Beruflich Dokumente
Kultur Dokumente
Professor de Neurologia da Faculdade de Medicina do ABC e pesquisador pelo Instituto Israelita de Ensino e Pesquisa Albert Einstein, Instituto do Crebro.
Geriatra graduada pela Faculdade de Medicina da Universidade de So Paulo (FMUSP) e coordenadora do Grupo de Estudos da Dor e Cuidados Paliativos do Hospital Israelita Albert Einstein.
Doutora em Tecnologias Energticas Nucleares pela Universidade Federal de Pernambuco (UFPE) e pesquisadora pelo Instituto Israelita de Ensino e Pesquisa Albert Einstein, Instituto do Crebro.
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Doutor em Neurocincias pela Universidade Federal de So Paulo (Unifesp) e pesquisador pelo Instituto Israelita de Ensino e Pesquisa Albert Einstein, Instituto do Crebro.
Resumo
Contexto: Dor um dos sintomas fsicos mais freqentemente relatados por pacientes, causando importante reduo
na qualidade de vida do indivduo. Pacientes com dor crnica so difceis de tratar. Objetivo: Descrever estratgias
atuais de abordagem de pacientes com dores crnicas, baseadas na literatura cientca, enfatizando medidas relacionadas espiritualidade e religiosidade. Mtodo: A presente reviso utilizou-se das atuais estratgias de manejo
para pacientes com dor crnica combinadas a medidas medicamentosas e no-medicamentosas, estas geralmente
incorporando medidas voltadas ao bem-estar fsico, mental, social e espiritual com base em publicaes indexadas pelo
Medline. Resultados: Muitos estudos demonstram associao positiva entre espiritualidade e religiosidade e melhora
em variveis e marcadores de doenas crnicas. Concluso: Pelo fato de a religiosidade e a espiritualidade serem
marcadamente relacionadas com a melhora clnica dos pacientes, importante que o reconhecimento desses aspectos
e a integrao no manejo dos pacientes com dor crnica sejam conduzidos por prossionais da rea de sade.
Peres, M.F.P. et al. / Rev. Psiq. Cln. 34, supl 1; 82-87, 2007
Palavras-chave: Dor crnica, manejo, cefalias, espiritualidade.
Abstract
Background: Pain is one of the most common physical complaints which negatively affects the patients quality of
life. Patients with chronic pain are difcult and often frustrating to treat. Objective: To describe the current strategies
for approaching patients with chronic pain based on scientic literature, emphasizing measures related to spirituality
and religiosity. Method: For the present work, authors reviewed data supporting the application of clinical procedures regarding to chronic pain and palliative care with the importance of spirituality background incorporation based
on indexed Medline data. Results: Many studies have demonstrated a positive association between spirituality and
religiosity and improvement of chronic diseases variables and markers. Conclusion: As religiosity and spirituality
are notoriously related to the patients clinical improvement, it is highly important that the recognition of these aspects
and their incorporation in the management of patients with chronic pain be conducted by health professionals.
Peres, M.F.P. et al. / Rev. Psiq. Cln. 34, supl 1; 82-87, 2007
Key-words: Chronic pain, management, headache, spirituality.
Endereo para correspondncia: Mario F. P. Peres. Al. Joaquim Eugenio de Lima, 881, cj. 708 01403-001 So Paulo, SP. Fone: (11) 3285-5726. E-mail: marioperes@yahoo.com
Peres, M.F.P. et al. / Rev. Psiq. Cln. 34, supl 1; 82-87, 2007
Introduo
Discusso
83
84
Peres, M.F.P. et al. / Rev. Psiq. Cln. 34, supl 1; 82-87, 2007
Sofrimento
No centro do estresse espiritual de morrer est o sofrimento individual. George Eliot comenta: Profundo e
indescritvel sofrimento pode bem ser chamado de um
batismo, uma regenerao, uma iniciao de um novo
estado de ser (Steensma, 2003). Torna-se importante
avaliar o estresse espiritual de morrer para entender
mais profundamente o sofrimento humano. Eric Cassel
dene o sofrimento como um estado de estresse grave
Peres, M.F.P. et al. / Rev. Psiq. Cln. 34, supl 1; 82-87, 2007
Espiritualidade e dor
Se estudos mostram que as medidas de religiosidade e
espiritualidade se comportam como fatores preditivos de
bem-estar e suporte social em outras doenas crnicas,
potencialmente isso deve ocorrer tambm no mbito do
controle da dor (Sinclair et al., 2006; Harrison et al., 2005;
Cooper-Effa et al., 2001; Koenig, 2001; Brand, 1995).
