Influence of pain prognosis and electrical stimulation modality on the amplitude of current elicited at sensory threshold in chronic lumbar pain sufferers / Influência do prognóstico para dor e da modalidade de estimulação elétrica na amplitude de corrente elicitada no limiar sensorial em lombálgicos crônicos

ABSTRACT BACKGROUND AND OBJECTIVES: Sensory function may be altered in chronic low back pain (CLBP), which may alter the perception of therapeutic currents. The aim of this study was to verify whether the risk of poor prognosis for CLBP pain influences the amplitude elicited at the sensory threshold (ST) in different modalities of neuromuscular electrical stimulation (NMES). METHODS: This is a quasi-experimental counterbalanced study with 40 subjects divided into four groups (n=10 each), according to the risk of poor prognosis for pain: no risk (control group - CG), low (LrG), medium (MrG), and high (HrG) risks. Four modalities of NMES were tested: two medium frequency currents (Aussie current [AC] and Russian current [RC]) and two low frequency currents (commonly known as functional electrical stimulation [FES]), with two phase durations of200 μs (FES_200) and 500 μs (FES_500), in the region of the lumbar multifidus muscles. All subjects were exposed to all current modalities with interval periods, and when the ST was reached, the amplitude of the current measured in mA was recorded. RESULTS: The currents that elicited the highest and lowest amplitude in the ST were FES_200 and AC, respectively. As for the risk of poor prognosis, the highest amplitudes were for the HrG and the lowest for the LrG. CONCLUSION: The amplitude of the current elicited in the ST tended to be higher among those with a higher risk of poor prognosis for pain and, among the currents, those of medium frequency elicited lower amplitudes.

RESUMO JUSTIFICATIVA E OBJETIVOS: A função sensorial é potencialmente alterada na presença de dor lombar crônica (DLC), o que pode alterar a percepção de passagem de correntes terapêuticas. O objetivo deste estudo foi verificar se o risco de mau prognóstico para DLC influencia a amplitude elicitada no limiar sensorial (LS) em diferentes modalidades de estimulação elétrica neuromuscular (EENM). MÉTODOS: Trata-se de um estudo quase-experimental contrabalanceado composto por 40 voluntários alocados em quatro grupos (n=10 cada), de acordo com o risco de mau prognóstico para dor: sem risco (grupo controle - GC), baixo risco (GBR), médio risco (GMR) e alto risco (GAR). Foram testadas quatro modalidades de EENM: duas correntes de média frequência (corrente Aussie [CA] e corrente Russa [CR]) e duas correntes de baixa frequência (comumente denominada estimulação elétrica funcional [FES]), com duas durações de fases 200 μs (FES_200) e 500 μs (FES_500) na região dos músculos multífidos lombares. Todos os voluntários foram submetidos a todas as modalidades de corrente, com períodos de intervalos, e ao ser atingido o LS, foi realizado o registro da amplitude da corrente medida em mA. RESULTADOS: As correntes que elicitaram a maior e a menor amplitude no LS foram, respectivamente, FES_200 e CA. Quanto ao risco de mau prognóstico, as maiores amplitudes foram do GAR e as menores do GBR. CONCLUSÃO: A amplitude da corrente elicitada no LS tendeu a ser mais alta entre aqueles com maior risco de mau prognóstico para dor e, dentre as correntes, aquelas de média frequência elicitaram amplitudes mais baixas.A amplitude da corrente elicitada no LS tendeu a ser mais alta entre aqueles com maior risco de mau prognóstico para dor e, dentre as correntes, aquelas de média frequência elicitaram amplitudes mais baixas.

Cryotherapy in Postoperative Shoulder Surgery: A Systematic Review.

Cryotherapy, a therapeutic technique involving localized cooling of the body, has gained popularity for postsurgical rehabilitation. It induces a reduction in cellular metabolism, vasoconstriction, and pain relief, making it an attractive option for managing postoperative (PO) shoulder pain. This systematic review aimed to assess the effectiveness of cryotherapy in PO shoulder patients, focusing on pain, range of motion, functionality, and temperature changes. The review included six randomized clinical trials, involving a total of 233 patients who underwent various shoulder surgeries. Cryotherapy was applied using different methods, including Cryo/Cuff, Cryoton®, Polar Care 300, and ice packs. Results indicated that cryotherapy was generally effective in reducing PO shoulder pain. However, one study found no significant difference in pain outcomes between the cryotherapy group and control group. Furthermore, three studies demonstrated a decrease in intra-articular and skin temperatures with cryotherapy application. A risk of bias analysis revealed some concerns in the overall risk of bias for five studies, with one study considered to have a high risk of bias. Although publication bias assessment was not conducted due to the limited number of included studies, it was noted that the studies exhibited heterogeneity in terms of population, intervention methods, and outcome measures. In conclusion, cryotherapy appears to be a promising adjunctive treatment for PO shoulder pain, although the existing evidence has some limitations, including small sample sizes and methodological concerns. More high-quality studies are needed to establish the full extent of cryotherapy's effectiveness in PO shoulder rehabilitation, especially regarding its impact on functionality and range of motion.

Therapeutic effects of laser on psoriasis plaques: a systematic review.

Given the relevance of laser application, the objective of this study was to carry out a systematic review to verify the therapeutic effects of laser application on psoriasis plaques. The databases used were PubMED, Scopus, Embase, Cochrane, Web of Science, and in the gray literature: Google Scholar, Open Grey and LIVIVO. A total of 1,227 records were found, after removal of duplicates 851 studies remained for Phase 1 (reading titles and abstracts) and 31 for Phase 2 (reading the full studies) and finally 9 studies remained for this review, 7 randomized and 2 non-randomized. The risk of bias analysis had two studies with moderate risk and seven with high risk. The present study presented evidence that laser application has positive effects such as reduction of psoriasis plaques. However, due to the high risk of bias, there is a need for further studies.

Acute effects of photobiomodulation applied on the dorsal root ganglion in gout model-induced rats.

