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1.
Medicine (Baltimore) ; 100(3): e24259, 2021 Jan 22.
Artigo em Inglês | MEDLINE | ID: mdl-33546047

RESUMO

BACKGROUND: Osteoporosis (OP) results in an increased risk of fragility fractures, representing a major public health problem. In preventing OP, complementary and alternative medicine, such as acupuncture, was recommended because of the low efficiency and side effects of medications. Recently, there is insufficient evidence on electroacupuncture as an effective therapy for OP management. Hence, we evaluated the effectiveness of electroacupuncture for OP treatment. METHODS: We conducted a systematic review and meta-analysis of clinical studies on patients with OP. Five databases (PubMed, Embase, Cochrane Central Register of Controlled Trials, China National Knowledge Infrastructure, and Wanfang) were searched from the earliest publication date to March 12, 2020. Randomized controlled trials (RCTs) were included if electroacupuncture was applied as the sole treatment or as an adjunct to other treatments compared with medications in patients with OP. The measurement outcomes included serum aminoterminal propeptide of type I procollagen (PINP) and C-telopeptide of type I collagen (CTX) levels, bone mineral density (BMD) of lumbar, and visual analog scale scores for OP-related pain. Acupoints were extracted when available. RESULTS: In total, 11 RCTs involving 731 participants were included for further meta-analysis. The meta-analysis showed that the use of electroacupuncture as a sole treatment or as an adjunct to other treatments could relieve OP-related pain compared with medications [mean difference (MD) =  -0.58, 95% confidence interval (CI); MD =  -0.97 to -0.19, P = .003, I2 = 88%; MD =  -1.47, 95% CI = -2.14 to -0.79, P < .001, I2 = 96%). Meanwhile, the results showed a favorable effect of electroacupuncture on decreasing serum beta-CTX levels. However, there were no significant differences in serum PINP levels and BMD of lumbar. Shenshu (BL23) was the most frequent acupoint stimulation among these studies. CONCLUSIONS: The application of electroacupuncture as an independent therapy or as an adjunct to other treatments might attenuate OP-related pain and serum beta-CTX levels. However, to overcome the methodological shortcomings of the existing evidence, due to a small size of samples and high risk of bias in these included RCTs, further rigorous studies are required.


Assuntos
Eletroacupuntura , Osteoporose/terapia , Dor nas Costas/terapia , Densidade Óssea , Colágeno Tipo I/sangue , Humanos , Osteoporose/sangue , Fragmentos de Peptídeos/sangue , Peptídeos/sangue , Pró-Colágeno/sangue
3.
Internist (Berl) ; 62(1): 24-33, 2021 Jan.
Artigo em Alemão | MEDLINE | ID: mdl-33337525

RESUMO

A systematic survey of the symptoms of back pain in terms of the triggering event and onset, nature of the pain and the extent to which pain dynamics can be influenced (lying or standing, under stress, nocturnal pain, localized percussion tenderness, B symptoms, etc.), as well as a structured clinical examination (segment height, radiance, projection, reflex status, sensitivity, and motor function), allows an initial and therefore orienting classification of back pain as non-specific or specific. Thus, in the primary care setting, many patients can be treated extremely effectively and economically from a cost perspective. The more precise the initial findings are, the more effective the measures taken are in general. In addition to the fastest possible pain relief, it is important to prevent the disease taking an unfavorable course and to avoid chronicity. In addition to non-pharmacological measures (initial rest and starting home exercises early on, promoting everyday mobility, physiotherapy, manual therapy, etc.), a wide range of pharmacological treatment alternatives is available. In the further course of treatment, it may be necessary to consult medical specialists in the fields of radiology, orthopedics, neurology, neurosurgery, rheumatology, psychotherapy, and psychiatry, among others. Treatment is managed by the primary care provider, who should also receive and re-evaluate all findings during the course of the disease.


Assuntos
Dor nas Costas/diagnóstico , Dor nas Costas/terapia , Terapia por Exercício , Atenção Primária à Saúde/métodos , Dor nas Costas/etiologia , Humanos , Modalidades de Fisioterapia
4.
Internist (Berl) ; 62(1): 34-46, 2021 Jan.
Artigo em Alemão | MEDLINE | ID: mdl-33355682

RESUMO

Back pain is a common reason for consulting a general practitioner. For 80% of patients, the back pain is nonspecific. Specific back pain has a determinable cause that needs to be rapidly identified. The diagnostic work-up to clarify spinal pain involves a detailed patient history taking into account the "red flags", a clinical examination and further stepwise diagnostics. In addition to laboratory diagnostics, structured morphological imaging is necessary. Causes of specific back pain include: fractures, infections, radiculopathy, tumors, axial spondylarthritis, as well as extravertebral causes. The diagnosis, treatment and continuous follow-up of the patient with specific back pain is interdisciplinary and requires close communication with the relevant specialists.


