Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 5.606
Filtrar
1.
Zhongguo Gu Shang ; 34(3): 282-7, 2021 Mar 25.
Artigo em Chinês | MEDLINE | ID: mdl-33787176

RESUMO

OBJECTIVE: To observe the analgesic effect of manipulation loading on chronic low back pain (CLBP) model rats and the expression of inflammatory factors in psoas major muscle tissue, and to explore the improvement of manipulation on local inflammatory microenvironment. METHODS: Thirty two SPF male SD rats weighing 340-360g were randomly divided into blank group, sham operation group, chronic low back pain model group and treatment group, with 8 rats in each group. In the model group, L4-L6 lumbar vertebrae were implanted with external link fixation system (ELFS). After implantation of ELFS, the treatment group received manualintervention with 5N force and 2Hz frequency on both sides of the spine, 15 min / time, once a day, for 14 consecutive days. Paw with drawl threshold (PWT) and paw withdrawl latency (PWL) was measured before modeling and on the 1st, 3rd, 7th, 10th and 14th day after intervention. At the end of the treatment cycle, the concentrations of calcitonin gene-related peptide (CGRP) and nerve growth factor (NGF) in psoas muscle were detected by enzyme-linked immunosorbent assay (ELISA). RESULTS: There was no significant difference in PWT and PWL between the blank group and the sham operation group after modeling (P>0.05);after modeling, PWT and PWL in the CLBP model group and the treatment group were significantly decreased(P<0.01);PWT in the treatment group was not significantly improved than that in the CLBP model group on the 1st and 3rd day after manual loading(P>0.05);on the 7th day after manual loading, the pain threshold value in the treatment group was higher than that in the CLBP model group, but there was no significant difference There was no significant difference between the two groups (P=0.056>0.05). On the 10th and 14th day of treatment, the mechanical pain threshold of the treatment group began to rise, and it was statistically significant compared with CLBP model rats (P<0.05, P< 0.01);on the 1st and 3rd day after manual treatment, the PWL of the treatment group was not significantly improved compared with CLBP model group (P>0.05);on the 7th day, the PWL of the treatment group was significantly higher than that of CLBP model group, there was statistical significance (P=0.016<0.05). Manual loading improved thermal hyperalgesia in CLBP rats until the end of the experiment. The contents of CGRP and NGF in psoas major muscle of CLBP model group were higher than those of blank group and sham operation group (P<0.01). After treatment, the contents of CGRP and NGF decreased significantly(P<0.01). CONCLUSION: Local massage loading has analgesic effect on CLBP rats, at the same time, it can inhibit the content of CGRP and NGF in psoas muscle tissue of CLBP rats, and improve the local inflammatory microenvironment.


Assuntos
Peptídeo Relacionado com Gene de Calcitonina , Dor Lombar , Animais , Calcitonina , Dor Lombar/terapia , Masculino , Fator de Crescimento Neural/genética , Ratos , Ratos Sprague-Dawley
2.
Medicine (Baltimore) ; 100(9): e24535, 2021 Mar 05.
Artigo em Inglês | MEDLINE | ID: mdl-33655920

RESUMO

OBJECTIVE: To establish whether early use of magnetic resonance imaging (MRI) or computed tomography (CT) influences treatment and outcome of patients with low back pain. METHODS: This study will be implemented from March 2021 to March 2022 at Huzhou Traditional Chinese Medicine Hospital Affiliated to Zhejiang Chinese Medical University. The experiment was granted through the Research Ethics Committee of Huzhou Traditional Chinese Medicine Hospital Affiliated to Zhejiang Chinese Medical University (R609320987). Patients who have symptomatic lumbar spine disorders at presentation are eligible for the trial if there is clinical uncertainty about the need for imaging (MRI or CT). Patients are excluded who required immediate referral for imaging (those who had signs suggestive of serious abnormalities or disease or who required surgical intervention), who have undergone MR imaging or CT of the spine within 1 year, who do not need imaging, and who have pain of a nonspinal origin. The primary outcome measure is the Aberdeen Low Back Pain (ALBP) score. Other principal outcome measure is the Short Form 36. RESULTS: Table 1 will show the quality of life outcome measures between groups. CONCLUSION: This study may guide the policy makers to develop an evidence-based protocol to assess the effect of early use of MRI or CT in the treatment of patients with low back pain.


