DOLORE LOMBARE: IL FUTURO E’ LA RIABILITAZIONE

DOLORE LOMBARE: IL FUTURO E’ LA RIABILITAZIONE

Il dolore lombare è la condizione muscolo-scheletrica più comune che influisce sulla qualità della vita degli individui, specialmente se persistente.

Nel corso dei decenni, è stato fatto molto lavoro nel tentativo di ridurre l’impatto negativo della lombalgia e aiutare i pazienti a recuperare e mantenere una migliore qualità della vita.

Nuove intuizioni provengono da diversi campi di ricerca, con molto lavoro svolto nella ricerca della sua eziologia, descrivendo i diversi fenotipi sintomatici e indentificando i fattori coinvolti nella persistenza di tale condizione.

Tuttavia, resta ancora molto da fare per comprendere appieno il problema della lombalgia e delle sue cause.

Ancora oggi, sembra esserci un ampio divario tra la scienza di base e la ricerca sulla riabilitazione applicata a questa condizione clinica. Il primo è ancora alla ricerca in molti modi diversi del “Santo Graal” del generatore del dolore e fornisce risultati molto interessanti con particolare rilevanza per approcci chirurgici, correlati ai farmaci e altri approcci biologici, mentre il secondo si concentra pragmaticamente sui fattori modificabili che possono influenzare gli esiti di tale condizione dolorosa.

Tuttavia, una cura personalizzata ed efficace non è stata ancora pienamente realizzata. Pur riconoscendo il potenziale dei progressi scientifici, vi è un’immediata necessità di una maggiore ricerca traslazionale sulla riabilitazione, nonché di studi incentrati sull’efficacia degli approcci riabilitativi e sull’identificazione di nuovi “principi attivi”.

In base alle recenti ricerche e alle conoscenze acquisite sul campo quali sarebbero quindi le EBM della medicina fisica e riabilitativa? le linee guida consigliano di concentrare l’attenzione sul subacuto e sul dolore lombare cronico. Una condizione acuta ha di solito una buona prognosi, la lombalgia cronica è invece tipicamente persistente con ridotte possibilità di recupero totale.

Mentre ci sono prove che un approccio riabilitativo possa migliorare la qualità della vita di questi pazienti, non c’è evidenza di alcun trattamento in grado di risolvere totalmente il problema.

La riabilitazione si basa principalmente su esercizi e sull’educazione posturale, ma è previsto anche un ruolo per altre terapie, compresa la manipolazione e massaggi, se applicati in un approccio multimodale. Le linee guide raccomandano auto-gestione, terapie fisiche e psicologiche, e alcune forme di medicina complementare, mentre pongono meno enfasi sui trattamenti farmacologici e chirurgici.

Mentre la ricerca ha completamente cambiato l’approccio generale per il dolore lombare, sono necessari nuovi paradigmi al fine di garantire il futuro progresso in tale ambito.

Soluzioni promettenti per la cura del dolore lombare e la riabilitazione dei pazienti includono quindi l’attuazione di una best practice, la riprogettazione dei percorsi clinici, l’integrazione di salute e assistenza sul lavoro e nuove strategie di sanità pubblica e prevenzione. Inoltre c’è definitivamente bisogno di classificare i vari sottotipi specifici per una corretta diagnosi e cura.

 

Eur J Phis Rehabil Med. 2020 Apr;56(2):212-219.doi: 10.23736/S1973-9087.20.06257-7. Epub 2020 Mar 25

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