Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 4.395
Filtrar
1.
Bone Joint J ; 103-B(3): 542-546, 2021 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-33641429

RESUMO

AIMS: The aim of this study was to investigate the efficacy of coccygectomy in patients with persistent coccydynia and coccygeal instability. METHODS: The Danish National Spine Registry, DaneSpine, was used to identify 134 consecutive patients who underwent surgery, performed by a single surgeon between 2011 and 2019. Routine demographic data, surgical variables, and patient-reported outcomes, including a visual analogue scale (VAS) (0 to 100) for pain, Oswestry Disability Index (ODI), EuroQol five-dimension questionnaire (EQ-5D), and the Physical Component Score (PCS) and Mental Component Score (MCS) of the 36-Item Short-Form Health Survey questionnaire (SF-36) were collected at baseline and one-year postoperatively. RESULTS: A total of 112 (84%) patients with a minimum follow-up of one year had data available for analysis. Their mean age was 41.9 years, and 15 (13%) were males. At 12 months postoperatively, there were statistically significant improvements (p < 0.001) from baseline for the mean VAS for pain (70.99 to 35.34), EQ-5D (0.52 to 0.75), ODI (31.84 to 18.00), and SF-36 PCS (38.17 to 44.74). A total of 78 patients (70%) were satisfied with the outcome of treatment. CONCLUSION: Patients with persistent coccydynia and coccygeal instability resistant to nonoperative treatment may benefit from coccygectomy. Cite this article: Bone Joint J 2021;103-B(3):542-546.


Assuntos
Cóccix/fisiopatologia , Cóccix/cirurgia , Dor Lombar/fisiopatologia , Dor Lombar/cirurgia , Adolescente , Adulto , Idoso , Dinamarca , Avaliação da Deficiência , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Manejo da Dor/métodos , Medição da Dor , Sistema de Registros , Inquéritos e Questionários
2.
JAMA Netw Open ; 4(2): e2037371, 2021 02 01.
Artigo em Inglês | MEDLINE | ID: mdl-33591367

RESUMO

Importance: Acute low back pain (LBP) is highly prevalent, with a presumed favorable prognosis; however, once chronic, LBP becomes a disabling and expensive condition. Acute to chronic LBP transition rates vary widely owing to absence of standardized operational definitions, and it is unknown whether a standardized prognostic tool (ie, Subgroups for Targeted Treatment Back tool [SBT]) can estimate this transition or whether early non-guideline concordant treatment is associated with the transition to chronic LBP. Objective: To assess the associations between the transition from acute to chronic LBP with SBT risk strata; demographic, clinical, and practice characteristics; and guideline nonconcordant processes of care. Design, Setting, and Participants: This inception cohort study was conducted alongside a multisite, pragmatic cluster randomized trial. Adult patients with acute LBP stratified by SBT risk were enrolled in 77 primary care practices in 4 regions across the United States between May 2016 and June 2018 and followed up for 6 months, with final follow-up completed by March 2019. Data analysis was conducted from January to March 2020. Exposures: SBT risk strata and early LBP guideline nonconcordant processes of care (eg, receipt of opioids, imaging, and subspecialty referral). Main Outcomes and Measures: Transition from acute to chronic LBP at 6 months using the National Institutes of Health Task Force on Research Standards consensus definition of chronic LBP. Patient demographic characteristics, clinical factors, and LBP process of care were obtained via electronic medical records. Results: Overall, 5233 patients with acute LBP (3029 [58%] women; 4353 [83%] White individuals; mean [SD] age 50.6 [16.9] years; 1788 [34%] low risk; 2152 [41%] medium risk; and 1293 [25%] high risk) were included. Overall transition rate to chronic LBP at six months was 32% (1666 patients). In a multivariable model, SBT risk stratum was positively associated with transition to chronic LBP (eg, high-risk vs low-risk groups: adjusted odds ratio [aOR], 2.45; 95% CI, 2.00-2.98; P < .001). Patient and clinical characteristics associated with transition to chronic LBP included obesity (aOR, 1.52; 95% CI, 1.28-1.80; P < .001); smoking (aOR, 1.56; 95% CI, 1.29-1.89; P < .001); severe and very severe baseline disability (aOR, 1.82; 95% CI, 1.48-2.24; P < .001 and aOR, 2.08; 95% CI, 1.60-2.68; P < .001, respectively) and diagnosed depression/anxiety (aOR, 1.66; 95% CI, 1.28-2.15; P < .001). After controlling for all other variables, patients exposed to 1, 2, or 3 nonconcordant processes of care within the first 21 days were 1.39 (95% CI, 1.21-2.32), 1.88 (95% CI, 1.53-2.32), and 2.16 (95% CI, 1.10-4.25) times more likely to develop chronic LBP compared with those with no exposure (P < .001). Conclusions and Relevance: In this cohort study, the transition rate to chronic LBP was substantial and increased correspondingly with SBT stratum and early exposure to guideline nonconcordant care.


