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Aldin Z, Diss JK, Mahmood H, Sadik T, Basra H, Ahmed M, Danawi Z, Gul A, Sayed-Noor AS. Long-term effectiveness of transforaminal anterolateral approach CT-guided cervical epidural steroid injections for cervical radiculopathy treatment. Clin Radiol 2024; 79:e775-e783. [PMID: 38369438 DOI: 10.1016/j.crad.2024.01.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Revised: 11/18/2023] [Accepted: 01/17/2024] [Indexed: 02/20/2024]
Abstract
AIM To evaluate the long-term clinical effectiveness of computed tomography (CT)-guided transforaminal cervical epidural steroid injection using an anterolateral approach for the treatment of cervical radiculopathy (CR) using well-established robust clinical scoring systems for neck pain and neck disability. Despite its widespread use, evidence to support the long-term benefit of routine cervical epidural steroid injection is currently very limited. MATERIALS AND METHODS This study included 113 patients with magnetic resonance imaging (MRI)-confirmed CR who underwent a steroid injection at a single cervical level via a unilateral transforaminal anterolateral approach. Pain was assessed quantitatively at pre-injection, 15 minutes post-injection, 1 month, 3 months, and at 1 year. Neck disability was assessed using the Oswestry Neck Disability Index (NDI) at pre-injection, 1 month, 3 months, and 1 year time points. RESULTS Eighty patients completed the study. Sixty per cent reported reduced neck pain (mean pain reduction, 55%), which was clinically significant in 45% cases. Furthermore, 66% reported an improvement in neck disability (mean improvement, 51%), which was clinically significant for 56% patients. Clinically significant good outcomes in both neck pain and neck disability were evident from as early as 1-month, and importantly, were independent both of pre-treatment CR characteristics (including severity of pre-injection neck pain or disability) and of findings on pre-injection MRI imaging. CONCLUSION Transforaminal anterolateral approach CT-guided epidural steroid injection resulted in a clinically significant long-term improvement in both neck pain and disability for half of the present cohort of patients with unilateral single-level CR. This improvement was independent of the severity of the initial symptoms and pre-injection MRI findings.
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Affiliation(s)
- Z Aldin
- Radiology Department, Princess Alexandra NHS Trust, Hamstel Road, Harlow, Essex, UK
| | - J K Diss
- Radiology Department, Princess Alexandra NHS Trust, Hamstel Road, Harlow, Essex, UK.
| | - H Mahmood
- Imaging Department, Chelsea and Westminster Hospital NHS Foundation Trust, Chelsea and Westminster Hospital, Chelsea, London, UK
| | - T Sadik
- Orthopaedic/Spinal Surgery Department, Princess Alexandra NHS Trust, Hamstel Road, Harlow, Essex, UK
| | - H Basra
- Radiology Department, Princess Alexandra NHS Trust, Hamstel Road, Harlow, Essex, UK
| | - M Ahmed
- Orthopaedic/Spinal Surgery Department, Princess Alexandra NHS Trust, Hamstel Road, Harlow, Essex, UK
| | - Z Danawi
- Department of Trauma and Orthopaedics, Southend University Hospital, Southend, Essex, UK
| | - A Gul
- Orthopaedic/Spinal Surgery Department, Princess Alexandra NHS Trust, Hamstel Road, Harlow, Essex, UK
| | - A S Sayed-Noor
- Department of Surgical and Perioperative Sciences (Orthopedics), Sundsvall and Norrland University Hospitals, Umeå University, Stockholm, Sweden; Clinical Sciences Department, College of Medicine, University of Sharjah, United Arab Emirates
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Chen Y, Yang C, Nie K, Huang J, Qu Y, Wang T. Effects of scapular treatment on chronic neck pain: a systematic review and meta-analysis of randomized controlled trials. BMC Musculoskelet Disord 2024; 25:252. [PMID: 38561733 PMCID: PMC10983729 DOI: 10.1186/s12891-024-07220-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2023] [Accepted: 01/21/2024] [Indexed: 04/04/2024] Open
Abstract
BACKGROUND Chronic neck pain (CNP) is a common public health problem that affects daily living activities and quality of life. There is biomechanical interdependence between the neck and scapula. Studies have shown that shoulder blade function might be related to chronic neck pain. We therefore evaluated the effects of scapular targeted therapy on neck pain and function in patients with CNP. METHODS Databases, including MEDLINE (via PubMed), EMBASE (via Ovid), Ovid, Web of Science, and Scopus, were systematically searched for randomized controlled trials published in English investigating treatment of the scapula for CNP before July 16, 2023. RESULTS A total of 313 participants were included from 8 RCTs. Compared with those in the control group, the intervention in the scapular treatment group exhibited greater improvement in pain intensity (standardized mean difference (SMD) = 2.55; 95% CI = 0.97 to 4.13; P = 0.002), with moderate evidence. Subgroup analysis for pain intensity revealed a significant difference between the sexes, with only the female population (SMD = 6.23, 95% CI = 4.80 to 7.65) showing better outcomes than those with both sexes (SMD = 1.07, 95% CI = 0.57 to 1.56) (p < 0.00001). However, moderate evidence demonstrated no improvement in neck disability after scapular treatment (SMD of 0.24[-0.14, 0.62] of Neck Disability Index or Northwick Park Neck Pain Questionnaire). No effect of scapular treatment was shown on the pressure pain threshold (PPT). The cervical range of motion (CROM) and electromyographic activity of neck muscles could not be conclusively evaluated due to limited support in the articles, and further study was needed. However, the patient's head forward posture appeared to be corrected after scapular treatment. CONCLUSION Scapular therapy was beneficial for relieving pain intensity in patients with CNP, especially in women. Head forward posture might also be corrected with scapular therapy. However, scapular therapy may have no effect on the PPT or neck disability. However, whether scapular therapy could improve CROM and cervical muscle activation in patients with CNPs had not been determined and needed further study.
