Resumen
La lumbalgia es un síndrome caracterizado por dolor, tensión muscular y rigidez, que se localiza en la espalda, por debajo de la reja costal y por encima del pliegue glúteo inferior. En Colombia, al igual que en el resto del mundo, es el segundo más frecuente, con múltiples etiologías y con factores individuales, psicosociales, ocupacionales y genéticos que pueden empeorar el dolor. Este articulo hace recomendaciones para la evaluación y del dolor lumbar de origen específico, en el cual se trata el mecanismo etiológico, y se siguen todos los parámetros generales para manejo del dolor y bases para el dolor inespecífico y el asociado a dolor radicular, situaciones en las cuales se ha observado un inadecuado tratamiento y abuso de procedimientos quirúrgicos.
Citas
HERNÁNDEZ JJ, PALACIOS L. El problema del dolor lumbar. En: Hernández JJ, Moreno C eds. Medicina del Dolor. Bogotá: Ediciones Rosaristas. 2005.
GRABOIS M. Management of Low Back Pain. Am J Phys Med Rehabil 2005; 84 (suppl): 29-41
OCHOA G. Dolor Lumbar: Una re-evaluación de los Conceptos. En: Hernández JJ, Fernández CF eds. Dolor 2001. Bogotá: Asociación Colombiana Para Estudio del Dolor, 2001: 87-116.
MOUNCE K. Back Pain. Rheumatology 2002; 41: 1-5
VAN TULDER M, KOES BW. Low Back Pain. Am
Fam Physician 2002; 65: 925-929.
Asociación Colombiana para Estudio del Dolor. Encuesta Nacional de Dolor. 2008; www.dolor.org.co
Asociación Colombiana para Estudio del Dolor. Encuesta Nacional de Dolor. 2010. www.dolor.org.co
BERNSTEIN E, CAREY TS, GARRTE JM. The use of muscle relaxant medications in acute low back pain. Spine 2004; 29: 1346-1351
MANCHUKONDA R, MANCHIKANTI KN,CASH KA, ET AL. Facet joint pain in chronic spinal pain: an evaluation of prevalence and false –positive rate of diagnostic blocks. J Spinal Disord Tech 2007; 20: 539–545
LEVIN JH, SMUCK MW. Radiculopathy from herniation of the nucleus pulposus: 1. Epidemiology, pathophysiology, and natural history. J Back Musculo- skeletal Reh 2007; 20: 97–101
VALAT JP, GENEVAY S, MARTY M, ET AL. Sciatica. Best Pract Res Clin Rheumatol 2010; 24: 241–252
ZHAO F, POLLINTINE P, HOLE BD, ET AL. Discogenic Origins of Spinal Instability. Spine 2005; 30: 2621–2630
SINGH K, MASUDA K, THONAR E, ET AL.
Age-Related Changes in the Extracellular Matrix of Nucleus Pulposus and Anulus Fibrosus of Human Intervertebral Disc. Spine 2009, 34: 10–16.
ROUGHLEY PJ. Biology of Intervertebral Disc Aging and Degeneration. Spine 2004, 29: 2691–2699.
MARCHEVSKY ED. Relación entre la hiperpre- sión axial crónica y la radiculopatía compresiva en columna lumbar. Comahue Medico 2007; 27: 5-13
MULLEMAN D, MAMMOU S, GRIFFOUL I, ET
AL. Pathophysiology of disk-related sciatica. Evi- dence supporting a chemical component. Joint Bone Spine 2006; 73: 151-158.
PENG B, WU W, LI Z, ET AL. Chemical radiculi- tis. Pain 2007; 127: 11–16.
BARTYNSKI WS. Clinical, Anatomic, and Imag- ing Correlation in Spine-Related Pain: The Essential Elements. Tech Vasc Interventional Rad 2009; 12: 2-10.
JHAWAR BS, FUCHS CHS, COLDITZ GA,
STAMPFER MJ. Cardiovascular risk factors for phy- sician-diagnosed lumbar disc herniation. Spine Journal 2006; 6: 684-691.
YOUNG IA, HAIG AJ, YAMAKAWA KS. The association between backpack weight and low back pain in children. J Back Musculoskeletal Reh 2006; 19: 25–33
MARRAS WS, FERGUSON SA, BURR D, ET AL. Low back pain recurrence in occupational enviro- ments. Spine 2007; 32: 2387-2397
VIDEMAN T, LEVÄLAHTI E, BATTIÉ MC. The effects of anthropometrics, lifting strenght, and physical activities in disc degeneration. Spine 2007; 32 : 1406-1413.
