Relato de caso de lombalgia inflamatória com extenso comprometimento anatômico-funcional: a importância de uma adequada abordagem da dor lombar na Atenção Primária à Saúde / Case report of inflammatory low back pain with extensive anatomical-functional impairment: The importance of an adequate approach to low back pain in Primary Care / Presentación de un caso de lumbalgia inflamatoria con afectación anatómico-funcional extensa: La importancia de un abordaje adecuado de la lumbalgia en Atención Primaria de Salud

Introdução: A lombalgia é uma condição prevalente e que apresenta importante impacto na capacidade funcional e na qualidade de vida, sendo a sua correta abordagem na Atenção Primária à Saúde fundamental para a identificação e o estabelecimento de um diagnóstico etiológico precoce de possíveis patologias que possam estar relacionadas a desfechos mórbidos e a graves limitações funcionais. Apresentação do caso: Paciente de 56 anos, sexo masculino, hipertenso, foi encaminhado para serviço especializado de reumatologia com histórico de lombalgia havia mais de 20 anos. Ao exame físico foi constatada presença de deformidades da coluna vertebral e extensa limitação de movimentos. Exames radiográficos mostravam esclerose de articulações sacroilíacas, osteopenia difusa e coluna vertebral em aspecto de "bambu". Conclusões: Constata-se a importância de que na abordagem das lombalgias na atenção primária se busque o reconhecimento de possíveis etiologias graves e potencialmente incapacitantes que possam estar subjacentes à queixa de dor lombar. Com esse objetivo, é fundamental o reconhecimento das chamadas red flags relacionadas às lombalgias, além de sua caracterização como mecânica ou inflamatória. Perante a atuação da atenção primária no oferecimento de um cuidado pautado na integralidade e na prevenção de agravos, reafirma-se a importância de uma avaliação clínica pormenorizada das lombalgias nesse nível de atenção à saúde.

Introduction: Low back pain is a prevalent condition that has an important impact on functional capacity and quality of life, and its correct approach in Primary Care is fundamental to the identification and establishment of an early etiological diagnosis of possible pathologies that may be related to outcomes morbid conditions and serious functional limitations. Case presentation: 56-year-old male patient, hypertensive, referred to a specialized rheumatology service with a history of low back pain for over 20 years. Physical examination revealed the presence of spinal deformities and extensive movement limitations. Radiographic examinations showing sclerosis of the sacro-iliac joints, diffuse osteopenia and a "bamboo" appearance of the spine. Conclusions: It is important that in the approach of low back pain in Primary Care, we seek to recognize possible serious and potentially disabling etiologies that may underlie the complaint of low back pain. For that, it is essential to recognize the so-called "red flags" related to low back pain, in addition to its characterization as mechanical or inflammatory. Given the role of Primary Care in offering care based on integrality and in the prevention of injuries, the importance of a detailed clinical assessment of low back pain at this level of health care is reaffirmed.

Introducción: La lumbalgia es una patología prevalente que tiene un impacto importante en la capacidad funcional y la calidad de vida, y su correcto abordaje en Atención Primaria de Salud es fundamental para la identificación y establecimiento de un diagnóstico etiológico precoz de posibles patologías que puedan estar relacionadas con los resultados, condiciones morbosas y limitaciones funcionales graves. Presentación del caso: Paciente masculino de 56 años, hipertenso, remitido a servicio especializado de reumatología con antecedentes de dolor lumbar de más de 20 años. El examen físico reveló la presencia de deformidades de la columna y amplias limitaciones de movimiento. Los exámenes radiológicos muestran esclerosis de las articulaciones sacroilíacas, osteopenia difusa y una apariencia de "bambú" de la columna. Conclusiones: Es importante que al abordar la lumbalgia en Atención Primaria de Salud busquemos reconocer las posibles etiologías graves y potencialmente incapacitantes que pueden subyacer a la queja de lumbalgia. Con este objetivo, es fundamental reconocer las llamadas "banderas rojas" relacionadas con la lumbalgia, además de su caracterización como mecánica o inflamatoria. Dado el papel de Atención Primaria de Salud a la hora de ofrecer una atención basada en la integralidad y prevención de enfermedades, se reafirma la importancia de una evaluación clínica detallada de la lumbalgia en este nivel de atención sanitaria.

