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1.
Nat Commun ; 11(1): 3948, 2020 08 07.
Artigo em Inglês | MEDLINE | ID: mdl-32769984

RESUMO

Thalamocortical dysrhythmia is a key pathology of chronic neuropathic pain, but few studies have investigated thalamocortical networks in chronic low back pain (cLBP) given its non-specific etiology and complexity. Using fMRI, we propose an analytical pipeline to identify abnormal thalamocortical network dynamics in cLBP patients and validate the findings in two independent cohorts. We first identify two reoccurring dynamic connectivity states and their associations with chronic and temporary pain. Further analyses show that cLBP patients have abnormal connectivity between the ventral lateral/posterolateral nucleus (VL/VPL) and postcentral gyrus (PoCG) and between the dorsal/ventral medial nucleus and insula in the less frequent connectivity state, and temporary pain exacerbation alters connectivity between the VL/VPL and PoCG and the default mode network in the more frequent connectivity state. These results extend current findings on thalamocortical dysfunction and dysrhythmia in chronic pain and demonstrate that cLBP pathophysiology and clinical pain intensity are associated with distinct thalamocortical network dynamics.


Assuntos
Córtex Cerebral/fisiopatologia , Dor Crônica/fisiopatologia , Núcleos Laterais do Tálamo/fisiopatologia , Dor Lombar/fisiopatologia , Núcleos Ventrais do Tálamo/fisiopatologia , Adulto , Mapeamento Encefálico , Estudos de Casos e Controles , Córtex Cerebral/diagnóstico por imagem , Dor Crônica/diagnóstico , Conjuntos de Dados como Assunto , Feminino , Humanos , Núcleos Laterais do Tálamo/diagnóstico por imagem , Dor Lombar/diagnóstico , Imagem por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Rede Nervosa/fisiopatologia , Medição da Dor , Núcleos Ventrais do Tálamo/diagnóstico por imagem , Adulto Jovem
2.
PLoS One ; 15(6): e0233858, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32479547

RESUMO

PURPOSE: Low back pain (LBP) is a common ailment in most developed countries. Because most cases of LBP are known as 'non-specific', it has been challenging to develop experimental pain models of LBP which reproduce patients' clinical pain. In addition, previous models have limited applicability in a steady-pain-state neuroimaging environment. Thus, this study aims to devise a low back pain model with a simple methodology to induce experimental LBP, which has similar pain properties to patients' clinical pain, and to apply the model in a steady-pain-state neuroimaging study. METHODS: Our low back extension (LBE) pain model was tested on 217 LBP patients outside the magnetic resonance imaging (MRI) scanner to determine the reproducibility of endogenous pain and the similarity to their own clinical pain (STUDY1), and applied in a steady-pain-state functional MRI study (47 LBP patients and 23 healthy controls) to determine its applicability (induced head motions and brain functional connectivity changes; STUDY2). RESULTS: By the LBE pain model, 68.2% of the LBP patients reported increased LBP with high similarity of sensations to their own clinical pain (STUDY1), and the head motions were statistically similar to and correlated with those in resting state (STUDY2). Furthermore, the LBE model altered brain functional connectivity by decreasing the default-mode and the sensorimotor networks, and increasing the salience network, which was significantly associated with the intensity of the induced pain. Conversely, the healthy controls showed increased somatosensory network (but not of the cognitive pain processing). CONCLUSION: Our investigations suggest that our LBE pain model, which increased LBP with high similarity to the LBP patients' own pain sensation and induced patient-specific brain responses with acceptable head motion, could be applied to neuroimaging studies investigating brain responses to different levels of endogenous LBP.


Assuntos
Encéfalo/fisiopatologia , Dor Lombar/fisiopatologia , Modelos Neurológicos , Rede Nervosa/fisiopatologia , Nociceptividade/fisiologia , Adulto , Encéfalo/diagnóstico por imagem , Mapeamento Encefálico/métodos , Feminino , Humanos , Dor Lombar/diagnóstico , Imagem por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Medição da Dor , Reprodutibilidade dos Testes
3.
Health Qual Life Outcomes ; 18(1): 175, 2020 Jun 10.
Artigo em Inglês | MEDLINE | ID: mdl-32522196