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Affiliation(s)
- Yin Chen
- Department of Rehabilitation Medicine, West China Hospital of Sichuan University, Chengdu, 610041, Sichuan, China, #37, Guo Xue Lane
- College of Rehabilitation Medicine, West China Hospital of Sichuan University, Chengdu, 610041, Sichuan, China
- Sichuan Provincial Key Laboratory of Rehabilitation Medicine, Sichuan University, Chengdu, 610041, Sichuan, China
| | - Chunlan Yang
- Department of Rehabilitation Medicine, West China Hospital of Sichuan University, Chengdu, 610041, Sichuan, China, #37, Guo Xue Lane
- College of Rehabilitation Medicine, West China Hospital of Sichuan University, Chengdu, 610041, Sichuan, China
- Sichuan Provincial Key Laboratory of Rehabilitation Medicine, Sichuan University, Chengdu, 610041, Sichuan, China
| | - Kailu Nie
- Department of Rehabilitation Medicine, West China Hospital of Sichuan University, Chengdu, 610041, Sichuan, China, #37, Guo Xue Lane
- College of Rehabilitation Medicine, West China Hospital of Sichuan University, Chengdu, 610041, Sichuan, China
- Sichuan Provincial Key Laboratory of Rehabilitation Medicine, Sichuan University, Chengdu, 610041, Sichuan, China
| | - Jiapeng Huang
- Department of Rehabilitation Medicine, West China Hospital of Sichuan University, Chengdu, 610041, Sichuan, China, #37, Guo Xue Lane
- College of Rehabilitation Medicine, West China Hospital of Sichuan University, Chengdu, 610041, Sichuan, China
- Sichuan Provincial Key Laboratory of Rehabilitation Medicine, Sichuan University, Chengdu, 610041, Sichuan, China
| | - Yun Qu
- Department of Rehabilitation Medicine, West China Hospital of Sichuan University, Chengdu, 610041, Sichuan, China, #37, Guo Xue Lane
- College of Rehabilitation Medicine, West China Hospital of Sichuan University, Chengdu, 610041, Sichuan, China
- Sichuan Provincial Key Laboratory of Rehabilitation Medicine, Sichuan University, Chengdu, 610041, Sichuan, China
| | - Tingting Wang
- Department of Rehabilitation Medicine, West China Hospital of Sichuan University, Chengdu, 610041, Sichuan, China, #37, Guo Xue Lane.
- College of Rehabilitation Medicine, West China Hospital of Sichuan University, Chengdu, 610041, Sichuan, China.
- Sichuan Provincial Key Laboratory of Rehabilitation Medicine, Sichuan University, Chengdu, 610041, Sichuan, China.
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Blohm JE, McMahon LR, Hsu CD. Recurrent disseminated coccidioidal meningitis in two subsequent pregnancies. Taiwan J Obstet Gynecol 2024; 63:242-244. [PMID: 38485323 DOI: 10.1016/j.tjog.2024.01.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/16/2024] [Indexed: 03/19/2024] Open
Abstract
OBJECTIVE Recurrent disseminated coccidioidal meningitis in two subsequent pregnancies is rare and can pose a challenge in ensuring the health of both mother and baby. In this unique case we highlight this rare occurrence and subsequent treatment. CASE REPORT A 29-year-old G4P1021 with a history of disseminated coccidioidomycosis in a previous pregnancy presented at 8 weeks gestation with nausea, headache, and neck pain. Cerebrospinal fluid analysis was positive for recurrent coccidioidal infection. She was started on Amphotericin and discharged. She re-presented at 30 week's gestation with phonophobia and photophobia, emesis, neck pain and swelling. MRI showed evidence of ventriculomegaly with communicating hydrocephalus. She was treated with therapeutic lumbar punctures throughout her pregnancy and a ventriculoperitoneal shunt following delivery. She had a spontaneous vaginal delivery at 38 weeks and 3 days with no complications. CONCLUSION This unique case highlights the susceptibility of recurrent disseminated coccidioidomycosis in subsequent pregnancies and treatment thereof.
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Affiliation(s)
- Jonathan E Blohm
- University of Arizona College of Medicine-Tucson, University of Arizona, Banner-University Medical Center, Tucson, AZ, United States
| | - Lee R McMahon
- University of Arizona College of Medicine-Tucson, University of Arizona, Banner-University Medical Center, Tucson, AZ, United States
| | - Chaur-Dong Hsu
- University of Arizona College of Medicine-Tucson, University of Arizona, Banner-University Medical Center, Tucson, AZ, United States; Department of Obstetrics and Gynecology, University of Arizona, Banner-University Medical Center, Tucson, AZ, United States.
