https://pubmed.ncbi.nlm.nih.gov/?

term=Chronic%20pain%5BTitle%5D
%20pharmacological%20musculoskeletal&page=2

REFERÊNCIA REMUME 2020 -

https://www.joinville.sc.gov.br/public/portaladm/pdf/jornal/3c415e8ee2afb4dcd0a
97676aefac34d.pdf
● A Relação Municipal de Medicamentos Essenciais (REMUME) contempla
todos os medicamentos selecionados e padronizados pelo município (que
incluem os medicamentos do Componente Básico da Assistência
Farmacêutica – CBAF), e também os medicamentos padronizados pelo
Ministério da Saúde e pela Secretaria Estadual de Saúde.
● O CBAF é constituído por medicamentos e insumos farmacêuticos voltados
aos principais agravos e programas de saúde da Atenção Primária.
● O CESAF destina-se à garantia do acesso a medicamentos e insumos para
controle de doenças e agravos específicos com potencial impacto endêmico,
muitas vezes relacionados a situações de vulnerabilidade social e pobreza. O
financiamento deste componente é destinado à aquisição de medicamentos
e insumos relacionados em programas estratégicos de saúde do SUS, para o
tratamento de tuberculose, hanseníase, malária, leishmanioses, doença de
Chagas, cólera, esquistossomose, filariose, meningite, tracoma,
toxoplasmose, micoses sistêmicas, entre outras doenças. Também são
garantidos antivirais para o combate à influenza, antirretrovirais para
tratamento de pessoas com HIV/AIDS, hemoderivados e pró-coagulantes
para pessoas com doenças hematológicas, vacinas, soros e imunoglobulinas,
além de medicamentos e insumos destinados ao combate do tabagismo e ao
programa de alimentação e nutrição.

A seleção dos itens do elenco de medicamentos do Hospital São José de Joinville é

realizada pela Comissão de Farmácia e Terapêutica (CFT) do próprio hospital, com
ciência do Diretor-Presidente

A RENAME define a Relação Nacional de Medicamentos do Componente Básico da

Assistência Farmacêutica (CBAF), do Componente Estratégico da Assistência
Farmacêutica (CESAF), do Componente Especializado da Assistência Farmacêutica
(CEAF), bem como a Relação Nacional de Medicamentos de Uso Hospitalar
(RENAME 2020).
Os medicamentos do CEAF são recebidos da Secretaria de Saúde do Estado na
Farmácia Escola (FAE), serviço integrante da GAFL, que está subordinada à DMC da
Secretaria Municipal da Saúde. A FAE realiza a entrega/dispensação dos
medicamentos aos usuários.

