The effect of kinesiophobia in older people with acute low back pain: longitudinal data from Back Complaints in the Elders (BACE) / O efeito da cinesiofobia em idosos com dor lombar aguda: dados longitudinais do estudo Back Complaints in the Elders (BACE) / El efecto de la quinesofobia en personas mayores con dolor lumbar agudo: datos longitudinales de Back Complaints in the Elders (BACE)

Abstract: This study aimed to investigate the course of low back pain (LBP) intensity over a period of 12 months in older people with and without kinesiophobia.This was an international multicenter study. LBP intensity was examined by using the Numerical Pain Scale at baseline and over five follow-up periods. The Fear-Avoidance Beliefs Questionnaire was used to measure patients' beliefs and fears. The study included 532 older adults (non kinesiophobic = 227; kinesiophobic = 305). The individuals had moderate pain at baseline, with a significant difference observed between the groups. Participants showed a rapid improvement in the first 6 weeks, followed by minor improvements in the succeeding months. However, a significant difference between groups remained during the follow-up period. Independently, kinesiophobia is a significant prognostic factor. These findings suggest the importance of screening for psychosocial factors in the management of older patients with LBP. Practice implications: patients need to be warned that pain can be perpetuated by inappropriate avoidance behaviors that may later lead to disability.

Resumo: O estudo teve como objetivo investigar a evolução da intensidade da dor lombar (DL) ao longo de 12 meses em idosos com e sem cinesiofobia. Este foi um estudo multicêntrico internacional. A intensidade da DL foi avaliada com a Numerical Pain Scale na linha de base e ao longo de 5 períodos de seguimento. As crenças e os medos dos pacientes foram medidos com o Fear-Avoidance Beliefs Questionnaire. O estudo incluiu 532 idosos (sem cinesiofobia = 227; com cinesiofobia = 305). Os idosos apresentavam dor moderada na linha de base, com uma diferença significativa entre os grupos. Os participantes mostraram melhora rápida nas primeiras seis semanas, seguida por melhoras menores nos meses seguintes. Entretanto, persistiu uma diferença significativa entre os grupos durante o período de seguimento. A cinesiofobia é um fator prognóstico importante e independente. Os achados sugerem a importância da triagem de fatores psicossociais no manejo de pacientes idosos com DL. Implicações práticas: os pacientes devem ser advertidos que a dor pode ser perpetuada por comportamentos inadequados de evitação, podendo à incapacidade no longo prazo.

Resumen: El objetivo fue investigar el curso de la intensidad del dolor lumbar (LBP), durante un período de 12 meses, en personas ancianas con y sin quinesofobia. Se trata de un estudio multicéntrico internacional. La intensidad del LBP se evaluó usando la Escala Numérica de Dolor en una base de referencia y sobre 5 períodos de seguimiento. Con el fin de medir las creencias y temores de los pacientes, usamos el Fear-Avoidance Beliefs Questionnaire. El estudio incluyó a 532 ancianos (no quinesofóbicos = 227; quinesofóbicos = 305). Los ancianos sufrieron un dolor moderado en la base de referencia, con una significativa diferencia observada entre grupos. Los participantes mostraron una rápida mejora durante las 6 primeras semanas, seguidas por mejoras menores en los meses siguientes. No obstante, se mantuvo una diferencia significativa entre grupos durante el período de seguimiento. Independientemente, la quinesofobia es un factor pronóstico importante. Estos resultados sugieren la importancia de monitorear factores psicosociales en la gestión de pacientes ancianos con LBP. Implicaciones clínicas: los pacientes necesitan ser avisados de que el dolor puede perpetuarse por comportamientos inapropiados de prevención que quizás más tarde conduzcan a la discapacidad.

Cross-cultural adaptation, validity and reproducibility of the Back Beliefs Questionnaire among older Brazilians with acute low back pain. A cross-sectional study

ABSTRACT BACKGROUND: Low back pain (LBP) has emerging as an epidemic, multifactorial and multidimensional condition in older age. Assessment of attitudes and beliefs of patients with back pain is necessary for understanding the impact of psychosocial factors on pain perception and management. OBJECTIVES: To cross-culturally adapt and examine the validity and reproducibility (intra and interrater reliability and agreement) of the Back Beliefs Questionnaire (BBQ) in older Brazilians with acute LBP. DESIGN AND SETTING: Cross-sectional methodological report conducted at the Department of Physical Therapy of the Universidade Federal de Minas Gerais, Belo Horizonte, Brazil. METHODS: The present study was conducted for translating, adapting, and examining the psychometric properties of a questionnaire. Participants aged ≥ 60 years experiencing an acute episode of LBP were recruited. Coefficients of internal consistency, reliability and agreement were obtained using Cronbach's α, intraclass correlations, and standard error of measurement and the smallest detectable change, respectively. RESULTS: Twenty-six participants aged between 60-84 years and reporting a mean of 9.8 (4.3) years of schooling completed the study. The Brazilian Portuguese-language version of the BBQ (BBQ-Brazil) was proposed and presented with adequate conceptual, semantic, operational, and measurement equivalence from the original version. Intra and interrater evaluations showed moderate (0.74) and excellent (0.91) intraclass correlation coefficients, respectively, with small standard error of measurement for both evaluations. Internal consistency was considered adequate (0.70). CONCLUSION: BBQ-Brazil had consistent measurements of validity and reproducibility, and proved to be a valuable tool in clinical practice for addressing attitudes and beliefs of older patients with acute LBP.