Comparison of US elastography and chemical shift magnetic resonance imaging in multifidus muscle fatty degeneration.

OBJECTIVE: The purpose of this study was to investigate the feasibility of the use of shear wave elastography (SWE) in comparison to chemical shift encoding (CSE) magnetic resonance imaging (MRI) for the evaluation of multifidus muscle fatty degeneration in patients with chronic low back pain. METHOD: Multifidus muscles were evaluated with the CSE-MRI and SWE examinations in control and patient groups. With the in-phase and out-phase sequences in CSE-MRI, signal intensity index (SII), and signal intensity suppression ratio (SISR) values; with the SWE method, shear wave velocity values were determined. Differences in the mean values of these parameters per level and study group were analyzed by Student's t-test. RESULTS: SWE revealed significantly lower stiffness at the L2-3 level, consistent with the signal index values (SII-SISR) showing increased fatty infiltration on MRI in the patient group. No such relationship was found at the L4-5 level or in control group. CONCLUSIONS: SWE may be a promising method to show muscle fatty infiltration at L2-3 level in patients with chronic low back pain.

OBJETIVO: Investigar la viabilidad del uso de la elastografía de ondas de corte en comparación con la resonancia magnética con codificación de desplazamiento químico (RM-CDQ) para la evaluación de la degeneración grasa del músculo multífido en pacientes con dolor lumbar crónico. MÉTODO: Los músculos multífidos se evaluaron con RM-CDQ y elastografía de ondas de corte en los grupos de control y de pacientes. Se consideraron las secuencias en fase y fuera de fase en RM-CDQ, y los valores del índice de intensidad de señal y del índice de supresión de intensidad de señal; con el método de elastografía de ondas de corte se determinaron los valores de velocidad de onda de corte. Las diferencias en los valores medios de estos parámetros por nivel y por grupo de estudio se analizaron mediante la prueba t de Student. RESULTADOS: La elastografía de ondas de corte reveló una rigidez significativamente menor en el nivel L2-3, consistente con los valores de los índices de señal que muestran una mayor infiltración grasa en la RM en el grupo de pacientes. No se encontró tal relación en el nivel L4-5 ni en el grupo de control. CONCLUSIONES: La elastografía de ondas de corte puede ser un método prometedor para mostrar la infiltración grasa muscular a nivel L2-3 en pacientes con dolor lumbar crónico.

Effects of osteopathic manipulative treatment associated with transcranial direct current stimulation in individuals with chronic low back pain: A double-blind, randomised placebo-controlled trial.

OBJECTIVE: To evaluate the effectiveness of osteopathic manipulative treatment (OMT) associated with transcranial direct current stimulation (tDCS) in reducing pain, disability, and improving quality of life in participants with non-specific chronic low back pain. DESIGN: A randomised double-blind clinical trial. SETTING: Clinical outpatient unit. SUBJECTS: 72 participants with non-specific chronic low back pain were randomised into three groups: active tDCS + OMT (n = 24), sham tDCS + sham OMT (n = 24), and sham tDCS + OMT (n = 24). INTERVENTIONS: Evaluations were performed before, after the intervention, and one month post-intervention. tDCS consisted of ten 20-minute sessions over two weeks (five sessions per week). OMT was administered once per week, with two sessions conducted before the first and sixth tDCS sessions. MAIN MEASURES: Pain, disability, and quality of life were assessed at baseline, after two weeks, and at one month of follow-up. RESULTS: The visual analogue scale showed a significant decrease in all groups (p < 0.001). However, tDCS + OMT and sham tDCS + OMT demonstrated a clinically significant reduction compared to the sham combination (effect size n² = 0.315). Roland-Morris scores decreased across all groups without specific group effects. EuroQoL 5-Dimension 3-Level improvement was observed only in the tDCS + OMT and sham tDCS + OMT groups (significant difference between T2 and T0, p = 0.002). CONCLUSION: The combination of OMT and tDCS did not provide clinically significant improvement over OMT alone in participants with non-specific chronic low back pain.

Optimal days of application of kinesiotaping for the treatment of lumbo-pelvic pain during pregnancy. A systematic review and dose-response meta-analysis.