Assuntos
Dor nas Costas/etiologia , Exame Físico , Atenção Primária à Saúde/métodos , Doenças da Coluna Vertebral/diagnóstico por imagem , Dor nas Costas/diagnóstico , Dor nas Costas/terapia , Diagnóstico por Imagem/métodos , Humanos , Dor Lombar/etiologia , Anamnese , Fatores de Risco , Doenças da Coluna Vertebral/complicações , Doenças da Coluna Vertebral/terapia , Avaliação de Sintomas/métodos
5.
Ann. intern. med ; 173(9): 739-748, Nov. 3, 2020. tab.
Artigo em Inglês | BIGG - guias GRADE | ID: biblio-1146639

RESUMO

The American College of Physicians (ACP) and American Academy of Family Physicians (AAFP) developed this guideline to provide clinical recommendations on nonpharmacologic and pharmacologic management of acute pain from non­low back, musculoskeletal injuries in adults in the outpatient setting. The guidance is based on current best available evidence about benefits and harms, taken in the context of costs and patient values and preferences. This guideline does not address noninvasive treatment of low back pain, which is covered by a separate ACP guideline that has also been endorsed by AAFP.


Assuntos
Humanos , Adulto , Dor nas Costas/terapia , Dor Aguda/terapia , Sistema Musculoesquelético/lesões , Dor nas Costas/etiologia , Dor nas Costas/tratamento farmacológico , Dor Aguda/etiologia , Dor Aguda/tratamento farmacológico
6.
Fisioterapia (Madr., Ed. impr.) ; 42(5): 250-259, sept.-oct. 2020. graf, tab
Artigo em Espanhol | IBECS | ID: ibc-195141

RESUMO

INTRODUCCIÓN Y OBJETIVO: El dolor de cuello y/o espalda (DCE) es uno de los trastornos musculoesquéleticos que más carga social y económica supone en los maestros. El objetivo de este estudio fue determinar la necesidad de intervención preventiva sanitaria percibida por este colectivo. MATERIAL Y MÉTODOS: Estudio transversal en la comunidad en una provincia española. Participaron maestros de educación infantil y primaria. Se utilizó un cuestionario anónimo autoadministrado redactado en español que incluía información sobre el dolor, datos sociodemógráficos, laborales y del estilo de vida, tratamientos y perspectivas de participación en programas de educación sanitaria. RESULTADOS: Se analizaron 311 cuestionarios. La prevalencia actual del DCE fue 76,8% (n = 239), OR mujer/hombre 2,99 [IC 95% 1,66-5,36]). El 59% presentaba DCE desde hace más de 5 años. El 22,6% había tenido alguna incapacidad temporal por el DCE. No se encontró relación significativa entre el dolor y la edad, ni nivel de educación o tipo de profesor. El 38,1% disponían de diagnóstico médico y el 69,9% había recibido tratamiento alguna vez. El 60,9% atribuía el DCE a posturas incorrectas y el 75,7% mostró predisposición para participar en un programa de educación para la salud. CONCLUSIONES: La alta prevalencia del DCE en maestros justifica poner en marcha protocolos viables de educación para la salud destinados a disminuir la incidencia e intensidad de los episodios de dolor en este colectivo, mejorar su calidad de vida y su rendimiento laboral


INTRODUCTION AND OBJECTIVE: Neck and/or back pain (NBP) is a musculoskeletal disorder that has become one of the greatest social and economic burdens afflicting teachers. The aim of the study was to determine the need for preventative healthcare among teachers. MATERIAL AND METHODS: A community-based cross-sectional study was carried out in a Spanish province. Elementary and preschool teachers at all schools within the province participated. An anonymous self-administered ad hoc questionnaire written in Spanish including information about pain, sociodemographic and work data, lifestyle, treatments and perspectives on participation in health education programmes was used. RESULTS: 311 questionnaires were analysed. The current prevalence of NBP was 76.8%, female/male OR 2.99 [95%CI 1.66-5.36]). Fifty-nine percent had presented symptoms of NBP for more than 5 years. Also 22.6% had experienced some type of temporary disability due to NBP. No significant correlation was found between pain and age, grade level taught or type of teacher. Of all the respondents, 38.1% had received a medical diagnosis and 69.9% had received treatment at some point. Almost two thirds (60.9%) attributed their NPB to incorrect posture and 75.7% indicated a willingness to participate in a health education programme. CONCLUSIONS: The high prevalence of NBP among teachers warrants the application of viable protocols for health education aimed at diminishing the incidence and intensity of pain among this professional group, improving their quality of life and professional productivity


Assuntos
Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Determinação de Necessidades de Cuidados de Saúde , Dor nas Costas/prevenção & controle , Dor nas Costas/terapia , Cervicalgia/prevenção & controle , Cervicalgia/terapia , Estudos Transversais , Professores Escolares/estatística & dados numéricos , Inquéritos e Questionários , Qualidade de Vida , Desempenho Profissional
7.
J. negat. no posit. results ; 5(9): 963-982, sept. 2020. ilus, tab, graf
Artigo em Espanhol | IBECS | ID: ibc-199375

