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Introdução: A lombalgia é uma condição prevalente e que apresenta importante impacto na capacidade funcional e na qualidade de vida, sendo a sua correta abordagem na Atenção Primária à Saúde fundamental para a identificação e o estabelecimento de um diagnóstico etiológico precoce de possíveis patologias que possam estar relacionadas a desfechos mórbidos e a graves limitações funcionais. Apresentação do caso: Paciente de 56 anos, sexo masculino, hipertenso, foi encaminhado para serviço especializado de reumatologia com histórico de lombalgia havia mais de 20 anos. Ao exame físico foi constatada presença de deformidades da coluna vertebral e extensa limitação de movimentos. Exames radiográficos mostravam esclerose de articulações sacroilíacas, osteopenia difusa e coluna vertebral em aspecto de "bambu". Conclusões: Constata-se a importância de que na abordagem das lombalgias na atenção primária se busque o reconhecimento de possíveis etiologias graves e potencialmente incapacitantes que possam estar subjacentes à queixa de dor lombar. Com esse objetivo, é fundamental o reconhecimento das chamadas red flags relacionadas às lombalgias, além de sua caracterização como mecânica ou inflamatória. Perante a atuação da atenção primária no oferecimento de um cuidado pautado na integralidade e na prevenção de agravos, reafirma-se a importância de uma avaliação clínica pormenorizada das lombalgias nesse nível de atenção à saúde.

Introduction: Low back pain is a prevalent condition that has an important impact on functional capacity and quality of life, and its correct approach in Primary Care is fundamental to the identification and establishment of an early etiological diagnosis of possible pathologies that may be related to outcomes morbid conditions and serious functional limitations. Case presentation: 56-year-old male patient, hypertensive, referred to a specialized rheumatology service with a history of low back pain for over 20 years. Physical examination revealed the presence of spinal deformities and extensive movement limitations. Radiographic examinations showing sclerosis of the sacro-iliac joints, diffuse osteopenia and a "bamboo" appearance of the spine. Conclusions: It is important that in the approach of low back pain in Primary Care, we seek to recognize possible serious and potentially disabling etiologies that may underlie the complaint of low back pain. For that, it is essential to recognize the so-called "red flags" related to low back pain, in addition to its characterization as mechanical or inflammatory. Given the role of Primary Care in offering care based on integrality and in the prevention of injuries, the importance of a detailed clinical assessment of low back pain at this level of health care is reaffirmed.

Introducción: La lumbalgia es una patología prevalente que tiene un impacto importante en la capacidad funcional y la calidad de vida, y su correcto abordaje en Atención Primaria de Salud es fundamental para la identificación y establecimiento de un diagnóstico etiológico precoz de posibles patologías que puedan estar relacionadas con los resultados, condiciones morbosas y limitaciones funcionales graves. Presentación del caso: Paciente masculino de 56 años, hipertenso, remitido a servicio especializado de reumatología con antecedentes de dolor lumbar de más de 20 años. El examen físico reveló la presencia de deformidades de la columna y amplias limitaciones de movimiento. Los exámenes radiológicos muestran esclerosis de las articulaciones sacroilíacas, osteopenia difusa y una apariencia de "bambú" de la columna. Conclusiones: Es importante que al abordar la lumbalgia en Atención Primaria de Salud busquemos reconocer las posibles etiologías graves y potencialmente incapacitantes que pueden subyacer a la queja de lumbalgia. Con este objetivo, es fundamental reconocer las llamadas "banderas rojas" relacionadas con la lumbalgia, además de su caracterización como mecánica o inflamatoria. Dado el papel de Atención Primaria de Salud a la hora de ofrecer una atención basada en la integralidad y prevención de enfermedades, se reafirma la importancia de una evaluación clínica detallada de la lumbalgia en este nivel de atención sanitaria.

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Objective: To compare the ef?cacy of ?uoroscopic guided transforaminal steroid vs autologous Platelet-rich plasma (PRP) injection in lumbar disc herniation. A total of 80 patients were studied who had complaints of low back pain with radiculopathy and MRIMaterials And Methods: evidence of single level disc prolapse. Out of this group, patients were randomly assigned to two groups each having 40 patients. The ?rst group received a transforaminal steroid injection and the second group transforaminal PRP injection. All patients were followed up for 12 months, and the results were compared using a change in Visual Analogue Scale (VAS) score and Oswestry Disability Index (ODI). : Both groups wereResults comparable in terms of demographics, pre-procedure VAS scores, and ODI scores. At the 1-week follow-up, the steroid group had signi?cantly better improvement than the PRP group. At 3 weeks, 6 weeks, and 6 months no difference in outcomes was observed. PRP is a saferConclusion: alternative to steroids for transforaminal lumbar injections in lumbar radiculopathy. Although improvement was delayed, 6 weeks and 6 months outcomes were comparable. Multiple PRP injections may be bene?cial because of its autologous nature.