Medicamentos:
● TODAS AS UBSFs
○ Ácido Acetilsalicílico, 100 mg - comprimido CBAF
○ Dipirona Sódica, 500 mg/mL, solução oral - Frasco 20 mL
○ Ibuprofeno, 50 mg/mL, suspensão oral - frasco 30 mL
○ Ibuprofeno, 600 mg - comprimido
○ Lidocaína, cloridrato 2% (20 mg/g), geléia - bisnaga 30 g
○ Paracetamol, 200 mg/mL, solução oral - frasco 15 mL
○ Paracetamol, 500 mg - comprimido
○ Prednisona, 5 mg - comprimido
○ Prednisona, 20 mg - comprimido
● UBSFs com farmacêutico
○ Amitriptilina, Cloridrato 25 mg - comprimido CBAF
○ Codeína 30 mg + Paracetamol 500 mg - comprimido
○ Imipramina, cloridrato 25 mg - comprimido
○ Valproato de Sódio (Ácido Valpróico), 50 mg/mL, solução oral - frasco
100 mL
○ Valproato de Sódio (Ácido Valpróico), 250 mg - cápsulas
○ Valproato de Sódio (Ácido Valpróico), 500 mg - comprimido
● Uso restrito/não fornecido
○ Cetoprofeno, 100 mg, pó liófilo para injetável, endovenoso - frasco-
ampola - apenas em caixa de emergência em UBSF
○ Dipirona sódica, 500 mg/mL, solução injetável - ampola 2 mL
○ Hidrocortisona - apenas em caixa de emergência em UBSF
○ Succinato Sódico, 100 mg, pó liófilo p/ injetável - frasco-ampola -
apenas em caixa de emergência em UBSF
○ Tramadol, Cloridrato 50 mg/mL, solução injetável - ampola 2 mL
● Farmácia Escola
○ Gabapentina 300 mg (por cápsula)
■ Apenas após consulta médica com neurologista, anestesista,
reumatologista, oncologista, ortopedista/traumatologista ou
outro especialista da dor, por meio do Sistema Único de Saúde
(SUS)
○ Gabapentina 400 mg (por cápsula)
■ Apenas após consulta médica com neurologista, anestesista,
reumatologista, oncologista, ortopedista/traumatologista ou
outro especialista da dor, por meio do Sistema Único de Saúde
(SUS)
○ Anticonvulsivantes (disponíveis apenas para tratamento de epilepsia
ou transtorno afetivo bipolar, e apenas após consulta com neurologista
ou psiquiatra).
■ Clobazam (1) 10 mg (comprimido);
■ Etossuximida (2) 50 mg/ml (solução oral frasco 120 ml);;
 ■ Lamotrigina (4) 25 e 100 mg (comprimido);
■ Levetiracetam 250 mg e 750 mg (comprimido) e 100 mg/ml
(frasco 100 ml);
■ Primidona 100 mg (comprimido);
■ Topiramato (4) 25, 50 e 100 mg (comprimido);
■ Vigabatrina (5) 500 mg (comprimido).
○ Naproxeno 500 mg (por comprimido) - apenas para artrite psoriática,
artrite reumatoide, espondilite anquilosante e artrite idiopatica juvenil -
somente após consulta e prescrição de reumatologista
○ Metadona, 5 mg - comprimido
○ Morfina, Sulfato, 10 mg/mL, solução oral - frasco 60 mL

REFERÊNCIA MEDICAMENTOS DOR CRÔNICA

https://www.joinville.sc.gov.br/servicos/obter-medicamento-para-dor-cronica/

Bicket, Mark C.; Mao, Jianren (2015). Chronic Pain in Older Adults. Anesthesiology
Clinics, (), S1932227515000592–. doi:10.1016/j.anclin.2015.05.011
● the prevalence of chronic pain increases in an age-related manner up to at
least the seventh decade but seems to plateau among age groups older than
65 when adjusting for other comorbidities and characteristics
● Bothersome pains in older persons disproportionately affect women more
than men, and more than 50% of community-dwelling older persons report
such pain on a regular basis
● A large meta-analysis suggests that among older adults the pain threshold
increases and pain tolerance decreases.
● Stresses placed on older adults expand beyond organ-based diseases and
into relationship and population-based transitions common to aging
● The best indicator of pain in older adults remains a person’s self-reported pain
level, and several assessment tools for pain intensity are both useful and valid
in this population
● Mild to moderate cognitive impairment, common to conditions such as
dementia, does not impair the appropriate use of these tools in most
situations
● The management of chronic pain in the older adult is best accomplished
through a multimodal approach that builds on stepwise interventions,
including pharmacologic and nonpharmacologic treatments, physical
rehabilitation, and a strong patient physician relationship
● Some evidence suggests that older adults have historically experienced an
age-related bias limiting referral for pain treatment
 ● Pharmacologic approaches represent one treatment modality that should
complement nonpharmacologic approaches to help achieve specific patient
goals such as improved quality of life or greater functional status
● Older adults are not immune from harmful modern trends in pharmacologic
management, as evidenced by the opioid overdose epidemic with a 4-fold
increase in opioid drug-poisoning deaths in those aged 65 years and older in
the 10-year period leading up to 2010
●

