RESUMO
OBJECTIVE: To analyze the effects of using foam roller on pain intensity in individuals with chronic and acute musculoskeletal pain. METHODS: This systematic review was registered in the National Institute for Health Research's prospective online registry of systematic reviews (PROSPERO) under CRD42023456841. The databases Pubmed, Medline (via Ovid), Embase, BVS, and PEDro (Physiotherapy Evidence Database) were consulted to carry out this systematic review. Notably, the records of clinical trials characterized as eligible were manually searched. The search terms were: (foam rolling OR foam rolling vibration) AND (acute musculoskeletal pain) AND (chronic musculoskeletal pain). The search was performed until August 22, 2023. For the analysis of the methodological quality, the PEDro scale was used for each of the manuscripts included in the systematic review. Due to the heterogeneity in the studies included in this systematic review, performing a meta-analysis of the analyzed variables was impossible. RESULTS: Only six manuscripts were eligible for data analysis. The type of FR used was non-vibrational, being applied by a therapist in only one of the manuscripts. With an application time ranging from at least 45 s to 15 min, the non-vibrational FR was applied within a day up to six weeks. Using the PEDro scale, scores were assigned that varied between 4 and 8 points, with an average of 6 ± 1.29 points. Only two randomized clinical trials found a significant benefit in pain intensity of adding FR associated with a therapeutic exercise protocol in individuals with patellofemoral pain syndrome and chronic neck pain. CONCLUSION: The results of this systematic review do not elucidate or reinforce the clinical use of FR in pain intensity in individuals with chronic and acute musculoskeletal pain.
Assuntos
Dor Aguda , Dor Crônica , Dor Musculoesquelética , Medição da Dor , Humanos , Dor Aguda/terapia , Dor Aguda/diagnóstico , Dor Crônica/terapia , Dor Crônica/diagnóstico , Dor Musculoesquelética/terapia , Dor Musculoesquelética/diagnóstico , Manejo da Dor/métodos , Modalidades de Fisioterapia , Ensaios Clínicos Controlados Aleatórios como Assunto/métodos , Resultado do Tratamento , Vibração/uso terapêuticoRESUMO
BACKGROUND: Spinal manipulative therapy (SMT) demonstrates small effects on pain intensity in low back pain. Combining SMT with a psychosocial intervention like pain neuroscience education (PNE) could promote additional effect. OBJECTIVES: To evaluate the additional effect of PNE when combined to SMT on pain intensity and low back pain-related disability in patients with chronic low back pain (CLBP). METHOD: One hundred and four patients with CLBP of both sexes aged between 18 and 55 years were treated with PNE + SMT compared to SMT alone. The primary outcome measures were pain intensity and disability post-treatment (4 weeks). Secondary outcomes were fear-avoidance beliefs, global perceived effect of improvement, and pain self-efficacy. Results were obtained immediately post-treatment and at three follow-ups (30-days, 90-days, and 180-days). RESULTS: No significant between-group difference was observed for pain intensity and disability post-treatment. In contrast, our results showed a significantly longer additional effect for the group treated with SMT + PNE for the following outcomes: pain intensity (change baseline to 90 day follow-up = -0.90 [95% CI= -1.76, -0.4] and change baseline to 180 day follow-up = -1.19 [95% CI= -2.06, -0.32]) and low back pain-related disability, global perceived effect of improvement and pain self-efficacy (180th day follow-up). CONCLUSION: The results of this trial suggest the addition of PNE to SMT did not bring any additional effect on pain intensity and disability in the short term, but SMT + PNE can result in longer-lasting effects in patients with CLBP and that such an effect could be related to a possible mediator effect of pain self-efficacy.
Assuntos
Dor Crônica , Dor Lombar , Manipulação da Coluna , Masculino , Feminino , Humanos , Adolescente , Adulto Jovem , Adulto , Pessoa de Meia-Idade , Dor Lombar/terapia , Dor Lombar/psicologia , Resultado do Tratamento , Manipulação da Coluna/métodos , Manejo da Dor , Medo , Dor Crônica/terapiaRESUMO
OBJECTIVES: This study aims to examine age differences in the intensity of chronic pain among middle-aged and older adults, where intensity is measured on a scale differentiating between chronic pain that is often troubling and likely requires intervention versus more endurable sensations. We aim to explore whether individual health and national gross domestic product (GDP) explain these differences as well. METHODS: Cross-nationally harmonized data from 20 countries on self-reported intensity of chronic pain (0 = no, 1 = mild, 2 = moderate, 3 = severe) in 104,826 individuals aged 50+ observed in 2012-2013. Two-level hierarchical ordinal linear models with individuals nested within countries were used to isolate estimations from heterogeneity explained by methodological differences across single-country studies. RESULTS: Overall, mean participant age was 66.9 (SD = 9.9), 56.1% were women, and 41.9% of respondents reported any chronic pain. Chronic pain intensity rose sharply with age in some countries (e.g., Korea and Slovenia), but this association waned or reversed in other countries (e.g., the United States and Denmark). Cross-country variation and age differences in chronic pain were partly explained (85.5% and 35.8%, respectively) by individual-level health (especially arthritis), country-level wealth (as indicated by GDP per capita), and demographics. DISCUSSION: Chronic pain intensity is not an inevitable consequence of chronological age, but the consequence of potential selection effects and lower activity levels combined with individual-level health and country-level wealth. Our findings suggest further investigation of health conditions and country affluence settings as potential targets of medical and policy interventions aiming to prevent, reduce, or manage chronic pain among older patients and aging populations.
