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Ma J, Jin Y, Ni Y, Hu R, Han R, Huang D, Zhou H. Ultrasound-guided percutaneous laser cervical discectomy for intractable hiccups: A rare case report. Heliyon 2023; 9:e13830. [PMID: 36873525 PMCID: PMC9976316 DOI: 10.1016/j.heliyon.2023.e13830] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Revised: 02/06/2023] [Accepted: 02/13/2023] [Indexed: 02/19/2023] Open
Abstract
Background Intractable hiccups serve no physiological purpose, but significantly reduce the quality of life. There are a variety of medications suggested for the treatment of persistent or intractable hiccups. However, it remains a great challenge for the management of intractable hiccups. In this case report, we describe the technique of percutaneous laser cervical discectomy under the sonographic guidance in treatment of intractable hiccups. Case description A 41-year-old male, who suffered intractable hiccups over 11 years, came to our pain department in December 2020. Neither oral medication nor phrenic nerve block achieved satisfactory relief of hiccups. Magnetic resonance imaging and computed tomography scan revealed cervical disc herniation of C4/5 and C5/6. Following selective cervical nerve root block, complete but short-term control of symptoms lasted less than 48 hours. Percutaneous laser cervical discectomy was then performed under ultrasound guidance and achieved complete and enduring symptomatic relief up to 14-month follow-up. Conclusion Cervical degenerative changes may be considered as potential cause for intractable hiccups, and ultrasound-guided percutaneous laser cervical discectomy may be used to treat hiccups caused by cervical discogenic etiology.
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Affiliation(s)
- Jiahui Ma
- Department of Pain, The Third Xiangya Hospital and Institute of Pain Medicine, Central South University, Changsha, China
| | - Yangqing Jin
- Department of Pain, The Third Xiangya Hospital and Institute of Pain Medicine, Central South University, Changsha, China
| | - Yuncheng Ni
- Department of Pain, The Third Xiangya Hospital and Institute of Pain Medicine, Central South University, Changsha, China
| | - Rong Hu
- Department of Pain, The Third Xiangya Hospital and Institute of Pain Medicine, Central South University, Changsha, China
| | - Rui Han
- Department of Pain, The Third Xiangya Hospital and Institute of Pain Medicine, Central South University, Changsha, China
| | - Dong Huang
- Department of Pain, The Third Xiangya Hospital and Institute of Pain Medicine, Central South University, Changsha, China.,Hunan Key Laboratory of Brain Homeostasis, Central South University, Changsha, China
| | - Haocheng Zhou
- Department of Pain, The Third Xiangya Hospital and Institute of Pain Medicine, Central South University, Changsha, China.,Hunan Key Laboratory of Brain Homeostasis, Central South University, Changsha, China
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Chae JS, Kim WJ, Lee GY, Choi YJ. Evaluation of lung function and clinical features of interlaminar cervical epidural steroid injections: a randomized controlled trial. J Int Med Res 2022; 50:3000605221108101. [PMID: 35766053 PMCID: PMC9247383 DOI: 10.1177/03000605221108101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE Interlaminar cervical epidural steroid injections (ICESIs) are commonly used to treat axial neck pain and cervical radicular pain. However, local anesthetics can spread to and block the phrenic nerve and upper segments of the thoracic spinal cord where the sympathetic innervation of the lungs emerges. Therefore, changes in lung function may occur following ICESIs. METHODS The primary outcome measure was the pulmonary function test (PFT) result 30 minutes before and after ICESI with ropivacaine (0.1875% or 0.25%). The secondary outcome measure was the comparison of the pain scores and functional disability between the two concentrations of ropivacaine 4 weeks after the ICESIs. RESULTS Fifty patients were randomly assigned to either the R1 (0.1875% ropivacaine) or R2 (0.25% ropivacaine) group. No significant difference was observed between the pre-ICESI and 30-minute post-ICESI PFT results within each group, and no difference was observed between the two groups. After 4 weeks of treatment, both groups showed a significant decrease in pain scores and functional disability; however, no significant differences were observed between the two groups. CONCLUSIONS This study showed no significant change in lung function after ICESIs in either group and no local anesthetic concentration-based difference in the clinical efficacy of the ICESIs.
