Enfermedad de Scheuermann lumbar atípica en rara asociación con artritis idiopática juvenil / Atypical lumbar Scheuermann disease and juvenile idiopathic arthritis: a rarely association

El dolor lumbar en los adolescentes es causa frecuente de motivo de consulta en reumatología y obedece a diferentes causas. Se presenta un caso clínico de un adolescente de 14 años de edad, de procedencia rural que acudió a consulta refiriendo dolor y aumento de volumen de ambas rodillas de 3 meses de evolución, acompañado de dolor lumbar desde hacía más de 2 años y que había requerido tratamiento con antinflamatorios no esteroideos y reposo, sin otros síntomas sistémicos acompañantes. Al examen físico se encontró artritis de rodillas, aumento de la cifosis fisiológica en la columna dorsal y puntos sacroilíacos positivos. En los exámenes complementarios fue significativa la presencia del HLA-B27, sinovitis en bolsa subcuadricipital bilateral detectada mediante ultrasonido de rodillas, así como hallazgos en las radiografías a nivel de los cuerpos de las vértebras lumbares característicos de la enfermedad de Scheuermann, y esclerosis de ambas sacroilíacas, características de artritis idiopática juvenil. Se concluyó que el paciente padecía de dos afecciones que por mecanismos diferentes causan dolor lumbar(AU)

Low back pain in adolescents is a frequent reason for consultation in rheumatology and is due to different causes. A clinical case of a 14-year-old adolescent from rural origin who comes to the clinic reporting pain and volume increase in both knees of three months of evolution accompanied by low back pain of more than two years of evolution that had required treatment is presented. with non-steroidal anti-inflammatory drugs and rest, without other accompanying systemic symptoms, physical examination revealed knee arthritis, increased physiological kyphosis in the thoracic spine and positive sacroiliac points. In the complementary tests, the presence of HLA-B27, synovitis in the bilateral sub quadriceps bursa on ultrasound of the knees, findings in the radiographs at the level of the bodies of the lumbar vertebrae characteristic of Scheuermann's disease, and sclerosis of both sacroiliacs' characteristic of juvenile idiopathic arthritis, it is concluded that the patient suffers from two conditions, which by different mechanisms cause low back pain(AU)

Administración prolongada de morfina intratecal por bomba de infusión implantada, en un caso de dolor crónico no oncológico / Prolonged administration of intratecal morphine by infusion pump implanted in a case of non-oncological chronic pain / Administração prolongada de morfina intratecal por bomba de infusão implantada, em caso de dor crônica não oncológica

Introducción: Se describe la evolución de un paciente que recibe morfina intratecal mediante una bomba de infusión, que le fuera implantada hace 14 años para tratamiento de su dolor lumbar crónico post-laminectomía. Material y método: Requería la administración de 60 mg/día de morfina subcutánea que le provocaban efectos secundarios que no toleraba, y múltiples internaciones para control del dolor. Se le implantó una bomba de infusión continua (Isomed) conectada a un catéter subaracnoideo, que libera 1 ml/día, y requiere ser llenada cada 60 días. Resultados: Se observó una disminución del dolor promedio de 50% al año, y de 75% a los 6 y 14 años. Requirió un aumento progresivo de las dosis de llenado, que pasaron de 30 mg de morfina (0.5 mg/día) al inicio, a 40 mg de morfina (0.66 mg /día) al año, a 70 mg de morfina (1.16 mg/día) a los 6 años, a 140 mg (2.33 mg/día) a los 14 años. No se registraron complicaciones médicas graves. Mantuvo constipación y sudoración durante todo el período, e instaló un hipogonadismo secundario con trastornos de la libido y de la erección que fueron corregidos con la administración de testosterona. No requirió más internaciones por dolor. No se observaron complicaciones relacionadas con el funcionamiento o llenado de la bomba, ni vinculadas al catéter. El paciente manifestó estar satisfecho con el implante. Discusión: A pesar del aumento de las dosis de llenado, expresión del desarrollo de tolerancia, las dosis de morfina/día requeridas son francamente inferiores al límite recomendado. Conclusiones: El balance del riesgo-beneficio del implante resultó positivo, considerando el mejor control del dolor logrado, las menores dosis de morfina utilizadas, así como la ausencia de complicaciones graves y de internaciones para control del dolor.

Introduction: The evolution of a patient receiving intrathecal morphine through an infusion pump that was implanted 14 years ago for the treatment of chronic post-laminectomy low back pain is described. Material and method: It required the administration of 60 mg / day of subcutaneous morphine that caused side effects that did not tolerate, and multiple hospitalizations for pain control. He was implanted with a continuous infusion pump (Isomed) connected to a subarachnoid catheter, which releases 1 ml / day, and needs to be filled every 60 days. Results: An average pain decrease of 50% per year, and 75% at 6 and 12 years was observed. It required a progressive increase in filling doses, which went from 30 mg of morphine (0.5 mg / day) at the beginning, to 40 mg of morphine (0.66 mg / day at the first year, to 70 mg of morphine (1.16 mg / day) at the sixth year, at 140 mg (2.33 mg / day) at the fourteen year. No serious medical complications were recorded, he maintained constipation and sweating throughout the period, and installed secondary hypogonadism with libido and erection disorders, that were corrected with the administration of testosterone. No further hospitalizations were required due to pain. No complications were observed related to the operation or filling of the pump or linked to the catheter. The patient stated that he was satisfied with the implant. Discussion: Despite the increase in filling doses, expression of tolerance development, the required morphine / day doses are frankly below the recommended limit. Conclusions: The risk-benefit balance of the implant was positive, considering the best pain control, the lowest doses used, the absence of serious complications, and the lack of hospitalizations for pain control.