In vivo exposure for fear of pain and avoidance of movement in low back pain / Exposición en vivo al miedo al dolor y evitación del movimiento en dolor lumbar / Exposição ao vivo para o medo da dor e evitação do movimento em dor lombar

ABSTRACT Objectives: to verify the effects of hierarchization and in vivo exposure for fear of pain, avoidance of movement, and anxiety in chronic low back pain. Methods: quasi-experimental study. The 27 patients who participated graded the damage associated with the movements in each of the 40 activities of daily living depicted in pictures using a scale from 0 to 100. The patients chose five out of all the activities that received a score higher than 50 to carry out the exposure. The intensities of fear and anxiety were measured before and after each exposure session. Results: the frequencies of the gender were equal, and the mean age was 44.9 years. The activities chosen more frequently for the exposure were shoveling (33.3%) and running (33.3%). There was reduction of fear and anxiety before and after exposure (p<0.001). Conclusions: hierarchization and in vivo exposure were effective in reducing fear and anxiety.

RESUMEN Objetivos: verificar los efectos de la jerarquización y exposición viva al supuesto miedo al dolor y evitar el movimiento y la ansiedad en pacientes con dolor lumbar crónico. Métodos: estudio cuasiexperimental. Los 27 pacientes que participaron clasificaron el dolor de cada uno de los 40 movimientos de la actividad cotidiana representados en fotos, utilizando una escala de 0-100. Entre las actividades clasificadas con más de 50, eligieron 5 para realizar la exposición. La intensidad del miedo y la ansiedad fueron medidas antes y después de cada sesión de exposición. Resultados: la muestra expresó equivalencia entre sexos, media etaria de 44,9 años. Las actividades más elegidas para la exposición fueron: trabajar con la pala (33,3%) y correr (33,3%). Hubo reducción del miedo y de la ansiedad antes y después de las exposiciones (p<0,001). Conclusiones: la jerarquización y exposición vivas fueron efectivas para reducir el miedo y la ansiedad.

RESUMO Objetivos: verificar os efeitos do uso da hierarquização e exposição ao vivo para a crença de medo da dor e evitação do movimento e ansiedade em pacientes com dor lombar crônica. Métodos: estudo quase-experimental. Os 27 pacientes que participaram graduaram o dano de cada um dos 40 movimentos de atividades da vida diária representados em fotos, utilizando uma escala de 0 a 100. Dentre as atividades graduadas acima de 50, escolheram 5 para realizar a exposição. As intensidades do medo e da ansiedade foram mensuradas antes e depois de cada sessão de exposição. Resultados: a frequência entre os sexos foi equitativa, a média da idade foi de 44,9 anos. As atividades mais escolhidas para a exposição foram trabalhar com a pá (33,3%) e correr (33,3%). Houve redução do medo e ansiedade antes e após as exposições (p<0,001). Conclusões: a hierarquização e exposição ao vivo foram efetivas na redução do medo e da ansiedade.

Fatores biopsicossociais associados com a incapacidade em idosos com dor lombar aguda: estudo BACE-Brasil / Biopsychosocial factors associated with disability in older adults with acute low back pain: BACE-Brasil study

Resumo Este estudo transversal avaliou a associação de fatores biopsicossociais com a incapacidade em idosos com um novo episódio de dor lombar aguda. Foram incluídos idosos com um novo episódio de dor lombar aguda e excluídos aqueles com alterações cognitivas e deficiências motoras graves. A incapacidade foi avaliada pelo Roland Morris Disability Questionnaire. Os fatores biopsicossociais (variáveis clínicas, funcionais, estado de saúde, psicológicas e sociais) foram avaliados por um questionário estruturado multidimensional e exame físico. Regressão linear multivariada foi utilizada para análise dos dados com significância estatística de 0,05. Participaram 386 idosos com média de idade de 71,6 (±4,2) anos e incapacidade de 13,7 (±5,7) pontos. A análise de regressão linear multivariada identificou que pior saúde física e mental (avaliados através do SF-36), baixa autoeficácia em quedas, dificuldade para dormir por causa da dor, piores níveis de cinesiofobia, maiores índices de massa corporal, presença de rigidez matinal na coluna lombar, maior intensidade de dor, sexo feminino e pior mobilidade funcional foram significativamente associados com incapacidade (p < 0,05). Incapacidade relacionada à dor lombar está significativamente associada com piores condições biopsicossociais de saúde em idosos.

Abstract This cross-sectional study evaluated the association of biopsychosocial factors with disability in older adults with a new episode of acute low back pain. Older patients with a new episode of acute low back pain were included and those with cognitive alterations and severe motor impairment were excluded. Disability was assessed using the Roland Morris Disability Questionnaire. The biopsychosocial factors (clinical, functional, health status, psychological and social variables) were evaluated by a structured multidimensional questionnaire and physical examination. A multivariate linear regression was used to analyze data with a statistical significance of 0.05. A total of 386 older individuals with a mean age of 71.6 (± 4.2) years and disability of 13.7 (± 5.7) points were enrolled. Our regression analyses identified that worse physical and mental health (assessed through SF-36), low falls self-efficacy, trouble sleeping due to pain, worse kinesiophobia levels, higher body mass indexes, lumbar morning stiffness, increased pain intensity, female gender and worse functional mobility were significantly associated with baseline disability (p < 0.05). Low back pain-related disability is significantly associated with worse biopsychosocial health conditions in older adults.

