This is the third edition of the document Acute Pain Management: Scientific Evidence. The first edition was written by a multidisciplinary committee headed by Professor Michael Cousins and published by the National Health and Medical Research Council (NHMRC) of Australia in 1999. The second edition was written by multiple contributors and a working party chaired by Assoc Prof Pam Macintyre. It was approved by the NHMRC and published by the Australian and New Zealand College of Anaesthetists (ANZCA) and its Faculty of Pain Medicine (FPM) in 2005. It was also endorsed by a number of major organisations — the International Association for the Study of Pain (IASP), the Royal College of Anaesthetists (United Kingdom), the Australasian Faculty of Rehabilitation Medicine, the Royal Australasian College of Physicians, the Royal Australasian College of Surgeons, the Royal Australian and New Zealand College of Psychiatrists and the Australian Pain Society — and recommended to its members by the American Academy of Pain Medicine. After publication, a companion document for consumers — Managing Acute Pain: a Guide for Patients — was prepared and approved by the NHMRC (ANZCA & FPM 2005). In accord with NHMRC requirements that documents such as these be revised as further evidence accumulates, and as there had been an ongoing and substantial increase in the quantity and quality of information available about acute pain management, it was seen as timely to reassess the available evidence. ANZCA and the FPM therefore again took responsibility for revising and updating the document — this third edition. As with the second edition, this third edition has been endorsed by a number of key professional organisations (see list on the title page). It was also approved by the NHMRC on 4th February 2010, under section 14A of the National Health and Medical Research Council Act 1992.

Acesse o PDF


For both economic and ethical reasons, identification of the optimal treatment for each individual patient is a pressing concern, not only for the patients and their physician, but also health care payers and the pharmaceutical industry. In the field of osteoarthritis (OA) this is of particular relevance, due to the heterogeneity of the disease and the very large number of affected individuals. There is a need to pair the right patients with the right therapeutic modes of action. At present, the clinical trial failures in OA may be a consequence of both bona fide treatment failures and trial failures due to clinical design de- ficiencies. Tools are needed for characterization and segregation of patients with OA. Key lessons may be learned from advances with another form of arthritis, namely rheumatoid arthritis (RA). Personalized health care (PHC) may be more advantageous for a number of specific indications which are characterized by costly therapy, low response rates and significant problems associated with trial and error prescription, including the risk of serious side effects. We discuss the use of diagnostic practices guiding RA treatment, which may serve as a source of key insights for diagnostic practices in OA. We discuss the emerging concept of PHC, and outline the opportunities and current successes and failures across the RA field, as the OA field collects further data to support the hypothesis. We attempt to outline a possible path forward to assist patients, physicians, payers and the pharmaceutical industry in assuring the ‘right’ patients are treated with the ‘right drug’ in OA. Finally we highlight methods for possible segregation of OA patients that would allow identification of patient subtypes, such as OA driven by inflammation that may be ideally suited for PHC and for targeted therapies.  2013 Osteoarthritis Research Society International. Published by Elsevier Ltd. All rights reserved

Acesse o PDF


Revisão Sistematizada sotre Terapia por Ondas de Choque no tratamento de Fascites Plantares. 

Effectiveness of Different Physical Therapy in Conservative Treatment of Plantar Fasciitis. Systematic Review Background: Plantar fasciitis is the most common disease of nonraumatic pain in the ankle-foot. It is more common in women aged 40 - 0 years and diffuse progressive start the foot or ankle that gradually worens preventing progress. The aim of this work is to determine whether ifferent physical therapies used in the conservative treatment of plantar asciitis of at least one month duration in adults are effective individually nd / or in combination. Methods: A systematic review databases in The Cochrane Library, edline, Lilacs, IBECS, IME, PEDro and ENFISPO no date restriction, n Spanish and English languages. Randomized controlled trials were ncluded of adult patients diagnosed with plantar fasciitis, intervention tudies, prospective and systematic reviews. Assessment of study eligibiity was developed by two reviewers independently and unblinded stanardized. To classify, we used the PEDro scale critical, form of methodoogical quality plus a critical review of each summary and if this was not onclusive assessment of the full text. Results: 32 full-text articles were reviewed. Most used techniques re the stretches and shock waves, although the best results are obtained y combining several techniques. Shock waves are effective when other echniques have failed. Conclusion: Physical therapies used in the various studies have proen effective to varying degrees either to reduce pain or relieve the ymptoms of plantar fasciitis. Keyword: Systematic review. Plantar fasciitis. Pain. Therapeutics. hysical Therapy Modalities.