Assuntos
Tomada de Decisão Clínica/métodos , Dor Lombar/diagnóstico por imagem , Imagem por Ressonância Magnética , Tomografia Computadorizada por Raios X , Adulto , Idoso , Idoso de 80 Anos ou mais , Diagnóstico Precoce , Feminino , Humanos , Dor Lombar/terapia , Masculino , Pessoa de Meia-Idade , Medição da Dor , Qualidade de Vida , Ensaios Clínicos Controlados Aleatórios como Assunto , Resultado do Tratamento
3.
Am J Phys Med Rehabil ; 100(3): 243-249, 2021 03 01.
Artigo em Inglês | MEDLINE | ID: mdl-33595936

RESUMO

OBJECTIVE: The aim of the study was to analyze the effects of pain education and the combined use of cryotherapy and transcutaneous electrical nerve stimulation on the pain sensation, functional capacity, and quality of life of patients with nonspecific chronic low back pain. DESIGN: This is a randomized controlled and blind clinical trial including patients with nonspecific chronic low back pain in the following 4 groups: control group, cryotherapy group, burst transcutaneous electrical nerve stimulation group, and cryotherapy combined with burst transcutaneous electrical nerve stimulation group. They were evaluated at baseline and after the protocol was concluded using the following: Roland-Morris questionnaire and sit-to-stand test; quality-of-life questionnaire; and pain. The protocol consisted of 10 sessions with pain education associated the combination of the electrophysical agents. RESULTS: There were no statistical differences between groups after the intervention protocol. In the within analysis, all groups presented an improvement in visual analog scale scores, Roland-Morris questionnaire, sit-to-stand test, and pain domain of quality-of-life questionnaire. CONCLUSIONS: This study showed that with pain education, there was no difference between cryotherapy and transcutaneous electrical nerve stimulation alone, combined, or placebo mode in improving pain, functional capacity, and quality of life in patients with nonspecific chronic low back pain.


Assuntos
Dor Crônica/terapia , Crioterapia/métodos , Dor Lombar/terapia , Manejo da Dor/métodos , Qualidade de Vida , Estimulação Elétrica Nervosa Transcutânea/métodos , Adulto , Terapia Combinada , Feminino , Humanos , Masculino , Medição da Dor , Educação de Pacientes como Assunto , Método Simples-Cego , Inquéritos e Questionários , Adulto Jovem
5.
J Am Board Fam Med ; 34(Suppl): S77-S84, 2021 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-33622822

RESUMO

INTRODUCTION: This study was conducted to determine if limited access to health care during the COVID-19 pandemic impacted utilization of recommended nonpharmacological treatments, nonsteroidal anti-inflammatory drugs, and opioids by patients with chronic low back pain and affected clinical outcomes relating to pain intensity and disability. METHODS: Participants within the Pain Registry for Epidemiological, Clinical, and Interventional Studies and Innovation were eligible if they provided encounter data in the 3 months immediately before and after the national emergency proclamation date (NEPD). RESULTS: The mean age of the 528 study participants was 53.9 years and 74.1% were women. Utilization of exercise therapy, massage therapy, and spinal manipulation decreased during the pandemic. Increasing age was associated with decreased utilization of all nonpharmacological treatments except exercise therapy, and with increased opioid use during the pandemic. African American participants reported decreased utilization of yoga and spinal manipulation during the pandemic. Overall, mean change scores for pain intensity and disability before and after the NEPD were not significant. However, African American participants consistently reported worse pain intensity and disability outcomes during the pandemic. Marginally worse outcomes were observed less consistently for pain intensity with increasing age and for disability among women. DISCUSSION: Social distancing during the pandemic impacted the uptake of recommended nonpharmacological treatments for chronic low back pain that require visiting community-based facilities or interacting closely with providers. CONCLUSIONS: The pandemic threatens to exacerbate the impact of chronic low back pain, particularly among African American patients and the older population, by impeding access to guideline-informed noninvasive treatments.


Assuntos
Dor Crônica/terapia , Dor Lombar/terapia , Adulto , Idoso , Demografia , Feminino , Fidelidade a Diretrizes/organização & administração , Fidelidade a Diretrizes/tendências , Acesso aos Serviços de Saúde/estatística & dados numéricos , Acesso aos Serviços de Saúde/tendências , Humanos , Masculino , Pessoa de Meia-Idade , Pandemias , Qualidade de Vida , Sistema de Registros , Estados Unidos
6.
Medicine (Baltimore) ; 100(4): e23285, 2021 Jan 29.
Artigo em Inglês | MEDLINE | ID: mdl-33530156

