A importância da integração da espiritualidade e da religiosidade no manejo da dor e dos cuidados paliativos ResumoContexto: Dor é um dos sintomas físicos mais freqüentemente relatados por pacientes, causando importante redução na qualidade de vida do indivíduo. Pacientes com dor crônica são difíceis de tratar. Objetivo: Descrever estratégias atuais de abordagem de pacientes com dores crônicas, baseadas na literatura científica, enfatizando medidas relacionadas à espiritualidade e à religiosidade. Método: A presente revisão utilizou-se das atuais estratégias de manejo para pacientes com dor crônica combinadas a medidas medicamentosas e não-medicamentosas, estas geralmente incorporando medidas voltadas ao bem-estar físico, mental, social e espiritual com base em publicações indexadas pelo Medline. Resultados: Muitos estudos demonstram associação positiva entre espiritualidade e religiosidade e melhora em variáveis e marcadores de doenças crônicas. Conclusão: Pelo fato de a religiosidade e a espiritualidade serem marcadamente relacionadas com a melhora clínica dos pacientes, é importante que o reconhecimento desses aspectos e a integração no manejo dos pacientes com dor crônica sejam conduzidos por profissionais da área de saúde.Peres, M.F.P. et al. / Rev. Psiq. Clín. 34, supl 1; 82-87, 2007 Palavras-chave: Dor crônica, manejo, cefaléias, espiritualidade. AbstractBackground: Pain is one of the most common physical complaints which negatively affects the patient's quality of life. Patients with chronic pain are difficult and often frustrating to treat. Objective: To describe the current strategies for approaching patients with chronic pain based on scientific literature, emphasizing measures related to spirituality and religiosity. Method: For the present work, authors reviewed data supporting the application of clinical procedures regarding to chronic pain and palliative care with the importance of spirituality background incorporation based on indexed Medline data. Results: Many studies have demonstrated a positive association between spirituality and religiosity and improvement of chronic diseases' variables and markers. Conclusion: As religiosity and spirituality are notoriously related to the patient's clinical improvement, it is highly important that the recognition of these aspects and their incorporation in the management of patients with chronic pain be conducted by health professionals.

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A small collection of neurons in the dorsal lateral medulla, the paratrigeminal nucleus (Pa5), projects directly to the rostroventrolateral reticular nucleus (RVL). Bradykinin (BK) microinjections in the Pa5 produce marked pressor responses. Also, the Pa5 is believed to be a component of the neuronal substrates of the somatosensory response and the baroreflex arc. Considering the developing interest in the functional physiology of the Pa5, the present study was designed to characterize RVL neuronal activity in response to BK microinjections in the Pa5 as well as to phenylephrine-induced blood pressure increases in freely behaving rats. Of the 46 discriminated RVL neurons, 82% responded with a 180% mean increase in firing rate after BK application to the paratrigeminal nucleus, before the onset of the blood pressure increase. Thirty (79%) of the RVL BK-excited neurons were baroreceptor-inhibited units that responded with a 30% decrease in firing rate in response to a phenylephrine-produced increase of blood pressure. Twenty-seven (71%) units of the latter population displayed cardiac-cycle-locked rhythmic activity. The findings demonstrate a BK-stimulated functional connection between the Pa5 and RVL that may represent the neural pathway in the BK-mediated pressor response. This pathway may be relevant to baroreflex mechanisms since it relates to cardiovascular pressure-sensitive neurons.

The nucleus of the solitary tract (NTS), a termination site for primary afferent fibers from baroreceptors and other peripheral cardiovascular receptors, contains blood pressure-sensitive neurons, some of which have rhythmic activity locked to the cardiac cycle, making them key components of the central pathway for cardiovascular regulation. The paratrigeminal nucleus (Pa5), a small collection of medullary neurons in the dorsal lateral spinal trigeminal tract, like the NTS, receives primary somatosensory inputs of glossopharyngeal, vagal, and other nerves. Recent studies show that the Pa5 has efferent connections to the rostroventrolateral reticular nucleus (RVL), NTS, and ambiguous nucleus, suggesting that its structure may play a role in the baroreceptor reflex modulation. In the present study, simultaneous recording from multiple single neurons in freely behaving rats challenged with i.v. phenylephrine administration, showed that 83% of NTS units and 72% of Pa5 units were baroreceptor sensitive. Whereas most of the baroreceptor-sensitive NTS and Pa5 neurons (86 and 61%, respectively) increased firing rate during the ascending phase of the pressor response, about 16% of Pa5 and NTS baroreceptor-sensitive neurons had a decreased firing rate. On one hand, the decrease in firing rate occurred during the ascending phase of the pressor response, indicating sensitivity to rapid changes in arterial pressure. On the other hand, the increases in neuron activity in the Pa5 or NTS occurred during the entire pressor response to phenylephrine. Cross-correlational analysis showed that 71% of Pa5 and 93% of NTS baroreceptor-activated neurons possessed phasic discharge patterns locked to the cardiac cycle. These findings suggest that the Pa5, like the NTS, acts as a terminal for primary afferents in the medullary-baroreflex or cardiorespiratory-reflex pathways.