Jornada do paciente com lombalgia crônica no Brasil: uma revisão semi-sistemática sobre a melhor abordagem
DOI:
https://doi.org/10.11606/issn.1679-9836.v101i5e-194651Palavras-chave:
Brasil, Dor, Reestruturação do sistema de saúde, Mapeamento da jornada do paciente, Envolvimento do pacienteResumo
Histórico - O tratamento de pacientes com lombalgia crônica (LC) em muitos países, incluindo o Brasil, é um grande desafio no nível de atendimento primário e especializado. Além disso, as informações sobre epidemiologia e tratamento de pacientes com LC são escassas. O objetivo principal desta revisão semi-sistemática foi a construção de evidências locais sobre a prevalência e o padrão de tratamento da LC. Métodos. Esta revisão semi-sistemática utilizou Medline, Embase e Biosis via plataforma Ovid e recursos adicionais (Google, Google Scholar, Banco de dados de incidência e prevalência, Organização Mundial da Saúde, Ministério da Saúde do Brasil e informações anedóticas de especialistas locais) para identificar literatura relevante entre 2002 e 2020 para mapear a jornada do paciente. Artigos de texto completos e originais do Brasil em inglês contendo dados sobre pontos de contato predefinidos na jornada do paciente (conscientização, triagem, diagnóstico, tratamento, adesão e controle) foram selecionados. Os dados foram obtidos usando uma média simples ou ponderada, conforme aplicável para os componentes da jornada do paciente. Resultados. De 297 registros, incluindo os fornecidos por especialistas locais, oito estudos foram incluídos para análise. A conscientização da LC e da LC-NeP foi de 30,4% e 12%, respetivamente. De acordo com estudos publicados, a adesão e o controle dos sintomas dos pacientes foram estimados com percentual semelhante de 38% e 18%, respetivamente para a LC e a LC-NeP. A prevalência de LC-NeP (3,6%) foi menor que a de LC (20,6%). Com exceção de uma porcentagem comparável da população tratada, para LC (39,1%) e LC-NeP (38%), a porcentagem de pontos de contato restantes foi maior no caso de LC do que no LC-NeP, o que implicava uma melhora no trajeto do paciente para a LC. Conclusão. O estudo destaca a necessidade de melhorar os resultados dos pacientes em nível nacional, medindo esses pontos de contato da jornada do paciente. O resultado deste estudo baseado em evidências é importante para preencher a lacuna de conhecimento do paciente com LC. Portanto, recomenda-se garantir a educação médica contínua, a conscientização do paciente e a restruturação do sistema de saúde brasileiro, ao mesmo tempo em que adota novas práticas sobre o gerenciamento da dor.
Downloads
Referências
Franco D, Mahtabfar A, Hines K, Sabourin V, Stefanelli A, Harrop J. Neurosurgical evaluation for patients with chronic lower back pain. Curr Pain Headache Rep. 2020;24(10):1-6. doi: https://doi.org/10.1007/s11916-020-00894-4
Meucci RD, Fassa AG, Faria NMX. Prevalence of chronic low back pain: a systematic review. Rev Saude Publica. 2015;49:73. doi: https://doi.org/10.1590/S0034-8910.2015049005874
Dutmer AL, Preuper HR, Soer R, Brouwer S, Bültmann U, Dijkstra PU, Coppes MH, Stegeman P, Buskens E, van Asselt AD, Wolff AP. Personal and societal impact of low back pain: the Groningen spine cohort. Spine. 2019;44(24):E1443-51. doi: https://doi.org/10.1097/BRS.0000000000003174
GBD 2016 Disease and Injury Incidence and Prevalence Collaborators. Global, regional, and national incidence, prevalence, and years lived with disability for 328 diseases and injuries for 195 countries, 1990-2016: a systematic analysis for the Global Burden of Disease Study 2016. Lancet. 2017;390(10100):1211-1259. doi: https://doi.org/10.1016/S0140-6736(17)32154-2
