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1.
Pain Manag ; 12(1): 25-33, 2022 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-34192885

RESUMO

Tolperisone is a nonopioid, centrally acting muscle relaxant in clinical development in the USA for the treatment of symptoms associated with acute, painful muscles spasms of the back. CLN-301, RESUME-1, is a 14-day double-blind, randomized, placebo-controlled, parallel-group Phase III study of the efficacy and safety of tolperisone administered orally three-times daily in 1000 male and female subjects at approximately 70 clinical sites in the USA experiencing back pain due to or associated with muscle spasm of acute onset. Tolperisone is a promising therapeutic for managing acute, painful muscle spasms of the back as it appears to lack the off-target CNS effects often seen with conventional skeletal muscle relaxants. Clinical Trials registration number: NCT04671082.


Assuntos
Relaxantes Musculares Centrais , Tolperisona , Dor nas Costas , Feminino , Humanos , Masculino , Relaxantes Musculares Centrais/uso terapêutico , Espasmo/tratamento farmacológico , Tolperisona/uso terapêutico , Resultado do Tratamento
3.
MMW Fortschr Med ; 163(20): 12-13, 2021 Nov.
Artigo em Alemão | MEDLINE | ID: mdl-34767202
4.
MMW Fortschr Med ; 163(20): 71, 2021 Nov.
Artigo em Alemão | MEDLINE | ID: mdl-34767233
5.
Spine (Phila Pa 1976) ; 46(21): 1455-1460, 2021 Nov 01.
Artigo em Inglês | MEDLINE | ID: mdl-34618706

RESUMO

STUDY DESIGN: Prospective, multi-centric, cross-sectional study. OBJECTIVE: To analyze the construct validity of the Tampa Scale of Kinesiophobia (TSK) in a cohort of patients with adolescent idiopathic scoliosis (AIS). SUMMARY OF THE BACKGROUND DATA: Back pain is not uncommon in AIS. The fear of movement (kinesiophobia) in response to pain is related to back pain. TSK psychometric properties in AIS patients have not been properly analyzed. METHODS: Patients with AIS and no prior spine surgery were prospectively included. They fulfilled the Spanish version of the TSK-11 questionnaire, a pain intensity numerical rating scale (NRS), refined SRS-22 (SRS-22r), the Hospital Anxiety and Depression Scale (HADS), and item 7 of the Core Outcome Measurement Index (COMI). The sample was split into two groups for the statistical analysis: adolescents and young adults. Cronbach alpha was used to assess internal consistency. Discriminant and concurrent validity were obtained by computing Pearson correlation coefficients between the TSK score and several criterion measures. RESULTS: A total of 275 patients were included-198 adolescents (mean age of 14.6 yrs) and 77 young adults (mean age of 26.9 yrs). The Cobb of largest curve means were 44.9° and 48.9°, respectively. In the adolescent group, the TSK mean (±SD) was 21.5 (±5.93), with a floor effect of 2.5%. In the adult group, the TSK mean was 24.2 (±6.63), with a floor effect of 3.9%. The ceiling effect was 0% in both groups. Cronbach alphas for the adolescent and adult groups were 0.76 and 0.79, respectively. No correlation was found in any group between the TSK score and the curve magnitude or pattern (Lenke classification). The TSK was significantly correlated with HAD depression and SRS-22r in both groups. However, these correlations were weaker in adolescents. In adults, the TSK also significantly correlates with NRS and work/school absenteeism. CONCLUSION: The Spanish version of TSK-11 is a reliable and valid instrument to analyze kinesiophobia in AIS. However, the weak correlation between kinesiophobia and pain intensity, disability, and emotional condition in adolescents requires further study.Level of Evidence: 4.


