Postural Hypervigilance and Perception of Correct Sitting Posture in Individuals With and Without Low Back Pain / Hipervigilância postural e percepção da postura correta sentada em indivíduos com e sem dor lombar

Abstract Objectives To verify if there is a difference in postural hypervigilance in sitting in individuals with and without low back pain. Additionally, to observe whether there is a difference in the perception of correct sitting posture between individuals with low back pain and without low back pain. Methods The present study has a cross-sectional observational design, as a sample size of 92 individuals, later divided equally into two groups (with low back pain and without low back pain). Two instruments were used: the hypervigilance scale to analyze the frequency that volunteers correct their sitting posture during the day, and posture scans to investigate the perception of volunteers about the correct sitting posture. The data were submitted to the Shapiro-Wilk Normality test. To compare the values of Hypervigilance Scale, the Mann-Whitney, Chi-Square, and Fisher Exact tests were used to assess correct sitting posture. Results There was no significant difference between postural hypervigilance in sitting between individuals with low back pain and without low back pain. There was no significant difference between the choice of correct sitting posture between the group of individuals with and without low back pain. Conclusion There is no difference between the choice of correct sitting posture and the amount of postural hypervigilance in individuals with or without low back pain.

Resumo Objetivos Verificar se há diferença na hipervigilância postural sentada em indivíduos com e sem dor lombar. Além disso, observar se há diferença na percepção da postura correta sentada entre indivíduos com dor lombar e sem dor lombar. Métodos O presente estudo possui delineamento observacional transversal, como tamanho amostral de 92 indivíduos, posteriormente divididos igualmente em dois grupos (com dor lombar e sem dor lombar). Foram utilizados dois instrumentos: a escala de hipervigilância para analisar a frequência que voluntários corrigem a postura sentada no dia; e o quadro de posturas para investigar a percepção dos voluntários sobre a postura correta sentada. Os dados foram submetidos ao teste de Normalidade de Shapiro-Wilk. Para comparar os valores da Escala de Hipervigilância foi utilizado o teste de Mann-Whitney e o teste Qui-quadrado e exato de Fisher para avaliação da postura correta sentada. Resultados Não houve diferença significativa entre a hipervigilância postural sentada entre indivíduos com dor lombar e sem dor lombar. Não houve diferença significativa entre a escolha da postura correta sentada entre o grupo de indivíduos com e sem dor lombar. Conclusão Não há diferença entre a escolha da postura correta sentada e quantidade de hipervigilância postural em indivíduos com ou sem dor lombar.

Dolor lumbar en el embarazo, aspectos fisiopatológicos y tratamiento / Low back pain in pregnancy, pathophysiological aspects and treatment

INTRODUCCIÓN: El dolor lumbar es una condición de alta prevalencia en la población general. La gestación genera cambios fisiológicos que favorecen la aparición de síntomas dolorosos que pueden comprometer la calidad de vida. MÉTODO: Revisión de la literatura con términos MeSH en inglés y español en las bases de datos Embase, PubMed, Lilacs, Sage, Google Academics y Scielo desde el año 1994 hasta el año 2021. Se encontraron 74 artículos y fueron seleccionados 50, basados en su impacto clínico. RESULTADOS: El dolor lumbar afecta a más del 50% de las mujeres embarazadas. Existen antecedentes gineco-obstétricos que pueden intervenirse para disminuir el riego o la intensidad de los síntomas. El diagnóstico es clínico, pero puede asociarse a imágenes diagnósticas cuando se sospechan condiciones de riesgo. El tratamiento se basa en intervenciones no farmacológicas como ejercicio y terapia física, pero pueden utilizarse algunos medicamentos e intervenciones en dolor según su riesgo-beneficio materno y fetal. CONCLUSIONES: El dolor lumbar en el embarazo es muy frecuente y debe ser conocido, diagnosticado y tratado por los profesionales de la salud que atienden esta población, dentro de un equipo multidisciplinario de tratamiento.

INTRODUCTION: Low back pain is a condition of high prevalence in the general population. Gestation generates physiological changes that favor the appearance of painful symptoms that can compromise the quality of life. METHOD: Review of the literature with MeSH terms in English and Spanish in the databases Embase, PubMed, Lilacs, Sage, Google Academics and Scielo from the year 1994 to the year 2021. Seventy-four articles were found and 50 were selected based on their clinical impact. RESULTS: Low back pain affects more than 50% of pregnant women. There are gyneco-obstetric antecedents that can be intervened to reduce the risk or intensity of symptoms. The diagnosis of this entity is clinical, but it can be associated with diagnostic imaging when risk conditions are suspected. Treatment is based on non-pharmacological interventions such as exercise and physical therapy, but some medications and pain interventions can be used according to their risk of maternal and fetal benefit. CONCLUSIONS: Low back pain in pregnancy is very frequent, it should be known, diagnosed, and treated by health professionals who care for this population, based on a multidisciplinary treatment team.

Terminology and Legislation referring to Percutaneous Facet Procedures to Treat Low Back Pain in Brazil ­ Current Status

Incongruities in the terminology and in the Brazilian legislation about percutaneous facet procedures (PFPs) for the treatment of chronic lower back pain are frequently the subject of litigations between health professionals and supplementary healthcare providers. The Brazilian Hierarchical Classification of Medical Procedures (CBHPM, in the Portuguese acronym) describes four types of PFPs, while the Brazilian Unified Supplementary Health Terminology (TUSS, in the Portuguese acronym) describes five distinct lumbar PFPs, which correlate with the ones described on the List of Procedures and Events in Health, created by the Brazilian National Agency of Supplementary Health (ANS, in the Portuguese acronym). In the present paper, we review the terminology of the procedures, proposing the unification of the terminology and the abolition of redundancies in the tables. Finally, we developed a single terminology proposal for the PFPs based on their complexity and objectives to be used for the treatment of lower back pain.

