Tratamento inadequado para dor lombar

Fisioterapeuta avaliando paciente

Leda Segala estava fazendo a unha do pé em janeiro de 2013 quando, ao abaixar, sentiu as costas “repuxarem”. Com muita dor, ela procurou um médico e recebeu remédio e repouso como receita para o tratamento, e mesmo após ter feito infiltração por algumas semanas, o sintoma não passava e já não conseguia fazer quase nada por causa da dor. Quatro meses depois, após procurar pela especialista em patologias da coluna vertebral Silvia Canevari, é que conseguiu controlar e aliviar a dor. Hoje, após 4 anos, Leda continua muito bem e fazendo exercícios.

O problema

Assim como Leda, muitos pacientes com dor lombar estão sendo tratados de forma inadequada por profissionais de saúde no mundo todo. Essa foi a conclusão que chegou uma série de estudos publicados pela revista americana The Lancet. Baseada em dados levantados por 33 profissionais de saúde, médicos cirurgiões, reumatologistas e fisioterapeutas de 195 países durante 26 anos, a série de estudos mostrou que a dor na região lombar é o principal motivo de incapacitação no trabalho.

O problema atinge 540.000 pessoas no mundo, ou seja, quase 1 em cada 10 habitantes no planeta. Um dado bem preocupante nesse estudo é a forma como alguns médicos tem lidado com a dor lombar dos pacientes. Eles prescrevem remédios desnecessários e até cirurgia, quando o mais indicado seria fisioterapia especializada, exercícios e reeducação postural e mudanças na rotina.

Tratamento e diagnóstico inadequado

Diego Ito também teve o seu primeiro diagnóstico inadequado. Há nove anos, ele passou por uma cirurgia na coluna por conta de um acidente em uma piscina, mas há dois anos, após o nascimento do seu filho, ele começou a sentir dores na coluna. Um dos profissionais consultados por ele receitou exercícios físicos para fortalecimento. Na academia, entretanto, a sua dor apenas aumentou.

Segundo Silvia Canevari, fisioterapeuta do ITC Vertebral Jundiaí, o repouso e medicação contribuem para que a dor lombar se torne crônica, e os exercícios devem ser elaborados pelo fisioterapeuta.. “A academia ou pilates bem orientados pelo fisioterapeuta, seria a melhor forma de fazer a manutenção após o tratamento”, comenta Silvia Canevari.

Pela ineficácia dos tratamentos, é comum encontrar pacientes de dor lombar que já passaram por inúmeros profissionais, fizeram vários exames de imagem e tiveram que tomar muita medicação. Muitas pessoas são afastados do serviço, diminuindo a renda da família, ou fazem cirurgias desnecessárias.

Consequências deste tratamento inadequado

No Brasil, entre 1995 e 2017, houve um aumento de 226% do número de cirurgias na coluna e um aumento de 540% no custo relacionado às cirurgias de coluna. Em 2011, o INSS apontou que a dor nas costas foi a principal causa de pedidos de compensação (afastamento e aposentadoria), representando um aumento de 17% nos últimos 5 anos. “Quando a dor lombar é tratada de forma correta, o custo para o paciente, convênios, empresas e governo é muito menor.” Segundo a fisioterapeuta, o exame clínico é o mais importante. “ É muito importante entender o dia a dia do paciente”, explica a especialista Silvia.

Ela reitera que uma conversa cuidadosa e individualizada com o paciente, que inclui a investigação da rotina, as características da dor e testes específicos são fundamentais. “Mais do que exames de imagem, o exame clínico ajuda a entender e prosseguir com o tratamento de uma forma mais assertiva.”

A fisioterapeuta do ITC Vertebral aponta os três pilares que devem ser utilizados para fazer o tratamento correto: informação e orientação, exercícios e profilaxia. Para ela é necessário alterar o modelo de atendimento clínico para os pacientes de dor lombar para assim reduzir o desperdício com os gastos em saúde tanto das famílias, empresas, convênios e governo.

Fonte da reportagem: Jornal de Jundiaí – JJ

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