Mathew J, Singh SB, Garis S, Diwan AD. Backing up the stories: The psychological and social costs of chronic low-back pain. Int J Spine Surg. 2013;7:e29-e38. doi: https://doi.org/10.1016/j.ijsp.2013.02.001
Carregaro RL, Tottoli CR, Rodrigues DD, Bosmans JE, da Silva EN, van Tulder M. Low back pain should be considered a health and research priority in Brazil: Lost productivity and healthcare costs between 2012 to 2016. PloS One. 2020;15(4):e0230902. doi: https://doi.org/10.1371/journal.pone.0230902
Koes BW, Van Tulder M, Thomas S. Diagnosis and treatment of low back pain. BMJ. 2006;332(7555):1430-4. doi: https://doi.org/10.1136/bmj.332.7555.1430
Patrick N, Emanski E, Knaub MA. Acute and chronic low back pain. Med Clin North Am. 2016;100(1):169-81. doi: https://doi.org/10.1016/j.mcna.2015.08.015
Payne R. Chronic pain: challenges in the assessment and management of cancer pain. J Pain Sympt Manag. 2000;19(1):12-5. doi: https://doi.org/10.1016/S0885-3924(99)00123-2
Atlas SJ, Deyo RA. Evaluating and managing acute low back pain in the primary care setting. J Gen Intern Med. 2001;16(2):120-31. doi: https://doi.org/10.1111/j.1525-1497.2001.91141.x
Morlion B. Pharmacotherapy of low back pain: targeting nociceptive and neuropathic pain components. Curr Med Res Opin. 2011;27(1):11-33. doi: https://doi.org/10.1185/03007995.2010.534446
IASP. Council Adopts Task Force Recommendation for Third Mechanistic Descriptor of Pain - IASP. [cited August 21, 2020. Available from: https://www.iasp-pain.org/PublicationsNews/NewsDetail.aspx?ItemNumber=6862
Johnson MI. The landscape of chronic pain: broader perspectives. Medicina (Mex). 2019;55(5). doi: https://doi.org/10.3390/medicina55050182
Binder A, Baron R. The pharmacological therapy of chronic neuropathic pain. Dtsch Ärztebl Int. 2016;113(37):616-626. doi: https://doi.org/10.3238/arztebl.2016.0616
Freynhagen R, Parada HA, Calderon-Ospina CA, Chen J, Rakhmawati Emril D, Fernández-Villacorta FJ, Franco H, Ho KY, Lara-Solares A, Li CC, Mimenza Alvarado A. Current understanding of the mixed pain concept: a brief narrative review. Curr Med Res Opin. 2019;35(6):1011-1018. doi: https://doi.org/10.1080/03007995.2018.1552042
Chimenti RL, Frey-Law LA, Sluka KA. A mechanism-based approach to physical therapist management of pain. Phys Ther. 2018;98(5):302-14. doi: https://doi.org/10.1093/ptj/pzy030
Fornasari D. Pain mechanisms in patients with chronic pain. Clin Drug Invest. 2012;32(1):45-52. doi: https://doi.org/10.2165/11630070-000000000-00000
Lim YZ, Chou L, Au RT, Seneviwickrama KM, Cicuttini FM, Briggs AM, Sullivan K, Urquhart DM, Wluka AE. People with low back pain want clear, consistent and personalised information on prognosis, treatment options and self-management strategies: a systematic review. J Physiother. 2019;65(3):124-35. doi: https://doi.org/10.1016/j.jphys.2019.05.010
Geurts JW, Willems PC, Kallewaard J-W, van Kleef M, Dirksen C. The Impact of Chronic Discogenic Low Back Pain: Costs and Patients’ Burden. Pain Res Manag. 2018;2018:4696180. doi: https://doi.org/10.1155/2018/4696180
Loeser JD, Schatman ME. Chronic pain management in medical education: a disastrous omission. Postgrad Med. 2017;129(3):332-335. doi: https://doi.org/10.1080/00325481.2017.1297668
Rofail D, Myers L, Froggatt D. Treatment satisfaction and Dissatisfaction in chronic low back pain: a systematic review. J Psychol Psychother. 2016;6(260):2161-0487. doi: https://doi.org/10.4172/2161-0487.1000260
Nuseir K, Kassab M, Almomani B. Healthcare providers’ knowledge and current practice of pain assessment and management: how much progress have we made?. Pain Res Manag. 2016;2016. doi: https://doi.org/10.1155/2016/8432973
Leão Ferreira KA, Bastos TR, Andrade DC, Silva AM, Appolinario JC, Teixeira MJ, Latorre MD. Prevalence of chronic pain in a metropolitan area of a developing country: a population-based study. Arq Neuro-Psiquiatria. 2016;74:990-8. doi: https://doi.org/10.1590/0004-282x20160156
