of Pain. 4th Ed. Edinburgh, UK: Harcourt Publishers Limited. 1999.;11-57
Additional key words: descriptor
Dor
 Experiência sensorial e emocional desagradável, associada a uma lesão tecidular real ou potencial
 Tipos de Dor:
 Nociceptiva, Neuropática e Mista
Dor nociceptiva
Experiência sensorial, traduzindo-se numa resposta de neurônios sensoriais periféricos específicos (nociceptores) a estímulos nocivos
3
Note to speaker: this slide contains an animated build. The first bullet appears automatically, then click on the slide to bring up the remaining 4 bullets sequentially.
The painful region is typically localized at the site of injury in nociceptive pain. This contrasts with neuropathic pain where the painful region may not necessarily be the same as the site of injury and occurs in the neurological territory of the affected structure (nerve, root, spinal cord, brain). This is outlined on slide 15.
Nociceptive pain usually responds well to conventional analgesics such as acetaminophen (paracetamol), non-steroidal anti-inflammatory drugs (NSAIDs), cyclo-oxygenase (COX)-2 inhibitors or opioids.
Dor nociceptiva
 Nociceptor é um receptor sensorial que envia sinal que causa a percepção da dor em resposta a um estímulo que possui potencial de dano. 
4
Note to speaker: this slide contains an animated build. The first bullet appears automatically, then click on the slide to bring up the remaining 4 bullets sequentially.
The painful region is typically localized at the site of injury in nociceptive pain. This contrasts with neuropathic pain where the painful region may not necessarily be the same as the site of injury and occurs in the neurological territory of the affected structure (nerve, root, spinal cord, brain). This is outlined on slide 15.
Nociceptive pain usually responds well to conventional analgesics such as acetaminophen (paracetamol), non-steroidal anti-inflammatory drugs (NSAIDs), cyclo-oxygenase (COX)-2 inhibitors or opioids.
Dor Neuropática
Dor iniciada ou causada por disfunção ou lesão primária do sistema nervoso central ou periférico
5
This slide illustrates three broad categories of Pain: neuropática (pathologic), nociceptiva (physiologic), and mixed Pain states that encompass both nociceptiva and neuropática components, with examples of common causes of each type of Pain.
The key talking points on this slide are as follows:
neuropathic pain has been defined by the International Association for the Study of Pain as ‘initiated or caused by a primary lesion or dysfunction in the nervous system’.1 Depending on where the lesion or dysfunction occurs within the nervous system, neuropathic pain can be peripheral or central in origin. 
 Causas of neuropathic pain periférica include nevralgia pós-herpética (PHN) and neuropatia diabética periférica (DPN). Due to the prevalence and characteristics of PHN and DPN, these states may be considered representative of neuropathic pain periférica.
Nociceptive Pain is an appropriate physiologic response that occurs when specific peripheral sensory neurons (nociceptors) respond to noxious stimuli. Nociceptive Pain has a protective role because it elicits reflex and behavioral responses that keep tissue damage to a minimum.
Acute Pain, such as that seen with tissue inflamação and chronic Pain, such that accompanying osteoarthritis, are examples of nociceptiva Pain.
Although there are no specific descriptors for each type of Pain, neuropathic pain is frequently described as ‘queimadura or formigueiro’ in quality, while nociceptiva Pain is often described as ‘aching or throbbing’.
There are cases in which an individual experiences Pain sensations that are a blend of Pain having a nociceptiva and a neuropática origin. For example, in carpal tunnel syndrome, it is common experience to have nociceptiva Pain, felt around the wrist, and neuropathic pain, felt in the distribution territory of the median nerve (fingers). 
References
International Association for the Study of Pain. IASP Pain Terminology.
