Ney Meziat-Filho

Chronic low back pain and disability in Brazilian jiu-jitsu athletes

OBJECTIVES To identify the prevalence of chronic low back pain (CLBP) and functional disability in Brazilian jiu-jitsu athletes. STUDY DESIGN Cross-sectional, observational. SETTINGS The study was conducted at jiu-jitsu training sites in the State of Rio de Janeiro. MAIN OUTCOME MEASURES Presence of Chronic low back pain and Quebec Back Pain Disability Scale. RESULTS The sample was composed of 72 athletes (mean age of 26.7), being 36 recreational and 36 professional. Chronic low back pain was present in 80.6% of athletes. Pain was present in 88.9% of professional and 72.2% of recreational athletes. In the professional jiu-jitsu group, the median of the Quebec Back Pain Disability Scale (QBPDS) was 10 (IQR = 16), and in the recreational group the QBPDS result was 6.0 (IQR = 12) (p = .001). Professional athletes had a marginally significant increased risk of developing CLBP [OR = 3.0; CI(95%) 0.8-10.9)]. CONCLUSION The prevalence of low back pain in jiu-jitsu practice was high and professional athletes seem to have a high risk of developing CLBP.

Association between home posture habits and neck pain in High School adolescents.

BACKGROUND Neck pain (NP) in adolescence is as frequent as in adulthood. However, the relationship between home posture habits and neck pain is still unknown. OBJECTIVE To investigate the prevalence of NP and the association with home posture habits (HPH) in adolescents. METHODS Cross-sectional study with High School adolescents. Students answered questions regarding sociodemographic variables, lifestyle, HPH (illustration in the questionnaire), time (TV, computer, video-game) and the presence of NP. Multivariate logistic regression was used to investigate the association between HPH and NP. RESULTS The prevalence of NP was 48.9%. The ones who watched TV lying supine in bed for 2 hours or more a day yielded an odds ratio (OR) of 6.21 (1.45-26.52) for acute neck pain (ANP). Who watched TV and used the desktop in the slump posture yielded, respectively, an OR of 4.0 (1.63-9.85), and 2.03 (1.23-3.34) for chronic neck pain (CNP). The ones who frequently changed their positions while using the desktop and used it for 2 hours or more a day yielded an OR of 0.34 (0.14-0.85) for ANP. CONCLUSION Our findings support the high prevalence of NP in adolescence and raise the association between some HPH and neck pain.

Association between pain drawing and psychological factors in musculoskeletal chronic pain: A systematic review

ABSTRACT Background: It has been speculated that there is an association between pain area and psychological factors in chronic musculoskeletal pain conditions; however, this relation is not well established. Purpose: To investigate the association between pain distribution and psychological factors in chronic musculoskeletal pain conditions. Study Design: Systematic review. Methods: We searched the following databases using optimized search strategies: MEDLINE, PsycINFO, Scopus, Web of Science and Cochrane. Studies were included if they investigated the relation between pain area using a pain drawing (PD) and psychological factors measured by any consistent available method. Results: Eleven articles were included. A total of 1301 participants with different musculoskeletal pain conditions, including low back pain, whiplash-associated disorders and fibromyalgia took part in the studies. In three studies, the correlation between pain area and depression was weak (r = 0.15, p = N/A; r = 0.26, p < 0.05; r = 0.25, p = 0.01). Depression seemed to be a risk factor for pain in more body areas in one study (relative risk = 6.09, 95% CI = 1.1–33.5; p < 0.05). The relation between pain area and other psychological factors such as anxiety, kinesiophobia, catastrophizing, memory disturbances and concentration difficulties was also reported. Conclusions: A definitive answer on the relation of psychological factors and pain area is not available; the findings suggest that only depression might have a weak relation with pain area. Future studies that investigate sensory, psychological, emotional, cognitive and behavioral aspects, and also more accurate methods of PD assessment, are needed.

Overview of Curricula About Pain in Physical Therapist Education Programs in Brazil: A Faculty Survey

Background Educating health professionals about pain (pain education) during undergraduate studies may be an important step in changing ineffective pain management practices. Objective The objective of this study was to assess the extent of pain education in current accredited physical therapist education programs in Brazil. Design This study was designed as a cross-sectional survey study. Methods Brazilian physical therapist education programs accredited by the Ministry of Education participated in this study. The main outcome measures were frequency of a specific curriculum about pain (pain curriculum) in physical therapist education programs and content analysis according to discipline-specific pain curriculum recommendations developed by the International Association for the Study of Pain. Results A total of 811 physical therapist education programs in Brazil were identified. After duplicates and universities no longer offering a physical therapist education program were removed, a total of 566 physical therapist education programs were left; 399 of the 566 (70.5%) provided information about the curriculum on their websites. Among the identified physical therapist education programs with available curricula, 26 (6.5%) had a specific course about pain (pain course), covering a mean of 44.3 hours. Limitations Limitations included the inability to cover all the physical therapist education programs in Brazil and the inability to identify whether pain content is distributed in other disciplines such as pediatrics, geriatrics, and neurological and orthopedic physical therapy. Conclusions Most Brazilian physical therapist education programs do not offer a specific pain course. When a pain course is presented in the curriculum, some content recommended for physical therapist education programs by the International Association for the Study of Pain is not covered. The absence of a pain course in physical therapist education programs may have implications for pain management. To the best of our knowledge, this is the first study about pain education in physical therapist education programs in Brazil.