Assuntos
Transtornos Fóbicos , Escoliose , Adolescente , Adulto , Dor nas Costas , Estudos Transversais , Humanos , Medição da Dor , Transtornos Fóbicos/diagnóstico , Transtornos Fóbicos/epidemiologia , Estudos Prospectivos , Qualidade de Vida , Reprodutibilidade dos Testes , Escoliose/diagnóstico , Escoliose/epidemiologia , Adulto Jovem
6.
Medicina (Kaunas) ; 57(10)2021 Oct 18.
Artigo em Inglês | MEDLINE | ID: mdl-34684162

RESUMO

Background and Objectives: To compare the long-term pain characteristics and its chronic management following minimally invasive spinal (MIS) decompression and open laminectomy with fusion for lumbar stenosis. Materials and Methods: The study cohort included patients with a minimum 5-year postoperative follow-up after undergoing either MIS decompression or laminectomy with fusion for spinal claudication. The primary outcome of interest was chronic back and leg pain intensity. Secondary outcome measures included pain frequency during the day, chronic use of non-opioid analgesics, narcotic medications, medical cannabinoids, and continuous interventional pain treatments. Results: A total of 95 patients with lumbar spinal stenosis underwent one- or two-level surgery for lumbar spinal stenosis between April 2009 and July 2013. Of these, 50 patients underwent MIS decompression and 45 patients underwent open laminectomy with instrumented fusion. In the fusion group, a higher percentage of patients experienced moderate-to-severe back pain with 48% compared to 21.8% of patients in the MIS decompression group (p < 0.01). In contrast, we found no significant difference in the reported leg pain in both groups. In the fusion group, 20% of the patients described their back and leg pain as persistent throughout the day compared to only 2.2% in the MIS decompression group (p < 0.05). A trend toward higher chronic dependence on analgesic medication and repetitive pain clinic treatments was found in the fusion group. Conclusions: MIS decompression for the treatment of degenerative spinal stenosis resulted in decreased long-term back pain and similar leg pain outcomes compared to open laminectomy and instrumented fusion surgery.


Assuntos
Fusão Vertebral , Estenose Espinal , Dor nas Costas , Descompressão , Humanos , Laminectomia/efeitos adversos , Vértebras Lombares/cirurgia , Procedimentos Cirúrgicos Minimamente Invasivos , Estudos Retrospectivos , Fusão Vertebral/efeitos adversos , Estenose Espinal/cirurgia , Resultado do Tratamento
7.
BMC Musculoskelet Disord ; 22(1): 857, 2021 Oct 08.
Artigo em Inglês | MEDLINE | ID: mdl-34625083

RESUMO

BACKGROUND: Neck and back pain are musculoskeletal conditions with serious individual and societal consequences. Current evidence about the prognostic value for neck and back pain is limited and conflicting. This prospective cohort study aimed to assess the association between leisure-time physical activity (LPA) and improvement of neck and/or back pain in a working population receiving manual therapy or general care in one of two randomized controlled trials (RCTs). METHODS: Analyses of data from two RCTs evaluating the effect of manual therapies for neck and/or back pain was conducted. Participants (n = 1 464) answered questionnaires about frequency and effort level of LPA at baseline. LPA on moderate or vigorous levels was compared to no or low/irregular moderate and vigorous levels. Pain intensity was assessed with numerical scales at baseline and 3-, 6-, and 12-month follow-up. The outcome was minimal clinically important improvement in pain intensity, defined as ≥2 points improvement in mean pain intensity at follow-up. Crude- and adjusted risk ratios (RR) with 95% confidence intervals (CI) were calculated with Poisson regression analysis and stratified by pain location. RESULTS: Participants with neck and/or back pain performing vigorous LPA showed a minimal clinically important improvement after 12 months compared to the control group; RR 1.35 (95% CI; 1.06-1.73). No effect was observed at 3 or 6 months. Moderate LPA did not improve pain intensity in any follow-up. Stratified analyses revealed that the effect of vigorous LPA at 12 months in back pain was RR 1.83 (95% CI; 1.26-2.66) and neck pain RR 1.06 (95% CI; 0.75-1.49). CONCLUSIONS: Persons with neck and/or back pain receiving manual therapy or general evidence-based care have greater chance of improvement after 12 months if they prior to treatment frequently practice vigorous LPA. When analyzed separately, the effect was only present for back pain. TRIAL REGISTRATION: Registration in Current Controlled Trials (ISRCTN), Stockholm Manual Intervention Trial (MINT), ISRCTN92249294 BJORN-trial, ISRCTN56954776.


