RESUMO
STUDY DESIGN: Topic overview. OBJECTIVE: To describe the varied etiologies resulting in chronic spinal pain and review the current available evidence for treatments. SUMMARY OF BACKGROUND DATA: Chronic pain conditions, especially those that affect the axial back and radiate to the extremities, affect a large population. This results in pronounced disability and a high socioeconomic burden. Our understanding of the underlying mechanisms for chronic pain is limited. This prevents a comprehensive diagnostic approach. Evidence from high-level clinical trials supporting treatments for chronic spinal pain is also limited. METHODS: Articles were identified through PubMed searches or already known to the author. The literature was reviewed and summarized, indicating the strength of evidence available for many treatment modalities. RESULTS: There are very few studies published that evaluate behavioral modifications for chronic spinal pain and only one long-term study investigating chronic pharmacological treatments. The data on the success of spinal surgeries to relieve chronic spinal pain suggest an unacceptably high failure rate. The best evidence (Level I) currently available suggests that spinal cord stimulation is a safe, effective, and durable treatment for chronic spinal pain. Recent clinical data support further investigation of new innovations and earlier therapeutic consideration of currently employed approaches. CONCLUSION: Currently, physicians are limited in the practice of evidence-based medicine regarding chronic spinal pain treatments due to both the paucity of data available and an inconsistent diagnostic nomenclature. The introduction of new neurostimulation modalities is promising but requires better characterization through ongoing prospective clinical investigation. LEVEL OF EVIDENCE: 5.
Assuntos
Dor nas Costas/diagnóstico , Dor nas Costas/terapia , Dor Crônica/diagnóstico , Dor Crônica/terapia , Estimulação da Medula Espinal/métodos , Dor nas Costas/classificação , Dor Crônica/classificação , Medicina Baseada em Evidências/métodos , Medicina Baseada em Evidências/tendências , Humanos , Estudos Prospectivos , Estimulação da Medula Espinal/tendênciasAssuntos
Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Idoso , Adulto Jovem , Ciática/tratamento farmacológico , Pregabalina/uso terapêutico , Analgésicos/uso terapêutico , Qualidade de Vida , Ciática/classificação , Medição da Dor , Ensaios Clínicos Controlados Aleatórios como Assunto , Falha de Tratamento , Dor nas Costas/classificação , Avaliação da Deficiência , Tontura/induzido quimicamente , Pregabalina/administração & dosagem , Pregabalina/efeitos adversos , Analgésicos/administração & dosagem , Analgésicos/efeitos adversosRESUMO
Se incluyeron en la investigación 100 pacientes, tanto de los hospitalizados como los de sola consulta externa. En su mayoría se trataba de gente de escasos recursos, hombres y mujeres, con actividades muy diversas. Algunos de ellos, habían nacido ya en la ciudad, pero otros habían emigrado del campo a la capital. Se recabaron los datos personales y familiares del paciente, la enfermedad que padecía, sus causas, terapéuticas y consecuencias de esta situación. Se obtuvieron entre otros los siguientes resultados: 1) concepto de enfermedad, 2) frecuencia en que acude al médico y al practicante, 3) condiciones socioeconómicas de los pacientes, 4) terapéuticas empleadas en la curación de esta enfermedad, 5) edades promedio y duración de estas enfermedades, 6) razón por la cual acuden al Hospital General de México y a la alternativa terapéutica, 7) costo, 8) para qué entidades patológicas se utilizó la alternativa terapéutica más frecuentemente, 9) grado de mejoría obtenida, y 10) complicaciones. En este trabajo se presentan los resultados que pudimos obtener