Gouty arthritis is an inflammatory disease that triggers symptoms such as pain, swelling, and joint stiffness. Since its main therapy is medication, research on other forms of treatment that do not generate side effects is necessary. Given this, the objective of this research was to evaluate the effects of combined photobiomodulation (LASER and LED) applied on the dorsal root ganglion (DRG) in an experimental model of gouty arthritis. For this, 40 Wistar rats were randomized into 4 groups: simulation of the model with saline injection, without treatment (CTL; n = 10); gout simulation with photobiomodulation treatment (CTL-PBM; n = 10); gout model with the injection of monosodium urate crystals (1.25 mg) in the femorotibial joint, without treatment (GOT; n = 10); or gout model with photobiomodulation treatment (GOT-PBM; n = 10). After 7 h of gout induction, photobiomodulation was performed with a cluster of 4 diodes applied to the GRD region in animals from the CTL-PBM and GOT-PBM groups. After analysing the results, it was concluded that the therapy favored the reduction of edema and joint incapacity, as well as the increase in the nociceptive threshold and plantar grip strength. Furthermore, PBM stimulated an increase in the inflammatory response (with increased levels of IL-1ß and greater recruitment of leukocytes) and greater activation of the antioxidant system. Therefore, PBM can be considered an effective therapeutic alternative to improve the functional status in this model of joint disease.

Resistance exercise and low-level laser therapy improves grip strength and morphological aspects in the ankle joint of Wistar rats with experimental arthritis.

Rheumatoid arthritis (RA) is an inflammatory disease mainly affecting synovial joints. Photobiomodulation through low-level laser therapy (LLLT) and resistance exercise may improve the inflammatory process. Therefore, we analyzed the effects of resistance exercise, LLLT, and the combination of both treatments on hind paw grip strength and ankle joint histomorphometric aspects of Wistar rats subjected to experimental RA. A total of 64 male Wistar rats were divided into eight groups: control, control LLLT, control exercise, control LLLT and exercise, arthritis, arthritis LLLT, arthritis exercise, and arthritis LLLT and exercise groups. The experimental RA was induced by a complete Freund's adjuvant injection into the knee joint cavity. Climbing exercises and LLLT (660 nm; 5 J/cm2 per point) were performed as the treatment. In addition, muscle strength was evaluated using the grip strength test, and morphometric evaluations were performed on the ankle joint. Generalized mixed models and multivariate analysis of variance tests were used for statistical analysis. Statistical significance was set at a p-value of .05. Arthritis LLLT, exercise, and LLLT and exercise had positive effects on grip strength between the groups (F[7.56] = 5.8, p < .004) and within the groups (F[4.3] = 9.9, p < .002) throughout the evaluations. Morphometry revealed degenerative lesions in the ankle joint as subintima with angiogenesis, inflammatory cells, flocculated articular cartilage, chondrocyte disorganization, and pannus in the arthritis group (p < .001). The treated groups exhibited morphological characteristics similar to those of the control group. LLLT and resistance exercise restored muscle strength and morphological aspects of the ankle joint in rats with experimentally induced RA.

Articular mobilization promotes improvement in functional and inflammatory parameters in a gouty arthritis model

ABSTRACT Objective Gouty arthritis is characterized by painful inflammation due to the deposition of monosodium urate crystals in joint tissues. Despite available treatments, many patients experience ineffective management and adverse effects. This study evaluated a manual therapy protocol involving passive joint mobilization at the peak of inflammation in a gouty arthritis model using functional and inflammatory parameters. Methods Twenty male Wistar rats, 12 weeks old, were divided into two groups (n=10 each): Gouty Arthritis and Control Groups, which were further subdivided into treated and untreated groups (n=5 each). The Gouty Arthritis Group received intraarticular knee injection of 50µL of monosodium urate crystals, while the Control Group received 50µL of phosphate buffered saline. The treatment involved a 9-minutes session of grade III joint mobilization (according to Maitland). Nociception, grip strength, and edema were evaluated before induction (EV0), 7 hours after assessment (EV1), immediately after treatment (EV2), and 1 hour after treatment (EV3). The animals were euthanized, and synovial fluid was collected to analyze leukocyte migration. Results The model mimicked the signs of the Gouty Arthritis Group, with a decrease in the threshold of nociception and strength and an increase in edema and leukocyte count. The mobilization protocol significantly increased the nociceptive threshold and grip strength and reduced edema; however, it did not reverse the increase in leukocyte count. Conclusion Our results suggest that mobilization promotes analgesia and may modulate the inflammatory process owing to reduced edema and subtle attenuation of cell migration, which contributes to strength gain.

Avaliação da incapacidade de indivíduos com diabetes mellitus: um estudo transversal com o WHODAS 2.0 / Evaluación de la incapacidad de individuos con diabetes mellitus: un estudio transversal con WHODAS 2.0 / Disability assessment of individuals with diabetes mellitus: a cross-sectional study with the WHODAS 2.0

RESUMO A diabetes mellitus (DM) causa diversas limitações funcionais, que podem impactar negativamente na vida pessoal e profissional do indivíduo, acarretando mais complicações e incapacidades. O objetivo do estudo foi identificar em quais domínios do World Health Organization Disability Assessment Schedule versão 2.0 (WHODAS 2.0) os indivíduos com DM apresentam as maiores incapacidades. Para tanto, foi realizado um estudo transversal com 111 pessoas com diagnóstico da doença, independentemente do tipo. Foram aplicados um questionário sociodemográfico e o WHODAS 2.0 com 36 questões, para avaliar as dificuldades apresentadas nos últimos 30 dias. A amostra foi composta predominantemente pelo sexo feminino (60,3%) e classificada como independente na comunidade (90,1%). A maior prevalência foi de indivíduos aposentados (35,1%). O domínio mobilidade apresentou o maior comprometimento (48±23), enquanto o domínio atividades de vida apresentou o menor comprometimento (28±13). Porém, para todos os domínios, o comprometimento ficou abaixo de 50, em uma escala que varia de 0 a 100. Todos os indivíduos com DM apresentaram alguma deficiência, havendo maior comprometimento do domínio relacionado à mobilidade.

