The contemporary management of neck pain in adults.

Neck pain is a common condition with a high prevalence worldwide. Neck pain is associated with significant levels of disability and is widely considered an important public health problem. Neck pain is defined as pain perceived between the superior nuchal line and the spinous process of the first thoracic vertebra. In some types of neck conditions, the pain can be referred to the head, trunk and upper limbs. This article aims to provide an overview of the available evidence on prevalence, costs, diagnosis, prognosis, risk factors, prevention and management of patients with neck pain.

Acute and chronic back pain in adults and elderly in southern Brazil: a population-based study / Dor aguda e crônica nas costas em adultos e idosos no sul do Brasil: um estudo de base populacional

Aims: to determine the prevalence of acute and chronic back pain and associated factors and identify the consequences of this pain in adults and the elderly in southern Brazil. Methods: cross-sectional study conducted in 2019, in Criciúma, Santa Catarina, in individuals aged 18 and over. Acute back pain was pain in the cervical, thoracic, or lumbar regions not exceeding 3 months and chronic pain as pain for 3 months or more. Bivariate analyzes and multinomial logistic regression were performed. Results: among the 820 participants, the prevalence of back pain was 67.0%, acute pain 39.3% (95% CI: 35.5% to 43.3%) and chronic pain 27.4% (95% CI: 24.5% to 30.4%). Acute back pain was associated with women, overweight, obesity, and with WMSD/RSI, while chronic pain chronic pain was found mostly in women, being related to leisure inactivity ...were female, leisure inactivity, falls, Work-related musculoskeletal disorder/repetitive strain injury, and arthritis/rheumatism. Conclusions: acute pain was greater among overweight/obese and chronic pain contribute to absenteeism and demand for health services.

Objetivos: determinar a prevalência de dores aguda e crônica nas costas e fatores associados e identificar as consequências dessas dores em adultos e idosos no Sul do Brasil. Métodos: estudo transversal realizado em 2019, em Criciúma, Santa Catarina, em indivíduos com 18 anos ou mais. Dor aguda foi a dor nas regiões cervical, torácica ou lombar não superior a três meses e dor crônica como dor por três meses ou mais. Foram realizadas análises bivariadas e regressão logística multinomial. Resultados: entre os 820 participantes, a prevalência de dor nas costas foi de 67,0%, dor aguda 39,3% (IC 95%: 35,5% a 43,3%) e dor crônica 27,4% (IC 95%: 24,5% a 30,4%). A dor aguda nas costas foi associada a mulheres, sobrepeso, obesidade e a distúrbio musculoesquelético relacionado ao trabalho/lesão por esforço repetitivo, enquanto a dor crônica, foi constatada majoritariamente em mulheres, tendo relação com sedentarismo, quedas, distúrbio musculoesquelético relacionado ao trabalho/lesão por esforço repetitivo e artrite/reumatismo. Conclusões: a dor aguda mais associada a excesso de peso/obesidade e a dor crônica contribuiu para o absenteísmo e procura pelos serviços de saúde.

Profile of Patients With Acute Low Back Pain Who Sought Emergency Departments: A Cross-sectional Study.

STUDY DESIGN: A cross-sectional study. OBJECTIVE: The aim of this study is to describe the profile of patients with acute low back pain (LBP) who sought emergency departments (EDs) in Brazilian public hospitals. We also described the profile of these patients according to the STarT Back Screening Tool (SBST). SUMMARY OF BACKGROUND DATA: LBP is the most common musculoskeletal condition worldwide and is one of the main complaints in EDs. There is a lack of evidence describing the profile of these patients from low- to middle-income countries. METHODS: This is a cross-sectional study involving patients with a new episode of nonspecific acute LBP that was conducted between August 2014 and August 2016. Variables related to clinical, psychological, sociodemographic and work status characteristics were investigated through structured, in-person oral questionnaire. RESULTS: A total of 600 patients were included in the study. The majority of the patients were women (58%), with a median of eight points on pain intensity (measured on an 11-point scale) and 17 points on disability (measured on a 24-item questionnaire). With regards to the SBST evaluation, 295 (49.2%) patients were classified as being at high risk of developing an unfavorable prognosis with a median pain intensity of nine points on pain intensity, 20 points on disability, and seven points on depression (measured on an 11-point scale). Despite this, the majority of the patients (74%) continued working normally without interference from LBP. CONCLUSION: Identifying the profile of patients seeking care in EDs can help to define effective management for LBP in low- and middle-income countries. Patients with nonspecific acute LBP who seek EDs in Brazil present high levels of pain intensity and disability. Most patients were classified as having a high risk of developing an unfavorable prognosis. LEVEL OF EVIDENCE: 2.