Makris UE, Abrams RC, Gurland B, Reid MC. Management of persistent pain in
the older patient: a clinical review. JAMA. 2014;312(8):825-836.
doi:10.1001/jama.2014.9405

● Search of MEDLINE and the Cochrane database from January

1990 through May 2014, using the search terms older adults,
senior, ages 65 and above, elderly, and aged along with non-
 cancer pain, chronic pain, persistent pain, pain management,
intractable pain, and refractory pain to identify
● the majority (n = 50) focused on older adults with osteoarthritis
● This evidence base supports a stepwise approach with
acetaminophen as first-line therapy
● If treatment goals are not met, a trial of a topical nonsteroidal
anti-inflammatory drug, tramadol, or both is recommended
● Describes the number of studies, dividing them in pharmacologic
interventions and non-pharmacologic interventions (including
meta–analyses, reviews, crossover studies, etc.)
● Barriers to managing persistent pain specific to geriatric
populations include age-related physiologic changes resulting in
altered drug absorption and decreased renal excretion; sensory
and cognitive impairments; polypharmacy; and multimorbidity,
particularly involving chronic conditions such as cognitive
impairment, gait disorders, and kidney, lung, and cardiovascular
disease
● These individuals are most likely to benefit from a
multidisciplinary team
● Use medication combinations (in which each analgesic works by
a different mechanism) to enhance analgesic effectiveness
● Very important table about the efficacy of medications
(using Effect Size, rate ratioNNT and CI) as well as the level
of evidence
●

● Aside from obvious toxicity or intolerance, no single algorithm

currently exists to determine how much time physicians should
allot before determining that a given analgesic medication is
effective.
● ther core elements of the therapeutic alliance include (1) setting
realistic expectations about what can and cannot be
accomplished, taking into account such immutable factors as
patient age, etiology, and duration of the pain; (2) availability of
the physician for advice, reassurance, and support during pain
flares; (3) tenacity and commitment on the part of both
physician and patient; (4) mutual respect; and (5) a reciprocal
bond generated by both parties' having an emotional investment
in the outcomes of treatment
● The use of 2 or more analgesic medications with
complementary mechanisms of action, as opposed to higher
 doses of a single pain medication, may lead to greater relief
of pain with less toxicity