Dolor lumbar: revisión y evidencia de tratamiento / Low back pain: review and evidence of treatment

El dolor lumbar corresponde a uno de los síntomas más prevalentes en la humanidad, siendo la segunda causa más frecuente de atención médica a nivel mundial. Existen diversos enfoques de diagnóstico y tratamiento para dolor lumbar, entre ellos la temporalidad del síntoma, el trabajo de diagnóstico sindromático, los síntomas de alarma, también llamados "banderas rojas", que pueden hacer sospechar patologías de mayor gravedad o urgencia. El estudio etiológico puede ser necesario en casos agudos con estas banderas rojas y en casos crónicos. Este estudio se realiza principalmente con imágenes (radiografías, tomografía computada, resonancia magnética, SPECT/CT) y ocasionalmente con exámenes de laboratorio. La mayor parte de los tratamientos están enfocados en el manejo conservador, principalmente el ejercicio físico guiado y asociado a fármacos analgésicos. Existen terapias alternativas tales como la acupuntura, el tai-chi, entre otros, algunas de ellas han mostrado ser un buen complemento al manejo del dolor lumbar. El enfoque multidisciplinario es la tendencia más actual de manejo, esto incluye el trabajo e intervención de diversos profesionales abordando el problema de forma integral, incluyendo el manejo psicoterapéutico. Intervenciones como las infiltraciones de columna han demostrado reducir el dolor por tiempos cortos, siendo útiles como puente para realizar un tratamiento apropiado. La cirugía solo se reserva para casos refractarios, siendo controversiales los resultados existentes en la literatura.

Low back pain is one of the most prevalent symptoms in humanity, being the second most common cause of medical attention worldwide. There are various approaches to diagnosis and treatment for low back pain, including the temporality of the symptom, the work of syndromatic diagnosis, the alarm symptoms, also called "red flags", that can make suspect pathologies of greater severity or emergency. The etiological study may be necessary in acute cases with these "red flags" and in chronic cases. This study is mainly done with images (X-rays, CT scan, MRI, SPECT/CT) and occasionally with laboratory tests. Most of the treatments are focused on conservative management, mainly guided physical exercise associated with analgesic drugs. There are alternative therapies such as acupuncture, tai-chi, among others, some of them have proven to be a good complement to the management of low back pain. The multidisciplinary approach is the most current management trend, this includes the work and intervention of various professionals addressing the problem in an integral way, including psychotherapeutic management. Interventions such as spinal infiltrations have been shown to reduce pain for short times, being useful as a bridge for proper treatment. Surgery is only reserved for refractory cases, the results existing in the literature being controversial.

Dolor sacroilíaco: epidemiología, fisiopatología, diagnóstico y tratamiento / Sacroiliac pain: epidemiology, physiopathology, diagnosis and treatment

El dolor sacroilíaco es una causa generalmente subdiagnosticada de dolor lumbar, que afecta del 15% a 30% de los pacientes con dolor lumbar bajo crónico no radicular. La articulación sacroilíaca (ASI) recibe continuo stress durante la bipedestación y marcha, siendo estabilizada por estructuras ligamentarias, capsulares y miofasciales fuertes, que reciben una abundante inervación. Destaca la dificultad en el diagnóstico del dolor sacroilíaco; debido a su naturaleza heterogénea. Éste se debe sospechar en todo paciente con síndrome de dolor lumbar no radicular, unilateral y no central. El examen físico debería descartar patología de cadera y columna lumbar. La realización de maniobras de provocación del dolor sacroilíaco aporta en el diagnóstico, teniendo la combinación de 3 o más maniobras positivas una sensibilidad de 85% y especificidad de 79%. Se ha recurrido a inyecciones diagnósticas con anestésicos locales, tanto intraarticulares como de ligamentos circundantes. El tratamiento del dolor sacroilíaco es multimodal e individualizado para cada paciente. El tratamiento conservador­basado en terapia física y antiinflamatorios no esteroidales­ es la terapia de primera línea. Las infiltraciones esteroidales tanto intra como extraarticulares pueden proveer alivio en un grupo de pacientes con inflamación activa. La denervación de los ramos dorsales laterales con radiofrecuencia ha mostrado ser un tratamiento exitoso en pacientes con dolor sacroilíaco, logrando 6 meses a 1 año de alivio del dolor. En pacientes con dolor refractario, la fusión de la articulación sacroilíaca es una opción, prefiriéndose la técnica mínimamente invasiva de fijación trans-sacroilíaca.

Sacroiliac pain is an frecuent underdiagnosed source of low back pain, affecting 15% to 30% of individuals with chronic, non-radicular pain. The sacroiliac joint (SIJ) is subject to continuous stress during standing position and gait, being stabilized by strong ligament, capsular and myofascial structures with rich innervation. Due to its heterogeneous nature, SIJ pain is difficult to diagnose, and it should be suspected in all patients with non-radicular unilateral and non-central low back pain syndrome. Physical examination should rule out hip and lumbar spine pathology. SIJ provocation maneuvers are used for diagnosis, with the combination of 3 or more positive maneuvers resulting in a sensitivity of 85% and a specificity of 79%. Diagnostic injections of local anesthetics, both intra-articular and in the surrounding ligaments have been used. treatment of SIJ pain is multimodal and individualized for each patient. Conservative treatment, based on physical therapy and non-steroidal anti-inflammatory drugs (NSAIDs) is the first line therapy. Both intra- and extra-articular steroid infiltrations can provide relief in a group of patients with active inflammation. Radiofrequency denervation of lateral dorsal branches has proven to be a successful treatment in SIJ pain patients, achieving 6 to 12 months of pain relief. In patients with refractory pain, SIJ fusion is an option, with minimally invasive trans-sacroiliac fixation being the preferred technique.