RESUMEN La diabetes mellitus (DM) causa varias limitaciones funcionales que pueden impactar negativamente la vida personal y profesional del individuo, ocasionándole más complicaciones e incapacidades. El objetivo de este estudio fue identificar en qué dominios del World Health Organization Disability Assessment Schedule, versión 2.0 (WHODAS 2.0), las personas con DM presentan las mayores incapacidades. Para ello, se realizó un estudio transversal con 111 personas diagnosticadas con la enfermedad, independientemente del tipo. Se aplicaron un cuestionario sociodemográfico y WHODAS 2.0 con 36 preguntas para evaluar las dificultades presentadas en los últimos 30 días. La muestra fue predominantemente femenina (60,3%) y clasificada como independiente en la comunidad (90,1%). La mayor prevalencia fue de individuos jubilados (35,1%). El dominio movilidad tuvo mayor comprometimiento (48±23), mientras que el dominio actividades de la vida presentó el menor comprometimiento (28±13). Sin embargo, para todos los dominios, el comprometimiento fue inferior a 50 en una escala que varía de 0 a 100. Todos los individuos con DM presentaron una discapacidad, con mayor implicación del dominio relacionado con la movilidad.

ABSTRACT Diabetes mellitus (DM) causes several functional limitations, which can negatively affect the personal and professional life of individuals. This effect can lead to more complications and disabilities. This study aimed to analyze in which domains of the World Health Organization Disability Assessment Schedule version 2.0 (WHODAS 2.0) individuals with diabetes mellitus have the greatest disabilities. cross-sectional study was performed with 111 individuals with diabetes mellitus, of any type. A sociodemographic questionnaire and the WHODAS 2.0 with 36 questions were applied to assess individuals' difficulties in the last 30 days. Most individuals were women (60.3%) and classified as independent in the community (90.1%). The highest prevalence was among retired individuals (35.1%). The mobility domain presented the highest impairment (48±23) whereas the life activities domain presented the lowest impairment (28±13). However, for all domains, the impairment was below 50 on a scale ranging from zero to 100. All individuals with diabetes mellitus showed some disability, but the greatest impairment was in the mobility domain.

Effects of Platelet Rich Plasma on Pain in Adult and Elderly Patients with Knee Osteoarthritis: a Systematic Review / Efeitos do Plasma Rico em Plaquetas na Dor em Pacientes Adultos e Idosos com Osteoartrite de Joelho: uma Revisão Sistemática

Platelet-rich plasma (PRP) has been shown to be a promising treatment for osteoarthritis (OA) of the knee in adult and elderly patients, acting in the repair of joint tissues damaged by OA - a degenerative disease that mainly affects articular cartilage. This process of degradation of joint components leads to an increase in the level of pain in these patients. Therefore, this study aimed to evaluate the effectiveness of intra-articular injection of PRP in knee OA in relation to pain. For this systematic review, five databases were used: PubMed, Lilacs, PEDro, Cochrane Library and Google Scholar. Search strategies included the keywords Osteoarthritis, Knee, Platelet-rich plasma, and Pain. In order to be included in this review, the studies had to be of the randomized clinical trial type; use as a sample people between 18 and 80 years old diagnosed with knee OA; use intra-articular PRP treatment compared to placebo; and assess pain intensity. After completion of the selection phase, 5 studies were included in this review. These showed positive results in reducing pain in patients with lower-degeneration OA, and less effective in advanced OA. Furthermore, few side effects were reported after the application of PRP. Therefore, the intra-articular application of PRP can be an important tool for the treatment of knee OA, as it is an effective therapy in decreasing pain levels in patients affected by this pathology. (AU)

O plasma rico em plaquetas (PRP) tem se mostrado um tratamento promissor na osteoartrite (OA) de joelho de pacientes adultos e idosos, atuando no reparo dos tecidos articulares lesados pela OA - doença degenerativa que afeta principalmente a cartilagem articular. Esse processo de degradação dos componentes articulares leva ao aumento do nível de dor nesses pacientes. Sendo assim, este estudo objetivou avaliar a eficácia da injeção intra-articular de PRP na AO de joelho em relação a dor. Para esta revisão sistemática, cinco bases de dados foram utilizadas: PubMed, LILACS, PEDro, Cochrane Library e Google Scholar. As estratégias de busca incluíram as palavras-chave Osteoarthritis, Knee, Platelet-rich plasma e Pain. Para serem incluídos nesta revisão, os estudos deveriam ser do tipo ensaio clínico randomizado; utilizar como amostra pessoas entre 18 e 80 anos diagnosticadas com AO de joelho; utilizar o tratamento com PRP intra articular comparado ao placebo; e avaliar a intensidade da dor. Após o término da fase de seleção, 5 estudos foram incluídos nesta revisão. Estes apresentaram resultados positivos na redução da dor em pacientes com OA de menor grau de degeneração, e menor efetividade na OA avançada. Ademais, poucos efeitos colaterais foram relatados após a aplicação do PRP. Portanto, a aplicação intra-articular do PRP pode ser um importante instrumento para o tratamento da OA de joelhos, visto que é uma terapia eficaz na diminuição dos níveis dor dos pacientes acometidos por tal patologia. (AU)

Effect of neuromuscular electrical stimulation on muscle function in chronic low back pain patients: systematic review / Efeito da estimulação elétrica neuromuscular na função muscular em pacientes com dor lombar crônica: revisão sistemática

ABSTRACT BACKGROUND AND OBJECTIVES: Neuromuscular electrical stimulation (NMES) is one of the resources that can be used in the treatment of patients with chronic low back pain. It is possible that issues related to the stimulation parameters may affect the results obtained with the use of these currents. Therefore, the aim of this review was to investigate the effects of NMES on aspects of lumbopelvic muscle function in individuals with chronic low back pain. CONTENTS: The study is a systematic review that used 10 databases for the search through a comprehensive combination of descriptors that met the research question. The selection criteria based on the PICOT strategy were population - individuals with chronic low back pain (specific and/or non-specific); intervention - NMES; outcomes - paravertebral and/or abdominal muscle changes (muscle power and endurance). The articles were selected by two independent reviewers, who developed the tools for data extraction. Four articles were included in this review. In three of them, there was a significant increase in muscle strength and endurance, as well as muscle cross-sectional area in the group that received NMES compared to the control group. CONCLUSION: NMES showed positive effects in optimizing aspects of muscle function in individuals with chronic low back pain. However, the methods employed are very heterogeneous, which made it impossible to perform a quantitative analysis.

