Avaliação do efeito terapêutico da L-carnitina + piracetam no tratamento da dor na síndrome pós-poliomielite
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2017-12-21
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Dissertação de mestrado
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Introdução: A Síndrome Pós-Poliomielite (SPP) é uma desordem do sistema nervoso que pode atingir indivíduos que tiveram poliomielite aguda. A dor é um dos sintomas mais frequentes na SPP e seu tratamento baseia-se na reabilitação física, mudança no estilo de vida e tratamento medicamentoso. Diversos medicamentos têm sido avaliados para o tratamento da SPP, sem resultados totalmente satisfatórios. O piracetam é um agente nootrópico que eleva a eficácia energética dos neurônios e melhora as funções cognitivas, enquanto a L-carnitina é um composto que facilita o transporte intramitocondrial de gorduras, gerando energia para o funcionamento muscular. Considerando que a dor na SPP esta relacionada ao uso excessivo e ao desuso muscular, presume-se que a suplementação com L- carnitina + piracetam melhore o desempenho das células musculares e diminuía o quadro de dor. Objetivos: avaliar e caracterizar a dor do paciente com SPP; quantificar, qualificar e investigar a repercussão da dor em aspectos da vida diária; analisar o efeito terapêutico do uso de L-carnitina + piracetam na dor dos pacientes. Método: este foi um ensaio clínico randomizado, duplo-cego, controlado por placebo, que comparou o uso da L-carnitina + piracetam ao placebo, no tratamento da dor em pacientes com SPP. O estudo foi realizado no ambulatório de Síndrome Pós Poliomielite da UNIFESP, entre agosto de 2013 e dezembro de 2014. Participaram do estudo 94 pacientes randomizados (2:1), que receberam tratamento via oral, por 180 dias, com L-carnitina + piracetam, ou placebo. Os participantes foram avaliados em três visitas, com a Escala Visual Analógica de Dor, Questionário McGill de Avaliação da Dor e Inventario Multidimensional de Dor. O tratamento estatístico dos dados foi feito com a utilização da ANOVA; teste T-Student Pareado; Correlação de Pearson; Teste de Correlação e P-valor. Resultados: a população era predominantemente do sexo feminino (64,9%) e com media de idade de 48,7 anos (mediana 49 anos, ±6,6). O perfil clínico mostrou participantes com maior frequência de monoparesia (52,2%), que apresentavam dor durante e após atividades físicas (91,5%), tanto em membro acometido pela poliomielite quanto em membros não acometidos (61,9%), com grande frequência de escoliose e/ou encurtamento de membro (79,8%) e artrose (41,5%). Com relação à adesão aos tratamentos para alivio da dor, as orientações domiciliares não eram seguidas por 25,5% da população e 76,5% dos participantes não fazia fisioterapia. A dor do tipo I, II e III estava presente em 37,2% dos pacientes e a média de intensidade de dor foi de 5,1. A avaliação do efeito terapêutico da medicação mostrou que ambos os grupos apresentaram diminuição da intensidade de dor (grupo Ativo: V1=5,0/V3=4,2. p-valor=0,0099; grupo Placebo: V1=5,0/V3=3,8. p-valor=0,03), todavia o grupo Placebo não apresentou melhora na avaliação de atividades funcionais. Conclusão: os pacientes do estudo apresentam dor tipo I, II e III; a dor resulta de comprometimentos osteomusculares e é agravada pela pouca adesão aos tratamentos terapêuticos. A análise do efeito da L-carnitina + Piracetam indica que a terapêutica é eficiente, visto que os pacientes do grupo Ativo obtiveram diminuição da intensidade da dor e melhora da funcionalidade.