Trial Protocol: Cognitive functional therapy compared with combined manual therapy and motor control exercise for people with non-specific chronic low back pain: protocol for a randomised, controlled trial

INTRODUCTION Chronic low back pain is a public health problem, and there is strong evidence that it is associated with a complex interaction of biopsychosocial factors. Cognitive functional therapy is an intervention that deals with potentially modifiable multidimensional aspects of pain (eg, provocative cognitive, movement and lifestyle behaviours). There is evidence (from a single randomised, controlled trial) that cognitive functional therapy is better than combined manual therapy and motor control exercise. However, this study had significant methodological shortcomings including the failure to carry out an intention-to-treat analysis and a considerable loss of follow-up of participants. It is important to replicate this study in another domain through a randomised clinical trial with similar objectives but correcting these methodological shortcomings. AIM To investigate the efficacy of cognitive functional therapy compared to combined manual therapy and exercise on pain and disability at 3 months in patients with chronic non-specific low back pain. DESIGN Two-group, randomised, multicentre controlled trial with blinded assessors. PARTICIPANTS AND SETTINGS One hundred and forty-eight participants with chronic low back pain that has persisted for >3months and no specific spinal pathology will be recruited from the school clinic of the Centro Universitário Augusto Motta and a private clinic in the city of Rio de Janeiro, Brazil. INTERVENTION A Four to 10 sessions of cognitive functional therapy. The physiotherapists who will treat the participants in the cognitive functional therapy group have previously attended 2 workshops with two different tutors of the method. Such physiotherapists have completed 106 hours of training, including workshops and patient examinations, as well as conducting a pilot study under the supervision of another physiotherapist with>3 years of clinical experience in cognitive functional therapy. INTERVENTION B Four to 10 sessions of combined manual therapy and motor control exercises. Participants in the combined manual therapy and exercise group will be treated by two physiotherapists with an average of >10years of clinical experience in manual therapy and motor control exercises, including isolated contractions of the deep abdominal muscles. MEASUREMENTS The primary outcome measures will be pain intensity and disability 3 months after randomisation. Secondary outcomes will be pain and disability assessed 6 and 12 months after randomisation, and both global perceived effect and patient satisfaction at 3, 6 and 12 months after randomisation. The potential outcome mediators will be assessed at 3 and 6 months after randomisation, with brief screening questions for anxiety, social isolation, catastrophisation, depression, fear of movement, stress and sleep. Non-specific predictors and moderators will include age, gender, duration of chronic low back pain, chronicity risk (Örebro and Start Back score), number of pain areas, stressful life event, MRI scan imaging, and family history. ANALYSIS Intention-to-treat analysis will be performed. Linear mixed models will be used to compare the mean differences in pain intensity, disability and global perceived effect between the intervention arms. The analysis of the effect of potential mediators of the treatment will be performed using the causal mediation methods described by Imai and colleagues. The baseline variables will be evaluated as predictors and moderators of treatment, including terms and interaction models. A level of statistical significance of 5% will be used in the analysis. All the analyses will be performed using RStudio. SIGNIFICANCE This study will investigate whether the results of the first cognitive functional therapy randomised clinical trial are reproducible. The present study will have a sample size capable of detecting clinically relevant effects of the treatment with a low risk of bias. In pragmatic terms, this clinical trial is designed to reproduce the intervention as it would be performed in clinical practice by a trained physiotherapist who works with cognitive functional therapy, which increases the relevance of this study. The combined manual therapy and exercise group comprises an intervention strategy widely used by physiotherapists to treat low back pain. As evidence of efficacy is still limited, the results of a randomised, controlled clinical trial of high methodological quality will help physiotherapists in clinical decision-making.

Cognitive Functional Therapy (CFT) for chronic non-specific neck pain

This case report presents the effect of Cognitive Functional Therapy (CFT) in a patient with chronic non-specific neck pain. The patient believed that pain signified tissue damage, and demonstrated pain catastrophizing, hypervigilance, stress sensitivity, and movement impairment of the neck, during extension and rotation. The CFT intervention integrated a cognitive approach with manual therapy and active exercises to encourage the patient to trust her neck again. One month after the first appointment, the patient had recovered confidence, and the pain and disability had disappeared almost entirely.

EditorialAn E-Pain intervention to spread modern pain education in Brazil

a Departmento de Fisioterapia, Instituto Federal do Rio de Janeiro (IFRJ), Rio de Janeiro, RJ, Brazil b Programa de Pós Graduação em Clínica Médica, Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, RJ, Brazil c Universidade Federal do Rio do Janeiro (UFRJ), Rio de Janeiro, RJ, Brazil d Clinical Therapies Department, University of Limerick, Limerick, Ireland e Programa de Pós Graduação em Ciências da Reabilitação, Centro Universitário Augusto Motta (UNISUAM), Rio de Janeiro, RJ, Brazil