Fatores biopsicossociais associados com a incapacidade em idosos com dor lombar aguda: estudo BACE-Brasil / Biopsychosocial factors associated with disability in older adults with acute low back pain: BACE-Brasil study

Resumo Este estudo transversal avaliou a associação de fatores biopsicossociais com a incapacidade em idosos com um novo episódio de dor lombar aguda. Foram incluídos idosos com um novo episódio de dor lombar aguda e excluídos aqueles com alterações cognitivas e deficiências motoras graves. A incapacidade foi avaliada pelo Roland Morris Disability Questionnaire. Os fatores biopsicossociais (variáveis clínicas, funcionais, estado de saúde, psicológicas e sociais) foram avaliados por um questionário estruturado multidimensional e exame físico. Regressão linear multivariada foi utilizada para análise dos dados com significância estatística de 0,05. Participaram 386 idosos com média de idade de 71,6 (±4,2) anos e incapacidade de 13,7 (±5,7) pontos. A análise de regressão linear multivariada identificou que pior saúde física e mental (avaliados através do SF-36), baixa autoeficácia em quedas, dificuldade para dormir por causa da dor, piores níveis de cinesiofobia, maiores índices de massa corporal, presença de rigidez matinal na coluna lombar, maior intensidade de dor, sexo feminino e pior mobilidade funcional foram significativamente associados com incapacidade (p < 0,05). Incapacidade relacionada à dor lombar está significativamente associada com piores condições biopsicossociais de saúde em idosos.

Abstract This cross-sectional study evaluated the association of biopsychosocial factors with disability in older adults with a new episode of acute low back pain. Older patients with a new episode of acute low back pain were included and those with cognitive alterations and severe motor impairment were excluded. Disability was assessed using the Roland Morris Disability Questionnaire. The biopsychosocial factors (clinical, functional, health status, psychological and social variables) were evaluated by a structured multidimensional questionnaire and physical examination. A multivariate linear regression was used to analyze data with a statistical significance of 0.05. A total of 386 older individuals with a mean age of 71.6 (± 4.2) years and disability of 13.7 (± 5.7) points were enrolled. Our regression analyses identified that worse physical and mental health (assessed through SF-36), low falls self-efficacy, trouble sleeping due to pain, worse kinesiophobia levels, higher body mass indexes, lumbar morning stiffness, increased pain intensity, female gender and worse functional mobility were significantly associated with baseline disability (p < 0.05). Low back pain-related disability is significantly associated with worse biopsychosocial health conditions in older adults.

Clinical research on lumbar oblique-pulling manipulation in combination with sling exercise therapy for patients with chronic nonspecific low back pain

SUMMARY OBJECTIVE: To investigate clinical curative effects of lumbar oblique-pulling manipulation in combination with sling-exercise-therapy training on chronic nonspecific lower back pain. METHODS: A total of 60 patients with chronic nonspecific lower back pain in the Outpatient Department were included in this study. These patients were randomly divided into two groups: the observation group and the control group. The control group adopted a single sling-exercise-therapy training three times a week, while the observation group adopted lumbar oblique-pulling manipulation in combination with manipulation treatment once a week. The course of treatment lasted for four weeks. RESULTS: (1) Before and after treatment, the ODI score was compared within the group. A remarkable statistical significance was observed from the third day (P<0.05). At the third month of follow-up, the difference in ODI scores between these two groups was statistically significant (P<0.05). (2) Before and after treatment, it was observed that differences in VAS scores from the third day were statistically significant (P<0.05). (3) The difference in muscle strength between these two groups had remarkable statistical significance in the third month of follow-up (P<0.05). CONCLUSION: The effective rehabilitation function of lumbar oblique-pulling manipulation in combination with sling-exercise-therapy training in patients with CNLBP is superior to that of sling-exercise-therapy training alone.

RESUMO OBJETIVO: Investigar os efeitos curativos da manipulação lombar com o movimento de puxar oblíquo combinado a terapia por exercícios de sling-training para dor lombar baixa crônica não específica. METODOLOGIA: Um total de 60 pacientes com dor lombar baixa crônica não específica no ambulatório foram incluídos neste estudo. Esses pacientes foram divididos aleatoriamente em dois grupos: o grupo de observação e o grupo de controle. O grupo de controle aderiu apenas à terapia por exercícios de sling-training três vezes por semana, enquanto o grupo de observação aderiu à manipulação lombar com o movimento de puxar oblíquo combinado à terapia por exercícios de sling-training uma vez por semana. O tratamento durou quatro semanas. RESULTADOS: (1) Antes e após o tratamento, o escore de ODI foi comparado no grupo. Uma significância estatística notável foi observada a partir do terceiro dia (P<0,05). No terceiro mês de acompanhamento, a diferença nos escores de ODI entre os dois grupos foi estatisticamente significante (P<0,05). (2) Antes e após o tratamento, observou-se que diferenças nos escores de VAS a partir do terceiro dia foram estatisticamente significantes (P< 0,05). (3) A diferença de força muscular entre os dois grupos apresentou significância estatística notável no terceiro mês de acompanhamento (p<0,05). CONCLUSÃO: A função de reabilitação efetiva da manipulação lombar com o movimento de puxar oblíquo combinada à terapia por exercícios de sling-training em pacientes com dor lombar baixa crônica não específica é superior à da terapia por exercícios de sling-training sozinha.

