RESUMEN
Abstract Pain is the most common complaint reported to orthopedists in the outpatient clinic, emergency room, or booth. Numerous publications report the inadequate management of both acute and chronic pain by health professionals. This updated article aims to provide information about musculoskeletal pain, its classification, evaluation, diagnosis, and the multimodal therapeutic approach for each case. For acute pain, adequate control allows for earlier rehabilitation to work and reduces the rates of pain chronification. For chronic pain, the goal is to reduce its intensity and improve the quality of life. Currently, some procedures are increasingly used and aided by imaging tests for diagnostic and therapeutic purposes.
Resumo A dor é a queixa mais comum recebida pelo ortopedista no ambulatório e/ou emergência. Inúmeras publicações relatam o manejo inadequado tanto da dor aguda quanto da dor crônica pelos profissionais da saúde. O objetivo desse artigo de atualização é trazer informações sobre a dor musculoesquelética, sua classificação, avaliação, diagnóstico e abordagem terapêutica multimodal para cada situação. Desta maneira, nas dores agudas seu controle adequado possibilita um trabalho de reabilitação mais precoce, bem como diminui os índices de cronificação da dor. Nas dores crônicas sua abordagem além da diminuição de sua intensidade, visa também melhorar a qualidade de vida. Atualmente alguns procedimentos estão sendo cada vez mais utilizados com auxílio de aparato de imagem com objetivo diagnóstico e terapêutico.
Asunto(s)
Humanos , Dolor/clasificación , Dolor/diagnóstico , Dolor Agudo/clasificación , Dolor Musculoesquelético , Manejo del DolorRESUMEN
BACKGROUND: Temporomandibular disorder (TMD) patients might present a number of concurrent clinical diagnoses that may be clustered according to their similarity. Profiling patients' clinical presentations can be useful for better understanding the behavior of TMD and for providing appropriate treatment planning. The aim of this study was to simultaneously classify symptomatic patients diagnosed with a variety of subtypes of TMD into homogenous groups based on their clinical presentation and occurrence of comorbidities. METHODS: Clinical records of 357 consecutive TMD patients seeking treatment in a private specialized clinic were included in the study sample. Patients presenting multiple subtypes of TMD diagnosed simultaneously were categorized according to the AAOP criteria. Descriptive statistics and two-step cluster analysis were used to characterize the clinical presentation of these patients based on the primary and secondary clinical diagnoses. RESULTS: The most common diagnoses were localized masticatory muscle pain (n = 125) and disc displacement without reduction (n = 104). Comorbidity was identified in 288 patients. The automatic selection of an optimal number of clusters included 100% of cases, generating an initial 6-cluster solution and a final 4-cluster solution. The interpretation of within-group ranking of the importance of variables in the clustering solutions resulted in the following characterization of clusters: chronic facial pain (n = 36), acute muscle pain (n = 125), acute articular pain (n = 75) and chronic articular impairment (n = 121). CONCLUSION: Subgroups of acute and chronic TMD patients seeking treatment can be identified using clustering methods to provide a better understanding of the clinical presentation of TMD when multiple diagnosis are present. Classifying patients into identifiable symptomatic profiles would help clinicians to estimate how common a disorder is within a population of TMD patients and understand the probability of certain pattern of clinical complaints.