Low back pain among primary school teachers in rural Kenya: prevalence and contributing factors

Background: Low back pain (LBP) has been recognised as a common occupational problem with a high prevalence among work-related musculoskeletal disorders. Although there appears to be a high prevalence of LBP among school teachers, there is inadequate information on the prevalence and predisposing factors of LBP among primary school teachers in rural Western Kenya.Aim: To determine the prevalence, factors associated with LBP and physical disability caused by LBP.Setting: The setting was public schools in rural Western Kenya selected by simple random sampling method.Methods: A cross-sectional study was conducted among primary teachers from public schools using a self-administered questionnaire. The questionnaire included information on LBP, demographic data, occupational and psychosocial factors and disability score. The 12-month prevalence, associated factors and LBP disability were analysed.Results: The 12-month self-reported prevalence of LBP among primary teachers was 64.98%, with close to 70% of them reporting minimal disability. The logistic regression analysis showed that female gender (odds ratio [OR]: 1.692, p < 0.02) was associated with LBP and high supervisor support (OR: 0.46, p < 0.003) was negatively associated with LBP.Conclusion: The prevalence of LBP among primary school teachers in rural Western Kenya is 64.98%, with the majority of them reporting minimal disability. The identified risk factors were female gender and low supervisor support. The presence of work-related psychosocial risk factors in this study suggests a comprehensive approach in evaluation and management of LBP. Preventive measures should be in place to prevent and reduce the progression of LBP disability

Evaluación de ansiedad y depresión en pacientes con lumbalgia crónica en la unidad de dolor de un hospital universitario / Evaluation of anxiety and depression in patients with chronic low back pain of a university hospital pain unit

La ansiedad y la depresión son las formas más frecuentes de alteraciones psicológicas que se ven en pacientes con dolor crónico, en general; y lumbalgia crónica, en particular. No existen, en nuestro medio, reportes sobre estos trastornos psicológicos en pacientes con lumbalgia crónica, siendo pocos los estudios en latinoamérica. El objetivo del presente estudio piloto fue evaluar la presencia de ansiedad y depresión en pacientes con lumbalgia crónica, acompañada o no de dolor radicular, que consultaron en el servicio de tratamiento del dolor de nuestro hospital universitario. La escala de ansiedad y depresión Hospitalaria (EADH, versión en español de la hospital anxiety and depression scale, HADS) fue el instrumento utilizado para la valoración de ansiedad y depresión. La muestra fue de 25 pacientes. De éstos, 16 (64 por ciento) presentaron diagnóstico de ansiedad y 7 (28 por ciento) de depresión. La frecuencia de ansiedad en esta muestra fue más alta que la de depresión que, sin contar los casos probables, fue de 28 por ciento. Se registraron 3 casos de diagnóstico probable de ansiedad y 7 de depresión. Los pacientes estudiados presentaban dolor intenso e incapacitante, evaluado por el Inventario abreviado de dolor. Se observó una correlación lineal positiva moderada a débil, pero estadísticamente significativa entre ansiedad y depresión, y la intensidad del dolor medido el Índice de Intensidad. Se encontró una correlación positiva débil, aunque estadísticamente significativa entre ansiedad y depresión y el Índice de Interferencia. En conclusión, en este estudio piloto en pacientes con lumbalgia crónica se detectaron, utilizando la escala de ansiedad y depresión hospitalaria, niveles elevados de ansiedad, con niveles menores de depresión, trastornos que se correlacionan con la intensidad del dolor y la incapacidad derivada de éste de manera moderada a débil. Este es el primer estudio en nuestro medio que evalúa ansiedad y depresión en pacientes con lumbalgia crónica, utilizando la escala de ansiedad y depresión hospitalaria validada en español. Los hallazgos obtenidos exigen un abordaje interdisciplinario de la lumbalgia crónica, que podrá incluir el uso de antidepresivos con acción ansiolítica como la duloxetina.

Anxiety and depression are frequent disorders in patients with chronic pain, in particular in the spine. No studies evaluating these psychological disorders have been performed in our country in chronic low back pain patients, and a few were found in latin America. The goal of the present pilot study was to evaluate the presence of anxiety and depression in chronic back pain patients with or without radicular pain, utilizing the hospital anxiety and depression scale, in the Spanish validated version. 25 patients were chosen of the ambulatory consultation of the chronic pain treatment unit of the university hospital. 16 (64 percent) presented anxiety and 7 depression (28 percent). The probable cases were 3 for anxiety and 7 for depression. All the patients had intense pain and functional impairment, evaluated by the brief pain Inventory instrument. A moderate to weak, statistically significant, positive correlation, were observed between anxiety and depression and pain intensity and interference, measured by the Intensity and interference scores. In conclusion, in the present pilot study in chronic low back pain patients, high levels of anxiety was observed, with lower frequency of depression, utilizing, for first time in our country, the hospital anxiety and depression scale in Spanish. Weak to moderate positive correlations were observed between anxiety and depression and pain intensity and interference in patient daily activities. Under the light of these findings, an interdisciplinary approach of chronic low back pain patients is mandatory, including the use of antidepressants with a tranquilizer profile, as it is duloxetine.

Relación de los factores psicoemocionales en la intensidad del dolor y la funcionalidad en usuarios adultos con lumbalgia crónica inespecífica de las comunas de Coquimbo y La Serena / Relationship of psycho-emotional factors in pain intensity and functionality in adult users with non-specific chronic low back pain in the commune of Coquimbo and La Serena

Introducción: el dolor es una experiencia multidimensional que considera los tres ejes de la salud: el biológico, el psicológico y el social. Cuando el daño estructural no es la causa esencial del dolor experimentado, tal como sucede en la lumbalgia crónica inespecífica (LCI), se hace necesario considerar los ejes no biológicos para un abordaje integral. Por lo tanto, el objetivo de este estudio es analizar la relación entre los factores psicoemocionales con la intensidad del dolor y la funcionalidad de las personas con LCI. Materiales y métodos: el tipo de estudio es no-experimental, cuantitativo y correlacional. La muestra corresponde a un n=55 usuarios de los CESFAM Sergio Aguilar, de la comuna de Coquimbo y Juan Pablo II, de la comuna de La Serena. Se aplicaron cuestionarios sobre los factores psicoemocionales: kinesofobia, catastrofismo y autoeficacia, y las variables de limitación de la funcionalidad e intensidad del dolor. Los instrumentos utilizados fueron: escala de tampa para kinesofobia (TSK 11), escala de catastrofismo del dolor (PCS), cuestionario sobre la percepción de autoeficacia, escala de funcionalidad o incapacidad por dolor lumbar Oswestry y escala visual análoga (EVA), respectivamente. Resultados: hubo una relación entre las variables catastrofismo-limitación de la funcionalidad (rho=0,537, p<0,005), catastrofismo-intensidad del dolor (rho=0,437, p=0,001), kinesofobia-limitación de la funcionalidad (rho=0,418, p=0,002) y autoeficacia-limitación de la funcionalidad (rho=-0,518, p<0,005), siendo estas correlaciones significativas estadísticamente. Discusión: los tres factores psicoemocionales se relacionan con la funcionalidad. No obstante, solo el catastrofismo se relaciona con la intensidad del dolor. Por ende, es relevante que el kinesiólogo considere en su intervención terapéutica estos factores para enfocar el posterior abordaje kinésico con una visión e interacción multidisciplinar.