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Cohen SP, Larkin TM, Weitzner AS, Dolomisiewicz E, Wang EJ, Hsu A, Anderson-White M, Smith MS, Zhao Z. Multicenter, Randomized, Placebo-controlled Crossover Trial Evaluating Topical Lidocaine for Mechanical Cervical Pain. Anesthesiology 2024; 140:513-523. [PMID: 38079112 DOI: 10.1097/aln.0000000000004857] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/15/2024]
Abstract
BACKGROUND There are few efficacious treatments for mechanical neck pain, with controlled trials suggesting efficacy for muscle relaxants and topical nonsteroidal anti-inflammatory drugs. Although studies evaluating topical lidocaine for back pain have been disappointing, the more superficial location of the cervical musculature suggests a possible role for topical local anesthetics. METHODS This study was a randomized, double-blind, placebo-controlled crossover trial performed at four U.S. military, Veterans Administration, academic, and private practice sites, in which 76 patients were randomized to receive either placebo followed by lidocaine patch for 4-week intervals (group 1) or a lidocaine-then-placebo patch sequence. The primary outcome measure was mean reduction in average neck pain, with a positive categorical outcome designated as a reduction of at least 2 points in average neck pain coupled with at least a 5-point score of 7 points on the Patient Global Impression of Change scale at the 4-week endpoint. RESULTS For the primary outcome, the median reduction in average neck pain score was -1.0 (interquartile range, -2.0, 0.0) for the lidocaine phase versus -0.5 (interquartile range, -2.0, 0.0) for placebo treatment (P = 0.17). During lidocaine treatment, 27.7% of patients experienced a positive outcome versus 14.9% during the placebo phase (P = 0.073). There were no significant differences between treatments for secondary outcomes, although a carryover effect on pain pressure threshold was observed for the lidocaine phase (P = 0.015). A total of 27.5% of patients in the lidocaine group and 20.5% in the placebo group experienced minor reactions, the most common of which was pruritis (P = 0.36). CONCLUSIONS The differences favoring lidocaine were small and nonsignificant, but the trend toward superiority of lidocaine suggests more aggressive phenotyping and applying formulations with greater penetrance may provide clinically meaningful benefit. EDITOR’S PERSPECTIVE
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Affiliation(s)
- Steven P Cohen
- Department of Anesthesiology, Pain Medicine Division and Departments of Physical Medicine and Rehabilitation, Neurology, Psychiatry and Neurosurgery, Northwestern Feinberg School of Medicine, Chicago, Illinois; Departments of Anesthesiology and Physical Medicine and Rehabilitation, Walter Reed National Military Medical Center, Uniformed Services University of the Health Sciences, Bethesda, Maryland
| | - Thomas M Larkin
- Pain Management Institute, Bethesda, Maryland, and Washington, D.C
| | | | - Edward Dolomisiewicz
- Department of Physical Medicine and Rehabilitation, Walter Reed National Military Medical Center, Uniformed Services University of the Health Sciences, Bethesda, Maryland
| | - Eric J Wang
- Department of Anesthesiology and Critical Care Medicine, Pain Medicine Division, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Annie Hsu
- Department of Anesthesiology and Critical Care Medicine, Pain Medicine Division, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Mirinda Anderson-White
- Department of Anesthesiology and Critical Care Medicine, Pain Medicine Division, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Marin S Smith
- Department of Physical Medicine and Rehabilitation, Walter Reed National Military Medical Center, Uniformed Services University of the Health Sciences, Bethesda, Maryland; Geneva Foundation, Bethesda, Maryland
| | - Zirong Zhao
- Departments of Neurology and Internal Medicine, District of Columbia Veterans Affairs Medical Center, Washington, D.C
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Yildiz G, Perdecioglu GRG, Akkaya OT, Can E, Yuruk D. Comparison of Selective Nerve Root Pulsed Radiofrequency Vs Paramedian Interlaminar Epidural Steroid Injection for the Treatment of Painful Cervical Radiculopathy. Pain Physician 2024; 27:E221-E229. [PMID: 38324787] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/09/2024]
Abstract
BACKGROUND Although there are studies evaluating ultrasound-guided selective nerve root pulsed radiofrequency (ULSD-SNRPRF) and fluoroscopy-guided paramedian cervical interlaminar epidural steroid injection (FL-CIESI) for the treatment of chronic cervical radicular pain, no study has compared the efficacy of these 2 methods. OBJECTIVES This study aimed to compare the efficacy of these 2 methods, their superiority to each other, and the incidence of adverse events. STUDY DESIGN A prospective, randomized controlled trial. SETTING Outpatient department of a single-center pain clinic. METHODS Sixty patients who did not respond to conservative treatments for lower cervical radicular pain were randomly divided into 2 groups. One group underwent ULSD-SNRPRF (Group U), and the other underwent paramedian FL-CIESI (Group F). Patients were evaluated pretreatment, and 3 and 6 months posttreatment. The Numeric Rating Scale (NRS-11) was used to assess clinical improvement, The Neck Disability Index (NDI) to assess improvement in functional disability, and the Self-Leeds Assessment of Neuropathic Symptoms and Signs Pain Score (S-LANSS) to assess the treatment's effect on neuropathic pain. Clinically significant pain relief was defined as a 50% or more pain reduction in the NRS-11. The posttreatment reduction in medication consumption was assessed using the Medication Quantification Scale Version III (MQS III). We also evaluated whether there was a difference in treatment-related characteristics, such as procedure time and adverse events. RESULTS The procedure time was significantly longer in Group U. Blood aspiration was observed in 2 patients in Group U and vascular spread in one patient in Group F, with no significant difference. At 3 and 6 months posttreatment, NRS-11 and NDI scores showed a significant decrease compared to the pretreatment scores in both groups; there was no difference between the groups. Both treatments effectively improved neuropathic pain, with no significant difference between the S-LANSS scores. There was no difference in the reduction of medication consumption between the groups. LIMITATIONS There was no sham or control group, and the follow-up period was limited to 6 months. CONCLUSIONS Pain relief, functional improvement, and safety were similar between groups. ULSD-SNRPRF and paramedian FL-CIESI are 2 different effective techniques for chronic cervical radicular pain. The choice of method should depend on various factors, such as patient preference, operator experience, and availability of resources. An advantage of ULSD over fluoroscopy is that patients and physicians are not exposed to radiation.