Relación de los factores psicoemocionales en la intensidad del dolor y la funcionalidad en usuarios adultos con lumbalgia crónica inespecífica de las comunas de Coquimbo y La Serena / Relationship of psycho-emotional factors in pain intensity and functionality in adult users with non-specific chronic low back pain in the commune of Coquimbo and La Serena

Introducción: el dolor es una experiencia multidimensional que considera los tres ejes de la salud: el biológico, el psicológico y el social. Cuando el daño estructural no es la causa esencial del dolor experimentado, tal como sucede en la lumbalgia crónica inespecífica (LCI), se hace necesario considerar los ejes no biológicos para un abordaje integral. Por lo tanto, el objetivo de este estudio es analizar la relación entre los factores psicoemocionales con la intensidad del dolor y la funcionalidad de las personas con LCI. Materiales y métodos: el tipo de estudio es no-experimental, cuantitativo y correlacional. La muestra corresponde a un n=55 usuarios de los CESFAM Sergio Aguilar, de la comuna de Coquimbo y Juan Pablo II, de la comuna de La Serena. Se aplicaron cuestionarios sobre los factores psicoemocionales: kinesofobia, catastrofismo y autoeficacia, y las variables de limitación de la funcionalidad e intensidad del dolor. Los instrumentos utilizados fueron: escala de tampa para kinesofobia (TSK 11), escala de catastrofismo del dolor (PCS), cuestionario sobre la percepción de autoeficacia, escala de funcionalidad o incapacidad por dolor lumbar Oswestry y escala visual análoga (EVA), respectivamente. Resultados: hubo una relación entre las variables catastrofismo-limitación de la funcionalidad (rho=0,537, p<0,005), catastrofismo-intensidad del dolor (rho=0,437, p=0,001), kinesofobia-limitación de la funcionalidad (rho=0,418, p=0,002) y autoeficacia-limitación de la funcionalidad (rho=-0,518, p<0,005), siendo estas correlaciones significativas estadísticamente. Discusión: los tres factores psicoemocionales se relacionan con la funcionalidad. No obstante, solo el catastrofismo se relaciona con la intensidad del dolor. Por ende, es relevante que el kinesiólogo considere en su intervención terapéutica estos factores para enfocar el posterior abordaje kinésico con una visión e interacción multidisciplinar.

Introduction: pain is a multidimensional experience that considers the three axes of health: biological, psychological and social. When structural damage is not the essential cause of the pain experienced, as it happens in non-specific chronic low back pain (NSCL), it is necessary to consider the non-biological axes for an integral approach. Therefore, the objective of this study is to analyze the relationship between psychoemotional factors with pain intensity and functionality of persons with NSCL pain. Materials and Methods: the type of study is non-experimental, quantitative and correlational. The sample corresponds to n=55 users of the CESFAM Sergio Aguilar, of the commune of Coquimbo and Juan Pablo II, of the commune La Serena. Questionnaires were applied on psychoemotional factors: kinesophobia, catastrophism and self-efficacy, and the variables of limitation of the functionality and intensity of pain. With the instruments: Tampa scale for kinesophobia (TSK 11), pain catastrophism scale (PCS), self-efficacy perception questionnaire, Oswestry functionality scale and analogous visual scale (EVA) respectively. Results: there was a relationship between the variables catastrophism - limitation of the functionality (rho=0,537, p<0,005), catastrophism - intensity of pain (rho=0,437, p=0,001), kinesophobia - limitation of the functionality (rho=0,418, p=0,002) and self-efficacy-limitation of the functionality (rho = - 0,518, p<0,005), these correlations being statistically significant (p<0,005). Discussion:tThe three psychoemotional factors are related to functionality. However, only catastrophism is related to pain intensity. Therefore, it is relevant that the physical therapist considers these factors in his therapeutic intervention, in order to focus the subsequent kinesthetic approach with a multidisciplinary vision and interaction.

Home-based exercise therapy for treating non-specific chronic low back pain

SUMMARY OBJECTIVE To evaluate pain, functional capacity, and quality of life of patients with non-specific chronic low back pain, after home-based exercise therapy with different kinds of supervision. METHOD Thirty individuals of both gender, between 18 and 65 years old, performed the proposed exercises three times a week, for eight weeks. Group A (N = 17) performed the exercises after a single supervised session. Group B (N = 13) was supervised once a week at the rehabilitation center. Both groups received a booklet with instructions, and questionnaires to evaluate pain, functional capacity and quality of life; during the initial evaluation, after four and eight weeks. RESULTS There was an improvement in pain and functional capacity between the initial evaluation and week 4, and the initial evaluation and week 8 in both groups (p <0.05). In the quality of life evaluation, the criteria for pain, functional capacity, and physical aspects had significant improvement after 8 weeks (p <0.05). There was no difference when comparing groups A and B (p >0,05). CONCLUSION Home-based exercise therapy, when performed in a period of eight weeks, using the booklet, was effective for improving level of pain, functional capacity, and quality of life in patients with non-specific chronic low back pain. The weekly supervision did not significantly influence the final outcome between the groups.