RESUMO

OBJETIVOS: El propósito de este estudio es comprobar los efectos de un entrenamiento de Vibración de Cuerpo Completo (VCC) de 8 semanas sobre el Umbral de Sensibilidad a la Vibración Periférica (USVP) en personas con Diabetes Mellitus (DM) tipo 2. CONFIGURACIÓN Y DISEÑO: Estudio controlado aleatorizado a doble ciego (ISRCTN16866781). MATERIALES Y MÉTODOS: Un total de 76 personas con DM tipo 2 son incluidas en el análisis estadístico, siendo repartidos 39 pacientes en el grupo de VCC y 37 pacientes en el grupo placebo. A ambos grupos se les aplicó un entrenamiento de 8 semanas de VCC, siendo 3 sesiones por semana, para ser en total 24 sesiones de VCC y de placebo. Se les evaluó el USVP a través del Biotensiómetro Vibratron II antes de la intervención y después de las 8 semanas de entrenamiento. ANÁLISIS ESTADÍSTICO UTILIZADO: Para comprobar que los grupos eran comparables en la línea base en cuanto a las características de los participantes se realizó una prueba T para muestras independientes. Para determinar si la intervención de VCC había tenido efecto sobre el USVP, se realizó un ANCOVA, utilizando como covariable el nivel inicial del USVP. La significación estadística fue establecida en P <,05. RESULTADOS: El grupo de VCC y el grupo placebo fueron comparables en la línea base en todas las variables incluídas para la caracterización de la muestra. El entrenamiento de VCC no tuve ningún efecto estadísticamente significativo sobre el USVP. CONCLUSIONES: Tras un entrenamiento de Vibración de Cuerpo Completo de 8 semanas de duración no hubo efectos sobre el umbral de sensibilidad a la vibración periférica


AIMS: The purpose of this study is to assess the effects of an 8-week Whole Body Vibration (WBV) training on the Peripheral Vibration Sensitivity Threshold (PVST) in people with Diabetes Mellitus (DM) type 2. SETTING AND DESIGN: A double-blind randomized controlled study (ISRCTN16866781). Methods and Material: A total of 76 people with DM type 2 are included in the statistical analysis, 39 patients in the WBV group and 37 patients in the placebo group. Both groups were given 8 weeks of WBV training, 3 sessions per week, for a total of 24 sessions of WBV and placebo. The PVST was assessed through the Biotensiometer Vibratron II before the intervention and after the 8 weeks of training. STATISTICAL ANALYSIS USED: To check that the groups were comparable at the baseline in terms of participant characteristics, a T-test for independent samples was performed. To determine whether the WBV intervention had had an effect on the PVST, an ANCOVA was performed, using the initial level of the PVST as a covariate. Statistical significance was established at P <.05. RESULTS: The WBV group and the placebo group were comparable at baseline on all variables included for sample characterization. The WBV training had no statistically significant effect on the PVST. CONCLUSIONS: After 8 weeks of Whole Body Vibration training there was no effect on the Peripheral Vibration Sensitivity Threshold


Assuntos
Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Idoso , Idoso de 80 Anos ou mais , Diabetes Mellitus Tipo 2/terapia , Terapia por Exercício/estatística & dados numéricos , Vibração/uso terapêutico , Limiar Sensorial/classificação , Avaliação de Resultado de Intervenções Terapêuticas , Complicações do Diabetes/prevenção & controle , Dor nas Costas/terapia , Método Duplo-Cego , Efeito Placebo
8.
PLoS One ; 15(8): e0236780, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32822361

RESUMO

BACKGROUND: According to present guidelines, active exercise is one key component in the comprehensive treatment of nonspecific chronic back pain (NSCBP). Whole body electromyostimulation (WB-EMS) is a safe, and time-effective training method, that may be effective in NSCBP-patients. METHODS: In this prospective and controlled nonrandomized clinical study, two therapeutic approaches were compared. One group received 20 minutes WB-EMS per week. An active control group (ACG) received a multimodal therapy program. A third group included subjects without back pain. To all groups, the following measurement instruments were applied: Numeric Rating Scale (NRS), Oswestry Disability Index (ODI), North American Spine Society Instrument (NASS); SF 36 survey and measurements for muscular function and postural stability. In the EMS-group: T0: baseline; T1: at 6 weeks; T2: at 12 weeks and T3: at 24 weeks. In the ACG: T0 baseline and T1 after 4 weeks. RESULTS: In the intervention group, 128 patients with low back pain were enrolled, 85 in the WB-EMS group and 43 in the ACG. 34 subjects were allocated to the passive control group. The average age was 58.6 years (18-86 years). In the EMS group, the NRS (1-10) improved statistically and clinically significantly by 2 points. The ODI was reduced by 19.7 points. The NASS and most of the SF 36 items improved significantly. In the multimodal treatment group, only the muscular function improved slightly. CONCLUSION: Our data support the hypothesis that WB-EMS is at least as effective as a multimodal treatment, which is often referred to as being the golden standard. Therefore WB-EMS may be an effective and, with 20 min./week training time, very time-efficient alternative to established multimodal treatment models.


Assuntos
Dor nas Costas/terapia , Terapia por Estimulação Elétrica , Adulto , Dor nas Costas/fisiopatologia , Doença Crônica , Terapia Combinada , Feminino , Humanos , Masculino , Movimento , Estudos Prospectivos , Inquéritos e Questionários , Fatores de Tempo , Resultado do Tratamento
9.
BMC Public Health ; 20(1): 1283, 2020 Aug 26.
Artigo em Inglês | MEDLINE | ID: mdl-32842995