Assuntos
Dor Crônica , Humanos , Feminino , Estados Unidos/epidemiologia , Pessoa de Meia-Idade , Idoso , Masculino , Estudos Transversais , Dor Crônica/epidemiologia , EnvelhecimentoRESUMO
Abstract Interventions based on pain education and self-management are dependent on factors such as attention, memory, concentration, and executive function. Objective To explore the relationship between cognitive performance and the variables pain intensity, central sensitization, catastrophizing, and hypervigilance in women diagnosed with chronic pain-related TMD. Methodology This is a cross-sectional study. A total of 33 women (mean age: 38±4.6 years; range: 18 to 66 years) with chronic pain-related TMD (myalgia and/or arthralgia) diagnosed according to the Diagnostic Criteria for Temporomandibular Disorders (DC/TMD). Specific questionnaires were used to evaluate cognitive performance, overall pain intensity, central sensitization, hypervigilance, and pain catastrophizing. The data were analyzed using Pearson's correlation coefficient and backward stepwise multiple linear regression (statistical significance at 5% alpha). Results Approximately 53% of the study sample showed decreased cognitive performance. High central sensitization, hypervigilance, and pain catastrophizing were observed. A significant negative correlation was observed between cognitive performance and hypervigilance (p=.003, r=−.49), cognitive performance and catastrophizing (p<.001, r=−.58), and cognitive performance and pain intensity (p<.001, r=−.58). Regarding the partial regression coefficients, only catastrophizing and pain intensity showed statistical significance (t=−2.12, p=.043; t=−2.64, p=.014, respectively), indicating a significant role in explaining cognitive performance at the sample. Conclusion High pain intensity and the presence of catastrophic thoughts regarding pain can predict impaired cognitive performance in women with chronic pain-related TMD. Management strategies addressing psychosocial dimensions such as reducing catastrophizing and ensuring complete understanding of the condition are important.
RESUMO
Adequate pain control after total knee arthroplasty (TKA) has been associated with improved patient mobility and satisfaction, and is a task that has historically relied on opioids. Multimodal analgesic regimens can be considered a therapeutic alternative for postoperative pain control to avoid opioid consumption and its adverse side effects. This study aimed to evaluate the use of a multimodal analgesia protocol based on nonsteroidal anti-inflammatory drugs (NSAIDs) and acetaminophen as an alternative to reduce opioid consumption in Hispanic patients undergoing primary TKA. Methods: An institutional review board-approved, randomized controlled trial evaluated postoperative pain control after TKA in a Hispanic population. The experimental opioid-sparing group received 30-mg ketorolac intravenously every 6 hours and 1-g acetaminophen orally every 6 hours as the patient requested. The experimental group had the option to use morphine and oxycodone combined with acetaminophen as a rescue therapy. The control group received opioids in the form of 0.1-mg/kg morphine intravenously every 6 hours and/or oxycodone combined with acetaminophen (2.5 and 325 mg), 2 tablets orally every 6 hours, as the patient requested. Sociodemographic, operative, and immediate postoperative data and pain intensity measurements according to the numerical rating scale (NRS) were compared between groups. Analgesic efficacy was assessed according to the NRS scores at 12, 24, and 48 hours postoperatively. Results: Eighty-one Hispanic patients met inclusion criteria: 42 patients in the experimental group and 39 patients in the control group. None of the patients in the experimental group requested oxycodone combined with acetaminophen as a rescue therapy. Only 2 patients in the experimental group used a mean of 3.0 ± 1.4 mg of rescue morphine; in comparison, the control group consumed a mean of 28.0 ± 7.9 mg of morphine and 64.8 ± 26.0 mg of oxycodone per patient. A pain intensity decrease was observed in the experimental and control groups, with no postoperative evaluation differences at 12 hours (6.7 ± 2.9 compared with 5.9 ± 2.8; p = 0.209), 24 hours (6.2 ± 2.0 compared with 6.1 ± 2.2; p = 0.813), and 48 hours (4.7 ± 2.1 compared with 4.6 ± 1.7; p = 0.835). Conclusions: The use of a multimodal analgesic regimen based on intravenous ketorolac and oral acetaminophen was adequate in reducing postoperative pain and opioid consumption in Hispanic patients undergoing TKA. Level of Evidence: Therapeutic Level I. See Instructions for Authors for a complete description of levels of evidence.