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Affiliation(s)
- Gokhan Yildiz
- Ankara Etlik City Hospital, Department of Algology, Ankara, Turkey
| | | | | | - Ezgi Can
- Ankara Etlik City Hospital, Department of Algology, Ankara, Turkey
| | - Damla Yuruk
- Ankara Etlik City Hospital, Department of Algology, Ankara, Turkey
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Latini E, Nusca SM, Curci ER, Boaretto D, Santoboni F, Trischitta D, Vetrano M, Vulpiani MC. Intramuscular paravertebral oxygen-ozone therapy for chronic neck pain and low back pain: evaluation of 6-month clinical outcomes. Med Gas Res 2024; 14:6-11. [PMID: 37721249 DOI: 10.4103/2045-9912.374388] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/19/2023] Open
Abstract
Spinal pain is recognized as the most common cause of disability, work absenteeism and need of healthcare services worldwide. Although many strategies have been developed for conservative treatment of spinal pain, its increasing prevalence diagnosis highlights the need for new treatments. Oxygen-ozone (O2-O3) therapy is considered to be an alternative therapy due to its analgesic and anti-inflammatory effects. This retrospective study evaluated the effects of O2-O3 intramuscular paravertebral injections in 76 patients with chronic neck pain or low back pain, in terms of pain and disability reduction, quality of life improvement, and analgesic drug intake. Patients were evaluated before, at the end of the treatment, and at 1, 3 and 6 months after the last treatment, using Numeric Rating Scale, Neck Disability Index or Oswestry Disability Index, and Short Form-12 Health Survey. There were significant beneficial effects of O2-O3 therapy in reducing pain and disability reduction and improving quality of life during the 6-month follow-up period. O2-O3 therapy was associated with a reduction in analgesic drug intake at each assessment. Our results allow us not only to support treatment with O2-O3 intramuscular paravertebral injections as a safe and beneficial treatment for chronic low back pain, but also to consider it as a valuable conservative therapy for patients with chronic neck pain.
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Affiliation(s)
- Eleonora Latini
- Unit of Physical Medicine and Rehabilitation, Sant'Andrea Hospital, "Sapienza" University of Rome, Rome, Italy
| | - Sveva Maria Nusca
- Unit of Physical Medicine and Rehabilitation, Sant'Andrea Hospital, "Sapienza" University of Rome, Rome, Italy
| | - Enrico Roberto Curci
- Unit of Physical Medicine and Rehabilitation, Sant'Andrea Hospital, "Sapienza" University of Rome, Rome, Italy
| | - Davide Boaretto
- Unit of Physical Medicine and Rehabilitation, Sant'Andrea Hospital, "Sapienza" University of Rome, Rome, Italy
| | - Flavia Santoboni
- Unit of Physical Medicine and Rehabilitation, Sant'Andrea Hospital, "Sapienza" University of Rome, Rome, Italy
| | - Donatella Trischitta
- Unit of Physical Medicine and Rehabilitation, Sant'Andrea Hospital, "Sapienza" University of Rome, Rome, Italy
| | - Mario Vetrano
- Unit of Physical Medicine and Rehabilitation, Sant'Andrea Hospital, "Sapienza" University of Rome, Rome, Italy
| | - Maria Chiara Vulpiani
- Unit of Physical Medicine and Rehabilitation, Sant'Andrea Hospital, "Sapienza" University of Rome, Rome, Italy
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Casillas-Berumen SS, Kasanga S, Salik A, Briski N, Alreqi MDA, Ali A, Kashan A, Garsondiya B. Does That Go There? A Rare Occurrence of Spontaneous Sternocleidomastoid Abscess without Trauma in a Diabetic Individual. Am J Case Rep 2023; 24:e942265. [PMID: 38113193 PMCID: PMC10750220 DOI: 10.12659/ajcr.942265] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Revised: 11/17/2023] [Accepted: 11/03/2023] [Indexed: 12/21/2023]
Abstract
BACKGROUND Spontaneous abscesses are generally typical in patients with significant risk factors and have been linked to numerous muscle groups. The sternocleidomastoid muscle, however, piqued our interest as an unusual location, especially in this patient who, other than diabetes mellitus, had no associated risk factors or signs of trauma. CASE REPORT A 61-year-old man appeared with neck pain, erythema, and swelling that had been present for 9 days and for which he had previously been examined in the Emergency Department. He was discharged on oral doxycycline after initial computed tomography (CT) of the neck revealed infiltration without collection. He returned with worsening symptoms and new-onset fever and chills. Vital signs were normal on assessment, with no evidence of trauma. Swelling was observed near the right sternocleidomastoid muscle insertion. A repeat CT scan of the neck revealed an abscess 2.5 cm in diameter. He was originally treated with empiric antibiotics before being moved to targeted medications. Incision and drainage were completed without complication. The patient was given a 6-week course of oral antibiotics. CONCLUSIONS Spontaneous intramuscular abscesses are uncommon in people who have had no previous trauma or other known risk factors, but could be encountered in diabetic patients with non-optimal blood glucose levels, due to bacteremia. As a result, these cases require a high level of suspicion to be recognized and treated early. The scarcity of literature on this illness makes determining the cause challenging. However, by highlighting this case, we intend to raise awareness and facilitate early diagnosis and treatment.