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Resumen Introducción: El 90% de las lumbalgias agudas son de causa inespecífica. Existen guías internacionales que permiten identificar a aquellos pacientes que requieren atención especializada. En nuestro país la orientación a la atención primaria de la salud es escasa, centrada prin cipalmente en la atención en los hospitales. El objetivo del presente estudio fue describir los recursos de salud, diagnósticos y terapéuticos, utilizados en la atención inicial de pacientes con dolor lumbar que acuden a la consulta del médico especialista Métodos: Estudio descriptivo y transversal, con re colección prospectiva de los datos a través de un cues tionario destinado a pacientes con dolor lumbar que acuden por primera vez a la consulta especializada. Resultados: Se incluyeron 44 pacientes, edad media 53 años; 50% concurrió por dolor crónico. La derivación informal se asoció con: especialidad de derivación (no traumatólogo), pacientes con mayor número de consul tas a guardia y mayor demora en obtener la consulta. El 52% concurrió con al menos un estudio complementario. Conclusión: La mayor parte de las derivaciones fueron correctas, sin embargo, predominó la derivación infor mal. Solo 1/5 de los pacientes fue examinado y menos del 30% de los pacientes con banderas rojas acudió con estudios complementarios adecuados. La mediana del tiempo de espera para la consulta fue 24 días.

Abstract Introduction: 90% of cases of acute low back pain have no specific underlying cause. International guide lines are available to help identify those individuals who require specialized care. However, in our country, there is a limited emphasis on primary healthcare, with the primary focus on hospital-based care. The aim of this study is to provide an overview of the diagnostic and therapeutic resources utilized in the initial care of patients experiencing low back pain at their first con sultation with a specialist physician. Methods: Descriptive and cross-sectional study, with prospective data collection through a questionnaire administered to patients experiencing low back pain during their first visit to a specialist's office. Results: A total of 44 patients were included, with an average age of 53 years; 50% sought medical atten tion for chronic pain. Informal referrals were associated with the referring physician's specialty (non-orthopedic), patients with a higher number of emergency depart ment visits, and longer waiting times to obtain the consultation; 52% of patients arrived with at least one complementary study. Conclusion: Most of the referrals were appropriate; however, informal referrals were more common. Only 1/5 of the patients underwent an physical examination, and less than 30% of those with red flag symptoms presented with suitable complementary studies. The median wait ing time for the consultation was 24 days.

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Background: Nerve root compression is often inadequately understanding radicular pain due to prolapsed lumbar intervertebral disc, a common neurosurgical presentation. Inflammation is proved as an important etio-pathological component of radiculopathy, even after surgery. Methods: This cross-sectional intervention study conducted from March 2022 to September 2023. Data collected from 45 patients with prolapsed lumber intervertebral Disc, who underwent surgical intervention in Department of Neurosurgery, BSMMU. Results: The mean±SD age of the patients was 38.4±11.6 years, most of them 37 (82.2%) aged within 29 to 60 years. Majority 30 (66.7%) of them were male. Patients presented with pain, numbness and weakness was 45 (100%), 33 (73.3%) and 8 (17.8%) respectively. Among the participants most 36 (80%) had right sided and 9 (20%) had left sided radiation. The mean±SD level of pre-operative high sensitive C-reactive protein was 2.1±1.7. Pre-operative high sensitive C-reactive protein was significantly associated pre-operative, post-operative and mean change in visual analogue score (p<0.001, p<0.001, p= 0.006 respectively). Correlation of high sensitive C-reactive protein and VAS score (both pre and post-operative) were also statistically significant with p =0.017 and p <0.001 respectively. Conclusions: In our study, there is an association between pre-operative serum high sensitive C- reactive protein and post-operative radicular pain following surgical intervention in patients with prolapsed lumbar intervertebral disc.

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Background: A large percentage of young adults suffer from low back pain. Due to their demanding curriculum, medical students are most susceptible. This study aims to assess the frequency and factors associated with low back pain among undergraduate medical students at a college in Bangalore. Methods: An online cross-sectional study using a questionnaire was conducted among undergraduate medical students at Bangalore Medical College and Research Institute. SPSS 26.0 was used to analyze the data with a significance level of p <0.05. Results: Of the 250 students enrolled, 45.6% had low back pain. Long hours of sitting were the common factor aggravating the pain. The logistic regression analysis revealed that Phase 3 (part 2) MBBS (OR=2.53, 95% CI: 1.34 - 4.66), overweight (BMI>25) (OR=3.03, 95% CI: 1.42-6.50), coffee consumption regularly (OR=1.761, 95% CI: 1.007-3.009), Family history of LBP (OR=5.900, 95% CI: 3.182-10.939), duration of exercise/sports 1-2 hours per week (OR=1.691, 95% CI: 1.023-2.794), spending >8 hours for electronic gadgets daily (OR=2.02, 95% CI: 1.14-3.59) were found to be independently associated with low back pain. These results demonstrate an increased risk of low back pain among medical students with high BMI, lack of physical activity and increased electronic device usage. Conclusions: It highlights the necessity of focused treatments to control stress, minimize extended periods of sitting, enhance physical activity, and support proper posture among medical students. By preventing and managing low back pain, medical students can improve overall performance and quality of life.

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Abstract Objective This study aimed to describe the methodological process for developing a questionnaire to identify the prevalence and risk factors for chronic occupational low back pain in healthcare professionals working at hospitals. Method An exploratory crossectional survey study was carried out in Belo Horizonte, MG, Brazil, and its metropolitan region, in two stages. Initially, the authors prepared a questionnaire based on the Roland Morris disability questionnaire and sent it to a committee of low back pain specialists for validation using the Delphi technique. The second stage consisted of sending the final questionnaire to health professionals working in a hospital environment for at least 2 years and presenting chronic low back pain for at least 3 months. Results Validation occurred in two rounds of questionnaire adjustments by a panel consisting of physical therapists and physician experts in the field (orthopedists with more than 3 years of experience). Both rounds had 13 participants. The questionnaire initially consisted of 27 items, and, after validation, it had 19 items. The study included 65 subjects, with an average age of 40.91 years old and an average time working at a hospital of 40 hours per week. The total sample had 76.9% of physicians, 10.8% of physical therapists, and 12.3% of nurses or nursing technicians. Most (52.3%) subjects reported staying in uncomfortable positions affecting the lower back for 5 to 10 hours per day. Conclusion We developed and validated, using the Delphi technique, a questionnaire on the prevalence and risk factors associated with chronic occupational low back pain among healthcare professionals working at hospitals. This unprecedented tool can benefit the population studied since the questionnaires currently used to evaluate chronic low back pain are not specific for investigating the occupational cause of this condition.