Introdução: Descreve-se a evolução de um paciente que recebeu morfina intratecal através de uma bomba de infusão, implantada há 14 anos para o tratamento de lombalgia crônica pós-laminectomia. Material e método: Necessitou de administração de 60 mg/dia de morfina por via subcutânea, que provocou efeitos colaterais intolerantes, e múltiplas internações para controle da dor. Foi implantada uma bomba de infusão contínua (Isomed) conectada a um cateter subaracnóideo, que libera 1 ml/dia, necessitando de reenchimento a cada 60 dias. Resultados: Observou-se redução média da dor de 50% em um ano e 75% em 6 e 14 anos. Foi necessário um aumento progressivo das doses de enchimento, que passaram de 30 mg de morfina (0,5 mg/dia) no início, para 40 mg de morfina (0,66 mg/dia) por ano, para 70 mg de morfina (1,16 mg/dia) dia) aos 6 anos, para 140 mg (2,33 mg/dia) aos 14 anos. Não foram registradas complicações médicas graves. Manteve constipação e sudorese durante todo o período e desenvolveu hipogonadismo secundário com distúrbios de libido e ereção que foram corrigidos com administração de testosterona. Ele não necessitou de mais hospitalizações por dor. Não foram observadas complicações relacionadas à operação ou enchimento da bomba, ou relacionadas ao cateter. O paciente afirmou estar satisfeito com o implante. Discussão: Apesar do aumento das doses de enchimento, expressão do desenvolvimento da tolerância, as doses necessárias de morfina/dia são francamente inferiores ao limite recomendado. Conclusões: A relação risco-benefício do implante foi positiva, considerando o melhor controle da dor alcançado, as menores doses de morfina utilizadas, bem como a ausência de complicações graves e internações para controle da dor.

Hipo persistente: una rara complicación de una inyección epidural transforaminal de corticoides / Persistent hiccup: a rare complication of a transforaminal epidural corticoid injection / Soluços persistentes: uma complicação rara da injeção peridural transforaminal de corticosteroide

Se describe el caso de un paciente que instaló un hipo persistente luego de recibir una inyección epidural transforaminal lumbar de corticoides. Se destaca que es una complicación raramente reportada y por ende poco conocida por quienes practican intervencionismo en dolor. Se discuten los posibles mecanismos por los que puede presentarse, se reseña la evolución observada, y se describe el tratamiento instituido. Se señala el impacto que el hipo puede tener sobre la calidad de vida.

The case of a patient who installed a persistent hiccup after receiving a lumbar transforaminal epidural injection of corticosteroids is described. It is highlighted that it is a rarely reported complication and little known by those who practice interventional pain medicine. Possible mechanisms by which it may occur are discussed, the evolution observed and the treatment instituted are reviewed. The impact that hiccups can have on quality of life is pointed out.

Descrevemos o caso de um paciente que desenvolveu soluços persistentes após receber uma injeção peridural transforaminal lombar de corticosteróides. Ressalta-se que é uma complicação pouco relatada e, portanto, pouco conhecida por quem pratica o intervencionismo na dor. Discutem-se os possíveis mecanismos pelos quais pode ocorrer, revisa-se a evolução observada e descreve-se o tratamento instituído. O impacto que os soluços podem ter na qualidade de vida é apontado.

Estudio comparativo de una asociación de diclofenac, betametasona y vitamina b12 (blokium b12®) con diclofenac (sin asociar) en el tratamiento de patología dolorosa de columna con compromiso neural / COMPARATIVE STUDY OF AN ASSOCIATION OF DICLOFENAC, BETAMETASONE AND VITAMIN B12 (BLOKIUM B12®) WITH DICLOFENAC (WITHOUT ASSOCIATION) IN THE TREATMENT OF PAINFUL SPINE PATHOLOGY WITH NEURAL COMMITMENT

El dolor lumbar bajo y el dolor cervical con o sin irradiación son causas muy comunes de consulta a los médicos generalistas en los países desarrollados. La discopatía aguda y el dolor por estenosis del canal espinal son los diagnósticos más frecuentes. La postura tradicional ha sido la de administrar antiinflamatorios no esteroideos (AINES) para estas lumbalgias o cervicalgias agudas. Cuando existe irradiación neural por compresión radicular es usual asociar al AINE un corticoide a baja dosis, así como un antineurítico, para lograr un mejor resultado. Con el objeto de documentar la utilidad de esta práctica habitual, efectuamos en 142 pacientes ambulatorios un estudio multicéntrico randomizado que compara la efectividad y la tolerancia de una asociación a dosis fija de diclofenac, betametasona y cianocobalamina administrada por vía oral versus la administración de diclofenac como monofármaco en el tratamiento de la patología dolorosa de la columna lumbar y cervical asociada a compresión neural. La asociación demostró ser más eficaz en controlar el dolor y mejorar la funcionalidad de los pacientes que la administración de diclofenac en forma aislada y se asoció a escasos efectos colaterales, principalmente digestivos

Low back pain and neck pain with or without radiation are very common causes of consultation with general practitioners in developed countries. Acute discopathy and pain due to spinal canal stenosis are the most frequent diagnoses. The traditional approach has been to administer non-steroidal antiinflammatory drugs (NSAIDs) for these acute low back or cervical pain. When there is neural radiation due to root compression, it is usual to associate a low-dose corticosteroid with the NSAID, as well as an antineuritic, to achieve a better result. In order to document the usefulness of this routine practice, we conducted a randomized multicenter study in 142 outpatients that compared the effectiveness and tolerance of a fixed-dose combination of diclofenac, betamethasone, and cyanocobalamin administered orally versus the administration of diclofenac as Monopharmaceutical in the treatment of painful pathology of the lumbar and cervical spine associated with neural compression. The association proved to be more effective in controlling pain and improving the functionality of patients than the administration of diclofenac in isolation and was associated with few side effects, mainly digestive

Terapia combinada para el tratamiento de la lumbalgia / Combination therapy for the treatment of low back pain