RESUMO

BACKGROUND: Intensive neuromuscular stabilization exercise on highly obese patients with low back pain results in positive effects of body fat decline and prevention of complications. The purpose of this study is to investigate the effects of progressive neuromuscular stabilization exercise on unstable surface on pain, motor function, psychosocial factors, balance, and abdominal contraction with highly obese patients with lumbar instability. METHODS: This study is a double-blinded randomized controlled trial. A total of 46 highly obese patients (body mass index [BMI] ≥ 30 kg/m2) with lumbar instability were assigned randomly to experimental group (n = 23) and control group (n = 23). The control group performed the intensive progressive exercise on a stable surface and the experimental group on an unstable surface. RESULT: Significant differences were shown for BMI, QVAS, K-ODI, FABQ, and balance ability for both groups before and after the intervention (P < .05), and only the experimental group showed significant difference for transverse abdominis muscle thickness in contraction and contraction rate (P < .05). Compared to the control group, the experimental group showed significant difference (P < .05) in the amount of changes for QVAS, K-ODI, balance ability, transverse abdominis muscle thickness in contraction, and contraction rate. CONCLUSION: Progressive neuromuscular stabilization exercise program on unstable surfaces demonstrated to be an effective and clinically useful method to decrease pain level, increase motor function, balance, and transverse abdominis muscle thickness in contraction and contraction rate for highly obese patients with lumbar instability.


Assuntos
Terapia por Exercício/métodos , Instabilidade Articular/terapia , Dor Lombar/terapia , Obesidade/complicações , Doenças da Coluna Vertebral/terapia , Músculos Abdominais/fisiopatologia , Adulto , Método Duplo-Cego , Feminino , Humanos , Instabilidade Articular/etiologia , Dor Lombar/etiologia , Vértebras Lombares/fisiopatologia , Região Lombossacral/fisiopatologia , Masculino , Contração Muscular , Obesidade/fisiopatologia , Medição da Dor , Equilíbrio Postural , Doenças da Coluna Vertebral/etiologia , Resultado do Tratamento
7.
Medicine (Baltimore) ; 100(4): e24281, 2021 Jan 29.
Artigo em Inglês | MEDLINE | ID: mdl-33530216

RESUMO

BACKGROUND: Low back pain (LBP) is a common symptom that affects almost 80% of the global population. LBP manifests as diverse pathologies and has different causes. The focus of this paper is nonspecific chronic low back pain (NSCLBP) wherein the pain lasts for more than 12 weeks, and for which there is no definite cause. Although there are various treatment options for NSCLBP, including medication and exercise, each option has its own limitations. Although electroacupuncture (EA) has been known to have useful analgesic effects on chronic LBP, there is no systematic review (SR) on EA in the literature. Therefore, this study aims to systematically review and validate the effectiveness and safety of EA for NSCLBP. METHODS: We will search for randomized controlled trials on the use of EA for NSCLBP in multiple electronic databases, manual searches, and contacting authors. We will screen and select studies according to the predefined criteria and extract the data needed for this SR. The primary outcome will be the pain index (Visual Analog Scale and Numeric Rating Scale), and the secondary outcomes will be the functional status (Roland-Morris Disability Questionnaire), patient-centered outcomes, and adverse events. We will perform a meta-analysis using Review Manager software (Version 5.3; Copenhagen; The Nordic Cochrane Center, The Cochrane Collaboration, 2014) and assess the risk of bias using Cochrane Collaboration "risk of bias" tools and the quality of evidence using the Grades of Recommendation, Assessment, Development and Evaluation. RESULTS: Our SR will investigate the effectiveness and safety of EA on NSCLBP. CONCLUSION: Our SR will support the published clinical evidence of the usage of EA for NSCLBP to assess the effectiveness and safety of EA. TRIAL REGISTRATION NUMBER: INPLASY; INPLASY2020120039.


Assuntos
Dor Crônica/terapia , Eletroacupuntura/métodos , Dor Lombar/terapia , Adolescente , Adulto , Feminino , Humanos , Masculino , Metanálise como Assunto , Medição da Dor , Ensaios Clínicos Controlados Aleatórios como Assunto , Projetos de Pesquisa , Revisões Sistemáticas como Assunto , Resultado do Tratamento , Adulto Jovem
8.
Medicine (Baltimore) ; 100(4): e24448, 2021 Jan 29.
Artigo em Inglês | MEDLINE | ID: mdl-33530252