RESUMO OBJETIVO Avaliar dor, capacidade funcional e qualidade de vida de pacientes com dor lombar crônica inespecífica após terapia por exercícios domiciliares, com diferentes maneiras de supervisão. MÉTODO Trinta indivíduos de ambos os sexos, com idade entre 18 e 65 anos, apresentando dor lombar crônica inespecífica, realizaram os exercícios propostos três vezes por semana, durante oito semanas. Indivíduos do Grupo A (N=17) realizaram os exercícios após única sessão supervisionada. Já os indivíduos do Grupo B (N=13) foram supervisionados uma vez por semana no centro de reabilitação. Ambos receberam cartilha com orientações e questionários para avaliar dor, capacidade funcional e qualidade de vida; durante avaliação inicial, após quatro e oito semanas. RESULTADOS Houve melhora da dor e capacidade funcional entre as avaliações inicial e semana 4, e inicial e semana 8 nos dois grupos (p<0,05). Na avaliação de qualidade de vida (SF-36), os critérios de dor, capacidade funcional e aspectos físicos obtiveram melhora significativa após oito semanas (p<0,05). Não houve diferença significativa ao comparar os grupos (p>0,05). CONCLUSÃO A terapia por exercícios domiciliares, quando realizada num período de oito semanas, com auxílio da cartilha, foi eficaz para melhora da dor, capacidade funcional e qualidade de vida, em pacientes com dor lombar crônica inespecífica. A supervisão semanal não influenciou de forma significativa o resultado final quando comparados os grupos.

Chronic low back pain in patients with systemic lupus erythematosus: prevalence and predictors of back muscle strength and its correlation with disability / Lombalgia crônica em pacientes com lúpus eritematoso sistêmico: prevalência e preditores da força muscular de extensão de tronco e sua correlação com a incapacidade

Abstract Objective: To determine the prevalence of Chronic Low Back Pain and predictors of Back Muscle Strength in patients with Systemic Lupus Erythematosus. Methods: Cross-sectional study. Ninety-six ambulatory patients with lupus were selected by non-probability sampling and interviewed and tested during medical consultation. The outcomes measurements were: Point prevalence of chronic low back pain, Oswestry Disability Index, Tampa Scale of Kinesiophobia, Fatigue Severity Scale and maximal voluntary isometric contractions of handgrip and of the back muscles. Correlation coefficient and multiple linear regression were used in statistical analysis. Results: Of the 96 individuals interviewed, 25 had chronic low back pain, indicating a point prevalence of 26% (92% women). The correlation between the Oswestry Index and maximal voluntary isometric contraction of the back muscles was r = −0.4, 95% CI [−0.68; −0.01] and between the maximal voluntary isometric contraction of handgrip and of the back muscles was r = 0.72, 95% CI [0.51; 0.88]. The regression model presented the highest value of R 2 being observed when maximal voluntary isometric contraction of the back muscles was tested with five independent variables (63%). In this model handgrip strength was the only predictive variable (β = 0.61, p = 0.001). Conclusions: The prevalence of chronic low back pain in individuals with systemic lupus erythematosus was 26%. The maximal voluntary isometric contraction of the back muscles was 63% predicted by five variables of interest, however, only the handgrip strength was a statistically significant predictive variable. The maximal voluntary isometric contraction of the back muscles presented a linear relation directly proportional to handgrip and inversely proportional to Oswestry Index i.e. stronger back muscles are associated with lower disability scores.

Resumo Objetivo: Determinar a prevalência de lombalgia crônica (LBC) e os preditores de força muscular nas costas (FMC) em pacientes com lúpus eritematoso sistêmico (LES). Métodos: Estudo transversal. Selecionaram-se 96 pacientes ambulatoriais com LES por amostragem não probabilística, entrevistados e testados durante consultas médicas. As medidas de desfecho foram: prevalência ocasional de LBC, Índice de Incapacidade de Oswestry, Escala Tampa para Cinesiofobia, Escala de Gravidade da Fadiga e contrações isométricas voluntárias máximas (CIVM) de preensão manual e dos músculos das costas. Usaram-se o coeficiente de correlação e a regressão linear múltipla na análise estatística. Resultados: Dos 96 indivíduos entrevistados, 25 apresentavam LBC, o que indicou uma prevalência circunstancial de 26% (92% mulheres). A correlação entre o Índice de Incapacidade de Oswestry e a contração isométrica voluntária máxima dos músculos das costas foi de r = -0,4, IC 95% [-0,68; -0,01] e entre a CIVM de preensão manual e dos músculos das costas foi de r = 0,72, IC 95% [0,51; 0,88]. O modelo de regressão apresentou o maior valor de R2 observado quando a CIVM dos músculos das costas foi testada com cinco variáveis independentes (63%). Nesse modelo, a força de preensão manual foi a única variável preditiva (ß = 0,61, p = 0,001). Conclusões: A prevalência de LBC em indivíduos com LES foi de 26%. A CIVM dos músculos das costas foi 63% prevista por cinco variáveis de interesse. No entanto, apenas a força de preensão manual foi uma variável preditiva estatisticamente significativa. A CIVM dos músculos das costas apresentou uma relação linear diretamente proporcional à força de preensão manual e inversamente proporcional ao Índice de Incapacidade de Oswestry (ou seja, músculos das costas mais fortes estão associados a menores pontuações de incapacidade).

Effects of ozone on the pain and disability in patients with failed back surgery syndrome / Efeitos do ozônio na dor e na incapacidade em pacientes com síndrome dolorosa pós-laminectomia

Summary Introduction: Low back pain is one of the painful disorders of higher prevalence. It has several etiologies and surgery may be indicated in the presence of neurological deficits or compression syndromes. However, in up to 40% of cases, patients develop worsening of pain and failed back surgery syndrome (FBSS), which is an important cause of chronic pain with high morbidity and disability. In the last two decades, ozone has been shown to be a new therapeutic option for FBSS due to its analgesic and anti-inflammatory properties. Objective: To evaluate the effect of ozone therapy on pain and disability in patients with failed back surgery syndrome. Method: We selected 19 patients undergoing epiduroscopy and injection of ozone. Patients were evaluated preoperatively and 21 days after the procedure, using the following instruments: Visual Analogue Scale (VAS), Brief Pain Inventory, Roland-Morris Questionnaire Disability, Oswestry Disability Index (ODI), Neuropathic Pain Symptom Inventory and Douleur Neuropathique 4. Results: The patients showed significant pain relief, but no improvement was observed in the functional scales. Conclusion: Our results suggest that epidural ozone therapy can be a treatment option in FBSS to reduce the intensity of the pain.

