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Influência dos Mecanismos de Produção de Dor Subjacentes à Dor Lombar Crónica, na Resposta ao Tratamento Multimodal de Fisioterapia
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Abstract(s)
Introdução: Nas últimas duas décadas a literatura tem apontado para a potencial influência dos
mecanismos de produção de dor subjacentes à dor lombar crónica (DLC), nas respostas à
intervenção multimodal de fisioterapia. Com base nestes mecanismos parece existir alguma
evidência que sugere a existência de diferenças nas características clínicas pré-intervenção entre
indivíduos com diferentes tipos de dor. Além disso, evidência preliminar também sugere que
diferentes tipos de dor, parecem responder clinicamente de forma diferente à intervenção
multimodal de fisioterapia. Objetivo: Investigar se os diferentes mecanismos de produção de dor,
subjacentes à DLC, permitem antever respostas de intervenção mais ou menos favoráveis, ao
nível da intensidade da dor, incapacidade funcional e perceção global de melhoria. Metodologia:
Foi realizado um estudo de coorte prospetivo com 40 participantes a iniciar tratamento de
Fisioterapia, avaliados antes da intervenção (baseline), após 4 semanas, após 8 semanas ou à
data de alta por melhoria clínica se anterior a este período e 3 meses após o início da intervenção.
Os instrumentos utilizados foram o Questionário de Caracterização Sociodemográfica e Clínica, o
questionário PainDetect, a Escola Numérica da Dor (END), a Quebec Back Pain Disability Scale –
Versão Portuguesa (QBPDS-PT) e a Global Back Recovery Scale – Versão Portuguesa (GBRSPT).
Foi realizada uma análise a dois níveis: avaliação das diferenças inter-grupos, em cada
momento de avaliação, e uma análise intra-grupo, ao longo dos diferentes momentos de avaliação,
nos outcomes considerados. Resultados: Dos 40 participantes avaliados na baseline, 39
completaram o período de intervenção, e 31 o follow-up 3 meses após o início da intervenção. Na
análise da baseline, apesar dos participantes com dor de predomínio neuropático reportarem
níveis superiores de intensidade da dor (7.00 ± 0.89) e incapacidade funcional (49.33 ± 13.69) em
relação aos indivíduos com dor de predomínio nocicetivo (6.38 ± 1.79 e 39.81 ± 18.45,
respetivamente) e dor de padrão misto (6.00 ± 0.93 e 32.88 ± 12.77, respetivamente), as
diferenças encontradas não são estatisticamente significativas. Na resposta à intervenção da
fisioterapia, também não foram encontradas diferenças entre os diferentes subgrupos (p>0.05).
Os participantes parecem responder favoravelmente ao longo do tempo, diminuindo os níveis de
intensidade da dor e incapacidade funcional, independentemente do mecanismo de dor
predominante (p<0.05). Conclusão: Os resultados parecem sugerir que subgrupos de indivíduos
com diferentes mecanismos de produção de dor, não diferem entre si nas respostas à intervenção
de fisioterapia multimodal, verificando-se que independentemente dos mecanismos de dor
predominantes, os indivíduos parecem evoluir de forma favorável ao longo da intervenção
Introduction: In the past two decades, the literature has pointed to a potential influence of underlying pain production mechanisms for chronic low back pain (DLC), regarding a multimodal Physical Therapy intervention. It seems there is evidence that suggests the existence of differences between individuals with different types of pain, regarding the pre-intervention clinical characteristics. In addition, preliminary evidence also suggests that different types of pain seem to respond clinically different to a multimodal physiotherapy intervention. Aim: Investigate if different pain production mechanisms allow to anticipate more or less favorable intervention responses, regarding pain intensity, functional disability and global perceived improvement. Methodology: Prospective cohort study with 40 participants that started Physical Therapy intervention and were assessed before the intervention (baseline); at 2 weeks; 8 weeks or less if discharged before; and at 3 months after the start of the intervention. The measurement instruments used were the Sociodemographic and Clinical Characterization Questionnaire; PainDetect Questionnaire; Numeric Rating Pain Scale (END); Quebec Back Pain Disability Scale – Portuguese Version (QBPDS-PT); and Global Back Recovery Scale – Portuguese Version (GBRS-PT). A two level analysis was completed: assessment of the inter-groups differences, at each assessment