RESUMO

BACKGROUND: Although the Japanese Orthopedic Association Back Pain Evaluation Questionnaire (JOABPEQ), Numerical Pain Rating Scale (NPRS), Oswestry Disability Index (ODI), Roland Morris Disability Questionnaire (RMDQ), and Short Form 36 Health Survey (SF-36) has shown a preferable psychometric properties in patients with low back pain (LBP), but no study has yet determined these in conservative treatment of patients with lumbar disc herniation (LDH). Thus the current study aimed to compare those scales in LDH patients receiving conservative treatment to select the better option to assess the severity of disease. METHODS: LDH patients were invited to complete the JOABPEQ, NPRS, ODI, RMDQ, and SF-36 twice. The internal consistency was evaluated by the Cronbach's α. Test-retest reliability was tested by the intraclass correlation coefficient (ICC). The relationships of these scales were evaluated by the Pearson correlation coefficients (r). The responsiveness was operationalised using the receiver operating characteristic (ROC) curve, as well as the comparison of smallest detectable change (SDC), minimum important change (MIC). RESULTS: A total of 353 LDH patients were enrolled. Four subscales of the Chinese JOABPEQ were over 0.70, then the ICCs for the test-retest reliability were over 0.75. For functional status, remarked negative correlations could be seen between JOABPEQ Q2-Q4 and ODI, as well as RMDQ (r = - 0.634 to - 0.752). For general health status, remarkable positive correlations could also be seen between Q5 Mental health and SF-36 PCS (r = 0.724) as well as SF-36 MCS (r = 0.736). Besides, the area under of the curves (AUC) of the JOABPEQ ranged from 0.743 to 0.827, indicating acceptale responsiveness, as well as the NPRS, ODI, and RMDQ. CONCLUSION: NPRS, and ODI or RMDQ is recommended in studies related to LDH patients, while if the quality of life also is needed to observe, the NPRS, and JOABPEQ would be more appropriate rather than SF-36.


Assuntos
Degeneração do Disco Intervertebral/terapia , Deslocamento do Disco Intervertebral/terapia , Dor Lombar/diagnóstico , Medição da Dor/normas , Inquéritos e Questionários/normas , Adulto , Tratamento Conservador , Feminino , Humanos , Degeneração do Disco Intervertebral/complicações , Deslocamento do Disco Intervertebral/complicações , Dor Lombar/etiologia , Masculino , Pessoa de Meia-Idade , Diferença Mínima Clinicamente Importante , Qualidade de Vida , Reprodutibilidade dos Testes
4.
Medicine (Baltimore) ; 99(21): e20276, 2020 May 22.
Artigo em Inglês | MEDLINE | ID: mdl-32481306

RESUMO

RATIONALE: The most common fractures of the spine are associated with the thoracolumbar junction (T10-L2). And burst fractures make up 15% of all traumatic thoracolumbar fractures, which are often accompanied by neurological deficits and require open surgeries. Common surgeries include either anterior, posterior or a combination of these approaches. Here, we report the first attempt to treat thoracolumbar burst fracture (TLBF) with severe neurologic deficits by percutaneous pedicle screw fixation (PPSF) and transforaminal endoscopic spinal canal decompression (TESCD). PATIENT CONCERNS: A 46-year-old Chinese woman suffered from severe lower back pain with grade 0 muscle strength of lower limbs, without any sensory function below the injury level, with an inability to urinate or defecate after a motor vehicle accident. Imaging studies confirmed that she had Magerl type A 3.2 L1 burst fracture. DIAGNOSES: Burst fracture at L1. INTERVENTIONS: The patient underwent PPSF at the level of T12 to L2, but her neurological function did not fully recover after the operation. One week after the injury, we performed TESCD on her. OUTCOMES: There was an immediate improvement in her neurological function in just 1 day after 2-stage operation. During the 6-month follow-up period, her neurological functions gradually recovered, and she was able to defecate and urinate. At the last follow-up visit, her spinal cord function was assessed to be at Frankel grade D. LESSONS: PPSF plus TESCD can achieve complete spinal cord decompression, promote neurological recovery, and is therefore an effective method for the treating lumbar burst fractures with severe neurologic deficits.


Assuntos
Endoscopia/métodos , Fixação Interna de Fraturas/métodos , Dor Lombar/etiologia , Vértebras Lombares/lesões , Parafusos Pediculares , Fraturas da Coluna Vertebral/cirurgia , Vértebras Torácicas/lesões , Descompressão Cirúrgica/métodos , Feminino , Fraturas por Compressão/complicações , Fraturas por Compressão/diagnóstico , Fraturas por Compressão/cirurgia , Humanos , Laminectomia/métodos , Dor Lombar/diagnóstico , Dor Lombar/cirurgia , Imagem por Ressonância Magnética , Pessoa de Meia-Idade , Fraturas da Coluna Vertebral/complicações , Fraturas da Coluna Vertebral/diagnóstico , Tomografia Computadorizada por Raios X
5.
Medicine (Baltimore) ; 99(24): e20292, 2020 Jun 12.
Artigo em Inglês | MEDLINE | ID: mdl-32541453

