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1.
Medicine (Baltimore) ; 99(38): e22198, 2020 Sep 18.
Artigo em Inglês | MEDLINE | ID: mdl-32957350

RESUMO

Consistency between back pain intensity and degenerative changes on magnetic resonance imaging (MRI) of the lumbar spine is poor. This study aimed to show whether tender point (TP) examination, used as a test for diffuse central sensitization, may add valuable information to clinical assessment of patients with low back pain (LBP).This was a cross-sectional study including 141 patients with LBP on sick leave. Baseline measures comprised back pain, leg pain intensity, and LBP examination including TP examination. Degenerative MRI findings were assessed in a standardized manner and blinded for clinical data. The number of TPs was analyzed in relation to sex, widespread pain, radiculopathy, pain duration, and degenerative changes on MRI.The number of TPs was positively associated with the female sex, widespread pain, and pain duration. It was negatively associated with degenerative manifestations and radiculopathy, the latter displaying a low level similar to that of the general population. A positive association between back pain intensity and TPs was present in patients with and without radiculopathy and in patients with substantial degenerative changes. Men with >7-8 TPs and women with >10-11 TPs had more back pain and similar or fewer degenerative changes than patients with few TPs (<3 and <6 TPs, respectively), thereby identifying 34% to 44% of patients with nonspecific LBP and 5% to 8% of patients with radiculopathy, respectively, with disproportionate back pain in relation to degenerative changes.Supplemental TP examination improved clinical and MRI evaluation of patients with LBP. By using gender-specific cut points, patients with disproportionate back pain were identified, presumably indicating diffuse central sensitization.


Assuntos
Sensibilização do Sistema Nervoso Central , Dor Crônica/complicações , Hiperalgesia/diagnóstico , Dor Lombar/complicações , Adulto , Estudos Transversais , Feminino , Humanos , Hiperalgesia/etiologia , Dor Lombar/diagnóstico por imagem , Vértebras Lombares/diagnóstico por imagem , Imagem por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Tato
2.
Pain Physician ; 23(5): 519-530, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32967394

RESUMO

BACKGROUND: Lumbar facet joints are a clinically important source of chronic low back pain. There have been extensive diagnostic accuracy studies, along with studies of influence on the diagnostic process, but most of them have utilized the acute pain model. One group of investigators have emphasized the importance of the chronic pain model and longer lasting relief with diagnostic blocks. OBJECTIVE: To assess the diagnostic accuracy of lumbar facet joint nerve blocks with controlled comparative local anesthetic blocks and concordant pain relief with an updated assessment of the prevalence, false-positive rates, and a description of a philosophical paradigm shift from an acute to a chronic pain model. STUDY DESIGN: Retrospective study to determine diagnostic accuracy, prevalence and false-positive rates. SETTING: A multidisciplinary, non-university based interventional pain management practice in the United States. METHODS: Controlled comparative local anesthetic blocks were performed initially with 1% lidocaine, followed by 0.25% bupivacaine if appropriate response was obtained, in an operating room under fluoroscopic guidance utilizing 0.5 mL of lidocaine or bupivacaine at L3, L4 medial branches and L5 dorsal ramus. All patients non-responsive to lidocaine blocks were considered to be negative for facet joint pain. All patients were assessed after the diagnostic blocks were performed with >= 80% pain relief for their ability to perform previously painful movements. RESULTS: The prevalence of lumbar facet joint pain in chronic low back pain was 34.1% (95% CI, 28.8%, 39.8%), with a false-positive rate of 49.8% (95% CI, 42.7%, 56.8%). This study also showed a single block prevalence rate of 67.9% (95% CI, 62.9%, 73.2%). Average duration of pain relief >= 80% was 6 days with lidocaine block and total relief of >= 50% of 32 days. With bupivacaine, the average duration of pain relief >= 80% was 13 days with total relief of >= 50% lasting for 55 days. CONCLUSION: This study demonstrated that the chronic pain model is more accurate and reliable with concordant pain relief. This updated assessment also showed prevalence and false-positive rates of 34.1% and 49.8%.


Assuntos
Artralgia/diagnóstico , Dor Crônica/diagnóstico , Dor Lombar/diagnóstico , Bloqueio Nervoso , Articulação Zigapofisária , Adulto , Artralgia/complicações , Dor Crônica/etiologia , Reações Falso-Positivas , Feminino , Humanos , Dor Lombar/complicações , Masculino , Pessoa de Meia-Idade , Prevalência , Estudos Retrospectivos , Articulação Zigapofisária/patologia
3.
Artigo em Inglês | MEDLINE | ID: mdl-32824543

RESUMO

The purpose of this study was to describe the association between psychosocial factors in patients with work-related neck or low back pain (n = 129), in order to study sickness leave, its duration, the disability reported, and to analyze the relationship of these factors with different sociodemographic variables. This was a descriptive cross-sectional study. Data on kinesiophobia, catastrophizing, disability, and pain were gathered. Sociodemographic variables analyzed included sex, age, occupational, and educational level. Other data such as location of pain, sick leave status and duration of sickness absence were also collected. Educational level (p = 0.001), occupational level (p < 0.001), and kinesiophobia (p < 0.001) were found to be associated with sickness leave; kinesiophobia (b = 1.47, p = 0.002, r = 0.35) and catastrophizing (b = 0.72, p = 0.012, r = 0.28) were associated with the duration of sickness leave. Educational level (p =0.021), kinesiophobia (b = 1.69, p < 0.000, r = 0.505), catastrophizing (b = 0.76, p < 0.000, r = 0.372), and intensity of pain (b = 4.36, p < 0.000, r = 0.334) were associated with the degree of disability. In the context of occupational insurance providers, educational and occupational factors, as well as kinesiophobia and catastrophizing, may have an influence on sickness leave, its duration and the degree of disability reported.


