COMPARAÇÃO DA UTILIZAÇÃO DAS TÉCNICAS WATSU E RELAXAMENTO AQUÁTICO EM FLUTUAÇÃO ASSISTIDA NOS SINTOMAS DE ANSIEDADE, DEPRESSÃO E PERCEPÇÃO DA DOR

Este estudo teve como objetivo comparar o efeito do método Watsu e do relaxamento aquático em flutuação assistida em piscina, no tratamento da dor crônica. Também objetiva avaliar o efeito dos sintomas de depressão e ansiedade como co-fatores nesses tratamentos. A amostra é constituída por 23 indivíduos de ambos os sexos, acima de 18 anos. No método Watsu são atendidas 13 pessoas, sendo 11 mulheres e 02 homens. Na técnica de relaxamento assistido são atendidas 10 pessoas, sendo 07 mulheres e 03 homens, entre pacientes que procuram tratamento fisioterápico no centro clínico Escola de Fisioterapia da UMESP, com dor crônica. Os dados são colhidos através de entrevista estruturada. Aplicada escala associada para avaliar percepção de dor, questionário de avaliação de sintomas de depressão Beck, de Ansiedade Idate-Estado e Ansiedade Idate-Traço. Devido ao pequeno tamanho da amostra, as comparações entre os dois tipos de tratamento (Watsu e relaxamento) e, como os resultados obtidos são equivalentes em ambos os procedimentos, optou se por apresentar os resultados apenas das análises por métodos paramétricos (teste t de média, regressão linear e análise de variância). Não são observadas diferenças significativas entre os dois grupos em relação aos escores de ansiedade e depressão antes e após a realização da pesquisa. Em relação à comparação entre os dois grupos pesquisados, quanto à percepção de dor, observou-se que tanto o método de Watsu quanto as técnicas de relaxamento mostram um efeito significativo na redução da dor. Esta pesquisa sugere que o método Watsu é tão eficaz para o controle da dor quanto o método de relaxamento, porém, o grupo de pacientes submetidos ao método Watsu é constituído por pessoas com níveis de intensidade de dor iniciais maiores do que o grupo de relaxamento. Com isso, pode-se supor que a demanda por eficácia clinica é maior para o método Watsu. Outro achado interessante é que os níveis de ansiedade ou depressão presentes nos participantes não parecem influenciar a resposta ao efeito do tratamento sobre a dor. Novos estudos do tipo duplo-cego controlados são necessários para, além de confirmar a eficácia do método, ajudar a entender quais detalhes dos procedimentos da técnica Watsu são mais eficazes para cada tipo de dor e de estado afetivo do paciente.

Gamma oscillatory amplitude encodes stimulus intensity in primary somatosensory cortex

Gamma oscillations have previously been linked to pain perception and it has been hypothesised that they may have a potential role in encoding pain intensity. Stimulus response experiments have reported an increase in activity in the primary somatosensory cortex (SI) with increasing stimulus intensity, but the specific role of oscillatory dynamics in this change in activation remains unclear. In this study, Magnetoencephalography (MEG) was used to investigate the changes in cortical oscillations during 4 different intensities of a train of electrical stimuli to the right index finger, ranging from low sensation to strong pain. In those participants showing changes in evoked oscillatory gamma in SI during stimulation, the strength of the gamma power was found to increase with increasing stimulus intensity at both pain and sub-pain thresholds. These results suggest that evoked gamma oscillations in SI are not specific to pain but may have a role in encoding somatosensory stimulus intensity. © 2013 Rossiter, Worthen, Witton, Hall and Furlong.