Apesar disso, no so muitos os estudos que avaliam
a inuncia da religiosidade e da espiritualidade em
pacientes com dor.
Espiritualidade pode ser denida como aquilo que
traz signicado e propsito vida das pessoas. Essa denio utilizada como base em cursos mdicos sobre
espiritualidade e sade. A espiritualidade reconhecida
como um fator que contribui para a sade e a qualidade
de vida de muitas pessoas. Esse conceito encontrado
em todas as culturas e sociedades. expressa como uma
busca individual mediante a participao de grupos religiosos que possuem algo em comum, como f em Deus,
naturalismo, humanismo, famlia e arte (Puchalski,
1999). Um dos primeiros estudos em pacientes com dor
por crises de falcizao na anemia falciforme mostrou
que os pacientes com nveis mais altos de religiosidade
apresentaram um senso de controle maior da dor, mas
no de sua intensidade (Banks, 2006).
Harrison et al. (2005), ao avaliarem 50 pacientes
americanos com anemia falciforme, demonstraram que
freqncia igreja mais de uma vez por semana implica
85
86
Peres, M.F.P. et al. / Rev. Psiq. Cln. 34, supl 1; 82-87, 2007
Concluso
muito importante para a melhora na qualidade de vida
de pacientes com dor crnica integrar aspectos da espiritualidade, f e religiosidade com seu atendimento em
diversos aspectos. Futuras pesquisas na rea so necessrias para se denir o exato papel da religiosidade e/ou
espiritualidade na prevalncia, impacto e tratamento de
pacientes com dor. Novos avanos devem decorrer do
aprofundamento dessas investigaes clnico-cientcas
e da aplicao da espiritualidade na prtica mdica, em
especial no manejo daqueles com dor crnica.
Referncias
Abbot, N.C.; Harkness, E.F.; Stevinson C.; Marshall, F.P.; Conn, D.A.; Ernst, E.
- Spiritual healing as a therapy for chronic pain: a randomized, clinical
trial. Pain 91:79-89, 2001.
Ameling, A. Prayer: an ancient healing practice becomes new again. Holist
Nurs Pract 14:40-48, 2000.
Anaya, C.J. - Religion and health. Mayo Clin Proc 77:600-601, 2002.
Banks, J.W. - The importance of incorporating faith and spirituality issues in
the care of patients with chronic daily headache. Curr Pain Headache
Rep 10(1):41-46, 2006.
Barnard, D.; Dayringer, R.; Cassel, C.K. - Toward a person-centered medicine: religious studies in the medical curriculum. Acad Med 70(9):
806-813, 1995.
Brand, P. - Coping with a chronic disease: the role of the mind and spirit.
Patient Educ Couns 26(1-3):107-112, 1995.
Breen, J. - Transitions in the concept of chronic pain. Adv Nurs Sci 24:
48-59, 2002.
Byock, I. - Where do we go from here? A palliative care perspective. Crit
Care Med 34(11): 416-420, 2006.
Campbell, L.C.; Clauw, D.J.; Keefe, F.J. - Persistent pain and depression: a
biopsychosocial perspective. Biol Psychiatry 54:399-409, 2003.
Cassel, E.J. - The nature of suffering and the goals of medicine. N Engl J
Med. 1982 Mar 18;306(11):639-645.
Chibnall, J.T.; Brooks, C.A. - Religion in the clinic: the role of physician
beliefs. South Med J 94: 374-349, 2001.
Cooper-Effa, M.; Blount, W.; Kaslow, N.; Rothenberg, R.; Eckman, J. - Role
of spirituality in patients with sickle cell disease. J Am Board Fam
Pract 14:116-122, 2001.
Cowan, J.D.; Burns, D.; Palmer, T.W.; Scott, J.; Feeback, E. - A palliative
medicine program in a community setting: 12 points from the rst 12
months. Am J Hosp Palliat Care 20(6): 415-433, 2003.
Davis, P.J.; Reeves, J.L.; Graff-Radford, S.B.; Hastie, B.A.; Naliboff, B.D. - Multidimensional subgroups in migraine: differential treatment outcome to a
pain medicine program. Pain Med 4: 215-222, 2003.
Engel, G.L. - The clinical application of the biopsychosocial model. Am J
Psychiatry 137:535-544, 1980.