OBJECTIVE: To determine the optimal dose and short-term effectiveness of kinesiotaping (KT) on pain intensity and disability in pregnant women with lumbo-pelvic pain. DATA SOURCES: MEDLINE (via PubMed Central), CINAHL, Epistemonikos, Scopus, and Web of Science from inception to 21st March 2023. STUDY SELECTION: We included randomized controlled trials (RCT) conducted on pregnant women with lumbo-pelvic pain treated with KT. DATA EXTRACTION: The outcomes included pain intensity and disability. ROB-2 and GRADE were used to assess the risk of bias and the certainty of the evidence, respectively. A random effects meta-analysis was performed using the standardized mean difference (SMD) and the corresponding 95% confidence interval (CI). The dose-response association was evaluated using a restricted cubic spline model. DATA SYNTHESIS: Seven RCTs involving 527 patients were included. Meta-analysis revealed a statistically significant effect in favor of KT on pain intensity (SMD = -1.71; 95% CI = -2.51 to -0.90; P = <0.001) and on disability (SMD = -1.15; 95% CI = -2.29 to -0.02; P = <0.001). The total duration of KT use ranged from 5 to 35 days. It was estimated that a dose of 5-10 days exceeded the minimal clinically important difference (MCID) for pain intensity (mean difference at 10 days = -2.63; 95% CI = -3.05 to -2.22). Low certainty of evidence was identified for both outcomes. CONCLUSIONS: In pregnant women with lumbo-pelvic pain, the use of KT for 5 to 10 days produces a short-term reduction in pain intensity that exceeds the MCID, with a low certainty of evidence. SYSTEMATIC REVIEW REGISTRATION NUMBER: Systematic Review Registration Number PROSPERO CRD42023388174. CONTRIBUTION OF PAPER.

Replacing sedentary time or light physical activity with moderate physical activity is associated with a lower prevalence of back pain: a cross-sectional study using isotemporal analysis: Isotemporal substitution and LBP prevalence.

BACKGROUND: Evidence shows that lack of physical activity and sedentary time are associated with higher prevalence of low back pain (LBP). OBJECTIVE: To investigate the association between replacing sedentary time and light physical activity with a higher physical activity level with the prevalence of LBP. METHODS: Two hundred and sixty-six individuals from a city in southeastern Brazil were recruited to this cross-sectional study. Sedentary behavior and physical activity level were evaluated using an ActiGraph GT3X tri-axial accelerometer during 7 days. The prevalence of LBP was assessed using the Nordic questionnaire. Isotemporal substitution using logistic regression analyses were performed to investigate the association between replacing an activity with another in the prevalence of LBP. RESULTS: Replacing time spent in sedentary behavior with moderate physical activity slightly reduced the prevalence of LBP (odds ratio [OR]= 0.97; 95% CI: 0.95, 0.98). In addition, replacing time spent in light physical activity with moderate physical activity also slightly reduced the prevalence of LBP (OR= 0.97; 95% CI: 0.95, 0.98). There was no association for replacing sedentary time and light or moderate physical activity with vigorous physical activity on the prevalence of LBP. CONCLUSIONS: The results suggest a small protective effect for LBP when replacing time in sedentary activities or light physical activity with moderate physical activity.

Efficacy of antidepressants in the treatment of chronic nonspecific low back pain: a systematic review and meta-analysis.

Aim: This study reassesses the efficacy and safety of antidepressants in treating nonspecific chronic low back pain (NCLBP).Materials & methods: A systematic review was conducted following PRISMA guidelines, including randomized clinical trials (RCTs) from PubMed, Embase, Scopus, LILACS, SciELO and Cochrane CENTRAL, published through August 2024. Studies compared antidepressants with placebo or active comparators. The primary outcomes were pain relief and quality of life. Protocol registration: www.crd.york.ac.uk/prospero identifier is CRD42023307516.Results: Nine RCTs involving 1758 patients were analyzed. The antidepressants examined included duloxetine, escitalopram, bupropion, amitriptyline, imipramine and desipramine. Duloxetine 60 mg significantly reduced pain (MD = -0.57; 95% CI = -0.78 to -0.36) and improved quality of life compared with placebo, with side effects that were generally tolerable. Notably, higher doses of duloxetine (120 mg) were associated with an increase in adverse events. However, other antidepressants like amitriptyline and escitalopram demonstrated only modest or inconsistent effects.Conclusion: Duloxetine at 60 mg provides consistent pain relief and improves the quality of life in NCLBP, but higher doses increase adverse events. Escitalopram might offer modest benefits but should be considered a third-line treatment. Other antidepressants, such as amitriptyline, bupropion, imipramine and desipramine, have limited evidence supporting their efficacy and are associated with adverse effects.