RESUMO
Abstract Background Many people with non-specific chronic low back pain (NSCLBP) do not recover with current conventional management. Systematic reviews show multidimensional treatment improves pain better than usual active interventions. It is unclear whether multidimensional physiotherapy improves pain better than usual physiotherapy. This study determines the effectiveness of this treatment to reduce pain and disability and improve quality of life, pain cognitions, and electroencephalographic pattern in individuals with NSCLBP. Methods 70 eligible participants aged 18 to 50 years with NSCLBP were randomized into either the experimental group (multidimensional physiotherapy) or the active control group (usual physiotherapy). Pain intensity was measured as the primary outcome. Disability, quality of life, pain Catastrophizing, kinesiophobia, fear Avoidance Beliefs, active lumbar range of motion, and brain function were measured as secondary outcomes. The outcomes were measured at pre-treatment, post-treatment, 10, and 22 weeks. Data were analyzed using intention-to-treat approaches. Results There were 17 men and 18 women in the experimental group (mean [SD] age, 34.57 [6.98] years) and 18 men and 17 women in the active control group (mean [SD] age, 35.94 [7.51] years). Multidimensional physiotherapy was not more effective than usual physiotherapy at reducing pain intensity at the end of treatment. At the 10 weeks and 22 weeks follow-up, there were statistically significant differences between multidimensional physiotherapy and usual physiotherapy (mean difference at 10 weeks, -1.54; 95% CI, -2.59 to -0.49 and mean difference at 22 weeks, -2.20; 95% CI, - 3.25 to - 1.15). The standardized mean difference and their 95% confidence intervals (Cohen's d) revealed a large effect of pain at 22 weeks: (Cohen's d, -0.89; 95% CI (-1.38 to-0.39)). There were no statistically significant differences in secondary outcomes. Conclusions In this randomized controlled trial, multidimensional physiotherapy resulted in statistically and clinically significant improvements in pain compared to usual physiotherapy in individuals with NSCLBP at 10 and 22 weeks. Trial Registration ClinicalTrials.gov NCT04270422; IRCT IRCT20140810018754N11.
RESUMO
To investigate the efficacy of hip strengthening on pain, disability, and hip abductor strength in musculoskeletal conditions of the trunk and lower limbs, we searched eight databases for randomized controlled trials up to 8 March 2022 with no date or language restrictions. Random-effect models estimated mean differences (MDs) with 95% confidence intervals (CIs), and the quality of evidence was assessed using the GRADE approach. Very low quality evidence suggested short-term effects (≤3 months) of hip strengthening on pain intensity (MD of 4.1, 95% CI: 2.1 to 6.2; two trials, n = 48 participants) and on hip strength (MD = 3.9 N, 95% CI: 2.8 to 5.1; two trials, n = 48 participants) in patellofemoral pain when compared with no intervention. Uncertain evidence suggested that hip strengthening enhances the short-term effect of the other active interventions on pain intensity and disability in low back pain (MD = -0.6 points, 95% CI: 0.1 to 1.2; five trials, n = 349 participants; MD = 6.2 points, 95% CI: 2.6 to 9.8; six trials, n = 389 participants, respectively). Scarce evidence does not provide reliable evidence of the efficacy of hip strengthening in musculoskeletal conditions of the trunk and lower limbs.
RESUMO
Introduction: Pediatric back pain evaluation nowadays relies on patient history, physical examination, and plain radiographs to identify underlying pathologies. Constant pain, night pain, radicular pain, and abnormal neurological examination were previously recommended as clinical markers to assess the need for magnetic resonance imaging evaluation. Recent studies have challenged the use of these clinical markers, recommending further studies. This study aimed to assess pain intensity as a predictor of underlying magnetic resonance imaging pathology in children with back pain. Methods: An observational cross-sectional study of pediatric patients between 8 and 17 years with back pain for more than 4 weeks from 2009 to 2021 was conducted. A whole spine magnetic resonance imaging was performed on patients with back pain without an identifiable cause and no prior spine treatment. The numerical rating scale questionnaire was administered to each patient, and answers were divided into three groups: mild (1-3), moderate (4-6), and severe (7-10) numerical rating scale score. Student's t-test and chi-square analysis were used to correlate differences between continuous and categorical values, respectively. Results: Of 590 patients (70% female and a mean age of 15.25 years), there were 35.1% of patients had a magnetic resonance imaging underlying pathology. No association was found between severe numerical rating scale score and the presence of underlying MRI pathology (p = 0.666). Patients with low or moderate numerical rating scale scores had similar associations to an underlying magnetic resonance imaging pathology as patients with a severe numerical rating scale score (p = 0.256; p = 0.357, respectively). Conclusions: Back pain intensity was not found to be an effective clinical marker for predicting underlying magnetic resonance imaging pathology in pediatric patients with back pain.