RESUMO JUSTIFICATIVA E OBJETIVOS: A estimulação elétrica neuromuscular (EENM) é um dos recursos que podem ser utilizados no tratamento de pacientes com dor lombar crônica. É possível que questões relacionadas aos parâmetros de estimulação possam afetar os resultados obtidos com o uso dessas correntes. Portanto, o objetivo deste estudo foi investigar os efeitos da EENM em aspectos da função muscular da região lombopélvica em indivíduos com dor lombar crônica. CONTEÚDO: Trata-se de uma revisão sistemática que utilizou 10 bases de dados para a busca por meio da combinação abrangente de descritores que atendessem a pergunta da investigação. Os critérios de seleção com base na estratégia PICOT foram: população - indivíduos com dor lombar crônica (específica e/ ou não específica); intervenção - EENM; desfechos - alterações musculares de paravertebrais e/ou abdominais (potência e resistência muscular). A seleção dos artigos foi feita por dois revisores independentes que elaboraram as ferramentas para extração dos dados. Ao todo, quatro artigos foram incluídos nesta revisão. Em três deles, houve aumento significativo de força e resistência muscular, assim como da área de secção transversa muscular no grupo que recebeu EENM, em relação ao controle. CONCLUSÃO: A EENM apresentou efeitos positivos na otimização dos aspectos da função muscular em indivíduos com dor lombar crônica. Porém, os métodos empregados são muito heterogêneos, o que impossibilitou a realização da análise quantitativa.

Morphometric aspects of the articular cartilage of rats treated with low-level laser therapy and exercise in a rheumatoid arthritis model

INTRODUCTION: Rheumatoid arthritis (RA) is classified as an autoimmune, chronic disease affecting diarthrodial joints and periarticular structures. OBJECTIVE: To evaluate whether low-intensity laser treatment (LLLT) and/or exercise reduce the deleterious effects of tissue in a rheumatoid arthritis model. METHODS: 128 rats were divided into two inflammatory periods: acute (7 days) and chronic (28 days) and subdivided into control, injury and treatment. The protocol with Freund's Complete Adjuvant was used in two inoculations, one intradermal and one intraarticular in the tibiofemoral joint, the control animals received saline solution. For treatment, LLLT 660 nm, 5 J/cm² was used in the sensitized joint and climbing exercise in stairways with an overload of 100 grams. After the experimental period, the animals were euthanized and the joints were prepared for morphometric analysis of the total thickness, superficial, deep, and cellular density of the articular cartilage. Generalized Linear Models with Sidak post-test were chosen. RESULTS: The control group was found to be different from the lesion group with greater joint cartilage thickness, andthe animals treated with exercise alone increased the joint cartilage compared to thecontrol group. CONCLUSION: The animals treated with laser association and exercise showed improvement in the morphometric aspects of the articular cartilage.

Heteropterys tomentosa and Interactions with the Musculoskeletal System: Systematic Review / Heteropterys tomentosa e Interações com o Sistema Musculoesquelético: Revisão Sistemática

Abstract Although Brazil is a country with the greatest plant biodiversity, there are still shortcomings regarding phytotherapy studies and their practical application. In Brazil alone there are 65 plants with psychoactive principles, and Heteropterys tomentosa, from the ethnobotanical point of view, is one of the most famous plants in the Midwest region, it is known for its aphrodisiac, physical and mental invigorating and depurative properties. The objective of this review was to point out the number of scientific articles published about the benefits of using the plant H. aphrodisiac in interactions with the musculoskeletal system. A consultation was performed in 10 databases: Embase, Scopus, Pubmed, Livivo, Science Direct, Web of science, Cochrane, Koreamed, Lilacs and Clinical trials for the elaboration of a systematic review, for this there was no limitation of time, language or type of study. Results: the search described found 111 articles, all primary studies; of these only 5 original studies (4.5%) were included in the review. Positive adaptations were observed in bones, tendons, muscles and hormone release, which resulted in improvements in exercise time and load, delaying fatigue and increasing functional capacity. However, the scarcity of studies, pointed out several gaps, opening space for other works. (AU)

Resumo Embora o Brasil seja um país com a maior biodiversidade vegetal, ainda existem carências com relação a estudos fitoterápicos e sua aplicação prática. Só no Brasil existem 65 plantas com princípios psicoativos, e a Heteropterys tomentosa, no ponto de vista etnobotânico, é uma das plantas mais famosas da região Centro-Oeste, ela é conhecida por propriedades afrodisíacas, de revigorante físico e mental, e depurativa. O objetivo desta revisão foi apontar a quantidade de artigos científicos publicados sobre os benefícios da utilização da planta H. aphrodisiaca em interações com o sistema musculoesquelético. Foi realizada uma consulta em 10 bases de dados, sendo elas: Embase, Scopus, Pubmed, Livivo, Science Direct, Web of science, Cochrane, Koreamed, Lilacs e Clinical trials para a elaboração de uma revisão sistemática, para isso não houve limitação de tempo, de língua ou tipo de estudo. A busca descrita encontrou 111 artigos, sendo todos estudos primários; destes apenas 5 estudos originais (4,5%) foram incluídos na revisão. Foram observadas adaptações positivas em ossos, tendões, músculos e liberação hormonal, que acarretaram melhorias no tempo e carga de exercício, retardando a fadiga e aumentando a capacidade funcional. Contudo, a escassez de estudos, apontou diversas lacunas, abrindo espaço para outros trabalhos. (AU)