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Barry HC. Opioids Are Equal to Placebo in Adults With Acute Nonspecific Low Back or Neck Pain. Am Fam Physician 2023; 108:Online. [PMID: 38215430] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2024]
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Suri P, Elgaeva EE, Williams FMK, Freidin MB, Verzun DA, Tsepilov YA. Repurposing Antihypertensive and Statin Medications for Spinal Pain: A Mendelian Randomization Study. Spine (Phila Pa 1976) 2023; 48:1568-1574. [PMID: 37539717 DOI: 10.1097/brs.0000000000004790] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2023] [Accepted: 07/24/2023] [Indexed: 08/05/2023]
Abstract
STUDY DESIGN Mendelian randomization (MR) study. OBJECTIVE To examine whether antihypertensive medications (beta-blockers, calcium channel blockers, and angiotensin-converting enzyme inhibitors) and statins can be repurposed to prevent or treat spinal pain (back or neck pain). SUMMARY OF BACKGROUND DATA Observational studies and a recent MR study have found associations between elevated blood pressure and a greater risk of back pain. Observational studies have found associations between hyperlipidemia and statin use and greater risk of back pain. No prior MR studies have examined the effects of antihypertensives or statins on spinal pain. MATERIALS AND METHODS This was a two-sample MR study using publicly available summary statistics from large-scale genome-wide association studies (GWAS). Sample sizes in exposure GWASs were n=757,601 (systolic blood pressure) and n=173,082 (low-density lipoprotein cholesterol), and n=1,028,947 for the outcome GWAS of spinal pain defined as health care seeking for any spinal pain-related diagnosis. Genes and cis-acting variants were identified as proxies for the drug targets of interest. MR analyses used inverse-variance weighted meta-analysis. The threshold for statistical significance after correction for multiple testing was P <0.0125. RESULTS No statistically significant associations of these medications with spinal pain were found. However, findings were suggestive of a protective effect of beta-blockers on spinal pain risk (odds ratio [OR] 0.84, 95% confidence interval [CI] 0.72-0.98; P =0.03), and calcium channel blockers on greater spinal pain risk (OR 1.12, 95% CI 1.02-1.24; P =0.02). CONCLUSIONS A protective effect of beta-blockers on spinal pain was suggested in the current study, consistent with findings from observational studies of various other pain phenotypes. The detrimental effect of calcium channel blockers on spinal pain suggested in the current study must be interpreted in the context of conflicting directions of effect on nonspinal pain phenotypes in other observational studies.This Mendelian randomization study examined whether antihypertensive medications (beta-blockers, calcium channel blockers, and angiotensin-converting enzyme inhibitors) and statins can be repurposed to prevent or treat spinal.This was a two-sample MR study using publicly available summary statistics from large-scale genome-wide association studies ranging size from 173,082 to 1,028,947 adults.While no statistically significant associations were found, a protective effect of beta-blockers on spinal pain was suggested (odds ratio [OR] 0.84, 95% confidence interval [CI] 0.72 to 0.98; p= 0.03), as was a detrimental effect of calcium channel blockers on spinal pain (OR 1.12, 95% CI 1.02 to 1.24; p= 0.02).
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Affiliation(s)
- Pradeep Suri
- Division of Rehabilitation Care Services, VA Puget Sound Health Care System, Seattle, WA
- Seattle Epidemiologic Research and Information Center, VA Puget Sound Health Care System, Seattle, WA
- Clinical Learning, Evidence, and Research (CLEAR) Center, University of Washington, Seattle, WA
- Department of Rehabilitation Medicine, University of Washington, Seattle, WA
| | - Elizaveta E Elgaeva
- Department of Natural Sciences, Novosibirsk State University, Novosibirsk, Russia
- Laboratory of Recombination and Segregation Analysis, Institute of Cytology and Genetics, Novosibirsk, Russia
| | - Frances M K Williams
- Department of Twin Research and Genetic Epidemiology, School of Life Course Sciences, King's College London, London, UK
| | - Maxim B Freidin
- Department of Biology, School of Biological and Behavioural Sciences, Queen Mary University of London, UK
| | - Dmitrii A Verzun
- Department of Natural Sciences, Novosibirsk State University, Novosibirsk, Russia
- Laboratory of Recombination and Segregation Analysis, Institute of Cytology and Genetics, Novosibirsk, Russia
| | - Yakov A Tsepilov
- Laboratory of Recombination and Segregation Analysis, Institute of Cytology and Genetics, Novosibirsk, Russia
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Deniz R, Güzelbey T, Özgür DS, Karaalioğlu B, Akkuzu G, Yıldırım F, Bes C. Isolated inferior thyroidal artery vasculitis: A rare cause of neck pain. Int J Rheum Dis 2023; 26:2294-2296. [PMID: 37191117 DOI: 10.1111/1756-185x.14733] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Accepted: 05/05/2023] [Indexed: 05/17/2023]
Abstract
Vasculitis is the inflammatory changes in vessels of any size that usually have a systemic involvement with a quite variable clinical presentation affecting various organs. Although systemic presentation is more common, in some cases localized inflammation of vasculature of a single organ or limited branches of aorta are reported. Here we present, an isolated vasculitis of bilateral inferior thyroidal arteries in a female patient aged 49 years, who presented with neck pain and was diagnosed with ultrasonography and computed tomographic angiography. The clinical and imaging findings were managed successfully with glucocorticoid induction and addition of methotrexate to the treatment. Localized forms of vasculitis are rarer and the limited size of the affected area makes diagnostic investigations and management more complicated. Non-invasive imaging modalities rather than conventional angiography provide useful information in a safer and easier way. Isolated vasculitis of thyroidal arteries is an extremely uncommon site and should be excluded in case of unexplained neck pain, even in the presence of normal laboratory examinations, probably because of the size of the involved vessels.