Introducción: El dolor lumbar es una de las afecciones que causa mayor índice de incapacidad, por lo que se ha señalado como una de las principales causas de invalidez laboral temporal o definitiva. Objetivo: Identificar las ventajas de la aplicación de ozono médico como terapia combinada en el tratamiento de pacientes con lumbalgia aguda. Métodos: Se realizó un estudio experimental de casos y controles donde cada grupo estuvo integrado por 50 pacientes mayores de 20 años de edad con diagnóstico de dolor lumbar, previo consentimiento informado. El grupo control recibió tratamiento con esquemas terapéuticos tradicionales según los consensos internacionales para el tratamiento del dolor lumbar agudo. En el caso de los pacientes del grupo de casos se adicionó ozono médico en tres sesiones semanales por vía rectal hasta completar 10 sesiones. Se utilizó la prueba de comparación de medias y de McNemar para identificar cambios en la intensidad del dolor y en la presencia y tipo de incapacidad. Resultados: Hubo un promedio de edad por encima de los 50 años, con predominio de pacientes femeninas. La intensidad del dolor al inicio del tratamiento se comportó como media de ambos grupos en 8,76 puntos, mientras que el 87 por ciento de los pacientes refirió algún tipo de discapacidad. Predominó la incapacidad moderada. Conclusiones: La aplicación de ozono médico combinado influyó positivamente en la disminución de la intensidad del dolor y en la presencia y tipo de incapacidad(AU)

Introduction: Low back pain is one of the conditions that generates the highest rate of disability, has been identified as one of the main causes of temporary and / or permanent work disability. Objective: To identify the advantages of the application of medical ozone as a combined therapy in the treatment of patients with acute low back pain. Methods: An experimental case-control study was carried out where each group consisted of 50 patients over 20 years of age with a diagnosis of low back pain. The control group received treatment with traditional therapeutic schemes according to international consensus for the treatment of acute low back pain, in the case of patients in the case group the use of medical ozone was added, in three weekly sessions rectally until completing 10 sessions. The comparison test of means and McNemar were used to identify changes in pain intensity and in the presence and type of disability. Results: Average age above 50 years with a predominance of female patients. The intensity of pain at the start of treatment behaved as an average of both groups at 8.76 points, while 87 percent of the patients reported some type of disability with a predominance of moderate disability. Conclusions: The application of combined medical ozone positively influenced the decrease in pain intensity and the presence and type of disability(AU)

Evaluación de resultados tras la aplicación de esteroides epidurales caudales no particulados en pacientes con dolor lumbar, experiencia en un hospital militar / Evaluation of results after the application of non-particulated flowring epidural steroids in patients with lumbar pain, experience in a military hospital

Introducción: El dolor lumbar es uno de los principales motivos de consulta en diferentes escenarios clínicos; entre las causas más frecuentes de dolor lumbar se encuentra el canal lumbar estrecho, discopatía y radiculopatías, por lo que se han establecido diferentes modalidades de tratamiento que incluyen medidas invasivas, como las inyecciones de esteroides epidurales vía caudal. Objetivo: Evaluar la mejoría del dolor lumbar después de la aplicación de esteroides epidurales caudales no particulados en la población con dolor crónico lumbar bajo secundario a canal lumbar estrecho, discopatía y radiculopatía lumbar de un hospital en Bogotá, Colombia. Metodología: Se realizó un estudio observacional retrospectivo en el que se evaluó la reducción del dolor, en pacientes con diagnóstico de dolor lumbar crónico secundario a canal lumbar estrecho, radiculopatía, discopatía, mediante escala visualanáloga del dolor EVA seis meses después de la aplicación de dexametasona 8 mg vía epidural caudal en 147 pacientes en un período de 2 años. Resultados: Se evaluaron 147 pacientes con dolor lumbar crónico, de los cuales 58.32% eran mujeres y 47.76% hombres, con edades entre 44 y 77 años, de los cuales 50% eran mayores o igual a 65 años y 75% mayor o igual a 77 años. En la evaluación inicial del dolor lumbar, se encontró que el 50% de los pacientes tenían una EVA inicial mayor o igual a 8/10 y el 75% informó un EVA inicial 10/10. Se encontró que el canal lumbar estrecho fue la principal causa de dolor lumbar en el 53,06% de los pacientes, seguido de la enfermedad del disco lumbar el 49,66% y en el tercer lugar, los pacientes con radiculopatía lumbar correspondieron al 19.73% de la población. Sobre la mejoría del dolor de una manera particular, se encontró una mayor reducción del dolor en pacientes con enfermedad de disco lumbar 48,21%, seguido de estrecho canal lumbar estrecho 41,37% y radiculopatías lumbares 33,3%. En el análisis comparativo por patología aislada, la intervención no presentó una mejora considerable, sin embargo, cuando más de una de las entidades estudiadas coexistieron en el mismo paciente, hubo una mejoría significativa del dolor, por lo que en el 66,5% de los pacientes diagnosticados con un canal lumbar estrecho y radiculopatía, la mejoría de la lumbalgia y la radiculopatía disminuyó, de la misma forma que los pacientes que presentaron discopatía y radiculopatía tuvieron un alivio del dolor del 66% y, finalmente, aquellos con discopatía y canal lumbar estrecho, 60% tuvieron una reducción del dolor después del procedimiento. Conclusión: La aplicación de esteroides no particulados vía epidural caudal proporciona una mejora sintomática significativa en un porcentaje considerable de pacientes sometidos al procedimiento, especialmente en aquellos que tienen más de una de las causas de dolor lumbar crónico expuesta, por lo que se constituye en una medida invasiva de tratamiento efectivo para el dolor lumbar en este tipo de pacientes.