RESUMO

BACKGROUND: Chronic low back pain (CLBP) is 1 of the common clinical diseases, and many treatment methods can only improve the symptoms of pain in the short term. Traditional Chinese sports - Baduanjin has been proven to have a positive effect on chronic low back pain. However, the quality of the research is low, the sample size is small, and safety observations are lacking. We describe the protocol of a randomized controlled trial to study the efficacy and safety of Baduanjin chronic low back pain. METHODS: This randomized, controlled, evaluator-blind, two-arm, parallel clinical trial will include 90 outpatients with chronic low back pain recruited from the First Hospital of Nanping City, Fujian Province. The patients were randomly assigned to the intervention group (Baduanjin exercise training) and the control group (not receiving any special exercise training) at a ratio of 1:1. Patients in the intervention group will receive Baduanjin exercise training 3 times a week for 24 weeks. The 2 groups received a 4- week follow-up observation at 24 weeks. The main result from the intervention before intervention to 24 weeks later, and the follow-up of 4 changes the visual analog scale score at weeks, and by independent t are tested groups. It will also review the Pain-related disability index, The Quebec Back Pain Disability Scale, Health-related quality of life, Roland Morris (Roland Morris) Disability Questionnaire, Overall Perceived Effect (OPE) and safety Compare. Cost data for cost-benefit and cost-benefit analysis will be collected. DISCUSSION: This will be the first study to compare the effectiveness and safety of Baduanjin for patients with chronic low back pain. The results may help healthcare professionals make clinical decisions and may reduce the cost of treatment for this disease. TRIAL REGISTRATION: ChiCTR2000033908.


Assuntos
Dor Crônica/terapia , Técnicas de Exercício e de Movimento/métodos , Dor Lombar/terapia , Medicina Tradicional Chinesa/métodos , Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Medição da Dor , Ensaios Clínicos Controlados Aleatórios como Assunto , Método Simples-Cego , Resultado do Tratamento , Adulto Jovem
10.
Medicine (Baltimore) ; 100(5): e23851, 2021 Feb 05.
Artigo em Inglês | MEDLINE | ID: mdl-33592841

RESUMO

BACKGROUND: Presentation of musculoskeletal symptoms, such as pain, discomfort, or disability, caused by a traffic accident (TA) is a common occurrence. However, studies on treatment and management of sudden low back pain (LBP) caused by a TA are very scarce, while studies on the effectiveness of motion style acupuncture therapy (MSAT) used on such patients are also rare. Accordingly, a randomized controlled trial (RCT) is planned to assess the effectiveness and safety of MSAT using traction (T-MSAT) for the treatment of pain and functional problems in patients with acute LBP caused by a TA. METHODS: This study will be conducted at Jaseng Hospital of Korean Medicine in South Korea, using a two-armed, parallel, assessor-blinded RCT design. The study population will consist of 100 participants who will be randomly assigned in a 1:1 ratio to either the T-MSAT+integrative Korean medicine therapy (IKMT) group or IKMT control group. The treatment will be applied continuously for 3 days after admission. The primary outcome will be the difference between the numeric rating scale (NRS) scores at admission and immediately after treatment on the fourth day of admission. Secondary outcomes will include visual analogue scale (VAS) for LBP and radiating leg pain; NRS for radiating leg pain; lumbar active range of motion; Oswestry Disability Index (ODI); Patient Global Impression of Change (PGIC); the Post-traumatic Stress Disorder Checklist for DSM-5 (PCL-5-K); and 12-item short-form health survey (SF-12). DISCUSSION: This study is a RCT to assess the effectiveness and safety of T-MSAT for acute LBP caused by a TA. The findings could be used by healthcare-related policy makers and clinicians in primary care institutions, which are frequently visited by patients suffering from LBP caused by a TA.


Assuntos
Acidentes de Trânsito , Terapia por Acupuntura/métodos , Dor Aguda/terapia , Dor Lombar/terapia , Dor Aguda/etiologia , Adulto , Idoso , Feminino , Humanos , Pacientes Internados , Dor Lombar/etiologia , Masculino , Pessoa de Meia-Idade , Medição da Dor , Ensaios Clínicos Controlados Aleatórios como Assunto , República da Coreia , Método Simples-Cego , Resultado do Tratamento , Adulto Jovem
11.
Adv Exp Med Biol ; 1324: 73-81, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33474700

RESUMO

Chronic nonspecific low back pain is a frequent clinical condition affecting the general population and influencing disability level and quality of life. We performed a single-blinded, randomized, and controlled study to compare the effectiveness of manual pressure release (MPR) and electrical neuromodulation (ENM) treatments in the management of chronic low back pain. There were 20 patients with chronic low back pain randomly assigned to 6 treatment sessions with either technique. Both groups were treated for 2 days a week for 3 weeks. Myofascial trigger points (MTrPs) were identified and skin conductance, pressure-pain threshold, postural changes, and the Oswestry Disability Index were assessed before and after each treatment session, along with the protocol-end data compared against the baseline data in each group. We found an outstanding and about equal deactivation of MTrPs from pre- to post-treatment in both groups, reducing disability in patients with chronic low back pain. The study highlights the ENM as a reliable tool for the evaluation of MTrPs, given a high agreement with the MPR. The effect on the neuromuscular condition of treating the "key trigger points" found in this study advances the knowledge of medical rehabilitation.