Marcum ZA, Duncan NA, Makris UE. Pharmacotherapies in Geriatric Chronic

Pain Management. Clin Geriatr Med. 2016;32(4):705-724.
doi:10.1016/j.cger.2016.06.007
● There is limited evidence in the literature to guide
pharmacologic management because older adults are often
underrepresented or excluded from clinical trials.
● The American Geriatrics Society guideline (last updated in
2009) provides recommendations on the initiation and titration
of commonly used pharmacotherapies
● Topical medications provide a unique pathway to control pain
that is localized and less likely to be absorbed systemically.
● Available topical medications include menthol, capsaicin,
lidocaine, and diclofenac
● The analgesic activity of acetaminophen (APAP) results from the
central inhibition of prostaglandin synthesis. Yet, the primary
mechanism of prostaglandin synthesis inhibition by APAP
remains unknown
● Safety of paracetamol is being questioned (reference #52)
● Two of the most serious adverse drug events associated with
NSAID use are serious GI bleeds and cardiovascular events, such
as myocardial infarction and stroke
● One approach to reducing adverse drug events associated with
NSAIDs is to avoid the use of specific agents that are known to
interact with NSAIDs (warfarin, corticosteroids, ASA) and use
preferred alternative analgesics (eg, topicals, APAP), sometimes
in combination
● For those with moderate to moderately severe OA pain, a trial of
a low-dose opioid or an opioid-like agent (eg, codeine, tramadol)
in combination with APAP is another option. The rationale for
 this approach is to combine 2 different mechanisms of analgesic
action
● Adjuvant Therapies Adjuvant pain medications are those that
are not typically used as first-line agents for pain, but may be
helpful for its management - here are only 2 non opiate adjuvant
therapies approved by the FDA for the treatment of neuropathic
pain: pregabalin and duloxetine.
● Antidepressant use may have synergistic effects in older adults
experiencing depression along with chronic pain
● Several antidepressants are efficacious in the management of
chronic neuropathic pain, including the tricyclic antidepressants,
particularly tertiary amine subtypes, such as amitriptyline,
nortriptyline, and doxepin
● Despite having the strongest evidence for neuropathy-related
pain relief, this class should be avoided in older adults if
possible owing to increased risk for adverse effects such as
anticholinergic effects and cognitive impairment
● Serotonin–norepinephrine reuptake inhibitors (duloxetine
and venlafaxine) are generally well-tolerated by older adults and
have fewer side effects compared with tricyclic antidepressants
● Anticonvulsants, initially indicated for epileptic seizures with a
variety of mechanisms of action.
● Carbamazepine has shown efficacy in the treatment of
trigeminal neuralgia; however, its use is complicated by
pharmacokinetic factors and frequent adverse effects. It’s a first-
line treatment for neuropathic pain, alongside oxcarbazepine.
● If a patient is unable to tolerate carbamazepine, it is reasonable
to consider a trial of lamotrigine, which also has shown efficacy
in trigeminal neuralgia.
● Gabapentin and pregabalin are modulators of the alpha-2-delta
subunit of the calcium channels in the CNS, accounting for
antinociceptive and antiepileptic effects.
● Gabapentin shows similar efficacy in pain reduction to
pregabalin.
 ● When compared with antidepressants such as duloxetine and
amitriptyline on the primary outcome of subjective pain, there is
no difference among treatment groups (amitriptyline,
duloxetine, pregabalin) in the reduction of pain severity in
DIABETIC PERIPHERAL NEUROPATHIC PAIN.
● In the older adult population, there was an increased risk for
falls with the use of gabapentin and pregabalin owing mainly to
the side effects of dizziness and somnolence. Of note, the 2015
AGS Beers Criteria identify both agents as potentially
inappropriate medications in older adults with a history of
falls or fractures.
● Monitor renal function as gabapentin should be dose adjusted when CrCl <60
mL/min in gabapentin.
● Muscle relaxants (including cyclobenzaprine, carisoprodol,
methocarbamol, and metaxolone) are considered as being high-
risk medications in older adults due to anticholinergic adverse
drug effects, excessive sedation, and weakness; however, they
continue to be used among older adults
● “Success” is determined largely by what the patient and provider
determine are the treatment goals. Do not just rate the number
on a scale.
● Starting 1 medication at a time is a preferred strategy to better
evaluate effect and safety.

Missing: OPIOIDS FOR CHRONIC PAIN!!!!

Lawrence RC, Helmick CG, Arnett FC, et al. Estimates of the prevalence
of arthritis and selected musculoskeletal disorders in the United
States. Arthritis Rheum. 1998.

