A lombalgia e a cervicalgia estao entre as principais dores cr6nicas de origem musculoesqueletica. Alern do aspecto fisico, a dor possui aspectos cognitivos, emocionais e comportamentais e, quando cr6nica, pode tornar-se incapacitante. A percepcao e perpetuacao da dor resultam de inumeros mecanismos de transmissao e codificagao neural. Neste processo, participam diferentes moleculas e mensageiros quimicos. Destacamos as especies reativas de oxigenio e nitrogenio, envolvidas no processo de sensibilizacao central. A regulagao da formagao destas especies reativas depende de sistemas antioxidantes enzimaticos e nao enzimaticos. A manipulacao articular vertebral (MAV) parece ter influencia sobre mecanismos de controle envolvidos na sensibilidade dolorosa. Estudo anterior do nosso laboratorio demonstrou que a MAV pode influenciar a atividade de enzimas envolvidas no equilibrio entre pro- e antioxidantes num tratamento a curto prazo, por duas semanas. 0 presente estudo avaliou o efeito analgesic° do tratamento de MAV de alta velocidade e baixa amplitude em individuos corn cervicalgia e/ou lombalgia cr6nica apOs cinco semanas, sendo duas sessoes por semana, e a influencia deste tratamento sobre marcadores perifericos de estresse oxidativo e nitrosativo. Para avaliacao da dor e incapacitagao utilizou-se escala visual analogica, escala graduada de dor cronica, o formulario SF-36, o indice de disfuncao relacionado ao pescogo e o questionario de Roland-Morris. Alem disso, determinaram-se os limiares mecanicos de dor pars as regiOes cervical, lombar e dorsal. Os efeitos sobre marcadores perifericos de estresse oxidativo e nitrosativo foram avaliados pela medida do estudo oxidante total, do potencial reativo antioxidante total e dos metabolitos do oxido nitrico, em plasma. As defesas antioxidantes foram determinadas em eritr6citos pela atividade das enzimas superoxido dismutase (SOD), catalase e glutationa peroxidase (GPx). Determinouse, tambem, a concentragao do Fator de Necrose Tumoral alfa (TNF-a) em plasma. Devido a dificuldade em se realizar urn grupo placebo corn MAV, avaliou-se os mesmos parametros em pacientes tratados corn urn protocolo de exercicios fisicos de resistencia e estabilizacao da coluna, uma vez que os mesmos tambem demonstram efeitos positivos na reducao da dor lombar e/ou cervical. A reducao na percepcao dolorosa e na incapacitacao dos pacientes foram demonstradas logo apps cinco semanas de tratamento corn MAV, bem como passados trinta dias do final do tratamento. Alem disso, a MAV de alta velocidade e baixa amplitude foi capaz de aumentar significativamente a atividade das enzimas antioxidantes SOD e GPx. Os demais parametros de estresse oxidativo e nitrosativo estudados nao apresentaram alteracOes estatisticamente significativas. Por outro lado, o programa de exercicios utilizado neste estudo so foi capaz de reduzir a dor e incapacitagao imediatamente apOs o tratamento, sem alteracaes significativas em marcadores proou antioxidantes. Assim, os resultados mostram a eficacia da MAV e do exercicio terapeutico na reducao da dor e incapacitacao de pacientes corn cervicalgia e/ou lombalgia. Porem, apenas o efeito da MAV se estende por major period() de tempo. Ainda, nossos dados sugerem a existencia de relacao entre parametros oxidativos perifericos e analgesia apenas no tratamento corn MAV. Contudo, estudos complementares sao necessarios para melhor compreensao dessa relacao nos dois tipos de tratamentos. / Low back pain and neck pain are among the leading chronic pains of musculoskeletal origin. Besides the physical aspect, pain has cognitive, emotional and behavioral aspects, and chronic pain may become incapacitating. The perception and perpetuation of pain may result from numerous mechanisms of neural transmission. Different molecules and chemical messengers take part in this process, such as reactive oxygen and nitrogen species that are involved in the central sensitization process. Enzymatic and non-enzymatic antioxidant systems regulate the formation of these reactive species. Spinal manipulation treatment (SMT) seems to influence the control mechanisms involved in pain sensitivity. A previous study by our group demonstrated that short-term SMT can change the activity of enzymes involved in the balance between pro- and antioxidants. For this reason, the present study evaluated the analgesic effect of SMT of high velocity and low amplitude (HVLA) for a longer period in subjects with neck pain and/or chronic low back pain and also the influence of this treatment on peripheral markers of oxidative and nitrosative stress. The treatment was carried out for five weeks with two weekly sessions. Pain and disability were assessed using the visual analog scale (VAS), the Chronic Pain Grade, the SF-36 form, the Neck Pain Index, and the Roland Morris questionnaire. Pressure pain thresholds for cervical, lumbar and dorsal regions were determined as well. The effects on peripheral markers of oxidative and nitrosative stress were determined by measuring the total oxidant status (TOS), total reactive antioxidant potential (TRAP), and nitric oxide metabolites in plasma. The antioxidant defenses in erythrocytes were determined by the activity of superoxide dismutase (SOD), catalase and glutathione peroxidase (GPx). The concentration of tumor necrosis factor alpha (TNF-a) in plasma was also investigated. Due to the difficulty in performing a placebo group with SMT, we evaluated the same parameters in patients treated with a protocol of therapeutic exercises (resistance and stabilization of the spine), since these also show positive effects in the reduction of lumbar or neck pain. Our results indicate that SMT had analgesic effects and reduced disability, even past 30 days after end of treatment, and it significantly increased activity of antioxidant enzymes SOD and GPx. The other parameters of oxidative stress and nitrosative studied did not show statistically significant changes. On the other hand, the exercise protocol used in this study was able to reduce pain and disability only after the end of treatment, without significant changes in pro- or antioxidants markers. Thus, our results show the effectiveness of both SMT and therapeutic exercise in reducing pain and disability in patients with neck and/or back pain. However, only the effect of SMT extends for a longer period of time. In addition, our data suggest the existence of a relationship between oxidative parameters and peripheral analgesia only in SMT. Further studies are required to better understand this relationship in both treatments.
| Identifer | oai:union.ndltd.org:IBICT/oai:www.lume.ufrgs.br:10183/88621 |
| Date | January 2013 |
| Creators | Kolberg, Carolina |
| Contributors | Partata, Wania Aparecida |
| Source Sets | IBICT Brazilian ETDs |
| Language | Portuguese |
| Detected Language | English |
| Type | info:eu-repo/semantics/publishedVersion, info:eu-repo/semantics/doctoralThesis |
| Format | application/pdf |
| Source | reponame:Biblioteca Digital de Teses e Dissertações da UFRGS, instname:Universidade Federal do Rio Grande do Sul, instacron:UFRGS |
| Rights | info:eu-repo/semantics/openAccess |
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