Neuromodulation Techniques in Chronic Refractory Coccydynia: A Narrative Review

Refractory coccydynia is a condition characterized by severe coccygeal pain and poses a challenging management dilemma for clinicians. Advancements in neuromodulation (NM) technology have provided benefits to people experiencing chronic pain that is resistant to standard treatments. This review aims to summarize the spectrum of current NM techniques employed in the treatment of refractory coccydynia along with their effectiveness. A review of studies in the scientific literature from 2012 to 2023 was conducted, revealing a limited number of case reports. Although the available evidence at this time suggests significant pain relief with the utilization of NM techniques, the limited scope and nature of the studies reviewed emphasize the need for large-scale, rigorous, high-level research in this domain in order to establish a comprehensive understanding of the role of NM and its effectiveness in the management of intractable coccydynia.

Fampridine for gait imbalance in patients with multiple sclerosis (MS): a systematic review and meta-analysis

BACKGROUND

Gait imbalance is one of the frequent complications in subjects with multiple sclerosis (MS). Fampridine (4-aminopyridine) is a potassium-channel blocker that is administered for gait imbalance in MS. Different studies showed the effects of fampridine on gait status based on various tests in subjects with MS. Some showed significant improvement after treatment, and others did not. So, we designed this systematic review, and meta-analysis to estimate the pooled effects of fampridine on gait status in patients with MS.

METHODS

The main goal is the evaluation of times of different gait test pre and post fampridine treatment. Two independent expert researchers conducted a systematic and comprehensive search in PubMed, Scopus, EMBASE, Web of Science, and Google Scholar and also gray literature, including references of the references and conference abstracts. The search was done on September 16, 2022. Before-after studies trials reporting scores of the walking tests. We extracted data regarding the total number of participants, first author, publication year, country of origin, mean age, Expanded Disability Status Scale (EDSS), and the results of walking tests.

RESULTS

The literature search revealed 1963 studies; after deleting duplicates, 1098 studies remained. Seventy-seven full texts were evaluated. Finally, 18 studies were included for meta-analysis, while most of them were not placebo-controlled trials. The most frequent country of origin was Germany, and the mean age and EDSS ranged between 44 and 56 years and 4 and 6, respectively. The studies were published between 2013 and 2019. The pooled standardized mean difference (SMD) (after-before) of the MS Walking Scale (MSWS-12) was - 1.97 (95%CI: - 1.7, - 1.03) (I2 = 93.1%, P < 0.001). The pooled SMD (after-before) of the six-minute walk test (6MWT) was 0.49 (95%CI: 0.22, - 0.76) (I2 = 0%, P = 0.7). The pooled SMD (after-before) of T Timed 25-Foot Walk (T25FW) was - 0.99(95%CI: - 1.52, - 0.47) (I2 = 97.5%, P < 0.001).

CONCLUSION

This systematic review and meta-analysis show that fampridine improves gait imbalance in patients with MS.

Long-lasting mood deterioration following transcranial direct current stimulation treatment for fibromyalgia: A case report

Key Clinical Message

While tDCS has been studied as a safe and effective tool for managing pain in fibromyalgia, there is a possibility of triggered long-lasting mood changes. TDCS may potentially negatively affect mood in specific individuals with fibromyalgia.

Abstract

Transcranial direct current stimulation (tDCS) is a noninvasive neuromodulator that showed promising results in pain reduction among individuals with fibromyalgia (FM). Despite the potential benefits, it may have some adverse events that are mainly transient. However, long-lasting effects can also occur. We presented a 31-year-old man whose symptoms and signs were consistent with fibromyalgia, and he received tDCS over C3 to reduce diffuse pain. Although, immediately after fulfilling the session, he became restless, agitated, and aggressive, and his symptoms lasted approximately 2 months later.

The effects of supervision on the outcomes of exercise training in patients with ankylosing spondylitis: A single-blind randomized controlled trial

AIM

Exercise training is crucial for managing ankylosing spondylitis. We evaluated the effects of exercise with different levels of supervision on clinical outcomes in patients with ankylosing spondylitis.

METHODS

We performed a single-blind randomized controlled trial in a university outpatient clinic. Overall, 45 (31 men) patients with ankylosing spondylitis were randomly allocated to 3 groups. The mean (SD) for age and disease duration were 39.3 (9.3) and 8.4 (7.8) years. The primary outcome was chest expansion in cm, and the secondary outcomes were the index scores of 5 standard questionnaires. For each participant, adalimumab 40 mg/0.8 mL/2 wk was injected and a 3-session exercise program per week for 1 month was prescribed. Controls received a pamphlet on the exercise program. Another group received the pamphlet and underwent a 2-hour training session. The supervised group received the pamphlet, and the 2-hour training, and completed the program by attending each exercise session in the clinic.

RESULTS

Within-group analysis showed significant improvement in chest expansion (P = 0.016) and all subjective or objective questionnaire scores (all P < 0.001) for the full-supervised group. Between-group analysis implied best outcomes for chest expansion (P = 0.046), Ankylosing Spondylitis Disease Activity Score (P < 0.001), Bath Disease Activity (P = 0.010), and Metrology (P = 0.002) Indices for ankylosing spondylitis. The group with 2-hour training experienced an improvement in some indices, and the control group did not show significant changes in the outcomes.