Clinical and functional outcomes of acute lower extremity compartment syndrome at a Major Trauma Hospital

Background: Acute lower extremity compartment syndrome (CS) is a condition that untreated causes irreversible nerve and muscle ischemia. Treatment by decompression fasciotomy without delay prevents permanent disability. The use of intracompartmental pressure (iCP) measurement in uncertain situations aids in diagnosis of severe leg pain. As an infrequent complication of lower extremity trauma, consequences of CS include chronic pain, nerve injury, and contractures. The purpose of this study was to observe the clinical and functional outcomes for patients with lower extremity CS after fasciotomy. Methods: Retrospective chart analysis for patients with a discharge diagnosis of CS was performed. Physical demographics, employment status, activity at time of injury, injury severity score, fracture types, pain scores, hours to fasciotomy, iCP, serum creatine kinase levels, wound treatment regimen, length of hospital stay, and discharge facility were collected. Lower extremity neurologic examination, pain scores, orthopedic complications, and employment status at 30 days and 12 months after discharge were noted. Results: One hundred twenty‑four patients were enrolled in this study. One hundred and eight patients were assessed at 12 months. Eighty‑one percent were male. Motorized vehicles caused 51% of injuries in males. Forty‑one percent of injuries were tibia fractures. Acute kidney injury occurred in 2.4%. Mean peak serum creatine kinase levels were 58,600 units/ml. Gauze dressing was used in 78.9% of nonfracture patients and negative pressure wound vacuum therapy in 78.2% of fracture patients. About 21.6% of patients with CS had prior surgery. Nearly 12.9% of patients required leg amputation. Around 81.8% of amputees were male. Sixty‑seven percent of amputees had associated vascular injuries. Foot numbness occurred in 20.5% of patients and drop foot palsy in 18.2%. Osteomyelitis developed in 10.2% of patients and fracture nonunion in 6.8%. About 14.7% of patients underwent further orthopedic surgery. At long‑term follow‑up, 10.2% of patients reported moderate lower extremity pain and 69.2% had returned to work. Conclusion: Escalation in leg pain and changes in sensation are the cardinal signs for CS rather than reliance on assessing for firm compartments and pressures. The severity of nerve injury worsens with the delay in performing fasciotomy. Standardized diagnostic protocols and wound treatment strategies will result in improved outcomes from this complication.

Great Britain's Olympians with generalised joint hypermobility have a higher prevalence of knee osteoarthritis.

Purpose: Individuals with generalized joint hypermobility (GJH) are reported, in the clinical setting, to be at greater risk of developing musculoskeletal related joint pain, joint dislocations and tendinopathies. It is hypothesized that impaired static and dynamic neuromuscular movement control in those with GJH is responsible for contributing to an increased risk of injury and subsequent knee osteoarthritis (OA). Yet, to date, it remains unproven if there is an association between GJH and knee OA.

Spondylodiscitis as Complication of Transrectal Ultrasonography-guided Prostate Biopsy: a Case Report

A 61-year-old man presented with high fever, and severe back and abdominal pain following transrectal ultrasonography (TRUS)-guided prostate biopsy. Diagnosis of spondylodiscitis and psoas abscesses was made based on MRI images of the lumbar tract of the spine. Six-month broad-spectrum antibiotic treatment and immobilization with a girdle overcame the disease without any relapse at the 1-year follow-up. Spondylodiscitis after TRUS-guided prostate biopsy is a rare event, which is not yet included as a major complication of the procedure. It is probably due to the presence of fluoroquinolone-resistant bacteria in faeces. It is, therefore, important to highlight this possibility and to stress the use of targeted antibiotic prophylaxis after rectal flora swabbing with selected antibiotics at sufficient concentrations to be effective.

Back pain in adults living in quilombola territories of Bahia, Northeastern Brazil

OBJECTIVE To analyze the factors associated with back pain in adults who live in quilombola territories. METHODS A population-based survey was performed on quilombola communities of Vitória da Conquista, state of Bahia, Northeastern Brazil. The sample (n = 750) was established via a raffle of residences. Semi-structured interviews were conducted to investigate sociodemographics and employment characteristics, lifestyle, and health conditions. The outcome was analyzed as a dichotomous variable (Poisson regression). RESULTS The prevalence of back pain was of 39.3%. Age ≥ 30 years and being a smoker were associated with the outcome. The employment status was not related to back pain. CONCLUSIONS The survey identified a high prevalence of back pain in adults. It is suggested to support the restructuring of the local public service in order to outline programs and access to healthy practices, assistance, diagnosis, and treatment of spine problems.