Introduction: Low back pain is one of the main reasons for consultation in different clinical scenarios; among the most frequent causes of low back pain is the narrow lumbar canal, discopathy and radiculopathies, which is why different modalities have been established of treatment including invasive measures such as injections of epidural steroids caudal via. Objective: To evaluate the improvement of lumbar pain after application of non-particulate caudal epidural steroid via in the population with chronic low lumbar pain in the narrow lumbar canal, discopathy and lumbar radiculopathy of a military hospital in Bogotá, Colombia. Methodology: A retrospective observational study was performed in which the pain reduction measured by visual analogous scale of pain VAS was evaluated six months after the application of dexamethasone 8 mg caudal epidural via in 147 patients in a period of 2 years Results: 147 patients with chronic low back pain were evaluated, of which 58.32% were women and 47.76% men, with ages between 44 and 77 years, of which 50% were greater than or equal to 65 years and 75 % greater than or equal to 77 years. Concerning the initial evaluation of lumbar pain, it was found that 50% of the patients had an initial VAS greater than or equal to 8/10 and 75% reported an initial VAS 10/10. Regarding the prevalence of causes of low back pain in the evaluated patients, it was found that the narrow lumbar canal was the main cause in 53.06% of the patients, followed by lumbar disc disease 49.66% and in the third place patients with lumbar radiculopathy corresponded 19.73% of the population. About pain improvement in a particular way, greater pain reduction was found in patients with lumbar disc disease 48.21%, followed by narrow lumbar canal 41.37% and lumbar radiculopathies 33.3%. In the comparative analysis due to isolated pathology, the intervention did not present a considerable improvement, however, when more than one of the entities studied coexisted in the same patient, there was a significant improvement in pain, thus 66.5% of the patients diagnosed with a canal. Narrow lumbar and radiculopathy improved, in the same way those patients who presented with discopathy and radiculopathy 66% had relief of pain and finally those with discopathy and narrow lumbar canal 60% had pain reduction after the procedure. Conclusion: The application of non-particulate steroid via caudal epidural provides significant symptomatic improvement in a considerable percentage of patients undergoing the procedure, especially in those who have more than one of the causes of chronic low back pain exposed and evaluated, thus being able to constitute an invasive measure of effective treatment for low back pain in this type of patients.

The effectiveness of percutaneous injections of ozonotherapy in low back pain

SUMMARY INTRODUCTION Lumbar pain is one of the main reasons for medical consultation, causing the disruption of daily routines due to its disabling nature, thus resulting in social and personal damage. Among the complementary treatments, ozonotherapy offers analgesia to most patients, with reports of complications. However, great questions about its clinical effectiveness have not been answered yet, and there have been reports of serious complications. OBJECTIVE To describe the use of ozonotherapy in the treatment of lumbar pain, focusing on its favorable and unfavorable effects, and its analog profile. METHODS A cross-sectional bibliographic research was performed with scientific articles obtained from the Pubmed, LILACS and Scopus database, using the following descriptors: "Ozone", "Therapy", "Lumbar pain", "complication", "Disk herniation", "Guideline", "Protocol", "Standards", "Criteria". RESULTS The researched literature corroborates that, in clinical practice, there is safety in the use of oxygen-ozone therapy through percutaneous injections for the treatment of lumbar pain, especially when compared to surgeries and use of medicines, provided that strict criteria are followed. CONCLUSION The procedure is effective and has a favorable analgesic profile. However, it is necessary to produce a medical guideline that will help in its strict and systematic control.

RESUMO INTRODUÇÃO Dor lombar é um dos principais motivos de consultas médicas, provocando afastamento das rotinas diárias, por ser incapacitante, resultando em danos sociais e pessoais. Dentre os tratamentos complementares, a ozonioterapia oferece analgesia para a maioria dos pacientes e com mínimos relatos de complicações. Entretanto, grandes questionamentos sobre sua efetividade clínica ainda não foram respondidos, além de haver relatos de complicações graves. OBJETIVO Descrever o uso da ozonioterapia no tratamento da dor lombar, enfocando seus efeitos favoráveis e desfavoráveis, e seu perfil analgésico. MÉTODOS Foi realizada uma pesquisa bibliográfica transversal com artigos científicos obtidos das bases de dados PubMed, Lilacs e Scopus, utilizando os descritores: "Ozônio", "Terapia", "Dor lombar", "Complicação", "Hérnia de Disco","Diretriz", "Protocolo", "Padrões", "Critérios". RESULTADOS A literatura pesquisada corrobora que, na prática clínica, há segurança na utilização da terapia com a mistura oxigênio-ozônio por meio de injeções percutâneas para o tratamento de dor lombar, principalmente quando comparada às cirurgias e ao uso de medicamentos, desde que sejam seguidos critérios rígidos. CONCLUSÃO O procedimento é efetivo e tem perfil analgésico favorável. No entanto, é necessária a confecção de uma diretriz médica que auxiliará no controle rígido e sistemático do mesmo.

Masculinidad, envejecimiento y sexualidad en el proceso salud-enfermedad-cuidado entre hombres trabajadores de Campinas, San Pablo, Brasil / Masculinity, aging, and sexuality in health-disease-care processes among male workers in Campinas, São Paulo, Brazil

RESUMEN El artículo se propone analizar las representaciones y las experiencias de los trabajadores en relación con el autocuidado y cómo las configuraciones del proceso salud-enfermedad-cuidado y de envejecimiento afectan la sexualidad masculina. Se realizó un estudio cualitativo, con entrevistas semiestructuradas a quince hombres de un barrio popular en la ciudad de Campinas, San Pablo, Brasil, con una media de 56 años, con alguna enfermedad crónica, y la mayoría tenía educación primaria incompleta. Del análisis surgieron dos temas: por un lado, que las concepciones sobre la atención de la salud, el género y el proceso reproductivo están socialmente mediadas por prejuicios sexuales -entre ellos, de género- y estereotipos, como los de la medicina sexual; y, por otro, que el envejecimiento repercute sobre la práctica de la sexualidad masculina, y la enfermedad se opone a los valores socialmente atribuidos a la masculinidad tradicional. Sin embargo, el envejecimiento hizo posible que algunos reinterpretaran las relaciones de género y el ideal de masculinidad dominante.

