Educación sobre el dolor en pacientes con dolor lumbar en los últimos 10 años: una revisión exploratoria / Pain Education in Patients with Low-back Pain in the Last 10 Years: an Exploratory Review

Introducción: El síndrome del dolor lumbar (SDL) es una de las causas principales de discapacidad a nivel mundial. La educación sobre el dolor es un tratamiento posible, sin embargo, se desconocen las herramientas disponibles para pacientes con dolor lumbar. Objetivo: Describir las estrategias de educación sobre el dolor en personas con SDL descritas en la literatura científica y gris en los últimos 10 años. Metodología: Revisión exploratoria en las bases de datos MEDLINE/PubMed, CINAHL/EBSCO, Scielo y en Google Académico. Se filtraron por título, resumen y texto completo; incluyendo estudios que reportaran estrategias de educación sobre el dolor lumbar, en inglés o español, publicados en los últimos 10 años y cuyo texto completo estuviera disponible. Se excluyeron estudios en población infantil, adolescentes, animales, embarazadas, pacientes pre y post operatorio, cáncer, y revisiones sistemáticas. Resultados: De un total de 760 artículos, se incluyeron 42 artículos en esta revisión. Se identificaron 33 estrategias de abordaje de educación del dolor lumbar, clasificándose en tres categorías según la forma de entrega del programa de educación; a)presencial, b)no presencial y c)mixtas. Una misma estrategia puede incorporar diferentes instrumentos, siendo las estrategias más frecuentes Educación en neurofisiología del dolor (PNE). Conclusiones: Existen numerosas estrategias para la educación sobre el dolor lumbar, diferenciándose en su metodología y contenido. Futuras investigaciones deberían enfocarse en sus efectos, como una alternativa de terapia no invasiva y complementaria a los tratamientos habituales.

Introduction: Low back pain syndrome (LBP) is one of the leading causes of disability worldwide. Education about pain is a possible treatment, however, the strategies are unknown for patients with low back pain. Objective: Describe the pain education strategies in people with LBP described in the scientific and gray literature in the last 10 years. Methods: Exploratory review in the databases MEDLINE / PubMed, CINAHL / EBSCO, Scielo and in Google Scholar. They were filtered by title, abstract and full text; including studies that reported education strategies for LBP, in English or Spanish, published in the last 10 years and whose full text was available. Studies in children, adolescents, animals, pregnant women, pre- and post-operative patients, cancer, and systematic reviews were excluded. Results: Out of a total of 760 articles, 42 articles were included in this review. Thirty-three strategies for the education approach LBP were identified, classified into three categories according to the delivery method of the education program; a) face-to-face, b) non-face-to-face and c) mixed. The same strategy can incorporate different instruments, the most frequent strategy is Education in the Neurophysiology of Pain. Conclusions: There are numerous strategies for education about low back pain, differing in their methodology and content. Future research should focus on its effects, as a non-invasive therapy alternative and complementary to the usual treatments.

Estenosis lumbar degenerativa: conceptos básicos, evaluación clínica y manejo / Degenerative lumbar spinal stenosis: basic concepts, clinical evaluation, treatment

La estenorraquis lumbar es la disminución del volumen del canal raquídeo en la columna. Es la causa más frecuente de dolor lumbociático y lumbocrural en población mayor de 60 años. Existen múltiples causas. La más común es la degenerativa que consiste en una disminución del canal secundario a varios factores como protrusión del disco intervertebral, hipertrofia y abombamiento del ligamento amarillo, engrosamiento de la capsula articular y por osteofitos. Los síntomas principales son el dolor lumbar irradiado a extremidades inferiores tipo lumbociática o lumbocruralgia y la claudicación neural intermitente. Generalmente no hay déficit motor ni sensitivo. La resonancia magnética es el estudio de elección para el diagnóstico, pero debe complementarse con radiografías y con frecuencia con tac para una mejor valoración de la patología. El tratamiento inicial siempre es conservador, que incluye uso de antiinflamatorios, analgésicos, relajantes musculares, kinesioterapia e infiltraciones de columna (epidurales o radiculares). La mayoría de los pacientes responden satisfactoriamente a este manejo. El tratamiento quirúrgico está indicado a los pacientes que presentan un dolor intenso, que afecta su calidad de vida y que no mejora con el tratamiento conservador. Consiste en la descompresión quirúrgica de las raíces lumbares a través de laminectomía. En ocasiones se recomienda complementar la descompresión con artrodesis específicamente cuando la estenorraquis se asocia a otras condiciones como espondilolistesis degenerativa, escoliosis, desbalance sagital o coronal, inestabilidad segmentaria y en enfermedad del segmento adyacente.