Effects of Low-Level Laser Therapy (LLLT) in the Development of Exercise-Induced Skeletal Muscle Fatigue and Changes in Biochemical Markers Related to Postexercise Recovery

STUDY DESIGN: Randomized crossover double-blinded placebo-controlled trial. OBJECTIVE: To investigate if low-level laser therapy (LLLT) can affect biceps muscle performance, fatigue development, and biochemical markers of postexercise recovery. BACKGROUND: Cell and animal studies have suggested that LLLT can reduce oxidative stress and inflammatory responses in muscle tissue. But it remains uncertain whether these findings can translate into humans in sport and exercise situations. METHODS: Nine healthy male volleyball players participated in the study. They received either active LLLT (cluster probe with 5 laser diodes; A = 810 nm; 200 mW power output; 30 seconds of irradiation, applied in 2 locations over the biceps of the nondominant arm; 60 J of total energy) or placebo LLLT using an identical cluster probe. The intervention or placebo were applied 3 minutes before the performance of exercise. All subjects performed voluntary elbow flexion repetitions with a workload of 75% of their maximal voluntary contraction force until exhaustion. RESULTS: Active LLLT increased the number of repetitions by 14.5% (mean +/- SD, 39.6 +/- 4.3 versus 34.6 +/- 5.6; P = .037) and the elapsed time before exhaustion by 8.0% (P = .034), when compared to the placebo treatment. The biochemical markers also indicated that recovery may be positively affected by LLLT, as indicated by postexercise blood lactate levels (P<.01), creatine kinase activity (P = .017), and C-reactive protein levels (P = .047), showing a faster recovery with LLLT application prior to the exercise. CONCLUSION: We conclude that pre-exercise irradiation of the biceps with an LLLT dose of 6 J per application location, applied in 2 locations, increased endurance for repeated elbow flexion against resistance and decreased postexercise levels of blood lactate, creatine kinase, and C-reactive protein. LEVEL OF EVIDENCE: Performance enhancement, level 1b. J Orthop Sports Phys Ther 2010;40(8):524-532. doi:10.2519/jospt.2010.3294

Quality of life profile and correlated factors in chronic leg ulcer patients in the mid-west of São Paulo State, Brazil

BACKGROUND: Chronic leg ulcer may have an impact on patients' quality of life.OBJECTIVES:This study aimed to identify the impact of leg ulcers on patient's quality of life using the Dermatology Life Quality Index and to define the main factors correlated with this perception.METHOD:Cross-sectional, non-probabilistic sampling study. We included patients with chronic leg ulcers being treated for at least 3 months. A sociodemographic and clinical survey was conducted to assess the profile of the ulcers. We administered a screening for depressive symptoms and the Dermatology Life Quality Index. We performed a descriptive statistical analysis, chi-square test and Mann-Whitney test for categorical data, Pearson for numeric variables, and multiple regression for categorical data.RESULTS:Forty-one patients were assessed. Their mean age was 61.78 years. Venous ulcers (48.8%) were the most prevalent. Seventy-three percent of the sample perceived no impact/low impact on quality of life in the past week, and 26.8% perceived moderate/high impact. A multiple regression analysis identified the causes of lesion, pain related to the ulcers, time of onset, and severity of the depressive symptoms as the variables that had an influence on quality of life.CONCLUSIONS:The majority of the sample perceived low or no impact of the condition on the quality of the life. The variables etiology of the lesion (p<0.001), pain related to the ulcers (p=0.001), time of onset (p=0.006), and severity of the depressive symptoms (p<0.001) had an influence on the quality of life, suggesting the need for further studies with more robust designs to confirm the causal relationship between these characteristics and quality of life.