Peres, M.F.P. et al. / Rev. Psiq. Cln. 34, supl 1; 82-87, 2007
Fins, J.J.; Schwager Guest, R.; Acres, C.A. - Gaining insight into the care of
hospitalized dying patients: an interpretive narrative analysis. J Pain
Symptom Manage 20:399-407, 2000.
Harrison, M.O.; Edwards, C.L.; Koenig, H.G.; Bosworth, H.B.; DeCastro, L.;
Wood, M. - Religiosity/spirituality and pain in patients with sickle cell
disease. J Nerv Ment Dis 193:250-257, 2005.
Hatch, R.L.; Burg, M.A.; Naberhaus, D.S.; Hellmich, L.K. - The Spiritual
Involvement and Beliefs Scale. Development and testing of a new
instrument. J Fam Pract 46:476-86, 1998.
Hinshaw, D.B. - Spiritual issues in surgical palliative care. Surg Clin North
Am 85(2):257-272, 2005.
Hudson, T. - Measuring the results of faith. Hosp Health Netw 70:22-28, 1996.
Keefe, F.J.; Bonk, V. - Psychosocial assessment of pain in patients having
rheumatic diseases. Rheum Dis Clin North Am 25:81-103, 1999.
Kelly, B.; McClement, S.; Chochinov, H.M. - Measurement of psychological
distress in palliative care. Palliat Med 20(8):779-789, 2006.
Koenig, H.G. - Religion, spirituality, and medicine: how are they related and
what does it mean? Mayo Clin Proc 76:1189-1191, 2001.
Koenig, H.G. - Religion, spirituality, and medicine: research ndings and
implications for clinical practice. South Med J 97:1194-200, 2004.
Koenig, H.G.; Bearon, L.B.; Hover, M.; Travis, J.L. - Religious perspectives of
doctors, nurses, patients, and families. J Pastoral Care 45:254-267, 1991.
Koenig, H.G.; George, L.K.; Hays J.C.; Larson, D.B.; Cohen, H.J.; Blazer, D.G.
- The relationship between religious activities and blood pressure in
older adults. Int J Psychiatry Med 28:189-213, 1998.
Kraaimaat, F.W.; Van Dam-Baggen, R.M.; Bijlsma, J.W. - Association of
social support and the spouses reaction with psychological distress
in male and female patients with rheumatoid arthritis. J Rheumatol
22:644-648, 1995.
Larson, D.B.; Koenig, H.G. - Is God good for your health? The role of spirituality in medical care. Cleve Clin J Med 67(2):80, 83-84, 2000.
Lester, N.; Lefebvre, J.C.; Keefe, F.J. - Pain in young adults: relationships
of three pain-coping measures to pain and activity interference. Clin
J Pain 12:291-300, 1996.
Lukoff, D.; Lu, F.; Turner, R. - Towards a more culturally sensitive DSMIV: psychoreligious and psychospiritual problems. J Nerv Ment Dis
180(11):673-682, 1992.
Lukoff, D.; Lu, F.G.; Turner, R. - Cultural considerations in the assessment
and treatment of religious and spiritual problems. Psychiatr Clin N Am
18:467-485, 1995.
Marco, C.A.; Schears, R.M. - Death, dying and last wishes. Emerg Clin North
Am 24(4):969-987, 2006.
Marr, L.; Billings, J.A.; Weissman, D.E. - Spirituality training for palliative
care fellows. J Palliat Med 10(1):169-177, 2007.
McCallum, D.E.; Byrne, P.; Bruera, E. - How children die in hospital. J Pain
Symp Manag 20:417-423, 2000.
McWilliams, L.A.; Goodwin, R.D.; Cox, B.J. - Depression and anxiety associated with three pain conditions: results from a nationally representative
sample. Pain 111:77-83, 2004.
Moreira-Almeida, A.; Lotufo Neto, F. - Spiritist views of mental disorders in
Brazil. Transcult Psychiatry 42:570-595, 2005.
Moreira-Almeida, A.; Lotufo Neto, F.; Koenig, H.G. - Religiousness and mental
health: a review. Rev Bras Psiquiatr 28(3):242-250, 2006.
Mystakidou, K.; Tsilika, E.; Parpa, E.; Smyrnioti, M.; Vlahos, L. - Assessing
spirituality and religiousness in advanced cancer patients. Am J Hosp
Palliat Care 23(6):457-463, 2006.
Neumann, J.K.; Peeples, B. - Religious faith and nicotine cessation. Mil
Med 166(5):v., 2001.