Spinal lumbar stenosis is a narrowing of the spinal canal in the lumbar spine. Is the most frequent cause of sciatic pain or cruralgia in the elderly population over 60 years old. Exist many etiologies. The most common is degenerative caused by many factors including bulging disc, hypertrophy of flavum ligament as well as facet capsule thickening and by osteophytes formation. The main symptoms of spinal stenosis are radicular pain and neurogenic claudication. Lumbar flexion usually improves the symptom and deambulation often worsens the pain. Most of the time neurologic examination is normal. The gold standard study is mri but is necessary to complement with x rays and ct to obtain a better evaluation. Initial treatment is always conservative and consists in nsaid's, muscle relaxants, physical therapy and steroid spinal injections. Most of the patients respond well to this treatment. Surgical treatment is indicated when the patient has a severe pain, quality of life is miserable and conservative treatment fails. Decompression is the gold standard surgical treatment. The addition of an arthrodesis or spinal fusion is recommended in degenerative spondylolisthesis, scoliosis, sagital or coronal imbalance, deformity correction, recurrent spinal stenosis and in cases of adjacent level disease problem.

Acute effects of the use of external instability generating devices on neuromuscular performance / Efeitos agudos da utilização de dispositivos geradores de instabilidade externa sobre o desempenho neuromuscular

Abstract Physical training with the use of instability generator devices has become popular in the health area, in sport training and clinical practice (mainly in the prevention and treatment of injuries). To understand how the process of using these devices occurs and the results of their acute effects is important to guide professionals in choosing the appropriate device. The aim of this review was to present the main features of instability devices and analyze their acute effects on core muscle activation, neuromuscular performance and activation of lower and upper limbs. Studies have shown that the main acute effects of exercises performed with these devices are: 1) increased activation / muscular recruitment (especially in the middle zone or core); 2) greater co-activation of antagonist muscles (trunk, upper and lower limbs), with increased stiffness and joint stability; 3) lower force output, power and speed in extremities.

Resumo O treinamento físico com utilização de dispositivos geradores de instabilidade tem se popularizado na área da saúde, no treinamento desportivo e na prática clínica (principalmente na prevenção e tratamento de lesões). Entender como ocorre o processo de utilização desses dispositivos e quais são os resultados sobre os efeitos agudos é importante para nortear profissionais da área na escolha do dispositivo adequado. O objetivo desta revisão foi apresentar as principais características dos dispositivos desestabilizadores e analisar os efeitos agudos da utilização sobre a ativação da musculatura do core, rendimento neuromuscular e ativação das extremidades inferiores e superiores. Estudos têm demonstrado que os principais efeitos agudos dos exercícios realizados com estes dispositivos são: 1) maior ativação/recrutamento muscular (especialmente da zona média ou core); 2) maior coativação da musculatura antagonista (do tronco, membros superiores e inferiores), com aumento da rigidez e estabilidade articular; 3) diminuição da produção de força, potência e velocidade das extremidades.

The effect of aromatherapy on dysmenorrhea from high school girls

BACKGROUND: This study is to investigate on how much the dysmenorrhea and lower abdominal pain(LAP)/back pain are improved by the aromatherapy which is emerging as an alternative therapy. METHODS: In order to get the data by questionnaire, 245 subject was selected from women student class of a high school at rural area from June 2000 to August 2000. 125 subject was selected who are above the 5 grade of LAP/back pain. Among the 129 subject, aroma was given to 69 subject and placebo was given to 56 subject. The subject was investigated how the dysmenorrhea was improved by using the aroma and placebo. RESULTS: After the aromatherapy, severities of dysmenorrhea and LAP/back pain imporved in aroma group and placebo group. Therefore, there is not statistical difference between both groups. CONCLUSION: The herbal aroma is not effective more than placebo aroma to relieve dysmenorrhea.

Epidural Steroid Injection for Low Back Pain in Patients with Radicular Pain / 대한마취과학회지

BACKGROUND: This study describes the authors' experience with patients who received an epidural steroid injection (ESI) for lumbosciatica with radicular leg pain as predominant symptom. We analyzed the efficacy of ESI according to duration of pain and history of prior lumbar spine surgery. METHODS: One hundred thirty-six patients who had low back pain with radicular symptoms were included. Each patient was given 10 ml of 1% mepivacaine mixed with 40 mg of methylprednisolone every two weeks until at least a 75% improvement or reduction in pain was seen. We recommended no more than 3 injections within 3 months. RESULTS: Three to six months after the first injection the more favorable results were observed in patients with subacute radicular leg pain (less than 3 months' duration)(87.6 - 75%, good-excellent) and chronic leg pain with no prior surgery (greater than 3 months' duration)(84.8 - 71%, good-excellent) than in patients with chronic leg pain with prior surgery (50 - 40.1%, good-excellent). The efficacy of ESI was decreased after 1 year after the first ESI. CONCLUSIONS: ESI was effective in the management of lumbosacral radicular pain regardless of duration of symptoms. However, patient's who had had prior lumbar spine surgery had the least satisfactory results.

