Perfil de dor e fadiga de indivíduos com esclerose lateral amiotrófica do Rio Grande do Norte e melhores práticas fisioterapêuticas para manejo desses sintomas

Abstract

Introduction: Amyotrophic Lateral Sclerosis (ALS) is a rare neurodegenerative disease with heterogeneous symptoms that may include muscle weakness and spasms, dysphagia, dysarthria, as well as cognitive, respiratory, and other manifestations. Fatigue and pain are also common symptoms in ALS, affecting daily activities and social participation. Currently, there is no cure for ALS, but physiotherapeutic treatments can contribute to relieving the symptoms in these individuals. Objective: To analyze the profile of pain and fatigue in people with ALS in the state of Rio Grande do Norte (RN) and identify evidence-based physiotherapeutic approaches for such symptoms. Methodology: The study has a mixed methodology, with a prospective cross-sectional analysis and a systematic retrospective analysis. The prospective sample consisted of individuals diagnosed with ALS and followed at the Neuromuscular Diseases outpatient clinic in RN, assessed for pain using the Visual Analog Scale (VAS) and Body Diagram, and for fatigue using the Fatigue Severity Scale (FSS). In the retrospective design, the analysis of the best evidence of physiotherapeutic practices was conducted through a systematic search in scientific databases MEDLINE, EMBASE, Cochrane Library (CENTRAL), and Physiotherapy Evidence Database (PEDro), with no date or language restrictions, from July 2021 to January 2023. Results: Out of 71 individuals with ALS assessed prospectively, the average pain intensity was 4.35 (±3.38) points on the VAS, primarily located in the lumbar region, anterior leg, thigh, and thoracic spine. Fatigue was present in the majority of the sample, with an average fatigue level of 38.08 (±19.73) points on the FSS. In the systematic retrospective evaluation, 13 included studies brought approaches such as stretching, aerobic exercises, electrostimulation, massage therapy, relaxation techniques, and osteopathy techniques for pain and fatigue in ALS, but uncertainties about the effectiveness of physiotherapeutic interventions in managing these symptoms were highlighted. Conclusion: The prospective analysis indicated a profile with moderate levels of pain and significant fatigue among individuals with ALS in the state of RN. Retrospectively, the systematic analysis did not find studies capable of bringing significant impacts in managing these symptoms. This study is clinically relevant in exploring symptomatology in a regional context, as well as identifying physiotherapeutic practices used in the management of pain and fatigue.