RESUMO
Inferior alveolar nerve block (IANB) has a high failure rate in subjects with symptomatic irreversible pulpitis (SIP). It has been suggested that drugs with anti-inflammatory activity could improve the efficacy of the anesthetic used for IANB. The aim of this study was to assess the effect of dexamethasone on the success of dental anesthesia in patients with SIP. An information search was performed using PubMed and Google Scholar. The risk of bias of the included studies was evaluated with the Cochrane Collaboration's risk-of-bias tool. The anesthetic success rate, pain intensity (VAS), and adverse effects were extracted. Data were analyzed using the Mantel−Haenszel test and odds ratio or the inverse variance and standardized mean difference. Dexamethasone increased the anesthetic success in comparison with placebo (n = 502; p < 0.001; OR = 2.59; 95% CIs: 1.46 to 4.59). Moreover, patients who were given dexamethasone had lower pain scores at 6 h (n = 302; p < 0.001; MD= −1.43; 95% CIs: −2.28 to −0.58), 12 h (n = 302; p < 0.0001; MD = −1.65; 95% CIs: −2.39 to −0.92), and 24 h (n = 302; p < 0.0008; MD = −1.27; 95% CIs: −2.01 to −0.53) when compared with placebo. In conclusion, the systemic administration of dexamethasone increases the anesthetic success rate and improves pain management in patients with SIP.
RESUMO
Exercise is often pointed out as an effective form of treatment in the clinical management of chronic neck pain (CNP). However, due to its complex range of causal factors and great diversity of signs and symptoms, other resources such as photobiomodulation therapy (PBMT) have been routinely used for the treatment of CNP. The aim of this study was to systematically review the literature on the use of the association of PBMT and therapeutic exercises in relation to pain intensity and neck disability in individuals with CNP. PubMed, Medline (via Ovid), Embase (via Ovid), Cinahl (via Ebsco), and Central (via Cochrane library) databases were searched using the following terms: "laser," "low-level laser," "photobiomodulation," "light emitting diodes," "phototherapy," "exercise," "chronic neck pain." After verification and implementation of eligibility criteria, seven manuscripts were considered eligible for data analysis. These manuscripts had methodological quality between 5 and 8 points on the PEDro scale. Most studies used low infrared laser therapy to perform PBMT, with a wide range of parameters and energy density between 2 and 7 J/cm2 and a total treatment time between 2 and 6 weeks. Four studies showed significant benefits in terms of pain intensity at short-term follow-up and one at intermediate-term follow-up. However, only one showed a minimal clinically important change. No studies have shown significant improvement in disability. This review demonstrates that the association of PBMT with therapeutic exercises in general promotes significant benefits only for the intensity of pain. However, it does not seem to promote a minimally effective clinical difference in individuals with CNP.
Assuntos
Dor Crônica , Terapia com Luz de Baixa Intensidade , Dor Crônica/radioterapia , Humanos , Cervicalgia/radioterapia , Medição da Dor , Ensaios Clínicos Controlados Aleatórios como AssuntoRESUMO
OBJECTIVE: To identify self-reported pain scores that best represent categories of no pain, mild, moderate, and severe pain in children, and a pain score that accurately represents a child's perceived need for medication, that is, a minimum pain score at which a child would want an analgesic. STUDY DESIGN: Prospective cross-sectional cohort study of children aged 6-17 years presenting to a pediatric emergency department with painful and nonpainful conditions. Pain was measured using the 10-point Verbal Numerical Rating Scale. Receiver operating characteristic -based methodology was used to determine pain scores that best differentiated no pain from mild pain, mild pain from moderate pain, and moderate pain from severe pain. Descriptive statistics were used to determine the perceived need for medication. RESULTS: We analyzed data from 548 children (51.3% female, 61.9% with a painful condition). The scores that best represent categories of pain intensity are as follows: 0-1 for no pain; 2-5 for mild pain; 6-7 for moderate pain; and 8-10 for severe pain. The area under the curve for the cut points differentiating each category ranged from 0.76 to 0.88. The median pain score representing the perceived need for medication was 6 (IQR, 4-7; range, 0-10). CONCLUSIONS: We identified population-level self-reported pain scores in children associated with categories of pain intensity that differ from scores conventionally used. Implementing our findings may provide a more accurate representation of the clinical meaning of pain scores and reduce selection bias in research. Our findings do not support the use of pain scores in isolation for clinical decision making or the use of a pain score threshold to represent a child's perceived need for medication.