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Affiliation(s)
- Rabia Deniz
- Department of Rheumatology, University of Health Sciences Başakşehir Çam and Sakura City Hospital, Istanbul, Turkey
| | - Tevfik Güzelbey
- Department of Radiology, University of Health Sciences Başakşehir Çam and Sakura City Hospital, Istanbul, Turkey
| | - Duygu Sevinç Özgür
- Department of Rheumatology, University of Health Sciences Başakşehir Çam and Sakura City Hospital, Istanbul, Turkey
| | - Bilgin Karaalioğlu
- Department of Rheumatology, University of Health Sciences Başakşehir Çam and Sakura City Hospital, Istanbul, Turkey
| | - Gamze Akkuzu
- Department of Rheumatology, University of Health Sciences Başakşehir Çam and Sakura City Hospital, Istanbul, Turkey
| | - Fatih Yıldırım
- Department of Rheumatology, University of Health Sciences Başakşehir Çam and Sakura City Hospital, Istanbul, Turkey
| | - Cemal Bes
- Department of Rheumatology, University of Health Sciences Başakşehir Çam and Sakura City Hospital, Istanbul, Turkey
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Vinyes D, Traverso PH, Murillo JH, Sánchez-Padilla M, Muñoz-Sellart M. Improvement in post-orthodontic chronic musculoskeletal pain after local anesthetic injections in the trigeminal area: a case series. J Int Med Res 2023; 51:3000605231214064. [PMID: 38017361 PMCID: PMC10686034 DOI: 10.1177/03000605231214064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Accepted: 10/23/2023] [Indexed: 11/30/2023] Open
Abstract
Orthodontic treatment has been associated with chronic extraoral pain that is often resistant to common treatments such as drugs or physiotherapy, adversely affecting patients' quality of life. In this case series, we discuss the potential impact of orthodontics on chronic cervical spine pain or gonalgia and explore the long-term effect of local anesthetic injections as a possible therapeutic intervention. Six orthodontic patients with chronic cervical spine pain or gonalgia that substantially affected their quality of life were treated with injections of 0.5% procaine into individual lesions and at palpable points of tissue tension in the oral mucosa and extraoral myofascial areas. All patients in this case series reported significant improvement in their chronic pain, with no residual pain recorded at the 6-month follow-up. Injecting local anesthetic at stress points in the oral mucosal and extraoral myofascial regions may be an effective treatment for post-orthodontic neck and knee pain. Further research is required to better understand the potential benefits of this intervention for patients experiencing orthodontic-related musculoskeletal pain.
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Affiliation(s)
- David Vinyes
- Institute of Neural Therapy and Regulatory Medicine, Sabadell, Barcelona, Spain
- Master’s Degree in Continuing Education in Medical and Dental Neural Therapy, University of Barcelona, Barcelona, Spain
- Neural Therapy Research Foundation, Sabadell, Barcelona, Spain
| | - Paula Hermosilla Traverso
- Master’s Degree in Continuing Education in Medical and Dental Neural Therapy, University of Barcelona, Barcelona, Spain
- La Granja Family Health Center (CESFAM), La Granja Municipality, Santiago, Chile
| | - Julia Hartley Murillo
- Master’s Degree in Continuing Education in Medical and Dental Neural Therapy, University of Barcelona, Barcelona, Spain
| | - Maider Sánchez-Padilla
- Gimbernat University School, Universitat Autònoma de Barcelona, Sant Cugat del Vallès, Barcelona, Spain
| | - Montserrat Muñoz-Sellart
- Institute of Neural Therapy and Regulatory Medicine, Sabadell, Barcelona, Spain
- Master’s Degree in Continuing Education in Medical and Dental Neural Therapy, University of Barcelona, Barcelona, Spain
- Neural Therapy Research Foundation, Sabadell, Barcelona, Spain
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12
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Langford A. Critically appraised paper: In patients with acute low back or neck pain, a judicious short course of opioids did not reduce pain compared with placebo [commentary]. J Physiother 2023; 69:272. [PMID: 37673723 DOI: 10.1016/j.jphys.2023.08.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Accepted: 08/01/2023] [Indexed: 09/08/2023] Open
Affiliation(s)
- Aili Langford
- Centre for Medicine Use and Safety, Monash University, Melbourne, Australia
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Jones CMP, Day RO, Koes BW, Latimer J, Maher CG, McLachlan AJ, Billot L, Shan S, Lin CWC. Opioid analgesia for acute low back pain and neck pain (the OPAL trial): a randomised placebo-controlled trial. Lancet 2023; 402:304-312. [PMID: 37392748 DOI: 10.1016/s0140-6736(23)00404-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2022] [Revised: 02/13/2023] [Accepted: 02/16/2023] [Indexed: 07/03/2023]
Abstract
BACKGROUND Opioid analgesics are commonly used for acute low back pain and neck pain, but supporting efficacy data are scarce. We aimed to investigate the efficacy and safety of a judicious short course of an opioid analgesic for acute low back pain and neck pain. METHODS OPAL was a triple-blinded, placebo-controlled randomised trial that recruited adults (aged ≥18 years) presenting to one of 157 primary care or emergency department sites in Sydney, NSW, Australia, with 12 weeks or less of low back or neck pain (or both) of at least moderate pain severity. Participants were randomly assigned (1:1) using statistician-generated randomly permuted blocks to guideline-recommended care plus an opioid (oxycodone-naloxone, up to 20 mg oxycodone per day orally) or guideline-recommended care and an identical placebo, for up to 6 weeks. The primary outcome was pain severity at 6 weeks measured with the pain severity subscale of the Brief Pain Inventory (10-point scale), analysed in all eligible participants who provided at least one post-randomisation pain score, by use of a repeated measures linear mixed model. Safety was analysed in all randomly assigned eligible participants. The trial was registered with the Australian New Zealand Clinical Trials Registry (ACTRN12615000775516). FINDINGS Between Feb 29, 2016, and March 10, 2022, 347 participants were recruited (174 to the opioid group and 173 to the placebo group). 170 (49%) of 346 participants were female and 176 (51%) were male. 33 (19%) of 174 participants in the opioid group and 25 (15%) of 172 in the placebo group had discontinued from the trial by week 6, due to loss to follow-up and participant withdrawals. 151 participants in the opioid group and 159 in the placebo group were included in the primary analysis. Mean pain score at 6 weeks was 2·78 (SE 0·20) in the opioid group versus 2·25 (0·19) in the placebo group (adjusted mean difference 0·53, 95% CI -0·00 to 1·07, p=0·051). 61 (35%) of 174 participants in the opioid group reported at least one adverse event versus 51 (30%) of 172 in the placebo group (p=0·30), but more people in the opioid group reported opioid-related adverse events (eg, 13 [7·5%] of 174 participants in the opioid group reported constipation vs six [3·5%] of 173 in the placebo group). INTERPRETATION Opioids should not be recommended for acute non-specific low back pain or neck pain given that we found no significant difference in pain severity compared with placebo. This finding calls for a change in the frequent use of opioids for these conditions. FUNDING National Health and Medical Research Council, University of Sydney Faculty of Medicine and Health, and SafeWork SA.