BREEN A, AUSTIN H, CAMPION-SMITH CH, ET AL. “You feel so hopeless”: A qualitative study of GP management of acute back pain. Europ J Pain 2007; 11: 21-29.
LEBOEUF-Y DE CH. Back pain—individual and genetic factors. J Electromyogr Kines 2004; 14: 129–133.
CHOU R, QASEEM A, SNOW V, ET AL. Diagnosis and treatment of low back pain: a joint clinical practice guideline from the American college of phy- sician an the American pain society. Ann Intern Med. 2007;147:478-491
PRADHAN BB. Evidence-informed management of chronic low back pain with watchful waiting. Spine Journal 2008; 8: 253–257
RUBINSTEIN SM, VAN TULDER M. A best-evidence review of diagnostic procedures for neck and low-back pain. Best Pract Res Clin Rheum 2008; 22: 471–482.
VAN DEN BOSCH MA, HOLLINGWORTH W, KINMONTH AL, DIXON AK. Evidence against the use of lumbar spine radiography for low back pain. Clinical Radiology 2004; 59: 69–76
BALAGUÉ F, CEDRASCHI CH. Examens radiologiques chez les patients lombalgiques : anxiété du patient ? anxiété du thérapeute ? Revue du Rhuma- tisme 2006; 73: 895–901
MORENO NL. Psiquiatría y dolor. En: Hernán- dez JJ, Moreno C (eds). Medicina del Dolor. Edicio- nes Rosaristas. 2005.
GENET F, LAPEYRE E, SCHNITZLER A, ET AL. Évaluation psychocomportementale dans la lom- balgie chronique. Ann Readap Med Phys 2006; 49: 226- 233.
GONZÁLEZ-HIDALGO M. Indicaciones de los estudios neurofisiológicos en el dolor lumbar. Rev Neurol 2006; 43: 618-620.
SULLIVAN WJ, PANAGOS A, FOYE PM, ET AL. Industrial Medicine and Acute Musculoskeletal Reha- bilitation. 2. Medications for the Treatment of Acute Musculoskeletal Pain. Arch Phys Med Rehabil 2007; 88 (Suppl 1): S10-S13.
VAN TULDER MW. Muscle Relaxants for non- specific low back pain. Cochrane Database Syst Rev 2003; (2): cd004252
ASSENDELFT WJ. Spinal Manipulative Therapy for Low Back Pain. Ann Int Med 2003; 138: 871-881
LUIJSTERBURG PAJ, LAMERS LM, VERHA-
GEN AP, ET AL. Cost-effectiveness of physical ther- apy and general practitioner care for sciatica. Spine 2007; 32: 1942–1948
MALANGA G, WOLFF E. Evidence-informed management of chronic low back pain with trigger point injections. Spine Journal 2008; 8: 243–252
DIAMOND S. Chronic low back pain in a work- ing-age adult. Best Pract Res Clin Rheumatol 2006; 20: 707-720.
HEYMANS MW, VAN TULDER MW, ESMAIL R, ET AL. Back schools for nonspecific low back pain. Spine 2005; 30: 2153-2163.
ACKERMAN WE, AHMAD M. The efficacy of lumbar epidural steroid injections in patients with lumbar disc herniations. Anesth Analg 2007; 104: 1217–1222.
BENZON HT, CHEW TL, MCCARTHY RJ. Comparison of the Particle Sizes of Different Ste- roids and the Effect of Dilution. A Review of the Relative Neurotoxicities of the Steroids. Anesthesiology 2007; 106: 331–338.
SASSO RC, MACADAEG K, NORDMANN D, SMITH M. Selective nerve root injections can predict surgical outcome for lumbar and cervical radiculopa- thy. J Spinal Disord Tech 2005; 18: 471–478
VAN ZUNDERT J, VAN KLEEF M. Low back pain: from algorithm to cost effectiveness? Pain Prac- tice 2005; 5: 179-189.
