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Alterações no processamento central e na função dos sistemas inibitórios descendentes em utentes com Dor Lombar Crónica
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Advisor(s)
Abstract(s)
Introdução: A Dor Lombar Crónica (DLC) é a condição músculo-esquelética mais prevalente
da população portuguesa. Tendo em conta a sua natureza multidimensional, a evidência
sugere que o critério tempo (mais de 12 semanas de duração) não caracteriza
adequadamente os utentes com DLC, sendo importante avaliar os mecanismos de produção
de dor subjacentes.
Objetivo: Investigar a presença de alterações no funcionamento do Sistema Nervoso Central
compatíveis com um estado de sensitização central (alterações no processamento central e na
função dos sistemas inibitórios descendentes) em utentes com DLC.
Metodologia: Realizou-se um estudo observacional analítico do tipo caso-controlo, com base
numa amostra constituída por 13 utentes com DLC e 13 indivíduos assintomáticos com
características semelhantes de idade e género, que cumpriram os critérios de inclusão
estabelecidos. Foram avaliados os limiares de dor à pressão (LDP) na coluna lombar, dorso
do pé homolateral e região tenar da mão contralateral no sentido de avaliar a presença de
sinais de alterações no processamento central. Com o intuito de avaliar a função dos sistemas
inibitórios descendentes foram utilizados os testes Modulação Condicionada da Dor (MCD) e
Adaptabilidade à dor.
Resultados: Não se verificaram diferenças estatisticamente significativas entre grupos no
LDP, no limiar de tolerância à dor à pressão (estímulo de teste do protocolo MCD) e na
adaptabilidade à dor (p>0,05). Contudo, os resultados demonstram uma tendência para
pontuações médias inferiores no LDP na coluna lombar nos indivíduos com DLC. Os
resultados revelam também uma tendência para pontuações médias inferiores no limiar de
tolerância à dor à pressão (LTDP – estímulo de teste no protocolo de MCD) imediatamente
após o término da aplicação do estímulo de condicionamento e na adaptabilidade à dor nos
indivíduos com DLC. Indivíduos com DLC de origem predominantemente neuropática
demonstraram uma tendência para pontuações médias inferiores no LDP em todos os locais
de aplicação, bem como no LTDP em todos os momentos de avaliação definidos no protocolo
de MCD e na adaptabilidade à dor.
Conclusões: Embora sem diferenças estatisticamente significativas entre os grupos, os
resultados demonstram uma tendência para alterações no processamento central e função
dos sistemas inibitórios descendentes nos indivíduos com DLC de características
predominantemente neuropáticas, sugestivas de sensitização central e com elevado impacto
funcional e psicossocial. Estes resultados sugerem a necessidade de investigar diferenças
entre sub-grupos de utentes com DLC (dor nociceptiva/ neuropática) e as suas implicações em
contexto clínico e de investigação.
Introduction: Chronic Low Back Pain (CLBP) is the most prevalent musculoskeletal condition in the Portuguese population. Given its multidimensional nature, the evidence suggests that the time criterion (over 12 weeks duration) does not adequately characterize CLBP patients, and it is important to evaluate the mechanisms underlying pain production. Objetive: To investigate the presence of alterations in the functioning of the Central Nervous System compatible with a central sensitization state (changes in central processing and the function of the descending inhibitory systems) in patients with CLBP. Methodology: An observational, case-control, observational study was performed based on a sample of 13 patients with CLBP and 13 asymptomatic individuals with similar characteristics of age and gender, who met the established inclusion criteria. Pressure pain thresholds (PPT) were evaluated in the lumbar spine, back of the homolateral foot and the tenar region of the contralateral hand in order to evaluate the presence of signs of changes in central processing. In order to evaluate the function of the descending inhibitory systems, the Conditioned Pain Modulation (CPM) and Pain Adaptability tests were used. Results: There were no statistically significant differences between groups in PPT, in pressure pain tolerance threshold to pressure (PPTT - test stimulus in the CPM protocol) and pain adaptability (p> 0.05). However, the results demonstrate a tendency for lower mean scores in PPT in the lumbar spine in subjects with CLBP. The results also reveal a tendency for lower mean scores in PPTT immediately after the end of the application of the conditioning stimulus and in pain adaptability in individuals with DLC. Individuals with predominantly neuropathic CLBP demonstrated a tendency for lower mean scores in PPT at all sites of application as well as in PPTT at all time points defined in the CPM protocol and in pain adaptability. Conclusions: Although there were no statistically significant differences between groups, the results showed a tendency for alterations in central processing and function of the descending inhibitory systems in individuals with CLBP of predominantly neuropathic characteristics, suggestive of central sensitization and with high functional and psychosocial impact. These results suggest the need to investigate differences between subgroups of patients with CLBP (nociceptive / neuropathic pain) and their implications in clinical and research context.
Introduction: Chronic Low Back Pain (CLBP) is the most prevalent musculoskeletal condition in the Portuguese population. Given its multidimensional nature, the evidence suggests that the time criterion (over 12 weeks duration) does not adequately characterize CLBP patients, and it is important to evaluate the mechanisms underlying pain production. Objetive: To investigate the presence of alterations in the functioning of the Central Nervous System compatible with a central sensitization state (changes in central processing and the function of the descending inhibitory systems) in patients with CLBP. Methodology: An observational, case-control, observational study was performed based on a sample of 13 patients with CLBP and 13 asymptomatic individuals with similar characteristics of age and gender, who met the established inclusion criteria. Pressure pain thresholds (PPT) were evaluated in the lumbar spine, back of the homolateral foot and the tenar region of the contralateral hand in order to evaluate the presence of signs of changes in central processing. In order to evaluate the function of the descending inhibitory systems, the Conditioned Pain Modulation (CPM) and Pain Adaptability tests were used. Results: There were no statistically significant differences between groups in PPT, in pressure pain tolerance threshold to pressure (PPTT - test stimulus in the CPM protocol) and pain adaptability (p> 0.05). However, the results demonstrate a tendency for lower mean scores in PPT in the lumbar spine in subjects with CLBP. The results also reveal a tendency for lower mean scores in PPTT immediately after the end of the application of the conditioning stimulus and in pain adaptability in individuals with DLC. Individuals with predominantly neuropathic CLBP demonstrated a tendency for lower mean scores in PPT at all sites of application as well as in PPTT at all time points defined in the CPM protocol and in pain adaptability. Conclusions: Although there were no statistically significant differences between groups, the results showed a tendency for alterations in central processing and function of the descending inhibitory systems in individuals with CLBP of predominantly neuropathic characteristics, suggestive of central sensitization and with high functional and psychosocial impact. These results suggest the need to investigate differences between subgroups of patients with CLBP (nociceptive / neuropathic pain) and their implications in clinical and research context.
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 Dor Sensitização Central Limiar de Dor à Pressão Modulação Condicionada da Dor Adaptabilidade à Dor Chronic Low Back Pain Pain Mechanisms Central Sensitization Pressure Pain Threshold Conditioned Pain Modulation Pain Adaptability
Pedagogical Context
Citation
Publisher
Instituto Politécnico de Setúbal. Escola Superior de Saúde