Assuntos
Dor Aguda/psicologia , Medição da Dor/normas , Dor Aguda/diagnóstico , Adolescente , Criança , Estudos Transversais , Serviço Hospitalar de Emergência/estatística & dados numéricos , Feminino , Humanos , Masculino , Estudos Prospectivos , AutorrelatoRESUMO
ABSTRACT Objective This study was conducted to determine the frequency of vitamin D deficiency in patients with lumbar spinal stenosis and to define the relationship between vitamin D levels and obesity, depression, and pain intensity. Methods This study was conducted with 69 patients (Male = 32, Female = 37) diagnosed with lumbar spinal stenosis. The participants' 25(OH)D levels were measured by radioimmunoassay. In addition, bone metabolic status, including bone mineral density and bone turnover markers, was also evaluated. The Beck Depression Inventory was used to determine the depression statuses of the patients, while the McGill Melzack Pain Questionnaire was administered to measure pain intensity. The results were evaluated at a significance level of p<0.05. Results Vitamin D deficiency (<20 ng/mL) was found in 76.8% of the patients. Binary logistic regression analysis showed a significantly higher frequency of vitamin D deficiency in patients who: 1) had higher body mass indexes (OR 3.197, 95% CI 1.549-6.599); 2) fared higher in Beck's depression score (OR 1.817, 95% CI 1.027-3.217); and 3) were female rather than male (OR 1.700, 95% CI 0.931-3.224) (p<0.05). Conclusion In this study, vitamin D deficiency was prevalent in lumbar spinal stenosis patients. In addition, obese, depressed, and female individuals have higher risks of vitamin D deficiency.
RESUMO Objetivo Este estudo foi realizado para determinar a frequência de deficiência de vitamina D em pacientes com estenose espinhal lombar e para definir a relação entre os níveis de vitamina D e obesidade, depressão e intensidade da dor. Métodos Este estudo foi realizado com 69 pacientes (homens = 32, mulheres = 37) diagnosticados com estenose espinhal lombar. Os níveis de 25(OH)D dos participantes foram medidos por radioimunoensaio. Além disso, o estado metabólico ósseo, incluindo densidade mineral óssea e marcadores de remodelação óssea, também foi avaliado. O Inventário de Depressão de Beck foi usado para determinar os estados de depressão dos pacientes, enquanto o Questionário de Dor McGill Melzack foi aplicado para medir a intensidade da dor. Os resultados foram avaliados a um nível de significância de p<0,05. Resultados A deficiência de vitamina D (<20 ng/mL) foi encontrada em 76,8% dos pacientes. A análise de regressão logística binária mostrou uma frequência significativamente maior de deficiência de vitamina D nos seguintes pacientes: 1) com maior índice de massa corporal (OR 3,197, 95% IC 1,549-6,599); 2) com maior pontuação na escala de depressão de Beck (OR 1,817, 95% IC 1,027-3,217) e 3) do sexo feminino em vez de masculino (OR 1,700, 95% IC 0,931-3,224) (p<0,05). Conclusão Neste estudo, a deficiência de vitamina D foi prevalente em pacientes com estenose espinhal lombar. Além disso, pessoas obesas, deprimidas e mulheres correm maior risco de deficiência de vitamina D.
Assuntos
Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Idoso , Estenose Espinal/etiologia , Deficiência de Vitamina D/complicações , Medição da Dor , Estudos Transversais , Depressão/etiologia , Obesidade/etiologiaRESUMO
BACKGROUND: In the early stages of total knee arthroplasty (TKA) rehabilitation, in which physical function in general can be affected, motor imagery (MI) might play a relevant role. OBJECTIVE: To assess the impact of MI on strength, active range of motion (ROM), pain intensity, and physical function in patients with TKA. METHODS: We conducted a systematic review and meta-analysis of randomised controlled trials. Pooled effects were calculated as standardised mean differences (SMDs) and 95% confidence intervals (CIs) for the relevant outcomes using random effects model. The certainty of evidence was assessed with GRADE approach. RESULTS: This review included 7 articles. The addition of MI to standard therapy, based on low quality of evidence, showed a moderate increase in quadriceps strength (4 studies; SMD: 0.88; 95% CI: 0.42, 1.34) and a small reduction in pain intensity (SMD: 0.63; 95% CI: 0.08, 1.19). It is unclear whether MI can provide beneficial effects for active ROM and function. CONCLUSIONS: There is low to very low-quality evidence that adding an MI intervention to standard rehabilitation for patients with TKA may improve quadriceps strength and pain intensity, but the effects of MI on ROM and physical function is unclear.