Resumo Introdução: A dor lombar é um dos distúrbios dolorosos de maior prevalência. Tem diversas etiologias e, na presença de déficits neurológicos ou síndromes compressivas, pode ser indicada cirurgia. Entretanto, em até 40% dos casos os pacientes podem evoluir com piora da dor e síndrome dolorosa pós-laminectomia (SDPL), que se constitui em uma importante causa de dor crônica com grande morbidade e incapacidade. Nas últimas duas décadas, o ozônio tem se mostrado uma nova opção terapêutica para a SDPL em virtude das suas propriedades analgésicas e anti-inflamatórias. Objetivo: Avaliar o efeito da ozonioterapia na dor e na incapacidade de pacientes com SDPL. Método: Foram selecionados 19 pacientes, submetidos a epiduroscopia e aplicação de ozônio. Os pacientes foram avaliados no pré-operatório e 21 dias após o procedimento, por meio de Escala Visual Analógica, Inventário Breve de Dor, Questionário Roland-Morris de Incapacidade, Oswestry Disability Scale, Inventário de Sintomas de Dor Neuropática e Questionário de Dor Neuropática. Resultados: Os pacientes apresentaram redução significante nos escores das escalas de avaliação de dor; porém, essa redução não foi observada na avaliação da incapacidade funcional. Conclusão: Os dados obtidos sugerem que a ozonioterapia epidural pode ser uma opção de manejo da SDPL na diminuição da intensidade da dor.

The evolving role of physical therapists in the long-term management of chronic low back pain: longitudinal care using assisted self-management strategies

ABSTRACT Background Longitudinal studies have shown that the symptoms of chronic low back pain (CLBP) will follow an episodic trajectory characterized by periods of high and low pain intensity that can persist for many years. There is a growing belief that the contemporary approach of limiting physical therapy to short, but intense courses of treatment for (CLBP) may be sub-optimal because these limited “windows” of clinical care are not congruent with the natural history of this condition. Recent research has suggested that people with CLBP undergo substantial, and individualized long-term variations in the neural processing of nociception over time. This has led to the concept of a “unique biosignature of pain” that may explain much of the variation in a person’s clinical picture. These and other findings have led to the reconceptualization of CLBP as an individualized, and continually evolving condition that may be more suitably managed by empowering the patient toward self-management strategies that can be modified as needed over time by the PT. Objectives The purpose of this Master Class Paper is to describe an emerging approach for the treatment of CLBP that emphasizes the formation of a long-term therapeutic alliance between the patient and the PT with an emphasis on individualized, patient-preferred approaches for activity-based self-management as an alternative to the contemporary approach of short, intense episodes of care directed toward pain reduction. Conclusion Longitudinal care using assisted self-management strategies is more congruent with the natural history of CLBP than are traditional approaches for PT intervention. This approach may empower patients to undergo lifestyle changes that will favorably influence long-term outcomes; however additional research is needed.

Effectiveness of a healthy lifestyle intervention for low back pain and osteoarthritis of the knee: protocol and statistical analysis plan for two randomised controlled trials

ABSTRACT Background These trials are the first randomised controlled trials of telephone-based weight management and healthy lifestyle interventions for low back pain and knee osteoarthritis. This article describes the protocol and statistical analysis plan. Method These trials are parallel randomised controlled trials that investigate and compare the effect of a telephone-based weight management and healthy lifestyle intervention for improving pain intensity in overweight or obese patients with low back pain or knee osteoarthritis. The analysis plan was finalised prior to initiation of analyses. All data collected as part of the trial were reviewed, without stratification by group, and classified by baseline characteristics, process of care and trial outcomes. Trial outcomes were classified as primary and secondary outcomes. Appropriate descriptive statistics and statistical testing of between-group differences, where relevant, have been planned and described. Conclusions A protocol for standard analyses was developed for the results of two randomised controlled trials. This protocol describes the data, and the pre-determined statistical tests of relevant outcome measures. The plan demonstrates transparent and verifiable use of the data collected. This a priori protocol will be followed to ensure rigorous standards of data analysis are strictly adhered to.

Differences in pain perception, health-related quality of life, disability, mood, and sleep between Brazilian and Spanish people with chronic non-specific low back pain

ABSTRACT Background Cultural and social factors play an important role in the development and persistence of Low Back Pain (LBP). Nevertheless, there are few studies investigating differences in LBP features between countries. Objective To determine differences in pain perception between individuals with LBP living in Brazil and Spain. Method Thirty Spanish individuals and 30 age- and sex-comparable Brazilian individuals with LBP were recruited from the Public Health Services of both countries. The Numerical Pain Rating Scale and the pain rating index (PRI), the number of words chosen (NWC), and the present pain index (PPI) extracted from the McGill Pain Questionnaire were used to assess pain. The Oswestry Disability Index, the Short Form-36, Beck Depression Inventory-II, and Pittsburgh Sleep Quality Index were also applied. Differences between countries and the correlation between demographic and clinical variables in each country were assessed with parametric and the nonparametric tests. Results A significant Country by Gender interaction was found for the PRI total score (P=0.038), but not for intensity of pain, disability, PPI, or NWC, in which Spanish women exhibited greater pain ratio than Spanish men (P=0.014), and no gender differences were identified in Brazilians. The Spanish group showed a consistent pattern of correlations for clinical data. Within Brazilian patients, fewer correlations were found and all of the coefficients were lower than those in the Spanish group. Conclusion The pain perception in patients with LBP is different depending on the country. Within Spanish patients, LBP is considered a more global entity affecting multidimensional contexts.

