DANIEL CIAMPI ARAUJO DE ANDRADE

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LIM/62 - Laboratório de Fisiopatologia Cirúrgica, Hospital das Clínicas, Faculdade de Medicina - Líder

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Autor e Coautores FMUSP-HC Normalizados: LIN TCHIA YENG ×

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  • article 40 Citação(ões) na Scopus
    Thoracic sympathetic block for the treatment of complex regional pain syndrome type I: A double-blind randomized controlled study
    (2014) ROCHA, Roberto de Oliveira; TEIXEIRA, Manoel Jacobsen; YENG, Lin Tchia; CANTARA, Mirlene Gardin; FARIA, Viviane Gentil; LIGGIERI, Victor; LODUCA, Adrianna; MUELLER, Barbara Maria; SOUZA, Andrea C. M. S.; ANDRADE, Daniel Ciampi de
    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.
  • article 5 Citação(ões) na Scopus
    Sifting the wheat from the chaff? Evidence for the existence of an asymmetric fibromyalgia phenotype
    (2020) KAZIYAMA, Helena H.; BARBOUR, Julio; GALHARDONI, Ricardo; SILVA, Valquiria Aparecida da; SIQUEIRA, Silvia R. D. Tesseroli de; LISTIK, Clarice; SANTOS, Gabriel Jose dos; YENG, Lin T.; MARCOLIN, Marco Antonio; RAICHER, Irina; TEIXEIRA, Manoel J.; ANDRADE, Daniel Ciampi de
    Background The different phenotypic presentations of fibromyalgia (FM) have been infrequently studied and may have diagnostic and therapeutic implications. The aim of this study was to explore differences between FM patients with classical symmetric (s-FM) presentation and FM patients with marked asymmetric (a-FM) pain. Methods We performed two consecutive cross-sectional studies on FM patients and matched healthy volunteers (HV). FM patients were divided into a-FM (and s-FM groups according to their score of pain intensity on each body side; patients with a difference of >= 40 mm in VAS between left and right sides were classified as a-FM, otherwise classified as s-FM. Participants (FM = 32; HV = 31) were assessed for clinical, cortical excitability (CE), quantitative sensory testing (QST; study 1), and intraepidermal nerve fibre density (IENFD) determinations (study 2). Results While pain intensity did not significantly differ between s-FM and a-FM patients, pain interference in daily activities was significantly higher in the a-FM as compared to the s-FM group (54.7 +/- 8.9 and 37.6 +/- 13.5;p < .0001). PPT was significantly lower in the more painful side of a-FM as compared to the HV (27.7 +/- 7.9 and 49.9 +/- 13.0;p < .0001), while PPT in the less painful side of a-FM was significantly higher than PPT values in the s-FM (35.8 +/- 8.3 and 27.7 +/- 5.5;p = .031). S-FM and a-FM had significantly abnormal intracortical inhibition values on CE measurements compared to HV. There were no significant differences in IENFD between groups. Conclusions Within the current FM criteria, there exist different phenotypes with clinical, psychophysics, and neurophysiological findings that are not related to peripheral IENFD abnormalities. Significance Current fibromyalgia criteria may contain different phenotypes of fibromyalgia based on the lateralization of pain.
  • article 2 Citação(ões) na Scopus
    Corticomotor excitability is altered in central neuropathic pain compared with non-neuropathic pain or pain-free patients
    (2023) BARBOSA, Luciana Mendonca; VALERIO, Fernanda; SILVA, Valquiria Aparecida da; RODRIGUES, Antonia Lilian de Lima; GALHARDONI, Ricardo; YENG, Lin Tchia; JUNIR, Jefferson Rosi; CONFORTO, Adriana Bastos; LUCATO, Leandro Tavares; TEIXEIRA, Manoel Jacobsen; ANDRADE, Daniel Ciampi de
    Objectives: Central neuropathic pain (CNP) is associated with altered corticomotor excitability (CE), which can potentially provide insights into its mechanisms. The objective of this study is to describe the CE changes that are specifically related to CNP.Methods: We evaluated CNP associated with brain injury after stroke or spinal cord injury (SCI) due to neuromyelitis optica through a battery of CE measurements and comprehensive pain, neurological, functional, and quality of life assessments. CNP was compared to two groups of patients with the same disease: i. with non-neuropathic pain and ii. without chronic pain, matched by sex and lesion location.Results: We included 163 patients (stroke=93; SCI=70: 74 had CNP, 43 had non-neuropathic pain, and 46 were pain-free). Stroke patients with CNP had lower motor evoked potential (MEP) in both affected and unaffected hemispheres compared to non-neuropathic pain and no-pain patients. Patients with CNP had lower amplitudes of MEPs (366 mu V +/- 464 mu V) than non-neuro-pathic (478 +/- 489) and no-pain (765 mu V +/- 880 mu V) patients, p < 0.001. Short-interval intracorti-cal inhibition (SICI) was defective (less inhibited) in patients with CNP (2.6 +/- 11.6) compared to no-pain (0.80.7), p = 0.021. MEPs negatively correlated with mechanical and cold-induced allo-dynia. Furthermore, classifying patients' results according to normative data revealed that at least 75% of patients had abnormalities in some CE parameters and confirmed MEP findings based on group analyses.Discussion: CNP is associated with decreased MEPs and SICI compared to non-neuropathic pain and no-pain patients. Corticomotor excitability changes may be helpful as neurophysiological markers of the development and persistence of pain after CNS injury, as they are likely to pro-vide insights into global CE plasticity changes occurring after CNS lesions associated with CNP.(c) 2023 The Author(s).