Raja et al. in Wall PD, Melzack R (Eds). Textbook of Pain. 4th Ed. Edinburgh, UK: Harcourt Publishers Limited. 1999.;11-57
Additional key words: descriptor
Dor neuropática
Frequentemente descrita como “descarga”, “choque elétrico” ou “queimadura” 
Muitas vezes associada a “formigueiro” ou “dormência”
6
Note to speaker: this slide contains an animated build. The first bullet appears automatically, then click on the slide to bring up the remaining 4 bullets sequentially.
The painful region may not necessarily be the same as the site of injury. Pain occurs in the neurological territory of the affected structure (nerve, root, spinal cord, brain).
In peripheral neuropathic pain, it is in the territory of the affected nerve or nerve root.
In central neuropathic pain, it is related to the site of the lesion in the spinal cord or brain.
Neuropathic pain responds poorly to conventional analgesics. 
There is some evidence to show that opioids may have efficacy in the management of neuropathic pain.
Dor neuropática
A região dolorosa não se situa, necessariamente, no local da lesão; a dor ocorre no território nervoso da estrutura afetada (nervo, raiz, medula espinhal, cérebro)
 Quase sempre uma situação crônica (por exemplo neuropraxia braquial ou dor pós-AVC) 
7
Note to speaker: this slide contains an animated build. The first bullet appears automatically, then click on the slide to bring up the remaining 4 bullets sequentially.
The painful region may not necessarily be the same as the site of injury. Pain occurs in the neurological territory of the affected structure (nerve, root, spinal cord, brain).
In peripheral neuropathic pain, it is in the territory of the affected nerve or nerve root.
In central neuropathic pain, it is related to the site of the lesion in the spinal cord or brain.
Neuropathic pain responds poorly to conventional analgesics. 
There is some evidence to show that opioids may have
efficacy in the management of neuropathic pain.
Exemplo de dor neuropática:
lesão do nervo cubital após fratura óssea
Nervo Cubital 
8
This slide shows ulnar nerve damage, caused by direct trauma or compression following an elbow fracture, which can result in neuropathic pain.
The nerve damage involves destruction of the myelin sheath of the nerve or part of the
nerve (axon).
Direct nerve trauma is a key cause of neuropathic pain. The pain exists after tissue healing and no longer represents an alert to injury, but indicates dysfunction within the nervous system.
 
Dor mista ou combinada
A coexistência dos dois tipos de dor tem sido referida como estado de dor “mista” ou “combinada” e pode surgir em múltiplas situações, tais como dor lombar associada a radiculopatia e dor neoplásica
O seu tratamento efetivo requer uma abordagem terapêutica abrangente, para aliviar as componentes nociceptiva e neuropática da dor 
9
Note to speaker: this slide contains an animated build. The first bullet appears automatically, then click on the slide to bring up the remaining 3 bullets sequentially.
Ativação dos nociceptores periféricos –componente nociceptiva da dor
Compressão e inflamação da raíz nervosa –componente neuropática da dor
Exemplo de dor mista:
hérnia discal com radiculopatia
10
Note to speaker: this slide contains an animated build to represent co-presenting pain (herniated disc causing low back pain and lumbar radiculopathy). Clicking on this slide causes subsequent components of the build to appear automatically.
Nociceptive pain component: 
Localized, low back pain at the site of the herniated disc is mediated by the release of inflammatory mediators from degrading cartilage cells, activating peripheral nociceptors and sending impulses along the sensory (afferent) nerves to the dorsal horn and then to the brain.
Neuropathic pain component: 
Pain impulses are mediated by nerve damage following compression of the dorsal root and abnormal impulses enter the spinal cord to reach the dorsal horn.
These abnormal impulses can over-stimulate the secondary nerves ascending to the cortex through various pathways relaying in the brain stem, thalamus and limbic system where pain awareness develops.
Such nerve damage (a lesion or dysfunction at any point of the ascending or descending pathways) can cause:
Positive symptoms – spontaneous pain and tingling, radiating down to the lower legs.