Anterior Trunk Mobility Does Not Predict Disability in Elderly Women With Acute Low Back Pain: Brazilian Back Complaints in the Elders (BACE-Brazil) Study Results.

STUDY DESIGN: Cross-sectional, ancillary study of an international multicenter epidemiological study. OBJECTIVE: To investigate the relationship of the anterior trunk mobility with self-report and physical performance measures in elderly women with acute low back pain (LBP). SUMMARY OF BACKGROUND DATA: LBP is one of the most prevalent pain complaints in the elderly population. It is postulated that the increased range of motion of limited joints of the trunk may improve LBP and functionality of patients. Recent studies have, however, questioned the association between trunk range of motion and the functional status. METHODS: The present study included a convenience sample of elderly women from the community aged 60 years and older who presented with a new (acute) episode of LBP. Volunteers with severe diseases and visual, hearing and mobility losses, or cognitive impairment were excluded. Trunk mobility was assessed by the fingertip-to-floor test. Functionality was assessed by the Roland-Morris Questionnaire (RMQ) and gait speed test. Statistical analysis was performed by using hierarchical linear regression model. RESULTS: Data from 459 elderly women, mean age of 69.0 (6.1) years old, were used to describe this report. The additional predictive value for the inclusion of independent variable trunk mobility was only 4.4% in the RMQ score and 1.5% in the gait speed test, respectively. A reduced hierarchical linear regression model showed that the significant predictors for RMQ and gait speed test were body mass index, pain intensity, and trunk mobility. CONCLUSION: This was the first study to investigate the relationship between trunk mobility and functionality in elderly women with acute LBP. The results suggest that these clinical parameters are independent from each other. LEVEL OF EVIDENCE: N/A.

Association Between the Plasma Levels of Mediators of Inflammation With Pain and Disability in the Elderly With Acute Low Back Pain: Data From the Back Complaints in the Elders (BACE)-Brazil Study.

STUDY DESIGN: Cross-sectional study with subsample of elderly women with acute low back pain (LBP), from Back Complaints in the Elders-Brazil (BACE-Brazil) OBJECTIVE: To investigate the association between plasma levels of mediators of inflammation (interleukin-1 beta (IL-1ß), IL-6, tumor necrosis factor alpha (TNF-α), and soluble TNF receptor 1 (sTNF-R1)) with pain and disability experienced by elderly women with acute LBP. SUMMARY OF BACKGROUND DATA: Among the elderly, LBP is a complaint of great importance and can lead to disability. Inflammatory cytokines are elevated in painful conditions, and may promote pain. METHODS: We included 155 community-dwelling elderly women (age ≥ 65 yr), who presented with a new (acute) episode of LBP. Enzyme-linked immunosorbent assays were used to measure TNF-α, sTNF-R1, IL-1ß, and IL-6. Disability was assessed using the Roland Morris Disability Questionnaire; pain was assessed using the McGill Pain Questionnaire. Linear regression models were fit with each pain and disability outcome as dependent variables: Present Pain Intensity; Qualities of pain; Severity of pain in the last week; LBP frequency and disability. RESULTS: Depressive symptoms and IL-6 were associated and explained 20.9% of "qualities of pain" variability. TNF-α, sTNFR1, education, body mass index, and depressive symptoms explained 8.4% of "Severity of pain in the past week" variability. TNF-α, education, BMI, depressive symptoms, present pain intensity, qualities of pain, and LBP frequency explained 48.6% of "disability." No associations between inflammatory cytokines and "present pain intensity" and "LBP frequency" were found. CONCLUSION: Our results demonstrate associations between inflammatory markers (TNF-α and sTNFR1) and pain severity, IL-6 was associated with the qualities of pain, and TNF-α was also associated with disability. These inflammatory mediators represent new markers to be considered in the assessment and treatment of elderly patients with LBP. LEVEL OF EVIDENCE: 5.