Assuntos
Dor Aguda/fisiopatologia , Dor Crônica/fisiopatologia , Dor Lombar/fisiopatologia , Atenção Primária à Saúde , Dor Aguda/diagnóstico por imagem , Dor Aguda/epidemiologia , Dor Aguda/terapia , Adulto , Idoso , Analgésicos Opioides/uso terapêutico , Transtornos de Ansiedade/epidemiologia , Dor Crônica/epidemiologia , Transtorno Depressivo/epidemiologia , Diagnóstico por Imagem/estatística & dados numéricos , Progressão da Doença , Feminino , Fidelidade a Diretrizes/estatística & dados numéricos , Humanos , Dor Lombar/diagnóstico por imagem , Dor Lombar/epidemiologia , Dor Lombar/terapia , Masculino , Pessoa de Meia-Idade , Obesidade/epidemiologia , Razão de Chances , Guias de Prática Clínica como Assunto , Prognóstico , Encaminhamento e Consulta/estatística & dados numéricos , Fatores de Risco , Fumar/epidemiologia , Estados Unidos/epidemiologia
3.
Nat Med ; 27(1): 174-182, 2021 01.
Artigo em Inglês | MEDLINE | ID: mdl-33398159

RESUMO

Sustained pain is a major characteristic of clinical pain disorders, but it is difficult to assess in isolation from co-occurring cognitive and emotional features in patients. In this study, we developed a functional magnetic resonance imaging signature based on whole-brain functional connectivity that tracks experimentally induced tonic pain intensity and tested its sensitivity, specificity and generalizability to clinical pain across six studies (total n = 334). The signature displayed high sensitivity and specificity to tonic pain across three independent studies of orofacial tonic pain and aversive taste. It also predicted clinical pain severity and classified patients versus controls in two independent studies of clinical low back pain. Tonic and clinical pain showed similar network-level representations, particularly in somatomotor, frontoparietal and dorsal attention networks. These patterns were distinct from representations of experimental phasic pain. This study identified a brain biomarker for sustained pain with high potential for clinical translation.


Assuntos
Biomarcadores/análise , Neuroimagem Funcional/métodos , Medição da Dor/métodos , Adolescente , Adulto , Agentes Aversivos/toxicidade , Capsaicina/toxicidade , Conectoma/métodos , Conectoma/estatística & dados numéricos , Dor Facial/fisiopatologia , Feminino , Neuroimagem Funcional/estatística & dados numéricos , Humanos , Dor Lombar/fisiopatologia , Imagem por Ressonância Magnética/métodos , Imagem por Ressonância Magnética/estatística & dados numéricos , Masculino , Modelos Neurológicos , Rede Nervosa/fisiopatologia , Dor/fisiopatologia , Medição da Dor/estatística & dados numéricos , Valor Preditivo dos Testes , Sensibilidade e Especificidade , Paladar/efeitos dos fármacos , Paladar/fisiologia , Adulto Jovem
4.
Sci Rep ; 10(1): 21883, 2020 12 14.
Artigo em Inglês | MEDLINE | ID: mdl-33318516

RESUMO

Exercise is the most common conservative intervention for chronic low back pain (CLBP). We have developed an innovative exercise device for the abdominal trunk muscles that also measures muscle strength in a sitting position. The device, which is easy for patients with CLBP to use, allows for lumbar stabilization exercise under pressure. This study aimed to examine the efficacy of abdominal trunk muscle strengthening using the device in improving CLBP. We conducted a two-group non-randomized controlled clinical trial. CLBP patients were allocated into two groups. The strengthening group underwent a 12-week exercise program that included abdominal trunk muscle strengthening using our device and stretching exercises, while the control group received a 12-week stretching exercise program. The outcome measures included the improvement of the abdominal trunk muscle strength measured by the device, pain intensity of CLBP, physical function, and quality of life (QOL). A total of 40 participants (20 in each group) were analyzed. The strengthening group showed better improvement in the abdominal trunk muscle strength, CLBP, physical function, and QOL than in the control group. In conclusion, the strengthening exercise using the device with easy stretching was effective in improving the strength of the abdominal trunk muscles, pain intensity of CLBP, physical function, and QOL.


