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      Evolución de la lumbalgia en el paciente oncológico tratado con manejo intervencionista del dolor Translated title: Evolution of low back pain in cancer patients treated with interventional pain management

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          Abstract

          RESUMEN Objetivo: Identificar la evolución de la lumbalgia en el paciente oncológico tratado con manejo intervencionista del dolor. Material y métodos: Estudio descriptivo y retrospectivo. Se realizó búsqueda en la base de datos de los pacientes atendidos en la Clínica del dolor del Instituto Nacional de Cancerología sometidos a procedimiento intervencionista por lumbalgia en el periodo de enero de 2017 a diciembre de 2019. El análisis estadístico se realizó en el programa SPSS 15.0 y la información se presentó en tablas de frecuencia. Resultados: Se analizaron 143 pacientes quienes fueron en mayor porcentaje mujeres (69 %) con una media de edad de 65 años. Los factores de riesgo identificados más frecuentes fueron diabetes mellitus tipo 2 (18,2 %) e hipertensión arterial (14,7 %). Los diagnósticos oncológicos de mayor frecuencia fueron cáncer de mama (38,5 %), cáncer de próstata (14 %), mieloma múltiple (13,3 %) y cáncer cervicouterino (10,5 %). Los opioides utilizados fueron tramadol (48,3 %), morfina (32,2 %), buprenorfina y tapentadol (5,6 %), oxicodona (1,4 %), fentanilo y metadona (0,7 %). Los abordajes intervencionistas en mayor proporción fueron depósito de esteroides en ramo dorso medial de articulación cigoapofisiaria lumbar de 3 segmentos (11,2 %), depósito de esteroides de ramo dorso medial de articulación cigoapofisiaria lumbar de 4 o más segmentos el (7,7 %) y vertebroplastia (5,6 %). Además se observó que el 60,8 % de los pacientes recibió más de un abordaje intervencionista. La respuesta terapéutica mayor o igual al 50 % se presentó en el 86,7 % de los pacientes y el 35,7 % mostró una media de reducción de opioides de 22,2 miligramos/día. La lumbalgia con componente neuropático se presentó en el 57,3 % de los pacientes. De acuerdo con la evaluación de la escala verbal análoga antes y a la semana postratamiento, se observaron cambios de dolor leve del 8,4 al 77,6 %, dolor moderado del 21,7 al 46,9 % y dolor severo del 44,8 a 0,7 %. Al mes posterior al procedimiento se observó para dolor leve el 70,6 %, dolor moderado 23,8 % y severo 5,6 %. En cuanto a la evaluación del cuestionario Douleur Neuropathique-4 ítems antes del abordaje terapéutico, el 42,7 % de los pacientes presentaron una puntuación menor a 4, mientras que el 57,3 % presentó un puntaje mayor a 4. A la semana el porcentaje fue del 85,3 y 14,7 %, respectivamente, y posterior al mes el 84,6 % de los pacientes presentó una puntación menor a 4. Conclusiones: El depósito de esteroide de ramo dorso medial de articulación cigoapofisiaria lumbar de 3 segmentos, 4 o más segmentos y vertebroplastia fueron los abordajes más frecuentes. La respuesta terapéutica mayor o igual al 50 % se presentó en el 86,7 % de los pacientes, sin embargo debido a la etiología múltiple de este padecimiento administrar diferentes abordajes en un mismo paciente pudo mejorar el dolor lumbar. Esto se vio reflejado en la persistencia del dolor un mes posterior al procedimiento donde se observó un cambio significativo de dolor moderado y severo a dolor leve (70,6 %), así como en la disminución de analgésicos opioides; sin embargo se requieren estudios prospectivos para mayor caracterización de su efectividad. La elección de realizar estas técnicas se recomienda luego de un análisis individualizado de los pacientes para buscar el mayor beneficio y evitar complicaciones.