Chronic lower back pain is a condition that persists for a long time and can be difficult to manage. While the exact cause isn't always clear, it affects many people and can be difficult to manage. Doctors sometimes prescribe antidepressants, which are typically used for treating depression, but they may also help to reduce pain by influencing how the brain processes it.In this paper, we examined several studies to determine whether these antidepressants are effective in treating chronic lower back pain. We analyzed nine studies involving 1758 participants who were treated with different medications: bupropion, duloxetine, escitalopram, amitriptyline, imipramine and desipramine.Among these medications, duloxetine stood out as the most effective. It not only helped to relieve pain but also improved the participants' ability to carry out daily activities. Additionally, duloxetine had fewer side effects than some of the other medications, although it can still cause mild issues such as nausea.In conclusion, duloxetine appears to be a promising option for managing chronic lower back pain, as long as the appropriate dosage is used to balance pain relief and side effects.

The Patient Specific Functional Scale - Brazil as an instrument for the functional assessment of patients with chronic non-specific low back pain: Construct validity (hypothesis testing and structural validity) and test-retest reliability.

The objective was to assess the validity and reliability of the Patient-Specific Functional Scale-Brazil (PSFS-B) in patients with non-specific chronic low back pain. A methodological study was conducted, and 101 volunteers with chronic non-specific low back pain were interviewed and asked to complete the PSFS-B questionnaire and the Oswestry Disability Index-Brazil 2.0 reference questionnaire. The Oswestry Disability Index-Brazil 2.0 is a standardized tool used to assess functional disability of the lumbar spine. A new assessment (follow-up) was conducted one week later using the same instruments. The COSMIN checklist was utilized as a guide. Two questionnaires were employed to assess patients: the Patient-Specific Functional Scale-Brazil (PSFS-Br) and the Oswestry Disability Index-Brazil 2.0 (ODI-Br). Data were analyzed to assess construct validity (hypothesis testing and structural validity), internal consistency, and test-retest reliability. The statistical methods employed included Pearson's correlation coefficient, confirmatory factorial analysis, Cronbach's alpha, and intraclass correlation coefficient. The results of the Patient-Specific Functional Scale-Brazil demonstrated a moderate negative correlation with the ODI-Br in hypothesis testing (r = -0.691 and r = -0.754) and in structural validity (Comparative Fit Index (0.986), Tucker-Lewis Index (0.958), Root Mean Square Error of Approximation (0.194), and Standardized Root Mean Square Residual (0.134). Furthermore, the instrument demonstrated excellent internal consistency (α = 0.951) and test-retest reliability (intraclass correlation coefficient = 0.978), and was additionally validated by the Bland-Altman plot (0.125). In conclusion, the Patient-Specific Functional Scale-Brazil is a valid and reliable tool for the evaluation and follow-up of patients with non-specific chronic low back pain.

Effectiveness of Pilates compared with home-based exercises in individuals with chronic non-specific low back pain: Randomised controlled trial.

