RESUMO
INTRODUCTION:: Low back pain is one of the painful disorders of higher prevalence. It has several etiologies and surgery may be indicated in the presence of neurological deficits or compression syndromes. However, in up to 40% of cases, patients develop worsening of pain and failed back surgery syndrome (FBSS), which is an important cause of chronic pain with high morbidity and disability. In the last two decades, ozone has been shown to be a new therapeutic option for FBSS due to its analgesic and anti-inflammatory properties. OBJECTIVE:: To evaluate the effect of ozone therapy on pain and disability in patients with failed back surgery syndrome. METHOD:: We selected 19 patients undergoing epiduroscopy and injection of ozone. Patients were evaluated preoperatively and 21 days after the procedure, using the following instruments: Visual Analogue Scale (VAS), Brief Pain Inventory, Roland-Morris Questionnaire Disability, Oswestry Disability Index (ODI), Neuropathic Pain Symptom Inventory and Douleur Neuropathique 4. RESULTS:: The patients showed significant pain relief, but no improvement was observed in the functional scales. CONCLUSION:: Our results suggest that epidural ozone therapy can be a treatment option in FBSS to reduce the intensity of the pain.
Assuntos
Analgésicos/uso terapêutico , Avaliação da Deficiência , Síndrome Pós-Laminectomia/tratamento farmacológico , Dor Lombar/tratamento farmacológico , Ozônio/uso terapêutico , Adulto , Idoso , Análise de Variância , Síndrome Pós-Laminectomia/fisiopatologia , Feminino , Humanos , Injeções Epidurais , Dor Lombar/fisiopatologia , Masculino , Pessoa de Meia-Idade , Medição da Dor , Reprodutibilidade dos Testes , Estudos Retrospectivos , Perfil de Impacto da Doença , Inquéritos e Questionários , Fatores de Tempo , Resultado do Tratamento , Adulto JovemRESUMO
Summary Introduction: Low back pain is one of the painful disorders of higher prevalence. It has several etiologies and surgery may be indicated in the presence of neurological deficits or compression syndromes. However, in up to 40% of cases, patients develop worsening of pain and failed back surgery syndrome (FBSS), which is an important cause of chronic pain with high morbidity and disability. In the last two decades, ozone has been shown to be a new therapeutic option for FBSS due to its analgesic and anti-inflammatory properties. Objective: To evaluate the effect of ozone therapy on pain and disability in patients with failed back surgery syndrome. Method: We selected 19 patients undergoing epiduroscopy and injection of ozone. Patients were evaluated preoperatively and 21 days after the procedure, using the following instruments: Visual Analogue Scale (VAS), Brief Pain Inventory, Roland-Morris Questionnaire Disability, Oswestry Disability Index (ODI), Neuropathic Pain Symptom Inventory and Douleur Neuropathique 4. Results: The patients showed significant pain relief, but no improvement was observed in the functional scales. Conclusion: Our results suggest that epidural ozone therapy can be a treatment option in FBSS to reduce the intensity of the pain.
Resumo Introdução: A dor lombar é um dos distúrbios dolorosos de maior prevalência. Tem diversas etiologias e, na presença de déficits neurológicos ou síndromes compressivas, pode ser indicada cirurgia. Entretanto, em até 40% dos casos os pacientes podem evoluir com piora da dor e síndrome dolorosa pós-laminectomia (SDPL), que se constitui em uma importante causa de dor crônica com grande morbidade e incapacidade. Nas últimas duas décadas, o ozônio tem se mostrado uma nova opção terapêutica para a SDPL em virtude das suas propriedades analgésicas e anti-inflamatórias. Objetivo: Avaliar o efeito da ozonioterapia na dor e na incapacidade de pacientes com SDPL. Método: Foram selecionados 19 pacientes, submetidos a epiduroscopia e aplicação de ozônio. Os pacientes foram avaliados no pré-operatório e 21 dias após o procedimento, por meio de Escala Visual Analógica, Inventário Breve de Dor, Questionário Roland-Morris de Incapacidade, Oswestry Disability Scale, Inventário de Sintomas de Dor Neuropática e Questionário de Dor Neuropática. Resultados: Os pacientes apresentaram redução significante nos escores das escalas de avaliação de dor; porém, essa redução não foi observada na avaliação da incapacidade funcional. Conclusão: Os dados obtidos sugerem que a ozonioterapia epidural pode ser uma opção de manejo da SDPL na diminuição da intensidade da dor.
Assuntos
Humanos , Masculino , Feminino , Adulto , Idoso , Adulto Jovem , Ozônio/uso terapêutico , Dor Lombar/tratamento farmacológico , Avaliação da Deficiência , Síndrome Pós-Laminectomia/tratamento farmacológico , Analgésicos/uso terapêutico , Fatores de Tempo , Injeções Epidurais , Medição da Dor , Inquéritos e Questionários , Reprodutibilidade dos Testes , Estudos Retrospectivos , Análise de Variância , Resultado do Tratamento , Dor Lombar/fisiopatologia , Perfil de Impacto da Doença , Síndrome Pós-Laminectomia/fisiopatologia , Pessoa de Meia-IdadeRESUMO
OBJECTIVE: The authors show the clinical evaluation and follow-up results in 56 patients diagnosed with a failed back surgery pain syndrome. METHODS: Descriptive and prospective study conducted over a one-year period. In this study, 56 patients with a failed back surgery pain syndrome were assessed in our facility. The age ranged from 28 to 76 years (mean, 48.8 ± 13.9 years). The pain was assessed through a Visual Analog Scale (VAS). RESULTS: Postoperative pain was more severe (mean VAS score 8.3) than preoperative pain (7.2). Myofascial pain syndromes (MPS) were diagnosed in 85.7% of patients; neuropathic abnormalities associated or not with MPS were found in 73.3%. Drug therapy associated with physical medicine treatment provided > 50% pain improvement in 57.2% of cases; trigger point injection in 60.1%, and epidural infusion of morphine with lidocaína in 69.3% of refractory cases. CONCLUSION: In patients with a post-laminectomy syndrome, postoperative pain was more severe than preoperative pain from a herniated disk. A miofascial component was found in most patients.
