BackgroundThe neural mobilization (NM) technique is a noninvasive method that has been proven to be clinically effective in reducing pain; however, the molecular mechanisms involved remain poorly understood. The aim of this study was to analyze whether NM alters the expression of the mu-opioid receptor (MOR), the delta-opioid receptor (DOR) and the Kappa-opioid receptor (KOR) in the periaqueductal gray (PAG) and improves locomotion and muscle force after chronic constriction injury (CCI) in rats.MethodsThe CCI was imposed on adult male rats followed by 10 sessions of NM every other day, starting 14 days after the CCI injury. At the end of the sessions, the PAG was analyzed using Western blot assays for opioid receptors. Locomotion was analyzed by the Sciatic functional index (SFI), and muscle force was analyzed by the BIOPAC system.ResultsAn improvement in locomotion was observed in animals treated with NM compared with injured animals. Animals treated with NM showed an increase in maximal tetanic force of the tibialis anterior muscle of 172% (p < 0.001) compared with the CCI group. We also observed a decrease of 53% (p < 0.001) and 23% (p < 0.05) in DOR and KOR levels, respectively, after CCI injury compared to those from naive animals and an increase of 17% (p < 0.05) in KOR expression only after NM treatment compared to naive animals. There were no significant changes in MOR expression in the PAG.ConclusionThese data provide evidence that a non-pharmacological NM technique facilitates pain relief by endogenous analgesic modulation.

Treatments for spinal cord injury (SCI) still have limited effects. Electrical stimulation might facilitate plastic changes in affected spinal circuitries that may be beneficial in improving motor function and spasticity or SCI-related neuropathic pain. Based on available animal and clinical evidence, we critically reviewed the physiological basis and therapeutic action of transcutaneous spinal cord stimulation in SCI. We analyzed the literature published on PubMed to date, looking for the role of three main noninvasive stimulation techniques in the recovery process of SCI and focusing mainly on transcutaneous spinal stimulation. This review discusses the main clinical applications, latest advances, and limitations of noninvasive electrical stimulation of the spinal cord. Although most recent research in this topic has focused on transcutaneous spinal direct current stimulation (tsDCS), we also reviewed the technique of transcutaneous electric nerve stimulation (TENS) and neuromuscular electrical stimulation (NMES) as potential methods to modulate spinal cord plasticity. We also developed a finite element method (FEM) model to predict current flow in the spinal cord when using different electrode montages. We identified gaps in our knowledge of noninvasive electrical stimulation in the modulation of spinal neuronal networks in patients with SCI. tsDCS, TENS, and NMES have a positive influence on the promotion of plasticity in SCI. Although there are no randomized controlled studies of tsDCS in SCI, preliminary evidence is encouraging. FEMs predict that tsDCS electrode montage can be used to shape which spinal segments are modulated and what detailed areas of spinal anatomy can concentrate current density (eg, spinal roots). tsDCS is a technique that can influence conduction along ascending tracts in the spinal cord, so could modulate supraspinal activity. It may also be a promising new approach for a number of neuropsychiatric conditions.

O objetivo do estudo foi identificar a sobrecarga imposta ao cuidador informal através da escala de Burden Interview, de pacientes atendidos durante o estágio de fisioterapia em saúde coletiva. Foram selecionados 15 cuidadores de pacientes com dependência total ou dependência modificada, de acordo com a escala de MIF, os quais responderam ao questionário Burden Interview. Analisando os resultados, observa-se uma sobrecarga imposta a esses cuidadores em todos os domínios da escala (tensão geral, isolamento, decepção, envolvimento emocional e ambiente), bem como no score total 47,27 (±14,94). Desta forma, concluímos que o cuidador sofre uma sobrecarga física e emocional, apontando que apesar de contribuirmos para uma melhor qualidade de vida do internado, pode-se criar uma situação desfavorável ao cuidador. Por esse motivo, acreditamos que nosso estudo pode ser uma ferramenta válida para corroborar com a importância do atendimento multidisciplinar e programas de saúde específicos ao cuidador informal e não apenas ao ser cuidado.

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