Abstract
Objetivo
El dolor lumbar crónico (DLC) es una patología frecuente y de elevado impacto socioeconómico, especialmente en asistencia primaria, cuyo abordaje en la actualidad está variando. Se ofrecen los resultados de la valoración multidisciplinaria de 100 pacientes con lumbalgia crónica.
Diseño
Estudio transversal, observacional y prospectivo.
Emplazamiento
Consultas externas del servicio de reumatología de un hospital de tercer nivel (referencia del área básica correspondiente donde no existia reumatólogo en atención primaria).
Pacientes
Se analizaron 100 pacientes consecutivos que consultaron por dolor lumbar de más de 6 meses de duración.
Intervenciones
Estudio observacional sin ninguna intervención terapéutica.
Mediciones y resultados principales
Se analizaron las características demográficas, laborales, clínicas, exploratorias, radiológicas, funcionales y psicológicas de 100 pacientes con DLC. Se incluyeron 38 varones y 62 mujeres, edad 45 ± 10 años, bajo nivel sociocultural y laboral, duración del dolor 82 ± 7 meses y baja laboral en un 52%. La intensidad media del dolor fue de 6,5 ± 2,3 (0-10), hubo limitación vertebral en un 16% y conductas de dolor a la exploración en el 47%. La radiología se hallaba alterada en el 51% de los pacientes. La incapacidad funcional fue nula o leve en un 46% y severa en el 16%. Un 74,5% de los pacientes estaba deprimido, el 57% tenía un rasgo ansioso y estaba ansioso en el momento de la entrevista un 44%.
Conclusiones
El paciente con DLC es un sujeto de mediana edad, con dolor de larga evolución y baja laboral frecuente. La intensidad del dolor es alta, pero la limitación vertebral, alteraciones radiológicas e incapacidad funcional son escasas. Sin embargo, los niveles de ansiedad y depresión son elevados. Ello podría sugerirnos un cambio en el enfoque del DLC, incidiendo en el abordaje multidisciplinario y el estudio psicoafectivo, social y laboral, tanto en la valoración como en el tratamiento posterior de los pacientes.
Palabras clave: Abordaje multidisciplinario, Distrés psicológico, Dolor lumbar crónico
Abstract
Objectives
Chronic lower-back pain (CLP) is a common pathology and has a high social and economic impact, especially in primary care where its treatment is changing at present. The results of the multi-disciplinary assessment of 100 patients with chronic lower-back pain are given.
Design
Cross-sectional, observational and prospective study.
Setting
Out-patient clinics of the rheumatology service of a tertiary-level hospital (referral from base districts where there is no primary care rheumatologist).
Patients
100 consecutive patients seen for back pain lasting for more than 6 months were analysed.
Interventions
There was no therapeutic intervention.
Measurements and main results
The personal, work, clinical, examination, x-ray, functional and psychological features of 100 patients with CLP were analysed. There were 38 men and 62 women, with average age of 45 ± 10 years and low social, cultural and job levels. Pain had lasted 82 ± 7 months and 52% had had time off work. Mean intensity of pain was 6.5 ± 2.3 (scale of zero to 10). There was vertebral restriction in 16%, and conduct expressing pain on examination in 47%. The x-ray showed disorder in 51%. Functional incapacity was nil or light in 46% and severe in 16%. 74.5% of the patients were depressed; 57% had features of anxiety; and 44% were anxious at the time of the interview.
Conclusions
Patients with CLP are middle-aged, with long-standing pain and frequent time off work. Pain intensity is high, but vertebral restriction, disorders on x-rays and functional incapacity are scant. However, anxiety and depression levels are high. This could suggest a change in how we treat CLP towards a multi-disciplinary approach and psycho-affective, social and labour assessment, both at the time of assessment and in later treatment of patients.
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