● To provide a single source for the best available estimates of the national
prevalence of arthritis in general and of selected musculoskeletal
disorders (osteoarthritis, rheumatoid arthritis, juvenile rheumatoid
arthritis, the spondylarthropathies, systemic lupus erythematosus,
 scleroderma, polymyalgia rheumatica/giant cell arteritis, gout,
fibromyalgia, and low back pain).
● Together these conditions also are the leading cause of disability among
Americans over 65 years old (3,4).
● The National Arthritis Data Workgroup (NADW) was organized in 1986 by
the National Insti- tute of Arthritis and Musculoskelctal and Skin Diseases
(NIAMS) of thc NIH to provide a single source of national data on the
prevalence and socioeconomic impact of the rheumatic disorders
● US prevalence data for a few arthritic conditions and back pain are
available from 2 series of National Center for Health Statistics surveys:
the National Health Interview Survey (NHIS) and the National Health
Examination Survey (NHES), which evolved into the National Health and
Nutrition Examination Survey (NHANES).
● The data are self reported rather than obtained by objective physical
examination.
● The studies were made in the U/S with heterogeneous groups and
the majority of the population was predominantly white.
● There were 8273 people with self reported “arthritis”, with 1809 having
activity limitation.
● Prevalence per 1000 persons of definite rheumatoid arthritis were 18 in
Males and 49 in females.
● In summary, available data suggest that the prev- alence of definite RA
among adults in the US is approximately 10 pcr 1,000. This corresponds
to a total of approximately 2.1 million persons: 600,000 men and 1.5
million women.
● The prevalence of Juvenile Idiopathic Arthritis among adults in the US is
approximately 10 pcr 1,000. This corresponds to a total of approximately
2.1 million persons: 600,000 men and 1.5 million women.
● US overall Prevalence of Gout was 29,0 per 1.000 in persons age 65 or
older.
● Prevalence of Fibromyalgia was as high as 32,8 (in 1990) per 1000 in
persons age 65 or older.
● 5-10% of american adults will develop persistent low back symptoms.
● Because the usual natural history is one of recurrence, it is sometimes
difficult to tell when one episode ends and another begins
● Because back pain is a symptom, rather than a disease, investigators must
depend on patients’ self reports and recall to identify the condition
 ● Low back pain is frequently intermittent, and it’s hard from the surveys to
determine the incidence of prevalence of the disease.
● The lifetime prevalence of adults’ being told they had ruptured discs was
2.1% in the NHANES I1 (7)
● Among Americans age 65 and older, almost 6 million have frequent low
back pain

Improving the pharmacologic management of pain in older adults:

identifying the research gaps and methods to address them. Pain Med.
2011;12(9):1336–1357
● Up to 50% of community-dwelling older adults report
experiencing pain that interferes with normal function, and half
of all nursing home residents report experiencing pain on a daily
basis
● Older adults have the highest rates of chronic analgesic use[3,4]
● Although the panel recognized the need for similar efforts in the
area of non-pharmacologic interventions for pain, a focus on
pharmacotherapies was deemed most important at this time
given the high prevalence of analgesic medication use in later life
[3,9]and expanding evidence regarding the risks associated with
both opioid and NSAID medication use [10,11].
● While arthritis and arthritis-related diseases are the most
common causes of pain in older adults [15], other pain
producing conditions also occur commonly in this age group,
including neuropathies (e.g., diabetes, herpes zoster), vertebral
compression fractures, cancer and cancer treatments, as well as
advanced chronic illness[16–20]
● Pain is by far the most frequently cited symptom causing
activity of daily living disability in later life
● Factors Complicating the Study of Pain Management in Later