OBJECTIVE: To investigate the effectiveness of a Pilates exercise program compared with home-based exercises in individuals with chronic non-specific low back pain. DESIGN: A randomised controlled trial with a six-month follow-up. SETTING: Rehabilitation clinic. PARTICIPANTS: One hundred and forty-five individuals (18-50 years of age) with low back pain for ≥ 12 consecutive weeks were enrolled and randomly allocated to either Pilates (n = 72) or home-based exercise groups (n = 73). INTERVENTIONS: Method Pilates (Mat Pilates exercises using accessories) versus home-based exercise (postural exercises, muscle stretching and strengthening, and spine stabilisation/mobilisation), twice a week, for 6 weeks. MAIN MEASURES: Assessments were performed at baseline, post-intervention, and six months follow-up. Outcomes were pain intensity, disability, and health-related quality of life. RESULTS: At post-intervention, the Pilates group had significantly lower pain intensity (mean difference = -1.14; 95% CI -2.05; -0.23), less disability (mean difference = -6.7; 95% CI -11.3; -2.0), and higher health-related quality of life (mean difference = 0.102; 95% CI 0.054; 0151) compared to the home-based exercise group. At follow-up, the Pilates group had a significantly higher health-related quality of life (mean difference = 0.055; 95% CI 0.003; 0.106) compared with the home-based exercise group but there were no significant differences in pain and disability. A significant overall effect of Pilates compared to home-based exercise was found for disability (mean difference = -4.4; 95% CI -7.6; -1.1), and health-related quality of life (mean difference = 0.049; 95% CI 0.022; 0.076), but not for pain. CONCLUSION: Although Pilates was significantly superior to home exercise for pain and disability, the differences were not considered clinically relevant. However, Pilates did provide significant and clinically relevant differences in utility.

Exercises for the prevention of non-specific low back pain.

OBJECTIVES: This is a protocol for a Cochrane Review (intervention). The objectives are as follows: To evaluate the effects of exercise alone or exercise plus education compared with inactive control or education alone to prevent non-specific LBP.

Perceptions of medical doctors and patients about imaging for people with low back pain: A qualitative study.

BACKGROUND: Low-value care is the use of substitutive/ineffective/harmful strategies based on available evidence, and it is considered one of the main contributors to the burden related to low back pain in health care systems. The use of routine imaging for patients with low back pain is the main example of inappropriate care. Therefore, understanding the perceptions of medical doctors and patients from Brazil about this practice may help propose strategies to reduce imaging rates. OBJECTIVE: To investigate the perceptions of medical doctors and patients about imaging for the diagnosis of nonspecific low back pain. DESIGN: A qualitative study using the framework analysis method. SETTINGS: Primary and secondary care. PARTICIPANTS: Fifteen patients with low back pain and 15 doctors participated in this study. DATA COLLECTION: Sociodemographic data were collected from all participants, and the interviews were performed using a set of questions created based on the literature. MAIN RESULTS: Patients and doctors believe that the main reason for ordering imaging tests is to identify the source of pain, and imaging could be useful for tracking disease progression over time or if there is a lack of improvement after treatment. Patients' expectations and pressures play a role in the decision to order imaging tests, but clinicians believe that education is the preferred strategy to reduce imaging rates. CONCLUSION: Identifying the source of pain, tracking the disease progression, and patients' expectations and pressures were the main drivers of imaging requests for low back pain. Educational strategies were suggested to reduce the use of routine imaging.

One spinal manipulation session reduces local pain sensitivity but does not affect postural stability in individuals with chronic low back pain: a randomised, placebo-controlled trial.

BACKGROUND: Clinical practice guidelines recommend spinal manipulation for patients with low back pain. However, the effects of spinal manipulation have contradictory findings compared to placebo intervention. Therefore, this study investigated the immediate effects of lumbar spinal manipulation on pressure pain threshold (PPT) and postural stability in people with chronic low back pain (cLBP). Second, we investigated the immediate effect of lumbar spinal manipulation on pain intensity and the interference of the participant beliefs about which treatment was received in the PPT, postural stability, and pain intensity. METHODS: A two-arm, randomised, placebo-controlled, double-blind trial was performed. Eighty participants with nonspecific cLPB and a minimum score of 3 on the Numeric Pain Rating Scale received one session of lumbar spinal manipulation (n = 40) or simulated lumbar spinal manipulation (n = 40). Primary outcomes were local and remote PPTs and postural stability. Secondary outcomes were pain intensity and participant's perceived treatment allocation. Between-group mean differences and their 95% confidence intervals (CIs) estimated the treatment effect. One-way analysis of covariance (ANCOVA) was performed to assess whether beliefs about which treatment was received influenced the outcomes. RESULTS: Participants had a mean (SD) age of 34.9 (10.5) years, and 50 (62.5%) were women. Right L5 [between-group mean difference = 0.55 (95%CI 0.19 to 0.90)], left L5 [between-group mean difference = 0.45 (95%CI 0.13 to 0.76)], right L1 [between-group mean difference = 0.41 (95%CI 0.05 to 0.78)], left L1 [between-group mean difference = 0.57 (95%CI 0.15 to 0.99)], left DT [between-group mean difference = 0.35 (95%CI 0.04 to 0.65)], and right LE [between-group mean difference = 0.34 (95%CI 0.08 to 0.60)] showed superior treatment effect in the spinal manipulation group than sham. Neither intervention altered postural stability. Self-reported pain intensity showed clinically significant decreases in both groups after the intervention. A higher proportion of participants in the spinal manipulation group achieved more than two points of pain relief (spinal manipulation = 90%; sham = 60%). The participants' perceived treatment allocation did not affect the outcomes. CONCLUSION: One spinal manipulation session reduces lumbar pain sensitivity but does not affect postural stability compared to a sham session in individuals with cLPB. Self-reported pain intensity lowered in both groups and a higher proportion of participants in the spinal manipulation group reached clinically significant pain relief. The participant's belief in receiving the manipulation did not appear to have influenced the outcomes since the adjusted model revealed similar findings.