Association of pain catastrophizing with the incidence and severity of acute and persistent perineal pain after natural childbirth: longitudinal cohort study.

BACKGROUND AND OBJECTIVES: Vaginal birth delivery may result in acute and persistent perineal pain postpartum. This study evaluated the association between catastrophizing, a phenomenon of poor psychological adjustment to pain leading the individual to magnify the painful experience making it more intense, and the incidence and severity of perineal pain and its relationship to perineal trauma. METHOD: Cohort study conducted with pregnant women in labor. We used the pain catastrophizing scale during hospitalization and assessed the degree of perineal lesion and pain severity in the fi rst 24 hours and after 8 weeks of delivery using a numerical pain scale. RESULTS: We evaluated 55 women, with acute pain reported by 69.1%, moderate/severe pain by 36.3%, and persistent pain by 14.5%. Catastrophizing mean score was 2.15 } 1.24. Catastrophizing patients showed a 2.90 relative risk (RR) for perineal pain (95% CI: 1.08-7.75) and RR: 1.31 for developing persistent perineal pain (95% CI: 1.05-1.64). They also showed a RR: 2.2 for developing acute and severe perineal pain (95% CI: 1.11-4.33). CONCLUSIONS: The incidence of acute and persistent perineal pain after vaginal delivery is high. Catastrophizing pregnant women are at increased risk for developing acute and persistent perineal pain, as well as severe pain. Perineal trauma increased the risk of persistent perineal pain.

Associação da catastrofização da dor com a incidência e a intensidade da dor perineal aguda e persistente após parto normal: estudo longitudinal tipo coorte / Association of pain catastrophizing with the incidence and severity of acute and persistent perineal pain after natural childbirth: longitudinal cohort study / Asociación de la catastrofización del dolor con la incidencia y la intensidad del dolor perineal agudo y persistente posteriormente al parto normal: estudio longitudinal tipo cohorte

JUSTIFICATIVA E OBJETIVOS: O parto vaginal pode resultar em dor perineal aguda e persistente pósparto. Este estudo avaliou a associação da catastrofização, fenômeno de má adaptação psicológica à dor que leva o indivíduo a magnificar a experiência dolorosa, tornando-a mais intensa, com a incidência e a intensidade da dor perineal e sua relação com o trauma perineal. MÉTODO: Estudo coorte. Realizado com gestantes em trabalho de parto. Foi aplicada a escala de pensamentos catastróficos sobre a dor durante o internamento e foram avaliados o grau da lesão perineal e a intensidade da dor perineal nas primeiras 24 horas e após oito semanas do parto por meio da escala numérica de dor. RESULTADOS: Avaliadas 55 mulheres. Sentiram dor aguda 69,1% das pacientes. Dessas, 36,3% queixaram-se de dor de moderada/forte intensidade e 14,5% de dor persistente. O escore médio de catastrofização foi de 2,15 ± 1,24. As pacientes catastrofizadoras apresentaram um risco 2,90 vezes maior (95% IC: 1,08-7,75) de apresentar dor perineal aguda e 1,31 vezes maior (95% IC: 1,05-1,64) de desenvolver dor perineal persistente. Também apresentaram um risco 2,2 vezes maior de desenvolver dor perineal aguda de maior intensidade (95% IC: 1,11-4,33). CONCLUSÕES: A incidência de dor perineal aguda e persistente após parto vaginal é alta. Gestantes catastrofizadoras apresentam maior risco de desenvolver dor perineal aguda e persistente, como também dor de maior intensidade. O trauma perineal aumentou o risco de ocorrência de dor perineal persistente.