RESUMO

To examine the psychometric properties of a short form TSK-AV in Arabic-speaking patients with chronic low back pain (CLBP).One hundred one CLBP patients recruited from Jordan University Hospital provided demographic information and completed the TSK-AV full version and measures of pain severity and disability. Explorative factor analysis was used to determine whether a generally accepted 2-factor model consisting of fewer TSK items applies to the TSK-AV and exhibits acceptable psychometric properties.A 2-factor model provided an adequate-to-good fit to our data, explaining 46.54% of the variance. Factor 1 (labeled as "activity avoidance") comprised items 1, 2, 7, 9, 14, 15, and 17. Factor 2 was labeled as "somatic focus" and comprised items 3, 6, 11, and 13. The 11-item TSK-AV comprised of the 2 factors (TSK-AV-11) as well as its subscales all remained independent significant (P < .001) predictors of pain disability in Jordanian patients with CLBP after accounting for factors such as age, gender, pain duration, and pain severity.The short, 11-item TSK-AV (TSK-AV-11) appears to be an ideal clinical and research tool for measuring fear of movement/re (injury) in Arabic-speaking patients.


Assuntos
Árabes/psicologia , Dor Lombar/psicologia , Transtornos Fóbicos/psicologia , Psicometria/métodos , Adulto , Árabes/estatística & dados numéricos , Aprendizagem da Esquiva , Doença Crônica , Avaliação da Deficiência , Análise Fatorial , Medo/psicologia , Feminino , Humanos , Jordânia/epidemiologia , Dor Lombar/diagnóstico , Masculino , Pessoa de Meia-Idade , Movimento , Dor Nociceptiva/diagnóstico , Medição da Dor/métodos , Índice de Gravidade de Doença
7.
Schmerz ; 34(4): 343-349, 2020 Aug.
Artigo em Alemão | MEDLINE | ID: mdl-32322971

RESUMO

BACKGROUND: Psychological factors have an influence on the manifestation as well as on the maintenance of chronic low back pain (CLBP) and are increasingly considered in research. OBJECTIVES: The present study investigated the validity and clinical relevance of the Mainz Pain Staging System (MPSS) to replicate previous study results in the setting of inpatient multidisciplinary orthopedic rehabilitation (MOR). METHODS: In this multicenter study, psychological and pain-related parameters were investigated among 1012 patients with nonspecific CLBP (ICD-10: M51/53/54) at the beginning of an inpatient MOR stratified according to the stage of pain in the MPSS (I-III). In addition, frequency distributions of scores in the clinical range for depression, anxiety, somatization, and pain-related self-efficacy were determined as a function of pain chronification. RESULTS: Stage of pain had a significant effect on all psychological and pain-related parameters in the expected direction. Alongside patients with stage III, patients with stage II showed higher levels of impairment regarding psychological factors. Furthermore, patients with stage III often had higher clinical scores than expected for depression, anxiety, and somatization. CONCLUSION: These results confirm the validity and clinical relevance of the MPSS. Moreover, the psychological burden of the patients increased with the stage of pain. Therefore, psychological treatments are required that are tailored to patients' needs. Thus, measurement of the MPSS and psychological diagnostic assessments are recommended.


Assuntos
Dor Crônica , Dor Lombar , Medição da Dor , Transtornos de Ansiedade , Estudos Transversais , Humanos , Pacientes Internados , Dor Lombar/diagnóstico
8.
Acta Orthop Traumatol Turc ; 54(2): 161-167, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-32254032

RESUMO

OBJECTIVE: This study aimed to validate the Turkish version of the Low Back Outcome Score and check its reliability in patients with chronic low back pain (LBP). METHODS: Overall, 105 patients (81 women and 24 men; mean age: 49.5 years (18-65 years)) with a complaint of LBP for at least 3 months were included in this study. Test-retest reliability was assessed after 7 days. Overall score of LBOS was compared with the overall scores of "Rolland-Morris Disability Questionnaire," "Oswestry Disability Index," "Quebec Back Pain Disability Scale," "SF-36," and "Bournemouth Questionnaire for Back Pain" to calculate the convergent validity by using Pearson correlation coefficient. RESULTS: The questionnaire was noted to have high internal consistency. The test-retest analysis revealed an excellent correlation (ICC=0.80). Pearson correlation coefficient of the LBOS was assessed using VAS and had an excellent correlation with all the questionnaires included in this study. CONCLUSION: The Turkish version of the LBOS questionnaire appeared to be a valid and reliable outcome measure. LEVEL OF EVIDENCE: Level III, Diagnostic study.