Newshan, G. - Transcending the physical: spiritual aspects of pain in patients
with HIV and/or cancer. J Adv Nurs 28:1236-1241, 1998.
87
Nickel, R.; Raspe, H.H. - Chronic pain: epidemiology and health care utilization. Nervenarzt 72:897-906, 2001.
Okon, T.R. - Spiritual, religious, and existential aspects of palliative care. J
Palliat Med 8(2):392-414, 2005.
Otis-Green, S.; Sherman, R.; Perez, M.; Baird, R.P. - An integrated psychosocial-spiritual model for cancer pain management. Cancer Pract
10:58-65, 2002.
Pagot, J. - Radiesthsie et mission de Forme. Gif-sur-Yvette, 1988.
Phillips, C.J. - Pain management: health economics and quality of life
considerations. Drugs 63(2):47-50, 2003.
Puchalski, C. - Task force report: spirituality, cultural issues, and end of
life care. Assoc of Am Med Colleg, Contemporary issues in medicine,
communication in medicine, medical school objectives project, pp.
25-26, 1999.
Quill, T.E.; Byock, I.R. - Responding to intractable terminal suffering: the
role of terminal sedation and voluntary refusal of food and uids.
ACP-ASIM End-of-Life Care Consensus Panel. American College of
Physicians-American Society of Internal Medicine. Ann Intern Med
7(132):408-414, 2000.
Rippentrop, E.A.; Altmaier, E.M.; Chen, J.J.; Found, E.M.; Keffala, V.J. - The
relationship between religion/spirituality and physical health, mental
health, and pain in a chronic pain population. Pain 116:311-321, 2005.
Saunders, C.; Sykes, N. - The management of terminal malignant disease.
3rded. London, Edward Arnold, 1993.
Shelly, J.A. - The mystery of healing. J Christ Nurs 22:6-14, 2005.
Steensma, D.P. Why me? J Clin Oncol 21(9):64-66, 2003.
Steinhauser, K.E.; Christakis, N.A.; Clipp, E.C.; McNeilly, M.; McIntyre, L.; Tulsky,
J.A. - Factors considered important at the end of life by patients, family,
physicians, and other care providers. JAMA 284:2476-2482, 2000.
Sieber, W.J.; David, K.M.; Adams, J.E.; Kaplan, R.M.; Ganiats, T.G. - Assessing
the impact of migraine on health-related quality of life: an additional
use of the quality of well-being scale-self-administered. Headache
40:662-671, 2000.
Silva, M.C.; Fassa, A.G.; Valle, N.C. - Chronic low back pain in a Southern
Brazilian adult population: prevalence and associated factors. Cad
Saude Publica 20:377-385, 2004.
Sinclair, S.; Pereira, J.; Rafn, S. - A thematic review of the spirituality
literature within palliative care. J Palliat Med 9(2):464-479, 2006.
Smith, B.H.; Elliott, A.M.; Chambers, W.A.; Smith, W.C.; Hannaford, P.C.;
Penny, K. - The impact of chronic pain in the community. Fam Pract
18:292-299, 2001.
Storch, E.A.; Strawser, M.S.; Storch, J.B. - Two-week test-retest reliability
of the Duke Religion Index. Psychol Rep 94:993-994, 2004.
Sorajjakool, S.; Thompson, K.M.; Aveling, L.; Earl, A. - Chronic pain, meaning, and
spirituality: a qualitative study of the healing process in relation to the role
of meaning and spirituality. J Pastoral Care Counsel 60(4):369-378, 2006.
Sundblom, D.M.; Haikonen, S.; Niemi-Pynttari, J.; Tigerstedt, I. - Effect of
spiritual healing on chronic idiopathic pain: a medical and psychological study. Clin J Pain 10:296-302, 1994.
Urzua, J. - Modern medicine and the rejection of death. Anaesth Intens
Care 19(3): 400-403, 1991.
Wachholtz, A.B.; Keefe, F.J. - What physicians should know about spirituality
and chronic pain. South Med J 99(10):1174-1175, 2006.
Wachholtz, A.B.; Pargament, K.I. - Is spirituality a critical ingredient of meditation? Comparing the effects of spiritual meditation, secular meditation,
and relaxation on spiritual, psychological, cardiac, and pain outcomes.
J Behav Med 28:369-384, 2005.
Waldfogel, S.; Wolpe, P.R. - Using awareness of religious factors to enhance
interventions in consultation-liaison psychiatry. Hosp Community
Psychiatry 44(5): 473-477, 1993.