Effect of a single session of ear acupuncture on pain intensity and postural control in individuals with chronic low back pain: a randomized controlled trial

ABSTRACT Background Ear Acupuncture (EA) is a form of acupuncture in which needles are applied to the external ear and has been used in multiple painful conditions. Low back pain (LBP) is highly prevalent in active individuals and causes high economic burden to health systems worldwide. LBP affects the person’s ability to keep balance, especially in challenging conditions. Objective The aim of the study was to examine the effects of a single session of EA on pain intensity and body sway during postural tasks. Method Eighty adults with LBP and pain intensity equal to or greater than 4 (0-10 scale) were randomly allocated (1:1) to EA group (EAG) or placebo group (PG). Initially, the level of pain intensity was assessed. Next, participants stood still on a force plate either with feet in parallel or in semi-tandem and with eyes open or closed. Then, the EAG was treated with EA for 20 min and the PG was treated with detuned ultrasound. After the treatment, pain intensity was assessed again and the postural test was repeated. Pain intensity was the primary outcome and center of pressure sway area and speed were the secondary outcomes measured. Results Results revealed that pain intensity decreased in both groups after treatment, but decreased more in the EAG. For postural control, no effect of treatment and no interaction between treatment and postural condition on body sway were found. Conclusion Those findings indicate that EA is better than placebo to reduce pain, but neither treatment has any effect on postural control.

Efficacy of Anti-NaV1.7 Antibody on the Sensory Nervous System in a Rat Model of Lumbar Intervertebral Disc Injury

PURPOSE: The pathophysiology of discogenic low back pain is not fully understood. Tetrodotoxin-sensitive voltage-gated sodium (NaV) channels are associated with primary sensory nerve transmission, and the NaV1.7 channel has emerged as an analgesic target. Previously, we found increased NaV1.7 expression in dorsal root ganglion (DRG) neurons innervating injured discs. This study aimed to examine the effect of blocking NaV1.7 on sensory nerves after disc injury. MATERIALS AND METHODS: Rat DRG neurons innervating the L5/6 disc were labeled with Fluoro-Gold (FG) neurotracer. Twenty-four rats underwent intervertebral disc puncture (puncture group) and 12 rats underwent sham surgery (non-puncture group). The injury group was divided into a saline infusion group (puncture+saline group) and a NaV1.7 inhibition group, injected with anti-NaV1.7 antibody (puncture+anti-NaV1.7 group); n=12 per group. Seven and 14 days post-surgery, L1 to L6 DRGs were harvested and immunostained for calcitonin gene-related peptide (CGRP) (an inflammatory pain marker), and the proportion of CGRP-immunoreactive (IR) DRG neurons of all FG-positive neurons was evaluated. RESULTS: The ratio of CGRP-IR DRG neurons to total FG-labeled neurons in the puncture+saline group significantly increased at 7 and 14 days, compared with the non-puncture group, respectively (p<0.05). Application of anti-NaV1.7 into the disc significantly decreased the ratio of CGRP-IR DRG neurons to total FG-labeled neurons after disc puncture at 7 and 14 days (40% and 37%, respectively; p<0.05). CONCLUSION: NaV1.7 antibody suppressed CGRP expression in disc DRG neurons. Anti-NaV1.7 antibody is a potential therapeutic target for pain control in patients with lumbar disc degeneration.

Quality of life, school backpack weight, and nonspecific low back pain in children and adolescents / Qualidade de vida, peso das mochilas escolares e lombalgia não específica em crianças e adolescentes

OBJECTIVES: To describe the degree of disability, anthropometric variables, quality of life (QoL), and school backpack weight in boys and girls aged 11-17 years. The differences in QoL between those who did or did not report low back pain (LBP) were also analyzed. METHODS: Eighty-six girls (13.9 ± 1.9 years of age) and 63 boys (13.7 ± 1.7 years of age) participated. LBP was assessed by questionnaire, and disability using the Roland-Morris Disability Questionnaire. QoL was assessed by the Pediatric Quality of Life Inventory (PedsQL). Multivariate analyses of variance and covariance were used to assess differences between groups. RESULTS: Girls reported higher disability than boys (p = 0.01), and lower QoL in the domains of physical (p < 0.001) and emotional functioning (p < 0.01), psychosocial health (p = 0.02) and physical health summary score (p < 0.001), and on the total PedsQL score (p < 0.01). School backpack weight was similar in both genders (p = 0.61) and in participants with and without LBP (p = 0.15). After adjustments, participants with LBP reported lower physical functioning (p < 0.01), influencing lower physical health summary score (p < 0.01). CONCLUSIONS: Girls had higher disability and lower QoL than boys in the domains of physical and emotional functioning, psychosocial health, and physical health summary scores, and on the total PedsQL score; however, similar school backpack weight was reported. Participants with LBP revealed lower physical functioning and physical health summary score, yet had similar school backpack weight to those without LBP. .

