Efeito imediato da terapia por ondas de choque extracorpórea em pacientes com dor lombar crônica não específica: ensaio clínico randomizado, duplo cego, placebo controlado
Back, Cláudio Gregório Nuernberg
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The clinical guideline for interventions for the management of chronic low back pain recommends that physical therapists should use an exercise-based treatment program, but when exercise engagement is limited by pain, one of the recommendations for physical therapists is to use soft tissue mobilization to reduce short-term pain and disability. Shockwave therapy could be used for this purpose, but there is little data on the immediate effects of this resource. As the effects of shock waves are dose-dependent, dose modulation by the tip type can interfere with the effectiveness of the treatment. The aim of this study was to investigate the immediate effect of extracorporeal radial shock waves, modulated by the type of tip, in patients with chronic non-specific low back pain. This study was a randomized clinical trial, placebo-controlled with patient, evaluator, and therapist blinded. Eighty-one patients were randomized into three groups 1:1:1, concave group, radial shock waves with concave tip, convex group, with convex tip and placebo group, the applicator did not generate shock waves. The three groups performed an intervention session. The primary outcome measure was pain intensity as measured by the Numerical Pain Scale (END). Secondary outcomes were pressure pain threshold (PPT), temporal summation of pain, and functional performance measured by repeated trunk flexion tests and the sit-and-stand test. The concave group showed a significant reduction in pain intensity compared to the convex group, mean 1.44 points (SD=2.9) and the placebo group, 2 points (3.1) and a significant increase in PPT, to the convex group of 62.8kPa (116.1) and placebo 76.4kPa (155.1), post-intervention. No intergroup differences were observed in temporal summation and in the repeated trunk flexion and sit and stand tests. We conclude that the application of shock waves with the concave tip was more effective in reducing pain intensity and increasing pressure pain threshold in patients with chronic low back pain.
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