Acesse o PDF


Practice Guideline J.B. StaalI , E.J.M. HendriksII, M. HeijmansIII, H. KiersIV, A.M. Lutgers-BoomsmaV, G. RuttenVI, M.W. van TulderVII, J. den BoerVIII, R. OsteloIX, J.W.H. CustersX I Bart Staal, PhD, physical therapist/epidemiologist, senior researcher, IQ Healthcare, Radboud University Nijmegen Medical Center, Nijmegen, The Netherlands. II Erik Hendriks PhD, physical therapist/epidemiologist, senior researcher, Dept. of Epidemiology, Maastricht University, Maastricht, The Netherlands III Marcel Heijmans, MSc, physical therapist/manual therapist, Dept. of Research and Development, Dutch Institute of Allied Health Care, Amersfoort, The Netherlands. IV Henri Kiers, MSc, physical therapist/manual therapist, researcher at Utrecht University of Applied Sciences, representing NVMT, Amersfoort, The Netherlands. V Marlene Lutgert-Boomsma, MSc, physical therapist/company physical therapist / Master of Stress Management and Reintegration, representing NVBF (association of Dutch occupational and company physical therapists) and College van Specialisten Verenigingen (Dutch college of associations of specialists). VI Geert Rutten PhD, MPH, physical therapist/manual therapist, postdoc researcher at Dept. of Health Promotion, Maastricht University, Maastricht, The Netherlands. VII Professor Maurits van Tulder, PhD, epidemiologist, Professor of Health Technology Assessment, Dept. of Health Sciences, Faculty of Earth and Life Sciences, VU University, and Dept. of Epidemiology & Biostatistics, VU University Medical Center, Amsterdam, The Netherlands. VIII Jasper den Boer, PhD, physical therapist/senior researcher, Dept. of Rehabilitation, Radboud University Medical Center, Nijmegen, The Netherlands. IX Prof. Raymond Ostelo, PhD, Professor of Evidence Based Physiotherapy, Faculty of Earth and Life Sciences, VU University and Dept. of Epidemiology & Biostatistics, VU University, Amsterdam, The Netherlands. X Jan Custers, PhD, physical therapist, senior policy adviser, Dept. of Policy and Development, Royal Dutch Society for Physical Therapy, Amersfoort, The Netherlands (until August 2010); lecturer at Institute for Human Movement Studies, Utrecht University of Applied Sciences, Utrecht, The Netherlands. A Introduction This KNGF guideline describes the physical therapy and manual therapy interventions that can be used to treat patients with low back pain. The guideline is supplemented by a Review of the Evidence, which sets out and explains the choices made as regards the definition of the health problem at hand, its diagnostics and treatment, as well as offering background information to support the Practice Guideline. The guideline is summarized on a flowchart. The Dutch Association for Manual Therapy (NVMT) and KNGF have decided to merge the updates of their guidelines on low back pain for the two professions. The present update thus replaces the 2006 KNGF guideline on manual therapy for low back pain and the 2005 KNGF practice guideline on low back pain. Any manual therapist is also a physical therapist, and the two disciplines overlap to a considerable extent. Most of the recommendations presented in the present guideline for the diagnostics and treatment of non-specific low back pain are valid for both physical therapists and manual therapists. Any recommendations that are specifically aimed at manual therapists are indicated as such in the guideline. A.1 Objective and target group The KNGF Guideline on Low Back Pain is intended to guide the diagnostics and treatment of patients with non-specific low back pain by a physical therapist and/or manual therapist. A.2 Scope of the Guideline Low back pain is usually subdivided into specific and non-specific low back pain. In this guideline, the term ‘low back pain’ refers to ‘non-specific low back pain’, unless otherwise indicated. • Non-specific low back pain is defined as low back pain for which no specific cause can be identified. 

Acesse o PDF


Effectiveness of Radial Shock-Wave Therapy for Calcific Tendinitis of the Shoulder: Single-Blind, Randomized Clinical Study Background and Purpose. Radial shock-wave therapy (RSWT) is a pneumatically generated, low- to medium-energy type of shock-wave therapy. This single-blind, randomized, “less active similar therapy”- controlled study was performed to evaluate the effectiveness of RSWT for the management of calcific tendinitis of the shoulder. Subjects. Ninety patients with radiographically verified calcific tendinitis of the shoulder were tested. Methods. Subjects were randomly assigned to either a treatment group (n45) or a control group (n45). Pain and functional level were evaluated before and after treatment and at a 6-month follow-up. Radiographic modifications in calcifications were evaluated before and after treatment. Results. The treatment group displayed improvement in all of the parameters analyzed after treatment and at the 6-month follow-up. Calcifications disappeared completely in 86.6% of the subjects in the treatment group and partially in 13.4% of subjects; only 8.8% of the subjects in the control group displayed partially reduced calcifications, and none displayed a total disappearance. Discussion and Conclusion. The results suggest that the use of RSWT for the management of calcific tendinitis of the shoulder is safe and effective, leading to a significant reduction in pain and improvement of shoulder function after 4 weeks, without adverse effects. [Cacchio A, Paoloni M, Barile A, et al. Effectiveness of radial shock-wave therapy for calcific tendinitis of the shoulder: single-blind, randomized clinical study. Phys Ther. 2006;86:672– 682.] 

Acesse o PDF


A Terapia Manual adequada, vem sendo citada como uma importante aliada, do fisioterapeuta, no tratamento das dores nas costas inespecíficas. Saiba um pouco mais sobre estas técnicas.

Acesse o PDF


The Treatment of Achilles Tendonitis Using Therapeutic Laser Evidence supports considering therapeutic laser in the treatment and rehabilitation of Achilles tendonitis alone or in combination with more conventional therapies.