Assuntos
Músculos Abdominais/fisiopatologia , Terapia por Exercício/instrumentação , Dor Lombar , Força Muscular , Qualidade de Vida , Idoso , Idoso de 80 Anos ou mais , Terapia por Exercício/métodos , Feminino , Humanos , Dor Lombar/fisiopatologia , Dor Lombar/terapia , Masculino , Medição da Dor
5.
Tech Vasc Interv Radiol ; 23(4): 100700, 2020 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-33308584

RESUMO

Degenerative lumbar spine disorder (DLSD) is a ubiquitously occurring event that may be induced or accelerated by multiple factors such as from overuse, trauma, genetic predisposition, nutrition deficiency, and others. While our understanding of this degenerative disorder is limited, in terms of prevention, the symptoms from DLSD can be significant and may lead to the reduction in the patient's quality of life and loss of work time. In the Global Burden of Disease Study, low back pain was ranked the highest of 291 different conditions, due to the number of years lost to disability, amounting to 83 million disability-adjusted life years lost in 2010. DLSD contains conditions involving disc degeneration, lumbar spinal stenosis, and spondylolisthesis, including symptoms ranging from low back pain to lower extremity radicular pain and weakness. In this issue, we will be discussing treatments for patients suffering with chronic low back pain from endplate disruption, utilizing basivertebral nerve radiofrequency ablation, also known as the INTRACEPT procedure. This issue will also cover minimally invasive lumbar decompression from lumbar spinal stenosis, due to contributory ligamentum flavum hypertrophy, utilizing the percutaneous image-guided lumbar decompression technique known as the MILD procedure.


Assuntos
Dor Crônica/cirurgia , Descompressão Cirúrgica , Dor Lombar/cirurgia , Vértebras Lombares/cirurgia , Manejo da Dor , Ablação por Radiofrequência , Radiografia Intervencionista , Doenças da Coluna Vertebral/cirurgia , Dor Crônica/diagnóstico , Dor Crônica/fisiopatologia , Descompressão Cirúrgica/efeitos adversos , Humanos , Dor Lombar/diagnóstico , Dor Lombar/fisiopatologia , Vértebras Lombares/diagnóstico por imagem , Vértebras Lombares/fisiopatologia , Manejo da Dor/efeitos adversos , Ablação por Radiofrequência/efeitos adversos , Radiografia Intervencionista/efeitos adversos , Doenças da Coluna Vertebral/diagnóstico por imagem , Doenças da Coluna Vertebral/fisiopatologia , Resultado do Tratamento
6.
PLoS One ; 15(12): e0244111, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33332431

RESUMO

OBJECTIVES: In patients with chronic low back pain (CLBP), reduced lumbar flexion-relaxation and reduced variability of muscle activity distribution are reported as abnormal muscle activity. It is not known how abnormal muscle activity and pain-related factors are related to CLBP-based disability. Here, we performed an association rule analysis to investigated how CLBP disability, muscle activity, and pain-related factors in CLBP patients are related. METHODS: Surface electromyographic signals were recorded from over the bilateral lumbar erector spinae muscle with four-channel electrodes from 24 CLBP patients while they performed a trunk flexion re-extension task. We calculated the average value of muscle activities of all channels and then calculated the flexion relaxation ratio (FRR) and the spatial variability of muscle activities. We also assessed the pain-related factors and CLBP disability by a questionnaire method. A clustering association rules analysis was performed to determine the relationships among pain-related factors, the FRR, and the variability of muscle activity distribution. RESULTS: The association rules of severe CLBP disability were divisible into five classes, including 'low FRR-related rules.' The rules of the mild CLBP disability were divisible into four classes, including 'high FRR-related rules' and 'high muscle variability-related rules.' When we combined pain-related factors with the FRR and muscle variability, the relationship between abnormal FRR/muscle variability and CLBP disability became stronger. DISCUSSION: Our findings thus highlight the importance of focusing on not only the patients' pain-related factors but also the abnormal motor control associated with CLBP, which causes CLBP disability.