RESUMO

BACKGROUND: Back pain is an important public health problem and the leading cause of adult disability worldwide and is rising among schoolchildren populations. Despite numerous studies reporting on back care interventions in pediatric population; there is currently no existing theory-based instrument to assess impact and outcome of these programs. This paper reports on development and psychometric testing of a theory based back-care behavior instrument for use among elementary schoolchildren. METHODS: This was a three-phases study that included the following steps: a) a literature research to review existing instruments that assess healthy spine-related behavior in elementary schoolchildren; b) development of a new instrument namely the Back-care Behavior Assessment Questionnaire (BABAQ) based on the Social Cognitive Theory and existing instruments, and c) conducting a cross sectional study to test psychometric properties of the BABAQ by estimating the content validity ratio (CVR), the content validity index (CVI), performing confirmatory factor analysis (CFA), reliability analysis, and convergent validity as estimated by the Average Variance Extracted (AVE). RESULTS: First, a questionnaire (the BABAQ) was developed. It contained of 49 items tapping into 5 pre-defined constructs (skills, knowledge, self-efficacy, expectation beliefs, and behavior). Then, 610 fifth-grade female schoolchildren were entered into a cross sectional study and they completed the BABAQ. The CVR and the CVI of the questionnaire was found to be ≥0.54 and > 0.7, respectively. The CFA confirmed the five constructs and showed good fit for the data. The intraclass correlation (ICC) and the Cronbach's alpha coefficients for the BABAQ were 0.84 (P < 0.001) and 0.93, respectively. The convergent validity as measured by the AVE also showed satisfactory results. CONCLUSION: The findings suggest that the Back-care Behavior Assessment Questionnaire (BABAQ) is a valid instrument for measuring healthy spine-related behaviors among schoolchildren.


Assuntos
Dor nas Costas/psicologia , Dor nas Costas/terapia , Psicometria/métodos , Estudantes/psicologia , Estudantes/estatística & dados numéricos , Inquéritos e Questionários/normas , Criança , Estudos Transversais , Análise Fatorial , Feminino , Humanos , Irã (Geográfico) , Reprodutibilidade dos Testes
10.
Med Care ; 58(8): 689-695, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32692134

RESUMO

BACKGROUND: Although complementary and alternative medicine (CAM) has been associated with reduced morbidity among adults with chronic back pain, less is known about the association between CAM use and health care expenditures. OBJECTIVES: The objective of this study was to first estimate health care expenditures of adult CAM users and nonusers with chronic back pain and then assess CAM's influence on health care expenditures. RESEARCH DESIGN: This was an ambidirectional cohort study. DATA: Linked National Health Interview Survey (2012) and Medical Expenditure Panel Survey (2013-2014). MEASURES: CAM use was defined as 3 or more visits to a practitioner in the 12 months before the National Health Interview Survey interview. Covariates included age, sex, race-ethnicity, and body mass index. The outcome was annual health care expenditures (overall and within 8 categories, including office-based visits and prescription medication). ANALYSES: Survey-weighted, covariate adjusted predicted marginal means models were applied to quantify health care expenditures. Survey-weighted, covariate adjusted linear and logistic regression models were used to investigate CAM's influence on expenditures, and the Z mediation test statistic was applied to quantify the independent effects of CAM. RESULTS: Overall, health care expenditures were significantly lower among CAM users with chronic back pain compared with non-CAM users for both 2013 and 2014: $8402 versus $9851 for 2013; $7748 versus $10,227 in 2014, annual differences of -$1499 (95% confidence interval: -$1701 to -$1197) and -$2479 (95% confidence interval: -$2696 to -$2262), respectively (P<0.001). Adult CAM users also had significantly lower prescription medication as well as outpatient expenses (P<0.001). CAM use was identified as a partial mediator to health care expenditures. CONCLUSION: CAM use is associated with lower overall health care expenditures, driven primarily by lower prescription and outpatient expenditures, among adults with chronic back pain in the United States.


Assuntos
Dor nas Costas/economia , Terapias Complementares/estatística & dados numéricos , Custos de Cuidados de Saúde/estatística & dados numéricos , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Adulto , Idoso , Dor nas Costas/terapia , Estudos de Coortes , Terapias Complementares/métodos , Estudos Transversais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Inquéritos e Questionários , Estados Unidos
11.
Pain Physician ; 23(4): E369-E376, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-32709183

RESUMO

BACKGROUND: Surgical options for thoracic pain are limited and carry significant risk and morbidity. Spinal cord stimulation has the potential to be used for treatment of thoracic pain, as it has been useful for treating multiple types of chronic pain. Conventional tonic stimulation is limited in the treatment of thoracic pain, as it can produce paresthesia that is difficult to localize. Conversely, high-frequency spinal cord stimulation (HF-SCS) does not activate dorsal column A Beta fibers and does not produce paresthesia, and thus may be more beneficial in treating thoracic back pain not manageable with tonic stimulation. OBJECTIVES: To evaluate (1) the efficacy of 10 kHz HF-SCS for patients with chronic thoracic pain; and (2) appropriate paresthesia-free lead placement and programming targets for 10 kHz HF-SCS for patients with chronic thoracic pain. STUDY DESIGN: Retrospective case series. SETTING: Multisite academic medical center or pain clinic. METHODS: A retrospective chart review was performed on 19 patients with thoracic back pain who underwent HF-SCS implantation. These patients had lead placement and stimulation between the T1-T6 vertebral levels. Outcome measures collected include location of device implant, stimulation settings, and pain scores at baseline, end of trial, and 1, 6, and 12 months postimplant. Follow-up phone calls collected information on if the patient reported functional improvement, improved sleep, or decreased pain medication usage. A Wilcoxon signed-rank test compared differences in mean pain scores across time points. RESULTS: Significantly decreased Visual Analog Scale scores were observed with 17/19 (89.5%) patients demonstrating response to therapy (> 50% reduction in pain scores). These results were sustained relative to baseline at 1, 6, and 12 months postimplant, depending on length of follow-up. Many patients also reported functional improvement (17/19), improved sleep (14/19), and reduction in use of pain medications after implantation (9/19). A total of 15/19 patients reported best relief when contacts over T1 or T2 vertebrae were used for stimulation. LIMITATIONS: This study is limited by its retrospective design. Additionally, including documentation from multiple sites may be prone to selection and abstraction bias. Data were also not available for all patients at all time points. CONCLUSIONS: HF-SCS may be a viable option for significant, long-lasting pain relief for thoracic back pain. There may also be evidence for anatomically based lead placement and programming for thoracic back pain. Randomized, controlled trials with extended follow-up are needed to further evaluate this therapy. KEY WORDS: Thoracic pain, back pain, spinal cord stimulation, high frequency, 10 kHz.