Assuntos
Dor Crônica , Dor Lombar , Humanos , Dor Lombar/terapia , Medição da Dor , Limiar da Dor , Qualidade de Vida , Pontos-Gatilho
12.
Artigo em Inglês | MEDLINE | ID: mdl-33467603

RESUMO

Low back pain is one the most common forms of musculoskeletal disorders. Thus, several physiotherapeutic strategies (e.g., global postural re-education therapy) have been used for reducing low back pain. The aim of this study was to determinate if acute application of global postural re-education session associated effects are influenced by the time-of-day when this physical therapy is applied. Eight participants in a randomized, counterbalanced order were acutely tested both before and 24 h after a global postural re-education therapy session (10 min session) in three different time-of-day points; morning (i.e., AM; 7:00-9:00 h), midday (i.e., AM; 12:00-14:00 h) and afternoon (i.e., PM; 18:00-20:00 h). In each session, low back pain Visual Analogue Pain Scale [VAS]), flexibility, function capacity (Roland Morris Questionnaire [RMQ], and physical functioning Oswestry Disability Index [ODI]) were recorded. Results showed a pain reduction (VAS Scale) 24 h post Global postural re-education [GPR] session (p = 0.001) and increasing of flexibility pre-post GPR session in all the time-of-day points (morning, midday, and afternoon) (p = 0.001) while no differences were reported in RMQ (p = 0.969) and ODI (p = 0.767). Thus, acute GPR session produces the same effects on flexibility, low back pain, function capacity, and physical functioning values independently of time-of-day when it is applied.


Assuntos
Dor Lombar , Avaliação da Deficiência , Humanos , Dor Lombar/terapia , Medição da Dor , Modalidades de Fisioterapia , Inquéritos e Questionários , Resultado do Tratamento
13.
J Med Internet Res ; 23(2): e26292, 2021 02 22.
Artigo em Inglês | MEDLINE | ID: mdl-33484240

RESUMO

BACKGROUND: Chronic low back pain is the most prevalent chronic pain condition worldwide and access to behavioral pain treatment is limited. Virtual reality (VR) is an immersive technology that may provide effective behavioral therapeutics for chronic pain. OBJECTIVE: We aimed to conduct a double-blind, parallel-arm, single-cohort, remote, randomized placebo-controlled trial for a self-administered behavioral skills-based VR program in community-based individuals with self-reported chronic low back pain during the COVID-19 pandemic. METHODS: A national online convenience sample of individuals with self-reported nonmalignant low back pain with duration of 6 months or more and with average pain intensity of 4 or more/10 was enrolled and randomized 1:1 to 1 of 2 daily (56-day) VR programs: (1) EaseVRx (immersive pain relief skills VR program); or (2) Sham VR (2D nature content delivered in a VR headset). Objective device use data and self-reported data were collected. The primary outcomes were the between-group effect of EaseVRx versus Sham VR across time points, and the between-within interaction effect representing the change in average pain intensity and pain-related interference with activity, stress, mood, and sleep over time (baseline to end-of-treatment at day 56). Secondary outcomes were global impression of change and change in physical function, sleep disturbance, pain self-efficacy, pain catastrophizing, pain acceptance, pain medication use, and user satisfaction. Analytic methods included intention-to-treat and a mixed-model framework. RESULTS: The study sample was 179 adults (female: 76.5%, 137/179; Caucasian: 90.5%, 162/179; at least some college education: 91.1%, 163/179; mean age: 51.5 years [SD 13.1]; average pain intensity: 5/10 [SD 1.2]; back pain duration ≥5 years: 67%, 120/179). No group differences were found for any baseline variable or treatment engagement. User satisfaction ratings were higher for EaseVRx versus Sham VR (P<.001). For the between-groups factor, EaseVRx was superior to Sham VR for all primary outcomes (highest P value=.009), and between-groups Cohen d effect sizes ranged from 0.40 to 0.49, indicating superiority was moderately clinically meaningful. For EaseVRx, large pre-post effect sizes ranged from 1.17 to 1.3 and met moderate to substantial clinical importance for reduced pain intensity and pain-related interference with activity, mood, and stress. Between-group comparisons for Physical Function and Sleep Disturbance showed superiority for the EaseVRx group versus the Sham VR group (P=.022 and .013, respectively). Pain catastrophizing, pain self-efficacy, pain acceptance, prescription opioid use (morphine milligram equivalent) did not reach statistical significance for either group. Use of over-the-counter analgesic use was reduced for EaseVRx (P<.01) but not for Sham VR. CONCLUSIONS: EaseVRx had high user satisfaction and superior and clinically meaningful symptom reduction for average pain intensity and pain-related interference with activity, mood, and stress compared to sham VR. Additional research is needed to determine durability of treatment effects and to characterize mechanisms of treatment effects. Home-based VR may expand access to effective and on-demand nonpharmacologic treatment for chronic low back pain. TRIAL REGISTRATION: ClinicalTrials.gov NCT04415177; https://clinicaltrials.gov/ct2/show/NCT04415177. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): RR2-10.2196/25291.