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Affiliation(s)
- Ji Seon Chae
- Department of Anesthesiology and Pain Medicine, College of Medicine, Ewha Womans University, Seoul, Republic of Korea
| | - Won-Joong Kim
- Department of Anesthesiology and Pain Medicine, College of Medicine, Ewha Womans University, Seoul, Republic of Korea
| | - Gi Year Lee
- Department of Anesthesiology and Pain Medicine, College of Medicine, Ewha Womans University, Ewha Womans University Mokdong Hospital, Seoul, Republic of Korea
| | - Yong Ju Choi
- Department of Anesthesiology and Pain Medicine, College of Medicine, Ewha Womans University, Ewha Womans University Mokdong Hospital, Seoul, Republic of Korea
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Hopster K, Watkins AR, Hurcombe SD. Comparison of cervical epidural morphine with intravenous morphine administration on antinociception in adult horses using thermal threshold testing. Vet Anaesth Analg 2022; 49:417-422. [DOI: 10.1016/j.vaa.2022.03.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Revised: 03/06/2022] [Accepted: 03/06/2022] [Indexed: 11/28/2022]
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García M, Lertxundi U, Aguirre C. Tramadol-induced hiccups: a case-noncase study in the European pharmacovigilance database. Ther Adv Drug Saf 2021; 12:20420986211021230. [PMID: 34211690 PMCID: PMC8216342 DOI: 10.1177/20420986211021230] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2020] [Accepted: 05/06/2021] [Indexed: 11/17/2022] Open
Abstract
Background Hiccups are usually benign and self-limiting, but can sometimes be persistent. If left untreated, they can provoke severe discomfort, and even death. Hiccups can be idiopathic, organic, psychogenic, and caused by drugs. Although some case reports have suggested a possible association between tramadol and hiccups, to our knowledge, no study has analyzed this possible relationship. The aim of this study was to analyze whether a disproportionate number of cases of hiccups are reported for tramadol in the EudraVigilance database. Methods A case-noncase study was conducted to assess the association between hiccups and tramadol, calculating reporting odds ratios (RORs) from 1 January 1995 to 11 September 2020. Cases were selected using the preferred term 'Hiccups'. The noncases used as controls were all other adverse drug reaction reports recorded in EudraVigilance during the same period. Exposure was defined as exposure to tramadol among cases and noncases. To reduce the risk of confounding by indication, the RORs for tramadol compared with other opioids were obtained. Additionally, we performed a confirmatory analysis in the World Health Organization pharmacovigilance database, VigiBase®. Results There were 3089 cases of hiccups in the 7,213,623 reports. Tramadol was involved in 50 cases. The ROR for tramadol exposure was 3.35 [95% confidence interval (CI) 2.53-4.43]. This association persisted when comparing tramadol with other opioids; ROR: 2.13 (95% CI 1.52-2.99). Disproportionality was also observed in VigiBase®: ROR 1.69 (95% CI 1.47-1.93). Conclusion Our study confirms, for the first time, a possible signal for a tramadol-hiccups association. Nevertheless, observational analytical studies are needed to confirm these results. Plain Language Summary Evaluation of the relationship between the tramadol and the risk of hiccupsIntroduction: Hiccups are sudden involuntary contractions of the diaphragm. This involuntary contraction causes the vocal cords to close very briefly, which produces the characteristic sound of a hiccup. Hiccups are usually benign and self-limiting, but can sometimes be persistent. If left untreated, they can provoke severe discomfort, depression, disability, and in the most extreme cases, even death. Drugs are a rare cause of hiccups.Methods: This study investigated the possible association between tramadol and hiccups (an unmentioned adverse drug reaction in the Summary of Product Characteristics) in the European pharmacovigilance database (EudraVigilance) and a confirming analysis in the World Health Organization pharmacovigilance database (VigiBase).Results: Our analysis shows that hiccups is relatively more frequently reported in association with tramadol than with other medicinal products, with EudraVigilance and VigiBase confirming this association.Conclusion: Tramadol is an opioid analgesic indicated, alone or in combination with dexketoprofen or paracetamol for pain with various causes, so healthcare professionals and patients should be aware of this possible association.