Assuntos
Dor nas Costas/terapia , Dor Crônica/terapia , Neuroestimuladores Implantáveis/normas , Estimulação da Medula Espinal/métodos , Estimulação da Medula Espinal/normas , Vértebras Torácicas , Adulto , Dor nas Costas/diagnóstico , Dor Crônica/diagnóstico , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Clínicas de Dor/normas , Medição da Dor/métodos , Medição da Dor/normas , Estudos Retrospectivos , Resultado do Tratamento
12.
Pain Physician ; 23(3S): S1-S127, 2020 05.
Artigo em Inglês | MEDLINE | ID: mdl-32503359

RESUMO

BACKGROUND: Chronic axial spinal pain is one of the major causes of significant disability and health care costs, with facet joints as one of the proven causes of pain. OBJECTIVE: To provide evidence-based guidance in performing diagnostic and therapeutic facet joint interventions. METHODS: The methodology utilized included the development of objectives and key questions with utilization of trustworthy standards. The literature pertaining to all aspects of facet joint interventions, was reviewed, with a best evidence synthesis of available literature and utilizing grading for recommendations.Summary of Evidence and Recommendations:Non-interventional diagnosis: • The level of evidence is II in selecting patients for facet joint nerve blocks at least 3 months after onset and failure of conservative management, with strong strength of recommendation for physical examination and clinical assessment. • The level of evidence is IV for accurate diagnosis of facet joint pain with physical examination based on symptoms and signs, with weak strength of recommendation. Imaging: • The level of evidence is I with strong strength of recommendation, for mandatory fluoroscopic or computed tomography (CT) guidance for all facet joint interventions. • The level of evidence is III with weak strength of recommendation for single photon emission computed tomography (SPECT) . • The level of evidence is V with weak strength of recommendation for scintography, magnetic resonance imaging (MRI), and computed tomography (CT) .Interventional Diagnosis:Lumbar Spine: • The level of evidence is I to II with moderate to strong strength of recommendation for lumbar diagnostic facet joint nerve blocks. • Ten relevant diagnostic accuracy studies with 4 of 10 studies utilizing controlled comparative local anesthetics with concordant pain relief criterion standard of ≥80% were included. • The prevalence rates ranged from 27% to 40% with false-positive rates of 27% to 47%, with ≥80% pain relief.Cervical Spine: • The level of evidence is II with moderate strength of recommendation. • Ten relevant diagnostic accuracy studies, 9 of the 10 studies with either controlled comparative local anesthetic blocks or placebo controls with concordant pain relief with a criterion standard of ≥80% were included. • The prevalence and false-positive rates ranged from 29% to 60% and of 27% to 63%, with high variability. Thoracic Spine: • The level of evidence is II with moderate strength of recommendation. • Three relevant diagnostic accuracy studies, with controlled comparative local anesthetic blocks, with concordant pain relief, with a criterion standard of ≥80% were included. • The prevalence varied from 34% to 48%, whereas false-positive rates varied from 42% to 58%.Therapeutic Facet Joint Interventions: Lumbar Spine: • The level of evidence is II with moderate strength of recommendation for lumbar radiofrequency ablation with inclusion of 11 relevant randomized controlled trials (RCTs) with 2 negative studies and 4 studies with long-term improvement. • The level of evidence is II with moderate strength of recommendation for therapeutic lumbar facet joint nerve blocks with inclusion of 3 relevant randomized controlled trials, with long-term improvement. • The level of evidence is IV with weak strength of recommendation for lumbar facet joint intraarticular injections with inclusion of 9 relevant randomized controlled trials, with majority of them showing lack of effectiveness without the use of local anesthetic. Cervical Spine: • The level of evidence is II with moderate strength of recommendation for cervical radiofrequency ablation with inclusion of one randomized controlled trial with positive results and 2 observational studies with long-term improvement. • The level of evidence is II with moderate strength of recommendation for therapeutic cervical facet joint nerve blocks with inclusion of one relevant randomized controlled trial and 3 observational studies, with long-term improvement. • The level of evidence is V with weak strength of recommendation for cervical intraarticular facet joint injections with inclusion of 3 relevant randomized controlled trials, with 2 observational studies, the majority showing lack of effectiveness, whereas one study with 6-month follow-up, showed lack of long-term improvement. Thoracic Spine: • The level of evidence is III with weak to moderate strength of recommendation with emerging evidence for thoracic radiofrequency ablation with inclusion of one relevant randomized controlled trial and 3 observational studies. • The level of evidence is II with moderate strength of recommendation for thoracic therapeutic facet joint nerve blocks with inclusion of 2 randomized controlled trials and one observational study with long-term improvement. • The level of evidence is III with weak to moderate strength of recommendation for thoracic intraarticular facet joint injections with inclusion of one randomized controlled trial with 6 month follow-up, with emerging evidence. Antithrombotic Therapy: • Facet joint interventions are considered as moderate to low risk procedures; consequently, antithrombotic therapy may be continued based on overall general status. Sedation: • The level of evidence is II with moderate strength of recommendation to avoid opioid analgesics during the diagnosis with interventional techniques. • The level of evidence is II with moderate strength of recommendation that moderate sedation may be utilized for patient comfort and to control anxiety for therapeutic facet joint interventions. LIMITATIONS: The limitations of these guidelines include a paucity of high-quality studies in the majority of aspects of diagnosis and therapy. CONCLUSIONS: These facet joint intervention guidelines were prepared with a comprehensive review of the literature with methodologic quality assessment with determination of level of evidence and strength of recommendations. KEY WORDS: Chronic spinal pain, interventional techniques, diagnostic blocks, therapeutic interventions, facet joint nerve blocks, intraarticular injections, radiofrequency neurolysis.