Assuntos
Dor Lombar/diagnóstico , Medição da Dor/métodos , Comparação Transcultural , Avaliação da Deficiência , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Psicometria/normas , Reprodutibilidade dos Testes , Inquéritos e Questionários , Turquia
9.
PLoS One ; 15(4): e0231382, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32267896

RESUMO

BACKGROUND: The Modified Oswestry Low Back Pain Disability Questionnaire (MODQ) is used for evaluating the functional disability in patients with low back pain (LBP). However, the measurement characteristics of the MODQ among Arab patients are unknown. In this study, we aimed to translate and cross-culturally adapt the MODQ into Arabic and evaluate its psychometric properties. METHODS: An Arabic version of the MODQ was developed through forward translation, translation synthesis, and backward translation. Sixty-eight patients (55 males and 13 females) with a mean age 37.01 ± 7.57 years were recruited to assess its psychometric properties. Reliability was evaluated using internal consistency (Cronbach's α), test retest reliability (utilizing intraclass correlation coefficient [ICC]), standard error of measurement (SEM), minimal detectable change at 95% confidence level (MDC95%), and 95% limits of agreement (LOA). The construct validity was investigated by correlating the new translation with four other measures of LBP (using Spearman's rho). Finally, receiver operating characteristic curve was constructed to compute the sensitivity, using the area under the curve (AUC), and the minimum important change (MIC). An alpha level of 0.05 was set for statistical tests and all the psychometric values were tested against a priori hypotheses. RESULTS: The culturally aligned MODQ showed good internal consistency (Cronbach's α = 0.85). The ICC, SEM, MDC95%, and LOA between baseline and two days later were 0.98, 1.60, 4.43, and -4.23 to 7.70, respectively, while the values between baseline and 14 days later were 0.94, 2.77, 7.67, and -6.59 to 13.53, respectively. The scale also demonstrated moderate to excellent correlation (rho = 0.54-0.86) with the other four questionnaires. The AUC value of the Arabic-MODQ was 0.68, and the MIC was 3 points. CONCLUSION: The Arabic version of the MODQ demonstrates adequate psychometric properties and can be used to assess disability level in patients with LBP in Arabic-speaking communities.


Assuntos
Pessoas com Deficiência/psicologia , Dor Lombar/diagnóstico , Psicometria/métodos , Adulto , Árabes , Área Sob a Curva , Comparação Transcultural , Feminino , Humanos , Dor Lombar/fisiopatologia , Masculino , Pessoa de Meia-Idade , Curva ROC , Reprodutibilidade dos Testes , Inquéritos e Questionários , Tradução
10.
J Orthop Sports Phys Ther ; 50(3): 118-120, 2020 03.
Artigo em Inglês | MEDLINE | ID: mdl-32116105

RESUMO

Clinicians who provide high-value musculoskeletal care offer evidence-based management that can improve pain, function, and quality of life. However, the current approach to improving outcomes emphasizes treatment strategies at the expense of accurate diagnosis. Guidelines rarely provide quality information on differential diagnosis and prognosis. The disconnect is worrying, because accurate diagnosis can lead to more appropriate care and improved patient outcomes. In this Viewpoint, we reflect on how the clinician can refine musculoskeletal diagnoses to provide high-value care. We (1) argue that the link between musculoskeletal diagnosis and patient outcomes must be strengthened, (2) introduce a diagnostic framework to help clinicians go beyond "special tests," and (3) present new methods for researchers to move forward from diagnostic accuracy studies. J Orthop Sports Phys Ther 2020;50(3):118-120. doi:10.2519/jospt.2020.0603.


Assuntos
Doenças Musculoesqueléticas/diagnóstico , Doenças Musculoesqueléticas/terapia , Avaliação de Resultados da Assistência ao Paciente , Qualidade da Assistência à Saúde , Tomada de Decisão Clínica , Humanos , Dor Lombar/diagnóstico , Dor Lombar/etiologia , Dor Lombar/terapia , Dor Musculoesquelética/diagnóstico , Dor Musculoesquelética/etiologia , Dor Musculoesquelética/terapia , Síndrome da Dor Patelofemoral/diagnóstico , Síndrome da Dor Patelofemoral/etiologia , Síndrome da Dor Patelofemoral/terapia , Ensaios Clínicos Controlados Aleatórios como Assunto
11.
Pain Physician ; 23(1): E19-E30, 2020 01.
Artigo em Inglês | MEDLINE | ID: mdl-32013285