ABSTRACT This article presents an analysis of the representations and experiences of male workers regarding self-care, and the ways in which configurations of health-disease-care processes and aging affect male sexuality. A qualitative study was conducted that included semi-structured interviews with fifteen men living with a chronic disease. Respondents had an average age of 56 years old, most had not completed elementary school, and they were residents of a low-income neighborhood in the city of Campinas, São Paulo, Brazil. Two findings emerge from the analysis: on one hand, conceptions of health care, gender, and the reproductive process are socially mediated by gender-biased sexual prejudices or reproduce stereotypes such as those based on sexual medicine; on the other hand, the aging process has repercussions on the conception and practice of male sexuality, and disease opposes values socially attributed to traditional masculinity. However, the aging process has made it possible for some to reinterpret gender relations, as well as ideals of dominant masculinity.

Lumbar transforaminal epidural block for treatment of low back pain with radicular pain / 南方医科大学学报

OBJECTIVE@#To evaluate the efficacy of lumbar transforaminal epidural block (LTEB) for treatment of low back pain with radicular pain.@*METHODS@#We retrospectively analyzed the clinical data of 78 patients with low back pain and radicular pain admitted to the Department of Orthopedics of Beijing Chuiyangliu Hospital from March, 2017 to April, 2019. Thirty-three of the patients received treatment with LTEB (LTEB group), and 45 received comprehensive conservative treatment including traction, massage, acupuncture and physiotherapy (control group). The demographic and clinical data of the two groups were compared. The patients were followed up for 3 to 24 months, and numerical rating scale (NRS) and Oswestry disability index (ODI) scores of the patients were evaluated before the treatment and at 2 weeks, 1 month and 3 months after discharge to assess the efficacy of the treatment.@*RESULTS@#The mean operation time of LTEB was 25.7 7.5 min (15-45 min). After the operation, 5 patients developed weakness of the lower limbs but all recovered within 24-72 h. The patients receiving LTEB all showed significantly decreased NRS scores for low back and radicular pain and ODI scores after the operation (@*CONCLUSIONS@#As a minimally invasive approach, LTEB is effective for treatment of low back pain with radicular pain and can produce good short-term effects of pain relief and functional improvement.

Effectiveness of ozone therapy compared to other therapies for low back pain: a systematic review with meta-analysis of randomized clinical trials / Efetividade da ozonioterapia comparada a outras terapias para dor lombar: revisão sistemática com metanálise de ensaios clínicos randomizados

Abstract Background and objectives: Low back pain is a prevalent disease in the adult population, whose quality of life is considerably affected. In order to solve this problem, several therapies have been developed, of which ozone therapy is an example. Our objective in this study was to determine the effectiveness of ozone therapy for lumbar pain relief in adult patients compared to other therapies (steroid and placebo). Method: We used randomized clinical trials to compare the effectiveness of ozone and other therapies for lumbar pain relief in adults (Prospero: CRD42018090807). Two independent reviewers searched the Medline (1966-April/2018), Scopus (2011-May/2018), Lilacs (1982-May/2018), and EMBASE (1974-March/2018) databases. We use the terms ozone and pain as descriptors. The primary variable was pain relief and the secondary ones were complication, degree of satisfaction, quality of life and recurrence of pain. Results: Of the 779 identified articles, six selected clinical trials show that ozone therapy is more effective for lumbar pain relief; however, they were mostly classified as having a high or uncertain risk of bias (Cochrane Handbook). The meta-analysis regarding the effectiveness of pain relief did not show a significant difference between groups in the three-month period (RR = 1.98, 95% CI: 0.46-8.42, p= 0.36; 366 participants). It also showed greater effectiveness of the ozone therapy at six months compared to other therapies (steroid and placebo) (RR = 2.2, 95% CI: 1.87-2.60, p< 0.00001; 717 participants). Conclusions: The systematic review has shown that ozone therapy used for six months for lumbar pain relief is more effective than other therapies; however, this result is not definitive as data from studies with moderate to high risk of bias were used.

Resumo Justificativa e objetivos: A lombalgia é uma enfermidade prevalente na população adulta, que tem sua qualidade de vida afetada consideravelmente. Com intuito de resolver este problema, desenvolveram-se várias terapias. Um exemplo é a ozonioterapia. Objetivamos neste estudo determinar a efetividade da ozonioterapia para alívio da dor lombar em pacientes adultos, quando comparada a outras terapias (esteroide e placebo). Método: Usamos de ensaios clínicos randomizados para comparar a efetividade do ozônio e de outras terapias para o alívio da dor lombar em adultos (Prospero: CRD42018090807). Dois revisores independentes analisaram as bases Medline (1966-Abril/2018), Scopus (2011-Maio/2018), Lilacs (1982-Maio/2018) e Embase (1974-Março/2018). Como descritores, usamos termos ozone e pain. Temos como variável primária o alívio da dor e como variáveis secundárias: complicação, grau de satisfação, qualidade de vida e recorrência da dor. Resultados: Os seis ensaios clínicos selecionados, de 779 artigos identificados, mostram que o grupo do ozônio é mais efetivo para o alívio da dor lombar, porém, foram classificados em sua maioria com alto ou incerto risco de viés (Handbook Cochrane). A metanálise referente à efetividade no alívio da dor não apresentou diferença significante entre os grupos no período de três meses (RR = 1,98; 95% IC: 0,46-8,42; p= 0,36; 366 participantes). Também denotou maior efetividade em seis meses do grupo ozônio em relação a outras terapias (esteroide e placebo) (RR = 2,2; 95% IC: 1,87-2,60; p< 0,00001; 717 participantes). Conclusões: A revisão sistemática demonstrou que ozonioterapia usada por seis meses para alívio da dor lombar é mais efetiva do que outras terapias. Entretanto, esse resultado não é definitivo, visto que foram usados dados de estudos com moderado a alto risco de viés.