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Affiliation(s)
- Montserrat García
- Osakidetza Basque Health Service, Galdakao-Usansolo Hospital, Basque Country Pharmacovigilance Unit, Biocruces Bizkaia Health Research Institute, Barrio Labeaga 46A, Galdakao, 48960, Spain
| | - Unax Lertxundi
- Araba Mental Health Network, Araba Psychiatric Hospital, Pharmacy Service, Bioaraba Health Research Institute, Osakidetza Basque Health Service, Vitoria-Gasteiz, Araba, Spain
| | - Carmelo Aguirre
- Osakidetza Basque Health Service, Galdakao-Usansolo Hospital, Basque Country Pharmacovigilance Unit, Biocruces Bizkaia Health Research Institute, Galdakao, Spain
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Zhang Y, Jiang X, Wang Z, He M, Lv Z, Yuan Q, Qin W. Efficacy of acupuncture for persistent and intractable hiccups: A protocol for systematic review and meta-analysis of randomized controlled trials. Medicine (Baltimore) 2021; 100:e24879. [PMID: 33663115 PMCID: PMC7909209 DOI: 10.1097/md.0000000000024879] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Accepted: 02/02/2021] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND Persistent and intractable hiccups are a common clinical symptom that cause considerable physical pain to patients and severely damage their quality of lives. An increasing number of studies have demonstrated that acupuncture applied at acupoints dominated by Cuanzhu (BL2) can be used as one of the nonpharmacological therapies for controlling intractable hiccups. However, there is insufficient evidence evaluating the safety and effectiveness of those interventions. Therefore, this study is intended to conduct a systematic review and meta-analysis to provide evidence for a further study investigating alternative treatment options for persistent and intractable hiccups. METHODS AND ANALYSIS Randomized controlled trials (RCTs) of adult patients aged >18 years who meet the criteria for intractable hiccup diagnosis will be included, regardless of gender, nationality, and education level. Eight electronic databases will be searched, including 4 Chinese databases (CNKI, SinoMed, Wanfang Database, and Chinese Scientific Journal Database), 4 English databases (Web of Science, Medline, Embase, and Cochrane Library), from their date of establishment to September 2020. Two independent reviewers will evaluate the title summary for each RCT. Disagreements will be discussed with a third commentator. Data integration, heterogeneity analysis, subgroup analysis, and sensitivity analysis, will be performed using R-3.3.2 software. The RevMan 5.3 software will be used for the meta-analysis, and the "risk of bias" assessment will be conducted based on the methodological quality of the included trials recommended by the Cochrane Handbook 5.1. The quality evaluation of this study will be completed by the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE). RESULTS This study will summarize all the selected trials aimed at estimating the effectiveness, as well as safety, of applying acupuncture at acupoints dominated by Cuanzhu (BL2) to persistent and intractable hiccups. CONCLUSIONS This systematic review will provide evidence to assess the validity and safety of applying acupuncture at acupoints dominated by Cuanzhu (BL2) for persistent and intractable hiccups, which may provide clinicians with more choices in the treatment of this disease. PROSPERO REGISTRATION NUMBER CRD42020114900.