RESUMO

BACKGROUND: There is a dearth in our understanding of the factors that are predictive of successful spinal cord stimulator (SCS) trials and eventual conversion to permanent implants. Knowledge of these factors is important for appropriate patient selection and treatment optimization. OBJECTIVES: Although previous studies have explored factors predictive of trial success, few have examined the role of waveform in trial outcomes. This study sought to establish the relationship of neuraxial waveform and related measures to trial outcomes. STUDY DESIGN: This study used a retrospective chart review design. METHODS: Data were retrospectively collected on 174 patients undergoing SCS trials upon institutional review board approval of the study protocol. Indications for SCS were: complex regional pain syndrome, failed back surgery syndrome with radicular symptoms, peripheral neuropathy, and axial low back pain. Descriptive statistics and logistic regression analyses were used to assess the association of demographic and clinical variables with SCS trial outcomes. RESULTS: The study population comprised 56% women, had a median age of 55 (interquartile range [IQR], 44-64), and 32 of 174 (18%) patients failed SCS trials. Individuals with successful trials (>= 50% pain relief) were significantly younger and had a median age of 54 years (IQR, 42-60) compared to those who failed SCS trials (median age 66 years; IQR, 50-76; P = .005). Adjusting for age, gender, number of leads, pain category, and diagnoses: surgical history (odds ratio [OR] = 4.4; 95% confidence interval [CI], 1.3-15.8) and paresthesia-based tonic-stimulation (OR = 10.3; 95% CI, 1.7-62.0), but not burst or high frequency, were significantly associated with successful trials. Of note, the number of leads (whether dual or single), pain duration, characteristics, and category (nociceptive vs neuropathic) were not significant factors. An interaction between surgical spine history and lower extremity pain was significantly associated with a positive trial (P = .005). LIMITATIONS: This study was limited by its retrospective nature and focus on a patient population at a single major academic medical center. CONCLUSIONS: Paresthesia-based tonic stimulation, age, and surgical history have significant effects on SCS trials. Prospective and randomized controlled studies may provide deeper insights regarding impact on costs and overall outcomes.IRB Approval #: 2018P002216. KEY WORDS: Pain duration, pain location, spinal cord stimulator trial, stimulator waveform, surgical history.


Assuntos
Dor Crônica/terapia , Síndromes da Dor Regional Complexa/terapia , Síndrome Pós-Laminectomia/terapia , Dor Lombar/terapia , Seleção de Pacientes , Estimulação da Medula Espinal/métodos , Adulto , Fatores Etários , Idoso , Dor Crônica/diagnóstico , Síndromes da Dor Regional Complexa/diagnóstico , Síndrome Pós-Laminectomia/diagnóstico , Feminino , Humanos , Dor Lombar/diagnóstico , Masculino , Pessoa de Meia-Idade , Manejo da Dor/métodos , Estudos Prospectivos , Estudos Retrospectivos , Resultado do Tratamento
12.
Eur Radiol ; 30(5): 2583-2593, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-32020402

RESUMO

OBJECTIVE: To show that for the MRI workup of non-specific low back pain and/or lumbar radiculopathy, the acquisition of T1-weighted sequences in the sagittal plane could be waived when using an FSE T2-weighted Dixon sequence. MATERIALS AND METHODS: Three musculoskeletal radiologists retrospectively reviewed fifty lumbar spine MRI examinations performed for non-specific low back pain and/or lumbar radiculopathy. Two protocols were separately analyzed in the sagittal plane: a standard protocol (T1-weighted, in-phase, and water-only images of an FSE T2-weighted Dixon sequence) and a simplified protocol (fat-only, in-phase, and water-only images of an FSE T2-weighted Dixon sequence). Eight items usually assessed on T1-weighted sequences were analyzed for each of the vertebrae (n = 250), vertebral endplates (n = 500), vertebral corners (n = 1000), foramina (n = 500), lamina (n = 500), and facet joints (n = 500). Interchangeability of these protocols was tested using the individual equivalence index. A decrease in interobserver agreement of ≥ 5% when one reader used the simplified protocol compared with when both readers used the standard protocol was considered clinically significant. Interreader and intrareader agreement were assessed using kappa statistics. Rates of findings with each protocol were compared using odd ratios. RESULTS: The standard and simplified protocols were interchangeable (range of upper bound of the 95%CI of individual equivalence index = 0.25 to 1.38%). Intraprotocol and interprotocol interreader kappa values were similar (0.253-0.671 vs. 0.236-0.723, respectively). Rates of findings were not statistically significantly different (p ≥ 0.074), or were higher with the simplified protocol (p ≤ 0.036). CONCLUSION: In our target population, a single sagittal T2-weighted Dixon sequence may replace the recommended combination of T1-, T2-, and fat-suppressed T2-weighted sequences. KEY POINTS: • In patients with non-specific low back pain or lumbar radiculopathy, spine MRI in the sagittal plane could be limited to a single FSE T2-weighted Dixon sequence, hereby reducing the acquisition time. • A simplified protocol of spine MRI in the sagittal plane combining FSE T2-weighted Dixon sequence provides the same information as a standard protocol including T1-, T2-, and fat-suppressed T2-weighted sequences for the workup of degenerative lumbar spine lesions. • For some findings shown on the simplified protocol, such as focal bone marrow replacement lesions or signs of infection, additional sequences including pre- and post-contrast T1-weighted sequences may be required, as is currently the case when using the standard protocol.