Assuntos
Dor Lombar , Cervicalgia , Licença Médica , Estudos Transversais , Pessoas com Deficiência , Humanos , Dor Lombar/complicações , Dor Lombar/economia , Cervicalgia/complicações , Cervicalgia/economia , Medição da Dor
4.
J Altern Complement Med ; 26(7): 592-601, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32543211

RESUMO

Objectives: To investigate whether chiropractic care influences strength, balance, and/or endurance in active-duty United States military personnel with low back pain (LBP). Design: This study employed a prospective randomized controlled trial using a pragmatic treatment approach. Participants were randomly allocated to 4 weeks of chiropractic care or to a wait-list control. Interventions: Chiropractic care consisted of spinal manipulation, education, advice, and reassurance. Settings/Location: Naval Air Technical Training Center branch clinic at the Naval Hospital Pensacola Florida. Subjects: One hundred ten active-duty military personnel 18-40 years of age with self-reported LBP. Outcome measures: Isometric pulling strength from a semisquat position was the primary outcome. Secondary outcomes were single-leg balance with eyes open and eyes closed, and trunk muscle endurance using the Biering-Sorensen test. Patient-reported outcomes such as pain severity and disability were also measured. Outcomes were measured at baseline and 4 weeks. Linear mixed-effects regression models over baseline and 4 weeks were used for analysis. Results: Participants had mean age of 30 years (18-40), 17% were female, 33% were non-white, and 86% reported chronic LBP. Mean maximum pulling strength in the chiropractic group increased by 5.08 kgs and decreased by 7.43 kgs in the wait-list group, with a statistically significant difference in mean change between groups (p = 0.003). Statistically significant differences in mean change between groups were also observed in trunk muscle endurance (13.9 sec, p = 0.002) and balance with eyes closed (0.47 sec, p = 0.01), but not in balance with eyes open (1.19 sec, p = 0.43). Differences in mean change between groups were statistically significant in favor of chiropractic for LBP-related disability, pain intensity and interference, and fear-avoidance behavior. Conclusions: Active-duty military personnel receiving chiropractic care exhibited improved strength and endurance, as well as reduced LBP intensity and disability, compared with a wait-list control.


Assuntos
Quiroprática/métodos , Terapias Complementares/métodos , Dor Lombar/terapia , Militares , Força Muscular , Resistência Física , Equilíbrio Postural , Adolescente , Adulto , Pessoas com Deficiência/psicologia , Medo , Feminino , Humanos , Dor Lombar/complicações , Dor Lombar/psicologia , Masculino , Manipulação Quiroprática , Manipulação da Coluna , Saúde Militar , Militares/psicologia , Terapias Mente-Corpo , Manejo da Dor , Educação de Pacientes como Assunto , Resultado do Tratamento , Estados Unidos , Adulto Jovem
5.
Am J Phys Med Rehabil ; 99(12): 1184-1188, 2020 12.
Artigo em Inglês | MEDLINE | ID: mdl-32541345

RESUMO

Knee osteoarthritis and chronic low back pain are common and often coexist. There are limited studies on the impact of coexisting musculoskeletal disorders on gait parameters and its association with self-assessed functional outcome. This study compared gait parameters, self-assessed functional outcome measurements, and quality-of-life scales between patients with knee osteoarthritis against those with coexisting knee osteoarthritis and chronic low back pain using gait analysis, Western Ontario and McMaster Osteoarthritis Index, and Short Form-36. Three hundred sixty-seven patients underwent gait analysis after the question-based functional outcome measurement. Pain, function, and quality of life were worse in the coexisting knee osteoarthritis and chronic low back pain group (n = 197) compared with the knee osteoarthritis only group (n = 170, P = 0.017, P = 0.004, P < 0.001, P = 0.004, respectively). The coexisting knee osteoarthritis and chronic low back pain group had significantly lower gait velocity and cadence than the knee osteoarthritis group (P = 0.028 and P = 0.003). The Western Ontario and McMaster Osteoarthritis Index Pain subscore was associated with gait velocity (P < 0.001) in the knee osteoarthritis group, whereas Short Form-36 physical composite was associated with gait velocity (P < 0.001) in the coexisting knee osteoarthritis and chronic low back pain group. Comorbid chronic low back pain in patients with knee osteoarthritis was associated with worse pain, function, quality of life, gait velocity, and cadence. Compared with the Western Ontario and McMaster Osteoarthritis Index, Short Form-36 may be a more suitable tool to track mobility outcome measure, such as gait velocity, in the management of the coexisting knee osteoarthritis and chronic low back pain.


Assuntos
Dor Crônica/complicações , Marcha/fisiologia , Dor Lombar/complicações , Dor Lombar/fisiopatologia , Osteoartrite do Joelho/complicações , Osteoartrite do Joelho/fisiopatologia , Adulto , Estudos de Casos e Controles , Dor Crônica/fisiopatologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Medição da Dor , Medidas de Resultados Relatados pelo Paciente , Qualidade de Vida
6.
Spine (Phila Pa 1976) ; 45(19): 1341-1347, 2020 Oct 01.
Artigo em Inglês | MEDLINE | ID: mdl-32453239

