Brazilian Journal of Pain
https://brjp.org.br/article/doi/10.5935/2595-0118.20240005-en
Brazilian Journal of Pain
Original Article

Multidisciplinary treatment program for improvement in pain and disability associated with nonspecific chronic low back pain

Programa de tratamento multidisciplinar para melhora da dor e incapacidade associada a dor crônica lombar inespecífica

Grasiele Correa de Melo Padilha; Rafael Fernandes Zanin; Charles Francisco Ferreira; Liciane Fernandes Medeiros

http://dx.doi.org/10.5935/2595-0118.20240005-en BrJP, vol.7, e20240005, 2024
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Abstract

BACKGROUND AND OBJECTIVES: Lumbar disorders, which contribute to significant workplace absenteeism and chronic disability, are associated with a considerable financial and social burden. Although a conservative approach provides satisfactory pain relief, biomechanical improvement and is associated with a low risk of adverse effects, there is lack of consensus in the literature regarding the best therapeutic strategy in such cases.
METHODS: This retrospective longitudinal study used secondary data from the institutional medical records of patients who completed a multidisciplinary program for the treatment of low back pain between 2019 and 2021. Data regarding pain levels and motor skills were obtained from patients who completed the care program at a private hospital in Bento Gonçalves, RS. The following step-wise treatment algorithm was used: evaluation by a specialist physician for the etiological diagnosis of pain, pharmacological management and dry needling, followed by standard rehabilitation intervention performed by the physiotherapy team and exercises by the physical education team. The visual analogue scale (VAS) was used to measure pain at the start and at the completion of the intervention, and the Oswestry Disability Index (ODI) was used to measure motor skills at the start and at 6 and 12 months following the multiprofessional intervention for rehabilitation.
RESULTS: A reduction in pain and motor disability in patients who completed all stages of the treatment program was observed. Pain by the VAS presented the following scores: baseline 7 [5-8] and after treatment 2 [0-4]; and the scores of the ODI were: at baseline 0.34 [0.26 - 0.40], at 6 months 0.16 [0.08 - 0.26] and after treatment 0.12 [0.04 - 0.21].
CONCLUSION: The treatment program reduced the pain and disability associated with low back pain and can serve as the basis for further studies carried out to confirm the effectiveness of this intervention.

Keywords

Clinical protocols, Dry needling, Low back pain, Motor disability, Multidisciplinary protocol, Rehabilitation, Visual analogue scale

Resumo

JUSTIFICATIVA E OBJETIVOS: As doenças lombares, que contribuem para um absenteísmo significativo no local de trabalho e para a incapacidade crônica, estão associadas a um encargo financeiro e social considerável. Embora a abordagem conservadora proporcione alívio satisfatório da dor, melhore a biomecânica e esteja associada a baixo risco de efeitos adversos, não há consenso na literatura sobre a melhor estratégia terapêutica nesses casos. 
MÉTODOS: Neste estudo longitudinal retrospectivo, foram utilizados dados secundários dos prontuários médicos institucionais de pacientes que completaram um programa multidisciplinar para tratamento de dor lombar entre 2019 e 2021. Dados sobre níveis de dor e habilidades motoras foram obtidos de pacientes que completaram o programa assistencial de um hospital privado de Bento Gonçalves, RS. Foi utilizado o seguinte tratamento passo a passo: avaliação por médico especialista para diagnóstico etiológico da dor, manejo farmacológico e agulhamento a seco, seguido de intervenção de reabilitação padrão realizada pela equipe de fisioterapia e exercícios pela equipe de educação física. A escala analógica visual (EAV) foi utilizada para medir a dor no início e após a conclusão da intervenção, e o Índice de Incapacidade de Oswestry (ODI) foi usado para medir as habilidades motoras no início e aos 6 e 12 meses após a intervenção multiprofissional para reabilitação.
RESULTADOS: Observou-se redução na dor e na incapacidade motora em pacientes que completaram todas as etapas do programa de tratamento. A intensidade da dor medida pela EAV apresentou as seguintes pontuações: basal 7 [5-8] e após tratamento 2 [0-4]; enquanto o ODI apresentou as pontuações: basal 0,34 [0,26 – 0,40], até 6 meses 0,16 [0,08 – 0,26] e após o tratamento 0,12 [0,04 – 0,21].
CONCLUSÃO: O programa de tratamento reduziu a dor e a incapacidade associadas à dor lombar e pode servir de base para novos estudos realizados para confirmar a eficácia desta intervenção.