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Affiliation(s)
- Caitlin M P Jones
- Sydney Musculoskeletal Health, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia; The Institute for Musculoskeletal Health, Sydney Local Health District, Sydney, NSW, Australia
| | - Richard O Day
- Department of Clinical Pharmacology and Toxicology, St Vincent's Hospital Sydney and St Vincent's Clinical Campus, Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia
| | - Bart W Koes
- Department of General Practice, Erasmus MC, Rotterdam, Netherlands; Center for Muscle and Joint Health, University of Southern Denmark, Odense, Denmark
| | - Jane Latimer
- Sydney Musculoskeletal Health, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia; The Institute for Musculoskeletal Health, Sydney Local Health District, Sydney, NSW, Australia
| | - Chris G Maher
- Sydney Musculoskeletal Health, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia; The Institute for Musculoskeletal Health, Sydney Local Health District, Sydney, NSW, Australia
| | - Andrew J McLachlan
- Sydney Pharmacy School, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
| | - Laurent Billot
- The George Institute for Global Health, Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia
| | - Sana Shan
- The George Institute for Global Health, Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia
| | - Chung-Wei Christine Lin
- Sydney Musculoskeletal Health, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia; The Institute for Musculoskeletal Health, Sydney Local Health District, Sydney, NSW, Australia.
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14
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Bussieres MP, Jull P. A case of suspected canine multifocal cervical venous sinus thrombosis causing cervical myelopathy. Can Vet J 2023; 64:534-540. [PMID: 37265814 PMCID: PMC10204878] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
A 10-year-old spayed female standard poodle was admitted for marked cervical pain. Magnetic resonance imaging (MRI) suggested cervical venous sinus thrombi. An excellent clinical response to clopidogrel and warfarin combination was achieved. Repeat MRI showed partial resolution of the thrombosis. The etiology of the thrombosis is suspected to be due to the previous long-term, chronic use of corticosteroids. To the authors' knowledge, this is the first case report with follow-up imaging of canine venous sinus thrombosis. This clinical case report may help practitioners recognize this condition as a possible differential diagnosis for cervical pain, and it provides important guidelines in the prognosis. This case report highlights the use of anticoagulant therapy for 14 wk leading to complete resolution of clinical signs and to partial resolution of the thrombus 5 wk into the treatment, based on comparative MRI. Key clinical message: To the authors' knowledge, this is the first report of suspected multiple cervical venous sinus thrombi that includes comparative imaging into the course of therapy. The aim of this report is to provide additional information for future guidance on the duration of venous sinus thrombosis therapy.
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Affiliation(s)
- Marie-Philippe Bussieres
- Veterinary Specialty Clinic for Anesthesia and Neurology, 1155 Lola Street, #203, Ottawa, Ontario K1K 4C1
| | - Philip Jull
- Veterinary Specialty Clinic for Anesthesia and Neurology, 1155 Lola Street, #203, Ottawa, Ontario K1K 4C1
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15
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Sung SH, Lee HJ, Han JE, Sung ADM, Park M, Shin S, Jeong HI, Jang S, Lee G. Bee Venom Acupuncture for Neck Pain: A Review of the Korean Literature. Toxins (Basel) 2023; 15:toxins15020129. [PMID: 36828443 PMCID: PMC9967438 DOI: 10.3390/toxins15020129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2022] [Revised: 01/31/2023] [Accepted: 02/01/2023] [Indexed: 02/08/2023] Open
Abstract
Bee venom is a natural toxin that is effective in treating various types of pain. The purpose of this paper was to review all the features of clinical studies conducted on bee venom acupuncture (BVA) for the treatment of neck pain in Korean publications. Six Korean databases and 16 Korean journals were searched in August 2022 for clinical studies on BVA for neck pain. We identified 24 trials that met our inclusion criteria, of which 316 patients with neck pain were treated with BVA. The most common diagnosis in the patients with neck pain was herniated intervertebral discs (HIVDs) of the cervical spine (C-spine) (29.2%), and the concentration and dosage per session were 0.05-0.5 mg/mL and 0.1-1.5 mL, respectively. The visual analog scale was most often measured for neck pain severity (62.5%), and all clinical research reported improvements in 16 outcome measures. This study shows that BVA could be recommended for the treatment of neck pain, especially HIVD of the C-spine; however, the adverse effects of BVA must be examined in future studies.