RESUMO

STUDY DESIGN: A prospective follow-up study. OBJECTIVE: The aim of this study was to investigate whether early lumbar disc degeneration (DD) in young low back pain (LBP) patients predicts progression of degenerative changes, pain, or disability in a 30-year follow-up. SUMMARY OF BACKGROUND DATA: MRI is an accurate method for studying degenerative changes in intervertebral discs. Decreased signal intensity (SI) can be used as indication of decreased water content. Long-term prognosis of early DD remains unclear. METHODS: In an earlier study, 75 conscripts aged 20 years with LBP had their lumbar spine examined by MRI. At a follow-up of 30 years, the subjects were contacted; 35 of 69 filled a pain and disability questionnaire, and 26 of 35 were also reexamined clinically and by MRI. The images were evaluated for decreased SI and other degenerative changes. Association between decreased SI of a disc at baseline and the presence of more severe degenerative changes in the same disc space at follow-up was analyzed using Fisher exact test. Association between decreased baseline SI and pain/disability scores from the questionnaire was analyzed with Kruskal-Wallis H test. RESULTS: The total number of lumbar discs with decreased SI increased from 23 of 130 (18%) to 92 of 130 (71%)-from 0.9 to 3.5 per subject during the follow-up. Distribution of DD changed from being mostly in L4-L5 and L5-S1 discs to being almost even between the four lowermost discs. Discs that had even slightly decreased SI at baseline were more likely to have severely decreased SI at follow-up, compared to healthy discs (57% vs. 11%, P < 0.001). Other degenerative changes were also more common in these discs. Severity of DD at baseline did not have a significant association with current pain or disability. CONCLUSION: In young LBP patients, early degeneration in lumbar discs predicts progressive degenerative changes in the respective discs, but not pain, disability, or clinical symptoms. LEVEL OF EVIDENCE: 4.


Assuntos
Pessoas com Deficiência , Progressão da Doença , Degeneração do Disco Intervertebral/diagnóstico por imagem , Dor Lombar/diagnóstico por imagem , Vértebras Lombares/diagnóstico por imagem , Imagem por Ressonância Magnética/tendências , Adulto , Feminino , Seguimentos , Humanos , Degeneração do Disco Intervertebral/complicações , Dor Lombar/complicações , Imagem por Ressonância Magnética/métodos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Inquéritos e Questionários , Fatores de Tempo , Adulto Jovem
7.
Arch. esp. urol. (Ed. impr.) ; 73(3): 202-208, abr. 2020. ilus, tab
Artigo em Espanhol | IBECS | ID: ibc-192917

RESUMO

OBJETIVO: El manejo de la litiasis en anomalías renales es un desafío para el urólogo debido a su infrecuencia; motivo por el cual, el objetivo es presentar nuestra experiencia en Cirugía Retrógrada Intrarrenal (RIRS) en 4 casos con el uso del videoureterorrenoscopio flexible. MATERIAL Y MÉTODOS: Analizamos retrospectivamente la base de datos de las primeras 100 RIRS por litiasis desde la incorporación del videoureterorrenoscopio flexible (FLEX-X 8.4 Fr-STORZ®). Un total de 4 (4%) pacientes presentaban una anomalía renal asociada;un riñón en herradura, un riñón poliquístico, una ectopía renal cruzada fusionada y un divertículo calicial. Las variables analizadas fueron; demográficas (edad y género); tamaño de la litiasis, tratamientos previos, presentación clínica, tasa libre de litiasis y tasa de complicaciones perioperatorias según la clasificación Dindo-Clavien. RESULTADOS: Entre febrero 2017- marzo del 2018, 4 (4%) pacientes presentaban litiasis asociada a alguna malformación renal. Todos los procedimientos fueron ambulatorios y las litiasis accesibles a la deflexión del endoscopio a pesar de la malformación. La edad promedio fue de 56 años (43 a 65 años) siendo 3 hombres y 1 mujeres. El tamaño medio de la litiasis fue de 16,25 milímetros (6 a 23 mm). Todos los pacientes habían sido tratados previamente con Litotricia Extracopórea por Ondas de Choque (LEOC) y, el paciente con ectopía renal cruzada, mediante un abordaje percutáneo sin éxito. El tiempo promedio de cirugía fue de 57 minutos (43 a 79 minutos) siendo la tasa libre de litiasis del 100%. Como complicaciones, un paciente presentó dolor lumbar a las 48 horas de la cirugía que no cedió con analgésicos vía oral requiriendo tratamiento endovenoso aunque sin hospitalización (Clavien II). CONCLUSIÓN: La cirugía retrógrada intrarrenal es factible, segura y efectiva para el manejo de la litiasis en anomalías renales. No obstante, se necesitan mayor número de casos y estudios comparativos con la litotricia percutánea y extracorpórea como para optarlo como tratamiento de primera línea y no como alternativa a los anteriores


OBJECTIVE: The management of Stone disease in renal abnormalities is a challenge for urologist due to its rarity. The aim of the current manuscript is to report our experience in Retrograde Intrarenal Surgery (RIRS) in 4 complex-abdnormal cases using the flexible videoureterorrenoscopy. MATERIAL AND METHODS: Data was prospectively collected and retrospectively analyzed regarding our first 100 RIRS for stone disease with flexible videoureterorrenoscope (FLEX-X 8.4 Fr- STORZ®) between 2017 and 2018. Four patients presented with renal anomalies and stone disease; one horseshoe kidney, polycystic kidney, a renal ectopia fused and a caliceal diverticulum. We analyzed demographic variables (age and gender), stone size, previous treatment received, clinical presentation, stone free rate and complication rate using Dindo-Clavien classification. RESULTS: 4 (4%) cases of renal stone disease associated to renal anomalies were identified. All procedures were ambulatory. The mean age was 56 years (43 to 65) being 3 male and 1 female. The average Stone size was 16.25 mm (6 to 23). All cases represented recurrent stone disease, initially treated with a primary treatment such as extracorporeal shock wave or percutaneous lithotripsy. The mean surgical time was 57 minutes (43 to 79) and the stone free rate 100%. As complications, one patient presented low back pain at 48 hours after surgery, which did not yield with oral analgesics requiring intravenous treatment, although without admission (Clavien II). CONCLUSION: Retrograde intrarenal surgery for the management of renal stone in kidney anomalies is safe, feasible and effective. However; more cases and comparative studies with percutaneous and extracorporeal lithotripsy are needed to optimize treatment decisión making