Factores de crecimiento ozonizados en el síndrome facetario lumbar / Ozonized growth factors in the lumbar facet syndrome

El tratamiento de las patologías discales y degenerativas que afectan a las articulaciones interfacetarias de la columna vertebral representan entre ambas más del 95% de los objetivos curativos en esta área del cuerpo, en razón de esto, esta investigación evalúa los efectos de los factores de crecimiento ozonizados en pacientes con diagnóstico de síndrome facetario lumbar, así como también, valorar la intensidad del dolor en el síndrome facetario, determinando el grado de movilidad articular previo y posteriora la infiltración. Métodos: la presente investigación se considera un estudio descriptivo y prospectivo, con un diseño es preexperimental, en pacientes que acudieron a la consulta de terapia del dolor del Hospital Dr. Pedro García Clara, en Ciudad Ojeda, estado Zulia-Venezuela. Los resultados se expresaron como valores absolutos, en porcentajes, media ± desviación estándar (M±DE), analizando las diferencias de los resultados mediante la prueba "t" de Student, cuando fueron aplicables, tomando un valor de p<0.05. Resultados: se evidencia, que los factores de crecimiento ozonizados infiltrados en los pacientes con diagnóstico de síndrome facetario lumbar, tienen efectos clínicos significativos, en cuanto a la disminución de la intensidad del dolor y el aumento del grado de movilidad articular. Conclusiones: el uso del plasma rico ozonizado es una técnica efectiva para disminuir la intensidad del dolor cuando es utilizado en el síndrome facetario ya que permite una aumento significativo de los grados de movilidad articulares de la columna lumbar (flexión, extensión e inclinación. Es una técnica sencilla, eficaz, económica y con efectos adversos mínimos(AU)

The treatment of the disc and degenerative pathologies that affect the interfaceative joints of the spine represent between them more than 95% of the healing objectives in this area of the body, because of this, this research evaluates the effects of the growth factors Ozonized in patients with a diagnosis of lumbar facet syndrome, as well as assessing the intensity of pain in facet syndrome, determining the degree of joint mobility before and after infiltration. Methods: the present investigation is considered a descriptive and prospective study, with a pre-experimental design, in patients who attended the pain therapy consultation of the Dr. Pedro García Clara Hospital, in Ciudad Ojeda, Zulia-Venezuela state. thee results were expressed as absolute values, in percentages, mean ± standard deviation (M ± SD), analyzing the differences of the results by means of the Student "t" test, whenapplicable, taking a value of p <0.05. Results: it is evidenced that infiltrated ozonized growth factors in patients with a diagnosis of lumbar facet syndrome, have significant clinical effects, in terms of the decrease in pain intensity and the increase in the degree of joint mobility. Conclusions: the use of ozonated rich plasma is an effective technique to reduce the intensity of pain when used in facet syndrome because it allows a significant increase in the degrees of joint mobility of the lumbar spine (flexion, extension and tilt.) It is a simple, effective technique, economic and with minimal adverse effects(AU)

Uso del topiramato en pacientes con síndrome de dolor lumbar crónico con síntomas ansiosos y depresivos secundarios a sensibilización central con y sin compromiso neuropático resistente a tratamiento convencional / Use of topiramato in patients with chronic lumbar pain syndrome with ansiosius symptoms and secondary depression to central sensitization with and without neuro-pathic commitment resistant to conventional treatment

INTRODUCCIÓN: El dolor lumbar crónico genera alta disfuncionalidad, su tratamiento es complejo y en algunos casos se presenta refractariedad a tratamientos convencionales. El síndrome de sensibilización central por dolor lumbar involucra presencia de síntomas ansiosos, depresivos, trastorno del sueño, fatiga, alteraciones del apetito y disfuncionalidad en actividades de la vida diaria. El manejo del dolor lumbar crónico con síndrome de sensibilización central es dificultoso, requiere de intervenciones multidimensionales y esquemas farmacológicos atípicos. OBJETIVO: Se describe el uso de topiramato como fármaco coadyuvante en el manejo de pacientes con dolor lumbar crónico resistente a tratamiento standard en 25 pacientes. MATERIALES Y MÉTODO: Seguimiento a 12 semanas y evaluación de funcionalidad, sintomatología ansiosa-depresiva, control del dolor y fatiga a través de múltiples escalas. Resultados: La dosis mediana fue de 300mg. El 72 por ciento (18 pacientes) presenta mejoría estadística en síntomas angustiosos, depresivos, sueño, EVA de dolor y fatiga y funcionalidad. Solo el 16 por ciento (4 pac) presentan reacciones adversas que obligan a suspensión del fármaco. El 12 por ciento (3 pacientes) no presentaron respuesta terapéutica. DISCUSIÓN: El topiramato podría ser una opción coadyuvante para el manejo del síndrome de dolor lumbar crónico con síndrome de sensibilización central.

INTRODUCTION: The chronic low back pain causes severe dysfunction, treatment is complex and in some cases it can be refractory to usual treatment. Central Sensitivity syndrome secondary to chronic low back pain is characterized by anxious, depressive, sleep disorders, fatigue, eating disorders and damage in daily activities life. Management of this syndrome must be integrative and multidimensional. OBJECTIVES: Describe the use of topiramate in 25 patients with chronic low back pain for pain relief in refractory patients to standard treatment, during 12 weeks. MATERIALS AND METHODS: Following during 12 weeks, multiples Assessments about anxiety, depression, functionality, sleep quality, VAS pain and fatigue. Results: Median doses 300mg. 72 percent got pain relief, and decrease in anxious depressive symptoms, improve sleep quality, daily function. 16 percent didn't get pain relief and suffered adverse effects forcing suspension of the drug. 12 percent didn't get pain relief without adverse effects. DISCUSSION: Topiramate might be a treatment option for pain relief in these patients.

