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A disfunção dos mecanismos inibitórios da dor terá influência na resposta de utentes com condições músculo-esqueléticas durante a intervenção em Fisioterapia?
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Introdução: As condições músculo-esqueléticas (CME) representam uma das maiores causas de incapacidade a nível mundial e um dos motivos mais frequentes para a procura de cuidados de saúde. A disfunção dos mecanismos inibitórios endógenos (MIE) tem sido identificada como característica comum a diversas CME, podendo afetar negativamente a resposta às intervenções de Fisioterapia e constituir um potencial fator preditor para o desenvolvimento de estados de dor persistente. Contudo, a evidência sobre o seu papel como fator de prognóstico permanece limitada. Objetivo: Analisar a influência da disfunção dos MIE no curso clínico de utentes com CME, durante a intervenção em Fisioterapia, nomeadamente no outcome intensidade da dor. Métodos: Realizou-se um estudo observacional de coorte prospetivo, envolvendo 29 indivíduos com CME que iniciaram tratamentos de Fisioterapia. Na baseline foi mensurada a intensidade da dor através da Escala Numérica da Dor (END), e preenchido um Questionário Sociodemográfico e Clínico e o Musculoskeletal Health Questionnaire (MSKHQ). A função dos MIE foi avaliada através de um protocolo sequencial de Modulação Condicionada da Dor (MCD), sendo os participantes classificados como “sem disfunção” ou “com disfunção” de acordo com o valor da magnitude absoluta da MCD. A intensidade da dor foi reavaliada às 2, 4 e 6 semanas de intervenção, e o MSK-HQ no último momento de follow-up. A análise dos dados foi realizada através de estatística descritiva e inferencial. Resultados: A prevalência de disfunção dos MIE na amostra foi de 44,83%. Não se verificaram diferenças significativas entre grupos (p>0,05) em nenhuma das variáveis sociodemográficas, clínicas e psicossociais, no estado de saúde músculo-esquelética e na intensidade da dor na baseline. Observou-se uma redução estatisticamente significativa da intensidade da dor em ambos os grupos em todos os momentos de follow-up, exceto às 2 semanas no grupo “com disfunção”. A intensidade da dor foi significativamente maior no grupo “com disfunção” em comparação com o “sem disfunção” às 2 (p=0,036) e às 4 (p=0,016) semanas. Não se observaram diferenças significativas entre grupos na intensidade da dor (p=0,141) e no MSK-HQ (p=0,092) às 6 semanas. Conclusão: Os resultados do presente estudo sugerem que a disfunção dos MIE parece influenciar negativamente o padrão de recuperação em pessoas com CME, sobretudo nas fases iniciais da intervenção de Fisioterapia. São necessários estudos futuros, com amostras mais robustas, que confirmem estes resultados e que avaliem outros outcomes de interesse.
Keywords: Musculoskeletal Conditions; Endogenous Pain Inhibitory Systems; Conditioned Pain Modulation; Pain Intensity; Clinical Course Introduction: Musculoskeletal conditions (MSKC) represent one of the leading causes of disability worldwide and one of the most frequent reasons for seeking healthcare. Dysfunction in endogenous pain inhibitory systems (EPIS) has been identified as a common feature of several MSKC, which can negatively affect the response to physical therapy interventions and constitute a potential predictor for the development of persistent pain conditions. However, evidence on its role as a prognostic factor remains limited. Purpose: To analyze the influence of EPIS dysfunction on the clinical course of patients with MSKC during physical therapy intervention, particularly on the outcome pain intensity. Methods: A prospective observational cohort study was conducted involving 29 individuals with MSKC who began physical therapy treatments. At baseline, pain intensity was measured using the Numerical Pain Rating Scale (NPRS), and a Sociodemographic and Clinical Questionnaire and the Musculoskeletal Health Questionnaire (MSK-HQ) were completed. EPIS function was assessed using a sequential Conditioned Pain Modulation (CPM) protocol, with participants classified as “without dysfunction” or “with dysfunction” according to the absolute magnitude value of CPM. Pain intensity was reassessed at 2, 4, and 6 weeks of intervention, and the MSK-HQ at the last follow-up. Data analysis was performed using descriptive and inferential statistics. Results: The prevalence of EPIS dysfunction in the sample was 44.83%. No significant differences were found between groups (p>0.05) in any of the sociodemographic, clinical, and psychosocial variables, in musculoskeletal health status or pain intensity at baseline. A statistically significant reduction in pain intensity was observed in both groups at all followup times, except at 2 weeks in the “with dysfunction” group. Pain intensity was significantly higher in the “with dysfunction” group compared to the “without dysfunction” group at 2 (p=0,036) and 4 (p=0,016) weeks. No significant differences were observed between groups in pain intensity (p=0,141) and MSK-HQ (p=0,092) at 6 weeks. Conclusion: The results of the present study suggest that EPIS dysfunction appears to negatively influence the recovery pattern in patients with MSKC, especially in the early stages of physical therapy intervention. Future studies with larger samples are needed to confirm these results and to assess other outcomes of interest.
Keywords: Musculoskeletal Conditions; Endogenous Pain Inhibitory Systems; Conditioned Pain Modulation; Pain Intensity; Clinical Course Introduction: Musculoskeletal conditions (MSKC) represent one of the leading causes of disability worldwide and one of the most frequent reasons for seeking healthcare. Dysfunction in endogenous pain inhibitory systems (EPIS) has been identified as a common feature of several MSKC, which can negatively affect the response to physical therapy interventions and constitute a potential predictor for the development of persistent pain conditions. However, evidence on its role as a prognostic factor remains limited. Purpose: To analyze the influence of EPIS dysfunction on the clinical course of patients with MSKC during physical therapy intervention, particularly on the outcome pain intensity. Methods: A prospective observational cohort study was conducted involving 29 individuals with MSKC who began physical therapy treatments. At baseline, pain intensity was measured using the Numerical Pain Rating Scale (NPRS), and a Sociodemographic and Clinical Questionnaire and the Musculoskeletal Health Questionnaire (MSK-HQ) were completed. EPIS function was assessed using a sequential Conditioned Pain Modulation (CPM) protocol, with participants classified as “without dysfunction” or “with dysfunction” according to the absolute magnitude value of CPM. Pain intensity was reassessed at 2, 4, and 6 weeks of intervention, and the MSK-HQ at the last follow-up. Data analysis was performed using descriptive and inferential statistics. Results: The prevalence of EPIS dysfunction in the sample was 44.83%. No significant differences were found between groups (p>0.05) in any of the sociodemographic, clinical, and psychosocial variables, in musculoskeletal health status or pain intensity at baseline. A statistically significant reduction in pain intensity was observed in both groups at all followup times, except at 2 weeks in the “with dysfunction” group. Pain intensity was significantly higher in the “with dysfunction” group compared to the “without dysfunction” group at 2 (p=0,036) and 4 (p=0,016) weeks. No significant differences were observed between groups in pain intensity (p=0,141) and MSK-HQ (p=0,092) at 6 weeks. Conclusion: The results of the present study suggest that EPIS dysfunction appears to negatively influence the recovery pattern in patients with MSKC, especially in the early stages of physical therapy intervention. Future studies with larger samples are needed to confirm these results and to assess other outcomes of interest.
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Condições Músculo-esqueléticas Mecanismos Inibitórios Endógenos Modulação Condicionada da Dor Intensidade da Dor Curso Clínico Musculoskeletal Conditions Endogenous Pain Inhibitory Systems Conditioned Pain Modulation Pain Intensity Clinical Course