Resumo Objetivo Este estudo pretende descrever o processo metodológico para a elaboração de um questionário para identificar a prevalência e os fatores de risco associados à dor lombar ocupacional crônica nos profissionais da área da saúde que atuam em nível hospitalar. Método Foi realizado um estudo transversal exploratório do tipo questionário. O estudo foi realizado na cidade de Belo Horizonte e região metropolitana, em duas etapas. Inicialmente foi elaborado pelos autores um questionário baseado no questionário de deficiências Roland Morris e enviado a um comitê de especialistas em lombalgia para validação do mesmo através da técnica Delphi. A segunda etapa consistiu em enviar o questionário final a profissionais de saúde que atuam em ambiente hospitalar há pelo menos 2 anos e que tenham lombalgia crônica há pelo menos 3 meses. Resultados A validação foi realizada em duas rodadas de adequações do questionário, com painel composto por fisioterapeutas e médicos especialistas na área (ortopedistas com mais de 3 anos de atuação). Ambas as rodadas contaram com 13 participantes. O questionário foi composto inicialmente por 27 itens e, após validação, 19 itens. O estudo incluiu 65 indivíduos, com idade média de 40,91 anos e tempo médio de atuação em nível hospitalar semanal de 40 horas. A amostra total possuía 76,9% médicos, 10,8% fisioterapeutas e 12,3% enfermeiros ou técnicos de enfermagem. A maioria (52,3%) dos indivíduos relatou manter-se em posições desconfortáveis que afetam a região lombar por 5 a 10 horas por dia. Conclusão Foi desenvolvido e validado, pela técnica Delphi, um questionário sobre a prevalência e fatores de risco associados a dor lombar ocupacional crônica entre profissionais da área da saúde que atuam em nível hospitalar. Este instrumento inédito pode trazer benefícios para a população estudada, visto que os questionários utilizados atualmente para a avaliação de dor lombar crônica não são específicos para a investigação da causa ocupacional de tal condição.

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Introducción: El dolor lumbosacro es un importante problema de salud pues constituye la segunda causa más frecuente de asistencia al médico. Se debe a cambios osteodegenerativos de la columna vertebral, dentro de los cuales están las hernias discales. La mayor prevalencia es en personas de entre 30 y 50 años de edad; con más frecuencia en el sexo masculino. Objetivo: Evaluar la efectividad de la ozonoterapia por vía peridural transsacra y paravertebral en pacientes con hernias discales lumbares. Métodos: Se realizó un estudio cuasiexperimental en 55 pacientes, con el diagnóstico de hernias discales lumbares degenerativas, que acudieron a la consulta de neurocirugía y recibieron tratamiento con ozonoterapia paravertebral y peridural transsacra, durante el período de 1 año. Se estudió la evolución del dolor antes y después del tratamiento. Resultados: Se detectaron más pacientes con hernias discales múltiples, sobre todo la asociación de discopatías de los espacios intervertebrales L4-L5 y L5-S1 y estenosis del canal raquídeo. Los resultados en el tratamiento según la escala de Macnab fueron bueno o suficiente en la mayoría de los casos. Luego de aplicada la ozonoterapia el 94,5 % tuvo mejoría del dolor según la Escala Visual Analógica. Conclusiones: El tratamiento es efectivo tanto en las hernias discales lumbares simples como en las múltiples, así como en la estenosis del canal raquídeo lumbar; y la vía de empleo más efectiva y menos inocua es la peridural caudal transacra.

Introduction: Lumbosacral pain is an important health problem that constitutes the second most frequent cause of medical care. It is due to osteodegenerative changes of the spine, among which are discs herniations. The highest prevalence is found in people between 30 and 50 years of age, more frequently in the male sex. Objective: To evaluate the effectiveness of transacral and paravertebral peridural ozone therapy in lumbar disc herniations. Methods: A quasi-experimental study was performed in 55 patients with a diagnosis of degenerative lumbar disc herniation who attended the neurosurgery office and received treatment with paravertebral and transacro peridural ozone therapy over a period of one year. The behavior of pain before and after treatment was studied. Results: More patients with multiple discs herniations were detected, especially the association of discopathies of the intervertebral spaces L4-L5 and L5-S1 and stenosis of the spinal canal. Treatment results according to the Macnab scale were good or sufficient in most cases. After the application of ozone therapy, the 94.5% of the patients showed improvement in pain according to the Visual Analog Scale. Conclusions: The treatment is useful in both single and multiple lumbar disc herniations, as well as in lumbar spinal canal stenosis; and the most effective and least innocuous way of use is the transacro caudal epidural.

