A eficácia da exposição gradual para o tratamento da dor lombar crônica

Abstract

Introduction: Low back pain, a common and globally disabling condition, often leads to prolonged work absenteeism and high economic costs, especially in low-income countries. Although cognitive-behavioral therapy (CBT), particularly graded exposure (GE), is an intervention used in rehabilitation, specific evidence regarding its efficacy in treating low back pain remains limited. Therefore, the aim of this literature review was to investigate the effectiveness of graded exposure in reducing pain and disability in patients with low back pain. Methods: This study is a narrative review on the effect of GE on chronic low back pain in adults. The search was conducted in the PEDro, LILACS, and Medline databases via PUBMed, with no restriction on year or language, using terms related to graded exposure therapy and low back pain. Randomized or quasi-randomized clinical trials were included, with a sample composed of individuals aged 18 years or older, of both sexes, who reported chronic pain (for at least 3 months) in the lumbar region. Methodological quality was assessed using the PEDro scale. Results: Fifteen studies were considered eligible, revealing that GE outperforms graded activity in reducing fear, pain, disability, and cost-effectiveness, while also proving more effective than the waiting list for disability in five studies. Furthermore, it demonstrates superiority over CBT for pain perception and catastrophizing. However, there is no advantage of GE over general physical activity or exercise, and the effectiveness of graded exposure through virtual reality is uncertain. Conclusion: The review indicates that GE surpasses graded activity, the waiting list, and cognitive-behavioral approach in reducing pain and catastrophizing. However, it is not superior to general physical activity or exercise, and the effectiveness of virtual reality is inconclusive. More comprehensive future studies are recommended to evaluate clinically significant outcomes.