Acesse o PDF


Adaptações neurais e morfológicas ao
treinamento de força com ações excêntricas
Neural and morphological adaptations to resistance training with eccentric actions
RESUMO – A ação excêntrica tem sido estudada devido a possibilidade de otimizar as
respostas adaptativas dos músculos aos estímulos do treinamento de força. Essas
respostas incluem maiores ganhos de força e hipertrofia decorrentes de um treinamento
com apenas ações excêntricas. É provável que essas adaptações sejam conseqüência dos
eventos que ocorrem na estrutura neuromuscular em função das diferentes características
neurais e mecânicas associadas a este tipo de ação. A maior ocorrência de lesão, o maior
grau de tensão sobre as fibras musculares ativas e o alongamento a que estas são
submetidas aparentam maximizar as respostas ao treinamento de força.
PALAVRAS-CHAVE - dano muscular, hipertrofia, células satélites


Acesse o PDF


Lopes-Martins, Rodrigo A´ lvaro B., Rodrigo Labat Marcos, Patrı´- cia Sardinha Leonardo, Antoˆnio Carlos Prianti, Jr. , Marcelo Nicolas Muscara´, Flavio Aimbire, Lu´cio Frigo, Vegard V. Iversen, and Jan Magnus Bjordal. Effect of low-level laser (Ga-A1-As 655 nm) on skeletal muscle fatigue induced by electrical stimulation in rats. J Appl Physiol 101: 283–288, 2006. First published April 20, 2006; doi:10.1152/japplphysiol.01318.2005.—We investigated whether lowlevel laser therapy (LLLT) can reduce muscular fatigue during tetanic contractions in rats. Thirty-two male Wistar rats were divided into four groups receiving either one of three different LLLT doses (0.5, 1.0, and 2.5 J/cm2 ) or a no-treatment control group. Electrical stimulation was used to induce six tetanic muscle contractions in the tibial anterior muscle. Contractions were stopped when the muscle force fell to 50% of the initial value for each contraction (T50%). There was no significant difference between the 2.5 J/cm2 laser-irradiated group and the control group in mean T50% values. Laser-irradiated groups (0.5 and 1.0 J/cm2 ) had significantly longer T50% values than the control group. The relative peak force for the sixth contraction in the laserirradiated groups were significantly higher at 92.2% (SD 12.6) for 0.5 J/cm2 , 83.2% (SD 20.5) for 1.0 J/cm2 , and 82.9% (SD 18.3) for 2.5 J/cm2 than for the control group [50% (SD 15)]. Laser groups receiving 0.5 and 1.0 J/cm2 showed significant increases in mean performed work compared with both the control group and their first contraction values. Muscle damage was indirectly measured by creatine kinase levels in plasma. A distinct dose-response pattern was found in which 1.0 and 2.5 J/cm2 LLLT groups had significantly lower creatine kinase levels than the 0.5 J/cm2 LLLT group and the control group. We conclude that LLLT doses of 0.5 and 1.0 J/cm2 can prevent development of muscular fatigue in rats during repeated tetanic contractions. laser therapy; skeletal muscle; electrical stimulation; rats; fatigue 

Acesse o PDF


Rezende MU de, Gurgel HM de C, Vilaça Junior PR, Kuroba RK, Lopes ASS, Phillipi RZ, et al. Diacerein versus glucosamine in a rat model of osteoarthritis. CLINICS. 2006;61(5):461-6. PURPOSE: The purpose of this study was to compare the chondroprotective effect of diacerein and glucosamine regarding degenerative changes and articular stiffness in an experimental model of arthritis. METHODS: Twenty rats underwent medial meniscectomy on the right knee. Ten animals were given diacerhein, and 10 were given glucosamine, from day 1 to the third month postoperatively, when all of them were killed. Histological and functional analysis of the knees were performed (measurement of maximum extension). RESULTS: All operated knees showed more limited extension values and more degenerative changes as compared to nonoperated contralateral sides. A comparison of the two drugs showed that the degree of articular stiffness was significantly lower with diacerein, although degenerative changes were similar. CONCLUSIONS: 1) Prophylactic use of diacerein leads to lower degree of articular stiffness when compared to glucosamine; 2) The prophylactic chondroprotective effects of diacerein and glucosamine are histologically similar. KEYWORDS: Rats. Knee. Osteoarthritis. Anthraquinone. Meniscectomy. Glucosamine.

Acesse o PDF


Abstract: The purpose of this study is evaluate the
effect of far-infrared and microcurrent over the
wound healing process in rats. After produce a
wound with 8 mm, the rats were divided in 3 groups:
Control (C), Far-infrared (I), Microcurrent (M). The
effect of Far-infrared and Microcurrent were
evaluated with photographic and clinical analysis.
The I group presented inferior inflammation signs
like fluids and edema in comparison with the other
groups. With regard to wound diameter wasn’t had
significative difference among the groups in 24, 48
and 72 hours. The results suggest that the Farinfrared
increase the lymphatic drain in the first
moments of the inflammations process.
Key words: Far-infrared, Microcurrent, Wound
Acesse o PDF