Assuntos
Dor Crônica/fisiopatologia , Dor Lombar/fisiopatologia , Relaxamento Muscular , Músculos Paraespinais/fisiopatologia , Idoso , Idoso de 80 Anos ou mais , Eletromiografia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade
7.
Medicine (Baltimore) ; 99(46): e23178, 2020 Nov 13.
Artigo em Inglês | MEDLINE | ID: mdl-33181694

RESUMO

Low back pain (LBP) is a typical symptom in volleyball players, yet associated physical function factors have not been identified. This study purpose is to determine the relationship between LBP and physical function factors in order to identify potential factors for the management of LBP.Participants were 123 male and female volleyball players of 15- to 17-year-olds who, completed a questionnaire regarding demographic details, presence of LBP, and years of volleyball experience. Participants were divided into 2 groups based on the presence of current LBP and evaluated on physical function tests. The results of the questionnaire response and physical function test were compared between the 2 groups. Data were analyzed using a multivariate logistic regression analysis with presence and absence of current LBP as the explanatory variable.11.4% of all participants reported current LBP. Physical function factors associated with current LBP were a positive modified Thomas test, years of volleyball experience and reduced range of motion of shoulder horizontal abduction on the dominant hand side.The associations between physical function factors and LBP found in this survey suggest that attention should be given to more experienced players with decreased flexibility of hip and shoulder flexors on the dominant side in order to manage LBP in high school volleyball players.


Assuntos
Atletas/classificação , Dor Lombar/classificação , Desempenho Físico Funcional , Voleibol/lesões , Adolescente , Atletas/estatística & dados numéricos , Estudos de Casos e Controles , Estudos Transversais , Feminino , Humanos , Japão , Modelos Logísticos , Dor Lombar/fisiopatologia , Masculino , Instituições Acadêmicas/estatística & dados numéricos , Voleibol/estatística & dados numéricos
8.
Medicine (Baltimore) ; 99(46): e23223, 2020 Nov 13.
Artigo em Inglês | MEDLINE | ID: mdl-33181705

RESUMO

INTRODUCTION: Low back pain (LBP) is high prevalent and it is the leading cause of years lived with disability in both developed and developing countries. The sacroiliac joint (SIJ) is a common reason that caused LBP. At present, the treatment of chronic LBP attributed to SIJ is mainly conservative treatment and surgical treatment. However, there are still controversies between the 2 treating methods, and there is no recognized standard of treatment or surgical indications. Recent publications indicated that minimally invasive sacroiliac joint arthrodesis was safe and more effective improving pain, disability, and quality of life compared with conservative management in 2 years follow-up, which re-raise the focus of sacroiliac joints fusion. This paper will systematically review the available evidence, comparing the effectiveness of sacroiliac joint fusion and conservative therapy for the treatment of gait retraining for patients suffered from LBP attributed to the sacroiliac joint. METHOD AND ANALYSIS: A systematic review and meta-analysis of relevant studies in Pubmed, Embase, SCOPUS, and Cochrane Library will be synthesized. Inclusion criteria will be studies evaluating clinical outcomes (i.e., changes to pain and/or function) comparing sacroiliac joint fusion and conservative therapy in populations sacroiliac join related LBP; studies with less than 10 participants in total will be excluded. The primary outcomes measured will be pain score, Oswestry Disability Index (ODI), and adverse events during treatment. Review Manager (Revman; Version 5.3) software will be used for data synthesis, sensitivity analysis, meta-regression, subgroup analysis, and risk of bias assessment. A funnel plot will be developed to evaluate reporting bias and Begg and Egger tests will be used to assess funnel plot symmetries. We will use the Grading of Recommendations Assessment, Development and Evaluation system to assess the quality of evidence. ETHICS AND DISSEMINATION: Our aim is to publish this systematic review and meta-analysis in a peer-reviewed journal. Our findings will provide information comparing the efficacy and safety comparing sacroiliac joint fusion and non-surgical treatment for patients with LBP attributed to the sacroiliac joint. This review will not require ethical approval as there are no issues about participant privacy.