Avaliação da adaptação da corrente interferencial nas formas bipolar e tetrapolar em mulheres com lombalgia crônica não específica: ensaio clínico cruzado / Evaluation of interferential current adaptation in bipolar and tetrapolar forms in women with chronic non-specific low back pain: cross-over clinical trial

INTRODUÇÃO: A corrente interferencial é uma modalidade bastante utilizada, porém, apresenta como fator limitante a quantidade de acomodações, o que é comum em eletroestimulação. Apesar de possuir alguns recursos que visam reduzir a adaptação fisiológica, não é totalmente eficaz; neste sentido, pode haver diferenças devido à técnica de uso. Assim, o presente estudo pretendeu analisar se há diferenças na adaptação para as formas bipolar ou tetrapolar em indivíduos com dor lombar crônica não específica. MÉTODOS: Ensaio clínico cruzado, composto por 15 voluntárias com dor lombar crônica não específica, as quais receberam terapia bipolar ou tetrapolar em semanas subsequentes. Foi explicado sobre a adaptação à corrente e o que deveria avisar quando ocorresse, e, desta forma, foi computado o número de vezes em que o fenômeno ocorreu, o tempo necessário até ocorrer a primeira adaptação, a intensidade inicial da corrente utilizada e o quanto aumentou-se após a primeira adaptação. RESULTADOS: Para nenhuma das variáveis analisadas, foi observada diferença significativa entre as duas técnicas (p>0,05). CONCLUSÃO: As técnicas analisadas não mostraram diferenças na adaptação em mulheres jovens com dor lombar não específica.

INTRODUCTION: The interferential current is a widely used modality; however, it presents as a limiting factor the amount of accommodation, which is common in electrostimulation. Despite having some resources that aim to reduce physiological adaptation, it is not fully effective in this sense, but there may be differences due to the technique of use. Thus, the present study aimed to analyze whether there are differences in the accommodation for bi- or tetrapolar forms in individuals with chronic nonspecific low back pain. METHODS: Crossover clinical study, consisting of 15 volunteers with chronic nonspecific low back pain, who received bipolar or tetrapolar therapy in subsequent weeks. They were explained about the current accommodation and that they should be told when it occurred, and in this way, the number of times that the phenomenon occurred, the time needed until the first accommodation occurred, the initial intensity of the current used, and how much it increased after the first accommodation were computed. RESULTS: None of the variables analyzed had a significant difference between the two techniques (p>0.05). CONCLUSION: The techniques analyzed showed no differences in accommodation in young women with nonspecific low back pain.

Use of Laser Acupuncture in Chronic Tensional Headache: Randomized Clinical Trial / Uso do Laser Acupuntura na Cefaleia Tensional Crônica: Ensaio Clínico Randomizado

Since tension headache, besides being highly prevalent, has a deleterious effect on daily activities, the search for therapeutic resources is interesting. Thus, the objective of this study was to verify the effect of laser acupuncture in individuals with chronic tensional headache. The sample consisted of 14 volunteers with chronic tensional headache, separated into a control group (placebo) and an intervention group (laser acupuncture, 660nm, 10 J/cm²), in both groups the pen was positioned for 20 seconds in each of the six acupuncture points. There were three therapies on alternate days, and at the end there was previous evaluation by both the Visual Analog Pain Scale and the Headache Impact Test questionnaire. In both forms of evaluation there were significant differences in the comparison between evaluations, with reduction of values (p<0.001), but without differences between groups or interaction (p>0.05). It was concluded that the acupuncture laser showed no greater effectiveness than the placebo. (AU)

Visto que a cefaleia tensional, além de apresentar alta prevalência, tem um efeito deletério sobre as atividades diárias, apresenta-se interessante a busca por recursos terapêuticos. Desta forma, o objetivo deste estudo foi verificar o efeito do laser acupuntura em indivíduos com cefaleia tensional crônica. A amostra foi composta por 14 voluntários, com cefaleia tensional crônica, separados em grupo controle (placebo) e grupo intervenção (laser acupuntura, 660nm, 10 J/cm²), em ambos os grupos a caneta foi posicionada por 20 segundos em cada um dos seis pontos de acupuntura. Foram três terapias em dias alternados, sendo que houve avaliação prévia e ao final delas tanto pela Escala Visual Analógica de Dor quanto pelo questionário Headache Impact Test. Em ambas as formas de avaliação houve diferenças significativas na comparação entre avaliações, com redução dos valores (p<0,001), porém sem diferenças entre os grupos ou interação (p>0,05). Conclui-se que o laser acupuntura não mostrou eficácia superior ao placebo. (AU)

Photobiostimulation in patients with shoulder impact syndrome. Randomized clinical trial / Fotobioestimulação em pacientes com síndrome do impacto do ombro. Ensaio clínico randomizado

ABSTRACT BACKGROUND AND OBJECTIVES: To evaluate the effects of cluster therapy (Laser+LED) on shoulder impact syndrome, aiming at modulating pain and functionality. METHODS: Clinical, randomized, non double-blind study. Consisting of 28 individuals of both sexes, aged between 18 and 50 years, who were separated into: control group (CG n=13) and treatment group (TG n=15). The volunteers answered the Shoulder Pain and Disability Index (SPADI) questionnaire and goniometric evaluation of three active movements: flexion, abduction, and external rotation. The treatment group was submitted to Fluence Cluster - HTM, with energy of 12.8J, for 1 min and 30 seconds, 3 times a week, for 4 weeks, totaling 12 therapies, in the insertion of the tendon of the supraspinatus muscle and the passage of the long portion of the biceps brachii. The control group received orientation regarding daily activities. RESULTS: In both groups there was a reduction in pain, but the effect size observed was greater for the treatment group In the total SPADI evaluation, treatment presented a significant reduction in values, again with a greater effect size. In active movements, both flexion and external rotation, again the group that used the cluster had advantages, both inferential and in effect sizes. CONCLUSION: The cluster significantly reduced pain and increased functionality in patients with shoulder impingement syndrome.