Life
○ Many investigations employ an upper age limit as an
exclusion criterion for study entry and fail to examine
 potential confounders of differential treatment effects by
age
○ Multiple sites and causes of pain
○ Older (versus younger) adults are more likely to report
pain at multiple sites [41,42]and have pain-causing
diseases and injuries associated with more than one
mechanism (e.g., nociceptive, inflammatory, neuropathic,
visceral), often requiring more than one type of pain
medication for optimal treatment.
○ Older adults are often excluded from analgesic trials on
account of co-existing morbidities.
○ Polypharmacy
■ the typical community-dwelling older adult has over
three comorbid medical problems and takes an
average of seven different medications
○ Cognitive impairment
○ Although surrogate or proxy judgments, such as that from
health care providers and family members, can effectively
recognize presence of pain, they do not accurately rate its
severity, particularly in those with severe dementia.
○ Thus, researchers are challenged to identify approaches to
measure pain outcomes for those with advancing cognitive
impairment.
○ Older adults commonly fear the negative consequences of
analgesic use, including loss of cognitive abilities and other
adverse effects, and frequently endorse a fear of addiction
○ panel members acknowledged limitations associated
with using RCTs to study analgesic medication
use[67,68].These limitations include:1) sample sizes that
are too small to detect uncommon risks; 2) follow-up
periods that are typically too short to assess an analgesic
medication’s long-term benefits and risks; 3) problems
with generalizability, because higher-risk patients are
typically excluded from trials and levels of monitoring are
far more rigorous than what is customarily done in routine
practice; 4) high rates of medication discontinuation,
which occur commonly and limit investigators’ ability to
conduct intention-to-treat analyses and long-term
analgesic trials; and finally 5) many commonly prescribed
opioids and NSAIDs have achieved generic status, making
it unlikely that their manufacturers will undertake long-
term safety or effectiveness studies since these
investigations are not currently required by the FDA.
○ Chronic widespread pain has been associated with
increased risk of falls [82], incident self-report and
performance-based disability [83,84], and progression of
disability among disabled women [85], and could serve as
meaningful outcomes in studies of analgesic effectiveness
○ For healthcare providers faced with the task of caring for
aging adults with chronic pain, generating an age-
appropriate evidence base could improve the quality of
care they deliver and reduce the significant frustration
endorsed by many clinicians when caring for patients with
chronic pain
Musculoskeletal pain and incident disability in community-
dwelling older adults. Arthritis Care Res. 2010;62:1287–93

Campbell CI, Weisner C, Leresche L, et al. Age and gender trends in

long-term opioid analgesic use for non-cancer pain. Am J Pub
Health. 2010;100(12):2541–7.

Barber JB, Gibson SJ. Treatment of chronic non-malignant pain in the elderly: safety
considerations. Drug Saf. 2009;32(6):457-74. doi: 10.2165/00002018-200932060-
00003. PMID: 19459714.

PREVALÊNCIA DOENÇAS ÁLGICAS

MUSCULOSQUELÉTICAS

Segundo dados da Pesquisa Nacional de Saú de de

2019, 34,346 pessoas de 18 anos ou mais de idade
referem problema crô nico de coluna, sendo 7411
com idade igual ou maior que 65 anos de idade, e,
destes.
Destes, 1399 pessoas possuem alto grau de
incapacitaçã o de atividades habituais.

Pessoas de 18 anos ou mais de idade referem

diagnó stico médico de artrite ou remautismo.
Destes, 4547 pessoas têm idade igual ou maior que
65 anos de idade.
Pessoas de 18 anos ou mais de idade que referem
diagnó stico médico de DORT (Distú rbio
Osteomuscular Relacionado ao Trabalho), por sexo e
situaçã o do domicílio: 3991, sendo que 381 pessoas
têm idade igual ou maior que 65 anos de idade,
sendo que 85 possuem alto grau de limitaçã o de
atividades habituais.

Citação pesquisa nacional de saúde

Alonso Monteiro Bezerra M, Hellwig N, da Rocha Castelar Pinheiro G, Souza Lopes

C. Prevalence of chronic musculoskeletal conditions and associated factors in
Brazilian adults - National Health Survey. BMC Public Health. 2018 Feb
27;18(1):287. doi: 10.1186/s12889-018-5192-4. PMID: 29482524; PMCID:
PMC5828326.
● From August 2013 to February 2014, 69,954 households were visited and
60,202 individual adults were interviewed, resulting in an 86.1% response rate
● CMCs (Chronic Musculoskeletal Conditions) were 28% more
prevalent in the South region, followed by the North (PR = 1.16;
95% CI 1.07-1.26) and Northeast (PR = 1.10; 95% CI 1.03-1.18)
● Prevalence of CMCs in Brazil can be considered high, given that
they are reported by one in five adults
● Women displayed 40% greater prevalence of CMCs than men.
● Depression and multimorbidity were strongly associated with
CMCs. This association could be explained as depression and
multiple concomitant chronic diseases exert an influence on the
psychosomatization manifesting as physical disorders
● This study could not characterize CMCs according to bodily sites
and structures, because the 2013 PNS included no such
questions.
 ● Another possible limitation was response bias regarding the
definition of chronic musculoskeletal conditions, because the
evaluation of arthritis and spinal problems in the questionnaire
was based on self-reported physician diagnoses.
● The PNS was the first major health survey conducted in Brazil so
far and its maintenance in future will be imperative to develop
and evaluate trends studies about CNCDs, and particularly CMCs