Assuntos
Dor nas Costas , Cervicalgia , Dor nas Costas/diagnóstico , Dor nas Costas/epidemiologia , Dor nas Costas/terapia , Exercício Físico , Humanos , Atividades de Lazer , Cervicalgia/diagnóstico , Cervicalgia/epidemiologia , Cervicalgia/terapia
8.
BMC Musculoskelet Disord ; 22(1): 863, 2021 Oct 09.
Artigo em Inglês | MEDLINE | ID: mdl-34627214

RESUMO

BACKGROUND: To determine the relationship between clusters of back pain and joint pain and prescription opioid dispensing. METHODS: Of 11,221 middle-aged participants from the Australian Longitudinal Study of Women's Health, clusters of back pain and joint pain from 2001 to 2013 were identified using group-based trajectory modelling. Prescription opioid dispensing from 2003 to 2015 was identified by linking the cohort to Pharmaceutical Benefit Scheme dispensing data. Multinomial logistic regression was used to examine the association between back pain and joint pain clusters and dispensing of prescription opioids. The proportion of opioids dispensed in the population attributable to back and join pain was calculated. RESULTS: Over 12 years, 68.5 and 72.0% women reported frequent or persistent back pain and joint pain, respectively. There were three clusters ('none or infrequent', 'frequent' and 'persistent') for both back pain and joint pain. Those in the persistent back pain cluster had a 6.33 (95%CI 4.38-9.16) times increased risk of having > 50 opioid prescriptions and those in persistent joint pain cluster had a 6.19 (95%CI 4.18-9.16) times increased risk of having > 50 opioid prescriptions. Frequent and persistent back and joint pain clusters together explained 41.7% (95%CI 34.9-47.8%) of prescription opioid dispensing. Women in the frequent and persistent back pain and joint pain clusters were less educated and reported more depression and physical inactivity. CONCLUSION: Back pain and joint pain are major contributors to opioid prescription dispensing in community-based middle-aged women. Additional approaches to reduce opioid use, targeted at those with frequent and persistent back pain and joint pain, will be important in order to reduce the use of opioids and their consequent harm in this population.


Assuntos
Analgésicos Opioides , Artralgia , Analgésicos Opioides/efeitos adversos , Artralgia/diagnóstico , Artralgia/tratamento farmacológico , Artralgia/epidemiologia , Austrália/epidemiologia , Dor nas Costas/diagnóstico , Dor nas Costas/tratamento farmacológico , Dor nas Costas/epidemiologia , Estudos de Coortes , Feminino , Humanos , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos
9.
Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi ; 35(10): 1336-1340, 2021 Oct 15.
Artigo em Chinês | MEDLINE | ID: mdl-34651490

RESUMO

Low back pain is a common disease. In 2020, the North American Spine Society (NASS) formulated an evidence-based clinical guideline for the diagnosis and treatment of non-specific low back pain. The guidelines mainly addressed five aspects of non-specific low back pain: diagnosis, imaging examination, conservative treatment, interventional treatment, and surgical treatment. Based on an in-depth understanding of the guidelines, this article gives a brief explanation of the diagnosis and treatment of non-specific low back pain, so as to provide references for clinicians.


Assuntos
Dor Lombar , Dor nas Costas , Medicina Baseada em Evidências , Humanos , Dor Lombar/diagnóstico , Dor Lombar/terapia , América do Norte , Coluna Vertebral
10.
Medicine (Baltimore) ; 100(37): e27288, 2021 Sep 17.
Artigo em Inglês | MEDLINE | ID: mdl-34664889

RESUMO

RATIONALE: Solitary bone plasmacytoma (SBP) is a rare manifestation of plasma cell tumor. Although axial skeleton is the most frequently affected site of SBP, adjacent disc space involvement is rare. Herein we report a case of SBP in thoracic vertebra with involvement of adjacent disc space. PATIENT CONCERNS: A 57-year-old male presented with a 2-year history of intermittent back pain with activity. The patient's back pain intensity with activity was a score of 5 of the 10-point visual analog scale). DIAGNOSES AND INTERVENTION: The patient underwent a posterior fusion procedure from T6 to T10, and an open biopsy of the vertebral lesion confirmed that final diagnosis of SBP. The patient received postoperative radiotherapy with a total of 4000 Gy to the T7-T9 vertebral levels over a 20-day period. OUTCOMES: Following radiotherapy, the patient's pain intensity was reduced to the visual analog scale score of 1 at the 6-month follow-up. LESSONS: SBP lacks typical clinical symptoms, and the accurate diagnosis before clinical intervention remains challenging. Due to the disc involvement, SBP often manifests as spinal infection. Hence, differential diagnosis in spinal lesions involving the disc should include SBP.