Bishop MD, Bialosky JE, Penza CW, Beneciuk JM, Alappattu MJ. The influence of clinical equipoise and patient preferences on outcomes of conservative manual interventions for spinal pain: an experimental study. J Pain Res. 2017;10:965. doi: https://doi.org/10.2147/JPR.S130931
Suman A, Schaafsma FG, Buchbinder R, van Tulder MW, Anema JR. Implementation of a Multidisciplinary Guideline for Low Back Pain: Process-Evaluation Among Health Care Professionals. J Occup Rehabil. 2017;27(3):422-433. doi: https://doi.org/10.1007/s10926-016-9673-y
Traeger AC, Buchbinder R, Elshaug AG, Croft PR, Maher CG. Care for low back pain: can health systems deliver? Bull World Health Organ. 2019;97(6):423-433. doi: https://doi.org/10.2471/BLT.18.226050
Leopoldino AA, Diz JB, Martins VT, Henschke N, Pereira LS, Dias RC, Oliveira VC. Prevalence of low back pain in older Brazilians: a systematic review with meta-analysis. Rev Bras Reumatologia. 2016;56:258-69. doi: https://doi.org/10.1016/j.rbre.2016.03.011
Fatoye F, Gebrye T, Odeyemi I. Real-world incidence and prevalence of low back pain using routinely collected data. Rheumatol Int. 2019;39(4):619-626. doi: https://doi.org/10.1007/s00296-019-04273-0
Snyder H. Literature review as a research methodology: An overview and guidelines. J Business Res. 2019;104:333-9. doi: https://doi.org/10.1016/j.jbusres.2019.07.039
Devi R, Kanitkar K, Narendhar R, Sehmi K, Subramaniam K. A Narrative Review of the Patient Journey Through the Lens of Non-communicable Diseases in Low- and Middle-Income Countries. Adv Ther. 2020;37(12):4808-4830. doi: https://doi.org/10.1007/s12325-020-01519-3
Bharatan T, Devi R, Huang PH, Javed A, Jeffers B, Lansberg P, Sidhu K, Subramaniam K. A Methodology for Mapping the Patient Journey for Noncommunicable Diseases in Low-and Middle-Income Countries. J Healthcare Leadership. 2021;13:35. doi: https://doi.org/10.2147/JHL.S288966
Bahlas SM. A Semi-systematic Review of Patient Journey for Chronic Pain in Saudi Arabia to Improve Patient Care. Saudi J Med. 2021;6(2):47-56. doi: https://doi.org/10.36348/sjm.2021.v06i02.005
Munn Z, Stern C, Aromataris E, Lockwood C, Jordan Z. What kind of systematic review should I conduct? A proposed typology and guidance for systematic reviewers in the medical and health sciences. BMC Med Res Methodol. 2018;18(1):1-9. doi: https://doi.org/10.1186/s12874-017-0468-4
Lima S, Menin R, Vieira R, Ximenes A, Azevedo V, Suzuki C, Heringer F. Assessment of Inflammatory Back Pain and Axial Spondyloarthritis in Brazil. Arthritis Rheumatol. 2016;68:111.
Machado LA, Viana JU, da Silva SL, Couto FG, Mendes LP, Ferreira PH, Ferreira ML, Dias J, Dias RC. Correlates of a recent history of disabling low back pain in community-dwelling older persons: The Pain in the Elderly (PAINEL) Study. Clin J Pain. 2018;34(6):515-24. doi: https://doi.org/10.1097/AJP.0000000000000564.
Dellaroza MS, Pimenta CA, Duarte YA, Lebrão ML. Chronic pain among elderly residents in São Paulo, Brazil: prevalence, characteristics, and association with functional capacity and mobility (SABE Study). Cad Saude Publica. 2013;29(2):325-34. doi: https://doi.org/10.1590/S0102-311X2013000200019
Almeida IC, Sá KN, Silva M, Baptista A, Matos MA, Lessa Í. Chronic low back pain prevalence in the population of the city of Salvador. Rev Bras Ortop. 2008;43(3):96-102. doi: https://doi.org/10.1590/S0102-36162008000200007.
Udall M, Kudel I, Cappelleri JC, Sadosky A, King-Concialdi K, Parsons B, Hlavacek P, Hopps M, Salomon PA, DiBonaventura MD, Clark P. Epidemiology of physician-diagnosed neuropathic pain in Brazil. J Pain Res. 2019;12:243. doi: https://doi.org/10.2147/JPR.S160504.