Assuntos
Artroplastia do Joelho , Humanos , Medição da Dor , Músculo Quadríceps , Amplitude de Movimento ArticularRESUMO
OBJECTIVE: Pain catastrophizing is an important psychological predictor of pain. Recent evidence suggests the relationship between catastrophizing and pain intensity could be bidirectional, but most studies have been conducted on chronic pain patients and using criticized statistical methods. The present study aimed to examine if the relationship between pain intensity and catastrophizing was bidirectional in the context of childbirth. METHODS: A total of 504 women without chronic pain were recruited on their 32-37 gestational week. They completed measures of catastrophizing and pain intensity on the first encounter and then again at 1, 3, and 6 months postpartum. The temporal relationship between the variables was assessed using a random intercept cross-lagged panel model. RESULTS: The hypothesis of reciprocal association did not receive support, as pain intensity predicted catastrophizing during the postpartum period, but catastrophizing did not show an effect over pain intensity at any moment. CONCLUSIONS: Pain intensity predicting catastrophizing is consistent with previous literature, while the lack of effect of catastrophizing over pain intensity is an unexpected result, which may suggest that catastrophizing plays a different role in the postpartum period. These results highlight the importance of timely efforts for pain management during the postpartum period and contribute to the theoretical conceptualization of catastrophizing.
Assuntos
Catastrofização , Período Pós-Parto , Feminino , Humanos , Dor , Manejo da Dor , Medição da DorRESUMO
Abstract Objective To determine the average body composition (percentage of body fat), the anthropometric markers, and the intensity of clinical pain in women with a clinical diagnosis of chronic pelvic pain (CPP) secondary to endometriosis. Methods A case-control study performed with 91 women, 46 of whom with CPP secondary to endometriosis and 45 of whom with CPP secondary to other causes. They underwent an evaluation of the anthropometric parameters by means of the body mass index (BMI), the perimeters (waist, abdomen, hip), and the percentage of body fat (%BF), which were assessed on a body composition monitor by bioimpedance; the intensity of the clinical pain was evaluated using the visual analog scale (VAS), and the symptoms of anxiety and depression, using the hospital's anxiety and depression scale (HAD). Results The groups did not differ in terms of mean age, BMI, %BF or regarding the available waist-to-hip ratio (WHR). The mean intensity of the clinical pain by the VAS was of 7.2 ± 2.06 in the group with CPP secondary to endometriosis, and of 5.93 ± 2.64 in the group with CPP secondary to other causes (p = 0.03), revealing significant differences between the groups. Conclusion We concluded that, despite the difference in the pain score assessed between the two groups, there was no difference regarding body composition and anthropometry.
Resumo Objetivo Determinar a composição corporal média (porcentagem de gordura corporal), os marcadores antropométricos, e a intensidade de dor clínica em mulheres com diagnóstico clínico de dor pélvica crônica (DPC) secundária a endometriose. Métodos Um estudo de caso-controle realizado com 91 mulheres, 46 das quais com DPC secundária a endometriose, e 45 das quais com DPC secundária a outras causas. As pacientes foram submetidas à avaliação dos parâmetros antropométricos por meio do índice de massa corporal (IMC), dos perímetros (cintura, abdômen, quadril), e do percentual de gordura corporal (%GC), que foram avaliados emmonitor de composição corporal por bioimpedância; a intensidade clínica da dor foi avaliada usando-se a escala visual analógica (EVA), e os sintomas de ansiedade e depressão, usando a escala de ansiedade e depressão do hospital (EADH). Resultados Os grupos não diferiram quanto à idade média, ao IMC, ao %GC, nem quanto à relação da cintura-quadril (RCQ) disponível. Amédia da intensidade clínica da dor pela EVA foi de 7,2 ± 2,06 no grupo com DPC secundária a endometriose, e de 5,93 ± 2,64 no grupo com DPC secundária a outras causas (p = 0,03), revelando diferenças significativas entre os grupos. Emrelação à EADH, ambos os grupos estavam acima da média de corte. Conclusão Concluímos que, apesar da diferença no escore de dor avaliado entre os dois grupos, não houve diferença com relação à composição corporal e à antropometria.