Assuntos
Dor Lombar/diagnóstico , Vértebras Lombares/diagnóstico por imagem , Imagem por Ressonância Magnética/métodos , Radiculopatia/diagnóstico , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Reprodutibilidade dos Testes , Estudos Retrospectivos , Adulto Jovem
13.
Med Clin North Am ; 104(2): 279-292, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-32035569

RESUMO

Neck pain is the fourth leading cause of disability. Acute neck pain largely resolves within 2 months. History and physical examination play a key role in ruling out some of the more serious causes for neck pain. The evidence for pharmacologic interventions for acute and chronic musculoskeletal neck pain is limited. Lower back pain is the leading cause of disability and productivity loss. Consultation with a physical medicine and rehabilitation spine specialist within 48 hours for acute pain and within 10 days for all patients with lower back pain may significantly decrease rate of surgical interventions and increase patient satisfaction.


Assuntos
Dor Lombar , Cervicalgia , Administração dos Cuidados ao Paciente/métodos , Humanos , Dor Lombar/diagnóstico , Dor Lombar/terapia , Cervicalgia/diagnóstico , Cervicalgia/terapia , Prognóstico , Tempo para o Tratamento
14.
Spine (Phila Pa 1976) ; 45(5): E296-E303, 2020 Mar 01.
Artigo em Inglês | MEDLINE | ID: mdl-32045404

RESUMO

STUDY DESIGN: A cross-sectional study. OBJECTIVE: The aim of this study is to describe the profile of patients with acute low back pain (LBP) who sought emergency departments (EDs) in Brazilian public hospitals. We also described the profile of these patients according to the STarT Back Screening Tool (SBST). SUMMARY OF BACKGROUND DATA: LBP is the most common musculoskeletal condition worldwide and is one of the main complaints in EDs. There is a lack of evidence describing the profile of these patients from low- to middle-income countries. METHODS: This is a cross-sectional study involving patients with a new episode of nonspecific acute LBP that was conducted between August 2014 and August 2016. Variables related to clinical, psychological, sociodemographic and work status characteristics were investigated through structured, in-person oral questionnaire. RESULTS: A total of 600 patients were included in the study. The majority of the patients were women (58%), with a median of eight points on pain intensity (measured on an 11-point scale) and 17 points on disability (measured on a 24-item questionnaire). With regards to the SBST evaluation, 295 (49.2%) patients were classified as being at high risk of developing an unfavorable prognosis with a median pain intensity of nine points on pain intensity, 20 points on disability, and seven points on depression (measured on an 11-point scale). Despite this, the majority of the patients (74%) continued working normally without interference from LBP. CONCLUSION: Identifying the profile of patients seeking care in EDs can help to define effective management for LBP in low- and middle-income countries. Patients with nonspecific acute LBP who seek EDs in Brazil present high levels of pain intensity and disability. Most patients were classified as having a high risk of developing an unfavorable prognosis. LEVEL OF EVIDENCE: 2.


Assuntos
Dor Aguda/epidemiologia , Dor Aguda/terapia , Pessoas com Deficiência , Serviço Hospitalar de Emergência/tendências , Dor Lombar/epidemiologia , Dor Lombar/terapia , Dor Aguda/diagnóstico , Adulto , Brasil/epidemiologia , Estudos Transversais , Feminino , Humanos , Dor Lombar/diagnóstico , Masculino , Pessoa de Meia-Idade , Medição da Dor/tendências , Prognóstico , Estudos Prospectivos , Inquéritos e Questionários
15.
J Rehabil Med ; 52(3): jrm00036, 2020 03 31.
Artigo em Inglês | MEDLINE | ID: mdl-32095836

RESUMO

BACKGROUND: There is general agreement that non-specific low back pain is best understood within a biopsychosocial understanding of health. However, clinicians and patients seemingly adhere to a biomedically derived diagnostic model, which may introduce misperceptions of pain and does not inform treatment or prognosis. OBJECTIVE: To explore, from the perspective of health-care practitioners, how persistent non- specific low back pain may be communicated in a way that moves beyond a biomedical diagnosis. DESIGN: An explorative qualitative investigation using a constructivist diagnostic framework. METHODS: Focus group and individual interviews of 10 purposefully selected chiropractors, physio-therapists and general practitioners were codified and thematically analysed. RESULTS: Four themes emerged: "Clinicians' nuanced understanding of back pain"; "The challenges of shared decision-making"; "Cultural barriers to moving beyond biomedicine"; and "More than a label - individual explanations for pain". Pain and disability were perceived as products of multiple bio-psycho-social factors. Clinicians identified the impact of multiple social actors, an unhealthy work culture, and the organization of the medical system on the notion of pain and suffering. CONCLUSION: Clinicians perceived a need to communicate the complexity of non-specific low back pain in order to help patients make sense of their condition, rather than applying diagnostic labelling. There are multiple barriers to integrating a constructivistic diagnostic framework that need to be overcome.


