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1.
Ann Phys Rehabil Med ; 61(5): 323-338, 2018 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-29578102

RESUMO

BACKGROUND: Chronic musculoskeletal pain disorders are highly prevalent and have high personal and societal cost. Hence, early detection and care of patients at risk of developing chronic pain is important. Risk factors are well known and screening tools exist, but much less is known about the care of at-risk patients. The aim of this study was to investigate the effectiveness of secondary prevention strategies for musculoskeletal pain. METHODS: We performed a systematic review of clinical trials in which treatments were adjusted to the risk of chronicity in adults with acute or subacute musculoskeletal pain. Clinical trials, systematic reviews and meta-analyses published after January 1, 2000 were searched in PubMed and PEDro databases and in the reference list of relevant papers. The risk of bias was assessed by the PEDro score. RESULTS: We identified 4807 potentially eligible articles; 13, corresponding to 9 studies, met the inclusion criteria. Most studies investigated low back pain. The overall risk of bias was moderate, mainly because of the difficulty of blinding in physiotherapy studies. As compared with a "one-size-fits-all" treatment, stratified programmes showed significant improvements in several domains of the International Classification of Functioning, Disability and Health: body structures and functions (pain, mood), activities (functional capacity), participation (return to work, quality of life), as well as environmental factors (healthcare consumption). Effect sizes were moderate. Overall, simple educational messages seemed sufficient for low-risk patients. Medium- and high-risk patients benefited from a physical reactivation programme combined with education. In high-risk patients, an additional cognitive-behavioural intervention further improved the outcome. CONCLUSIONS: A stratified approach seems effective in reducing long-term disability in patients with musculoskeletal pain. However, more research is necessary to confirm these results.


Assuntos
Dor Musculoesquelética/prevenção & controle , Dor Musculoesquelética/terapia , Prevenção Secundária , Adulto , Dor Crônica/terapia , Terapia Cognitivo-Comportamental , Terapia por Exercício , Humanos , Dor Lombar/terapia , Qualidade de Vida , Ensaios Clínicos Controlados Aleatórios como Assunto
2.
Muscle Nerve ; 42(3): 328-38, 2010 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-20665509

RESUMO

Quantitative sensory testing with Semmes-Weinstein monofilaments suffers from several pitfalls. Our aims were to assess the reliability of these filaments for touch-pressure threshold detection, develop and validate a rapid and accurate procedure for measurements at the bedside, and establish normative data. After calibration of the monofilaments, an adaptive staircase algorithm was validated and used to establish normative data in healthy subjects. Calibration showed significant differences between manufacturer- and investigator-produced data. The relative humidity significantly affected the force exerted by the filaments. The adaptive procedure showed good accuracy and substantial time-saving. Touch-pressure thresholds showed significant gender differences (mean +/- 2 SD for females/males: 2.82-12.3/3.09-17.78 g/mm(2)). The influence of body site and age is small. Accurate use of Semmes-Weinstein monofilaments requires prior calibration, correction for humidity, and use of a validated procedure. In this study we provide normative data that can be used with our algorithm.


Assuntos
Limiar Sensorial/fisiologia , Tato/fisiologia , Adulto , Idoso , Algoritmos , Calibragem , Feminino , Dedos/inervação , Dedos/fisiologia , Lateralidade Funcional/fisiologia , Humanos , Umidade , Extremidade Inferior/fisiologia , Masculino , Pessoa de Meia-Idade , Estimulação Física , Pressão , Valores de Referência , Reprodutibilidade dos Testes , Adulto Jovem
3.
Clin J Pain ; 23(4): 375-9, 2007 May.
Artigo em Inglês | MEDLINE | ID: mdl-17449999

RESUMO

We describe a case of spontaneous complex regional pain syndrome developing first in the left arm and 2 years later in the right foot of a 14-year-old girl. Physical examination showed abnormalities in tactile and thermal sensitivity. Laser-evoked potentials (LEPs) after stimulation of the affected right foot were absent in the acute phase and then progressively recovered over a period of 5 months, in correlation with clinical changes. To our knowledge, no systematic analysis of LEPs in complex regional pain syndrome has been published. We suggest that the observed electrophysiologic alterations could result from a temporary dysfunction of attentional systems, which are assumed to contribute greatly to the LEPs vertex complex. Further studies are needed to test this hypothesis.


Assuntos
Potenciais Evocados/efeitos da radiação , Lasers , Distrofia Simpática Reflexa/fisiopatologia , Adulto , Área Sob a Curva , Progressão da Doença , Feminino , Pé/inervação , Pé/fisiopatologia , Lateralidade Funcional , Mãos/inervação , Mãos/fisiopatologia , Humanos
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