Risk of unfavorable pain prognosis impacts walking physiomechanical parameters and psychophysiological workload in sufferers of chronic low back pain.

BACKGROUND: Tolerating physical tasks depends not only on task-specific characteristics but also on an individual's psychophysiological capacity to respond to the imposed load. People suffering from chronic low back pain (CLBP) may experience reduced psychophysiological capacity and are at risk for poor pain prognosis, which could lead to an increased walking workload. AIM: To investigate how the risk of unfavorable pain prognosis in CLBP can impact walking physiomechanical parameters and psychophysiological workload. METHODS: A cross-sectional observational study. The study classified 74 volunteers into four groups based on their prognosis for pain: pain-free control (CG/n = 20), low (LrG/n = 21), medium (MrG/n = 22), and high (HrG/n = 11) risk of poor prognosis for CLBP. The ground assessments identified the self-selected (SSW) and optimal (OWS) walking speeds, as well as the locomotor rehabilitation index (LRI). Treadmill assessments were conducted at two different speeds (0.83 and 1.11 m s-1, SSW and OWS) to record physiomechanical parameters. Psychophysiological workloads during walking were measured via workload impulse for the session (TRIMP), determined by variations in heart rate. RESULTS: CLBP groups exhibited slower SSW and lower LRI compared to the CG. The TRIMP was lower in the LrG. However, both MrG and HrG exhibited a comparable overload to the CG, even while walking at a lower intensity with a psychophysical demand. SSW and OWS displayed an increased TRIMP compared to fixed speeds. CONCLUSION: Psychosocial factors may affect SSW in people with CLBP but not among the risk strata. An unfavorable prognosis for pain could jeopardize the psychophysiological capacity to withstand walking demands.

Effects of a mat Pilates-based exercise program for low back pain in helicopter pilots of the Brazilian Air Force: Randomized controlled trial.

INTRODUCTION: Helicopter pilots may present chronic low back pain due to vibration exposure and asymmetric posture during flight. OBJECTIVES: To analyze the effects of a Pilates-based exercise program on low back pain of helicopter pilots of the Brazilian Air Force. METHODS: This is a randomized controlled trial with fifteen helicopter pilots of the Brazilian Air Force, who were assessed for pain intensity (Numerical Pain Rating Scale), disability associated with low back pain, and spine muscle endurance in three positions: trunk extension (Ito test) and left and right lateral bridge. Individuals were randomly distributed into the regular exercises group (REG) (n = 7), oriented to maintain their exercise routine, and Pilates group (PG) (n = 8), which performed an exercise program based on Pilates method twice a week for 12 weeks. Reassessments occurred after 6 and 12 weeks. Data were analyzed on SPSS 20.0 software using a significance level of 5%. RESULTS: PG showed a significant reduction in low back pain after 12 weeks of training compared with REG (mean difference of 3.5 points, p < 0.0001). We also observed increased endurance of trunk extensors (p = 0.002) and right (p = 0.001) and left lateral muscles (p = 0.001) in the PG compared with REG. However, the indexes of disability did not change between groups. CONCLUSION: Pain intensity was significantly reduced while spine muscle endurance increased in PG compared with REG after intervention; thus, Pilates-based exercises should be considered in physical conditioning programs for helicopter pilots.