Assuntos
Dor Crônica/terapia , Comportamentos Relacionados com a Saúde , Dor Lombar/terapia , Manejo da Dor/métodos , Realidade Virtual , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Método Duplo-Cego , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Pandemias , Autorrelato , Fatores de Tempo , Adulto Jovem
14.
Medicine (Baltimore) ; 100(1): e24203, 2021 Jan 08.
Artigo em Inglês | MEDLINE | ID: mdl-33429811

RESUMO

BACKGROUND: Lumbar disc herniation (LDH) is an important factor of causing leg pain and numbness. As a secondary discipline of Traditional Chinese Medicine, tuina is widely used for the treatment of LDH in China even in other nations while its clinical value is not acknowledged universally. So, we focus on this article aims to evaluate its efficacy and safety of LDH. METHODS: Electronic databases involving Cochrane Library, PubMed, Web of Science, EMBASE, China Science and Technology Journal, China National Knowledge Infrastructure, Wanfang and Chinese Biomedical Literature Database will be pertained with appropriate search strategy. And RevMan V.5.3.5 software will be conducted as the assessment tool for bias risk, data synthesis, subgroup analysis as well as meta-analyses. RESULTS: This systematic review will provide a high-quality synthesis of current evidence of tuina for LDH. CONCLUSION: This protocol will determine whether Tuina is an effective and safe treatment method for LDH.


Assuntos
Terapia por Acupuntura , Degeneração do Disco Intervertebral/terapia , Deslocamento do Disco Intervertebral/terapia , Vértebras Lombares , Humanos , Dor Lombar/terapia , Medicina Tradicional Chinesa
15.
Am J Emerg Med ; 42: 103-109, 2021 04.
Artigo em Inglês | MEDLINE | ID: mdl-33503531

RESUMO

AIM: Low back pain (LBP) is a common musculoskeletal complaint among emergency department (ED) admissions. In this study, it was aimed to compare the effectiveness of systemic treatment with intradermal sterile water injection (ISWI) treatment protocol combined with systemic therapy in patients with LBP of unclear chronicity. METHODS: A prospective randomized, unblinded, controlled clinical study was conducted on patients admitted to the ED for LBP of unclear chronicity. One hundred twelve patients were randomly assigned to two groups; Group ISWI (n = 56) administered ISWI in the LBP region of patients along with systemic intravenous dexketoprofen therapy, while the other group (n = 56) received only systemic intravenous dexketoprofen therapy. The treatment methods' effectiveness was compared by measuring the pain intensity with the Visual Analog Scale (VAS) at admission, 10th minutes, 20th minutes, 30th minutes, and 24 h later. Also, opioid and analgesic consumptions in 24 h after treatment and patient satisfactions were compared. RESULTS: In the treatment of LBP, ISWI treatment was found to be more effective in relieving pain than systemic therapy alone (p < 0.001). Also, it was observed that opioid consumption in the ED and analgesic consumption within 24 h after treatments were decreased in the ISWI group (p < 0.001). The patient satisfaction in the ED was statistically increased (p < 0.001). DISCUSSION: In this unblinded study, ISWI with systemic therapy improved pain outcomes more than systemic therapy alone. Further research is needed to determine whether this was due entirely to placebo effect.


Assuntos
Anti-Inflamatórios não Esteroides/uso terapêutico , Serviço Hospitalar de Emergência , Cetoprofeno/análogos & derivados , Dor Lombar/terapia , Manejo da Dor/métodos , Trometamina/uso terapêutico , Água/administração & dosagem , Adulto , Analgésicos não Entorpecentes/uso terapêutico , Analgésicos Opioides/uso terapêutico , Anti-Inflamatórios não Esteroides/efeitos adversos , Feminino , Humanos , Injeções Intradérmicas , Cetoprofeno/efeitos adversos , Cetoprofeno/uso terapêutico , Masculino , Pessoa de Meia-Idade , Medição da Dor , Satisfação do Paciente , Estudos Prospectivos , Trometamina/efeitos adversos , Água/efeitos adversos
16.
Br J Anaesth ; 126(3): 692-699, 2021 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-33341226