Assuntos
Humanos , Feminino , Adulto , Composição Corporal/fisiologia , Dor Pélvica/etiologia , Endometriose/complicações , Endometriose/epidemiologia , Dor Crônica/etiologia , Ansiedade , Medição da Dor , Índice de Massa Corporal , Estudos de Casos e Controles , Depressão , Pessoa de Meia-IdadeRESUMO
BACKGROUND: Physical overload at work has been described as a risk factor for the development of low back pain. However, few studies have investigated the prognostic value of perceived physical overload at work in patients with chronic low back pain. OBJECTIVE: To investigate the association of perceived physical overload at work with pain and disability over a period of 6 months in patients with chronic non-specific low back pain. METHODS: Patients with chronic LBP seeking physiotherapy care were considered eligible. Clinical data collected were: pain intensity, disability, fear of movement, depression and perceived physical overload at work. Linear regression analyses were used to investigate the association of perceived physical workload at work at baseline with pain intensity and disability at 6-month follow-up. The total score and the score for each category of the physical overload at work questionnaire were analyzed separately. RESULTS: Ninety-two patients with chronic low back pain were included in the analysis. The subcategories of the physical overload questionnaire were not significantly associated with pain intensity at 6-month follow-up. However, age, disability at baseline and perceived physical overload related to postures of the trunk (B = -0.60 95% CI - 1.18 to - 0.02) and related to positions of the arms (B = 2.72 95% CI 0.07 to 5.37) were significantly associated with disability at 6-month follow-up. CONCLUSION: Although perceived physical overload at work was not associated with pain intensity in patients with chronic LBP at 6-month follow-up, we identified a significant association between perceived physical overload related to postures of the trunk and positions of the arms with disability at 6-month follow-up. These slides can be retrieved under Electronic Supplementary Material.
Assuntos
Dor Crônica/etiologia , Dor Lombar/etiologia , Doenças Profissionais/etiologia , Estresse Fisiológico/fisiologia , Carga de Trabalho , Adulto , Dor Crônica/diagnóstico , Dor Crônica/fisiopatologia , Dor Crônica/psicologia , Avaliação da Deficiência , Feminino , Humanos , Estudos Longitudinais , Dor Lombar/diagnóstico , Dor Lombar/fisiopatologia , Dor Lombar/psicologia , Masculino , Pessoa de Meia-Idade , Doenças Profissionais/diagnóstico , Doenças Profissionais/fisiopatologia , Doenças Profissionais/psicologia , Medição da Dor , Percepção , Exame Físico , Modalidades de Fisioterapia , Postura , Estudos Prospectivos , Fatores de Risco , Carga de Trabalho/psicologiaRESUMO
A melhora clínica do paciente com dores musculoesqueléticas (DME) deve ser monitorada em conjunto com a percepção do paciente sobre o efeito do tratamento, apesar da falta de informação sobre esse tema. Objetivo: Analisar a influência do tratamento fisioterápico na redução da intensidade da dor e no efeito global percebido de pacientes com DME. Métodos: Foi realizado um estudo observacional analítico retrospectivo em 61 pacientes com DME que responderam uma questão relacionada í intensidade de dor e outra questão sobre o efeito global percebido do tratamento fisioterápico. A intensidade de dor medida após 10 meses de acompanhamento foi comparada aos valores iniciais. Resultados: Os participantes eram predominantemente mulheres (83,3%) adultas (média de idade de 59,6 anos). A média de intensidade da dor na avaliação inicial foi de 6,4 (± 2,7), com média de tempo de dor de 20,3 meses. A média de intensidade de dor após o contato telefônico foi de 4,37 (± 3,9). A análise do efeito global percebido evidenciou melhora na maioria dos participantes (16,7% completamente recuperados; 39,7% melhoraram muito, 26,7% melhoraram pouco). Conclusão: Pacientes com DME apresentaram redução da intensidade da dor e melhora no efeito global percebido após um programa de Fisioterapia. (AU)
The clinical improvement of the patient with musculoskeletal pain (MP) should be monitored together with the perception of the patient about the treatment effect, despite the lack of information on this subject. Objective: To analyze the influence of physiotherapeutic treatment on the pain reduction and global perceived effect in patients with MP. Methods: A retrospective observational analytic study was performed in 61 patients with MP that answered a question about their pain intensity and another question about the global perceived effect of the physical therapy treatment. The pain intensity measured after 10 months of follow-up was compared to the initial values. Results: Participants were predominantly female (83.3%) adults (mean age 59.6 years old). The mean pain intensity at the initial evaluation was 6.4 (± 2.7), with a mean of pain time of 20.3 months. The mean pain intensity after telephone contact was 4.37 (± 3.9). The analysis of the global perceived effect evidenced improvement in most of the participants (16.7% completely recovered, 39.7% much improved, 26.7% slightly improved). Conclusion: Patients with MP showed pain reduction and improvement on the global perceived effect after a Physiotherapy treatment. (AU)
Assuntos