Effectiveness of in-group versus individually administered pain neuroscience education on clinical and psychosocial outcomes in patients with chronic low back pain: randomized controlled study protocol.

Objective: (1) This trial will compare the clinical and psychosocial effectiveness of in-group and individually pain neuroscience education (PNE) in patients with chronic low back pain (CLBP). In addition, (2) the influence of social determinants of health on post-treatment results will be analyzed. Methods: A three-arm randomized controlled trial will be conducted. Sixty-nine participants with CLBP will be recruited in a 1:1:1 ratio. Participants, assessor, and statistician will be blinded to group assignment. The PNE intervention will be adapted to the context of the participants. An experimental group (n = 33) will receive PNE in an in-group modality, the other experimental group (n = 33) will receive PNE in an individually modality and the control group (n = 33) will continue with usual care. Additionally, participants will be encouraged to stay active by walking for 20-30 min 3-5 times per week and will be taught an exercise to improve transversus abdominis activation (bracing or abdominal following). The outcome measures will be fear avoidance and beliefs, pressure pain threshold, pain self-efficacy, catastrophizing, pain intensity, and treatment expectation. Outcome measures will be collected at one-week before intervention, immediately post-intervention, and four-weeks post-intervention. Conclusion: The innovative approach of PNE oriented to fear beliefs proposed in this study could broaden the application strategies of this educational therapeutic modality. Impact. Contextualized PNE delivered by physical therapist could be essential to achieve a good cost-effectiveness ratio of this intervention to improve the clinical condition of people with CLBP.

Low back pain self-management mobile applications: a systematic review on digital platforms.

OBJECTIVE: To identify and analyze the features and quality of self-management support of mobile applications available in Brazil for chronic low back pain in adults. METHOD: A systematic review on the Apple Store® and Google Play® digital platforms. The Self-Management Support Assessment Tool scale was used to assess self-management support and the Institute for Healthcare Informatics Functionality Score scale was used to assess functionality. RESULTS: Seventeen applications were selected, which included around seven self-management skills. The applications that met the majority of self-management support skills were Pathways, Branch, Pancea, Pain Navigator, and Curable. The Curable, Branch and MoovButh applications had the highest scores, with ten features on the functionality scale. CONCLUSION: Some applications have the potential to complement in-person treatment in terms of validity, acceptability and clinical usefulness in pain management. However, barriers such as lack of partnership between healthcare providers and patients, limited evidence-based content, social support, cultural relevance, cost, language, security and privacy can limit their sustained use. PROSPERO Registration: CRD42022382686.

[Low back pain and referral to the spine specialist: situation and resources in Buenos Aires]. / Lumbalgia y derivación al especialista de columna: situación y recursos en hospitales públicos de la Ciudad Autónoma de Buenos Aires.

INTRODUCTION: 90% of cases of acute low back pain have no specific underlying cause. International guidelines are available to help identify those individuals who require specialized care. However, in our country, there is a limited emphasis on primary healthcare, with the primary focus on hospital-based care. The aim of this study is to provide an overview of the diagnostic and therapeutic resources utilized in the initial care of patients experiencing low back pain at their first consultation with a specialist physician. METHODS: Descriptive and cross-sectional study, with prospective data collection through a questionnaire administered to patients experiencing low back pain during their first visit to a specialist's office. RESULTS: A total of 44 patients were included, with an average age of 53 years; 50% sought medical attention for chronic pain. Informal referrals were associated with the referring physician's specialty (non-orthopedic), patients with a higher number of emergency department visits, and longer waiting times to obtain the consultation; 52% of patients arrived with at least one complementary study. CONCLUSION: Most of the referrals were appropriate; however, informal referrals were more common. Only 1/5 of the patients underwent an physical examination, and less than 30% of those with red flag symptoms presented with suitable complementary studies. The median waiting time for the consultation was 24 days.