Introduction: pain is a multidimensional experience that considers the three axes of health: biological, psychological and social. When structural damage is not the essential cause of the pain experienced, as it happens in non-specific chronic low back pain (NSCL), it is necessary to consider the non-biological axes for an integral approach. Therefore, the objective of this study is to analyze the relationship between psychoemotional factors with pain intensity and functionality of persons with NSCL pain. Materials and Methods: the type of study is non-experimental, quantitative and correlational. The sample corresponds to n=55 users of the CESFAM Sergio Aguilar, of the commune of Coquimbo and Juan Pablo II, of the commune La Serena. Questionnaires were applied on psychoemotional factors: kinesophobia, catastrophism and self-efficacy, and the variables of limitation of the functionality and intensity of pain. With the instruments: Tampa scale for kinesophobia (TSK 11), pain catastrophism scale (PCS), self-efficacy perception questionnaire, Oswestry functionality scale and analogous visual scale (EVA) respectively. Results: there was a relationship between the variables catastrophism - limitation of the functionality (rho=0,537, p<0,005), catastrophism - intensity of pain (rho=0,437, p=0,001), kinesophobia - limitation of the functionality (rho=0,418, p=0,002) and self-efficacy-limitation of the functionality (rho = - 0,518, p<0,005), these correlations being statistically significant (p<0,005). Discussion:tThe three psychoemotional factors are related to functionality. However, only catastrophism is related to pain intensity. Therefore, it is relevant that the physical therapist considers these factors in his therapeutic intervention, in order to focus the subsequent kinesthetic approach with a multidisciplinary vision and interaction.

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.

Fear-avoidance beliefs increase perception of pain and disability in Mexicans with chronic low back pain / Crenças de medo e evitação aumentam a percepção de dor e incapacidade em mexicanos com lombalgia crônica

ABSTRACT Background: Fear-avoidance beliefs are related to the prognosis of chronicity in low back pain in subacute stages, however in chronic pain, is no clear the influence of these factors; it has been suggested that the study population can determine the magnitude of influence on disability and pain of those suffering from back pain. Currently, information does not exist in the Mexican population. Objective: To analyze the relationship between fear-avoidance beliefs with pain and disability in Mexicans with chronic low back pain; analyze potentials differences between subgroups according to the time of evolution. Methods: Cross-sectional study in Mexicans with chronic LBP aged between 18 and 45. Data were collected on general socio demographic characteristics, time of evolution, body mass index, pain, disability and fear-avoidance beliefs. Results: 33 men and 47 women, with an average age of 34.19 ± 7.65 years. Higher scores of fear-avoidance beliefs were obtained in women (47.2 ± 20.99 versus 38.5 ± 9.7; p = 0.05) and single participants (p = 0.04). A positive correlation was found between disability (r = 0.603, p < 0.001) and pain (r = 0.234, p = 0.03) with high scores of fear-avoidance beliefs. Through generalized linear models for disability, total score of the fear avoidance beliefs questionnaire showed a standardized beta coefficient of 0.603, p < 0.001 (R 2 of 0.656); for pain showed a standardized beta coefficient of 0.29, p = 0.01 (R 2 of 0.721). Conclusion: The present study suggests that there is a strong relationship between pain severity, FABQ scores, and functional disability in Mexicans with chronic LBP.

RESUMO Introdução: As crenças de medo e evitação estão relacionadas com o prognóstico da cronicidade da lombalgia nas fases subagudas; contudo, na dor crônica, não é clara a influência desses fatores. Sugeriu-se que um estudo populacional pode determinar a magnitude da influência da lombalgia sobre a incapacidade e a dor. Atualmente não há informação a esse respeito na população mexicana. Objetivo: Analisar a relação entre as crenças de medo e evitação com a dor e incapacidade em mexicanos com lombalgia crônica; analisar potenciais diferenças entre subgrupos determinados pelo tempo de evolução. Métodos: Estudo transversal em mexicanos com lombalgia crônica entre 18 e 45 anos. Coletaram-se dados sobre características sociodemográficas gerais, tempo de evolução, índice de massa corporal, dor, incapacidade e crenças de medo e evitação. Resultados: Foram estudados 33 homens e 47 mulheres com média de 34,19 ± 7,65 anos. Obtiveram-se escores de crenças de medo e evitação mais elevados em participantes do sexo feminino (47,2 ± 20,99 versus 38,5 ± 9,7; p = 0,05) e solteiros (p = 0,04). Encontrou-se uma correlação positiva entre a incapacidade (r = 0,603, p < 0,001) e a dor (r = 0,234, p = 0,03), com altas pontuações de crenças de medo e evitação. Por meio de modelos lineares generalizados para incapacidade, a pontuação total no questionário de crenças de medo e evitação mostrou um coeficiente beta padronizado de 0,603, p < 0,001 (R2 de 0,656); para a dor, mostrou um coeficiente beta padronizado de 0,29, p = 0,01 (R2 de 0,721). Conclusão: O presente estudo sugere que há uma forte relação entre a intensidade da dor, os escores no FABQ e a incapacidade funcional em mexicanos com lombalgia crônica.