Assuntos
Dor nas Costas/terapia , Dor Crônica/terapia , Manejo da Dor/métodos , Articulação Zigapofisária , Humanos , Estados Unidos
13.
Anaesthesia ; 75(6): 775-784, 2020 06.
Artigo em Inglês | MEDLINE | ID: mdl-32383509

RESUMO

Spinal cord stimulation at 10 kHz is a promising therapy for non-surgical refractory back pain; however, published data are currently limited. We present a subanalysis of prospectively collected clinical outcome data for non-surgical refractory back pain patients treated with 10 kHz spinal cord stimulation, from the independent cohorts of two previous studies (SENZA-RCT and SENZA-EU). Clinical outcomes were evaluated at pre-implantation (baseline), 3 months, 6 months and 12 months following 10 kHz spinal cord stimulator implantation. These included: pain relief; responder rate (≥ 50% pain relief from baseline); remission rate (VAS ≤ 3.0 cm); disability (Oswestry Disability Index(ODI)); and opioid use. At 3 months, average back pain decreased by 70% in the combined cohort (60% in the SENZA-RCT and 78% in the SENZA-EU cohorts). This was sustained at 12 months, with a 73% back pain responder rate and 68% remission rate in the combined cohort. Leg pain relief results were generally comparable to those for back pain relief. At 12 months, the combined cohort had an average decrease in ODI scores of 15.7% points from baseline and opioid use more than halved. In conclusion, 10 kHz spinal cord stimulation reduced pain, disability and opioid consumption in non-surgical refractory back pain subjects. Application of this therapy may improve the care of non-surgical refractory back pain patients and reduce their opioid consumption.


Assuntos
Dor nas Costas/terapia , Dor Crônica/terapia , Manejo da Dor/métodos , Estimulação da Medula Espinal/métodos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Medição da Dor , Estudos Prospectivos , Resultado do Tratamento
14.
BMC Public Health ; 20(1): 805, 2020 May 29.
Artigo em Inglês | MEDLINE | ID: mdl-32471404

RESUMO

BACKGROUND: Children's health and welfare have a special place in research and policy in many countries. One of the most important concerns is the increasing rate of backache in children due to many of behavioral risk factors. The aim of this study was to evaluate the effectiveness of an educational program on promoting back-related behavior as well as knowledge, skills, beliefs, and self-efficacy among fifth grade girls. METHODS: The theory-based back care (T-Bak) study was a school-based randomised controlled trial (RCT) that assessed the effectiveness of developing a back care training program based on the social cognitive theory (SCT). A total of 104 schoolchildren aged 11 ± 1.0 years were assigned to intervention (n = 52) and control (n = 52) groups. The intervention group received six sessions training on proper lifting and carrying techniques, having proper posture during daily activities, and correct backpack wearing techniques with a 1-week interval while the control group received nothing. Then, the two groups were assessed for knowledge, skills, self-efficacy, beliefs, and behavior at four points in time: baseline, immediate, three and six-months post-intervention. The changes of the outcomes investigated using univariate repeated measures analysis of variance. Partial eta squared measure (ηp2) was used to calculate effect sizes. RESULTS: A positive change was found for the intervention group back-related behavior from baseline to immediate post-intervention and follow-ups (F = 78.865, p < 0.001, ηp2 = 0.22). Overall there were 36.4% improvement for knowledge (ηp2 = 0.21), 53.2% for the skills (ηp2 = 0.25), 19.5% for the self-efficacy (ηp2 = 0.11), and 25.6% for the beliefs (ηp2 = 0.14) scores from baseline to 6 months' follow-up assessments among the intervention group (p < 0.001). The results also showed a significant interaction effect between group and time. CONCLUSION: The T-Bak intervention was effective in improving back-related behavior in pupils. It is now available and could be evaluated further in back-care related studies. TRIAL REGISTRATION: Current Controlled Trials IRCT20180528039885N1, 30th Oct 2018, 'Prospectively registered'. https://www.irct.ir/trial/31534.