  • article 26 Citação(ões) na Scopus
    The assessment and management of pain in the demented and non-demented elderly patient
    (2011) ANDRADE, Daniel Ciampi de; FARIA, Jose Weber Vieira de; CARAMELLI, Paulo; ALVARENGA, Luciana; GALHARDONI, Ricardo; SIQUEIRA, Silvia R. D.; YENG, Lin T.; TEIXEIRA, Manoel Jacobsen
    Persistent pain is a frequent health problem in the elderly. Its prevalence ranges from 45% to 80%. Chronic diseases, such as depression, cardiovascular disease, cancer and osteoporosis have a higher prevalence in aged individuals and increase the risk of developing chronic pain. The presence of pain is known to be associated with sleep disorders in these patients, as well as functional impairment, decreased sociability and greater use of the health system, with consequent increase in costs. Alzheimer's disease patients seem to have a normal pain discriminative capacity and they may probably have weaker emotional and affective experience of pain when compared to other types of dementia. Many patients have language deficits and thus cannot properly describe its characteristics. In more advanced cases, it becomes even difficult to determine whether pain is present or not. Therefore, the evaluation of these patients should be performed in a systematic way. There are three ways to measure the presence of pain: by direct questioning (self-report), by direct behavioral observation and by interviews with caregivers or informants. In recent years, many pain scales and questionnaires have been published and validated specifically for the elderly population. Some are specific to patients with cognitive decline, allowing pain evaluation to be conducted in a structured and reproducible way. The next step is to determine the type of painful syndrome and discuss the bases of the pharmacological management, the use of multiple medications and the presence of comorbidities demand the use of smaller doses and impose contra-indications against some drug classes. A multiprofessional approach is the rule in the management of these patients.
  • article 73 Citação(ões) na Scopus
    Insular and anterior cingulate cortex deep stimulation for central neuropathic pain Disassembling the percept of pain
    (2019) GALHARDONI, Ricardo Geront; SILVA, Valquiria Aparecida da; GARCIA-LARREA, Luis; DALE, Camila; BAPTISTA, Abrahao F.; BARBOSA, Luciana Mendonca; MENEZES, Luciana Mendes Bahia; SIQUEIRA, Silvia R. D. T. de; VALERIO, Fernanda; ROSI JR., Jefferson; RODRIGUES, Antonia Lilian de Lima; FERNANDES, Diego Toledo Reis Mendes; SELINGARDI, Priscila Mara Lorencini; MARCOLIN, Marco Antonio; DURAN, Fabio Luis de Souza; ONO, Carla Rachel; LUCATO, Leandro Tavares; FERNANDES, Ana Mercia B. L.; SILVA, Fabio E. F. da; YENG, Lin T.; BRUNONI, Andre R.; BUCHPIGUEL, Carlos A.; TEIXEIRA, Manoel J.; ANDRADE, Daniel Ciampi de
    Objective To compare the analgesic effects of stimulation of the anterior cingulate cortex (ACC) or the posterior superior insula (PSI) against sham deep (d) repetitive (r) transcranial magnetic stimulation (TMS) in patients with central neuropathic pain (CNP) after stroke or spinal cord injury in a randomized, double-blinded, sham-controlled, 3-arm parallel study. Methods Participants were randomly allocated into the active PSI-rTMS, ACC-rTMS, sham-PSI-rTMS, or sham-ACC-rTMS arms. Stimulations were performed for 12 weeks, and a comprehensive clinical and pain assessment, psychophysics, and cortical excitability measurements were performed at baseline and during treatment. The main outcome of the study was pain intensity (numeric rating scale [NRS]) after the last stimulation session. Results Ninety-eight patients (age 55.02 +/- 12.13 years) completed the study. NRS score was not significantly different between groups at the end of the study. Active rTMS treatments had no significant effects on pain interference with daily activities, pain dimensions, neuropathic pain symptoms, mood, medication use, cortical excitability measurements, or quality of life. Heat pain threshold was significantly increased after treatment in the PSI-dTMS group from baseline (1.58, 95% confidence interval [CI] 0.09-3.06]) compared to sham-dTMS (-1.02, 95% CI -2.10 to 0.04, p = 0.014), and ACC-dTMS caused a significant decrease in anxiety scores (-2.96, 95% CI -4.1 to -1.7]) compared to sham-dTMS (-0.78, 95% CI -1.9 to 0.3; p = 0.018). Conclusions ACC- and PSI-dTMS were not different from sham-dTMS for pain relief in CNP despite a significant antinociceptive effect after insular stimulation and anxiolytic effects of ACC-dTMS. These results showed that the different dimensions of pain can be modulated in humans noninvasively by directly stimulating deeper SNC cortical structures without necessarily affecting clinical pain per se.
