Pain assessment in patients with adolescent idiopathic scoliosis at different stages of disease evolution

Abstract

OBJECTIVE:The correlation between pain complaints and the severity of the spinal curvature in adolescent idiopathic scoliosis remains controversial. The aim of this study was to evaluate the presence and intensity of back pain in adolescent idiopathic scoliosis patients at different stages of the disease. METHODS: Sixty-four individuals participated in this study with scoliotic curves (Cobb angles) between 20 and 90 degrees. Patients were divided into four groups according to the scoliotic curves: Group 1 (with 20 to 45 degrees) Group 2 (curves greater than 45 degrees before surgery), Group 3 (curves greater than 45 degrees one year after posterior spinal arthrodesis with pedicle screws) and Group 4 (healthy adolescents between 11 and 18 years of age; control group). RESULTS: The scores obtained from the pain domain of the SRS-30 questionnaire (specifically developed for the assessment of adolescent scoliosis) were significantly worse for patients with scoliosis, regardless of the evolutionary phase of the disease. Patients who underwent surgical treatment presented statistically better results one year after surgery than did the group of patients with moderate Cobb angles. CONCLUSION: Patients with adolescent idiopathic scoliosis had a higher intensity of back pain than healthy individuals. Pain was reduced one year after spinal arthrodesis.

The effectiveness of core stabilization exercise in adolescent idiopathic scoliosis

“…A preliminary study reported a higher complaint rate of back pain in patients with scoliosis than in healthy individuals. 38 In the natural course of scoliosis, due to asymmetrical loading on the spine, intervertebral disc and facet joint degeneration and differences in spinal muscle length occur, leading to chronic pain. Therefore, for the conservative treatment of AIS, pain relief is considered to be important.…”

Efectos de las técnicas de ejercicio terapéutico correctivo en la escoliosis idiopática del adolescente. Revisión sistemática

“…6 Algunos autores lo han atribuido a la carga asimétrica que provoca una degeneración prematura de facetas y discos intervertebrales y acortamiento de musculatura. 6,37,38 Sin embargo, no se conoce con exactitud el mecanismo por el que se habría mejorado esta variable, que puede venir determinado por la mejora de la flexibilidad de la columna y de los tejidos adyacentes 39 o por la propia liberación de sustancias moduladoras del dolor por el propio ejercicio. 40 Un artículo observó mejoras en la capacidad pulmonar.…”

“…5 Pese a no ser un factor clínico principal, l o s p a c i e n t e s c o n E I A p u e d e n presentar dolor; son más proclives a desarrollarlo en mayores grados de ángulo de Cobb. 6 Estudios de prevalencia han mostrado que el dolor se presenta entre el 27% y el 59% de los casos. 5,7 Además, se pueden asociar otros problemas, como la restricción d e l a v e n t i l a c i ó n , l a d e b i l i d a d de la musculatura respiratoria, la disminución de la calidad de vida 8 e, incluso, problemas psicológicos.…”

Effects of corrective, therapeutic exercise techniques on adolescent idiopathic scoliosis. A systematic review

“…6 Some authors have attributed them to the asymmetric burden that causes early intervertebral disc and facet degeneration and shortening of the muscles. 6,37,38 However, the mechanism that leads to the improvement in such outcome measure is not known accurately, given that it may be the result of an improved flexibility in the spine and adjacent tissues 39 or the release of pain modulatory substances resulting from exercise itself. 40 An article described improvements in pulmonary capacity.…”

“…5 Although it is not the main clinical factor, patients with AIS may have pain; they are more prone to pain when the degree of Cobb's angle is higher. 6 Studies on AIS prevalence have demonstrated that between 27% and 59% of patients suffer pain. 5,7 In addition, it may be associated with other conditions, such as restricted ventilation, respiratory muscle weakness, reduced quality of life, 8 and even psychological problems.…”