OBJETIVOS: Descrever o grau de incapacidade, as variáveis antropométricas, a qualidade de vida (QV) e o peso das mochilas escolares em meninos e meninas com 11-17 anos. Também são analisadas as diferenças na QV entre os que relataram ou não lombalgia (LBP). MÉTODOS: 86 meninas (13,9 ± 1,9 anos) e 63 meninos (13,7 ± 1,7 anos) participaram. A LBP foi avaliada por um questionário e a incapacidade pelo Questionário Roland-Morris. A QV foi avaliada pelo Questionário Pediátrico sobre Qualidade de Vida (PedsQL). As análises de variância e de covariância multivariadas foram usadas para avaliar as diferenças entre os grupos. RESULTADOS: As meninas relataram maior incapacidade do que os meninos (p = 0,01) e menor QV nos domínios de funcionamento físico (p < 0,001) e emocional (p < 0,01), no escore sumário de saúde psicossocial (p = 0,02) e saúde física (p < 0,001) e no escore total no PedsQL (p < 0,01). O peso das mochilas escolares era semelhante para ambos os sexos (p = 0,61) e para os participantes com e sem LBP (p = 0,15). Após ajustes, os participantes com LBP relataram menor funcionamento físico (p < 0,01), o que influenciou um menor escore sumário de saúde física (p < 0,01). CONCLUSÕES: As meninas tiveram maior incapacidade e menor QV do que os meninos nos domínios de funcionamento físico e emocional, nos escores sumários de saúde psicossocial e física e no escore total no PedsQL; contudo, foi relatado um peso semelhante das mochilas escolares. Os participantes com LBP revelaram menor funcionamento físico e escore sumário de saúde física, mesmo carregando mochilas escolares de mesmo peso do que aqueles sem LBP. .

Associations between low back pain, urinary incontinence, and abdominal muscle recruitment as assessed via ultrasonography in the elderly

Background: Low back pain (LBP) and urinary incontinence (UI) are highly prevalent among elderly individuals. In young adults, changes in trunk muscle recruitment, as assessed via ultrasound imaging, may be associated with lumbar spine stability. Objective: To assess the associations between LBP, UI, and the pattern of transversus abdominis (TrA), internal (IO), and external oblique (EO) muscle recruitment in the elderly as evaluated by ultrasound imaging. Method: Fifty-four elderly individuals (mean age: 72±5.2 years) who complained of LBP and/or UI as assessed by the McGill Pain Questionnaire, Incontinence Questionnaire-Short Form, and ultrasound imaging were included in the study. The statistical analysis comprised a multiple linear regression model, and a p-value <0.05 was considered significant. Results: The regression models for the TrA, IO, and EO muscle thickness levels explained 2.0% (R2=0.02; F=0.47; p=0.628), 10.6% (R2=0.106; F=3.03; p=0.057), and 10.1% (R2=0.101; F=2.70; p=0.077) of the variability, respectively. None of the regression models developed for the abdominal muscles exhibited statistical significance. A significant and negative association (p=0.018; β=-0.0343) was observed only between UI and IO recruitment. Conclusion: These results suggest that age-related factors may have interfered with the findings of the study, thus emphasizing the need to perform ultrasound imaging-based studies to measure abdominal muscle recruitment in the elderly. .

Tratamiento de síndrome de espalda fallida con nucleolisis percutánea más bloqueo peridural y foraminal con ozonoterapia / Treatment of failed back syndrome with percutaneous nucleolisis and Epidural, foraminal Block with oxygen-ozone

Se realiza estudio prospectivo para demostrar que la nucleolisis percutánea, más el bloqueo peridural y foraminal con ozonoterapia es efectiva y muy segura para disminuir el dolor producido por síndrome de espalda fallida. Material y método: previo consentimiento informado, a 45 pacientes con síndrome de espalda fallida, se les realizó un total de 45 nucleolisis percutáneas, más bloqueo peridural y foraminal con ozonoterapia, durante un periodo comprendido entre mayo 2012 a mayo del 2013. Todas las nucleolisis se realizaron bajo control fluoroscopio con medidas de asepsia y antisepsia estrictas, y sedación consciente. A todos los pacientes, se les administró ozono en disco, peridural y foraminal (5-10 ml) a 10ug/ml, más procaina al 2% y 1cc de 40mg de cristales esteroideos; en todos los casos se administró 1gr. de cefacidal como profilaxis. Discusión: La eficacia del tratamiento, se basa en el control del dolor según la escala visual analógica basal (EVA 0), a los 30 días (EVA 1), a los seis meses (EVA 3) y a los 12 meses (EVA 6). Se aplicó el test de oswestry, antes del tratamiento y al final del estudio; a todos los pacientes se les realizo encuesta en la primera consulta, y luego al final del tratamiento con una respuesta satisfactoria(AU)

This prospective study is to demonstrate that percutaneous nucleolisys and epidural, foraminal block with oxygen-ozone is effective and very safe to decrease the pain from failed back syndrome. Materials and Methods: previous reported 45 patients with failed back syndrome consent to a total of 45 percutaneous nucleolisys more and foraminal Epidural blockade with ozone therapy was conducted over a period from May 2012 to May 2013 all nucleolisys were performed under fluoroscopic control measures strict asepsis and antisepsis, conscious sedation. All patients were administered ozone in disk, epidural and foraminal (5-10 ml) at 10 ug / ml over 2% procaine more steroidal 1cc 40mg of crystals, in all cases of cefaolin sodium 1grs administered prophylactically. Discution: The effectiveness of treatment is based on pain control by baseline visual analog scale (EVA 0), 30 days (EVA 1), six (EVA 3) and 12 months (EVA 6). By oswestry test evaluated before treatment and at study end; all patients were conducted survey in the first query and then at the end of treatment with satisfactory response