Assuntos
Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Idoso , Nefrolitíase/cirurgia , Rim/anormalidades , Procedimentos Cirúrgicos Urológicos , Endoscopia , Nefrostomia Percutânea/métodos , Dor Lombar/complicações , Estudos Prospectivos , Tomografia Computadorizada por Raios X , Doenças Renais Policísticas/diagnóstico por imagem
8.
Clin Nucl Med ; 45(6): e299-e300, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-32349090

RESUMO

Low back pain with radiation to lower limbs is due to nerve root impingement or involvement in most cases. F-FDG PET/CT has shown sacral nerve root involvement in several peripheral nerve pathologies, including neurolymphomatosis, peripheral nerve sheath tumor, and plexopathies. We present 2 cases of a low back pain with ulcerative colitis and metastatic neuroendocrine tumor who underwent F-FDG PET/CT and Ga-DOTANOC PET/CT, respectively. PET/CT can be used as an adjunct tool to evaluate sacral nerve root involvement to look for malignant or inflammatory nerve involvement.


Assuntos
Colite Ulcerativa/complicações , Dor Lombar/complicações , Dor Lombar/diagnóstico por imagem , Tumores Neuroendócrinos/complicações , Tomografia Computadorizada com Tomografia por Emissão de Pósitrons , Raízes Nervosas Espinhais/diagnóstico por imagem , Adulto , Feminino , Fluordesoxiglucose F18 , Humanos , Masculino , Pessoa de Meia-Idade
9.
Ethiop J Health Sci ; 30(2): 233-242, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-32165813

RESUMO

Background: There is evidence supporting the efficacy of Graded Activity (GA) in managing clinical attributes of patients with Low-Back Pain (LBP) in the general population. However, it is unknown whether GA alone is efficacious in managing these clinical attributes in patients with concomitant LBP and Type-2 Diabetes (T2D) or additional daily-monitored walking will be required. Methods: A single-blind controlled trial involving 58 patients (mean age: 48.3±9.4 years, 64.7% females) with concomitant LBP and T2D who received treatment twice weekly for twelve weeks was conducted. Participants were randomized into GA or GA with daily-monitored-walking (GAMW) groups. Pain Intensity (PI), Static Back Extensors Endurance (SBEE), Static Abdominal Muscular Endurance (SAME) and Glycaemic Control (GC) were assessed using Visual Analogue Scale, Biering-Sorensen test, flexor endurance test, and in2itTM device respectively at baseline, 4th, 8th and 12th week. Data were analysed using repeated measures ANOVA and Unpaired t-tests at α = 0.05. Results: There were significant differences in PI, SAME and SBEE among participants in each of GA and GAMW groups respectively (p<0.05). Within-group difference on GC was significant for GAMW (6.3±0.9%, 5.7±0.7%) but not GA (6.3±0.9%, 6.3±0.9%). There was significant difference (p<0.05) between GA and GAMW group participants for SBEE (7.2±0.1 sec, 7.3±0.1 sec) at week 8 of the study and GC (-0.5±0.2%, -0.6±0.5%) at the end of the study. No differences were found between GA and GAMW groups for PI and SAME. Conclusion: Graded activity with daily-monitored-walking produced positive effects on GC and yielded a better improvement on SAME and SBEE.


Assuntos
Diabetes Mellitus Tipo 2/complicações , Terapia por Exercício/métodos , Dor Lombar/complicações , Dor Lombar/terapia , Resistência Física , Caminhada/estatística & dados numéricos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Método Simples-Cego , Resultado do Tratamento
10.
Tohoku J Exp Med ; 250(2): 79-85, 2020 02.
Artigo em Inglês | MEDLINE | ID: mdl-32062615

RESUMO

Basketball is a major sport worldwide among different age groups that leads to a high frequency of injuries at multiple body sites. Upper and lower extremities and lower back are common pain sites in basketball players; however, there is little information about the relationship between upper or lower extremity pain and lower back pain. This study elucidated the associations between upper extremity (shoulder and elbow) pain and lower back pain (LBP) among young basketball players. We conducted a cross-sectional study using self-reported questionnaires mailed to 25,669 young athletes; the final study population comprised 590 basketball players, and their median age was 13 years (range: 6-15 years). The point prevalence rates of lower back, shoulder, elbow, and upper extremity pain among young basketball players were 12.9% (76/590), 4.6% (27/590), 2.7% (16/590), and 7.1% (42/590), respectively. Multivariate logistic regression analyses revealed that upper extremity pain was significantly associated with LBP (adjusted odds ratio [OR]: 7.86; 95% confidential interval [CI], 3.93-15.72). Shoulder pain was significantly associated with training per week (> 4 days) (adjusted OR: 4.15; 95% CI: 1.29-13.40) and LBP (adjusted OR: 13.77; 95% CI: 5.70-33.24). This study indicates that upper extremity and shoulder pain is associated with LBP among young basketball players. Assessing for lower back pain, as well as elbow and/or shoulder pain, may help prevent severe injuries in young basketball players. In conclusion, parents and coaches should be properly re-educated to help improve lower back, upper extremity, and shoulder pain among young basketball players.