Reference values of mechanical and thermal pain tests in a pain-free population

Quantitative sensory tests are widely used in human research to evaluate the effect of analgesics and explore altered pain mechanisms, such as central sensitization. In order to apply these tests in clinical practice, knowledge of reference values is essential. The aim of this study was to determine the reference values of pain thresholds for mechanical and thermal stimuli, as well as withdrawal time for the cold pressor test in 300 pain-free subjects. Pain detection and pain tolerance thresholds to pressure, heat and cold were determined at three body sites: (1) lower back, (2) suprascapular region and (3) second toe (for pressure) or the lateral aspect of the leg (for heat and cold). The influences of gender, age, height, weight, body-mass index (BMI), body side of testing, depression, anxiety, catastrophizing and parameters of Short-Form 36 (SF-36) were analyzed by multiple regressions. Quantile regressions were performed to define the 5th, 10th and 25th percentiles as reference values for pain hypersensitivity and the 75th, 90th and 95th percentiles as reference values for pain hyposensitivity. Gender, age and/or the interaction of age with gender were the only variables that consistently affected the pain measures. Women were more pain sensitive than men. However, the influence of gender decreased with increasing age. In conclusion, normative values of parameters related to pressure, heat and cold pain stimuli were determined. Reference values have to be stratified by body region, gender and age. The determination of these reference values will now allow the clinical application of the tests for detecting abnormal pain reactions in individual patients.

Back pain in migrant farmworker families and farmworker high school students from Starr County, Texas

Back symptoms are a major global public health problem with the lifetime prevalence ranging between 50-80%. Research suggests that work-related factors contribute to the occurrence of back pain in various industries. Despite the hazardous nature, strenuous tasks, and awkward postures associated with farm work, little is known about back injury and symptoms in farmworker adults and children. Research in the United States is particularly limited. This is a concern given the large proportion of migrant farmworkers in the United States without adequate access to healthcare as well as a substantial number of youth working in agriculture. The present study describes back symptoms and identifies work-related factors associated with back pain in migrant farmworker families and farmworker high school students from Starr County, TX. Two separate datasets were used from two cohort studies "Injury and Illness Surveillance in Migrant Farmworkers (MANOS)" (study A: n=267 families) and "South Texas Adolescent Rural Research Study (STARRS)" (study B: n=345). Descriptive and inferential statistics including multivariable logistic regression were used to identify work-related factors associated with back pain in each study. In migrant farmworker families, the prevalence of chronic back pain during the last migration season ranged from 9.5% among youngest children to 33.3% among mothers. Chronic back pain was significantly associated with increasing age; fairly bad/very bad quality of sleep while migrating; fewer than eight hours of sleep at home in Starr County, TX; depressive symptoms while migrating; self-provided water for washing hands/drinking; weeding at work; and exposure to pesticide drift/direct spray. Among farmworker adolescents, the prevalence of severe back symptoms was 15.7%. Severe back symptoms were significantly associated with being female; history of a prior accident/back injury; feeling tense, stressed, or anxious sometimes/often; lifting/carrying heavy objects not at work; current tobacco use; increasing lifetime number of migrant farmworker years; working with/around knives; and working on corn crops. Overall, results support that associations between work-related exposures and chronic back pain and severe back symptoms remain after controlling for the effect of non-work exposures in farmworker populations. ^

Item validity of the physical demands from the Dictionary of Occupational Titles for the functional capacity evaluation of clients with chronic back pain

This study assessed the item validity of 15 of the physical demands from the Dictionary of Occupational Titles (DOT), as evaluated in a new approach to functional capacity evaluation (FCE) for clients with chronic back pain, the Gibson Approach to FCE (GAPP FCE). Fifty-two occupational therapists were sent the specifications of the items in the GAPP FCE procedures and were asked to rate the items in terms of item-objective congruence, relevance and difficulty. A response rate of 59.2% was obtained. The majority of the therapists agreed that most of the items were congruent with the objectives based on the definition of the physical demands from the DOT. The items evaluating Balancing and Pushing and Pulling had the lowest item-objective congruence. The evaluation of Balancing and the Lifting, Carrying and Pushing and Pulling of loads greater than light-medium weight (10–16 kg) were not considered significantly relevant. Concerns were raised about the difficulty and safety of the evaluation of Lifting, Carrying and Pushing and Pulling with clients with chronic back pain, particularly if the therapist evaluates the manual handling of medium to heavy loads. These results may have implications for other FCEs, particularly those which are based on the DOT, or when assessing clients with chronic back pain.