BACKGROUND AND OBJECTIVES: Vaginal birth delivery may result in acute and persistent perineal pain postpartum. This study evaluated the association between catastrophizing, a phenomenon of poor psychological adjustment to pain leading the individual to magnify the painful experience making it more intense, and the incidence and severity of perineal pain and its relationship to perineal trauma. METHOD: Cohort study conducted with pregnant women in labor. We used the pain catastrophizing scale during hospitalization and assessed the degree of perineal lesion and pain severity in the first 24 hours and after 8 weeks of delivery using a numerical pain scale. RESULTS: We evaluated 55 women, with acute pain reported by 69.1%, moderate/severe pain by 36.3%, and persistent pain by 14.5%. Catastrophizing mean score was 2.15 ± 1.24. Catastrophizing patients showed a 2.90 relative risk (RR) for perineal pain (95% CI: 1.08-7.75) and RR: 1.31 for developing persistent perineal pain (95% CI: 1.05-1.64). They also showed a RR: 2.2 for developing acute and severe perineal pain (95% CI: 1.11-4.33). CONCLUSIONS: The incidence of acute and persistent perineal pain after vaginal delivery is high. Catastrophizing pregnant women are at increased risk for developing acute and persistent perineal pain, as well as severe pain. Perineal trauma increased the risk of persistent perineal pain.

JUSTIFICATIVA Y OBJETIVOS: El parto vaginal puede traer dolor perineal agudo y persistente postparto. Este estudio evaluó la asociación de la catastrofización, fenómeno de mala adaptación psicológica al dolor, que hace con que el individuo exagere la experiencia dolorosa, convirtiéndola en algo más intenso, con la incidencia y la intensidad del dolor perineal y su relación con el trauma perineal. MÉTODO: Estudio de cohorte realizado con gestantes en trabajo de parto. Se aplicó la escala de pensamientos catastróficos sobre el dolor durante el ingreso, y se evaluaron el grado de la lesión perineal y la intensidad del dolor perineal en las primeras 24 horas y después de ocho semanas del parto, por medio de la escala numérica del dolor. RESULTADOS: Fueron evaluadas 55 mujeres. Sintieron dolor agudo 69,1% de las pacientes. De ellas, un 36,3% se quejaron de dolor de moderado/fuerte intensidad y 14,5% de dolor persistente. La puntuación promedio de catastrofización fue de 2,15 ± 1,24. Las pacientes catastrofizadoras tuvieron un riesgo 2,90 veces mayor (95% IC: 1,08-7,75) de presentar dolor perineal agudo y 1,31 veces mayor (95% IC: 1,05-1,64) de desarrollar dolor perineal persistente. También tuvieron un riesgo 2,2 veces mayor de desarrollar dolor perineal agudo de mayor intensidad (95% IC: 1,11-4,33). CONCLUSIONES: La incidencia de dolor perineal agudo y persistente posteriormente al parto vaginal es elevada. Las gestantes catastrofizadoras tienen un mayor riesgo de desarrollar dolor perineal agudo y persistente, como también dolor de mayor intensidad. El trauma perineal aumentó el riesgo de prevalencia de dolor perineal persistente.

Association of pain catastrophizing with the incidence and severity of acute and persistent perineal pain after natural childbirth: longitudinal cohort study.

BACKGROUND AND OBJECTIVES: Vaginal birth delivery may result in acute and persistent perineal pain postpartum. This study evaluated the association between catastrophizing, a phenomenon of poor psychological adjustment to pain leading the individual to magnify the painful experience making it more intense, and the incidence and severity of perineal pain and its relationship to perineal trauma. METHOD: Cohort study conducted with pregnant women in labor. We used the pain catastrophizing scale during hospitalization and assessed the degree of perineal lesion and pain severity in the first 24 hours and after 8 weeks of delivery using a numerical pain scale. RESULTS: We evaluated 55 women, with acute pain reported by 69.1%, moderate/severe pain by 36.3%, and persistent pain by 14.5%. Catastrophizing mean score was 2.15 ± 1.24. Catastrophizing patients showed a 2.90 relative risk (RR) for perineal pain (95% CI: 1.08-7.75) and RR: 1.31 for developing persistent perineal pain (95% CI: 1.05-1.64). They also showed a RR: 2.2 for developing acute and severe perineal pain (95% CI: 1.11-4.33). CONCLUSIONS: The incidence of acute and persistent perineal pain after vaginal delivery is high. Catastrophizing pregnant women are at increased risk for developing acute and persistent perineal pain, as well as severe pain. Perineal trauma increased the risk of persistent perineal pain.