Assuntos
Tratamento Conservador/normas , Dor Lombar/terapia , Articulação Sacroilíaca/anormalidades , Fusão Vertebral/normas , Protocolos Clínicos , Humanos , Dor Lombar/fisiopatologia , Metanálise como Assunto , Articulação Sacroilíaca/diagnóstico por imagem , Fusão Vertebral/métodos , Revisões Sistemáticas como Assunto
9.
PLoS One ; 15(9): e0239332, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32960909

RESUMO

The Low Back Activity Confidence Scale (LoBACS) assesses the self-efficacy to perform activities in individuals with chronic low back pain (CLBP). As self-efficacy appears to directly influence the patient's functional capacity and prognosis, it is important to develop a scale that evaluates this attribute to guide treatment strategy and monitor the clinical course of patients. This study aimed to evaluate the reliability, construct validity, and responsiveness of the Brazilian version of the LoBACS. The scale was applied to 112 male and female patients (age, 18-65 years) with specific and nonspecific CLBP. For evaluating the interobserver reliability, the scale was applied twice on the first evaluation day by two trained evaluators (A and B). Within 48-72 h of the first evaluation, assessor A reapplied the scale to evaluate intraobserver reliability (test-retest), which was analyzed by intraclass correlation coefficient (ICC). The first LoBACS applied in the baseline evaluation was also used to assess the construct validity of the scale by factor analysis. For responsiveness, the scale was applied 5 times at 2-week intervals and the change in scores was analyzed by the repeated measures ANOVA. Although factor analysis indicated three subscales, they did not present acceptable values of convergent and divergent validity. Reliability ranged from good to excellent, with ICC values of .90 (95% CI, .84; .93) and .85 (95% CI, .77; .91) for inter- and intraobserver variability for total score. Moreover, the total score was responsive in all comparisons, with no floor or ceiling effects. Thus, only the total score of the Brazilian version of LoBACS proved to be reliable, valid, and responsive.


Assuntos
Dor Lombar/fisiopatologia , Medição da Dor/métodos , Adolescente , Adulto , Idoso , Análise de Variância , Doença Crônica , Análise Fatorial , Feminino , Humanos , Dor Lombar/psicologia , Masculino , Pessoa de Meia-Idade , Reprodutibilidade dos Testes , Autoeficácia , Tradução , Adulto Jovem
10.
Work ; 67(1): 11-19, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32955470

RESUMO

BACKGROUND: The COVID-19 pandemic has caused global adoption of stay-at-home mandates in an effort to curb viral spread. This lockdown has had the unintended consequence of decreasing physical activity, and incidence of low back pain (LBP) is likely to rise as sedentary behavior increases. OBJECTIVE: In this article, we aim to provide a fundamental, novel approach to alleviate LBP including desk worker associated LBP exacerbated during the COVID-19 pandemic. METHODS: Individuals can alleviate their LBP through a simplistic, self-therapeutic approach: myofascial release and stretching of key musculature involved in LBP following a simple technique and associated time domain, as well as a 360-degree strengthening of the muscles surrounding the lower back. Additional muscular strength will support the lower back and lend resilience to aid in the mitigation of pain caused by poor work-related postural positions. RESULTS: We demonstrate several exercises and movements aimed at alleviating LBP. Additionally, we provide a summary graphic which facilitates ease of use of the exercise plan and represents a novel methodology for simple distribution of evidence-based pain reduction strategies. CONCLUSIOS: Through mitigation of sedentary behavior and adoption of the techniques described herein, LBP can be decreased and, in some cases, cured.


Assuntos
Dor Lombar/terapia , Massagem , Exercícios de Alongamento Muscular , Doenças Profissionais/terapia , Treinamento de Resistência , Comportamento Sedentário , Local de Trabalho/psicologia , Músculos do Dorso/fisiopatologia , Betacoronavirus , Infecções por Coronavirus/epidemiologia , Humanos , Dor Lombar/fisiopatologia , Doenças Profissionais/fisiopatologia , Manejo da Dor/métodos , Pandemias , Pneumonia Viral/epidemiologia , Telecomunicações
11.
PLoS One ; 15(9): e0239505, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32991582