Assuntos
Atletas , Basquetebol , Dor Lombar/complicações , Extremidade Superior/patologia , Adolescente , Criança , Estudos Transversais , Cotovelo/patologia , Feminino , Humanos , Japão/epidemiologia , Dor Lombar/epidemiologia , Masculino , Prevalência , Dor de Ombro/complicações , Dor de Ombro/epidemiologia
11.
Spine (Phila Pa 1976) ; 45(13): E760-E767, 2020 Jul 01.
Artigo em Inglês | MEDLINE | ID: mdl-32049935

RESUMO

STUDY DESIGN: Cohort study (level 3). OBJECTIVE: The aim of this study was to identify independent risk factors for residual low back pain (LBP) following osteoporotic vertebral fracture (OVF). SUMMARY OF BACKGROUND DATA: Nonunion has been proposed as the primary cause of residual LBP following OVF. However, LBP can occur even when union is maintained. Other reported causes of LBP after OVF include vertebral deformities and spinopelvic malalignment. METHODS: Sixty-seven patients with single-level thoracolumbar OVF who had not received previous osteoporotic treatment were enrolled. Conservative treatment was conducted using a soft lumbosacral orthosis plus osteoporosis drugs, either weekly alendronate (bisphosphonate) or daily teriparatide. Pain scores, kyphosis angle of fractured vertebra (VKA), and spinopelvic alignment, including pelvic incidence minus lumbar lordosis (PI-LL), were assessed periodically during treatment. Radiographic union was evaluated independently by three specialists at 24 weeks post-admission. Patients were divided by pain scores >40% at 24 weeks into the LBP (n = 36) and non-LBP (n = 31) groups. Temporal changes and statistical associations were examined to identify risk factors for LBP at 24 weeks. RESULTS: At 24 weeks, 25% of OVFs failed to achieve union. The LBP group consisted of 71% of nonunion and 48% of union cases. Stepwise multinomial regression analysis showed VKA at 24 weeks >25° was significant risk factor for the LBP group (odds ratio: 6.24, 95% confidence interval: 1.77-22.02, P = 0.004). Significant differences in VKA emerged during treatment in the LBP group, but PI-LL showed the tendency not to change throughout the treatment period. Non-union was correlated with VKA (area under the curve: 0.864). CONCLUSION: Although spinopelvic malalignment is considered as a preexisting factor for LBP, VKA exacerbated by nonunion predominantly led to LBP after a new OVF. Each incidence of OVF should be treated to limit further morphological changes to the fractured vertebra. LEVEL OF EVIDENCE: 3.


Assuntos
Dor Lombar/etiologia , Fraturas por Osteoporose/complicações , Fraturas da Coluna Vertebral/complicações , Idoso , Idoso de 80 Anos ou mais , Alendronato/uso terapêutico , Estudos de Coortes , Tratamento Conservador , Feminino , Humanos , Cifose , Dor Lombar/complicações , Masculino , Pessoa de Meia-Idade , Osteoporose/complicações , Osteoporose/tratamento farmacológico , Fraturas por Osteoporose/tratamento farmacológico , Fatores de Risco , Fraturas da Coluna Vertebral/tratamento farmacológico , Fraturas da Coluna Vertebral/etiologia , Coluna Vertebral , Teriparatida/uso terapêutico
12.
Turk Neurosurg ; 30(2): 277-284, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32091127

RESUMO

AIM: To assess spatiotemporal gait parameters in patients with lumbar disc herniation (LDH) and chronic mechanical low back pain (CMLBP), and compare with healthy control group. MATERIAL AND METHODS: A total of 70 patients was enrolled in this prospective, controlled cross-sectional study, of which 25 with LDH, 25 with CMLBP and 20 healthy individuals as the control group. Participants completed 10 passes on the "WIN-TRACK" Gait Analysis Platform at their self-selected walking speed. The arithmetic mean of the five flawless walking data was used for analysis. Pain intensity is assessed by the Visual Analog Scale (VAS). RESULTS: The spatiotemporal gait parameters were significantly decreased in LDH and CMLBP groups than the healthy control group, particularly in LDH groups (p≥0.001). It was found that pain intensity is negatively correlated to step and stride length, cadence and velocity (p < 0.001). Results of linear regression analysis showed that 10% of the changes in gait cycle duration of the left extremity and 74% of the changes in the velocity were associated with pain intensity. CONCLUSION: Pain intensity can affect the spatiotemporal gait parameters in patients with Low Back Pain (LBP). Rehabilitation programs with gait optimization should be considered in the management of patients with LDH and CMLBP.


Assuntos
Marcha , Degeneração do Disco Intervertebral/complicações , Deslocamento do Disco Intervertebral/complicações , Dor Lombar/complicações , Adulto , Estudos Transversais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Dor/etiologia , Estudos Prospectivos , Caminhada
13.
BMJ Open ; 10(2): e033396, 2020 02 09.
Artigo em Inglês | MEDLINE | ID: mdl-32041856