RESUMO JUSTIFICATIVA E OBJETIVOS: Avaliar os efeitos da terapia com cluster Laser+LED na síndrome do impacto do ombro, visando modulação da dor e funcionalidade. MÉTODOS: Estudo clínico, randomizado, não duplo-cego, que incluiu 28 indivíduos de ambos os sexos, com idade entre 18 e 50 anos, separados em grupo controle (GC n=13) e tratamento (GT n=15). Após responderem o questionário Shoulder Pain and Disability Index (SPADI) foi realizada avaliação goniométrica de três movimentos ativos: flexão, abdução e rotação externa. O grupo tratamento foi submetido ao Fluence Cluster - HTM com energia de 12,8J, durante 1 min e 30 segundos, 3 vezes por semana, durante 4 semanas, totalizando 12 terapias, na região de inserção do tendão do músculo supraespinhal e passagem da porção longa do bíceps braquial. O grupo controle recebeu orientações quanto às atividades diárias. RESULTADOS: Em ambos os grupos houve redução do quadro álgico, porém o efeito observado foi maior para o grupo tratamento. Na avaliação total do SPADI o grupo tratamento apresentou redução significativa dos valores com maior tamanho de efeito. Nos movimentos ativos, tanto flexão quanto rotação externa, o grupo tratamento apresentou vantagens, tanto de forma inferencial quanto nos tamanhos de efeito. CONCLUSÃO: A fotobioestimulação reduziu de modo significativo a dor e aumentou a funcionalidade dos pacientes com síndrome do impacto do ombro.

Foot reflexology in painful conditions: systematic review / Reflexologia podal em condições dolorosas: revisão sistemática

ABSTRACT BACKGROUND AND OBJECTIVES: Because foot reflexology is commonly associated with other interventions, its benefits are difficult to establish. In addition, systematic reviews have been carried out many years ago, analyzing unspecific parameters and with controversial results. Thus, the objectives of this study were: to analyze the results of randomized controlled trials with a control group in painful conditions, using foot reflexology as a single intervention; describe the proposed application and methodological quality of the studies (PEDro scale). CONTENTS: The PEDro, Pubmed, Scielo and LILACS data bases were consulted, searching for clinical trials with the following keywords and Boolean index: Foot Reflexology AND pain; reflexology foot massage AND pain (English, Portuguese and Spanish). These keywords should have been present in the title or summary of the article for inclusion, directing to pain and moving away from other variables. 95 studies were found, 17 were selected and most of the results were favorable. The usual application varies from 2-30 minutes of stimulation on each foot, varying between massaging in general or using the somatotopic map stimulating the solar plexus, pain correspondence zone and accessory points related to the diagnosis. In short, the studies showed moderate to good methodological quality according to the PEDro scale. CONCLUSION: Foot reflexology has shown promise for pain relief as an isolated therapy in neuromusculoskeletal cases in hospital and outpatient settings. The hope is that studies of excellent methodological quality can support this statement in the near future.

RESUMO JUSTIFICATIVA E OBJETIVOS: Os benefícios da reflexologia podal são difíceis de serem estabelecidos, pois revisões sistemáticas foram realizadas há muitos anos, analisando parâmetros inespecíficos com resultados controversos. Os objetivos deste estudo foram analisar os resultados de ensaios clínicos randomizados com grupo controle frente a quadros dolorosos, com a reflexologia podal como intervenção única; registrar sua aplicação e a qualidade metodológica dos estudos (escala PEDro). CONTEÚDO: Foram consultadas as bases de dados PEDro, Pubmed, Scielo e LILACS, buscando por ensaios clínicos com as seguintes palavras-chave e índice booleano: Foot Reflexology AND pain; reflexology foot massage AND pain (inglês, português e espanhol). Essas palavras-chave deveriam estar presentes nos tópicos de título ou resumo do artigo para sua inclusão, direcionando para quadro álgico e afastando-se de outras variáveis. Foram encontrados 95 estudos, 17 foram selecionados e em sua maioria os resultados foram favoráveis. A aplicação usual varia de 2-30 minutos de estimulação em cada pé, alterando massagear de maneira geral ou pelo mapa somatotópico estimulando o plexo solar, zona de correspondência de dor e pontos acessórios relacionados ao diagnóstico. Os estudos apresentaram qualidade metodológica de moderada a boa segundo a escala PEDro. CONCLUSÃO: A reflexologia podal mostrou-se promissora para alívio da dor como terapia isolada em casos de dor neuromusculoesquelética em ambiente hospitalar e ambulatorial. Estudos de melhor qualidade metodológica devem ser realizados para comprovar a importância da reflexologia podal na dor neuromusculoesquelética.

Exercício resistido promove reparo no musculoesquelético em modelo experimental de artrite reumatoide / Resisted exercise promotes repair in musculoskeletal structure in experimental model of rheumatoid arthritis

Distúrbios decorrentes da artrite reumatoide (AR) resultam em incapacitação funcional, com reflexos econômicos e sociais aos sistemas de saúde. Uma alternativa terapêutica que tem sido proposta é a atividade física na modalidade resistida. O presente estudo analisou os efeitos do exercício resistido de subida em escada (ERSE) na histomorfologia do músculo extensor longo dos dedos (EDL) de ratos Wistar, em modelo experimental de AR. Ratos machos (n=20) foram distribuídos aleatoriamente em quatro grupos. A lesão da AR foi induzida por administração intra-articular de Adjuvante Completo de Freund (CFA). Os resultados revelaram que a AR alterou a histomorfometria das fibras do EDL e que o ERSE promoveu reparo muscular, sugerindo sua eficiência na restauração da funcionalidade muscular. Ainda, o ERSE pode ser uma opção de tratamento voltado à melhoria na qualidade de vida dos portadores de AR.