  • article 102 Citação(ões) na Scopus
    Prevalence of chronic pain in developing countries: systematic review and meta-analysis
    (2019) SA, Katia Nunes; MOREIRA, Larissa; BAPTISTA, Abrahao Fontes; YENG, Lin Tchia; TEIXEIRA, Manoel Jacobsen; GALHARDONI, Ricardo; ANDRADE, Daniel Ciampi de
    Chronic pain (CP) is prevalent worldwide. Current reports on its prevalence in developing countries are heterogeneous, and to date, there is no quantitative synthesis providing a general estimation of its magnitude in the developing world. The goal of this study was to estimate the pooled prevalence of CP in the general population in developing countries. This was a PROSPERO-registered CRD42019118680 systematic review including population-based cross-sectional studies on CP from countries with <= 0.8 human developing index. We calculated prevalence using both random effects and fixed effects. Heterogeneity was calculated by the Cochran Q test and the I-2 statistic. Publication bias was evaluated by visual inspection of the Egger funnel plot, as well as by the Begg rank test and the Egger linear test. Sources of heterogeneity were also explored in subgroup analyses. Twelve studies with a total of 29,902 individuals were included in this meta-analysis, of which 7263 individuals were identified with CP. The overall pooled prevalence of CP after correction for publication bias was 18% (95% confidence interval: 10%-29%), the sample presenting significant heterogeneity (I2 = 100%, P < 0.001). Subgroup analyses demonstrated that year of publication and the adopted threshold for pain chronicity could partially explain the observed heterogeneity (P < 0.05). The proportion of individuals with CP in the general population of developing countries was 18%. However, reports of prevalence have high variability, especially related to year of publication and the threshold level adopted for pain chronicity.
  • article 15 Citação(ões) na Scopus
    Interdigital direct neurorrhaphy for treatment of painful neuroma due to finger amputation
    (2015) MARTINS, Roberto Sergio; SIQUEIRA, Mario Gilberto; HEISE, Carlos Otto; YENG, Lin Tchia; ANDRADE, Daniel Ciampi de; TEIXEIRA, Manoel Jacobsen
    Painful neuroma following amputation is a disabling condition for which treatments are not usually satisfactory. The aim of this study is to retrospectively evaluate the results of interdigital neurorrhaphy after neuroma resection as an option for the surgical treatment of painful digital neuroma. We retrospectively analyzed data from seven patients submitted to interdigital neurorrhaphy for treatment of digital neuroma. For evaluation of the results, the visual analog scale (VAS) for pain assessment, measurements with Simmens-Weinstein filaments and a handgrip dynamometer, and quantification of the Disabilities of the Arm, Shoulder and Hand (DASH) score were all performed. The mean improvements on the VAS and DASH scores were calculated. The mean follow-up was 28.3 months. All patients presented some degree of improvement in upper limb functionality and pain, and handling the affected finger was possible in all cases. The mean improvement on the VAS and DASH scores was 29.8 and 55.5 %, respectively. No patients presented long-term complications. Although this study was based on a small number of patients, it indicates that interdigital neurorrhaphy seems to be a feasible surgical treatment for painful digital neuroma.
  • article 15 Citação(ões) na Scopus
    Methadone in post-herpetic neuralgia: A pilot proof-of-concept study
    (2013) TEIXEIRA, Manoel J.; OKADA, Massako; MOSCOSO, Ana Sofia Cueva; PUERTA, Mariana Yumi Takahashi; YENG, Lin T.; GALHARDONI, Ricardo; TENGAN, Sergio; ANDRADE, Daniel Ciampi de
    OBJECTIVE: This research was designed as a pilot proof-of-concept study to evaluate the use of low-dose methadone in post-herpetic neuralgia patients who remained refractory after first and second line post-herpetic neuralgia treatments and had indications for adding an opioid agent to their current drug regimens. METHODS: This cross-over study was double blind and placebo controlled. Ten opioid naive post-herpetic neuralgia patients received either methadone (5 mg bid) or placebo for three weeks, followed by a 15-day washout period and a second three-week treatment with either methadone or placebo, accordingly. Clinical evaluations were performed four times (before and after each three-week treatment period). The evaluations included the visual analogue scale, verbal category scale, daily activities scale, McGill pain questionnaire, adverse events profile, and evoked pain assessment. All patients provided written informed consent before being included in the study. ClinicalTrials.gov: NCT01752699 RESULTS: Methadone, when compared to placebo, did not significantly affect the intensity of spontaneous pain, as measured by the visual analogue scale. The intensity of spontaneous pain was significantly decreased after the methadone treatment compared to placebo on the category verbal scale (50% improved after the methadone treatment, none after the placebo, p = 0.031). Evoked pain was reduced under methadone compared to placebo (50% improved after the methadone treatment, none after the placebo, p = 0.031). Allodynia reduction correlated with sleep improvement (r = 0.67, p = 0.030) during the methadone treatment. The side effects profile was similar between both treatments. CONCLUSIONS: Methadone seems to be safe and larger prospective studies.