RESUMO

BACKGROUND: The purpose of this study was to investigate the effectiveness and safety between electroacupuncture (EA) combined with usual care (UC) and UC alone for pain reduction and functional improvement in patients with non-acute low back pain (LBP) after back surgery. METHODS: In this multicentre, randomised, assessor-blinded active-controlled trial, 108 participants were equally randomised to either the EA with UC or the UC alone. Participants in the EA with UC group received EA treatment and UC treatment twice a week for 4 weeks; those allocated to the UC group received only UC. The primary outcome was the VAS pain intensity score. The secondary outcomes were functional improvement (Oswestry Disability Index [ODI]) and the quality of life (EuroQol-5-dimension questionnaire [EQ-5D]). The outcomes were measured at Week 5. RESULTS: Significant reductions were observed in the VAS (mean difference [MD] -8.15; P=0.0311) and ODI scores (MD -3.98; P=0.0460) between two groups after 4 weeks of treatment. No meaningful differences were found in the EQ-5D scores and incidence of adverse events (AEs) between the groups. The reported AEs did not have a causal relationship with EA treatment. CONCLUSIONS: The results showed that EA with UC treatment was more effective than UC alone and relatively safe in patients with non-acute LBP after back surgery. EA with UC treatment may be considered as an effective, integrated, conservative treatment for patients with non-acute LBP after back surgery. CLINICAL TRIAL REGISTRATION: KCT0001939.


Assuntos
Terapia por Estimulação Elétrica/métodos , Eletroacupuntura/métodos , Dor Lombar/terapia , Manejo da Dor/métodos , Fusão Vertebral , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Medição da Dor , Resultado do Tratamento
17.
Med Care ; 59(1): 82-90, 2021 01.
Artigo em Inglês | MEDLINE | ID: mdl-33201085

RESUMO

PURPOSE: To assess the impact of EQ-5D country-specific value sets on cost-utility outcomes. METHODS: Data from 2 randomized controlled trials on low back pain (LBP) and depression were used. 3L value sets were identified from the EuroQol Web site. A nonparametric crosswalk was employed for each tariff to obtain the likely 5L values. Differences in quality-adjusted life years (QALYs) between countries were tested using paired t tests, with United Kingdom as reference. Cost-utility outcomes were estimated for both studies and both EQ-5D versions, including differences in QALYs and cost-effectiveness acceptability curves. RESULTS: For the 3L, QALYs ranged between 0.650 (Taiwan) and 0.892 (United States) in the LBP study and between 0.619 (Taiwan) and 0.879 (United States) in the depression study. In both studies, most country-specific QALY estimates differed statistically significantly from that of the United Kingdom. Incremental cost-effectiveness ratios ranged between &OV0556;2044/QALY (Taiwan) and &OV0556;5897/QALY (Zimbabwe) in the LBP study and between &OV0556;38,287/QALY (Singapore) and &OV0556;96,550/QALY (Japan) in the depression study. At the NICE threshold of &OV0556;23,300/QALY (≈£20,000/QALY), the intervention's probability of being cost-effective versus control ranged between 0.751 (Zimbabwe) and 0.952 (Taiwan) and between 0.230 (Canada) and 0.396 (Singapore) in the LBP study and depression study, respectively. Similar results were found for the 5L, with extensive differences in ICERs and moderate differences in the probability of cost-effectiveness. CONCLUSIONS: This study indicates that the use of different EQ-5D country-specific value sets impacts on cost-utility outcomes. Therefore, to account for the fact that health state preferences are affected by sociocultural differences, relevant country-specific value sets should be used.


Assuntos
Análise Custo-Benefício/economia , Anos de Vida Ajustados por Qualidade de Vida , Ensaios Clínicos Controlados Aleatórios como Assunto , Inquéritos e Questionários/estatística & dados numéricos , Cultura , Depressão/terapia , Saúde Global , Humanos , Dor Lombar/terapia
18.
Med Clin North Am ; 105(1): 1-17, 2021 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-33246512

RESUMO

A review of the literature, including recent guidelines and original studies, has informed this detailed description of best clinic practices used to evaluate, diagnose, treat, and manage adult patients who present to the outpatient clinic with complaints of low back pain. A case-based format helps guide the reader through clinical decision making and the key learning objectives.