RESUMO

INTRODUCTION: Health-related quality of life in chronic low back pain (LBP) is an important issue since various individual factors such as perceived loss of autonomy, inability to continue daily life and anxiety can contribute to maintenance or deterioration of this condition. Health-related quality of life is also important because it can predict the probability of recovery or recrudescence over time. In the literature, there is no systematic review on this topic. The present paper describes a protocol of the first systematic review and meta-analysis aimed at summarising the data on health-related quality of life in patients with chronic LBP compared with healthy controls. Gender, age and comorbidity of psychiatric disorders (mood or anxiety disorders) will be explored as moderators. Studies will be included if they used a case-control design comparing adults with chronic LBP to healthy controls on health-related quality of life through validated interviews/questionnaires. METHODS AND ANALYSIS: According to Preferred Reporting Items for Systematic Reviews and Meta-Analyses, a systematic review and meta-analysis will be conducted from 10th to 17th January 2020. Independent reviewers will search published/unpublished studies through electronic databases (Scopus, PubMed, EMBASE and the Cochrane Library) and additional sources, will extract the data and assess the methodological quality through the Newcastle-Ottawa Scale. Random-effect meta-analysis will be carried out by calculating effect sizes as Cohen's d indices. Publication bias will be assessed and moderators of the effect sizes will be investigated through weighted least squares meta-regression.The knowledge whether health-related quality of life is better or worse as a function of some individual characteristics may suggest personalised care pathways according to a precision medicine approach. ETHICS AND DISSEMINATION: The current review does not require ethics approval. The results will be disseminated through publications in peer-reviewed journals. PROSPERO REGISTRATION NUMBER: CRD42019131749.


Assuntos
Atividades Cotidianas , Dor Lombar/complicações , Qualidade de Vida , Ansiedade/epidemiologia , Comorbidade , Feminino , Humanos , Dor Lombar/epidemiologia , Dor Lombar/psicologia , Masculino , Metanálise como Assunto , Transtornos do Humor/epidemiologia , Projetos de Pesquisa
14.
J Manipulative Physiol Ther ; 43(1): 13-23, 2020 01.
Artigo em Inglês | MEDLINE | ID: mdl-32081512

RESUMO

OBJECTIVE: Baseline characteristics of patients low back pain differ substantially between care settings, but it is largely unknown whether predictors are of equal importance across settings. The aim of this study was to investigate whether 8 known predictors relate differently to outcomes in chiropractic practice and in general practice and to which degree these factors may be helpful in selecting patients benefiting more from one setting or the other. METHODS: Patient characteristics were collected at baseline, and outcomes of pain intensity (numeric rating scale 0-10) and activity limitation (Roland-Morris Disability Questionnaire 0-100) after 2, 12, and 52 weeks. Differences in the prognostic strength between settings were investigated for each prognostic factor separately by estimating the interaction between setting and the prognostic factor using regression models. Between-setting differences in outcome in high-risk and low-risk subgroups, formed by single prognostic factors, were assessed in similar models adjusted for a propensity score to take baseline differences between settings into account. RESULTS: Prognostic factors were generally associated more strongly with outcomes in general practice compared with chiropractic practice. The difference was statistically significant for general health, duration of pain, and musculoskeletal comorbidity. After propensity score adjustment, differences in outcomes between settings were insignificant, but negative prognostic factors tended to be less influential in chiropractic practice except for leg pain and depression, which tended to have less negative impact in general practice. CONCLUSION: Known prognostic factors related differently to outcomes in the 2 settings, suggesting that some subgroups of patients might benefit more from one setting than the other.


Assuntos
Quiroprática , Dor Lombar/complicações , Seleção de Pacientes , Atenção Primária à Saúde , Adulto , Estudos de Coortes , Depressão/complicações , Feminino , Nível de Saúde , Humanos , Masculino , Pessoa de Meia-Idade , Limitação da Mobilidade , Doenças Musculoesqueléticas/complicações , Medição da Dor , Prognóstico
15.
Gesundheitswesen ; 82(1): e9-e16, 2020 Jan.
Artigo em Alemão | MEDLINE | ID: mdl-30340235

RESUMO

There is an increasing need for patient education in chronic low back pain with mental comorbidity. The present study was carried out in the setting of multidisciplinary inpatient rehabilitation and investigated the acceptance and feasibility of the Debora pain competence and depression prevention training comparing an intervention group with a control group. While patients of the intervention group took part in the pain competence and depression prevention training, patients of the control group only participated in pain competence training. METHOD: A total of 3 partial studies were used for formative evaluation. The triangulative design consisted of problem-centered interviews and focus groups with rehabilitation patients as well as focus groups with experts. The interviews were transcribed, anonymized, and content analysis was performed. RESULTS: The training was well accepted and feasible from the perspective of the patients and experts. The therapists had a significant influence on the participants' satisfaction. Suggestions for improvement focused on developing extensions of the pain and stress management aspects and on discussing individual problems. Compared to the intervention group and independent of depression, the control group assessed the training as being less satisfatory and showed poor group coherence. CONCLUSIONS: Results of the formal evaluation support the combined implementation of the Debora pain competence and depression prevention training program and suggest its long-term establishment in multidisciplinary inpatient rehabilitation.


Assuntos
Depressão , Dor Lombar , Educação de Pacientes como Assunto , Depressão/complicações , Estudos de Viabilidade , Alemanha , Humanos , Pacientes Internados , Dor Lombar/complicações
16.
Rev. Asoc. Argent. Ortop. Traumatol ; 84(4): 420-426, dic. 2019. []
Artigo em Espanhol | LILACS, BINACIS | ID: biblio-1057066

RESUMO

La acupuntura es una técnica de origen chino que surge hace aproximadamente 2000 años. Es una modalidad terapéutica que ha cobrado gran importancia en el mundo occidental para el tratamiento de diversos cuadros, incluida la lumbalgia. Comunicamos el caso de un hombre de 74 años de edad, que consulta por reagudización de la lumbalgia crónica, luego de un tratamiento alternativo, a quien se le diagnostica una complicación infecciosa. Si bien, en manos experimentadas e instruidas, es una técnica con relativamente escasas complicaciones, se han publicado diversos reportes que describen complicaciones, en su mayoría, menores y asociadas a una técnica estéril insuficiente o a falta de conocimiento por parte del acupunturista. El auge de estas técnicas alternativas puso el foco en las medidas de seguridad, por lo cual entes, como la Organización Mundial de la Salud han creado guías para su correcto uso. Conocer las posibles complicaciones facilita el diagnóstico temprano y el tratamiento. Se analiza la presentación clínica y se realiza una revisión bibliográfica del cuadro. Nivel de Evidencia: IV


