Cannabis Therapy in the Management of Fibromyalgia: A Systematic Review

Introduction: Fibromyalgia is a painful syndrome of little known etiology, characterized by generalized pain with difficult management. Thus, cannabis therapy, a therapeutic option for other painful conditions, becomes an alternative. Objective: To review the literature on cannabis therapy in the treatment of fibromyalgia. Design and Setting: A systematic review conducted at the Pontifical Catholic University of Goiás. Methods: Systematic review. Randomized studies and clinical trials published between 01/2011 and 01/2021 were selected. Incomplete studies and those that did not fit the objectives were excluded. Results: When analyzing the combination of inhaled CBD and THC, it was concluded that, regardless of the dosage, neither showed significantly greater response than placebo. Studies pointed out that THC-rich cannabis oil, at starting dose of one drop a day, reduced pain, fatigue, and depression scores; moreover, the therapy proved tolerated and without serious adverse effects. Third-level evidence indicated better effects of nabilone on sleep than amitriptyline, without significant differences for pain, mood, and life quality. Conclusion: Different approaches to cannabis therapy for patients with fibromyalgia lead to diverse effects, with some not proving effective and others promoting pain reduction, sleep and life qualities improvements and satisfactory effects on depression and fatigue scores. Hence, scientifically relevant studies should be done on this subject.

Analysis of care in neurosurgery outpatient clinic in Paraíba

Background: Currently the public health system encompasses numerous demands, including in the neurology and neurosurgery sector. The wide outpatient search shows several symptoms, with pain being one of the most prominent. Objectives: To analyze the consultations performed in a neurosurgery clinic, aiming to understand the main demands found at secondary health care. Design and setting: Retrospective and descriptive study, conducted through the analysis of data from a neurosurgery outpatient clinic in the state of Paraíba Methods: Conducted through the analysis of data from 73 patients relative to a neurosurgery outpatient clinic, during the period between 11/24/2020 and 12/15/2020. The variables were: gender, age and diagnostic suspicion. Results: A predominance of females was found (65.7%) and, among all patients, the youngest patient was 8 years old and the oldest was 83 years old. Among the patients, it was possible to observe an important presence of Headache (28.7%), followed by Back Pain (17.7%) and Psychiatric disorders (6.9%), the other patients presented several diagnoses, such as Cerebellar Syndrome (1.37%) and Neoplasms (5.5%). There was found male predominance in Sequelae of Stroke, Parkinson’s Disease, Spinal Pathologies, Autism, Brachial Plexus Injury, Carpal Tunnel Syndrome and Complex Painful Syndrome. Furthermore, it was noted equivalence of occurrence in both sexes of Neuropathic Pain, Convulsion, Post- Herpetic Neuralgia and Trigeminal Neuralgia. Conclusion: The search for regional standards and their comparison to the world scenario is important to assist in clinical diagnosis, besides helping in the allocation of resources and studies.

18F-FDG brain PET metabolism in post-SARS-CoV-2 infection: substrate for persistent/delayed disorders?

Purpose: Several brain complications of SARS-CoV-2 infection have been reported. It has been moreover speculated that this neurotropism could potentially cause a delayed outbreak of neuropsychiatric and neurodegenerative diseases of neuroinflammatory origin. A propagation mechanism has been proposed across the cribriform plate of the ethmoid bone, from the nose to the olfactory epithelium, and possibly afterwards to other limbic structures, and deeper parts of the brain including the brainstem. Methods: Review of clinical examination, and whole-brain voxel-based analysis of 18F-FDG PET metabolism in comparison to healthy subjects (p-voxel<0.001, p-cluster<0.05), of two patients with confirmed diagnosis of SARS-CoV-2 pneumonia explored at the post-viral stage of the disease.Results: Hypometabolism of the olfactory/rectus gyrus was found on the two patients, especially one with 4 weeks prolonged anosmia. Additional hypometabolisms were found within bilateral amygdala, hippocampus, cingulate cortex, thalamus, pons and medulla brainstem in the other patient who complained of delayed onset of an atypical painful syndrome.Conclusion: These preliminary findings reinforce the hypotheses of SARS-CoV-2 neurotropism through the olfactory bulb, and the possible extension of this impairment to other limbic structures and to the brainstem. 18F-FDG PET hypometabolism could constitute a cerebral quantitative biomarker of this involvement. Post-viral cohort studies are required to specify the exact relationship between limbic/brainstem hypometabolisms and the possible persistent disorders, especially involving cognitive or emotion disturbances, residual respiratory symptoms or painful complaints.

Botulinum Neurotoxin A Intravesical Injections in Interstitial Cystitis/Bladder Painful Syndrome: A Systematic Review with Meta-Analysis

Botulinum neurotoxin A (BoNT/A) appears to be one of the best intravesical treatments for interstitial cystitis/bladder painful syndrome (IC/BPS). We aimed to point out what the evidence is regarding the effects of BoNT/A intravesically injected in patients with IC/BPS. We performed a systematic review of all randomized controlled trials (RCTs) assessing BoNT/A for IC/BPS by using Medline, EMBASE, CINAHL, CENTRAL and MetaRegister of Controlled Trials. Standardized mean differences (SMD) were extracted from the available trials and combined in a meta-analysis applying a random effect model, including heterogeneity of effects. Twelve trials were identified. Significant benefits from BoNT/A injections were detected in: Interstitial Cystitis Symptom Index and Problem Index (ICSI, ICPI) (small to medium effect size: SMD = –0.302; p = 0.007 and –0.430, p = 0.004, respectively); Visual Analog Scale (VAS) for pain and day-time urinary frequency (medium effect size: SMD = –0.576, p < 0.0001 and –0.546, p = 0.013, respectively). A great effect size was detected for post-void residual volume (PVR, SMD = 0.728; p =0.002) although no clinically relevant in most cases. Great heterogeneity was observed in treatments’ methodologies and symptoms assessment. Overall, BoNT/A intravesical injections significantly improve some of the most relevant symptoms affecting IC/BPS patients.