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Affiliation(s)
- Yu Zhang
- The First Affiliated Hospital of Anhui University of Chinese Medicine, Hefei
| | - Xudong Jiang
- The First Affiliated Hospital of Anhui University of Chinese Medicine, Hefei
| | - Zhijie Wang
- Shanxi Province Hospital of Traditional Chinese Medical, Taiyuan
| | - Mingming He
- The Fourth Department of Acupuncture and Moxibustion, Shaanxi Traditional Chinese Medicine Hospital, Xi’an
| | - Zimeng Lv
- The First Affiliated Hospital of Anhui University of Chinese Medicine, Hefei
| | - Qing Yuan
- Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Weixun Qin
- The Fourth Department of Acupuncture and Moxibustion, Shaanxi Traditional Chinese Medicine Hospital, Xi’an
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Kocak AO, Akbas I, Betos Kocak M, Akgol Gur ST, Cakir Z. Intradermal injection for hiccup therapy in the Emergency Department. Am J Emerg Med 2020; 38:1935-1937. [DOI: 10.1016/j.ajem.2020.03.044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2020] [Accepted: 03/21/2020] [Indexed: 10/24/2022] Open
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Reichenbach ZW, Piech GM, Malik Z. Chronic Hiccups. CURRENT TREATMENT OPTIONS IN GASTROENTEROLOGY 2020; 18:43-59. [PMID: 31974814 DOI: 10.1007/s11938-020-00273-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE OF REVIEW Nearly 4000 patients will be admitted to hospital in the US this year for hiccups. Hiccups are controlled by a complex reflex arc between peripheral receptors and the brainstem. Any disruption along this pathway may produce hiccups. Typically, hiccups resolve spontaneously but in certain pathologies symptoms may persist. Persistent hiccups may be considered a sign of underlying pathology. The most common cause involves GERD. RECENT FINDINGS Based on etiologies, studies have shown that first-line therapy should use a proton pump inhibitor (PPI) and involve appropriate gastrointestinal consultation. If symptoms persist, other etiologies such as central causes need to be explored. SUMMARY We review the pathophysiology of hiccups including multiple causes and the appropriate work up for each. We review several studies examining new treatments, both pharmacological and interventional, that may help patients. Initial therapy should still involve a PPI but several new therapies may be beneficial.
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Affiliation(s)
- Zachary Wilmer Reichenbach
- Department of Gastroenterology, Lewis Katz School of Medicine at Temple University Hospital, 3401 N. Broad St., 8th floor Parkinson Pavilion, Philadelphia, PA, 19140, USA
- Center for Substance Abuse Research (CSAR), Lewis Katz School of Medicine, Temple University, Philadelphia, PA, USA
| | - Gregory M Piech
- Department of Gastroenterology, Lewis Katz School of Medicine at Temple University Hospital, 3401 N. Broad St., 8th floor Parkinson Pavilion, Philadelphia, PA, 19140, USA
| | - Zubair Malik
- Department of Gastroenterology, Lewis Katz School of Medicine at Temple University Hospital, 3401 N. Broad St., 8th floor Parkinson Pavilion, Philadelphia, PA, 19140, USA.
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Abstract
PURPOSE OF REVIEW Singultus or hiccups (HU) is a common, usually temporary, event. Its potentially serious consequences are often overlooked. This review explores published evidence describing HU burden (clinical, economic, and quality of life [QoL] consequences) across patient populations. RECENT FINDINGS Literature review identified 81 articles (including 57 individual case reports). We extracted relevant information to better understand the burden of HU and to identify knowledge gaps for future study. HU are physiologic events that can complicate existing medical conditions and treatments regardless of duration. Relatively short episodes can have devastating consequences in patients who have pre-existing conditions. HU appear to impact physical and psychological health, diminish QoL, increase healthcare resource use, and increase costs. A better understanding of HU burden is needed.
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Abstract
PURPOSE OF REVIEW Hiccups are a common problem that crosses multiple disciplines including neurology, gastroenterology and pulmonology, and primary care. There are no formal guidelines to the treatment of intractable hiccups and treatment is based on experience and anecdotal evidence often relying on older medications. We have reviewed the relevant literature with an emphasis on the last five years or so in management of intractable hiccups. RECENT FINDINGS The production of hiccups is a complex mechanism which involves multiple neurotransmitters and anatomical structure within the central and peripheral nervous system. A number of medications and other therapy have been reported successful for intractable hiccups. Intractable hiccups can occur more often than we realize and present to multiple medical disciplines. A number of pharmacologic option have been found to be useful including dopamine-blocking medication, baclofen, and gabapentin along with anticonvulsants.
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