LOMBALGIAS (4)

LOMBALGIAS - recomendações para o tratamento clinico da dor lombar não específica

• Give adequate information and reassure the patient (despitar os casos mais graves e dar apoio e informação correcta ajuda o paciente a tolerar e enfrentar de forma positiva o problema da dor lombar).

• Do not prescribe bed rest as a treatment

• Advise patients to stay active and continue normal daily activities including work if possible (pode haver necessidade de actividade protegida ou condicionada mas não deve ser repouso absoluto).

• Prescribe medication, if necessary for pain relief; preferably to be taken at regular intervals; first choice paracetamol, second choice NSAIDs
• Consider adding a short course of muscle relaxants on its own or added to NSAIDs, if paracetamol or NSAIDs have failed to reduce pain
• Consider (referral for) spinal manipulation for patients who are failing to return to normal activities. (A terapia manual deve ser feita por profissionais competentes e com experiência no tratamento das disfunções da coluna. São mais eficazes nos casos de dor lombar sub-aguda. Para os casos crónicos é necessário uma intervenção multifactorial).

• Multidisciplinary treatment programmes in occupational settings may be an optionfor workers with sub-acute low back pain and sick leave for more than 4 - 8 weeks

in EUROPEAN GUIDELINES FOR THE MANAGEMENT OF ACUTE NONSPECIFICLOW BACK PAIN IN PRIMARY CARE (http://www.backpaineurope.org/ )Maurits van Tulder, Annette Becker, Trudy Bekkering, Alan Breen, Maria Teresa Gil del Real, Allen Hutchinson, Bart Koes, Even Laerum, Antti Malmivaara, on behalf of the COST B13 Working Group on Guidelines for the Management of Acute Low Back Pain in Primary Care