Assuntos
Deslocamento do Disco Intervertebral/etiologia , Plasmocitoma/complicações , Coluna Vertebral/anormalidades , Dor nas Costas/etiologia , Dor nas Costas/fisiopatologia , Humanos , Deslocamento do Disco Intervertebral/fisiopatologia , Masculino , Pessoa de Meia-Idade , Plasmocitoma/fisiopatologia , Fusão Vertebral/métodos , Coluna Vertebral/diagnóstico por imagem , Tomografia Computadorizada por Raios X/métodos
11.
Medicine (Baltimore) ; 100(43): e27615, 2021 Oct 29.
Artigo em Inglês | MEDLINE | ID: mdl-34713844

RESUMO

INTRODUCTION: Osteoporosis is a condition commonly observed in elderly and postmenopausal women. Pregnancy and lactation-induced osteoporosis are rare, and the development of severe vertebral fractures is uncommon. Postpartum thyroiditis (PPT) is a minor cause of osteoporosis. To the best of our knowledge, the development of osteoporosis associated with pregnancy has not yet been reported. PATIENT CONCERNS: Here, we report a rare case of post-pregnancy osteoporosis-related multiple vertebral fractures associated with PPT. A 25-year-old woman developed lower back pain after her first delivery. She was then admitted to our medical center because of aggravated back pain. DIAGNOSIS: On radiographic examination, she had multiple compressions of the lumbar spine. Bone mineral density was associated with osteoporosis. Laboratory tests, thyroid scans, and thyroid ultrasonography were performed. The patient was diagnosed with PPT. INTERVENTIONS: The patient stopped lactating immediately. She was administered bisphosphate at 3 mg/3 months intravenously, elementary calcium at 1000 mg/day, and calcitriol 0.5 µg/day. OUTCOMES: A month later, her pain was relieved by proper management and she could independently walk indoors. CONCLUSION: PPT might play a role in aggravating post-pregnancy osteoporosis. It should be considered as a differential diagnosis in patients presenting with postpartum osteoporosis-related multiple spine fractures.


Assuntos
Fraturas por Osteoporose/complicações , Tireoidite Pós-Parto/epidemiologia , Fraturas da Coluna Vertebral/complicações , Adulto , Dor nas Costas/etiologia , Densidade Óssea , Calcitriol/uso terapêutico , Cálcio/uso terapêutico , Difosfonatos/uso terapêutico , Feminino , Humanos , Lactação/fisiologia , Vértebras Lombares/patologia , Fraturas por Osteoporose/tratamento farmacológico , Tireoidite Pós-Parto/patologia , Gravidez
13.
Artigo em Inglês | MEDLINE | ID: mdl-34682338

RESUMO

According to the latest data published by the WHO, 1.71 billion people suffer from musculoskeletal disorders and 568 million are affected by back pain, making these the most significant occupational health problems. The aim of this study was to analyze the effects of a newly developed Multimodal Workplace Training Program implemented among young sedentary employees in order to treat and prevent these problems. The 20-week Training Program was conducted at the National Instruments Corporations' Hungarian subsidiary in Debrecen between January and June, 2019. Pre- and post-intervention questionnaires were used to assess subjective parameters. Baseline and follow-up physical examinations were performed using the SpinalMouse, Y-Balance, Sit and Reach, Prone and Side Plank, Timed Abdominal Curl, and Biering-Sorensen tests. The results for 76 subjects were eligible for statistical analysis. Our Training Program was effective in several aspects, including a reduction in musculoskeletal symptoms and improvements in posture (p < 0.001), in dynamic (p < 0.01) and static-isometric (p < 0.001) core strength, in flexibility (p < 0.001), in spinal inclination in the sagittal (p < 0.001) and frontal (p < 0.01) plane, and in balance and coordination (p < 0.05). The Multimodal Progressive Functional-Proprioceptive Training was highly effective, and the application of such a complex training program can be recommended in workplace settings.