Relación entre estados emocionales y variables clínicas en pacientes con dolor crónico lumbar / Connection between emotional states and clinical variables in patient with chronic lumbar pain

Introducción: el dolor lumbar crónico es una de las causas de sufrimiento en el mundo, y las emociones influyen en la respuesta del individuo ante la enfermedad. Objetivo: relacionar los estados emocionales de ansiedad, depresión e ira en pacientes con dolor crónico lumbar con algunas variables clínicas (tiempo de evolución, intensidad y persistencia). Métodos: estudio observacional, descriptivo-correlacional, policlínico de Cartagena, entre septiembre de 2012 y abril de 2013. Universo: 30 pacientes, muestra: 25 pacientes escogidos por muestreo intencional. Técnicas empleadas: entrevista estructurada, escala analógica visual, Idare, Staxi-2, Inventario de Beck. Resultados: distinguen como variables identificativas el sexo masculino y la configuración del vínculo de pareja (84 por ciento), ocupación: trabajadores (76 por ciento), la edad: adultos jóvenes (52 por ciento), con niveles medios de escolaridad (40 por ciento). En las variables clínicas predominó tiempo de evolución de 13 a 24 meses (56 por ciento), con una intensidad leve del dolor (48 por ciento) y persistencia intermitente (84 por ciento). Los estados emocionales mostraron porcentajes medios de ansiedad estado (60 por ciento), altos de ansiedad rasgo (56 por ciento), niveles de depresión moderados (40 por ciento), nulos de ira estado, moderados como rasgo (48 por ciento), y expresiones elevadas de esta (52 por ciento). Conclusiones: la presencia de porcentajes altos de sintomatología ansiosa, depresión e ira manifiestas en la muestra estudiada se asemejó a lo descrito en la literatura. La ansiedad e ira como rasgo de la personalidad no guardó relación con las variables clínicas estudiadas, se hallaron asociaciones entre intensidad y persistencia del dolor con la depresión y ansiedad e ira como estado y entre tiempo de evolución de la enfermedad y la ira estado(AU)

Introduction: Chronic lumbar pain is one of the suffering causes worldwide, and emotions influence the individual's response to the disease. Objective: To relate the emotional states of anxiety, depression and anger in patients with chronic lumbar pain with some clinical variables (time of evolution, intensity and persistence). Methods: Observational, descriptive-correlational study at Cartagena Polyclinic between September 2012 and April 2013. Universe: 30 patients, sample: 25 patients, selected by intentional sampling. Techniques employed: structured interview, visual analogue scale, Idare, Staxi-2, Beck Inventory. Results: Male sex and engagement configuration (84 percent) appear as identification variables, occupation: workers (76 percent), age: young adults (52 percent), mean schooling (40 percent) were identified as identification. The clinical variables predominated in the evolution period from 13 to 24 months (56 percent), with mild pain intensity (48 percent) and intermittent persistence (84 percent). Emotional states showed average percentages of state anxiety (60 percent), high trait anxiety (56 percent), moderate depression (40 percent), and mild anger status, moderate as trait (48 percent), (52 percent). Conclusions: The presence of high percentages of anxious symptoms, depression and anger manifested in the sample studied was similar to that described in the literature. Anxiety and anger as a personality trait was not related to the clinical variables studied, associations were found between intensity and persistence of pain with depression and anxiety and anger as a state and between time evolution of disease and anger state(AU)

A prospective study predicting the outcome of chronic low back pain and physical therapy: the role of fear-avoidance beliefs and extraspinal pain / Estudo prospectivo de fatores prognósticos em lombalgia crônica tratados com fisioterapia: papel do medo-evitação e dor extraespinal

ABSTRACT Objective: To identify the prognostic factors for conventional physical therapy in patients with chronic low back pain (CLBP). Methods: Prospective observational study. Participants: One hundred thirteen patients with CLBP selected at the Spinal Disease Outpatient Clinic. Main outcome measures: Pain intensity was scored using the Numeric Rating Scale (NRS), and function was measured using the Roland-Morris Disability Questionnaire (RMDQ). Results: The Fear-Avoidance Beliefs Questionnaire work subscale results (FABQ-work; odds ratio [OR] = 0.27, 95% confidence interval [CI] 0.13–0.56, p < 0.001) and extraspinal pain (OR = 0.35, 95% CI 0.17–0.74, p = 0.006) were independently associated with a decreased response to conventional physical therapy for CLBP. Conclusion: We identified high FABQ-work and extraspinal pain scores as key determinants of a worse response to physical therapy among CLBP patients, supporting the need for a special rehabilitation program for this subgroup.

RESUMO Objetivo: Identificar os fatores prognósticos para a fisioterapia convencional em pacientes com lombalgia mecânica comum crônica (LMC). Métodos: Estudo prospectivo observacional. Participantes: Foram selecionados pelo Ambulatório de Doenças da Coluna Vertebral 113 pacientes com lombalgia mecânica comum crônica. Medidas de desfecho principais: A intensidade da dor foi pontuada utilizando a Escala Numérica de Dor (END) e a função foi medida usando o Questionário Roland-Morris de Incapacidade (RMDQ). Resultados: Os resultados da subescala trabalho do Fear-Avoidance Beliefs Questionnaire (FABQ-trabalho; odds ratio [OR] = 0,27, intervalo de confiança de 95% [IC 95%] 0,13–0,56, p < 0,001) e da dor extraespinal (OR = 0,35, IC 0,17–0,74, p = 0,006) estiveram independentemente associados a uma diminuição na resposta à fisioterapia convencional para a lombalgia crônica. Conclusão: Foram identificados escores elevados na FABQ-trabalho e dor extraespinal como determinantes-chave para uma pior resposta à fisioterapia em pacientes com LMC o que apoia a necessidade de um programa de reabilitação especial para este subgrupo.