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Background: Despite the availability of various clinical practice guidelines (CPGs) offering evidence-based recommendations, there exists a global diversity in physiotherapy practices for managing patients with non-specific low back pain (NSLBP). In this review, we aim to critically appraise and map the current evidence regarding physiotherapy management for patients with NSLBP. Methods: A search strategy was formulated and searched in MEDLINE, Scopus, EBSCOhost, PEDro and Google Scholar between 2013 and 2023 in English. Critical appraisal was performed using International Centre for Allied Health Evidence (iCAHE) guideline checklist. Results: A total of 12 CPGs met the selection criteria were synthesised. Exercise therapy, physical activity and manual therapy were consistently recommended for patients with NSLBP across most guidelines, irrespective of symptom duration. Cognitive-behavioural therapy was frequently advised for those with chronic NSLBP. However, notable absences of recommendations for electrotherapy, mechanical traction, bed rest, and lumbar corsets in NSLBP management. Moreover, emerging treatments such as shock wave therapy and cognitive-functional therapy were not extensively addressed in the guidelines. Conclusion: Multimodal and active forms of physiotherapy management were predominantly recommended in most of the guidelines. However, there is a clear necessity for updated CPG that effectively integrate biopsychosocial approaches into the management of patients with NSLBP.

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RESUMEN Objetivo: Realizar una adaptación transcultural y validación del cuestionario de creencias de miedo y evitación (FABQ, por sus siglas en inglés) para sujetos argentinos con dolor lumbar (DL) y reportar las propiedades psicométricas de confiabilidad, validez e interpretabilidad. Materiales y métodos: Se realizó un estudio observacional, prospectivo y longitudinal. Se incluyeron de forma consecutiva residentes argentinos hispanohablantes mayores de 18 años con DL. El estudio comprendió una fase de adaptación, seguida de una fase de validación. Los sujetos fueron evaluados el día de su admisión al estudio (T1) y 48 a 72 horas después (T2). Se utilizó una escala global de cambio como anclaje externo para evaluar la estabilidad clínica. Resultados: Fueron elegibles 74 sujetos. La media de la puntuación total del FABQ fue de 50,24 (DE 20,64). La consistencia interna (alfa de Cronbach) fue de 0,85 (IC 95 % 0,79 - 0,91). La confiabilidad test-retest fue aceptable, con un coeficiente de correlación intraclase de 0,765 (IC 95 % 0,61 - 0,86). El error estándar de medición fue de 4,85 puntos, y el cambio mínimo detectable (95 %) fue de 13,45. La mediana de tiempo para que los sujetos completen el cuestionario fue de 3,86 minutos (RIQ 3,44 - 4,85), y la media de tiempo para puntuarlo fue de 24,40 segundos (DE 13,77). No se observó efecto suelo o techo. Conclusión: El FABQ en su versión argentina es un cuestionario válido, confiable y viable para evaluar las creencias de miedo y evitación en sujetos con DL.

ABSTRACT Objective: To perform a cross-cultural adaptation and validation of the Fear and Avoidance Beliefs Questionnaire (FABQ) for Argentine subjects with low back pain (LBP) and to report the psychometric properties of reliability, validity, and interpretability. Materials and method: An observational, prospective, and longitudinal study was conducted. Spanish-speaking Argentine residents aged 18 years or older with LBP were consecutively included. The study comprised an adaptation phase followed by a validation phase. Subjects were evaluated on the day of study admission (T1) and 48 to 72 hours later (T2). A global change scale was used as an external anchor to assess clinical stability. Results: Seventy-four subjects were eligible. The mean FABQ total score was 50.24 (SD 20.64). The internal consistency (Cronbach's alpha) was 0.85 (95 % CI 0.79 - 0.91). Test-retest reliability was acceptable, with an intraclass correlation coefficient of 0.765 (95 % CI 0.61 - 0.86). The standard error of measurement was 4.85 points, and the minimum detectable change (95 %) was 13.45. The median time for subjects to complete the questionnaire was 3.86 minutes (IQR 3.44 - 4.85), and the mean time to score it was 24.40 seconds (SD 13.77). No floor or ceiling effect was found. Conclusion: The Argentine version of the FABQ is a valid, reliable, and feasible questionnaire for assessing fear and avoidance beliefs in subjects with LBP.

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RESUMEN Objetivo: Reportar la sensibilidad al cambio e interpretabilidad de la versión argentina de la escala de catastrofización del dolor (PCS-Arg, por sus siglas en inglés) en una muestra de sujetos con dolor lumbar crónico (DLC). Materiales y métodos: Estudio prospectivo, observacional y longitudinal. Se reclutaron sujetos con DLC derivados a la unidad de kinesiología de un hospital público de la Ciudad Autónoma de Buenos Aires. Inicialmente, se registraron los datos demográficos y las puntuaciones de la PCS-Arg, así como la intensidad del dolor, discapacidad, calidad de vida y depresión mediante cuestionarios autoadministrados. En una segunda instancia, al mes o alta del tratamiento, se repitieron los cuestionarios junto con una escala global de cambio. La sensibilidad al cambio fue evaluada mediante la validez de constructo longitudinal. La interpretabilidad se calculó mediante el método basado en el ancla, y se reportaron la diferencia mínima clínicamente importante (DMCI) y el beneficio clínico sustancial (BCS). Resultados: Se incluyeron 102 sujetos en el estudio. La PCS-Arg demostró una sensibilidad al cambio aceptable. La DMCI fue de 10 puntos, con un área bajo la curva (AUC) de 0,65 y un intervalo de confianza del 95 % (IC 95 % 0,47-0,83). El BCS fue de 17 puntos, con un AUC de 0,66 (IC 95 % 0,55-0,77). Conclusión: La PCS-Arg es un instrumento sensible al cambio. La capacidad discriminativa de los valores para identificar la DMCI y el BCS fue pobre. Estos resultados permitirán interpretar el impacto de diferentes terapéuticas orientadas a modificar el catastrofismo, así como potenciar futuros ensayos clínicos que incluyan sujetos con DLC.

