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Durerea lombară cronică şi tulburarile depresive secundare. cum putem interveni?

Iliescu Madalina Gabriela, Lupu Andreea Alexandra

Durerea lombară cronică este o problemă des întâlnită la pacienții în vârstă și nu numai, ce poate asocia dizabilitate și tulburări depresive. Scăderea abilităților fizice și psihosociale duce la dizabilitate funcțională în rândul pacienților cu durere lombară joasă. Pe lânga durerile musculoscheletale, durerea lombară joasă afectează din ce în ce mai mult pacienții vârstnici, aproape 20 milioane de oameni. Luând în considerare modelul biopsihosocial, pe lângă schimbările psihosociale legate de vârstă cum ar fi scăderea toleranței la durere, există și alți factori care sunt asociați durerii lombare joase, iar cel mai importat ar fi tulburarea depresivă. Dacă tulburarea depresivă este întâlnită în prezent la aproximativ 17% din populația adultă, se pare că la pacienții cu durere lombară joasă este întâlnită în proporție de 27-55%. Natura relației dintre durere în această patologie a coloanei vertebrale lombare și tulburarea depresivă pare să fie una strânsă, fapt ce rezultă din manifestările somatico-psihologice care includ dizabilitate fizică, tulburari anxioase, teama și chiar lipsa speranței de a scăpa de durere.

Un mediator important al relației dintre durerea lombară joasă și depresie este severitatea durerii. Pacienții care resimt durere mai intensă sunt pacienți depresivi. Dacă durerea scade în intensitate apare o îmbunătățire a simptomelor depresive. Mai mult decât atât, bărbații tind să raporteze severitatea durerii mai mică, în timp ce femeile raportează nivele mai crescute ale durerii și tind să fie mai depresive.

Ultimele descoperiri evidenţiază faptul că scăderea funcţiei neuromusculare şi a funcţiei fizice, în funcţie de vârstă, este parţial cauzată de deterioarea sistemului neural inclusiv de atrofia corticală, de alterarea neurochimică, pierderea de unităţi motorii şi funcţionalitatea unităţilor motorii rămase, de schimbările structurale ale joncţinilor neuromusculare. Scăderea progresivă, odată cu înaintarea în vârstă, a nivelului BDNF (o neuroproteină din sistemul nervos central) poate contribui la deteriorarea sistemului neural, ca de altfel şi al celui neuromuscular şi a funcţiei fizice la pacienţii vârstnici. Mai mult decât atât, multe studii au demonstrat că BDNF-ul a crescut la pacienţii care au efectuat exerciţii care au inclus şi contracţii izometrice. În special nivelul BDNF-ului a crescut la pacienţii consideraţi non-fragili sau pre-fragili (prin ”fragilitate” este considerat un sindrom al pacienţilor geriatrici care au 3 sau mai multe din următoarele criterii: scădere în greutate neintenţionată, oboseală cronică, slăbiciune, mers încetinit, greoi, şi activitate fizică redusă) care au efectuat timp de 10 săptămâni exerciţii fizice. Pe lângă creşterea BDNF-ului s-a înregistrat şi creşterea masei musculare şi a funcţiei fizice. 

Durerea lombară de cauză degenerativă este una din cele mai frecvente cauze de durere cronică şi dizabilitate la nivel mondial. Opioidele, inclusiv morfina, sunt medicamentele prescrise cel mai frecvent pentru tratamentul durerii cronice din acestă patologie, de aceea metodologiile de reabilitare şi medicină fizică rămân o alternativă de succes prin lipsa reacţiilor adverse şi creşterea stării de bine pe termen lung.

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Eric

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Eric

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Eric

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June 5, 2020, 4:40 a.m.
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