Analysis of epidemiology, lifestyle, and psychosocial factors in patients with back pain admitted to an orthopedic emergency unit / Análise epidemiológica, de hábitos de vida e de fatores psicossociais de pacientes com dorsolombalgia em unidade de pronto atendimento ortopédico

ABSTRACT Objective: To correlate epidemiological data, lifestyle, and psychosocial factors as predictors for clinical manifestation of back pain in patients treated at the orthopedic emergency unit of a Brazilian tertiary care hospital, and to evaluate their interest in participating in a hypothetical program for physical rehabilitation. Methods: This is an observational cross-sectional study. We evaluated 210 patients from the emergency department of a tertiary hospital with a major complaint of back pain. We used: epidemiological multiple-choice questionnaires developed for this study; Oswestry questionnaire for physical disability; Hospital Anxiety and Depression Scale (HAD) scale. Data analyses were performed using SAS - Statistical Analysis System (SAS Institute, 2001). Measurements were performed with the SAS functions Proc MEANS and Proc Freq. Results: The mean age was 39.1 years and there was no predominance between genders. The usual work activity was administrative (65.2% of cases). The mean body mass index was 26.0, indicating overweight. The majority (83.3%) of patients had low physical disability (Oswestry 0 – 40%). The number of medical visits in the previous 6 months (p=0.04) and the scores of anxiety and depression (p=0.05), independently, were correlated with physical disability. Most patients (77%) would agree to participate in a hypothetical program of physical rehabilitation for prevention of back pain. Conclusion: Patients with back pain complaints were predominantly young adults, sedentary or hypoactive, overweight, and with recurrent complaints of symptoms. Most participants had low levels of physical disability and would accept participation in a hypothetical physical rehabilitation program for the prevention of back pain. .

RESUMO Objetivo: Correlacionar dados epidemiológicos, hábitos de vida e fatores psicossociais como preditivos para manifestação clínica de dorsolombalgia em pacientes atendidos no setor de urgências ortopédicas de hospital terciário brasileiro, além de avaliar o interesse em participar de programa hipotético para reabilitação física. Métodos: Trata-se de estudo observacional do tipo transversal. Foram avaliados 210 pacientes provenientes do pronto atendimento de um hospital terciário, com queixa predominante de dor nas costas. Foram utilizados: questionários epidemiológicos do tipo múltipla escolha desenvolvidos para o presente estudo; questionário Oswestry para incapacidade física; e escala Hospital Anxiety and Depression Scale (HAD). As análises dos dados foram realizadas por meio do programa SAS - Statistical Analysis System (SAS Institute, 2001). Os cálculos foram realizados com as funções Proc MEANS e Proc Freq do SAS. Resultados: A média de idade foi de 39,1 anos e não houve predominância entre os gêneros. A atividade laborativa mais frequente foi a administrativa (65,2% dos casos). Observou-se índice de massa corporal médio de 26,0, que indicou sobrepeso. A maioria (83,3%) dos pacientes apresentou baixa incapacidade física (Oswestry de 0 – 40%). O número de visitas nos 6 meses anteriores (p=0,04) e os escores de ansiedade e depressão (p=0,05), isoladamente, tiveram correlação com a incapacidade física. A maioria dos pacientes (77%) aceitaria participar de programa hipotético de reabilitação física para prevenção de dores nas costas. Conclusão: Os pacientes com queixa de dorsolombalgia foram, predominantemente, adultos jovens, sedentários ou hipoativos, com sobrepeso e com queixas recorrentes dos sintomas. A maioria dos participantes apresentou baixa incapacidade física e aceitaria participar de programa hipotético de reabilitação física para a prevenção de dores nas costas. .

Psychometric properties of the Brazilian version of the Pain Catastrophizing Scale for acute low back pain / Propriedades psicométricas da versão brasileira da Escala de Catastrofização da Dor para dor lombar aguda

Measurement instruments of pain catastrophizing for middle-aged and elderly individuals are needed to understand its impact on low back pain. The goals were to cross-culturally adapt the Pain Catastrophizing Scale, assess the construct validity through Rasch analysis, and verify reliability and convergent validity of pain catastrophizing with psychosocial factors. 131 individuals aged 55 years and older with acute low back pain were interviewed . The intra-rater reliability was Kp = 0.80 and interrater Kp = 0.75. The Rasch analysis found adequate reliability coefficients (0.95 for items and 0.90 for individuals ). The separation index for the elderly was 2.95 and 4.59 items. Of the 13 items, one did not fit the model, which was justified in the sample evaluated. The pain catastrophizing correlated with most psychosocial factors. The instrument proved to be clinically useful. Subsequent studies should carry out the same analysis in different populations.

Instrumentos de medida da catastrofização da dor para indivíduos de meia-idade e idosos são necessários para compreensão do impacto na dor lombar nessa população. Os objetivos foram adaptar transculturalmente a Escala de Catastrofização da Dor, avaliar a validade de construto pela análise Rasch, verificar a confiabilidade e a validade convergente da catastrofização da dor com fatores psicossociais. Participaram 131 indivíduos comunitários com 55 anos e mais com dor lombar aguda. A confiabilidade intra-examinadores foi de Kp = 0,80 e inter-examinadores Kp = 0,75. A análise Rasch, detectou adequados coeficientes de confiabilidade (0,95 para itens e 0,90 para indivíduos). O índice de separação dos idosos foi de 2,95 e dos itens 4,59. Dos 13 itens, um não se enquadrou no modelo, o que se justificou na amostra avaliada. A catastrofização da dor se correlacionou com a maioria dos fatores psicossociais. O instrumento mostrou-se clinicamente útil. Estudos subsequentes devem proceder às mesmas análises em diferentes populações.