ABSTRACT Objective: To report the responsiveness and interpretability of the Argentine version of the Pain Catastrophizing Scale (PCS-Arg) in a sample of subjects with chronic low back pain (CLBP). Materials and methods: A prospective, observational, and longitudinal study was conducted. Subjects with CLBP referred to the physical therapy unit of a public hospital in the Autonomous City of Buenos Aires were recruited. At baseline, demographic data and PCS-Arg scores, as well as pain intensity, disability, quality of life, and depression were recorded through self-reported questionnaires. In a second instance, at one month or discharge, the same variables were collected, along with a Global Rating Of Change (GROC) scale. Responsiveness was assessed using longitudinal construct validity. Interpretability was calculated using the anchor-based method, and the minimal clinically important difference (MCID) and substantial clinical benefit (SCB) were reported. Results: A total of 102 subjects were included in the study. The PCS-Arg showed acceptable responsiveness. The MCID score was 10 points, with an area under the curve (AUC) of 0.65 and a confidence interval of 95 % (95 % CI 0.47-0.83). The SCB score was 17 points, with an AUC of 0.66 (95 % CI 0.55-0.77). Conclusion: The PCS-Arg is a responsive instrument. The discriminative ability of the values to identify the MCID and SCB was poor. These results will allow for interpreting the impact of different treatments aimed at targeting catastrophizing, as well as enhancing future clinical trials on subjects with CLBP.

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Background: Spinal Cord Injury is one of the severe injuries results in loss of sensory and motor function below the level of injury which deteriorates the quality of life. The bio-psycho-social model also emphasizes on the improving the quality of life than enhancing the physical function as the primary goals of SCI rehabilitation. Many authors have reported that there is significant positive effect on activities of daily living. Therefore, improving the quality of life in individuals with SCI. Aim: To study the Relationship between Functional Status and Quality of Life in Patients with Spinal Cord Injury. Methodology: Ten subjects were enrolled according to the inclusion and exclusion criteria of the study. WHOQOL-BREF and SCIM was administered at 3rd, 6th and 9th month of injury to assess the Quality of life and Functional Status of the individuals with Spinal Cord Injury. Result: There was significant correlation between SCIM Vs Psychological domain (r=-0.66, p= 0.03*) at 3rd month, SCIM Vs Social domain (r= 0.57, p= 0.08*) at 3rd month, SCIM Vs Environmental domain (r= 0.57, p= 0.07*) at 9th month post injury. Conclusion: The study concluded that there was a positive association between the functional status and quality of life in patients with spinal cord injury at 3, 6 and 9 months of injury.

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Introducción: La lumbalgia se presenta en aproximadamente 9,4 % de la población mundial. La acupuntura es empleada por la medicina tradicional china para estimular determinados puntos del cuerpo con diferentes tipos de agujas. Entre sus efectos beneficiosos se describe la remisión del dolor. Objetivo: Evaluar la efectividad del tratamiento acupuntural en pacientes con dolor lumbar asistidos en el cuerpo de guardia. Métodos: Se realizó un estudio cuasiexperimental de intervención terapéutica (sin grupo control) en 35 pacientes con dolor lumbar, los cuales fueron atendidos en el Cuerpo de Guardia de Medicina Natural y Tradicional del Hospital General Docente Dr. Juan Bruno Zayas Alfonso de Santiago de Cuba, desde julio hasta diciembre del 2021. Resultados: En la investigación primaron el grupo etario de 40-49 años (31,4 %), el sexo femenino (57,1 %), las amas de casa, el dolor entre grave y moderado al inicio del tratamiento, así como los pacientes sin dolor una hora después de la terapia. En cuanto a la evolución final, el total de la muestra clasificó en las categorías de aliviados y mejorados. Conclusiones: Se demostró la efectividad de la acupuntura en pacientes con dolor lumbar agudo.

Introduction: Low back pain is presented in approximately 9.4% of the world population. Acupuncture is used by Chinese traditional medicine to stimulate certain points of the body with different types of needles. Among its beneficial effects the pain remission is described. Objective: To evaluate the effectiveness of the acupuntural treatment in patients with lumbar pain assisted in the emergency room. Methods: A quasi-experiment of therapeutic intervention study (without control group) was carried out in 35 patients with lumbar pain, who were assisted in the Natural and Traditional Medicine Emergency Room of Dr. Juan Bruno Zayas Alfonso Teaching General Hospital in Santiago de Cuba, from July to December, 2021. Results: In the investigation there was a prevalence the 40-49 age group (31.4%), female sex (57.1%), housewives, serious and moderate pain at the beginning of the treatment, as well as patients without pain one hour after the therapy. As for the final clinical course, the total of the sample classified in the relieved and improved categories. Conclusions: The effectiveness of acupuncture was demonstrated in patients with acute lumbar pain.

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RESUMEN El caso es de una mujer de 46 años con pielonefritis aguda izquierda y duplicidad ureteral bilateral. La pielonefritis aguda es una infección grave del tracto urinario que puede variar en su presentación clínica, desde síntomas leves hasta sepsis. El dolor lumbar es un síntoma común en la pielonefritis aguda, y puede presentarse de forma unilateral o bilateral. La duplicidad ureteral es una anomalía congénita que resulta en uréteres que transportan la orina desde el mismo riñón hasta la vejiga, y puede causar complicaciones como reflujo vesicoureteral y obstrucción ureteral. El tratamiento incluyó antibióticos y control ambulatorio en consulta de Urología. El caso destaca la importancia de un enfoque diagnóstico meticuloso y la consideración de anomalías congénitas subyacentes que pueden complicar el cuadro clínico y el tratamiento. La integración de hallazgos clínicos, análisis de laboratorio y pruebas de imagen fue fundamental para el diagnóstico preciso y el plan de tratamiento adecuado.