Assuntos
Síndrome Pós-Laminectomia/terapia , Síndromes da Dor Miofascial/terapia , Dor Pós-Operatória/terapia , Adulto , Idoso , Analgésicos Opioides/uso terapêutico , Anestésicos Locais/uso terapêutico , Síndrome Pós-Laminectomia/fisiopatologia , Feminino , Humanos , Lidocaína/uso terapêutico , Masculino , Pessoa de Meia-Idade , Morfina/uso terapêutico , Síndromes da Dor Miofascial/fisiopatologia , Medição da Dor , Dor Pós-Operatória/fisiopatologia , Estudos ProspectivosRESUMO
OBJETIVO: Os autores apresentam os resultados da avaliação clínica e acompanhamento de 56 pacientes com diagnóstico de síndrome dolorosa pós-laminectomia lombar. MÉTODOS: Estudo descritivo, prospectivo realizado no período de um ano. Neste estudo foram avaliados 56 pacientes caracterizados com síndrome dolorosa pós-laminectomia lombar em nossa instituição. As idades variaram de 28 a 76 anos (média de 48,8 ± 13,9 anos). Avaliação da dor com Escala Visual e Analógica (EVA). RESULTADOS: A dor pós-operatória foi mais intensa (8,3, média de EVA) que a pré-operatória (7,2). Síndrome dolorosa miofascial (SDM) foi diagnosticada em 85,7 por cento dos pacientes, anormalidades neuropáticas associadas ou não à SDM em 73,3 por cento. O tratamento farmacológico associado à medicina física proporcionou melhora de mais de 50 por cento da dor em 57,2 por cento dos casos, a infiltração dos pontos-gatilho miofasciais em 60,1 por cento e a infusão de morfina com lidocaína no compartimento epidural lombar em 69,3 por cento dos casos refratários. CONCLUSÃO: Nos pacientes com síndrome pós-laminectomia, a dor pós-operatória foi mais intensa que a dor pré-operatória da hérnia de disco. Um componente miofascial foi verificado na maioria dos doentes.
OBJECTIVE: The authors show the clinical evaluation and follow-up results in 56 patients diagnosed with a failed back surgery pain syndrome. METHODS: Descriptive and prospective study conducted over a one-year period. In this study, 56 patients with a failed back surgery pain syndrome were assessed in our facility. The age ranged from 28 to 76 years (mean, 48.8 ± 13.9 years). The pain was assessed through a Visual Analog Scale (VAS). RESULTS: Postoperative pain was more severe (mean VAS score 8.3) than preoperative pain (7.2). Myofascial pain syndromes (MPS) were diagnosed in 85.7 percent of patients; neuropathic abnormalities associated or not with MPS were found in 73.3 percent. Drug therapy associated with physical medicine treatment provided > 50 percent pain improvement in 57.2 percent of cases; trigger point injection in 60.1 percent, and epidural infusion of morphine with lidocaína in 69.3 percent of refractory cases. CONCLUSION: In patients with a post-laminectomy syndrome, postoperative pain was more severe than preoperative pain from a herniated disk. A miofascial component was found in most patients.
Assuntos
Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Síndrome Pós-Laminectomia/terapia , Síndromes da Dor Miofascial/terapia , Dor Pós-Operatória/terapia , Analgésicos Opioides/uso terapêutico , Anestésicos Locais/uso terapêutico , Síndrome Pós-Laminectomia/fisiopatologia , Lidocaína/uso terapêutico , Morfina/uso terapêutico , Síndromes da Dor Miofascial/fisiopatologia , Medição da Dor , Dor Pós-Operatória/fisiopatologia , Estudos ProspectivosRESUMO
BACKGROUND: Failed-back surgery syndrome remains a challenge for spinal surgeons. It can be related to several causes, including poor surgical indication, misdiagnosis, surgical technique failure, spondilodiscitis and fibrosis. Fibrosis has been associated with a poorer outcome in lumbar disc surgery, although its role in the generation of symptoms is not yet clear. In this study, the authors have analyzed any possible correlation between the clinical outcome and the degree of fibrosis. METHOD: Forty consecutive patients were enrolled in a prospective study. All of them had operations in the lower lumbar disc in a single level for the first time. Three months after the operation they were submitted to clinical outcome evaluations and questionnaires, including Numeric Pain Rating scales (NPR) for lumbar and leg pain, the McGill Pain Questionnaire, The Quebec Back Pain Disability scale (QBPD) and Straight Leg Raising test. These data were correlated with the degree of fibrosis as revealed by Magnetic Resonance Imaging (MRI). FINDINGS: After 3 months, the NPR values for lumbar and leg pain ranged from 0 to 8 (mean 2.32 and 1.67 respectively). The values of the post-operative QBPD scale ranged from 1 to 71 (mean 25.9). Every patient showed a varied degree of fibrosis on MRI. However, statistical analysis depicted no significant correlation between fibrosis and a poorer clinical outcome for pain and disability. CONCLUSIONS: The authors found no correlation between excessive fibrosis with lumbar and leg pain, disability or straight leg resistance. The role of fibrosis in the generation of symptoms in patients who have had lumbar disc surgery should be reevaluated.