Palavras-chave

Agulhamento a seco, Deficiência motora, Dor lombar, Escala analógica visual, Protocolo multidisciplinar, Protocolos clínicos, Reabilitação

References

1 Ferreira GD, Silva MC, Rombaldi AJ, Wrege ED, Siqueira F V, Hallal PC. Prevalência de dor nas costas e fatores associados em adultos do Sul do Brasil: estudo de base populacional. Rev Bras Fisioter. 2011;15(1):31-6

2 Meucci RD, Fassa AG, Faria NM. Prevalence of chronic low back pain: systematic review. Rev Saude Publica. 2015;49:1.

3 Oliveira J, Salgueiro M, Alfieri F. Lombalgia e estilo de vida. UNOPAR Cient. 2014;16(4):737283.

4 Manek NJ, MacGregor AJ. Epidemiology of back disorders: prevalence, risk factors, and prognosis. Curr Opin Rheumatol. 2005;17(2):134-40.

5 Verbunt JA, Seelen HA, Vlaeyen J W, van der Heijden GJ, Knottnerus JA. Fear of injury and physical deconditioning in patients with chronic low back pain. Arch Phys Med Rehabil. 2003;84(8):1227-32.

6 Viola DC, Lenza M, Almeida SL, Santos O F, Cendoroglo Neto M, Lottenberg CL, Ferretti M. Spine surgery cost reduction at a specialized treatment center. Einstein. 2013;11(1):102-7.

7 Qaseem A, Wilt TJ, McLean RM, Forciea MA. Clinical Guidelines Committee of the American College of Physicians; Denberg TD, Barry MJ, Boyd C, Chow RD, Fitterman N, Harris R P, Humphrey LL, Vijan S. Noninvasive treatments for acute, subacute, and chronic low back pain: a clinical practice guideline from the American College of Physicians. Ann Intern Med. 2017;166(7):514-30.

8 Foster NE, Anema JR, Cherkin D, Chou R, Cohen S P, Gross D P, Ferreira PH, Fritz JM, Koes BW, Peul W, Turner JA, Maher CG; Lancet Low Back Pain Series Working Group. Prevention and treatment of low back pain: evidence, challenges, and promising directions. Lancet. 2018;391(10137):2368-83.

9 Oliveira CB, Maher CG, Pinto RZ, Traeger AC, Lin CC, Chenot J F, van Tulder M, Koes BW. Clinical practice guidelines for the management of non-specific low back pain in primary care: an updated overview. Eur Spine J. 2018;27(11):2791-803.

10 Lee JW, Lim YH, Won YH, Kim DH. Effect of gel seat cushion on chronic low back pain in occupational drivers: a double-blind randomized controlled trial. Medicine (Baltimore). 2018;97(40):e12598.

11 Liu L, Huang QM, Liu QG, Thitham N, Li LH, Ma Y T, Zhao JM. Evidence for dry needling in the management of myofascial trigger points associated with low back pain: a systematic review and meta-analysis. Arch Phys Med Rehabil. 2018;99(1):144-52.e2.

12 Jensen M P, Turner JA, Romano JM. What is the maximum number of levels needed in pain intensity measurement? Pain. 1994;58(3):387-92.

13 Poitras S, Loisel P, Prince F, Lemaire J. Disability measurement in persons with back pain: a validity study of spinal range of motion and velocity. Arch Phys Med Rehabil. 2000t;81(10):1394-400.

14 Airaksinen O, Brox JI, Cedraschi C, Hildebrandt J, Klaber-Moffett J, Kovacs F, Mannion AF, Reis S, Staal JB, Ursin H, Zanoli G; COST B13 Working Group on Guidelines for Chronic Low Back Pain. Chapter 4. European guidelines for the management of chronic nonspecific low back pain. Eur Spine J. 2006;15(Suppl 2):S192-300.

15 Global Burden of Disease Study 2013 Collaborators. Global, regional, and national incidence, prevalence, and years lived with disability for 301 acute and chronic diseases and injuries in 188 countries, 1990-2013: a systematic analysis for the Global Burden of Disease Study 2013. Lancet. 2015;386(9995):743-800.

16 Institute of Medicine (US) Committee on Quality of Health Care in America. Crossing the Quality Chasm: A New Health System for the 21st Century. Washington (DC): National Academies Press (US); 2001. PMID: 25057539.