ABSTRACT The case presents a 46-year-old woman with left acute pyelonephritis and bilateral duplicated ureters. Acute pyelonephritis is a severe urinary tract infection that can vary in clinical presentation, from mild symptoms to sepsis. Lower back pain is a common symptom and can be unilateral or bilateral. Duplicated ureters are a congenital anomaly resulting in the transport of urine from the same kidney to the bladder, and can cause complications such as vesicoureteral reflux and ureteral obstruction. Treatment involved antibiotics and outpatient urology follow-up. The case underscores the importance of a meticulous diagnostic approach and consideration of underlying congenital anomalies that can complicate clinical management and treatment. The integration of clinical findings and complementary tests was essential for an accurate diagnosis and appropriate treatment plan.

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Objective: This study aimed to characterize within the biopsychosocial understanding, patients with low back pain who sought for the physiotherapy service of a public hospital. Methods: Cross-sectional study carried out to assess biopsychosocial aspects related to pain in a public service in an underdeveloped country. To characterize patients with low back pain, considering the biopsychosocial aspect, data were collected regarding socioeconomic condition and lifestyle habits, pain intensity, functionality, considering psychological aspects, kinesiophobia, pain catastrophizing, central sensitization, depression and anxiety, were assessed with specific scales and questionnaires. Results: The study included 300 patients with low back pain, 70% of the sample was composed of women, with a mean age of 54 years and with socioeconomic vulnerability. The sample was marked by the high prevalence of previous treatments and imaging exams, showed an average level of disability and scores on psychological scales that suggest the presence of limiting beliefs and behaviors regarding pain and movement, in addition to 47% present a high risk for persistent disability and poor prognosis. Conclusion: The main descriptive findings of this study were a sample with chronic low back pain, mostly represented by an unemployed population, with low income, low education level, with a high average time of exposure to symptoms, and an average level of disability. With regard to psychosocial factors, a large part of the sample had a high risk of poor prognosis and persistent disability, in addition to scores that suggest the presence of catastrophic thoughts, anxiety, fear of movement, and central sensitization.

Objetivo: Este estudo teve como objetivo caracterizar, no entendimento biopsicossocial, pacientes com dor lombar que procuraram o serviço de fisioterapia de um hospital público. Método: Estudo transversal realizado para avaliar aspectos biopsicossociais relacionados à dor em um serviço público de um país subdesenvolvido. Para caracterizar os pacientes com dor lombar, considerando o aspecto biopsicossocial, foram coletados dados referentes à condição socioeconômica e hábitos de vida, intensidade da dor, funcionalidade, considerando aspectos psicológicos, cinesiofobia, catastrofização da dor, sensibilização central, depressão e ansiedade, foram avaliados com critérios específicos. escalas e questionários. Resultados: O estudo incluiu 300 pacientes com dor lombar, 70% da amostra era composta por mulheres, com idade média de 54 anos e com vulnerabilidade socioeconômica. A amostra foi marcada pela alta prevalência de tratamentos e exames de imagem anteriores, apresentou nível médio de incapacidade e pontuações em escalas psicológicas que sugerem a presença de crenças e comportamentos limitantes em relação à dor e ao movimento, além de 47% apresentarem alto risco para incapacidade persistente e mau prognóstico. Conclusão: Os principais achados descritivos deste estudo foram uma amostra com dor lombar crônica, representada maioritariamente por uma população desempregada, com baixa renda, baixa escolaridade, com tempo médio de exposição aos sintomas elevado e nível médio de incapacidade. No que diz respeito aos fatores psicossociais, grande parte da amostra apresentou alto risco de mau prognóstico e incapacidade persistente, além de escores que sugerem a presença de pensamentos catastróficos, ansiedade, medo de movimento e sensibilização central.

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A dor lombar é um importante problema de saúde pública e estudos apontam que todas as pessoas que sofrem de dor na coluna apresentam pontos-gatilho. Objetivo: Analisar o nível dor de pacientes com dor lombar aguda e crônica que quando assintomáticos apresentava pontos-gatilho latente, comparado com os níveis de dor de pacientes com dor lombar aguda e crônica que quando assintomáticos não apresentava pontos-gatilho. Método: 96 indivíduos de ambos os sexos entre 18 - 60 anos participaram de um estudo transversal com avaliador cego. Foram analisados o nível de dor, função, atividade física, cinesiofobia, algometria e mensurada a força do músculo glúteo máximo e médio do membro dominante e não dominante, no momento que os participantes estavam assintomáticos e após desenvolverem dor lombar aguda e crônica. Para análise estatística consideramos valores de significância igual ou menor que 0,05. Resultados: Foi observado diferenças significativas entre os grupos na intensidade da dor, funcionalidade, algometria, na dinamometria do músculo glúteo máximo do membro não dominante e da dinamometria do glúteo médio de ambos os membros na lombalgia aguda e diferença significativa da dinamometria do glúteo máximo de ambos os membros na lombalgia crônica. Conclusão: Indivíduos assintomáticos com pontos-gatilho latente nos músculos paravertebrais lombares apresentam pior intensidade da dor e outros desfechos quando desenvolvem dor lombar aguda comparados com indivíduos que não apresentam pontos-gatilho no momento que estão assintomáticos e na lombalgia crônica observamos diminuição da força do glúteo máximo quando comparado com indivíduos com lombalgia aguda.