Acupuncture originated in China approximately 2000 years ago and is a growing treatment modality worldwide. Patients resort to acupuncture for a variety of conditions, including lower back pain. We discuss the case of a 74-year-old man who received acupuncture to treat lower back pain, after which the pain increased. An infection was detected and treated. Despite the fact that acupuncture can be considered generally safe if performed by well-trained practitioners, literature from around the world reports all kinds of complications, most of which are minor and usually a result of an inappropriate technique. The popularity of this alternative treatment has driven some organizations, such as World Health Organization (WHO) to draft guidelines about its safety. Being aware of possible complications allows for an early diagnosis and treatment. On this paper, we discuss the aforementioned case and include a review of the related literature. Level of Evidence: IV


Assuntos
Idoso , Terapia por Acupuntura/efeitos adversos , Dor Lombar/complicações , Dor Lombar/terapia , Infecções/diagnóstico
17.
Rev. Hosp. Ital. B. Aires (2004) ; 39(4): 128-134, dic. 2019.
Artigo em Espanhol | LILACS | ID: biblio-1099754

RESUMO

Asociada o no a una enfermedad orgánica, la depresión tiene gran prevalencia en la práctica médica pero es subdiagnosticada. El trastorno del ánimo suele coexistir con variadas quejas somáticas y dolores crónicos, configurando síndromes mixtos con un diagnóstico diferencial complejo. En este artículo se describen distintas presentaciones clínicas de la depresión en medicina general, con énfasis en los estados depresivos atípicos, depresiones enmascaradas muy relevantes por su frecuencia y consecuencias: depresión posquirúrgica, cuadros dolorosos crónicos como cefaleas o lumbago, la fatiga crónica y la fibromialgia. Solo el reconocimiento y diagnóstico de la depresión subyacente posibilitará la implementación de las adecuadas intervenciones terapéuticas. Se revisan también algunas recomendaciones para el uso de antidepresivos en atención primaria y la eventual consulta psiquiátrica. (AU)


Associated or not with an organic disease, depression has a high prevalence in medical practice but is underdiagnosed. The mood disorder usually coexists with varied somatic complaints and chronic pain, forming mixed syndromes with a complex differential diagnosis. This article describes different clinical presentations of depression in general medicine, with emphasis on atypical depressive states, masked depressions very relevant for their frequency and consequences: post-surgical depression, chronic painful conditions such as headaches or lumbago, chronic fatigue and fibromyalgia. Only the recognition and diagnosis of the underlying depression will enable the implementation of appropriate therapeutic interventions. Some recommendations for the use of antidepressant drugs in primary care and the eventual psychiatric consultation are also reviewed. (AU)


Assuntos
Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Idoso , Adulto Jovem , Atenção Primária à Saúde/tendências , Depressão/diagnóstico , Psiquiatria/tendências , Sinais e Sintomas , Transtornos Somatoformes/diagnóstico , Citalopram/efeitos adversos , Citalopram/uso terapêutico , Fibromialgia/complicações , Síndrome de Fadiga Crônica/complicações , Fluoxetina/efeitos adversos , Fluoxetina/uso terapêutico , Inibidores de Captação de Serotonina/efeitos adversos , Dor Lombar/complicações , Antagonistas Colinérgicos/efeitos adversos , Erros Médicos , Sertralina/efeitos adversos , Sertralina/uso terapêutico , Depressão/classificação , Depressão/complicações , Depressão/terapia , Depressão/epidemiologia , Medicina Geral , Dor Crônica/complicações , Cloridrato de Venlafaxina/efeitos adversos , Cloridrato de Venlafaxina/uso terapêutico , Cloridrato de Duloxetina/efeitos adversos , Cloridrato de Duloxetina/uso terapêutico , Inibidores da Recaptação de Serotonina e Norepinefrina/efeitos adversos , Cefaleia/complicações , Amitriptilina/efeitos adversos , Amitriptilina/uso terapêutico , Antidepressivos/administração & dosagem
18.
Artigo em Russo | MEDLINE | ID: mdl-31626166

RESUMO

AIM: To evaluate the possibility of using symptomatic slow acting drugs for osteoarthritis (SYSADOA) in patients with nonspecific lower back pain and high cardiovascular risk. MATERIAL AND METHODS: The study registered as the observational program 'Possibilities of SYSADOA-therapy in patients with nonspecific lower back pain and high cardiovascular risk' was organized in outpatient clinics with sequential inclusion of patients (n=315) with lower back pain. All patients randomized into 5 main groups by method of envelopes were treated with different SYSADOA. The control group (group 6) included 63 patients without lower back pain syndrome. The duration of follow-up was 9 months. The results of the first 3 months of observation of group 1 treated with chondroitin sulfate (chondroguard) compared to the control group are presented. RESULTS: On the 21st day of therapy, the pain level decreased by more than 62% in group 1. There were no changes in the plasma hemostasis parameters (thrombin time, prothrombin index, activated partial thromboplastin time) and glomerular filtration rate, which was comparable with the control group. CONCLUSION: Chondroguard is safe for patients with comorbid osteoarthritis and high cardiovascular risk both in short and repeated long-term treatment.