Revisión de factores psicológicos y estrategias para el manejo del dolor crónico lumbar desde diferentes modelos teóricos / Review of psychological factors and strategies chronic low back pain management since different theoretical models

El presente trabajo tiene como objetivo revisar cuáles son los factores psicológicos más relevantes en el dolor crónico lumbar, describir los Modelos teóricos relacionados con el dolor y las técnicas o estrategias asociadas más efectivas para su manejo. Para lograr este objetivo, revisaremos la prevalencia en Chile del dolor crónico no oncológico, la epidemiología del dolor lumbar, los modelos teóricos específicos del dolor crónico más utilizados, desde los cuales se desprenden los factores psicológicos más relevantes que participan en el dolor. Posteriormente, se repasará cómo se comportan estos factores y la relación entre ellos, para finalmente describir las principales estrategias o técnicas con base empírica que permiten intervenir en dichos factores...

This paper aims to review what are the most relevant in chronic low back pain psychological factors, describe the theoretical models related to pain and associated techniques or more effective strategies for the management of the pain. To achieve this objective in Chile will review the prevalence of chronic non-cancer pain, back pain epidemiology, specific theoretical models of chronic pain commonly used from which the most relevant psychological factors involved in pain are released. Subsequently, we will review how these factors and the relationship between them, and finally describe the main strategies or evidence-based techniques that allow intervention in these factors behave...

Ocorrência de dor lombar e fatores associados em crianças e adolescentes de uma escola privada do sul do Brasil / Low back pain and associated factors in children and adolescents in a private school in Southern Brazil / La aparición de dolor de espalda y los factores asociados en niños y adolescentes en una escuela privada en el sur de Brasil

Estudos têm demonstrado que indivíduos que apresentam dor lombar na infância e adolescência são acometidos também na vida adulta, reforçando a importância de que as causas sejam investigadas desde a idade escolar. Avaliou-se a ocorrência de dor lombar e fatores associados em 770 escolares de 7 a 17 anos de idade de uma escola privada de Porto Alegre, Rio Grande do Sul, Brasil. A dor lombar foi definida como dor ou desconforto na região lombar no último mês e avaliada por meio de questionário. A ocorrência de dor lombar foi de 31,6%, sendo mais prevalente no sexo feminino (41,9%) do que no masculino (21,4%). Os fatores associados à dor lombar foram sexo feminino, idade de 9 a 17 anos e os aspectos psicossociais hiperatividade (categorias limítrofe e anormal) e sintomas emocionais (categoria anormal). O mapeamento da ocorrência de dor lombar, bem como a investigação de seus fatores associados é de fundamental importância para a identificação de crianças e adolescentes em risco e para o desenvolvimento de programas eficazes de prevenção primária.

Studies have shown that children and adolescents with low back pain are also similarly affected when they reach adulthood, thus highlighting the importance of investigating causes of low back pain in school-age children. The study examined low back pain and associated factors in 770 schoolchildren 7 to 17 years of age in a private school in Porto Alegre, Rio Grande do Sul State, Brazil. Low back pain was defined as pain or discomfort in the lumbar region in the previous month, assessed by a questionnaire. Low back pain was found in 31.6% of the subjects and was more prevalent in girls (41.9%) than boys (21.4%). Factors associated with lumbar pain were female gender, age 9 to 17 years, hyperactivity (borderline and abnormal categories), and emotional symptoms (abnormal category). Mapping the occurrence of low back pain and associated factors is important for identifying children and adolescents at risk and for developing effective programs for primary prevention.

Los estudios han demostrado que las personas con dolor de espalda en la infancia y la adolescencia también se ven afectadas en la edad adulta, lo que subraya la importancia de que las causas se investiguen desde la edad escolar. Se evaluó la incidencia de dolor de espalda y factores asociados, en 770 escolares de 7 a 17 años en una escuela privada en Porto Alegre, Rio Grande do Sul, Brasil. La lumbalgia se define como un dolor o molestia en la espalda en el último mes y fue evaluada mediante un cuestionario. La aparición de dolor lumbar se produjo en un 31,6%, siendo más frecuente en el sexo femenino (41,9%) que en hombres (21,4%). Los factores asociados con el dolor de espalda eran: mujeres, edad de 9 a17 años, y aspectos psicosociales como hiperactividad (categorías borderline y anormal) y síntomas emocionales (categoría anormal). El mapeo de la aparición de dolor en la zona baja de la espalda, así como investigar factores asociados, es fundamental para identificar a los niños, niñas y adolescentes en situación de riesgo, con el fin de desarrollar programas eficaces para la prevención primaria.

Dor, cinesiofobia e qualidade de Vida em pacientes com lombalgia crônica e depressão / Pain, kinesiophobia and quality of life in chronic low back pain and depression

Objetivo: Descrever características de dor, cinesiofobia e qualidade de vida em pacientes com lombalgia crônica associada a depressão. Métodos: Estudo de delineamento transversal em que foram incluídos 193 indivíduos com lombalgia crônica. A presença de depressão foi determinada pelo Inventário de Depressão de Beck, a partir de ponto de corte validado pela Mini International Neuropsychiatric Interview. A intensidade e a qualidade da dor nos grupos com e sem depressão foram avaliadas pelo Questionário McGill. A Escala Tampa para Cinesiofobia foi aplicada para avaliar medo do movimento. Com relação à qualidade de vida, utilizou-se o Medical Outcomes Study 36. O nível de significância estatístico estabelecido foi p< 0,05. Resultados: A prevalência de depressão foi de 32,1%. O grupo com depressão teve pior pontuação com relação à dor, cinesiofobia e qualidade de vida (capacidade funcional, aspectos físicos, dor, estado geral de saúde, vitalidade, aspectos sociais, aspectos emocionais e saúde mental). Conclusão: Pacientes com lombalgia e depressão apresentaram maior intensidade de dor, maior medo de movimento e pior qualidade de vida. Nível de Evidência III, Corte Transversal.