Introduction: The Post Poliomyelitis Syndrome (PPS) is a neurological disorder which may affect individuals who have had acute poliomyelitis. Pain is one of the most frequent symptoms of PPS and its treatment is based on physical rehabilitation, change in lifestyle and medicamental treatment. A great range of drugs have been evaluated for PPS treatment, without entirely satisfactory results. Piracetam is a nootropic agent which increases the energy efficiency of neurons and enhances cognitive functions, while L-carnitine is a compound that facilitates the intramitochondrial transport of fat, generating energy to muscle functioning. Considering that pain in PPS is related to muscle disuse and excessive use, it is presumed that L-carnitine + piracetam supplementation improves the performance of muscle cells and diminishes pain. Objectives: Evaluate and characterize pain in PPS patients; Quantify, qualify and investigate pain repercussion on daily life aspects; Analyze the therapeutic effects of the use of L-carnitine + piracetam in the pain of patients. Methods: this was a double-blind, placebo controlled, randomized clinical trial, which compared the use of L-carnitine + piracetam to placebo on the treatment of pain in patients with PPS. The study was conducted on the Post Poliomyelitis Syndrome ambulatory of UNIFESP, between august 2013 and december 2014. Participated on the study 94 randomized patients (2:1), who received oral treatment of L-carnitine + piracetam or placebo, during 180 days. The participants were evaluated on three visits, with the Analog Visual Pain Scale, The McGill Pain Questionnaire and Multidimensional Pain Inventory. The statistic treatment of data was made using ANOVA; T-Student Paired Test; Pearson Correlation; Correlation Coefficient and P-value. Results: the population were predominantly female (64,9%) with age average of 48,7 years (median of 49 years, ±6,6). The clinical profile showed participants with greater frequency of monoparesis (52,2%), presenting pain during and after physical activity (91,5%), in limbs affected by poliomyelitis, as well as in non affected limbs (61,9%), with high frequency of scoliosis and/or limb shortening (79,8%) and arthrosis (41,5%). In relation to adherence to pain relief treatment, the domiciliary orientation were not followed by 25,5% of the population and 76,5% of the participants did not practice physiotherapy. Pain of types I, II and III were present in 37,2% of the patients and the mean intensity of pain was 5,1. The evaluation of the therapeutical effect of medication showed that both groups presented a reduction in pain intensity (Active group: V1=5,0/V3=4,2. p- value=0,0099; Placebo group: V1=5,0/V3=3,8. pvalue=0,03), however, the Placebo group did not show improvement on the evaluation of functional activities. Conclusion: the patients of the study presented pain type I, II and III; the pain is a result of musculoskeletal compromise and it is aggravated by small adherence to therapeutical treatment. The analysis of the effect of L-carnitine + Piracetam indicates that the therapy is efficient, since patients in the Active group obtained a decrease in the intensity of pain and improvement of functionality.
Introduction: The Post Poliomyelitis Syndrome (PPS) is a neurological disorder which may affect individuals who have had acute poliomyelitis. Pain is one of the most frequent symptoms of PPS and its treatment is based on physical rehabilitation, change in lifestyle and medicamental treatment. A great range of drugs have been evaluated for PPS treatment, without entirely satisfactory results. Piracetam is a nootropic agent which increases the energy efficiency of neurons and enhances cognitive functions, while L-carnitine is a compound that facilitates the intramitochondrial transport of fat, generating energy to muscle functioning. Considering that pain in PPS is related to muscle disuse and excessive use, it is presumed that L-carnitine + piracetam supplementation improves the performance of muscle cells and diminishes pain. Objectives: Evaluate and characterize pain in PPS patients; Quantify, qualify and investigate pain repercussion on daily life aspects; Analyze the therapeutic effects of the use of L-carnitine + piracetam in the pain of patients. Methods: this was a double-blind, placebo controlled, randomized clinical trial, which compared the use of L-carnitine + piracetam to placebo on the treatment of pain in patients with PPS. The study was conducted on the Post Poliomyelitis Syndrome ambulatory of UNIFESP, between august 2013 and december 2014. Participated on the study 94 randomized patients (2:1), who received oral treatment of L-carnitine + piracetam or placebo, during 180 days. The participants were evaluated on three visits, with the Analog Visual Pain Scale, The McGill Pain Questionnaire and Multidimensional Pain Inventory. The statistic treatment of data was made using ANOVA; T-Student Paired Test; Pearson Correlation; Correlation Coefficient and P-value. Results: the population were predominantly female (64,9%) with age average of 48,7 years (median of 49 years, ±6,6). The clinical profile showed participants with greater frequency of monoparesis (52,2%), presenting pain during and after physical activity (91,5%), in limbs affected by poliomyelitis, as well as in non affected limbs (61,9%), with high frequency of scoliosis and/or limb shortening (79,8%) and arthrosis (41,5%). In relation to adherence to pain relief treatment, the domiciliary orientation were not followed by 25,5% of the population and 76,5% of the participants did not practice physiotherapy. Pain of types I, II and III were present in 37,2% of the patients and the mean intensity of pain was 5,1. The evaluation of the therapeutical effect of medication showed that both groups presented a reduction in pain intensity (Active group: V1=5,0/V3=4,2. p- value=0,0099; Placebo group: V1=5,0/V3=3,8. pvalue=0,03), however, the Placebo group did not show improvement on the evaluation of functional activities. Conclusion: the patients of the study presented pain type I, II and III; the pain is a result of musculoskeletal compromise and it is aggravated by small adherence to therapeutical treatment. The analysis of the effect of L-carnitine + Piracetam indicates that the therapy is efficient, since patients in the Active group obtained a decrease in the intensity of pain and improvement of functionality.
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CAMPOS, Katia Maria de. Avaliação do efeito terapêutico da L-carnitina + piracetam no tratamento da dor na síndrome pós-poliomielite. São Paulo, 2017. Dissertação (Mestrado em Neurologia/Neurociências) - Escola Paulista de Medicina (EPM), Universidade Federal de São Paulo (UNIFESP), São Paulo, 2017.