Assuntos
Doenças Cardiovasculares , Dor Lombar , Osteoartrite , Doenças Cardiovasculares/complicações , Humanos , Dor Lombar/complicações , Dor Lombar/etiologia , Dor Lombar/terapia , Osteoartrite/complicações , Fatores de Risco , Resultado do Tratamento
19.
BMC Musculoskelet Disord ; 20(1): 439, 2019 Oct 10.
Artigo em Inglês | MEDLINE | ID: mdl-31597562

RESUMO

BACKGROUND: Chronic low back pain (LBP) is a leading cause of disability worldwide. Biopsychosocial rehabilitation programs have been advocated for its management, especially since the widespread acceptance of the biopsychosocial model of chronic pain. Despite extensive evidence of its short-term benefits, few studies have reported on its long-term effect and more specifically on indirect outcomes such as return to work and quality of life (QoL). The present study evaluated the long-term effect of a multidisciplinary biopsychosocial rehabilitation (MBR) program for patients with chronic LBP, for which short- and intermediate-term efficacy had been established, with an emphasis on recovering work capability. METHODS: This prospective cohort study enrolled 201 patients on a four-week MBR program incorporating physical and occupational therapies and psychological counselling. Assessments occurred at program admission and discharge and at 6 and 18 months. Work capability, Oswestry Disability Index, Tampa Scale for Kinesiophobia, Core Outcome Measures Index (COMI), and Hospital Anxiety and Depression Scale were assessed. Multiple mixed models were used to detect changes in each outcome. Logistic regressions were calculated to identify predictors of recovery of work capability. RESULTS: Of the 201 patients who fulfilled the eligibility criteria, 160 (79.8%) attended the discharge assessment, 127 (63.2%) attended the 6-month follow-up, and 107 (53.3%) continued to the 18-month follow-up. Initially, 128 patients (71.5%) had been on sick leave. At 6 and 18 months, 72 (56.7%) and 84 (78.5%) participants had recovered their work capability, respectively. There were significant improvements in pain, disability, kinesiophobia, and anxiety and depression scores over time. Patients who recovered work capability showed significantly greater improvements in their total COMI score, general QoL, and disability, which were the best three predictors of recovering work capability. CONCLUSIONS: This study extends previous results confirming the program's contribution to recovering work capability among chronic LBP patients.


Assuntos
Ansiedade/reabilitação , Dor Crônica/reabilitação , Depressão/reabilitação , Dor Lombar/reabilitação , Terapia Ocupacional/métodos , Reabilitação Psiquiátrica/métodos , Adulto , Ansiedade/diagnóstico , Ansiedade/etiologia , Dor Crônica/complicações , Dor Crônica/diagnóstico , Dor Crônica/psicologia , Terapia Combinada/métodos , Depressão/diagnóstico , Depressão/etiologia , Avaliação da Deficiência , Feminino , Seguimentos , Humanos , Dor Lombar/complicações , Dor Lombar/diagnóstico , Dor Lombar/psicologia , Masculino , Pessoa de Meia-Idade , Medição da Dor , Equipe de Assistência ao Paciente , Questionário de Saúde do Paciente , Estudos Prospectivos , Qualidade de Vida , Resultado do Tratamento
20.
Rev Esp Salud Publica ; 932019 10 10.
Artigo em Espanhol | MEDLINE | ID: mdl-31597911

RESUMO

OBJECTIVE: Neurotic disorders are one of the main health problems of Western societies. Its impact on labor productivity grows exponentially with an increase in its incidence and the duration of temporary disability (TD) processes. To know the characteristics of the patients belonging to a mutual of work accidents who had transient disability due to neurotic disorders, their temporal and geographic distribution, their comorbidities and those variables that affected their duration. METHODS: Retrospective descriptive study of the workers protected from a mutual of work accidents, national scope, who studied a disability period between 2006-2016 with diagnoses included between codes 300 and 300.9 of the CIE-9-CM, corresponding to Neurotic Disorders. We analyze clinical-demographic variables of patients, comorbidities during studied period and distributions by year and province, by Bayesian inference. We performed a logistic regression for the dependent variable duration of the TD adjusted for age, sex, toxic consumption, consultations, year, regulatory base and payment type. RESULTS: We registered 56,619 processes in Spain, which corresponded to 1.5% of the total TD processes served in the period. The highest percentage of cases was grouped between 2007 and 2009, when 11% of the population were registered annually. The variables associated with an increase in this duration were: older age, male sex, psychiatric and psychological consultations, diagnostic year, regulatory base (whose average was 50.5 euros) and type of payment (delegate in 78.2% of cases and direct in 21.8%). The prevalence by provinces was more marked in the north and the islands (Barcelona, Lleida, Las Palmas, Islas Baleares, Coruña, Cantabria, Girona, Álava, Tarragona, Pontevedra y Asturias they have more than 6%).The durations of the disability were greater in the east of the country. The most prevalent comorbidities during the study period were low back pain (with an average of 65.1 days of IT anxiety), cervical pain (with an average of 67 days) and digestive disorders (with an average of 59.4 days). CONCLUSIONS: There are comorbidities and variables associated with the temporary disability derived from neurotic disorders, with geographical differences. Deepening their knowledge and impact could promote better preventive and therapeutic approaches that allow an earlier functional recovery.


Assuntos
Acidentes de Trabalho/psicologia , Transtornos de Ansiedade/terapia , Pessoas com Deficiência/psicologia , Licença Médica , Adulto , Transtornos de Ansiedade/complicações , Transtornos de Ansiedade/epidemiologia , Teorema de Bayes , Comorbidade , Feminino , Geografia , Humanos , Incidência , Modelos Logísticos , Dor Lombar/complicações , Masculino , Prevalência , Estudos Retrospectivos , Espanha/epidemiologia
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