Assuntos
Dor nas Costas/terapia , Terapia Comportamental/educação , Terapia Comportamental/métodos , Promoção da Saúde/métodos , Educação de Pacientes como Assunto/métodos , Estudantes/estatística & dados numéricos , Dor nas Costas/epidemiologia , Terapia Comportamental/estatística & dados numéricos , Criança , Análise Custo-Benefício , Feminino , Humanos , Irã (Geográfico)/epidemiologia , Instituições Acadêmicas
15.
Pain physician ; 23(3S): S1-S127, May 2020.
Artigo em Inglês | BIGG - guias GRADE | ID: biblio-1129928

RESUMO

Chronic axial spinal pain is one of the major causes of significant disability and health care costs, with facet joints as one of the proven causes of pain. To provide evidence-based guidance in performing diagnostic and therapeutic facet joint interventions. The methodology utilized included the development of objectives and key questions with utilization of trustworthy standards. The literature pertaining to all aspects of facet joint interventions, was reviewed, with a best evidence synthesis of available literature and utilizing grading for recommendations.


Assuntos
Humanos , Masculino , Feminino , Bloqueio Nervoso Autônomo , Dor nas Costas/terapia , Denervação/métodos , Dor Crônica/terapia , Manejo da Dor/métodos , Terapia por Radiofrequência , Avaliação de Resultado de Intervenções Terapêuticas , Injeções Intra-Articulares
16.
Emerg Med Clin North Am ; 38(2): 523-537, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-32336338

RESUMO

A careful history and thorough physical examination are necessary in patients presenting with acute neurologic dysfunction. Patients presenting with headache should be screened for red-flag criteria that suggest a dangerous secondary cause warranting imaging and further diagnostic workup. Dizziness is a vague complaint; focusing on timing, triggers, and examination findings can help reduce diagnostic error. Most patients presenting with back pain do not require emergent imaging, but those with new neurologic deficits or signs/symptoms concerning for acute infection or cord compression warrant MRI. Delay to diagnosis and treatment of acute ischemic stroke is a frequent reason for medical malpractice claims.


Assuntos
Serviço Hospitalar de Emergência , Doenças do Sistema Nervoso/diagnóstico , Dor nas Costas/diagnóstico , Dor nas Costas/etiologia , Dor nas Costas/terapia , Tontura/diagnóstico , Tontura/etiologia , Tontura/terapia , Cefaleia/diagnóstico , Cefaleia/etiologia , Cefaleia/terapia , Humanos , Imperícia , Doenças do Sistema Nervoso/terapia , Gestão de Riscos , Convulsões/diagnóstico , Convulsões/etiologia , Convulsões/terapia
17.
Pain Pract ; 20(6): 656-675, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-32196892

RESUMO

BACKGROUND: Virtual reality (VR) technologies have been shown to be beneficial in various areas of health care; to date, there are no systematic reviews examining the effectiveness of VR technology for the treatment of spinal pain. PURPOSE: To investigate the effectiveness of VR technology in the management of individuals with acute, subacute, and chronic spinal pain. METHODS: Six electronic databases were searched until November 2019. Randomized controlled trials (RCTs) assessing the effectiveness of VR were eligible for inclusion. Two independent reviewers extracted the data and assessed the risk of bias for each study and the overall quality of evidence. Mean differences of outcomes were pooled as appropriate using random-effects models. RESULTS: Seven RCTs with high risk of bias met review criteria. Quality of evidence ranged from very low to low quality. In patients with chronic neck pain, VR improved global perceived effect (GPE), satisfaction, and general health at short-term follow-up, as well as general health and balance at intermediate-term follow-up compared to kinematic training. VR improved pain intensity and disability at short-term and long-term follow-up compared to conventional proprioceptive training in patients with chronic neck pain. In patients with either subacute or chronic low back pain (LBP), VR improved pain, disability, and fear of movement compared to lumbar stabilization exercises and improved pain compared to conventional physical therapy (at short-term follow-up). In patients with chronic LBP, VR improved pain compared to lumbar stabilization exercises and improved fear of movement compared to conventional physical therapy (at short-term follow-up). CONCLUSION: VR's potential for improvement in outcomes for spinal pain that demonstrated statistical and/or clinical significance (pain intensity, disability, fear of movement, GPE, patient satisfaction, general health status, and balance) highlights the need for more focused, higher-quality research on the efficacy and effectiveness of VR for treatment of patients with spinal pain.


Assuntos
Dor nas Costas/terapia , Cervicalgia/terapia , Realidade Virtual , Dor Crônica/terapia , Humanos
18.
J Orthop Sports Phys Ther ; 50(3): 143-148, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-32116102