Disorders from rheumatoid arthritis (RA) result in functional disability, with economic and social impacts on health systems. A therapeutic alternative that has been proposed is physical activity in the resisted modality. Current study analyzed the effects of resistance exercise on stairs (ERSE) on the histomorphology of the extensor digitorum longus muscle (EDL) of Wistar rats in an experimental model of RA. Male rats (n=20) were randomly assigned to four groups. RA injury was induced by intra-articular administration of Freund's Complete Adjuvant (CFA). Results revealed that RA altered the histomorphometry of EDL fibers and that ERSE promoted muscle repair, suggesting its efficiency in restoring muscle functionality. Furthermore, ERSE may be a treatment option to improve the life quality of people with RA.

Effect of transcutaneous electrical nerve stimulation and hypnosis on chronic low back pain / Efeito da estimulação elétrica nervosa transcutânea e hipnose na dor lombar crônica

ABSTRACT BACKGROUND AND OBJECTIVES Among the main non-pharmacological analgesic techniques are physical therapies such as electrotherapy and cognitive-behavioral techniques, such as hypnosis. The objective of this study was to compare the analgesic effect of transcutaneous electrical nerve stimulation (TENS) and hypnosis in the control of chronic low back pain. METHODS A crossover study that included 19 young adults of both genders with chronic low back pain who underwent TENS and hypnosis, and pain education as a control group. The quality of pain was assessed by the McGill's questionnaire; pain intensity and threshold were assessed by the visual analog scale. The intensity of spontaneous pain, the threshold and intensity of pain induced by cold and the pressure pain threshold before the interventions, immediately after the interventions and 30 minutes after the end of the interventions were evaluated. Statistical analysis was performed with Generalized Mixed Linear Models, with 5% significance, and Cohen's G effect sizes. RESULTS There was a statistically significant decrease in the intensity of spontaneous and cold induced pain in the hypnosis and TENS groups compared to the pain education group. There was a statistically significant reduction of pain in the sensory and evaluation categories in the intervention groups compared to the control group. There was no significant difference for the pressure pain threshold and latency time for cold induced pain. CONCLUSION Hypnosis and TENS decreased the intensity of chronic low back pain with no statistically significant difference between them, but statistically different from the pain education control group.

RESUMO JUSTIFICATIVA E OBJETIVOS Entre as principais técnicas analgésicas não farmacológicas estão as terapias físicas como a eletroterapia e técnicas cognitivo-comportamentais, como a hipnose. O objetivo deste estudo foi comparar o efeito analgésico da estimulação elétrica nervosa transcutânea (TENS) e hipnose no controle da dor lombar crônica. MÉTODOS Estudo do tipo cruzado que incluiu 19 adultos jovens de ambos os sexos portadores de dor lombar crônica, submetidos a TENS, hipnose e educação em dor como grupo controle. A qualidade da dor foi avaliada pelo questionário de McGill, a intensidade e o limiar da dor pela escala analógica visual. Foi avaliada a intensidade da dor espontânea, o limiar e a intensidade de dor ao frio e o limiar da dor à pressão, imediatamente após as intervenções e 30 minutos depois do final das intervenções. A análise estatística foi realizada com modelos lineares generalizados mistos, com 5% de significância, e tamanhos de efeito G de Cohen. RESULTADOS Houve diminuição estatisticamente significativa da intensidade da dor espontânea e ao frio nos grupos hipnose e TENS comparados ao grupo de educação em dor. Ocorreu redução do quadro álgico estatisticamente significativo nas categorias sensorial e avaliativa nos grupos intervenção comparados ao grupo controle. Não houve diferença significativa para o limiar de dor à pressão e o tempo de latência para a dor ao frio. CONCLUSÃO A hipnose e a TENS diminuíram a intensidade da dor lombar crônica sem diferença estatisticamente significativa entre si, porém estatisticamente diferentes em relação ao grupo controle.

Short-term effects of whole-body vibration on the soleus of ooforectomized rats: Histomorphometric analysis and oxidative stress in an animal model.

PURPOSE: The aim of this study was to analyze the effects of mechanical vibration on the histomorphometry and oxidative stress of oophorectomized rats. METHOD: Seventy-two Wistar rats were randomized to Pseudoophorectomy (P) and Oophorectomy (O) and subdivided into untreated animals and euthanized after four (P4 and O4) and eight (P8 and O8) weeks and animals treated during four (PT4 and OT4) and eight (PT8 and OT8) weeks. The treatment consisted of use of whole-body vibration for 10 min, three times a week. After euthanasia, the soleus muscle was collected. The general morphological analysis was performed in the right soleus muscle and then the cross-sectional area, the largest and the smallest diameter of the muscle fiber in 100 fibers per muscle, also the nuclei and capillary/fiber ratios, and percentage of connective tissue were measured. The left soleous was used for oxidative stress analysis. RESULTS: PT4 presented higher values in cross-sectional area than P4 and PT8, while O8 was lower than O4, P8 and OT8; for the fiber diameters, the oophorectomized animals had lower values than the pseudo-oophorectomized animals and the treatments values higher than the ones that had no treatment. In oxidative stress, O8 and OT8 presented higher lipoperoxidation, without any alterations to the activities of superoxide dismutase, catalase and cholinesterase. CONCLUSION: Whole-body vibration induced muscle hypertrophy in the pseudo-oophorectomized rats after four weeks, as well as being able to reverse the changes caused by the surgery in eight weeks in that variable.

Comparação de diferentes comprimentos de onda do laser de baixa potência no sóleo de ratos Wistar após lesão nervosa / Comparación entre diferentes longitudes de onda de láser de baja potencia en el sóleo de ratas Wistar tras lesión nerviosa / Comparison of different low-level laser therapy wavelengths in the soleus of Wistar rats after nerve injury

RESUMO Os músculos esqueléticos podem ser afetados por lesões do sistema nervoso periférico, levando a fraqueza e atrofia muscular. Na tentativa de recuperar a funcionalidade dos músculos, existem vários recursos terapêuticos utilizados, dentre os quais o laser de baixa potência (LBP). Este estudo comparou o efeito do LBP em dois comprimentos de onda (660 nm e 830 nm), em características morfológicas do tecido muscular após axonotmese de nervos isquiáticos de ratos Wistar. Para tanto, foram utilizados 32 ratos Wistar, divididos em quatro grupos, sendo G1 (controle), G2 (lesão), G3 (lesão e tratamento com LBP de 660 nm) e G4 (lesão e tratamento com LBP de 830 nm). Os animais de G2, G3 e G4 foram submetidos à lesão do nervo isquiático e, três dias após a lesão, G3 e G4 realizaram tratamento com LBP de 660 nm e 830 nm, respectivamente. Após o tratamento, todos os animais foram eutanasiados e os músculos sóleos coletados para confecção das lâminas histológicas, visando a realização de análises morfológicas do tecido. Constatou-se que os animais submetidos à lesão sofreram alterações morfológicas na fibra, resultando em sua atrofia. Foi percebido também que o LBP com comprimento de onda de 830 nm apresentou ligeiros sinais de recuperação das características morfométricas analisadas.