RESUMO

Evidence suggests that the application of Kinesio Tape (KT) on patients with chronic non-specific low back pain (CNLBP) is inconclusive. Dynamic tape (DT) is a relatively new treatment technique, which is increasingly being used as an adjunctive method to treat musculoskeletal problems. To our knowledge, no study has investigated the application of DT in individuals with CNLBP. To compare the immediate and short-term effects of DT versus KT and no tape among patients with CNLBP on pain, endurance, disability, mobility, and kinesiophobia. Forty-five patients with CNLBP were randomly assigned to 1 of 3 groups. Outcomes were measured at baseline, immediately, and on the third day post-application of tapes. The primary outcomes of pain, endurance, and disability were measured through the visual analog scale (VAS), Biering-Sorensen test, and Oswestry disability index (ODI), respectively. Secondary outcome measures of mobility and kinesiophobia were measured using the modified-modified Schober test and the Tampa Scale of Kinesiophobia, respectively. No significant immediate and short-term differences were found between DT and KT in pain, disability, mobility, and kinesiophobia. Improved back extensor endurance was observed for the DT group than KT (p = 0.023) and control group (p = 0.006). The application of DT may result in improvements only in back extensor endurance among individuals with CNLBP. This finding suggests that DT controls the processes that lead to back muscle fatigue.


Assuntos
Fita Atlética , Dor Lombar/fisiopatologia , Dor Lombar/terapia , Medição da Dor/métodos , Resistência Física/fisiologia , Adulto , Músculos do Dorso/fisiopatologia , Avaliação da Deficiência , Pessoas com Deficiência , Humanos , Masculino , Fadiga Muscular/fisiologia , Amplitude de Movimento Articular/fisiologia
12.
BMJ Case Rep ; 13(9)2020 Sep 21.
Artigo em Inglês | MEDLINE | ID: mdl-32958554

RESUMO

Clinical manifestations of COVID-19 are known to be variable with growing evidence of nervous system involvement. In this case report, we describe the symptoms of a patient infected with SARS-CoV-2 whose clinical course was complicated with Guillain-Barré syndrome (GBS). We present a case of a 58-year-old woman who was initially diagnosed with COVID-19 pneumonia due to symptoms of fever and cough. Two weeks later, after the resolution of upper respiratory tract symptoms, she developed symmetric ascending quadriparesis and paresthesias. The diagnosis of GBS was made through cerebrospinal fluid analysis and she was successfully treated with intravenous immunoglobulin administration.


Assuntos
Infecções por Coronavirus/complicações , Síndrome de Guillain-Barré/fisiopatologia , Dor Lombar/fisiopatologia , Debilidade Muscular/fisiopatologia , Parestesia/fisiopatologia , Pneumonia Viral/complicações , Analgésicos/uso terapêutico , Betacoronavirus , Encéfalo/diagnóstico por imagem , Infecções por Coronavirus/diagnóstico , Diagnóstico Diferencial , Feminino , Gabapentina/uso terapêutico , Síndrome de Guillain-Barré/diagnóstico , Síndrome de Guillain-Barré/etiologia , Síndrome de Guillain-Barré/terapia , Humanos , Imunoglobulinas Intravenosas/uso terapêutico , Fatores Imunológicos/uso terapêutico , Vértebras Lombares/diagnóstico por imagem , Imagem por Ressonância Magnética , Pessoa de Meia-Idade , Pandemias , Pneumonia Viral/diagnóstico , Radiculopatia/diagnóstico , Medula Espinal/diagnóstico por imagem
13.
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
14.
PLoS One ; 15(7): e0234858, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32628670

RESUMO

Recent literature has indicated altered motor control in individuals with non-specific low back pain (NSLBP). These individuals present variations in back muscular activity and center of mass (CoM) oscillations. The aim of this study is to explore the possibility of quantitatively measuring these differences using standard parameters with electronic devices. Twenty individuals with NSLBP and 20 healthy controls, matched by sex and age, performed a total of three trials under three different conditions for 90 seconds each. These conditions were standing on firm ground with eyes open, with eyes closed and standing on unstable foam with eyes open. Balance data was acquired via a Kistler force platform and muscular activity was measured by electromyography derived bilaterally from the erector spinae. Afterwards, participants were asked to complete a questionnaire on their current mood, pain rating, well-being, disability and physical activity. Descriptive data from the questionnaire showed an average acute pain score of 2.6 and an average pain score of 5.1 for the prior six weeks in the NSLBP group, while the control group reported an acute pain of 0.1 and an average pain of 0.5. For wellbeing, differences were found only for the physical scale. Average disability was low for the NSLBP group. No differences in physical activity were found among groups. A repeated measures ANOVA did not show significant differences between groups for any parameter. There was also no main effect for the standing conditions and no interaction between group and condition. Simultaneously measuring biomechanical and neuromuscular parameters, allowed for a fine grain approach to understanding motor control in individuals with NSLBP. This study did not find differences as described in the literature, and suggests further examination of factors involved in pain and control processes to better understand implications of NSLBP and possible avenues for support.