Humanos , Masculino , Feminino , Modalidades de Fisioterapia , Dor Musculoesquelética , Dor Crônica , DorRESUMO
Objective: We aimed to empirically derive psychosocial and pain sensitivity subgroups using cluster analysis within a sample of individuals with chronic musculoskeletal pain (CMP) and to investigate derived subgroups for differences in pain and disability outcomes. Methods: Eighty female participants with CMP answered psychosocial and disability scales and were assessed for pressure pain sensitivity. A cluster analysis was used to derive subgroups, and analysis of variance (ANOVA) was used to investigate differences between subgroups. Results: Psychosocial factors (kinesiophobia, pain catastrophizing, anxiety, and depression) and overall pressure pain threshold (PPT) were entered into the cluster analysis. Three subgroups were empirically derived: cluster 1 (high pain sensitivity and high psychosocial distress; n = 12) characterized by low overall PPT and high psychosocial scores; cluster 2 (high pain sensitivity and intermediate psychosocial distress; n = 39) characterized by low overall PPT and intermediate psychosocial scores; and cluster 3 (low pain sensitivity and low psychosocial distress; n = 29) characterized by high overall PPT and low psychosocial scores compared to the other subgroups. Cluster 1 showed higher values for mean pain intensity (F(2,77) = 10.58, p < 0.001) compared with cluster 3, and cluster 1 showed higher values for disability (F(2,77) = 3.81, p = 0.03) compared with both clusters 2 and 3. Conclusions: Only cluster 1 was distinct from cluster 3 according to both pain and disability outcomes. Pain catastrophizing, depression, and anxiety were the psychosocial variables that best differentiated the subgroups. Overall, these results call attention to the importance of considering pain sensitivity and psychosocial variables to obtain a more comprehensive characterization of CMP patients' subtypes.
Assuntos
Dor Crônica/psicologia , Dor Musculoesquelética/psicologia , Limiar da Dor/psicologia , Adolescente , Adulto , Análise por Conglomerados , Estudos Transversais , Avaliação da Deficiência , Feminino , Humanos , Pessoa de Meia-Idade , Medição da Dor , Adulto JovemRESUMO
Background: Chronic pelvic pain (CPP) is a common and debilitating clinical condition in women. Objectives: The aim of this study was to compare the quality of life (QoL) of women with and without CPP and to investigate factors associated with the QoL of women with CPP. Patients and methods: A cross-sectional study was conducted with 100 women with CPP and 100 women without CPP. QoL was evaluated using the abbreviated version of the World Health Organization QoL instrument (WHOQOL-BREF). Depression and anxiety were evaluated using the Hospital Anxiety and Depression Scale, and sexual function was evaluated using the Female Sexual Function Index. Generalized linear models were used to analyze the data, permitting comparison of QoL scores and identification of the factors affecting QoL. Results: Mean age (± SD) was 37.8±8.0 and 37.2±9.6 years for women with and without CPP, respectively (P=0.648). Following adjustment, women with CPP had significantly lower QoL scores in the physical health (P<0.001) and social relationships' (P=0.025) domains. Anxiety, depression, sexual dysfunction, hypertension, diabetes mellitus, pain intensity, lower family income, and not having a partner were factors negatively associated with QoL, while being postmenopausal, being employed, and having a child were positively associated with QoL in women with CPP. Conclusion: Women with CPP had poorer QoL than those without CPP. Factors affecting the QoL of women with CPP were identified, some for the first time in this population of women. Interventions targeting these factors may prove effective in minimizing the negative repercussion of CPP on QoL.
RESUMO
BACKGROUND: Morphine is the first-choice drug for moderate-to-severe cancer pain, nevertheless, some patients do not achieve adequate pain relief or exhibit intolerable side effects. The purpose of this study was to establish whether the analgesic effect of morphine improves in patients with cancer when administered in combination with magnesium. METHODS: Randomized double-blind study was conducted with 40 patients older than 18 years with cancer pain using morphine. Group 1 (G1) patients were given magnesium sulfate (65 mg elemental magnesium) twice per day by the oral route. Group 2 (G2) patients were given placebo twice per day. All the patients were administered morphine as needed. They were also given acetaminophen at 2 to 3 g/d. Adjuvants could be used when indicated. The following variables were assessed: pain intensity on a numeric scale at baseline and at weeks 1, 2, 3, and 4; functional performance and quality of life at baseline and week 4; and dose of morphine used. RESULTS: No difference was found between the groups as to pain intensity, dose of morphine used, functional performance, quality of life, or side effects. The average daily dose of morphine increased gradually, being significant in G2. CONCLUSIONS: The use of morphine combined with elemental magnesium at a dose of 65 mg twice per day by patients with cancer did not induce a better analgesic effect, did not improve their functional performance or quality of life, and did not reduce the occurrence of side effects. The dose of morphine increased significantly in G2.