RESUMEN Las lesiones en el sistema nervioso periférico pueden afectar los músculos esqueléticos y provocar debilidad y atrofia muscular. Para recuperar la funcionalidad de los músculos, se utilizan varios recursos terapéuticos, entre los cuales el láser de baja potencia (LBP). Este estudio comparó el efecto del LBP en dos longitudes de onda (660 nm y 830 nm) sobre las características morfológicas del tejido muscular después de la axonotmesis de los nervios ciáticos en ratas Wistar. Para ello, se utilizaron 32 ratas Wistar, divididas en cuatro grupos: G1 (control), G2 (lesión), G3 (lesión y tratamiento con LBP de 660 nm) y G4 (lesión y tratamiento con LBP de 830 nm). Los animales de G2, G3 y G4 se sometieron a lesión del nervio ciático y, tres días después de la lesión, el G3 y G4 se sometieron al tratamiento con LBP de 660 nm y 830 nm, respectivamente. Después del tratamiento, todos los animales fueron sacrificados y se recogieron los músculos sóleos para la preparación de placas histológicas, con el fin de realizar análisis morfológicos del tejido. Se encontró que los animales sometidos a lesión sufrieron cambios morfológicos en la fibra, lo que resultó en atrofia. También se observó que el LBP con la longitud de onda de 830 nm presentó leves signos de recuperación de las características morfométricas analizadas.

ABSTRACT Skeletal muscles may be affected by peripheral nervous system injuries, leading to muscle weakness and atrophy. Several therapeutic resources may be used in the attempt to recover the functionality of muscles, such as low-level laser therapy (LLLT). This study compared the effect of LLLT of two wavelengths (660 nm and 830 nm) on morphological characteristics of muscle tissue after axonotmesis of ischiatic nerves of Wistar rats. A total of 32 Wistar rats were divided into four groups: G1 (control), G2 (injury), G3 (injury and treatment with 660 nm LLLT) and G4 (injury and treatment with 830 nm LLLT). G2, G3, and G4 animals were submitted to sciatic nerve damage and, three days after the injury, G3 and G4 were treated with LLLT of 660 nm and 830 nm, respectively. After the treatment, all animals were euthanized, and the soles muscles were collected to perform morphological analyzes of the tissue using histological slides. We verified that animals submitted to the lesion underwent morphological changes in the fiber, resulting in their atrophy. We also noticed that LLLT with a wavelength of 830 nm presented slight signs of recovery of the morphometric characteristics analyzed.

Evaluation of nociception induced by whole-body vibration remobilization in Wistar rats / Avaliação da nocicepção induzida pela remobilização com vibração de corpo inteiro em ratos Wistar

ABSTRACT BACKGROUND AND OBJECTIVES: The vibrating platform can attenuate the deleterious effects of immobilization related to muscle atrophy. However, there is still a gap regarding the effect of this modality on hyperalgesia related to immobilization. The objective of this study was to analyze the effect of remobilization with whole-body vibration on the nociception of Wistar rats. METHODS: Sixteen rats were randomly distributed into two groups: the FRG group - immobilization and free remobilization and the VPRG - immobilization and remobilization with the vibrating platform. For remobilization with the vibrating platform, the frequency of 60Hz for 10 minutes, five days a week for two weeks was used. The nociception was evaluated on the right paw by a digital analgesiometer, before and at the end of the immobilization, and after two weeks of remobilization. RESULTS: There were differences between evaluations but not between groups, indicating that immobilization reduced the nociceptive threshold and free remobilization, and the remobilization associated with vibration improved the nociceptive threshold compared to the post-immobilization moment. However, they were not able to return to the initial parameters. CONCLUSION: Joint immobilization reduced the nociceptive threshold; however, two weeks of whole-body vibration remobilization were not able to revert the threshold in the immobilized groups.

RESUMO JUSTIFICATIVA E OBJETIVOS: A plataforma vibratória pode atenuar os efeitos deletérios da imobilização relacionados à atrofia muscular, contudo, ainda há uma lacuna com relação ao efeito desta modalidade na hiperalgesia relacionada ao imobilismo. Assim, o objetivo deste estudo foi analisar o efeito da remobilização com plataforma vibratória sobre a nocicepção de ratos Wistar. MÉTODOS: Dezesseis ratos foram distribuídos aleatoriamente no grupo GRL - imobilização e remobilização livre, e no grupo GRPV - imobilização e remobilização com plataforma vibratória. Para a remobilização com plataforma vibratória foi utilizada a frequência de 60Hz, durante 10 minutos, cinco dias por semana, durante duas semanas. A nocicepção foi avaliada na pata direita, por meio de um analgesímetro digital, antes e ao final da imobilização, e após duas semanas de remobilização. RESULTADOS: Houve diferenças entre as avaliações, mas não entre os grupos, indicando que a imobilização reduziu o limiar nociceptivo, e a remobilização livre e associada à vibração melhoraram o limiar nociceptivo comparados com o momento pós-imobilização, no entanto, não foram capazes de retornar aos parâmetros iniciais. CONCLUSÃO: A imobilização articular reduziu o limiar nociceptivo. No entanto, duas semanas de remobilização com a vibração de corpo inteiro não foram capazes de reverter o limiar nos grupos imobilizados.