          Translated abstract

          ABSTRACT Objective: To identify the evolution of low back pain in cancer patients treated with interventional pain management. Material and methods: Descriptive and retrospective study. A search was carried out in data patients treated at Pain Clinic of the National Cancer Institute who underwent an interventional procedure for low back pain in the period from January 2017 to December 2019. The statistical analysis was performed in SPSS 15.0 program and information was presented in frequency tables. Results: 143 patients were analyzed, the highest percentage being women (69 %) with a mean age of 65 years. Most frequent risk factors identified were type 2 diabetes mellitus (18.2 %) and arterial hypertension (14.7 %). Most frequent oncological diagnoses were breast cancer (38.5 %), prostate cancer (14 %), multiple myeloma (13.3 %), and cervical cancer (10.5 %). Opioids used were tramadol (48.3 %), morphine (32.2 %), buprenorphine and tapentadol (5.6 %), oxycodone (1.4 %), fentanyl and methadone (0.7 %). Interventional approaches in greater proportion were steroid deposition in dorsal medial branch of the lumbar zygapophyseal joint of 3 segments (11.2 %), steroid deposition of dorsal medial branch of the lumbar zygapophyseal joint of 4 or more segments (7.7 %) and vertebroplasty (5.6 %), it was also observed that 60.8 % of patients received more than one interventional approach. Therapeutic response greater than or equal to 50 % was presented in 86.7 % of patients and 35.7 % showed a mean reduction in opioids of 22.2 milligrams / day. Low back pain with a neuropathic component occurred in 57.3 % of patients. According to verbal analogue scale evaluation before and a week after treatment, changes in mild pain were observed from 8.4 % to 77.6 %, moderate pain from 21.7 % to 46.9 % and severe pain from 44.8 % to 0.7 %. One month after the procedure, 70.6 % were observed for mild pain, 23.8 % moderate pain and 5.6 % severe. Evaluation of Douleur Neuropathique-4 items questionnaire before therapeutic approach, 42.7 % of patients presented a score lower than 4, while 57.3 % presented a score greater than 4. After one week percentage was 85.3 % and 14.7 % respectively, and after one month, 84.6 % of patients presented a score lower than 4. Conclusions: Steroid deposition in dorsal medial branch of the lumbar zygapophyseal joint of 3 segments, 4 or more segments and vertebroplasty were the most frequent approaches. Therapeutic response greater than or equal to 50 % was presented in 86.7 % of patients, however, due to the multiple etiology of this condition, administering different approaches in the same patient could improve lumbar pain, this was reflected in persistence of pain one month after the procedure where a significant change was observed from moderate and severe pain to mild pain (70.6 %) as well as a decrease in opioid analgesics; however, prospective studies are required to further characterize its effectiveness. The choice to perform these techniques is recommended after an individualized analysis of the patients to seek the greatest benefit and avoid complications.

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          The Epidemiology of low back pain.

          Low back pain is an extremely common problem that most people experience at some point in their life. While substantial heterogeneity exists among low back pain epidemiological studies limiting the ability to compare and pool data, estimates of the 1 year incidence of a first-ever episode of low back pain range between 6.3% and 15.4%, while estimates of the 1 year incidence of any episode of low back pain range between 1.5% and 36%. In health facility- or clinic-based studies, episode remission at 1 year ranges from 54% to 90%; however, most studies do not indicate whether the episode was continuous between the baseline and follow-up time point(s). Most people who experience activity-limiting low back pain go on to have recurrent episodes. Estimates of recurrence at 1 year range from 24% to 80%. Given the variation in definitions of remission and recurrence, further population-based research is needed to assess the daily patterns of low back pain episodes over 1 year and longer. There is substantial information on low back pain prevalence and estimates of the point prevalence range from 1.0% to 58.1% (mean: 18.1%; median: 15.0%), and 1 year prevalence from 0.8% to 82.5% (mean: 38.1%; median: 37.4%). Due to the heterogeneity of the data, mean estimates need to be interpreted with caution. Many environmental and personal factors influence the onset and course of low back pain. Studies have found the incidence of low back pain is highest in the third decade, and overall prevalence increases with age until the 60-65 year age group and then gradually declines. Other commonly reported risk factors include low educational status, stress, anxiety, depression, job dissatisfaction, low levels of social support in the workplace and whole-body vibration. Low back pain has an enormous impact on individuals, families, communities, governments and businesses throughout the world. The Global Burden of Disease 2005 Study (GBD 2005) is currently making estimates of the global burden of low back pain in relation to impairment and activity limitation. Results will be available in 2011. Further research is needed to help us understand more about the broader outcomes and impacts from low back pain. 2010 Elsevier Ltd. All rights reserved.
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            Diagnosis and treatment of low back pain: a joint clinical practice guideline from the American College of Physicians and the American Pain Society.