Discogenic Lumbar Pain: Correlation between Magnetic Resonance Imaging and Discography / 대한마취과학회지

BACKGROUND: Although numerous previous studies on the subject have been performed, the correlations between various pathologic findings on magnetic resonance imaging and pain reproduction by provoked discography have not been fully explained. A higher sensitivity and positive predictive value (PPV) of the high intensity zone (HIZ) for predicting concordant pain was reported. Moreover, although the apparent validity of this sign has been corroborated by some investigators, it has been questioned by others. The validity of this sign awaits confirmation. The various pathologic parameters seen on magnetic resonance imaging (MRI) in patients with discogenic lumbar pain was assessed and correlated with observations on discography. METHODS: There were 18 patients enrolled, ranging in age from 28 to 64 years with an average age of 48.8 +/- 10.2 (mean +/- SD) years. Five men (28%) and thirteen women (72%) participated in the study. All patients underwent provocation discography by a standard technique, as mentioned previously. The lumbar discs examined were L3-L4;(2), L4-L5;(14) and L5-S1;(10). The relationship between discogenic lumbar pain and disc morphology was investigated by using MRI and provocation discography. RESULTS: Of the 26 discs being studied, 16 proved to be concordantly painful at discography relative to clinical back, buttock, hip, groin, and proximal leg pain complaints. Fourteen of the 16 painful and concordant pain discs exhibit grade 2, 3 with annular tears, and four with free leakage of contrast into the epidural space. Using chi-square analysis, we observed a significant correlation (P 0.05) between a concordant pain response and the presence of an HIZ regardless of the level and grade of disc disruption. CONCLUSIONS: The presence or lack of the HIZ does not exclude the disc as a source of pain and should not replace provocation discography as a means of evaluating low back pain with or without sciatica.

Effect of Epidural Dexamethasone Injection for Back Pain after Lumbar Epidural Anesthesia / 대한마취과학회지

Background: Lumbar epidural anesthesia is widely used regional blockade method. But postepidural back pain is most common cause that experienced patients refuse epidural anesthesia. We planned this study to evaluate the effect of epidural dexamethasone injection for postepidural back pain. Methods: Adult patients free of back pain were randomly allocated into two groups. In both group anesthesia was induced with 2% lidocaine 20~25 ml mixed with 1:200,00 epinephrine and fentanyl 0.1 mg. After surgery, epidural catheter was removed after epidural dexamethasone injection in one group (group 2). In other group (group 1), catheter was removed without treatment. We visited patients and asked existence of back pain, and the intensity of back pain was measured by visual analogue scale at 24, 48 and 72 hours after surgery. Statistical analysis was done by Student's t-test and Mann-Whitney test. Results: In group 2, there was significant decrease in number of patients suffering from back pain and intensity of back pain. Conclusion: Epidural dexamethasone injection results in decreased number of patients suffering from back pain and also less in intensity of back pain.

Clinical Features of Single Lumbar Radiculopathy / 대한마취과학회지

BACKGROUND: Lower back pain or lower limb paresthesia is a symptom commonly encountered in otherwise healthy adults. The dilemma often faced by the clinician is to determine whether the symptom is a result of neurological compromise due to pathological changes in the spinal anatomy. METHODS: Electromyography (EMG) is widely used for diagnosing and localizing the level of radiculopathy. Single radiculopathy were considered to be true positive when electrophysiologic study diagnosed single root lesion. A series of 211 cases with lower back pain or paresthesia in the lower limb was studied. They were composed of 79 patients with single lumbar radiculopathy and 132 patients with normal EMG. RESULTS: The frequency of neurologic deficit was 63.3% in patients with radiculopathy and 44.7% in patients with normal EMG. The sensitivity of neurologic examination was 63.3% and the specificity, 78.6%. Nonsegmental neurologic deficit was more frequent and the rate of diagnosis of radiculopathy was less higher in the patients who needed a repayment. There was no significant effect of the time after onset on clinical features. CONCLUSIONS: This study confirmed that physical examination was not enough to detect radiculopathy and electrophysiological study would be required for accurate diagnosis. In addition, nonorganic factor should be considered in evaluation of the patients concerning for repayment.