Negative symptoms – weakness or loss of sensation and numbness, radiating down to the lower legs.
Broader analgesic treatment options may be required for the management of co-exisitng pain conditions to encompass both nociceptive and neuropathic elements.
Escalas de intensidade da dor
Escala visual analógica
Escala numérica
Escala qualitativa
Escala de faces
Avaliação clínica da dor 
Intensidade
Distribuição
Qualidade
Limiar de tolerância
Comportamento
Evolução temporal
Fadiga
“Stress”
Objetivo da fisioterapia na clínica da dor
Contribuir para o alívio da dor e evitar a deterioração funcional
Nunca esquecer que...
“...dor é quando o doente diz que dói !”
Termoterapia – ondas de calor e frio
cONCEITO
Medida terapêutica e ou de conforto que consiste no uso de calor e ou frio em aplicação cutânea, para auxiliar nas funções fisiológicas (Vasoconstrição e vasodilatação)
CALOR – FISIOLOGIA E FINALIDADE DE APLICAÇÃO
O calor age estimulando de acordo com a intensidade, tempo, local de aplicação 
Relaxa a musculatura reduzindo a dor e aumentando o conforto;
Aumenta o aporte de oxigênio e nutrientes das células;
CALOR – FISIOLOGIA E FINALIDADE DE APLICAÇÃO
Promove a vasodilatação numa determinada área;
 * Fluxo Sanguíneo 
 * Edemas 
 * Favorece a cicatrização
 * Dilatação dos vasos sanguíneos tornando a função venosa um procedimento mais fácil 
Método de aquecimento
Os métodos de aquecimento são classificados em superficiais e profundos:
Superficiais:
 São consideradas modalidades de calor superficial os que limitam à região cutânea, alcançando a profundidade de 1 a 3 cm tendo como resposta aquecimento local.
Métodos de aquecimento
Calor Superficial – capaz de aumentar a temperatura da pele dentro de um limite de 40°C a 45ºC. Ex.: forno de Bier
Calor profundo – os agentes de aquecimento excedem os 3 cm de profundidade nos tecidos subjacentes. Ex.: ultrassom
CALOR PROFUNDO - ULTRASSOM
CALOR SUPERFICIAL – FORNO DE BIER
Aplicação do calor: seco ou úmido
O calor seco inclui o emprego de:
* Raios infra – vermelhos
* Ultra som, ondas curtas
* Almofadas elétricas e Cobertores elétricos
 * Bolsas de água quente
Aplicação de calor: seco ou úmido
O Calor úmido em aplicação de:
 * Compressas quentes 
	 * Banhos 
Aplicação do calor é contra-indicado em:
Feridas cirúrgicas 
Hemorragias
 
Lesões abertas (como úlceras por pressão)
Pacientes com fragilidade capilar 
Crioterapia
Definição:
Aplicação terapêutica de qualquer substancia ao corpo que resulta em remoção do calor, diminuindo assim, a temperatura corporal dos tecidos
Aplicação do frio
A crioterapia tem a finalidade de:
 * Evitar edema 
 * Alívio da dor 
 * Diminuir o processo inflamatório
	 * Controlar Hemorragias 
Indicação para o frio
Traumatismo ou inflamação aguda
Dor aguda ou crônica
Edema e dor pós-cirúrgica
 Uso em conjunto com exercício de reabilitação 
Contra-indicações:
 Ferimentos abertos
 Insuficiência circulatória
 Alergia ao frio
 Pele anestesiada
 Diabetes avançada
Formas de aplicação
Aplicação da crioterapia no paciente:
Seco:
Bolsa de gelo 
Úmido:
Compressas frias
Tempo de aplicação
Realizar o processo no período de 15 a 20 minutos
Não fazer aplicação com bolsa de gelo além de 30 minutos devido ao risco de causar necrose 
Não expor o paciente
BOLSA DE GELO
COMPRESSAS DE GELO
Obrigada!!