17 Anderson DB, Shaheed CA. Medications for treating low back pain in adults. evidence for the use of paracetamol, opioids, nonsteroidal anti-inflammatories, muscle relaxants, antibiotics, and antidepressants: an overview for musculoskeletal clinicians. J Orthop Sports Phys Ther. 2022 Jul;52(7):425-31.

18 Jarvik JG, Gold LS, Comstock BA, Heagerty PJ, Rundell SD, Turner JA, Avins AL, Bauer Z, Bresnahan BW, Friedly JL, James K, Kessler L, Nedeljkovic SS, Nerenz DR, Shi X, Sullivan SD, Chan L, Schwalb JM, Deyo RA. Association of early imaging for back pain with clinical outcomes in older adults. JAMA. 2015;313(11):1143-53.

19 Mannion A F, Brox JI, Fairbank JC. Consensus at last! Long-term results of all randomized controlled trials show that fusion is no better than non-operative care in improving pain and disability in chronic low back pain. Spine J. 2016;16(5):588-90.

20 Will JS, Bury DC, Miller JA. Mechanical low back pain. Am Fam Physician. 2018;98(7):421-8.

21 Watson JA, Ryan CG, Cooper L, Ellington D, Whittle R, Lavender M, Dixon J, Atkinson G, Cooper K, Martin DJ. Pain neuroscience education for adults with chronic musculoskeletal pain: a mixed-methods systematic review and meta-analysis. J Pain. 2019;20(10):1140.e1-1140.e22.

22 Cuenda-Gago JD, Espejo-Antunez L. Effectiveness of education based on neuroscience in the treatment of musculoskeletal chronic pain. Rev Neurol. 2017;65(1):1-12.

23 Runciman WB, Hunt TD, Hannaford NA, et al. CareTrack: assessing the appropriateness of health care delivery in Australia. Med J Aust. 2012;197(2):100-5.

24 Delitto A, George SZ, Van Dillen L, Whitman JM, Sowa G, Shekelle P, Denninger TR, Godges JJ; Orthopaedic Section of the American Physical Therapy Association. Low back pain. J Orthop Sports Phys Ther. 2012;42(4):A1-57.

25 Wood L, Hendrick PA. A systematic review and meta-analysis of pain neuroscience education for chronic low back pain: short-and long-term outcomes of pain and disability. Eur J Pain. 2019;23(2):234-9.

26 Chenot J F, Greitemann B, Kladny B, Petzke F, Pfingsten M, Schorr SG. Non-specific low back pain. Dtsch Arztebl Int . 2017;114(51-52):883-90.

27 Gattie E, Cleland JA, Snodgrass S. The effectiveness of trigger point dry needling for musculoskeletal conditions by physical therapists: a systematic review and meta-analysis. J Orthop Sports Phys Ther. 2017;47(3):133-49.

28 Hernando-Jorge A, Pérez-Del-Pozo D, Sánchez-Martín D, Beltran-Alacreu H. Ejercicio terapéutico como tratamiento para el dolor crónico del raquis: revisión sistemática de ensayos clínicos aleatorizados [Terapeutic exercise as treatment for spinal chronic pain: systematic review of randomized clinical trials]. Rehabilitacion (Madr). 2021;55(1):49-66.

29 de Oliveira NTB, Ricci NA, Dos Santos Franco YR, Salvador EMES, Almeida ICB, Cabral CMN. Effectiveness of the Pilates method versus aerobic exercises in the treatment of older adults with chronic low back pain: a randomized controlled trial protocol. BMC Musculoskelet Disord. 2019;20(1):250.

30 Plaza-Manzano G, Cancela-Cilleruelo I, Fernández-de-Las-Peñas C, Cleland JA, Arias-Buría JL, Thoomes-de-Graaf M, Ortega-Santiago R. Effects of adding a neurodynamic mobilization to motor control training in patients with lumbar radiculopathy due to disc herniation: a randomized clinical trial. Am J Phys Med Rehabil. 2020;99(2):124-32.

31 Rached RADV, Rosa CPD, Alfieri FM, Amaro SMC, Nogueira B, Dotta L, Imamura M, Battistella LR, Bernado WM, Andrada NC. Lombalgia inespecífica crônica: reabilitação. Rev Assoc Méd Bras. 2013;59(6):536-53.

