Physiologie de la douleur et de l’hyperalgésie ou de la nociception à la contagion émotionnelle de la douleur

The intensity of a pain does not simply reflect the severity of the injury that caused it, but also depends very much on the individual’s history. Therefore, clinical pain is also largely the expression of neural plasticity associated with peripheral and central sensitization leading to hyperalgesia, allodynia and persistent, spontaneous pain.Although opioids are recognized as unsurpassed analgesics for moderate to severe pain, for more than a century, experimental and clinical studies have reported that the administration of exogenous opioids not only produces analgesia but also induces long-term hypersensitivity to pain, in the form of prolonged hyperalgesia after an injury which is capable of facilitating the development of chronic pain. Like exogenous opioids, endogenous opioids released during situations of stress induce a latent hypersensitivity to pain that may emerge in the form of more severe pain on subsequent injuries. The hypersensitivity to pain induced by opioids is associated with a more general hypersensitivity affecting the emotional sphere, for example in terms of anxiety.The consequences of hypersensitivity to pain cannot be managed using analgesics alone but require specific antisensitisation strategies, such as NMDA receptor antagonists, nitrous oxide, nefopam and nutrition low in polyamines.     

Beneficios de la sutura continua de la lesión perineal en la adaptación a la maternidad

ObjectiveTo assess the effect of the continuous suture technique of the perineal wound on the capacity and functional recovery of women when carrying out their self-care routine, the care of the newborn (NB), breastfeeding (BF) and Activities of Daily Living (ADLs), both basic (ABVD) and instrumental (IADL), during the postpartum period.MethodsNon-randomised clinical trial with blinding allocation to study groups, carried out at the Arnau de Vilanova tertiary hospital in Lérida. The intervention group received continuous suture for perineal repair and the control group discontinuous suture. The study population was women with eutocic delivery and second-degree perineal tears or episiotomy. Three postpartum assessment were performed (48 hours, 7-10 days and one month).Results126 women with eutocic delivery and second degree perineal tears or episiotomy participated (n = 126); 64 sutured with continuous technique (intervention group) and 62 with discontinuous technique (control group). At 48 hours postpartum, 85% of women from the continuous suture technique group were able to perform their self-care and 46,7% of them had recovered functionally. At 7-10 days, 96,7% of women with continuous suturing had acquired the ability to perform instrumental activities of daily living and 60% had recovered functionally compared to 68,3% and 15% respectively of women with discontinuous suturing (P<.001). At 7-10 days, 100% of women with continuous suturing achieved functional recovery for newborn care and 80% for breastfeeding and in the control group 81,7% and 30% respectively (P<.001 and P<.001).ConclusionsWomen who undergo the continuous suture technique restore their ability and functional recovery to perform activities of daily living earlier and with less pain than women with discontinuous suturing, adapting more quickly and satisfactorily way to motherhood.     

Necesidades de la familia en las unidades de cuidados intensivos. Revisión de la literatura

Admission to the Intensive Care Units (ICU) is perceived by both patients and their family as a stressful experience. This situation can cause shock, skepticism and anxiety in the patient's setting.ObjectiveTo analyze and present the needs of the family members of the critical patient.MethodologyA review was made of the literature in the following data bases: Pubmed, CINAHL, Cuiden and Cochrane Library. Furthermore, three journals specialized in Intensive Cares were reviewed.ResultsAfter including the articles that met the screening criteria, 30 articles were finally selected. Of these, 11 were reviews of the literature, 7 qualitative studies and 12 more were quantitative investigations. Four groups of needs in the families were identified after the analysis of these articles, these being cognitive, emotional, social and practical.DiscussionOne of the main needs of the family is to receive better information from the professionals followed by the need for closeness with the ill family member. This review proposes that, in order to cover these needs, the information should be protocolized and the visiting hours should be made flexible. Furthermore, incorporation of two familial evaluation tools, the genogram and ecomap, is proposed.ConclusionsThis work has revealed the importance of having the Intensive Care nurses identify the needs of the family during the admission of the patient in the ICU in order to be able to provide help, support and counseling care that relieves the suffering of the families.     

Les récepteurs des protons et de la capsa?cine: Contribution à la physiologie et la physiopathologie de la douleur

Les structures moléculaires de deux canaux ioniques activés par des ligands et présents dans les terminaisons nerveuses sensorielles nociceptives, le récepteur des protons ASIC et le récepteur de la capsaicine VR1, ont été récemment élucidées. Les canaux ASIC sont des canaux cationiques plut?t sélectifs pour le Na⁺ qui sont activés directement par une diminution du pH extracellulaire. Ils appartiennent à la superfamille des canaux Na⁺ sensibles à l’amiloride. Ils sont formés de plusieurs sous-unités homologues dont certaines sont aussi présentes dans le système nerveux central et qui peuvent s’assembler en homo- ou en hétéro-multiméres. Une combinaison particulière spécifique des neurones sensoriels (ASIC2b et ASIC3) a des propriétés proches de celles du cannal natif qui a été impliqué dans la perception de la douleur associée à une acidose tissulaire. VR1 est un canal cationique non sélectif très perméable au Ca²⁺ qui possède une structure différente de celle des canaux ASIC mais semblable à celle des canaux activés par la déplétion des stocks intracellulaires de Ca²⁺ VR1 est spécifiquement exprimé dans les neurones sensoriels et il est activé directement par les vanilliques comme la capsaicine. Il est surtout activé par la chaleur dans une gamme de températures douloureuses (à partir de 43°C). Ce seuil est considérablement abaissé par une diminution du pH extracellulaire et VR1 peut être activé à des températures physiologiques dans certaines conditions d’acidose. L’obtention de ces nouveaux outils moléculaires devrait permettre de mieux comprendre les mécanismes de la douleur associés à ces deux récepteurs et d’envisager le développement de nouveaux analgésiques capables de moduler leur activité.