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.

Metabolic transformation of dinophysistoxin-3 into dinophysistoxin-1 causes human intoxication by consumption of O-acyl-derivatives dinophysistoxins contaminated shellfish.

This paper describes for the first time a massive intoxication episode due to consumption of shellfish contaminated with 7-O-acyl-derivative dinophysistoxin-1, named Dinophysistoxin-3 (DTX-3). 7-O-acyl-derivative dinophysistoxin-1, a compound recently described in the literature, was found in shellfish samples collected in the Chilean Patagonia fjords. This compound does not inhibit Protein Phosphatases and also does not elicit the symptoms described for Diarrheic Shellfish Poisoning (DSP). The data showed here, give evidence of metabolic transformation of 7-O-acyl-derivative dinophysistoxin-1 (DTX-3) into Dinophysistoxin-1 (DTX-1, Methyl-Okadaic acid) in intoxicated patients. This metabolic transformation is responsible for the diarrheic symptoms and the intoxication syndrome showed by patients that consumed contaminated shellfish, which showed only the presence of 7-O-acyl-derivative dinophysistoxin-1. Patients fecal bacterial analysis for the presence of enteropathogens was negative and the mouse bioassay for DSP, performed as described for regulatory testing, was also negative. The HPLC-FLD and HPLC-MS analysis showed only the presence of DTX-3 as the only compound associated to DSP toxins in the contaminated shellfish samples. No other DSP toxins were found in the shellfish sample extracts. However, the patient fecal samples showed DTX-1 as the only DSP toxins detected in fecal. Moreover, the patient fecal samples did not show DTX-3. Since 7-O-acyl-derivative dinophysistoxin-1 (DTX-3) was the only compound associated to DSP toxins detected in the shellfish samples, an explanation for the diarrheic symptoms in the intoxicated patients would be the metabolic transformation of DTX-3 into DTX-1. This transformation should occur in the stomach of the poisoned patients after consuming 7-O-acyl-derivatives dinophysistoxin-1 (DTX-3) contaminated bivalves.