Objective: To describe the characteristics of pain, kinesiophobia and quality of life in patients with chronic low back pain and depression. Methods: Cross-sectional study in which 193 individuals with chronic low back pain were included. The presence of depression was measured by the Beck Depression Inventory, using a cutoff validated by the Mini International Neuropsychiatric Interview. The intensity and quality of pain in the groups with and without depression were assessed by the McGill Questionnaire. The Tampa Scale for Kinesiophobia was applied to assess fear of movement. With respect to quality of life, the Medical Outcomes Study 36 was used. The statistical significance level was set at p <0.05. Results: The prevalence of depression was 32.1%. The group with depression had worse scores in relation to pain, kinesiophobia and quality of life (physical functioning, role-physical, bodily pain, general health, vitality, social functioning, role-emotional, and mental health. Conclusion: Patients with low back pain and depression had higher pain intensity, greater fear of movement and poorer quality of life. Level of Evidence III, Cross-sectional.

[ effect of mindfulness-based stress reduction on the rate of depression in patients with chronic low back pain]

The main purpose of this study was to investigate effectiveness of Mindfulness-Based Stress Reduction [MBSR] on decreasing depression in patients with chronic low back pain. The statistical population included patients with chronic low back pain who appointed the pain clinics in Tehran. Among whom 23 participants were enrolled with convenience sampling and randomly assigned into two equal experimental and control groups. The questionnaire was consisted of the depression subscale of short form known as the depression anxiety stress scale [DASS -21] which was completed by the patients in pre-test and post-test formats. The results of this research, using Mann-Whitney test, showed that the mean depression score in the experimental group has reduced significantly in comparison with the control group. According to the findings of our study, the Mindfulness-Based Stress Reduction Therapy is significantly effective in decreasing depression in patients with chronic low back pain

Efeitos da intervenção exposição ao vivo e atividades graduais sobre a incapacidade e a crença de medo e evitação em pacientes com dor lombar crônica / Effects of exposure in vivo and graded activities on disability and pain related fear and avoidance in chronic low back pain patients

Revisão sistemática que objetivou avaliar os efeitos das intervenções "Exposição ao Vivo" (EV) e/ou "Atividades Graduais" (AG) sobre a crença de medo e evitação da dor e sobre a incapacidade, em doentes com lombalgia crônica. A estratégia de busca abrangeu seis bases de dados. Os estudos foram comparados de acordo com o desenho, método, resultados, nível de evidência e grau de recomendação. Seis artigos foram analisados, dos quais quatro estudos indicaram que a EV reduziu o medo e evitação da dor e três mostraram redução da incapacidade após a EV, em análise individual de cada paciente. Os estudos de maior nível de evidência e grau de recomendação (2b, B) favorecem a recomendação do uso da "Exposição ao Vivo" para redução do medo e evitação da dor em pacientes com lombalgia crônica. A presença de poucos estudos e as limitações metodológicas encontradas indicam a necessidade de maior investigação sobre o tema.

The aim of this systematic review was to evaluate the effects of cognitive behavioral interventions "Exposure in Vivo" (EV) and/or "Graded Activity" (GA) to the fear-avoidance beliefs and disability, in chronic low back pain patients. The search strategy was composed by indexed and free terms, had inclusion criteria and included six data bases. The studies were compared considering the design, method, results, evidence level and recommendation grade. Six articles were analyzed: three were randomized control trials and three were single experimental cross case. Four studies indicate that EV reduced fear-avoidance beliefs. Three showed disability reduction after EV in single analyses of each patient. The higher evidence level studies and better recomendation studies (2b, B) support the recommendation of EV to reduce fear-avoidance beliefs in chronic low back pain patients. Considering few studies available and methologic limitations is important to amply the exploration about this theme.

Physical and psychosocial risk factors for musculoskeletal disorders in Brazilian and Italian nurses / Fatores de risco físico e psicossocial para distúrbios musculoesqueléticos em enfermeiras brasileiras e italianas

As part of the international CUPID investigation, we compared physical and psychosocial risk factors for musculoskeletal disorders among nurses in Brazil and Italy. Using questionnaires, we collected information on musculoskeletal disorders and potential risk factors from 751 nurses employed in public hospitals. By fitting countryspecific multiple logistic regression models, we investigated the association of stressful physical activities and psychosocial characteristics with site-specific and multisite pain, and associated sickness absence. We found no clear relationship between low back pain and occupational lifting, but neck and shoulder pain were more common among nurses who reported prolonged work with the arms in an elevated position. After adjustment for potential confounding variables, pain in the low back, neck and shoulder, multisite pain, and sickness absence were all associated with somatizing tendency in both countries. Our findings support a role of somatizing tendency in predisposition to musculoskeletal disorders, acting as an important mediator of the individual response to triggering exposures, such as workload.

Como parte da pesquisa internacional CUPID, comparamos os fatores de risco físico e psicossocial para distúrbios osteomusculares entre enfermeiras no Brasil e na Itália. Foram coletados dados com questionários sobre distúrbios osteomusculares e seus fatores de risco potenciais com 751 enfermeiros de hospitais públicos. Com modelos de regressão logística específicas para cada país, investigamos a associação entre atividades físicas estressantes e as características psicossociais, com dores em sítios específicos e múltiplos, assim como ausências motivadas por doença. Não encontramos clara relação entre dor lombar e levantamento de pesos, porém dores no pescoço e ombros foram as mais relatadas entre as enfermeiras que realizam trabalho prolongado, com braços elevados. As dores na lombar, pescoço, ombros e em múltiplos sítios foram associadas à tendência somatizante e à ausência por doença em ambos os países. Nossos achados reforçam o papel da tendência somatizante como fator predisponente para distúrbios osteomusculares, atuando como um importante mediador da resposta individual.