            RECOMMENDATION 1: Clinicians should conduct a focused history and physical examination to help place patients with low back pain into 1 of 3 broad categories: nonspecific low back pain, back pain potentially associated with radiculopathy or spinal stenosis, or back pain potentially associated with another specific spinal cause. The history should include assessment of psychosocial risk factors, which predict risk for chronic disabling back pain (strong recommendation, moderate-quality evidence). RECOMMENDATION 2: Clinicians should not routinely obtain imaging or other diagnostic tests in patients with nonspecific low back pain (strong recommendation, moderate-quality evidence). RECOMMENDATION 3: Clinicians should perform diagnostic imaging and testing for patients with low back pain when severe or progressive neurologic deficits are present or when serious underlying conditions are suspected on the basis of history and physical examination (strong recommendation, moderate-quality evidence). RECOMMENDATION 4: Clinicians should evaluate patients with persistent low back pain and signs or symptoms of radiculopathy or spinal stenosis with magnetic resonance imaging (preferred) or computed tomography only if they are potential candidates for surgery or epidural steroid injection (for suspected radiculopathy) (strong recommendation, moderate-quality evidence). RECOMMENDATION 5: Clinicians should provide patients with evidence-based information on low back pain with regard to their expected course, advise patients to remain active, and provide information about effective self-care options (strong recommendation, moderate-quality evidence). RECOMMENDATION 6: For patients with low back pain, clinicians should consider the use of medications with proven benefits in conjunction with back care information and self-care. Clinicians should assess severity of baseline pain and functional deficits, potential benefits, risks, and relative lack of long-term efficacy and safety data before initiating therapy (strong recommendation, moderate-quality evidence). For most patients, first-line medication options are acetaminophen or nonsteroidal anti-inflammatory drugs. RECOMMENDATION 7: For patients who do not improve with self-care options, clinicians should consider the addition of nonpharmacologic therapy with proven benefits-for acute low back pain, spinal manipulation; for chronic or subacute low back pain, intensive interdisciplinary rehabilitation, exercise therapy, acupuncture, massage therapy, spinal manipulation, yoga, cognitive-behavioral therapy, or progressive relaxation (weak recommendation, moderate-quality evidence).
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              Chapter 4. European guidelines for the management of chronic nonspecific low back pain.

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                Author and article information

                Journal
                dolor
                Revista de la Sociedad Española del Dolor
                Rev. Soc. Esp. Dolor
                Inspira Network Group, S.L (Madrid, Madrid, Spain )
                1134-8046
                April 2021
                : 28
                : 2
                : 76-81
                Affiliations
                [1] Ciudad de México orgnameInstituto Nacional de Cancerología orgdiv1Clínica de Dolor México
                Article
                S1134-80462021000300005 S1134-8046(21)02800200005
                10.20986/resed.2021.3901/2020
                6735c27a-3315-4dc4-bb0d-c40b59e40dff

                This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.

                History
                : 08 February 2021
                : 17 April 2021
                Page count
                Figures: 0, Tables: 0, Equations: 0, References: 18, Pages: 6
                Product

                SciELO Spain

                Categories
                Originales

                Low back pain,interventional management,pain,dolor oncológico,dolor,cáncer,cancer pain,Lumbalgia,manejo intervencionista

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