Pesquisa de disautonomia, dor evocada por adrenalina e noradrenalina e efeito de beta-bloqueador na fibromialgia e no lupus eritematoso sistêmico.
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2010-08-05
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Universidade Federal de Goiás
Resumo
Lacerda Jacomini, LC. Investigation on dysautonomia, epinephrine and norepinephrine-evoked pain, and effect of beta-blocker in fibromyalgia and systemic lupus erythematosus. 2010, 169 p. Doctoral thesis - Universidade Federal de Goiás, Goiânia. Dysautonomia is a condition in which an altered autonomic function affects the health in an adverse way. The present study aims: to search for the presence of
epinephrine and norepinephrine-evoked pain; to evaluate the cardiovascular autonomic function and the effect of propranolol in women with fibromyalgia (FM), systemic lupus erythematosus (SLE) and controls (CTR). For each objective a separate research was developed, including a clinical trial. Epinephrine and norepinephrine-evoked pain were diagnosed when the
subcutaneous injections containing these substances (10 micrograms/ 0.1 mL saline solution) induced greater pain than the saline solution did (n=7). Autonomic function was assessed through the standard Ewing tests battery, through heart rate responses to Valsalva maneuver, deep breathing, standing
and blood pressure responses to ortostatism and to hand grip (n=7). Functional symptoms related to autonomic manifestations were checked. In a randomized,
double-blind, placebo-controlled, crossover clinical trial with 6 women with FM, SLE and CTR, propranolol (80 mg/day po/4 weeks) was added to the usual schedule of prescribed medicines and its effect was examined regarding: pain,
fatigue, tender points, blood pressure, heart rate, health related quality of life (SF-36) and fibromyalgia impact questionnaire. Epinephrine-evoked pain was diagnosed in SLE and FM groups and norepinephrine-evoked pain was
diagnosed in FM group. Epinephrine and norepinephrine-evoked pain intensity has a trend to be greater in FM patients when compared to healthy CTR. FM and SLE patients had an elevated number of functional symptoms related to autonomic manifestations. Cardiovascular autonomic function was altered in FM and SLE groups. Parasympathetic cardiovascular autonomic function tests were mainly abnormal in SLE patients while in FM patients both, parasympathetic and sympathetic tests were abnormal. Propranolol reduced tender points count and the number of symptoms related to autonomic manifestations in FM group. Four in six patients presented significant improvement in health related quality of life
evaluated by SF-36. These results suggest that FM belong to the group of sympathetically maintained pain syndromes. The study demonstrates that FM and SLE patients have cardiovascular autonomic function alterations which can
be detected by simple, standardized, non-invasive and inexpensively methodology and that propranolol has a potential benefit in FM treatment.
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lupus eritematoso sistêmico , fibromialgia , dor , adrenalina , noradrenalina , disautonomia , beta-bloqueadores adrenérgicos. , systemic lupus erythematosus , fibromyalgia , pain , norepinephrine , epinephrine , dysautonomia , adrenergic beta-blockers. , 1. Disautonomia 2. Fibromialgia 3. Lupus eritematoso sistêmico 4. Beta bloqueadores adrenérgicos
Citação
JACOMINI, Luiza Cristina Lacerda. Systemic lupus erythematosus, fibromyalgia, norepinephrine, epinephrine, dysautonomia, adrenergic beta-blockers.. 2010. 171 f. Tese (Doutorado em Ciencias da Saude) - Universidade Federal de Goiás, Goiânia, 2010.