Uso de pregabalina en el tratamiento de la lumbociatalgia / Pregabalin for treatment of low back pain

La lumbociatalgia es un problema clínico común, que en la mayoría de los casos se autolimita y se puede tratar en forma conservadora, usando medidas no farmacológicas y analgésicos como paracetamol o los antiinflamatorios no esteroi-deos. Otro medicamento muy utilizado en nuestro medio es la pregabalina, a pesar de que no se encuentra aprobada para dicha indicación. En este trabajo, el autor se pregunta acerca de la utilidad clínica de la pregabalina y luego de hacer una búsqueda bibliográfica sobre la evidencia más actualizada y de mejor calidad acerca del tema, concluye que no es efectiva para lumbociatalgia y que se acompaña de efectos adversos significativos. Esto coincide con las recomenda-ciones de las guías internacionales, que en su mayoría desaconsejan el uso de anticonvulsivantes para la lumbalgia. (AU)

Sciatica is a common clinical situation, in most cases self-limited and which can be managed conservatively with nonpharmaco-logic treatment and analgesics, such as paracetamol or nonsteroidal anti-inflammatory drugs. Pregabalin is also commonly used, despite not being approved for this indication. In this article, the author queries about the clinical usefulness of pregabalin, and after carrying out a bibliographic search of the most recent and best-quality evidence, concludes that it is not effective in sciatica while it causes significant adverse effects. This is in line with the recommendations of most international guidelines,that do not recommend the use of anticonvulsivants drugs for the treatment of lumbalgia. (AU)

Effects of ozone on the pain and disability in patients with failed back surgery syndrome / Efeitos do ozônio na dor e na incapacidade em pacientes com síndrome dolorosa pós-laminectomia

Summary Introduction: Low back pain is one of the painful disorders of higher prevalence. It has several etiologies and surgery may be indicated in the presence of neurological deficits or compression syndromes. However, in up to 40% of cases, patients develop worsening of pain and failed back surgery syndrome (FBSS), which is an important cause of chronic pain with high morbidity and disability. In the last two decades, ozone has been shown to be a new therapeutic option for FBSS due to its analgesic and anti-inflammatory properties. Objective: To evaluate the effect of ozone therapy on pain and disability in patients with failed back surgery syndrome. Method: We selected 19 patients undergoing epiduroscopy and injection of ozone. Patients were evaluated preoperatively and 21 days after the procedure, using the following instruments: Visual Analogue Scale (VAS), Brief Pain Inventory, Roland-Morris Questionnaire Disability, Oswestry Disability Index (ODI), Neuropathic Pain Symptom Inventory and Douleur Neuropathique 4. Results: The patients showed significant pain relief, but no improvement was observed in the functional scales. Conclusion: Our results suggest that epidural ozone therapy can be a treatment option in FBSS to reduce the intensity of the pain.

Resumo Introdução: A dor lombar é um dos distúrbios dolorosos de maior prevalência. Tem diversas etiologias e, na presença de déficits neurológicos ou síndromes compressivas, pode ser indicada cirurgia. Entretanto, em até 40% dos casos os pacientes podem evoluir com piora da dor e síndrome dolorosa pós-laminectomia (SDPL), que se constitui em uma importante causa de dor crônica com grande morbidade e incapacidade. Nas últimas duas décadas, o ozônio tem se mostrado uma nova opção terapêutica para a SDPL em virtude das suas propriedades analgésicas e anti-inflamatórias. Objetivo: Avaliar o efeito da ozonioterapia na dor e na incapacidade de pacientes com SDPL. Método: Foram selecionados 19 pacientes, submetidos a epiduroscopia e aplicação de ozônio. Os pacientes foram avaliados no pré-operatório e 21 dias após o procedimento, por meio de Escala Visual Analógica, Inventário Breve de Dor, Questionário Roland-Morris de Incapacidade, Oswestry Disability Scale, Inventário de Sintomas de Dor Neuropática e Questionário de Dor Neuropática. Resultados: Os pacientes apresentaram redução significante nos escores das escalas de avaliação de dor; porém, essa redução não foi observada na avaliação da incapacidade funcional. Conclusão: Os dados obtidos sugerem que a ozonioterapia epidural pode ser uma opção de manejo da SDPL na diminuição da intensidade da dor.

Comparison of transforaminal and interlaminar epidural steroid injections for the treatment of chronic lumbar pain / Comparação das técnicas transforaminal e interlaminar de injeções epidurais de esteroides para o tratamento de dor lombar crônica

Abstract Study design: A cross-sectional study. Objective: We compared the 12 month outcomes of fluoroscopically guided transforaminal epidural steroid injections with interlaminar epidural steroid injections for the treatment of chronic lumbar spinal pain. Chronic lower back pain is a multifactorial disorder with many possible etiologies. The lifetime prevalence of spinal pain is reportedly 65-80% in the neck and lower back. Epidural injection of corticosteroids is a commonly used intervention for managing chronic spinal pain. Methods: Patients who did not benefit from previous treatments were included in this study. Injections were performed according to magnetic resonance imaging findings at the nearest level of lumbar pathology; 173 patients received interlaminar epidural steroid injections and 126 patients received transforaminal epidural steroid injections. All of the patients were regularly followed up for 12 months using a verbal numeric rating scale. Magnetic resonance imaging findings, complications, verbal numeric rating scale, and satisfaction scores were recorded. Results: Lumbar disk pathology was the most frequently encountered problem. The interlaminar epidural steroid injections were preferred at the L4-L5 intervertebral level. Verbal numeric rating scale scores significantly decreased during the 12-month period compared to basal scores (p < 0.001). Significant differences between the two groups according to verbal numeric rating scale and satisfaction scores were not observed (p > 0.05). There were no major complications; however, the interlaminar epidural steroid injections group had 22 (12.7%) minor complications, and the transforaminal epidural steroid injections group had 12 (9.5%) minor complications. Conclusions: This study showed that interlaminar epidural steroid injections can be as effective as transforaminal epidural steroid injections when performed at the nearest level of lumbar pathology using fluoroscopy in 12-month intervals.

