Electroanalgesia en la cervicalgia mecánica inespecífica en atención primariaensayo clínico aleatorizado

Résumé

Chronic Neck pain is one of the health problems more extended among the general population which requires a multidisciplinary approach, coordinating specialist research teams and optimizing knowledge and technology developments in order to solve it. Neck pain is common, disabling and costly. Electrotherapy is an umbrella term that covers a number of therapies using electric current that aim to reduce pain and improve muscle tension and function. The present study presents a physical therapy procedure involving the use of Interferential Therapy. The basic principle of Interferential Therapy (IFT) is to utilise the significant physiological effects of low frequency (<250pps) electrical stimulation of nerves without the associated painful and somewhat unpleasant side effects sometimes associated with low frequency stimulation. Interferential Therapy (IFT / IFC) has been widely used in therapy for many years (usage reviewed in Pope et al, 1995 and more recently Shah and Farrow, 2012), Its use is probably disproportionate to both the volume and the quality of the published evidence, though it is strongly supported on an anecdotal evidence level, and several reviews are indicating an overall supportive evidence base, especially for pain based management (e.g. Fuentes et al, 2010). The main focus of this study is to compare the efficacy reducing the pain and the disability of patients suffering chronic neck pain treated by the combination of IFT and a program of supervised therapeutic exercises versus the use of a program of supervised therapeutic exercises alone. In order to respond to the hypotheses presented, a randomized clinical trial was designed to a single blind from a population of 49 patients who used the services of primary care physiotherapy of the Basic Health Zone of San José de la Rinconada in Seville diagnosed with non-specific mechanical cervicalgia (N = 49). This initial sample was divided into two subgroups to which the members were assigned randomly (using the statistical program Epidat in version 3.1). Thus, a control group (n = 24) was set up, with a supervised therapeutic exercise program exclusively applied and an experimental group to which, in addition to the aforementioned intervention, a treatment with interference currents interferential currents, bipolar method 4000 Hz carrier frequency and 60 Hz AMF with a modulation frequency of 90 Hz, with electrodes 5x10 cm2 placed in opposition to the neck (C5-C6-C7), during 25 minutes. The intensity (voltage) of the IFC will be adapted to the sensitivity of each patient. The current intensity during the treatment time must be increased 3 to 5 times, within the limits of patients' perception without exceeding the threshold of excitability and pain. The increased intensity is intended to retard the apparition of accommodative phenomena. Patients will receive 10 sessions from Mondayto Friday during two weeks. The Physiotherapist registered the daily attendance at sessions. The sample was evaluated at the beginning of the treatment and after the end of the session in order to make a systematic and detailed collection of the variables under study to facilitate the subsequent analysis of data. The variables analyzed analyzed were the level of pain perceived by visual analogue scale (VAS), the degree of disability through the Neck Discapacity Index (NDI) and the Core Outcome Measure (COM), the level of anxiety stress through The Goldberg scale, apprehension through the Personal Psychological Apprehension scale (EAPP), and the range of joint mobility of the cervical spine through both linear and angular determination. The data were analyzed using the SPSS software package in its version 15.0 for Windows, using a variety of techniques that were adapted according to the scientific objectives established at the beginning of the study. The level of statistical significance was established to rule out the null hypothesis for each variable if p <0.05. Both therapeutic alternatives were effective in the approach of non-specific mechanical cervicalgia since they achieve statistically significant changes both in the level of perceived pain, in the levels of disability and in the expansion of the range of articular mobility of the cervical spine. The combined treatment of therapeutic exercises with interferential currents additionally achieved statistically significant results in the improvement of the level of perceived pain and in the extension of the range of joint mobility at least in what refers to the movement of passive flexion, with effect size data that Make us consider that this difference is moderate in favor of the experimental group..