Assuntos
Atitude do Pessoal de Saúde , Dor Lombar/diagnóstico , Adulto , Comunicação , Feminino , Humanos , Dor Lombar/patologia , Masculino , Pessoa de Meia-Idade , Pesquisa Qualitativa
16.
World Neurosurg ; 137: 119-125, 2020 05.
Artigo em Inglês | MEDLINE | ID: mdl-32035203

RESUMO

BACKGROUND: Lumbar total disc replacement is increasingly becoming a more common treatment for discogenic low back pain refractory to conservative measures. Nevertheless, several complications have been reported, including, among others, wound infection, vascular injury, retrograde ejaculation, postsympathectomy syndrome, ileus, and cerebrospinal fluid (CSF) leak. Although CSF leakage is rare, we discuss a case of CSF leakage and the diagnosis and management of CSF leakage after lumbar total disc replacement. CASE DESCRIPTION: A 25-year-old man had presented with discogenic low back pain caused by degenerative disc disease of 9 years' duration. His symptoms were exacerbated by activity, worse with sitting, and relieved by ice baths. He developed a cerebrospinal fluid leak after L5-S1 lumbar total disc replacement. CONCLUSIONS: Our patient ultimately required device removal, direct repair, and replacement with a different prosthesis to treat his CSF leak.


Assuntos
Vazamento de Líquido Cefalorraquidiano/cirurgia , Deslocamento do Disco Intervertebral/cirurgia , Dor Lombar/cirurgia , Vértebras Lombares/cirurgia , Complicações Pós-Operatórias , Substituição Total de Disco/efeitos adversos , Adulto , Vazamento de Líquido Cefalorraquidiano/diagnóstico , Vazamento de Líquido Cefalorraquidiano/etiologia , Humanos , Disco Intervertebral/cirurgia , Dor Lombar/diagnóstico , Dor Lombar/etiologia , Região Lombossacral/cirurgia , Masculino
17.
Hip Int ; 30(2): 187-194, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-31984801

RESUMO

INTRODUCTION: We investigated the effects of lower back pain (LBP) on measures of pain, disability, and function in highly symptomatic hip OA patients receiving intra-articular steroid injection (IASI) therapy. We also investigated the effect of radiographic severity of hip OA for comparison to LBP. METHODS: 97 consenting subjects with symptomatic hip OA presenting for IASI were evaluated at baseline, assessed over an 8-week period, and followed at least 1 year later for new arthroplasty. At baseline and 8 weeks follow-up patient demographics, presence/absence of back pain, physical function tests, a single anteroposterior pelvis x-ray, and subjective scores of pain, stiffness and function (VAS and WOMAC) were collected. We also followed which subjects proceeded to obtain total hip arthroplasty in the examined hip. RESULTS: Cohorts with LBP reported significantly worse scores for all of VAS pain and WOMAC questionnaires but showed no difference in ROM and were not more likely to proceed to arthroplasty. Cohorts with severe radiographic OA had significantly worsened scores for stiffness (χ2 = 6.74, p = 0.009), decreased ROM (p < 0.01), and were more likely to proceed to arthroplasty (χ2 = 9.79, p = 0.044). DISCUSSION: Back pain has a substantial effect on clinical parameters relevant to assessment of severity of hip OA, especially self-reported pain and function. This finding highlights LBP as a significant confounding factor in hip OA patient assessments and will inform future studies to determine the most effective treatment strategies for hip OA patients.


Assuntos
Glucocorticoides/administração & dosagem , Dor Lombar/etiologia , Osteoartrite do Quadril/complicações , Medição da Dor/métodos , Radiografia/métodos , Adulto , Idoso , Idoso de 80 Anos ou mais , Artroplastia de Quadril/métodos , Feminino , Humanos , Injeções Intra-Articulares , Dor Lombar/diagnóstico , Dor Lombar/tratamento farmacológico , Masculino , Pessoa de Meia-Idade , Osteoartrite do Quadril/diagnóstico , Osteoartrite do Quadril/cirurgia , Índice de Gravidade de Doença , Inquéritos e Questionários , Resultado do Tratamento
18.
Radiologe ; 60(2): 117-122, 2020 Feb.
Artigo em Alemão | MEDLINE | ID: mdl-31970425

RESUMO

Low back pain is the leading cause of incapacitation and medical rehabilitation. The purpose of this German National Health Care Guideline "Nonspecific low back pain" is to optimize the care of patients with low back pain. This guideline was drawn up by 29 professional societies and organizations. In the case of nonspecific low back pain, a detailed medical history and physical examination should be carried out first, but no further diagnostics unless there are indications of the so-called "red flags". For symptomatic treatment, medicine should be given in low doses, and physical activity should be in the foreground. A physician should act as a point of contact throughout the course of the disease, and the patient must be continuously educated and motivated to have a healthy lifestyle, including regular physical activity.