Prevalence of chronic musculoskeletal

disorders in elderly Brazilians: a
systematic review of the literature
● Vivian S Miranda,
● Vivielle BF deCarvalho,
● Luciana AC Machado

● A comprehensive literature search was performed in five electronic

databases (from inception to January 2012)
● Twenty five studies reporting on a total of 116,091 elderly Brazilians
were included. Eight studies (32%) were of high methodological
quality
● Arthritis and rheumatism (including osteoarthritis) were the most
prevalent specific musculoskeletal diagnoses (9% to 40%), followed
by herniated disc (6% to 27%).
● In the most recent Brazilian National Household Survey, around 80%
of Brazilians aged 60 years or more reported having at least one
chronic non-communicable disease, with chronic musculoskeletal
disorders being the most prevalent group of diseases (including spine
problems, osteoarthritis and rheumatoid arthritis)
● Most individuals will present with “nonspecific pain”, a condition in
which it is not possible to identify a single specific cause for the pain,
even when pain is restricted to one location (e.g. lower back
● All were to be included except for temporomandibular joint (TMJ)
disorders, rheumatoid arthritis, systemic lupus erythematosus and
osteoporosis
 ● “We followed the recommendation of the Department of Economic
and Social Affairs of the United Nations (UN), which considers as
elders those individuals with 60 years of age or older”.
● The studies generally reported prevalence estimates for arthritis and
rheumatism in general (including osteoarthritis), with prevalence
estimates ranging from 9.4% [25] to 39.6% [17].
● Four studies investigated the presence of osteoarthritis in specific
body sites (hand [10, 20] and knee
● Four studies [12, 22, 23, 25] investigated the prevalence of other
musculoskeletal diagnoses and found the following prevalence
estimates: 3.8% to 16.9% for bursitis, 6.1% to 26.9% for herniated
disc, 9.2% to 18.1% for fracture, 9.2% to 14.4% for tendinitis, 9.4% for
chondromalacia and 0.0% to 5.5% for fibromyalgia.
● According to our results, the prevalence of low back pain in elderly
Brazilians ranged from 5.1% to 65.2%
● Low back pain is currently listed as the most prevalent
musculoskeletal disorder among adults in the world
● low back pain may be the most prevalent musculoskeletal disorder
among elders, but lower limb pain is more frequently reported by
them given its greater impact on function, including gait impairments
and increased risk of falls.
● Among the specific musculoskeletal diagnoses investigated by the
studies included in this review, the broad group of arthritis and
rheumatism (including osteoarthritis) was the most prevalent,
followed by the diagnosis of herniated disc.

de David CN, Deligne LMC, da Silva RS, Malta DC, Duncan BB, Passos VMA, Cousin E.
The burden of low back pain in Brazil: estimates from the Global Burden of Disease
2017 Study. Popul Health Metr. 2020 Sep 30;18(Suppl 1):12. doi: 10.1186/s12963-
020-00205-4. PMID: 32993673; PMCID: PMC7526352.
● The five defined MSK disorders in the GBD study are low back
pain (LBP), neck pain, osteoarthritis, rheumatoid arthritis, and
gout. LBP is the most significant of these, ranking as the top
cause of years lived with disability (YLDs) in GBD 2017 MSK
disorders —especially in the high-income, high-middle-income,
and middle-income countries (as defined by the socio–
demographic index)