Disorders of breathing and continence have a stronger association with back pain than obesity and physical activity

Although obesity and physical activity have been argued to predict back pain, these factors are also related to incontinence and breathing difficulties. Breathing and continence mechanisms may interfere with the physiology of spinal control, and may provide a link to back pain. The aim of this study was to establish the association between back pain and disorders of continence and respiration in women. We conducted a cross-sectional analysis of self-report, postal survey data from the Australian Longitudinal Study on Women's Health. We used multinomial logistic regression to model four levels of back pain in relation to both the traditional risk factors of body mass index and activity level, and the potential risk factors of incontinence, breathing difficulties, and allergy. A total of 38 050 women were included from three age-cohorts. When incontinence and breathing difficulties were considered, obesity and physical activity were not consistently associated with back pain. In contrast, odds ratios (OR) for often having back pain were higher for women often having incontinence compared to women without incontinence (OR were 2.5, 2.3 and 2.3 for young, mid-age! and older women, respectively). Similarly, mid-aged and older women had higher odds of having back pain often when they experienced breathing difficulties often compared to women with no breathing problems (OR of 2.0 and 1.9, respectively). Unlike obesity and physical activity, disorders of continence and respiration were strongly related to frequent back pain. This relationship may be explained by physiological limitations of co-ordination of postural, respiratory and continence functions of trunk muscles.

Reduced variability of postural strategy prevents normalization of motor changes induced by back pain: A risk factor for chronic trouble?

Variability is fundamental to biological systems and is important in posturomotor learning and control. Pain induces a protective postural strategy, although variability is normally preserved. If variability is lost, does the normal postural strategy return when pain stops? Sixteen subjects performed arm movements during control trials, when the movement evoked back pain and then when it did not. Variability in the postural strategy of the abdominal muscles and pain-related cognitions were evaluated. Only those subjects for whom pain induced a reduction in variability of the postural strategy failed to return to a normal strategy when pain stopped. They were also characterized by their pain-related cognitions. Ongoing perception of threat to the back may exert tighter evaluative control over variability of the postural strategy.

The upstream Variable Number Tandem Repeat polymorphism of the monoamine oxidase type A gene influences trigeminal pain-related evoked responses

Monoamines have an important role in neural plasticity, a key factor in cortical pain processing that promotes changes in neuronal network connectivity. Monoamine oxidase type A (MAOA) is an enzyme that, due to its modulating role in monoaminergic activity, could play a role in cortical pain processing. The X-linked MAOA gene is characterized by an allelic variant of length, the MAOA upstream Variable Number Tandem Repeat (MAOA-uVNTR) region polymorphism. Two allelic variants of this gene are known, the high-activity MAOA (HAM) and low-activity MAOA (LAM). We investigated the role of MAOA-uVNTR in cortical pain processing in a group of healthy individuals measured by the trigeminal electric pain-related evoked potential (tPREP) elicited by repeated painful stimulation. A group of healthy volunteers was genotyped to detect MAOA-uVNTR polymorphism. Electrical tPREPs were recorded by stimulating the right supraorbital nerve with a concentric electrode. The N2 and P2 component amplitude and latency as well as the N2-P2 inter-peak amplitude were measured. The recording was divided into three blocks, each containing 10 consecutive stimuli and the N2-P2 amplitude was compared between blocks. Of the 67 volunteers, 37 were HAM and 30 were LAM. HAM subjects differed from LAM subjects in terms of amplitude of the grand-averaged and first-block N2-P2 responses (HAM>LAM). The N2-P2 amplitude decreased between the first and third block in HAM subjects but not LAM subjects. The MAOA-uVNTR polymorphism seemed to influence the brain response in a repeated tPREP paradigm and suggested a role of the MAOA as a modulator of neural plasticity related to cortical pain processing. Monoamines have an important role in neural plasticity, a key factor in cortical pain processing that promotes changes in neuronal network connectivity. Monoamine oxidase type A (MAOA) is an enzyme that, due to its modulating role in monoaminergic activity, could play a role in cortical pain processing. © 2014 Federation of European Neuroscience Societies and John Wiley & Sons Ltd.