Alta prevalência de dor neuropática em sujeitos com lesão traumática do plexo braquial: um estudo de corte transversal

Nós incluímos 65 indivíduos com lesão traumática do plexo braquial. O Douleur Neuropathique 4 foi usado para classificar a dor e o SF-36 foi usado para avaliar a qualidade de vida.

Resultados

Sujeitos com lesão traumática do plexo braquial eram em sua maioria homens jovens, vítimas de acidentes motociclísticos. A dor esteve presete em 75.4% dos indivíduos e 79% deles apresentaram dor neuropática, mais frequentemente localizada nas mãos (30.41%). O uso de dispositivos auxiliares (p = 0.05) e o estado civil foram, ambos, preditores independentes de dor. A dor ainda impactou negativamente da qualidade de vida (p = 0.001).

Conclusões

A dor é frequente em sujeitos com lesão traumática do plexo braquial. Apesar de envolver uma lesão do sistema nervoso a dor nociceptiva não é infrequente. A avaliação da dor, incluindo instrumentos validados, é essencial para direcionar as condutas clínicas de sujeitos com esta condição.

plexo braquial; dor nociceptiva; dor; traumatismos dos nervos periféricos

Variables	n (% Mean/SD)
Gender
Male	58 (89,2)
Age	30 ± 11
Marital status
Single	37 (57.8)
Married/ Divorced	27(42.2)
Educational degree
≤ 6 years of study	2 (3.1)
≤ 7 years of study	9 (14.1)
≤ 11 years of study	14 (21.9)
≤ 14 years of study	36 (56.2)
≤ 19 years of study	3 (4.7)
Occupation
No occupation/ Retired/ Unemployed	10 (16.1)
Away from work	44 (71)
Employed	8 (12.9)
Social class
Middle class	45 (69.2)
Lower class	20 (30.8)
Pain
No	16 (24.6)
Yes	49 (75.4)
Type of pain
Neuropathic pain	38 (79.2)
Nociceptive pain	10 (20.8)
Pain intensity (VAS)	46 (33)
Duration of pain (weeks)	58 (92)
Number of pain sites
One site	13 (26.5)
Two sites	12 (24.5)
Three sites	14 (28.6)
Four sites	8 (16.3)
Five sites	1 (2)

Variables	OR* Not adjusted (IC95%)	p	OR* Adjusted (IC95%)	p
Age	1.02 (0.96–1.08)	0.507
Marital status
Single	1.00	-	1.00	-
Married/divorced	4.33 (1.09–17.17)	0.037	4.75 (1.12–20.22)	0.035
Educational degree
High school or college	1.00	-	-	-
Complete basic education	1.44 (0.34–6.17)	0.623	-	-
Incomplete basic education	1.77 (0.33–9.52)	0.507	-	-
Occupation
Employed	1.00	-	-	-
No occupation/retired/unemployed	2.40 (0.29–19.78)	0.419	-	-
Away from work	1.80 (0.37–8.79)	0.468	-	-
Race
Non white	1.00	-	-	-
White	1.00 (0.24–4.26)	1.000	-	-
Auxiliary devices
Neither	1.00	-	1.00	-
Sling or sling associated with other auxiliary devices*	4.61 (1.13–18.92)	0.034	4.32 (1.00–18.69)	0.051
Others	1.15 (0.27–4.87)	0.854	0.89 (0.19–4.22)	0.893
Level of injury
Complete injury	1.00	-	-	-
Incomplete injury	1.56 (0.25–9.65)	0.631	-	-
Social class
Middle class	1.00	-	-	-
Lower class	1.46 (0.41–5.23)	0.566	-	-
Physiotherapy or occupational therapy*
Yes	1.00	-	-	-
No	5.42 (0.65–45.18)	0.119	-	-

Variables	VAS* major pain			Total	G2	p

	Low intensity	Moderate intensity	High intensity
Frequency of physiotherapy	5 (33.3)	8 (53.3)	2 (13.3)	15 (25.4)	6.527	-
Absent	5 (33.3)	8 (53.3)	2 (13.3)	15 (25.4)	6.527	0.163
1-3 times/week	11 (39.3)	6 (21.4)	11 (39.3)	28 (47.5)	-	-
> 3 times	8 (50.0)	5 (31.3)	3 (18.8)	16 (27.1)	-	-
Total	24 (40.7)	19 (32.2)	16 (27.1)	59 (100)	--
Auxiliary devices
Neither	10 (55.6)	2 (11.1)	6 (33.3)	18 (28.1)	9.272	0.055
Sling or sling associated with other auxiliary devices**	8 (24.2)	16 (48.5)	9 (27.3)	33 (51.6)	-	-
Others	6 (46.2)	4 (30.8)	3 (23.1)	13 (20.3)	-	-
Total	24 (37.5)	22 (34.4)	18 (28.1)	64 (100)	-	-
Level of injury
Complete injury	7 (33.3)	7 (33.3)	7 (33.3)	21 (63.6)	2.102	0.350
Incomplete injury	2 (16.7)	7 (58.3)	3 (25.0)	12 (36.4)	-	-
Total	9 (27.3)	14 (42.4)	10 (30.3)	33 (100)	-	-
Surgical procedure
Neurotization	7 (58.3)	3 (25.0)	2 (16.7)	12 (31.6)	10.470	0.234
Grafting	0 (0.0)	1 (100)	0 (0.0)	1 (2.6)	-	-
Neurotization and grafting	2 (15.4)	5 (38.5)	6 (46.2)	13 (34.2)	-	-
No surgery	5 (45.5)	4 (36.4)	2 (18.2)	11 (28.9)	-	-
Neurolysis and neurotization	0 (0.0)	1 (100)	0 (0.0)	1 (2.6)	-	-
Total	14 (36.8)	14 (36.8)	10 (26.3)	38 (100)	-	-

Variables	DN4		Total	G2	p

	Nociceptive	Neurophatic
Frequency of physiotherapy (weeks)
Absent	5 (50.0)	9 (25.7)	14 (31.1)	7.524	0.023*
1-3 times	5 (50.0)	14 (40.0)	19 (42.2)	-	-
> 3 times	0 (0.0)	12 (34.3)	12 (26.7)	-	-
Total	10 (22.2)	35 (77.8)	45 (100)	-	-
Auxiliary devices
Neither	2 (20.0)	10 (25.0)	12 (24.0)	0.602	0.740
Sling + Sling and other auxiliary devices	7 (70.0)	23 (57.5)	30 (60.0)	-	-
Others	1 (10.0)	7 (17.5)	8 (16.0)	-	-
Total	10 (20.0)	40 (80.0)	50 (100)	-	-
Surgical procedure
Neurotization	2 (33.3)	4 (16.0)	6 (19.4)	5.160	0.271
Grafting	1 (16.7)	0 (0.0)	1 (3.2)	-	-
Neurotization and grafting	2 (33.3)	11 (44.0)	13 (41.9)	-	-
No surgery	1 (16.7)	9 (36.0)	10 (32.3)	-	-
Neurolysis and neurotization	0 (0.0)	1 (4.0)	1 (3.2)	-	-
Total	6 (19.4)	25 (80.6)	-100	-	-

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[1] Correspondence: Marcus V. B. Santana; Universidade Federal da Bahia, Instituto de Ciências da Saúde; Av. Reitor Miguel Calmon, s/n / sala 306; 40110-902 Salvador BA, Brasil; E-mail: marcusba@hotmail.com