Low back pain is an important public health problem and studies show that everyone who suffers from back pain has a trigger points. Objective: To analyze the pain level of patients with acute and chronic low back pain who, when asymptomatic, presented a latent trigger point, compared with the pain levels of patients with acute and chronic low back pain who, when asymptomatic, did not present a trigger points. Method: 96 individuals of both sexes between 18 - 60 years old participated in a cross-sectional study with a blinded evaluator. The level of pain, function, physical activity, kinesiophobia, algometry was analyzed and the strength of the gluteus maximus and medius muscles of the dominant and non-dominant limbs was measured, at a time when the participants were asymptomatic and after developing acute and chronic low back pain. For statistical analysis, we considered significance values equal to or less than 0.05. Results: Significant differences were observed between the groups in pain intensity, functionality, algometry, in the dynamometry of the gluteus maximus muscle of the non-dominant limb and in the dynamometry of the gluteus medius of both limbs in acute low back pain and a significant difference in the dynamometry of the gluteus maximus of both limbs in chronic low back pain. Conclusion: Asymptomatic individuals with latent trigger points in the lumbar paraspinal muscles have worse pain intensity and other outcomes when they develop acute low back pain compared to individuals who do not have a trigger points when they are asymptomatic and in chronic low back pain we observe a decrease in the strength of the gluteus maximus when compared to individuals with acute low back pain.

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INTRODUCTION: Chronic non-specific low back pain (CNSLBP) is a major worldwide condition that has severe emotional, social, and economic consequences. Management is difficult, requiring the development of new, effective, and safe approaches. OBJECTIVES: This study was conducted to examine the effects of Pulsed Electromagnetic Fields (PEMF) and retrowalking on pain, disability, spinal mobility, hamstring tightness, balance, and kinesiophobia in patients with chronic non-specific low back pain. MATERIALS AND METHODS: Participants (n = 48) with CNSLBP were randomised into four groups; Group A: Conventional group, Group B: PEMF group, Group C: retrowalking group, and Group D: PEMF and retrowalking group. The interventions were given three times per week for six weeks. The outcomes were pain, disability, hamstring tightness, balance, spinal mobility and kinesiophobia, measured at baseline and after 6 weeks. RESULTS: The result suggested a significant improvement in pain, disability, hamstring tightness, kinesiophobia and balance. However, no significant improvement in spinal mobility (flexion and extension ROM) was observed during the sixth week between-group comparison. The maximum improvement was seen in group D followed by group C and group B in comparison to group A. CONCLUSION: It can be concluded that PEMF and retrowalking when given in combination significantly decrease pain, disability, hamstring tightness, kinesiophobia and improve balance patients with chronic non-specific low back pain.

INTRODUÇÃO: A dor lombar crônica inespecífica (DLCI) é uma condição importante em todo o mundo que tem graves consequências emocionais, sociais e econômicas. O gerenciamento é difícil, exigindo o desenvolvimento de abordagens novas, eficazes e seguras. OBJETIVOS: Este estudo foi realizado para examinar os efeitos dos Campos Eletromagnéticos Pulsados (CEMP) e do retrowalking sobre a dor, a incapacidade, a mobilidade da coluna vertebral, a rigidez dos isquiotibiais, o equilíbrio e a cinesiofobia em pacientes com dor lombar crônica não específica. MATERIAIS E MÉTODOS: Os participantes (n = 48) com DLCI crônica foram divididos aleatoriamente em quatro grupos: Grupo A: Grupo convencional, Grupo B: Grupo CEMP, Grupo C: Grupo retrowalking e Grupo D: Grupo CEMP e retrowalking. As intervenções foram realizadas três vezes por semana durante seis semanas. Os resultados foram dor, incapacidade, tensão nos isquiotibiais, equilíbrio, mobilidade da coluna vertebral e cinesiofobia, medidos na linha de base e após seis semanas. RESULTADOS: O resultado sugeriu uma melhora significativa na dor, na incapacidade, na tensão dos isquiotibiais, na cinesiofobia e no equilíbrio. Entretanto, não foi observada melhora significativa na mobilidade da coluna vertebral (flexão e extensão da ADM) quando a comparação entre os grupos foi feita na sexta semana. A melhora máxima foi observada no grupo D, seguida pelo grupo C e pelo grupo B, em comparação com o grupo A. CONCLUSÃO: Pode-se concluir que a CEMP e o retrowalking, quando administrados em combinação, diminuem significativamente a dor, a incapacidade, a rigidez dos isquiotibiais, a cinesiofobia e melhoram o equilíbrio dos pacientes com dor crônica não espinhal.