Assuntos
Doenças Musculoesqueléticas , Coluna Vertebral , Dor nas Costas , Estudos de Coortes , Humanos , Local de Trabalho
15.
BMC Fam Pract ; 22(1): 200, 2021 10 09.
Artigo em Inglês | MEDLINE | ID: mdl-34627152

RESUMO

BACKGROUND: Adherence to guidelines for back pain continues to be a challenge, prompting strategies focused on improving education around biopsychosocial frameworks. OBJECTIVE: Assess the influence of an interactive educational mobile app for patients on initial care decisions made for low back pain by the primary care provider. The secondary aim was to compare changes in self-reported pain and function between groups. METHODS: This was a randomized controlled trial involving patients consulting for an initial episode of low back pain. The intervention was a mobile video-based education session (Truth About Low Back Pain) compared to usual care. The app focused on addressing maladaptive beliefs typically associated with higher risk of receiving low-value care options. The primary outcome was initial medical utilization decisions made by primary care practitioners (x-rays, MRIs, opioid prescriptions, injections, procedures) and secondary outcomes included PROMIS pain interference and physical function subscales at 1 and 6 months, and total medical costs. RESULTS: Of 208 participants (71.2% male; mean age 35.4 years), rates of opioid prescriptions, advanced imaging, analgesic patches, spine injections, and physical therapy use were lower in the education group, but the differences were not significant. Total back-related medical costs for 1 year (mean diff = $132; P = 0.63) and none of the 6-month PROMIS subscales were significantly different between groups. Results were no different in opioid-naïve subjects. Instead, prior opioid use and high-risk of poor prognosis on the STarT Back Screening Tool predicted 1-year back pain-related costs and healthcare utilization, regardless of intervention. CONCLUSION: Factors that influence medical treatment decisions and guideline-concordant care are complex. This particular patient education approach directed at patients did not appear to influence healthcare decisions made by primary care providers. Future studies should focus on high-risk populations and/or the impact of including the medical provider as an active part of the educational process. TRIAL REGISTRATION: clinicaltrials.gov NCT02777983 .


Assuntos
Dor Lombar , Adulto , Analgésicos Opioides/uso terapêutico , Dor nas Costas , Feminino , Humanos , Dor Lombar/terapia , Masculino , Modalidades de Fisioterapia , Atenção Primária à Saúde
16.
Midwifery ; 103: 103164, 2021 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-34670166

RESUMO

BACKGROUND: / OBJECTIVE: This integrative review summarises original research that explores the experiences and perceptions of midwives and women using sterile water injections (SWI's) during labour. DESIGN: Integrative review. METHODS: A robust search strategy was conducted using the following databases: Scopus, Cumulative Index to Nursing and Allied Health (CINAHL), Ovid Medline and PubMed. All articles were assessed for quality using the Joanna Briggs Institute Critical Appraisal Tools (2017) scoring. Whittemore and Knafl's (2005) five stage approach was used to analyse the primary literature related to midwives and women's experiences of sterile water injections (SWI's) for back pain during labour. FINDINGS: A total of 291 articles were retrieved and 13 papers were included in this review (four qualitative including one case report and nine quantitative) that fulfilled the inclusion criteria. Three overarching themes were identified: 'Assessment, perception and communication of pain', 'Techniques of administration of SWI's' and 'Barriers and resistance to using SWI's'. The 'Assessment, perception and communication of pain' theme included four subthemes: 'balancing the expectation of the injection pain against pain relief'; 'using appropriate language to prepare women'; 'rapid onset and increased pain relief with SWI's in comparison to saline'; and 'midwives high considerations for using SWI's as a form of pain relief'. The 'Techniques of administration of SWI's' theme included two subthemes: 'intradermal is better than subcutaneous injections'; and, 'four injections is better than one'. The 'Barriers and facilitators to using SWI's' theme included four subthemes: 'guidelines and evidence'; 'level of experience'; 'midwifery philosophy challenges'; and 'resistance from colleagues'. For example, 'midwifery philosophy challenges' included midwives being conflicted about providing an invasive, painful procedure as counter-intuitive to supporting women through the pain of labour. Midwives need opportunities to learn and develop skills for using SWI's. Women described feeling more empowered during their labour and appreciated the use of SWI's including the rapid onset of pain relief and the absence of side effects. The ability for women to exert some control over their pain whilst still being able to experience the physical sensations of labour and birth was important. CONCLUSIONS AND IMPLICATIONS FOR PRACTICE: The review supports the evidence for the use of SWI's however, there is limited evidence available and more information needs to be provided about the benefits of this non-pharmacological technique for back pain during labour. Generalised guidelines are needed to ensure consistent practice in the provision of care for women experiencing back pain during labour.