Assuntos
Dor Lombar/fisiopatologia , Atividade Motora/fisiologia , Equilíbrio Postural/fisiologia , Adulto , Músculos do Dorso/fisiologia , Dor nas Costas/fisiopatologia , Estudos de Casos e Controles , Feminino , Humanos , Masculino , Posição Ortostática
15.
Muscle Nerve ; 62(4): 462-473, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-32557709

RESUMO

Persons with back, neck, and limb symptoms constitute a major referral population to specialists in electrodiagnostic (EDX) medicine. The evaluation of these patients involves consideration of both the common and less common disorders. The EDX examination with needle electromyography (EMG) is the most important means of testing for radiculopathy. This test has modest sensitivity but high specificity and well complements imaging of the spine. Needle EMG in combination with nerve conduction testing is valuable in excluding entrapment neuropathies and polyneuropathy-conditions that frequently mimic radicular symptoms. In this first of a two-part review, the optimal EDX evaluation of persons with suspected radiculopathy is presented. In part two, the implications of EDX findings for diagnosis and clinical management of persons with radiculopathy are reviewed.


Assuntos
Técnicas de Diagnóstico Neurológico , Eletromiografia/métodos , Condução Nervosa , Radiculopatia/diagnóstico , Variação Anatômica , Vértebras Cervicais , Eletrodiagnóstico/métodos , Potencial Evocado Motor , Humanos , Dor Lombar/etiologia , Dor Lombar/fisiopatologia , Vértebras Lombares , Debilidade Muscular/etiologia , Debilidade Muscular/fisiopatologia , Cervicalgia/etiologia , Cervicalgia/fisiopatologia , Agulhas , Exame Neurológico , Exame Físico , Radiculopatia/complicações , Radiculopatia/fisiopatologia , Reflexo Anormal , Sacro , Ciática/etiologia , Ciática/fisiopatologia , Raízes Nervosas Espinhais
16.
J Occup Health ; 62(1): e12108, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-32515885

RESUMO

OBJECTIVES: The problem of spinal pain among nurses and lack of compliance with workplace ergonomy is increasing. The study aimed to assess the pressure pain threshold (PPT) at the cervical and lumbar spine in nursing staff. METHODS: The sample of this prospective and observational study consisted of 30 female nurses with a mean age of 38.6 ± 11.1 years. The standardized Oswestry (ODI) and the Neck Disability Index (NDI) were used, as well as the Authors' Designed Questionnaire (ADQ) was used to assess compliance with ergonomic principles. The PPT analysis using a computerized pressure algometer (CPA) was performed to examine the level of PPT. RESULTS: A mild disability was found in 56% of nurses (NDI and ODI). A value of <4 kg/cm2 (CPA), indicating musculoskeletal overload was observed in 57% of subjects. Also, 60% of nurses work with a lying patient; 73.4% grabs the patient's armpits while transferring in bed; 16.7% never adjusts the height of the bed, and only 13.4% choose specialist footwear for work. There is a correlation between PPT values for trapezius and erector spinae muscles on the same side of the body in nurses with mild and moderate disability (P < .05). CONCLUSIONS: Pain complaints are associated with lower PPT of trapezius and erector spinae muscles and asymmetry of muscle tension. Also, it was noted that the lack of implementation of ergonomic principles by nursing staff affects their degree of disability.


Assuntos
Dor Lombar/fisiopatologia , Cervicalgia/fisiopatologia , Enfermeiras e Enfermeiros , Limiar da Dor , Adulto , Estudos Transversais , Avaliação da Deficiência , Feminino , Humanos , Pessoa de Meia-Idade , Pressão , Estudos Prospectivos
17.
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
18.
Braz J Phys Ther ; 24(4): 373-380, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32451161