SCHOFFERMAN J, MAZANEC D. Evidence- informed management of chronic low back pain with opioid analgesics. Spine Journal 2008; 8: 185–194
GHROUBI S, ELLEUCH H, BAKLOUTI S, ELLEUCH MH. Chronic low back pain and verte- bral manipulation. Ann Réadap Médecine Phys 2007; 50: 570–576
BRONFORT G, HAAS M, EVANS R, ET AL. Evidence-informed management of chronic low back pain with spinal manipulation and mobilization. Spine Journal 2008, 8: 213–225
DAGENAIS S, MAYER J, WOOLEY JR, ET AL. Evidence-informed management of chronic low back pain with medicine-assisted manipulation. Spine Journal 2008; 8: 142–149
VAUTRAVERS P. Manipulations vertébrales et sciatique. Annal Réadap Méd Phys 2006; 49: 207–209
Ammendolia C, Furlan AD, Imamura M, et al. Evi- dence-informed management of chronic low back pain with needle acupuncture. Spine Journal 2008; 8: 160–172
CHOU R, HUFFMAN LH. Nonpharmacologic therapies for acute and chronic low back pain: a review of the evidence for an American Pain Soci- ety/American College of Physicians clinical practice guideline. Ann Intern Med. 2007; 147: 492-504
POITRAS S, ROSEAU L. Evidence-informed management of chronic low back pain with trans- cutaneous electrical nerve stimulation, interferential current, electrical muscle stimulation, ultrasound, and thermotherapy. Spine Journal 2008; 8: 226–233
IMAMURA M, FURLAN AD, DRYDEN T, ET AL. Evidence-informed management of chronic low back pain with massage. Spine Journal 2008; 8: 121-133
JOHNSON RE, JONES GT, WILES NJ, ET AL. Active exercise, education, and cognitive behavioral therapy for persistent disabling low back pain. Spine 2006; 32: 1578-1585.
OLESKE DM, LAVENDER SA, ANDERSSON GBJ, KWASNY MM. Are back supports plus educa- tion more effective than education alone in promot- ing recovery from low back pain? Spine 2007; 32: 2050–2057
GATCHEL RJ, ROLLINGS KH. Evidence- informed management of chronic low back pain with cognitive behavioral therapy. Spine Journal 2008; 8: 40-44
SUBIN B, SALEEMI S, MORGAN GA, ET AL. Treatment of Chronic Low Back Pain by Local Injec- tion of Botulinum Toxin-A. Internet J Anesthesiology 2003; 6 (2).
RAJ PP. Botulinum toxin therapy in pain manage- ment. Anesthesiol Clin N Am 2003; 21: 715– 731
LIM ECH, SEET RCS. Botulinum toxin: descrip- tion of injection techniques and examination of con- troversies surrounding toxin diffusion. Acta Neurol Scand 2008; 117: 73–84
MIRZA SK, DEYO RA. Systematic review of randomized trials comparing lumbar fusion surgery to nonoperative care for treatment of crhonic back pain. Spine 2007; 32: 816-823.
KOES BW, VAN TULDER MW, PEUL WC. Diagnosis and treatment of sciatica. BMJ 2007; 334: 1313-1317.
WEINSTEIN JN, LURIE JD, TOSTESONTD, ET AL. Surgical versus nonsurgical treatment for lumbar degenerative spondylolisthesis. N Engl J Med 2007; 356: 2257-2270
BIRKENMAIER C, VEIHELMANN A, TROUIL- LIER HH, ET AL. Medial branch blocks versus pericapsular blocks in selecting patients for percutaneous cryodenervation of lumbar facet joints. Reg Anesth Pain Med 2007; 32: 27-33.
BOGDUK N. Evidence-informed management of chronic low back pain with facet injections and radio- frequency neurotomy. Spine Journal 2008; 8: 56–64
HERNÁNDEZ JJ. Terapias avanzadas para manejo del dolor. En: Hernández JJ, Moreno C eds. Medicina del dolor. Bogotá: Ediciones Rosaristas. 2005.
DERBY R, BAKER RM, LEE CH H. Evidence- informed management of chronic low back pain with minimally invasive nuclear decompression. Spine Jour- nal 2008; 8: 150–159.
CARRAGEE EJ. The role of surgery in low back pain. Current Orthopaedics 2007; 21: 9–16.
Esta obra está bajo una licencia internacional Creative Commons Atribución-NoComercial-SinDerivadas 4.0.