  • article 16 Citação(ões) na Scopus
    Quality of Life After Motor Cortex Stimulation: Clinical Results and Systematic Review of the Literature
    (2019) PARRAVANO, Daniella C.; CIAMPI, Daniel A.; FONOFF, Erich T.; MONACO, Bernardo; NAVARRO, Jessie; YENG, Lin T.; TEIXEIRA, Manoel J.; HAMANI, Clement
    BACKGROUND: Motor cortex stimulation (MCS) is routinely used for the treatment of chronic neuropathic pain but its effect on quality of life remains uncertain. OBEJCTIVE: To systematically review the published literature on MCS and quality of life and report the effects of this therapy in a series of patients prospectively followed in our center. METHODS: The systematic literature review was conducted using the search words ""motor cortex stimulation and pain and neurosurgery"" and ""motor cortex stimulation and pain and quality of life."" Quality of life in our clinical trial was investigated in a series of 10 patients with chronic neuropathic pain prospectively followed for 12 mo after MCS. RESULTS: Two hundred eighteen nonreplicated articles were pooled for analysis. Of these, 6 described measures of quality of life in the pre- and postoperative period. In these studies, 64 patients with different clinical conditions associated with neuropathic pain were followed for 6 to 84 mo after MCS surgery. Improvement in quality of life ranged from 35% to 85%. In our clinical series, visual analog scale (VAS), SF-12 physical (PhysCS), and mental scores (MenCS) recorded 12 mo after MCS were improved by 60 +/- 10% (P = .002), 50 +/- 13% (P = .002), and 22 +/- 6% (P = .01), respectively. No significant correlation was found between postoperative improvement in pain and either PhysCS (r = 0.18; P = .6) or MenCS (r = -0.24; P = .5). CONCLUSION: MCS improves quality of life in patients with chronic refractory neuropathic pain. Additional factors other than a simple analgesic effect may contribute to these results.
  • article 111 Citação(ões) na Scopus
    Repetitive Transcranial Magnetic Stimulation in Chronic Pain: A Review of the Literature
    (2015) GALHARDONI, Ricardo; CORREIA, Guilherme S.; ARAUJO, Haniel; YENG, Lin T.; FERNANDES, Diego T.; KAZIYAMA, Helena H.; MARCOLIN, Marco A.; BOUHASSIRA, Didier; TEIXEIRA, Manoel Jacobsen; ANDRADE, Daniel Ciampi de
    Objective: To review the literature on the analgesic effects of repetitive transcranial magnetic stimulation (rTMS) in chronic pain according to different pain syndromes and stimulation parameters. Data Sources: Publications on rTMS and chronic pain were searched in PubMed and Google Scholar using the following key words: chronic pain, analgesia, transcranial magnetic stimulation, neuropathic pain, fibromyalgia, and complex regional pain syndrome. Study Selection: This review only included double-blind, controlled studies with >10 participants in each arm that were published from 1996 to 2014 and written in English. Studies with relevant information for the understanding of the effects of rTMS were also cited. Data Extraction: The following data were retained: type of pain syndrome, type of study, coil type, target, stimulation intensity, frequency, number of pulses, orientation of induced current, number of session, and a brief summary of intervention outcomes. Data Synthesis: A total of 33 randomized trials were found. Many studies reported significant pain relief by rTMS, especially high-frequency stimulation over the primary motor cortex performed in consecutive treatment sessions. Pain relief was frequently >30% compared with control treatment. Neuropathic pain, fibromyalgia, and complex regional pain syndrome were the pain syndromes more frequently studied. However, among all published studies, only a few performed repetitive sessions of rTMS. Conclusions: rTMS has potential utility in the management of chronic pain; however, studies using maintenance sessions of rTMS and assessing the effects of rTMS on the different aspects of chronic pain are needed to provide a more solid basis for its clinical application for pain relief. (C) 2015 by the American Congress of Rehabilitation Medicine