moment; and an intra-group analysis, at each assessment moment, in regards to the considered outcomes. Results: Out of the 40 participants assessed at baseline, 39 completed the intervention period and 31 completed the 3 months follow-up assessment. At baseline, despite the predominant neuropathic pain participants reporting superior pain intensity levels (7.00 ± 0.89) and functional disability (49.33 ± 13.69) compared to the predominant nociceptive pain individuals (6.38 ± 1.79 e 39.81 ± 18.45, respectively) and to the mixed pain pattern participants (6.00 ± 0.93 e 32.88 ± 12.77, respectively), the differences between these were not statistically significant. Regarding the Physical Therapy intervention responds there were also found no statistically significant differences between the subgroups. The participants seem to have a favorable response, decreasing pain intensity and functional disability levels, independently of the predominant pain mechanism (p<0.05). Conclusions: The results suggest that subgroups of individuals with different pain production mechanisms do not differ between themselves regarding a multimodal Physical Therapy intervention, verifying that independently of the predominant pain production mechanisms, the individuals seem to favorably respond during the intervention.
Introduction: In the past two decades, the literature has pointed to a potential influence of underlying pain production mechanisms for chronic low back pain (DLC), regarding a multimodal Physical Therapy intervention. It seems there is evidence that suggests the existence of differences between individuals with different types of pain, regarding the pre-intervention clinical characteristics. In addition, preliminary evidence also suggests that different types of pain seem to respond clinically different to a multimodal physiotherapy intervention. Aim: Investigate if different pain production mechanisms allow to anticipate more or less favorable intervention responses, regarding pain intensity, functional disability and global perceived improvement. Methodology: Prospective cohort study with 40 participants that started Physical Therapy intervention and were assessed before the intervention (baseline); at 2 weeks; 8 weeks or less if discharged before; and at 3 months after the start of the intervention. The measurement instruments used were the Sociodemographic and Clinical Characterization Questionnaire; PainDetect Questionnaire; Numeric Rating Pain Scale (END); Quebec Back Pain Disability Scale – Portuguese Version (QBPDS-PT); and Global Back Recovery Scale – Portuguese Version (GBRS-PT). A two level analysis was completed: assessment of the inter-groups differences, at each assessment moment; and an intra-group analysis, at each assessment moment, in regards to the considered outcomes. Results: Out of the 40 participants assessed at baseline, 39 completed the intervention period and 31 completed the 3 months follow-up assessment. At baseline, despite the predominant neuropathic pain participants reporting superior pain intensity levels (7.00 ± 0.89) and functional disability (49.33 ± 13.69) compared to the predominant nociceptive pain individuals (6.38 ± 1.79 e 39.81 ± 18.45, respectively) and to the mixed pain pattern participants (6.00 ± 0.93 e 32.88 ± 12.77, respectively), the differences between these were not statistically significant. Regarding the Physical Therapy intervention responds there were also found no statistically significant differences between the subgroups. The participants seem to have a favorable response, decreasing pain intensity and functional disability levels, independently of the predominant pain mechanism (p<0.05). Conclusions: The results suggest that subgroups of individuals with different pain production mechanisms do not differ between themselves regarding a multimodal Physical Therapy intervention, verifying that independently of the predominant pain production mechanisms, the individuals seem to favorably respond during the intervention.
Description
Relatório do Projeto de Investigação apresentado para cumprimento dos requisitos necessários
à obtenção do grau de Mestre em Fisioterapia, área de especialização em Fisioterapia em
Condições Músculo-Esqueléticas
Keywords
Dor Lombar Crónica Mecanismos de Produção de Dor Fisioterapia Questionário PainDetect Chronic Low Back Pain Underlying Pain Mechanisms Physiotherapy PainDetect Questionnaire
Citation
Publisher
Instituto Politécnico de Setúbal. Escola Superior de Saúde