Assuntos
Trabalho de Parto , Tocologia , Dor nas Costas , Feminino , Humanos , Parto , Gravidez , Água
17.
MMW Fortschr Med ; 163(15): 10, 2021 09.
Artigo em Alemão | MEDLINE | ID: mdl-34478065
18.
Rev Esp Salud Publica ; 952021 Sep 15.
Artigo em Espanhol | MEDLINE | ID: mdl-34521805

RESUMO

OBJECTIVE: At school age pain in the lower back is common. There is evidence that an adequate fit between the dimensions of the school furniture and the anthropometric characteristics will result in an improvement in their posture and a reduction in pain. The objectives of this research were to determine the degree of mismatch of furniture in primary education, check if the sizes of the current regulations are adequate and validate two instruments that allow teachers to correctly assign furniture. METHODS: 92 elementary students participated. Measurements to determine the ideal height of the chair and table were made with an anthropometer in a Galician public school in 2019. The recorded values were compared with those obtained by the two measurement instruments to be validated: TAIS and TAIM. The analysis techniques used were: descriptive, one-way ANOVA, t-test and effect size, significance level ρ<0.05. RESULTS: The mismatch between the furniture used in the classrooms and that calculated as ideal was 93.5% for chairs and 97.6% for tables. In 51% of cases they needed different chair and table sizes. The correlational analysis of the instruments to be validated showed an r=0.994 in the chair and r=0.99 in the table. CONCLUSIONS: The level of mismatch between the furniture and the anthropometric dimensions of the students was high. A reorganization of the sizes in the classroom is necessary, being able to follow the European size regulations and using furniture allocation instruments such as those proposed for their high level of correlation.


Assuntos
Dor nas Costas , Decoração de Interiores e Mobiliário , Instituições Acadêmicas , Antropometria , Dor nas Costas/epidemiologia , Dor nas Costas/prevenção & controle , Criança , Humanos , Decoração de Interiores e Mobiliário/normas , Reprodutibilidade dos Testes , Espanha/epidemiologia
19.
Isr Med Assoc J ; 23(9): 576-579, 2021 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-34472233

RESUMO

BACKGROUND: Fibromyalgia is characterized by diffuse musculoskeletal pain at the time of diagnosis, but many patients report their initial symptoms as being focal or local. OBJECTIVES: To evaluate, prospectively, the initial location of body pain in recently diagnosed patients with fibromyalgia. METHODS: Non-selected patients from the rheumatology clinic who were recently diagnosed with fibromyalgia (≤ 2 years) with symptoms of ≤ 4 years participated in our study. Demographic and clinical parameters were documented, as was the initial location of pain they had experienced. Sub-analysis of data according to gender and ethnicity was conducted using chi-squire test. RESULTS: The study comprised 155 patients. Mean age was 39.8 ± 11.7 years; 85% were female. Mean duration of symptoms was 2.11 years and of diagnosis was 0.78 years. Six patients (3.9%) reported initial symptoms of pain as being diffuse from the start, 10 (6.5%) could not remember the location of their initial symptoms, and 139 (90%) reported initial focal pain. Hands were reported as the initial area of pain for 25.2% of the patients, 19.4% reported the back, and 11% reported both trapezial areas as the initial area of pain. In 90% of the patients (excluding patients with back, abdominal, or chest pain) the initial symptoms were bilateral and symmetrical. No significant difference in initial presentation was found among different gender or ethnic groups. CONCLUSIONS: Pain in fibromyalgia patients usually presents as focal and symmetrical. Bilateral hand pain, followed by back pain, was the most common reported area of initial pain among fibromyalgia patients.


Assuntos
Fibromialgia/diagnóstico , Dor Musculoesquelética/diagnóstico , Adolescente , Adulto , Dor nas Costas/diagnóstico , Dor nas Costas/fisiopatologia , Feminino , Fibromialgia/fisiopatologia , Humanos , Masculino , Pessoa de Meia-Idade , Dor Musculoesquelética/fisiopatologia , Estudos Retrospectivos , Adulto Jovem
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