RESUMO

BACKGROUND: This a priori statistical analysis plan describes the methods of analysis for the Trial Of Prevention Strategies for low back pain (TOPS). OBJECTIVES: TOPS aimed to investigate the effectiveness and cost-effectiveness of exercise and education classes compared with a minimal intervention control in preventing recurrence of low back pain (LBP) in people who have recently recovered from an episode of LBP. METHODS: TOPS is a superiority, pragmatic, parallel-group randomized controlled trial with allocation concealment, blinded outcome assessors, and intention-to-treat analysis. Participants were randomized to a physical therapist-led exercise and education program for 12 weeks or minimal intervention. The primary outcome was days to recurrence of an episode of LBP. The three key secondary outcomes were days to recurrence of an episode of LBP resulting in (1) activity limitation, (2) care seeking for LBP; and (3) work absence of at least 1 day. Differences in survival curves for the primary (days to recurrence) and secondary outcome (days to LBP with activity limitation, days to care seeking due to LBP, and days to work absence due to LBP) will be compared using Cox regression. Hazard ratios (HRs) and median survival times with 95% confidence intervals (CI) will be calculated. The number of adverse events, including serious adverse events will be reported and the proportion of adverse events between groups will be compared using a Chi-squared test. DISCUSSION: This paper will provide a detailed description of the planned analyses for the TOPS trial. TRIAL REGISTRATION: Australian New Zealand Clinical Trials Registry (ACTRN12615000939594).


Assuntos
Exercício Físico/fisiologia , Dor Lombar/fisiopatologia , Austrália , Análise Custo-Benefício , Humanos , Avaliação de Resultados em Cuidados de Saúde , Resultado do Tratamento
19.
J Electromyogr Kinesiol ; 52: 102423, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-32416446

RESUMO

Faster trunk motions could be a strategy to prevent loss of balance and fall injuries due to unexpected perturbations. However, it is unclear how trunk sway velocities can be compensated during stepping in subjects with low back pain (LBP). The purpose of this study was to investigate lower limb reaction, swing, and step times, as well as trunk sway velocities at heel strike and toe-off, following repeated step perturbations between subjects with and without LBP. There were 30 subjects with LBP and 42 control subjects who were exposed to treadmill-induced perturbations at a velocity of 0.12 m/sec for 0.62 m. The treadmill-induced steps caused subjects to walk forward for 4.90 sec after the perturbation. The groups demonstrated significant interactions on the lower limb reaction times and on the number of repeated perturbations (F = 4.83, p = 0.03) due to a decreased step time at the first perturbation (t = 2.52, p = 0.01) in the LBP group. For the trunk sway velocities, the repeated perturbations demonstrated a significant interaction between groups (F = 4.65, p = 0.03). This adaptive trunk strategy for gait stability increased step times with repeated perturbations in the LBP group. The group interactions on the trunk sway velocities also indicated a possible somatosensory integration for step time adjustments to avoid potential fall hazards. This adaptive response with repeated step perturbations could result in compensatory trunk sway for gait stability.


Assuntos
Adaptação Fisiológica , Dor Lombar/fisiopatologia , Equilíbrio Postural , Tronco/fisiologia , Adulto , Fenômenos Biomecânicos , Feminino , Humanos , Masculino , Músculo Esquelético/fisiologia , Músculo Esquelético/fisiopatologia , Tempo de Reação , Tronco/fisiopatologia , Caminhada
20.
Phys Ther Sport ; 44: 33-40, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32375075

RESUMO

OBJECTIVES: To explore the multidisciplinary team experience of Low Back Pain (LBP) in elite gymnastics. DESIGN: A qualitative focus group. SETTING: British Gymnastics. PARTICIPANTS: Ten coaching, sports science and medicine multidisciplinary team members working with British gymnasts. MAIN OUTCOME MEASURES: A topic guide informed by literature/expert opinion enabled discussion that was recorded/transcribed verbatim. Initial inductive analytic process developed theoretical insights. Manual coding using constant comparative methods categorised meaningful themes and sub-themes. RESULTS: Two key aspects were identified. Emerging themes for LBP presentation included: early identification LBP and influence of multidisciplinary team members on outcomes; factors influencing LBP reporting e.g. coach-athlete relationship; frequent presentations of LBP and accepted norms; athlete history and physical examination e.g. training load. Emerging themes for causation of LBP included: intrinsic risk factors e.g. growth and maturation; extrinsic risk factors e.g. equipment. CONCLUSIONS: Individual responses of a gymnast to experiencing LBP were important across all themes. Some LBP was perceived as normal. The coach-athlete relationship and support team are crucial decision-makers around training load and adaptation. Early detection will help minimise time loss from training/performance to expedite healing.


Assuntos
Atletas , Ginástica/fisiologia , Dor Lombar/fisiopatologia , Percepção/fisiologia , Pesquisa Qualitativa , Adulto , Idoso , Feminino , Grupos Focais , Humanos , Masculino , Pessoa de Meia-Idade , Fatores de Risco
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA
...