CONCLUSION

We recommend the prescription of a supervised training program instead of in-home exercises for patients with ankylosing spondylitis.

The effects of adding splint use to corticosteroid injection for the treatment of trigger finger: A randomized controlled trial

BACKGROUND

Trigger finger is the most common flexor tendinopathy affecting the general population. We evaluated the effects of adding a static metacarpophalangeal joint splint to corticosteroid injection for the management of trigger finger in the short term.

METHODS

We carried out a randomized controlled trial with two parallel arms in Department of Physical Medicine and Rehabilitation at a university hospital. We randomly allocated 60 participants (34 women) with trigger fingers other than the thumb to two groups (both n = 30). The mean (SD) age was 41.5 (7.6) years. All participants received a single injection of 40 mg methylprednisolone plus 0.5 ml of lidocaine at the A1 pulley. Patients in the splint group wore a full time static splint for blocking the metacarpophalangeal joint for 3 months. The primary outcome was the Numerical Pain Rating Scale and the secondary outcomes were Boston questionnaire scores for symptom severity and functional status, grip strength, and the stages of stenosing tenosynovitis. We measured the outcomes at baseline, and in 1 and 3 months post-intervention.

RESULTS

Both interventions were effective; however, the splint group showed more reductions in pain (p = 0.013) and symptom severity (p = 0.047) and a larger decrease in the stages of tenosynovitis (p = 0.004) after 3 months. There was no significant difference in decreasing functional scores between the groups (p = 0.162). The splint group had a better (but not statistically significant) restoring grip strength (p = 0.056).

CONCLUSION

Wearing of a static metacarpophalangeal joint splint for 3 months following a single injection of corticosteroid increases and stabilises the benefits of the treatment for trigger finger.

Quantitative Changes in Gait Parameters after Cycling among Multiple Sclerosis Patients withAtaxia:APilot Study

Introduction: Cerebellar ataxia is a common symptom of multiple sclerosis (MS), particularly in progressive forms, where gait and balance problems are the most debilitating symptoms.  Exercise  training  is  a  critical  component  of  rehabilitation  in managing equilibrium dysfunction, and stationary  bicycling  is  a  safe,  feasible,  and effective method to reduce the symptom. Clinical walking performance tests are typically used to assess gait in these patients. However, gait analysis technologies are more sensitive and accurate at detecting subtle and subclinical changes. The purpose of this study was to determine the changes in gait parameters in MS patients with ataxic gait after using a stationary bicycle. Materials and Methods: Ten  secondary progressive MS patients with ataxic gait and  a mean expanded disability status scale (EDSS) of four were recruited. The participants cycled on a stationary bike. Gait analysis was performed before and after 12 sessions of cycling. It included spatiotemporal and balance parameter measurements. Results: Gait analysis showed statistically significant changes in spatiotemporal parameters, including speed (P=0.02, r=-0.51), and stride length (P=0.01, r=-0.63). Of balance-related indices, the mediolateral (ML) center of pressure (COP) displacement, anterior and posterior COP overshoot, and COP velocity changes were statistically remarkable after the intervention respectively. (P=0.01, r=-0.63), (P=0.02, r=-0.51), (P=0.03, r=-0.49), (P=0.01, r=-0.54). Conclusion: Gait analysis is applicable to track changes following rehabilitation in individuals with MS. The results indicate that using a stationary bicycle can improve some spatiotemporal and COP-related parameters.

Effects of Nonconsecutive Sessions of Transcranial Direct Current Stimulation and Stationary Cycling on Walking Capacity in Individuals With Multiple Sclerosis

BACKGROUND

Exercise has been demonstrated to be safe and well-tolerated in individuals with multiple sclerosis (MS). Physical activity has been shown to enhance the therapeutic effects of transcranial direct current stimulation (tDCS). This study aimed to determine the efficacy of intermittent tDCS combined with riding a stationary bicycle to improve walking capacity in individuals with MS.

METHODS

This double-blind randomized controlled trial enrolled 50 eligible participants. Thirty-nine participants completed the study: 21 in the active group and 18 in the control group. Participants were assigned randomly to exercise on a stationary bike in conjunction with anodal tDCS or to exercise combined with a sham tDCS protocol. Walking capacity tests (2-Minute Walk Test, 5-Meter Walk Test, Timed Up and Go test), manual muscle testing, the Fatigue Severity Scale, and the Multiple Sclerosis Quality of Life-54 were used to determine outcomes.

RESULTS

In terms of observed changes in 2-Minute Walk Test and 5-Meter Walk Test values, the exercise + tDCS group achieved significantly higher posttreatment values than the exercise + sham tDCS group. After the intervention and 1 month later, the intervention group's mean Timed Up and Go test value decreased significantly (P = .002) compared with that of the control group. There was no difference in Fatigue Severity Scale score, Multiple Sclerosis Quality of Life-54 score, or manual muscle testing improvement between the 2 groups.

CONCLUSIONS

Nonconsecutive sessions of anodal tDCS combined with stationary cycling may have a greater effect on the walking capacity of individuals with MS than exercise alone.