32 Gierthmühlen J, Baron R. Neuropathic pain. Semin Neurol. 2016;36(5):462-8.

33 Onakpoya IJ, Thomas ET, Lee JJ, Goldacre B, Heneghan CJ. Benefits and harms of pregabalin in the management of neuropathic pain: a rapid review and meta-analysis of randomised clinical trials. BMJ Open. 2019;9(1):e023600.

34 Baron R, Freynhagen R, Tölle TR, Cloutier C, Leon T, Murphy K T, Phillips K; A0081007 Investigators. The efficacy and safety of pregabalin in the treatment of neuropathic pain associated with chronic lumbosacral radiculopathy. Pain. 2010;150(3):420-7.

35 Simms BA, Zamponi GW. Trafficking and stability of voltage-gated calcium channels. Cell Mol Life Sci. 2012;69(6):843-56.

36 Chincholkar M. Analgesic mechanisms of gabapentinoids and effects in experimental pain models: a narrative review. Br J Anaesth. 2018;120(6):1315-334.

37 Evoy KE, Sadrameli S, Contreras J, Covvey JR, Peckham AM, Morrison MD. Abuse and misuse of pregabalin and gabapentin: a systematic review update. Drugs. 2021;81(1):125-56.

38 Sheahan PJ, Nelson-Wong EJ, Fischer SL. A review of culturally adapted versions of the Oswestry Disability Index: the adaptation process, construct validity, test-retest reliability and internal consistency. Disabil Rehabil. 2015;37(25):2367-74.

39 Fairbank JC, Pynsent PB. The Oswestry Disability Index. Spine (Phila Pa 1976). 2000;25(22):2940-52.

40 Lizier DT, Perez M V, Sakata RK. Exercises for treatment of nonspecific low back pain. Rev Bras Anestesiol. 2012;62(6):838-46.

41 Maher C, Underwood M, Buchbinder R. Non-specific low back pain. Lancet. 2017;389(10070):736-47.

42 Haeffner R, Sarquis LMS, Haas GFS, Heck RM, Jardim VMR. Prevalência de lombalgia e fatores associados em trabalhadores de uma empresa agropecuária do sul do Brasil. Rev Bras Med Trab. 2015;13(1):35-42.

43 Hoddevik GH, Selmer R. Kroniske korsryggssmerter hos 40-åringer i 12 norske fylker [Chronic low back pain in 40-year olds in 12 Norwegian counties]. Tidsskr Nor Laegeforen. 1999;119(15):2224-8.

44 Silva MC, Fassa AG, Valle NC. Chronic low back pain in a Southern Brazilian adult population: prevalence and associated factors. Cad Saude Publica. 2004;20(2):377-85.

45 Iguti AM, Bastos T F, Barros MBA. Dor nas costas em população adulta: estudo de base populacional em Campinas, São Paulo, Brasil. Cad Saúde Pública 2015;31(12):2546-58.

46 Hoy D, Bain C, Williams G, March L, Brooks P, Blyth F, Woolf A, Vos T, Buchbinder R. A systematic review of the global prevalence of low back pain. Arthritis Rheum. 2012;64(6):2028-37.

47 Barros MBA, Francisco PMSB, Zanchetta LM, César CLG. Tendências das desigualdades sociais e demográficas na prevalência de doenças crônicas no Brasil, PNAD: 2003-2008. Ciênc Saúde Coletiva. 2011;16(9):3755-68.

48 Rubin DI. Epidemiology and risk factors for spine pain. Neurol Clin. 2007;25(2):353-71.

49 Salaffi F, De Angelis R, Grassi W; MArche Pain Prevalence; INvestigation Group (MAPPING) study. Prevalence of musculoskeletal conditions in an Italian population sample: results of a regional community-based study. I. The MAPPING study. Clin Exp Rheumatol. 2005;23(6):819-28.

50 Vogt MT, Lauerman WC, Chirumbole M, Kuller LH. A community-based study of postmenopausal white women with back and leg pain: health status and limitations in physical activity. J Gerontol A Biol Sci Med Sci. 2002;57(8):M544-50.

51 Wijnhoven HA, de Vet HC, Picavet HS. Sex differences in consequences of musculoskeletal pain. Spine (Phila Pa 1976). 2007;32(12):1360-7.
 

Submitted date:
07/30/2023

Accepted date:
12/05/2023

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