RESUMO

OBJECTIVE: To determine how well the functional comorbidity index (FCI) predicts outcomes in older adults with back pain compared to Quan's modification of the Charlson comorbidity index (Quan-Charlson comorbidity index) and the Elixhauser comorbidity index. DESIGN: Secondary analysis of a prospective cohort study. METHODS: We included 5155 adults 65 years of age or older with new primary care visits for back pain. Comorbidity was measured using diagnosis codes 12 months prior to the new visit. Outcomes of functional limitation (Roland-Morris Disability Questionnaire), health-related quality of life (European Quality of Life-5 Dimensions [EQ-5D]), and total health care use (sum of relative value units) were measured 12 months after the new visit. We compared multivariable models containing preselected prognostic factors. RESULTS: Spearman correlation coefficients among the indices were 0.70 or greater. Multivariable models for the Roland-Morris Disability Questionnaire had similar R2 and root-mean-square error (RMSE) of prediction when using the FCI (R2 = 0.190; RMSE, 6.19), Quan-Charlson comorbidity index (R2 = 0.185; RMSE, 6.20), or Elixhauser comorbidity index (R2 = 0.189; RMSE, 6.19). Multivariable models for the EQ-5D score showed small differences in R2 and RMSE when using the FCI (R2 = 0.157; RMSE, 0.163), Quan-Charlson comorbidity index (R2 = 0.148; RMSE, 0.164), or Elixhauser comorbidity index (R2 = 0.154; RMSE, 0.163). Multivariable models for health care use had similar Akaike information criterion (AIC) values when using the FCI (AIC = 10.04), Quan-Charlson comorbidity index (AIC = 10.04), or Elixhauser comorbidity index (AIC = 10.01). CONCLUSION: All indices performed similarly in predicting outcomes. There does not seem to be an advantage to using one index over another for older adults with back pain. There is still a need to develop better function-based risk-adjustment models that improve prediction of functional outcomes versus standard comorbidity indices. J Orthop Sports Phys Ther 2020;50(3):143-148. Epub 23 Jul 2019. doi:10.2519/jospt.2020.8764.


Assuntos
Dor nas Costas/complicações , Dor nas Costas/terapia , Avaliação de Resultados da Assistência ao Paciente , Atenção Primária à Saúde/estatística & dados numéricos , Qualidade de Vida , Medição de Risco/métodos , Idoso , Comorbidade , Utilização de Instalações e Serviços , Feminino , Humanos , Masculino , Estudos Prospectivos , Estados Unidos
19.
Artigo em Alemão | MEDLINE | ID: mdl-32189043

RESUMO

Diagnostic and therapeutic procedures are popular and frequently performed for low back pain. This narrative review presents and discusses the myths and evidence related to these procedures.In most cases it is nonspecific pain, for which no underlying disease can be named. Image diagnostics using X­rays and MRI are rarely helpful in the case of new nonspecific back pain.Evidence for chirotherapy is doubtful. Also, evidence is lacking for invasive and surgical procedures in local and regional low back pain. These procedures show superiority in radicular pain only: extraction of disc herniation in acute and subacute leg pain and segmental lumbar fusion in chronic leg pain. Nevertheless, these and other invasive methods are being used to an increasing extent. Spontaneous healing and the possibilities of the patient to become pain-relieving for themselves are neglected and increased risks are accepted.Therapeutic approaches fostering self-efficacy by reconditioning physical and mental capability and improving positive self-perception ("interdisciplinary multimodal pain therapy") effect superior and sustainable results in subacute and chronic nonspecific back pain. Patients and physicians, however, tend to prefer passive and invasive therapy strategies. The underlying mechanisms should be understood. New thinking is necessary.


Assuntos
Dor nas Costas/diagnóstico , Dor nas Costas/terapia , Diagnóstico por Imagem/métodos , Medição da Dor , Dor Crônica , Alemanha , Humanos
20.
J Equine Vet Sci ; 86: 102891, 2020 03.
Artigo em Inglês | MEDLINE | ID: mdl-32067657

RESUMO

Low-level laser therapy has been used clinically to treat musculoskeletal pain; however, there is limited evidence available to support its use in treating back pain in horses. The objective of this study was to evaluate the clinical effectiveness of low-level laser therapy and chiropractic care in treating thoracolumbar pain in competitive western performance horses. The subjects included 61 Quarter Horses actively involved in national western performance competitions judged to have back pain. A randomized, clinical trial was conducted by assigning affected horses to either laser therapy, chiropractic, or combined laser and chiropractic treatment groups. Outcome parameters included a visual analog scale (VAS) of perceived back pain and dysfunction and detailed spinal examinations evaluating pain, muscle tone, and stiffness. Mechanical nociceptive thresholds were measured along the dorsal trunk and values were compared before and after treatment. Repeated measures with post-hoc analysis were used to assess treatment group differences. Low-level laser therapy, as applied in this study, produced significant reductions in back pain, epaxial muscle hypertonicity, and trunk stiffness. Combined laser therapy and chiropractic care produced similar reductions, with additional significant decreases in the severity of epaxial muscle hypertonicity and trunk stiffness. Chiropractic treatment by itself did not produce any significant changes in back pain, muscle hypertonicity, or trunk stiffness; however, there were improvements in trunk and pelvic flexion reflexes. The combination of laser therapy and chiropractic care seemed to provide additive effects in treating back pain and trunk stiffness that were not present with chiropractic treatment alone. The results of this study support the concept that a multimodal approach of laser therapy and chiropractic care is beneficial in treating back pain in horses involved in active competition.


Assuntos
Quiroprática , Doenças dos Cavalos , Dor Lombar , Terapia com Luz de Baixa Intensidade , Manipulação Quiroprática , Animais , Dor nas Costas/terapia , Dor nas Costas/veterinária , Doenças dos Cavalos/radioterapia , Cavalos , Dor Lombar/veterinária , Terapia com Luz de Baixa Intensidade/veterinária , Manipulação Quiroprática/veterinária
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