[Translated article] Frequency of use of discography findings for the diagnosis of low back pain of discogenic origin. Systematic review of the literature.

INTRODUCTION: There are different techniques and interpretations of discography findings to determine it positive for the diagnosis of discogenic pain. This study aims to evaluate the frequency of use of discography findings for the diagnosis of low back pain of discogenic origin. MATERIAL AND METHODS: A systematic review of the literature of the last 17 years was performed in MEDLINE and BIREME. A total of 625 articles were identified, 555 were excluded for duplicates, title and abstract. We obtained 70 full texts of which 36 were included in the analysis after excluding 34 for not meeting the inclusion criteria. RESULTS: Among the criteria in discography to determine it as positive, 8 studies used only the pain response to the procedure, 28 studies used more than one criterion during discography to consider it as positive, the evaluation of at least one adjacent intervertebral disc with a negative result was necessary in 26 studies to consider a discography as positive. Five studies formally expressed the use of the technique described by SIS/IASP to determine a discography as positive. CONCLUSIONS: Pain in response to contrast medium injection, assessed with the visual analogue pain scale ≥6, was the most used criterion in the studies included in this review. Although there are already criteria to determine a discography as positive, the use of different techniques and interpretations of discography findings to determine a positive discography for low back pain of discogenic origin persists.

Frequency of use of discography findings for the diagnosis of low back pain of discogenic origin. Systematic review of the literature. / Frecuencia de uso de los hallazgos de la discografía para el diagnóstico del dolor lumbar de origen discogénico. Revisión sistemática de la literatura.

INTRODUCTION: There are different techniques and interpretations of discography findings to determine it positive for the diagnosis of discogenic pain. This study aims to evaluate the frequency of use of discography findings for the diagnosis of low back pain of discogenic origin. MATERIAL AND METHODS: A systematic review of the literature of the last 17 years was performed in MEDLINE and BIREME. A total of 625 articles were identified, 555 were excluded for duplicates, title and abstract. We obtained 70 full texts of which 36 were included in the analysis after excluding 34 for not meeting the inclusion criteria. RESULTS: Among the criteria in discography to determine it as positive, 8 studies used only the pain response to the procedure, 28 studies used more than one criterion during discography to consider it as positive, the evaluation of at least one adjacent intervertebral disc with a negative result was necessary in 26 studies to consider a discography as positive. Five studies formally expressed the use of the technique described by SIS/IASP to determine a discography as positive. CONCLUSIONS: Pain in response to contrast medium injection, assessed with the visual analog pain scale≥6, was the most used criterion in the studies included in this review. Although there are already criteria to determine a discography as positive, the use of different techniques and interpretations of discography findings to determine a positive discography for low back pain of discogenic origin persists.

Ronald Melzack and Patrick Wall. La teoría de la compuerta. Más allá del concepto científico dos universos científicos dedicados al entendimiento del dolor / No disponible

La evolución histórica para el conocimiento del dolor ha tenido momentos cruciales en los que el curso evolutivo se modificó. Esos momentos son situaciones relevantes que cambiaron los conceptos previamente aceptados y abrieron nuevos horizontes de investigación, de entendimiento y de tratamiento. Cuando Melzack y Wall desarrollaron la “Teoría de la Compuerta” lograron aclarar fenómenos básicos del entendimiento del dolor pero igualmente abrieron múltiples tópicos de futuras investigaciones básicas y clínicas. Dieron sustento, con su teoría, a múltiples tratamientos del dolor que son la base de procedimientos que en la actualidad realizamos. Los aspectos psicológicos, el componente clínico y la base estructural anatomofisiológica fueron poco a poco conformando una de las teorías más completas de la ciencia médica y por supuesto principio básico para el mejor tratamiento del dolor. Son 50 años que se cumplen de la publicación de aquel artículo en la revista Science (Pain Mechanism: a new theory. A gate control system modulates sensory input from the skin before it evoques pain perception and response. Ronald Melzack and Patrick Wall. Science. 19 november 1965, volumen 150, number 3699), el cual ha sido reconocido hasta la actualidad como la referencia bibliográfica más utilizada en la ciencia médica en los últimos 50 años. Este artículo se escribió en un contexto científico particular y a la luz de dos vidas diferentes que ilustran un proceso ejemplar de desarrollo de la ciencia. El análisis es no solo científico sino humano de lo que ha sido este artículo para el entendimiento de las ciencias del dolor (AU)

The quest to acquire knowledge and understanding of pain has had crucial moments in which the evolution of the process has been dramatically changed. These moments have been revelations that have opened the path to rethinking previously accepted knowledge and created new horizons of research, understanding and treatment. When Melzack and Wall first described what would come to be known as the “Gate Control theory” they were able not only to clarify basic aspects of pain development but to lead the way to further basic and clinical research studies. They psychological aspects, the clinical basis and the structural anatomical and physiological components created one of the most complete theories in medical sciences and the ground for the basic management of pain. It has been fifty years since the original article was published in Science magazine (Pain Mechanism: a new theory. A gate control system modulates sensory input from the skin before it evokes pain perception and response. Ronald Melzack and Patrick Wall. Science. November 19, 1965 volume 150, number 3699). It has been recognized even until today as the most cited reference in medical journals in the past 50 years. The paper was written during a very particular moment in scientific history and the context of two very different lives, which illustrates the incredible process that leads to scientific development. The analysis of what this paper has symbolized to pain science must be done not only from a purely scientific view point but from a human one as well (AU)

Síndromefacetario lumbar. Nuevo signo de diagnóstico clínico / Lumbar facet syndrome. New sign of clinical diagnosis

Objetivo. El diagnóstico del síndrome facetario lumbar (SFL) se ve limitado por la ausencia de signos evidentes que puedan confirmar la presencia de esta patología. Surge entonces la necesidad de encontrar nuevos hallazgos clínicos que permitan acercarse a un diagnóstico y tratamiento adecuado. El objetivo es presentar un análisis preliminar sobre un nuevo signo clínico de provocación facetaria. Pacientes y métodos. Se incluyeron 150 pacientes consecutivos que asistieron a la consulta de dolor realizada por el autor. Los pacientes fueron clasificados de acuerdo a su diagnóstico clínico y radiológico en 4 grupos: el grupo 1 (control) son 60 pacientes sin patología lumbar, el grupo 2 son 30 pacientes con hernia discal o canal lumbar estrecho, el grupo 3 son 19 pacientes con dolor lumbar sin radiculopatía, producido por una causa distinta a un SFL, y el grupo 4 son 49 pacientes con diagnóstico de SFL confirmado por la respuesta positiva al bloqueo selectivo con tomografía computarizada (TC). En todos los pacientes se exploró el nuevo signo facetario lumbar. Resultados. El "nuevo signo facetario lumbar" demostró tener una sensibilidad del 95 por ciento (0,951) y una especificidad del 96 por ciento (0,963) para establecer el diagnóstico de un SFL. Su valor predictivo positivo fue del 90 por ciento, y el valor predictivo negativo, del 98 por ciento. Conclusiones. El análisis preliminar del "nuevo signo facetario lumbar" demostró que se trata de una ayuda clínica para el diagnóstico de esta patología. Son necesarios estudios ulteriores con varios observadores para confirmar estos hallazgos (AU)