Assuntos
Dor Lombar/diagnóstico , Dor Lombar/terapia , Dor Aguda/diagnóstico , Dor Aguda/etiologia , Dor Aguda/terapia , Algoritmos , Dor Crônica/diagnóstico , Dor Crônica/etiologia , Dor Crônica/terapia , Diagnóstico Diferencial , Feminino , Humanos , Dor Lombar/etiologia , Anamnese , Pessoa de Meia-Idade , Exame Físico , Prognóstico
19.
Fisioterapia (Madr., Ed. impr.) ; 42(6): 327-331, nov.-dic. 2020. graf, ilus
Artigo em Espanhol | IBECS | ID: ibc-197912

RESUMO

OBJETIVO: Describir los cambios termográficos tras la intervención con terapia manual instrumentalizada (TMI) en un sujeto con lumbalgia. MATERIAL Y MÉTODOS: Sujeto de estudio mujer de 28 años, oficinista, parcialmente activa con periodos prolongados de inactividad, sin toxicomanías. Presenta antecedentes de lumbalgia crónica, criterio principal de inclusión. El proceso de intervención fue realizado por un fisioterapeuta certificado en TMI siguiendo el protocolo de lumbalgia. La evaluación e intervención se desarrolló en una sola sesión con un total de 6 imágenes. Se analizó el comportamiento de la temperatura en grados centígrados una vez marcados los puntos térmicos a evaluar en cada zona. RESULTADOS: Se registraron cambios de temperatura en región lumbar con un aumento promedio de 0,45°C. Para la zona abdominal la temperatura final no superó la inicial a excepción del oblicuo derecho. CONCLUSIONES: La evaluación termográfica tras la intervención con TMI evidenció cambios en la temperatura de la zona intervenida. La termografía mostró ser una herramienta que ayuda a determinar los cambios de temperatura y sirve como pauta para la valoración del curso de intervención fisioterapéutica


OBJECTIVE: To describe the thermographic changes after intervention with Instrumentalized Manual Therapy (IMT) in a subject with low back pain. MATERIAL AND METHODS: 28-year-old female study subject, office worker, partially active with prolonged periods of inactivity. Presenting a history of chronic low back pain, the main inclusion criteria. The intervention process was carried out by an IMT-certified physical therapist following the low back pain protocol. The evaluation and intervention were carried out in a single session with a total of 6 images. The behaviour of the temperature in degrees centigrade was analysed once the thermal points to be evaluated in each zone were marked. RESULTS: Temperature changes were recorded in the lumbar region with an average increase of .45° C. For the abdominal area, the final temperature did not exceed the initial temperature except for the right oblique. CONCLUSIONS: The thermographic evaluation after the intervention with IMT showed changes in the temperature of the manipulated area. Thermography proved to be a tool that helps determine temperature changes and serves as a guideline for evaluating the course of physiotherapeutic intervention


Assuntos
Humanos , Feminino , Adulto , Termografia/classificação , Termografia/instrumentação , Dor Lombar/terapia , Temperatura Corporal/fisiologia , Manipulação da Coluna/métodos , Modalidades de Fisioterapia , Dor Lombar/reabilitação
20.
Medicine (Baltimore) ; 99(51): e23555, 2020 Dec 18.
Artigo em Inglês | MEDLINE | ID: mdl-33371083

RESUMO

BACKGROUND: Isokinetic training (IKT) and core stabilization training (CST) are commonly used for balance training in musculoskeletal conditions. The knowledge about the effective implementation of these training protocols on radiological and biochemical effects in university football players with chronic low back pain (LBP) is lacking. OBJECTIVE: To find and compare the effects of isokinetic training and CST on radiological and biochemical effects in university football players with chronic LBP. DESIGN: Randomized, double-blinded controlled study. SETTING: University hospital. PARTICIPANTS: 60 LBP participants were randomized into isokinetic group (IKT; n = 20), core stabilization group (CST; n = 20) and the control group (n = 20) and received respective exercises for 4 weeks. OUTCOME MEASURES: Radiological (muscle cross sectional area & muscle thickness) and biochemical (C-reactive protein, tumor necrosis factor -α, interleukin [IL]-2, IL-4, IL-6) values were measured at baseline and after 4 weeks (immediate effect). RESULTS: The reports of the IKT, CST and control group were compared between the groups. Four weeks following training IKT group shows more significant changes in muscle cross sectional area (Psoas Major, Quadratus Lumborum, Multifidus and Erector Spinae muscles) and muscle thickness (Multifidus) than CST and control groups (p < 0.001). Biochemical measures such as C-reactive protein, tumor necrosis factor -α, IL-2, IL-4 and IL-6 also show significant improvement in IKT group than the other 2 groups (P < .001). CONCLUSION: Training through Isokinetic is an effective treatment program than conventional exercise programs in the aspect of radiological and biochemical analysis in university football players with chronic LBP, which may also help to prevent further injury. The present study can be used to improve the physical therapist's knowledge and clinical decision skills on LBP in football players.


Assuntos
Terapia por Exercício/métodos , Dor Lombar/terapia , Futebol , Adolescente , Adulto , Doença Crônica , Método Duplo-Cego , Feminino , Humanos , Mediadores da Inflamação/metabolismo , Masculino , Músculo Esquelético/fisiologia , Medição da Dor , Universidades , Adulto Jovem
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA
...