Assuntos
Dor Lombar , Humanos , Dor Lombar/diagnóstico
19.
Med Care ; 58(2): 108-113, 2020 02.
Artigo em Inglês | MEDLINE | ID: mdl-31934957

RESUMO

INTRODUCTION: New low back pain (LBP) is a common outpatient complaint. Little is known about how care is delivered over the course of a year to patients who develop new LBP and whether such care patterns are guideline-concordant. METHODS: This retrospective analysis included Medicare claims of 162,238 opioid-naïve beneficiaries with new LBP from January 1, 2011, through December 31, 2014. Simple rates of modality use [computed tomography and magnetic resonance imaging (advanced imaging), physical therapy (PT), opioid and nonopioid medications] and percentiles (5th percentile, 25th percentile, median, 75th percentile, and 95th percentile) were reported. RESULTS: Within the first year, 29.4% [95% confidence interval (CI), 29.1-29.8] of patients with ≥2 visits for new LBP received advanced imaging, and 48.4% (95% CI, 47.7-49.0) of these patients received advanced imaging within 6 weeks of the first visit; 17.3% (95% CI, 17.1-17.6) of patients with ≥2 visits received PT; 42.2% (95% CI, 41.8-42.5) of patients with ≥2 visits received non-steroidal anti-inflammatory drugs (NSAIDs), 16.9% (95% CI, 16.6-17.1) received a muscle relaxant, and 26.2% (95% CI, 25.9-26.6) received tramadol; 32.3% (95% CI, 31.9-32.6) of patients with ≥2 visits received opioids; 52.4% (95% CI, 51.7-53.0) of these patients had not received a prescription NSAID, and 82.2% (95% CI, 81.7-82.7) of these patients had not received PT. CONCLUSIONS: Many patients who develop new LBP receive guideline nonconcordant care such as early advanced imaging and opioids before other modalities like PT and prescription NSAIDs.


Assuntos
Analgésicos/uso terapêutico , Dor Lombar/diagnóstico , Dor Lombar/terapia , Medicare/estatística & dados numéricos , Modalidades de Fisioterapia , Idoso , Idoso de 80 Anos ou mais , Analgésicos Opioides/uso terapêutico , Feminino , Humanos , Revisão da Utilização de Seguros/estatística & dados numéricos , Dor Lombar/diagnóstico por imagem , Masculino , Fármacos Neuromusculares/uso terapêutico , Padrões de Prática Médica/estatística & dados numéricos , Estudos Retrospectivos , Estados Unidos
20.
PLoS One ; 15(1): e0227801, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-31945105

RESUMO

INTRODUCTION AND OBJECTIVES: Low back pain (LBP) is a highly prevalent and disabling public health problem globally. However, little is known about factors affecting health care utilisation for optimal management of the pain, and there is no validated instrument to derive epidemiological data for a better understanding of these factors. The aim of this study was to develop and validate an instrument used to measure determinants of health care utilisation for LBP in Ethiopia. METHODS: The relevant domains of potential determinants of health care utilisation for LBP were identified following a comprehensive review of the literature. Items relating to each domain were then generated by considering the context of Ethiopia, and where necessary, existing items were adapted. The instrument was then translated, and an expert panel reviewed the instrument for content validity, clarity and any other suggestions. Using the data collected from 1303 adults with LBP, factorial validity was assessed by conducting principal component and parallel analyses. Internal consistency reliability was also assessed using Cronbach's alpha. Intraclass correlation coefficient (ICC) and Cohen Kappa statistic were calculated to evaluate temporal stability of the instrument. RESULTS: Parallel analysis showed that there were six components with Eigenvalues (obtained from principal component analysis) exceeding the corresponding criterion values for a randomly generated data matrix of the same size. Cronbach's alpha for the internal consistency reliability ranged from 0.65 to 0.82. In assessing temporal stability, ICC ranged from 0.60, 95% CI: 0.23-0.98 to 0.95, 95% CI: 0.81-1.00 while Cohen Kappa ranged from 0.72, 95% CI: 0.49-0.94 to 0.93, 95% CI: 0.85-1.00. CONCLUSIONS: This study demonstrated that the newly developed instrument has an overall good level of content and factorial validity, internal consistency reliability, and temporal stability. In this way, this instrument is appropriate for measuring determinants of health care utilisation among people with LBP in Ethiopia.


Assuntos
Dor Lombar/terapia , Aceitação pelo Paciente de Cuidados de Saúde/psicologia , Psicometria/métodos , Adulto , Etiópia/epidemiologia , Feminino , Humanos , Dor Lombar/diagnóstico , Dor Lombar/epidemiologia , Masculino , Pessoa de Meia-Idade , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Prevalência , Reprodutibilidade dos Testes
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