Introducción: El 90% de las lumbalgias agudas son de causa inespecífica. Existen guías internacionales que permiten identificar a aquellos pacientes que requieren atención especializada. En nuestro país la orientación a la atención primaria de la salud es escasa, centrada principalmente en la atención en los hospitales. El objetivo del presente estudio fue describir los recursos de salud, diagnósticos y terapéuticos, utilizados en la atención inicial de pacientes con dolor lumbar que acuden a la consulta del médico especialista Métodos: Estudio descriptivo y transversal, con recolección prospectiva de los datos a través de un cuestionario destinado a pacientes con dolor lumbar que acuden por primera vez a la consulta especializada. Resultados: Se incluyeron 44 pacientes, edad media 53 años; 50% concurrió por dolor crónico. La derivación informal se asoció con: especialidad de derivación (no traumatólogo), pacientes con mayor número de consultas a guardia y mayor demora en obtener la consulta. El 52% concurrió con al menos un estudio complementario. Conclusión: La mayor parte de las derivaciones fueron correctas, sin embargo, predominó la derivación informal. Solo 1/5 de los pacientes fue examinado y menos del 30% de los pacientes con banderas rojas acudió con estudios complementarios adecuados. La mediana del tiempo de espera para la consulta fue 24 días.

What are the costs of managing neck and low back pain in Brazil? Investigation of a ten-year period from the perspective of the Brazilian public health system.

INTRODUCTION: Considering the prospects of increased prevalence and disability due to neck and low back pain, it is relevant to investigate the care processes adopted, to assist future public policies and decision-making for a better allocation of resources. Objective: the aim of this study was to estimate the costs arising from inpatient and outpatient care of individuals with Neck Pain (NP) and Low Back Pain (LBP) in Brazil, between 2010 and 2019. METHODS: This is a cost-of-illness study from the perspective of the Brazilian public health system, based on health conditions with high prevalence (neck and low back pain). Data were presented descriptively using absolute and relative values. RESULTS: Between 2010 and 2019, the health system spent more than $600 million (R$ 2.3 billion) to treat NP and LBP in adults, and LBP accounted for most of the expenses. Female had higher absolute expenses in inpatient care and in the outpatient system. CONCLUSION: Our study showed that the costs with NP and LBP in Brazil were considerable. Female patients had higher outpatient costs and male patients had higher hospitalization costs. Healthcare expenses were concentrated for individuals between 34 and 63 years of age.

This study focused on understanding how much it cost to treat neck pain (NP) and low back pain (LBP) in Brazil between 2010 and 2019, from the point of view of the public health system (i.e. Unified Health System ­ SUS). The idea was to find out how much money was spent and where. It turned out that the SUS spent, in total, more than US$600 million (R$2.3 billion) with LBP responsible for most of these expenses. Furthermore, we noted that women had higher outpatient care costs, while men had higher hospitalization costs. Those costs were more concentrated in people aged between 34 and 63 years.

Embedded motivational interviewing combined with a smartphone application to increase physical activity in people with sub-acute low back pain: a cluster randomised controlled trial.

BACKGROUND: Moderately vigorous physical activity (PA) may be beneficial for people with sub-acute low back pain (LBP), but may initially be painful for patients and challenging for physical therapists to facilitate. OBJECTIVES: This study investigated motivational interviewing (MI) delivered by physical therapists and a smartphone app for increasing PA in people with LBP. METHODS: A mixed methods cluster randomised controlled trial involving 46 adults with LBP in Melbourne, Australia. Participants attended weekly 30-min physical therapy consultations for 6 weeks. Experimental group physical therapists were taught to embed MI into consultations and patients were provided with a self-directed app. The primary outcome was accelerometer-derived moderately vigorous PA. Secondary outcomes were LBP disability (Oswestry Disability Index), functional capacity (Patient Specific Functional Scale), and self-efficacy (Pain Self-Efficacy Questionnaire). Between-group differences were analysed by ANCOVA post-intervention. RESULTS: There was no statistically significant difference between the experimental group and control group for PA. Between-group differences in LBP disability (MD= 19.4 units, 95% CI: 8.5, 30.3), functional capacity (primary MD= -4.1 units, 95% CI: -6.9, -1.3; average MD= -3.1, 95% CI: -4.9, -1.2) and self-efficacy (MD -11.3 units, 95%CI -20.2, -2.5) favoured the control group with small to moderate effect sizes. There were low levels of overall engagement with the app. CONCLUSION: The embedded MI intervention was no more beneficial than physical therapy alone for PA and was associated with poorer LBP disability, function, and self-efficacy. The effectiveness of embedding MI and a smartphone app into usual care for LBP was not supported.