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INTRODUÇÃO: A dor lombar possui alta prevalência, sendo uma das principais causas de incapacidade no Brasil e no mundo. A dor lombar apresenta etiologia multifatorial, sendo extremamente comum em trabalhadores. OBJETIVOS: Verificar o conhecimento sobre os fatores de risco para dor lombar, crenças e atitudes sobre o manejo da dor lombar entre profissionais de saúde (fisioterapeutas e ergonomistas) atuantes na área ocupacional. MATERIAIS E MÉTODOS: Foi realizado um estudo observacional transversal com 81 profissionais de saúde ocupacional brasileiros. Os participantes preencheram um questionário eletrônico composto por dados profissionais, sociodemográficos, itens sobre fatores de risco para dor lombar e a Brazilian version of the Pain Attitudes and Beliefs Scale for Physiotherapists. Conhecimentos, crenças e atitudes foram analisados por meio do teste do qui-quadrado para fatores de risco para dor lombar e um modelo de regressão linear para crenças e atitudes dos profissionais de saúde. RESULTADOS: Obesidade (7,4%), ficar sentado mais de 2 horas (8,6%), atividade física (9,9%), falta de apoio psicossocial no trabalho (11,1%) e consumo de álcool (37,0%), apresentaram os menores índices de conhecimento sobre fatores de risco da dor lombar pelos profissionais. Itens sobre saúde geral apresentaram o menor conhecimento. Uma orientação biomédica e psicossocial equilibrada de crenças e atitudes sobre o manejo da dor lombar foi observada. CONCLUSÃO: Profissionais de saúde ocupacional brasileiros carecem de conhecimento sobre os fatores de risco não ocupacionais da dor lombar, especialmente o estado geral de saúde. Esses profissionais também possuem conceitos biomédicos e psicossociais equilibrados no manejo da dor lombar.

INTRODUCTION: Low back pain (LBP) is highly prevalent and is one of the main causes of disability in Brazil and around the world. LBP presents a multifactorial etiology, being extremely common in workers. OBJECTIVE: This study aimed to verify the knowledge about the LBP risk factors, beliefs and attitudes about the management of LBP among health professionals (physiotherapists and ergonomists) working in the occupational area. MATERIALS AND METHODS: A cross-sectional observational study was conducted with 81 Brazilian occupational health professionals. Participants completed an electronic questionnaire comprising professional data, sociodemographics, items about LBP risk factors, and the Brazilian version of the Pain Attitudes and Beliefs Scale for Physiotherapists. Knowledge, beliefs and attitudes were analyzed using the chi-square test for LBP risk factors and the linear regression model for health professionals' beliefs and attitudes. RESULTS: Obesity (7.4%), sitting for more than 2 hours (8.6%), physical activity (9.9%), lack of psychosocial support at work (11.1%) and consuming alcohol (37.0%) presented the lowest rate of knowledge about LBP risk factors by professionals. Items about general health showed the lowest knowledge. A balanced biomedical and psychosocial orientation of beliefs and attitudes about managing LBP was observed. CONCLUSION: Brazilian occupational health professionals lack knowledge about non-occupational LBP risk factors, especially general health status. These professionals also have balanced biomedical and psychosocial concepts in managing LBP.

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Background: Low back pain (LBP) constitutes a significant portion, 57%, of overall disability, posing a considerable burden on individuals, healthcare systems, and society. Despite the abundance of literature on various causes and treatments for LBP, success in its management remains inconsistent. There is a growing consensus for a more comprehensive investigation into the early stages of LBP to understand its origin and progression better, aiming to target interventions more precisely. Among adolescents, females exhibit a higher prevalence of LBP than that of males. Notably, thyroid imbalances can lead to physiological changes, resulting in fatigue and generalized muscle or joint pain, which often improve with thyroid medication. However, there is limited research exploring the association between LBP and thyroid dysfunction, particularly hypothyroidism. Therefore, this study seeks to examine the incidence of thyroid dysfunction, assessed through thyroid stimulating hormone (TSH) screening, in women aged 25 years and above who experience LBP. Materials and Methods: A prospective cohort study was conducted following ethical approval from D. Y. Patil Medical College, Hospital, and Research Centre, Nerul, Navi Mumbai, India, from April 15, 2021, to April 30, 2022. Upon obtaining informed consent and elucidating the study’s objectives, we randomly screened 852 females aged 25 years. Among them, 426 females reported experiencing LBP persisting for more than 3 weeks. Results: Out of 852 female subjects screened, 426 had LBP, of which 66.9% had high TSH levels. There was no substantial association between age and deranged thyroid (high TSH). There was a statistical correlation between high TSH and LBP with a P value of 0.00001 and a strong negative correlation. Conclusion: LBP in females aged 25 years and above may be a consequence of deranged thyroid levels, that is, elevated TSH levels (hypothyroidism). Therefore, this will help diagnose, treat, and subsequently prevent LBP by screening TSH Levels.

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Introduction : Micro discectomy is the surgical procedure of choice for treating lumbar disc herniations. A laminectomy can cause instability, significant epidural fibrosis, continued radiated pain, and surgical site infection, although there is still concern about the dangers of muscle damage, such as to the multifidus, and excessive articular facet resection. Unilateral biportal endoscopic discectomy has been suggested as a less invasive therapeutic approach.Objective: To compare the clinical effects in terms of pain, impairment, and complications associated with percutaneous endoscopic lumbar discectomy with standard micro discectomy for the treatment of disc herniations. Materials and methods: A study of 60 people with disc herniations who were treated with either microdiscectomy or unilateral biportal endoscopic lumbar discectomy. The Oswestry Disability Index and visual analogue score for back and leg pain was evaluated after three, six, and twelve months. Results: In comparison to Group E, Group M's mean operating time was substantially lower (p<0.05). In addition, it took group M more time on average to get back to work. (p<0.05), and the VAS score at 3 showed a statistically significant change (p<0.05). At three months, group M's Oswestry Low Back Pain Disability score was considerably greater than group E's. (p<0.001). Conclusion: In terms of a three-month return to work and wound infections, endoscopic surgery has a little advantage over microscopic surgery. Both techniques are efficient and safe for lumbar discectomy. However, after 6 months of follow-up, the results seem to be comparable.