Ferreira G, Costa LM, Stein A, Hartvigsen J, Buchbinder R, Maher CG. Tackling low back pain in Brazil: a wake-up call. Braz J Phys Ther. 2019;23(3):189-95. doi: https://doi.org/10.1016/j.bjpt.2018.10.001
Carvalho RC de, Maglioni CB, Machado GB, Araújo JE de, Silva JRT da, Silva ML da. Prevalence and characteristics of chronic pain in Brazil: a national internet-based survey study. BrJP. 2018;1(4):331-338. doi: https://doi.org/10.5935/2595-0118.20180063
Santos LG, Madeira K, Longen WC. Prevalence of self-reported spinal pain in Brazil: Results of the National Health Research. Coluna/Columna. 2017;16:198-201. doi: https://doi.org/10.1590/s1808-185120171603165890
Östhols S, Boström C, Rasmussen-Barr E. Clinical assessment and patient-reported outcome measures in low-back pain–a survey among primary health care physiotherapists. Disabil Rehabil. 2019;41(20):2459-67. doi: https://doi.org/10.1080/09638288.2018.1467503
Petersen L, Birkelund R, Schiøttz-Christensen B. Experiences and challenges to cross-sectoral care reported by patients with low back pain. A qualitative interview study. BMC Health Serv Res. 2020;20(1):96. doi: https://doi.org/10.1186/s12913-020-4952-x
Wáng YX, Wu AM, Santiago FR, Nogueira-Barbosa MH. Informed appropriate imaging for low back pain management: A narrative review. J Orthop Translation. 2018;15:21-34. doi: https://doi.org/10.1016/j.jot.2018.07.009
Pelozato de Oliveira DI, de Souza Teixeira BM, Gomes de Macedo O, Dos Santos V, Grossi Porto LG, Rodrigues Martins W. Prevalence of Chronic Low Back Pain in Brazilian Military Firefighters. Int J Occup Safety Ergon. 2021(just-accepted):1-22. doi: https://doi.org/10.1080/10803548.2021.1929699.
de Souza IM, Sakaguchi TF, Yuan SL, Matsutani LA, do Espírito-Santo AD, Pereira CA, Marques AP. Prevalence of low back pain in the elderly population: a systematic review. Clinics. 2019;74. doi: https://doi.org/10.6061/clinics/2019/e789
Trebble TM, Hansi N, Hydes T, Smith MA, Baker M. Process mapping the patient journey: an introduction. BMJ. 2010;341. doi: https://doi.org/10.1136/bmj.c4078
Chou L, Ranger TA, Peiris W, Cicuttini FM, Urquhart DM, Sullivan K, Seneviwickrama M, Briggs AM, Wluka AE. Patients’ perceived needs for medical services for non-specific low back pain: a systematic scoping review. PLoS One. 2018;13(11):e0204885. doi: https://doi.org/10.1371/journal.pone.0204885
Jenkins HJ, Downie AS, Maher CG, Moloney NA, Magnussen JS, Hancock MJ. Imaging for low back pain: is clinical use consistent with guidelines? A systematic review and meta-analysis. Spine J. 2018;18(12):2266-77. doi: https://doi.org/10.1016/j.spinee.2018.05.004
Malta DC, Bernal RT, Oliveira M. Trends in risk factors chronic diseases, according of health insurance, Brazil, 2008-2013. Cien Saude Coletiva. 2015;20:1005-16. doi: https://doi.org/10.1590/1413-81232015204.14712014
Hall H. Effective spine triage: patterns of pain. Ochsner J. 2014;14(1):88-95.
Romero DE, Muzy J, Maia L, et al. Chronic low back pain treatment in Brazil: inequalities and associated factors. Ciênc Amp Saúde Coletiva. 2019;24(11):4211-4226. doi: https://doi.org/10.1590/1413-812320182411.06352018
Lambeek LC, van Mechelen W, Knol DL, Loisel P, Anema JR. Randomised controlled trial of integrated care to reduce disability from chronic low back pain in working and private life. BMJ. 2010;340. doi: https://doi.org/10.1136/bmj.c1035
Downloads
Publicado
Edição
Seção
Licença
Copyright (c) 2022 Rogério Adas de Oliveira, Patrick Raymond Nicolas André Ghislain Stump, Marcelo Cruz Rezende, Luiz Fernando Vieira, Marco Antonio da Silva, Paola M. Elorza
Este trabalho está licenciado sob uma licença Creative Commons Attribution-ShareAlike 4.0 International License.
