Pain relief in complex regional pain syndrome (CRPS) remains a major challenge, in part due to the lack of evidence-based treatment trials specific for this condition. We performed a long-term randomized, double-blinded active-control study to evaluate the efficacy of thoracic sympathetic block (TSB) for upper limb type I CRPS. The study objective was to evaluate the analgesic effect of TSB in CRPS. Patients with CRPS type I were treated with standardized pharmacological and physical therapy and were randomized to either TSB or control procedure as an add-on treatment. Clinical data, pain intensity, and interference (Brief Pain Inventory), pain dimensions (McGill Pain Questionnaire [MPQ]), neuropathic characteristics (Neuropathic Pain Symptom Inventory [NPSI]), mood, upper limb function (Disabilities of Arm, Shoulder and Hand), and quality of life were assessed before, and at 1 month and 12 months after the procedure. Thirty-six patients (19 female, 44.7 ± 11.1 years of age) underwent the procedure (17 in the TSB group). Average pain intensity at 1 month was not significantly different after TSB (3.5 ± 3.2) compared to control procedure (4.8 ± 2.7; P=0.249). At 12 months, however, the average pain item was significantly lower in the TSB group (3.47 ± 3.5) compared to the control group (5.86 ± 2.9; P=0.046). Scores from the MPQ, evoked-pain symptoms subscores (NPSI), and depression scores (Hospital Anxiety and Depression Scale) were significantly lower in the TSB group compared to the control group at 1 and at 12 months. Other measurements were not influenced by the treatment. Quality of life was only slightly improved by TSB. No major adverse events occurred. Larger, multicentric trials should be performed to confirm these original findings.

Lesions of the hypoglossal and laryngeal nerve, recurrent in its unilateral or bilateral extracranial pathways, cause a motor deficit in the tongue with transient, partial or total loss of speech, which may be associated with mild or severe dysphagia, characterizing Tapia syndrome. This unusual condition is usually related to airway manipulation during anesthetic-surgical surgery, and few cases in the literature are correlated with maxillofacial surgeries, which partly explains the ignorance of this complication by a significant number of professionals. We describe a case report of bilateral Tapia syndrome established after a procedure for maxillomandibular advancement. This is a 55-year-old male patient diagnosed with retrognatism and retromaxillism. The patient underwent a maxillomandibular advancement with nasotracheal intubation. He evolved with bilateral Tapia syndrome, recovering from the signs and symptoms of this complication, being reoperated to correct aesthetic results obtained in the first intervention that was below acceptable, not evolving after this second surgery with the syndrome. We conclude that preventive measures should be taken, such as avoiding sudden movements in the head region and prolonged hyperextension of the neck during surgery, minimizing the trauma of the tracheal cannula on the tissues covering the hypoglossal and recurrent laryngeal nerves.

Recebido: 08/12/05 -Aceito: 23/08/06Resumo Contexto: Auto-eficácia é a crença na habilidade pessoal de desempenhar com sucesso tarefas ou de apresentar comportamentos para produzir um resultado desejável. É conceito-chave para o adequado controle de doenças crônicas e estudos sobre o tema são incipientes no Brasil. Objetivo: Avaliar a crença de auto-eficácia de pacientes com dor crônica e relacioná-la a variáveis sociodemográficas, de características da dor e à presença de sintomas depressivos. Métodos: A amostra, de conveniência, foi de 132 sujeitos. Os instrumentos utilizados foram a Escala de Auto-Eficácia para Dor Crônica (AEDC) e o Inventário de Depressão de Beck (IDB). Resultados: O escore médio de auto-eficácia foi 170,8 (DP = 56,7). Auto-eficácia menor foi observada nos pacientes com até 8 anos de escolaridade, quando comparada à de pacientes com escolaridade entre 9 e 11 anos (p = 0,015). Auto-eficácia mais elevada foi observada nos doentes com dor menos intensa (p = 0,042). A Escala AEDC apresentou correlação negativa com o IDB (r = -0,48; p < 0,01). Conclusões: Os doentes com escolaridade de até 8 anos apresentaram auto-eficácia menor que os doentes que tinham entre 9 e 11 anos de escolaridade. Os pacientes com dor menos intensa e os doentes com menos sintomas depressivos apresentaram maior auto-eficácia. Salvetti, M.G. et al. / Rev. Psiq. Clín. 34 (3); 111-117, 2007Palavras-chave: Auto-eficácia, dor crônica, depressão, crenças. AbstractBackground: Self-efficacy is the belief about one's personal ability to perform a task or specific behavior successfully. Self-efficacy is a key concept to manage chronic diseases and the studies about it are insufficient in Brazil. Objective: To evaluate chronic pain patient's self-efficacy belief and relate to social demographic variables, pain and depressive symptoms. Methods: The convenience sample was 132 subjects. The instruments utilized were Chronic Pain Selfefficacy Scale (CPSS) in Portuguese version (AEDC) and Beck Depression Inventory (BDI). Results: The self-efficacy average score was 170.8 (DP = 56.7). Low self-efficacy was observed in 8 year education level patients compared to 9 to 11 year education level (p = 0.015). Higher self-efficacy was observed in patients with lower pain intensity (p = 0.042). The AEDC was negative correlated to IDB depression (r = -0.48; p < 0.01). Conclusions: Patients with 8 year education level showed low self-efficacy than patients with 9 to 11 year education level. Subjects with lower pain intensity and fewer depressive symptoms showed higher self-efficacy scores.

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