Resumo Desenho do estudo: Estudo transversal. Objetivo: Comparamos os desfechos de 12 meses de injeções peridurais de esteroides usando a técnica transforaminal (IPETF) guiada por fluoroscopia com as injeções peridurais de esteroides usando a técnica interlaminar (IPEIL) para o tratamento da dor lombar crônica. A dor lombar crônica é uma doença multifatorial com muitas etiologias possíveis. Relata-se que a prevalência de dor na coluna durante a vida é de 65%-80% no pescoço e parte inferior das costas. A injeção peridural de corticosteroides é uma intervenção comumente usada para controlar a dor crônica da coluna vertebral. Métodos: Pacientes que não obtiveram benefício de tratamentos anteriores foram incluídos neste estudo. As injeções foram realizadas de acordo com os achados em Ressonância Magnética (RM) ao nível mais próximo da patologia lombar; 173 pacientes receberam IPEIL e 126 pacientes receberam IPETF. Todos os pacientes foram acompanhados regularmente por 12 meses, usando uma escala numérica verbal (ENV) para a classificação. Achados em RM, complicações, escores ENV e índices de satisfação foram registrados. Resultados: Patologia em disco lombar foi o problema mais frequentemente encontrado. IPEIL foi preferido ao nível intervertebral de L4-L5. Os escores da ENV diminuíram significativamente durante o período de 12 meses em comparação com os valores basais (p < 0,001). Não houve diferenças significativas entre os dois grupos de acordo com a ENV e os índices de satisfação (p > 0,05). Não houve grandes complicações, mas houve complicações menores em 22 (12,7%) no grupo IPEIL e 12 (9,5%) no grupo IPETF. Conclusões: Este estudo mostrou que IPEIL pode ser tão eficaz como IPETF quando realizadas ao nível mais próximo da patologia lombar usando a fluoroscopia em intervalos de 12 meses.

Tratamiento del síndrome lumbálgico agudo con auriculoterapia / Acute lumbar syndrome treatment with auriculotherapy

Introducción: en el primer nivel de atención, las lumbalgias representan el 5 por ciento de las consultas. Se utiliza un abordaje racional, siendo tratados con técnicas como la Auriculoterapia. Objetivo: evaluar el uso de la técnica de Auriculoterapia en el tratamiento del síndrome lumbálgico agudo. Métodos: estudio exploratorio, prospectivo, en pacientes con síndrome lumbálgico que asistieron al cuerpo de guardia del Policlínico María Emilia Alfonzo de Madruga, en el período de enero del 2015 a enero del 2016. Universo constituido por 120 pacientes, se seleccionó una muestra no probabilística de tipo intencionada de 60 pacientes diagnosticados por ortopedia, divididos en dos grupos para el tratamiento: grupo I: fisioterapia convencional indicada más medicamentos según la sintomatología del proceso, grupo II: fisioterapia convencional indicada más medicamentos según la sintomatología del proceso más Auriculoterapia según el diagnóstico asiático y la exploración del pabellón auricular. Se utilizó la hoja de cargo y la historia clínica individual, se tuvieron en cuenta variables como edad, sexo, diagnóstico según causa, síntomas asociados y evolución del tratamiento en ambos grupos. Resultados: predominó el grupo de edades de 56 a 65 años para un 37 por ciento, del sexo femenino para un 65 por ciento, diagnóstico de artrosis con 49 pacientes para un 82 por ciento, síntomas asociados de dolor en 60 para un 100 por ciento, con evolución buena en 42 para un 70 por ciento. Conclusiones: los pacientes con síndrome lumbálgico evolucionaron satisfactoriamente con el tratamiento convencional, siendo más efectivo el tratamiento convencional más Auriculoterapia(AU)

Introduction: In the first level of health care, lumbagos represent 5 percent of the consultations. A rational approach is used, being treated with techniques such as auriculotherapy. Objective: Assess the use of the technique auriculotherapy to treat the acute lumbar syndrome. Methods: Exploratory, prospective study on patients with lumbar syndrome who attended the emergency room of María Emilia Alfonzo Polyclinic of Madruga, in the period from January 2015 to January 2016. The universe was made up by 120 patients, we chose a nonprobabilistic and nontargeted sample of 60 patients diagnosed by orthopaedics, divided into two groups for treatment: group I: conventional physiotherapy and medication indicated for the process symptoms; group II: conventional physiotherapy and medication indicated for the process symptoms, and auriculotherapy, for the Asian diagnostic and the auricular pavilion exploration. The chart and person's clinical record were used, and variables such as age, sex, cause diagnosis, associated symptoms and treatment evolution were considered in both groups. Results: The predominating age group was 56-65 years (37 percent), female sex (65 percent), arthrosis diagnosed with 49 patients (82 percent), pain-associated symptoms in 60 (100 percent), with good evolution (70 percent). Conclusions: The patients with lumbar syndrome evolved satisfactorily with the conventional treatment, being more effective the conventional treatment plus auriculotherapy(AU)

The Effectiveness of Oral Corticosteroids for Management of Lumbar Radiating Pain: Randomized, Controlled Trial Study

BACKGROUND: Although both pregabalin and gabapentin are known to be useful for treating lumbar radiating pain and reducing the incidence of surgery, the oral corticosteroids sometimes offer a dramatic effect on severe radiating pain despite the lack of scientific evidence. METHODS: A total of 54 patients were enrolled among 703 patients who complained of lumbar radiating pain. Twenty patients who received an oral corticosteroid was classified as group A and 20 patients who received the control drugs (pregabalin or gabapentin) as group B. Oswestry Disability Index (ODI), Revised Roland Morris disability questionnaire (RMDQ), Short Form 36 (SF-36) questionnaire, lumbar radiating pain, objective patient satisfaction, and objective improvement of patients or physicians were assessed at 2, 6, and 12 weeks after medication. RESULTS: No difference in the sex ratio and age was observed between the groups (p = 0.70 and p = 0.13, respectively). Group A showed greater improvement in radiating pain after 2, 6, and 12 weeks than group B (p < 0.001, p = 0.001, and p < 0.001, respectively). No differences were observed between the groups in satisfaction at the beginning and 12 weeks after taking the medication (p = 0.062 and p = 0.061, respectively) and in objective improvement of patients and physicians (p = 0.657 and p = 0.748, respectively). Group A was less disabled and had greater physical health scores than group B (p = 0.014 and p = 0.017, respectively). CONCLUSIONS: Oral corticosteroids for the treatment of lumbar radiating pain can be more effective in pain relief than gabapentin or pregabalin. The satisfaction of patients and physicians with the drug and objective improvement status were not inferior to that with gabapentin or pregabalin.