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Affiliation(s)
- Soo-Hyun Sung
- Department of Policy Development, National Institute of Korean Medicine Development, Seoul 04554, Republic of Korea
| | - Hee-Jung Lee
- Department of Policy Development, National Institute of Korean Medicine Development, Seoul 04554, Republic of Korea
| | - Ji-Eun Han
- Department of Policy Development, National Institute of Korean Medicine Development, Seoul 04554, Republic of Korea
| | - Angela Dong-Min Sung
- Department of Policy Development, National Institute of Korean Medicine Development, Seoul 04554, Republic of Korea
| | - Minjung Park
- Center for Development of Innovative Technologies in Korean Medicine, National Institute of Korean Medicine Development, Seoul 04554, Republic of Korea
| | - Seungwon Shin
- Department of Korean Medicine, Graduate School, Kyung Hee University, Seoul 02447, Republic of Korea
| | - Hye In Jeong
- Department of Preventive Medicine, College of Korean Medicine, Kyung Hee University, Seoul 02447, Republic of Korea
| | - Soobin Jang
- Department of Preventive Medicine, College of Korean Medicine, Daegu Haany University, Gyeongsan 38609, Republic of Korea
| | - Gihyun Lee
- College of Korean Medicine, Dongshin University, Naju 58245, Republic of Korea
- Correspondence:
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16
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Ozturk EC, Sacaklidir R, Sencan S, Ertan G, Gunduz OH. The Impact of Contrast Spread Patterns to Clinical Outcomes of Cervical Interlaminar Epidural Steroid Injection: An Observational Study. Turk Neurosurg 2023; 33:1099-1105. [PMID: 37846539 DOI: 10.5137/1019-5149.jtn.44074-23.3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2023]
Abstract
AIM To investigate the relationship between epidural contrast spread patterns, and the treatment success of cervical interlaminar epidural steroid injection (CIESI) for cervical radicular pain. MATERIAL AND METHODS A total of 76 patients aged between 20 and 60 years who had neck and unilateral upper limb pain due to a single-level disc herniation at C5-C6 or C6-C7 were included. Severity of pain and disability were assessed with Numerical Rating Scale (NRS-11) and Neck Pain Disability Scale (NPDS) at baseline, three weeks, and three months after the treatment. Contrast dispersion prior to injection of the medication was graded in anteroposterior fluoroscopic view. Treatment success was defined as a ≥50% improvement at three months in the NRS-11 scores compared to baseline. RESULTS A significant improvement in pain and disability scores was observed at three months compared to baseline (p < 0.001). Treatment success was observed in 57% of the patients. The multivariate binary logistic regression analysis revealed that high initial NPDS scores, severe foraminal and central stenosis, Grade 1 contrast spread pattern were negative predictors of response to CIESI. CONCLUSION Lateral contrast spread toward the dorsal root ganglion (DRG) and spinal nerve root of the target level was associated with more favorable clinical responses. Clinicians performing CIESIs should exert effort to administer the injectate around the DRG and spinal nerve root at the target level.
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Affiliation(s)
- Ekim Can Ozturk
- Istanbul Goztepe Prof. Dr. Suleyman Yalcin City Hospital, Department of Physical Medicine and Rehabilitation, Pain Medicine Section, Istanbul, Turkey
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17
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Onan D, Bentivegna E, Martelletti P. OnabotulinumtoxinA Treatment in Chronic Migraine: Investigation of Its Effects on Disability, Headache and Neck Pain Intensity. Toxins (Basel) 2022; 15:29. [PMID: 36668849 PMCID: PMC9862733 DOI: 10.3390/toxins15010029] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2022] [Revised: 12/12/2022] [Accepted: 12/28/2022] [Indexed: 01/03/2023] Open
Abstract
Neck disability and pain are frequently encountered problems in patients with chronic migraine (CM). The long-term stimuli of neurons in the trigeminocervical junction may explain this situation. OnabotulinumtoxinA (ONA) treatment is one of the proven treatments for CM; however, there is no study data on the efficacy of ONA treatment on neck disability and pain in CM patients. Therefore, we aimed to investigate the effect of ONA treatment on disability, neck pain and headache intensity in CM patients. One hundred thirty-four patients who met the inclusion criteria were included in the study. ONA treatment was administered at a dose of 195 U to 39 sites in total as per Follow-the-Pain PREEMPT protocol. The disability was evaluated with the Neck Disability Index and the Migraine Disability Assessment; pain intensity was evaluated with the Visual Analogue Scale; the monthly number of headache days were recorded; quality of life was evaluated with the Headache Impact Test. All assessments were recorded at baseline and 3 months after treatment. After the treatment, neck−migraine disabilities decreased from severe to mild for neck and moderate for migraine (p < 0.001). Neck pain and headache intensities decreased by almost half (p < 0.001). The median number of monthly headache days decreased from 20 days to 6 days (p < 0.000). The quality-of-life level decreased significantly from severe to substantial level (p < 0.001). According to our results, ONA treatment was effective in reducing neck-related problems in CM patients. Long-term follow-up results may provide researchers with more comprehensive results in terms of the treatment of chronic migraine−neck-related problems.
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Affiliation(s)
- Dilara Onan
- Spine Health Unit, Faculty of Physical Therapy and Rehabilitation, Hacettepe University, Ankara 06230, Türkiye
- Department of Clinical and Molecular Medicine, Sapienza University, 000189 Rome, Italy
| | - Enrico Bentivegna
- Department of Clinical and Molecular Medicine, Sapienza University, 000189 Rome, Italy
| | - Paolo Martelletti
- Department of Clinical and Molecular Medicine, Sapienza University, 000189 Rome, Italy
- Regional Referral Headache Centre, Sant’Andrea Hospital, 000189 Rome, Italy
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Hu Y, Su J, Cui X, Pan L, Jin L, Teng F. How to Avoid Misdiagnosing Spontaneous Cervical Spinal Epidural Hematoma as Ischemic Stroke: 3 Case Reports and Literature Review. Cerebrovasc Dis 2022; 52:597-606. [PMID: 36516738 DOI: 10.1159/000527705] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Accepted: 10/13/2022] [Indexed: 10/04/2023] Open
Abstract
When spontaneous cervical spinal epidural hematoma (SCEH) presents with hemiparesis, it can be misdiagnosed with ischemic stroke (IS), and the treatment of IS such as thrombolysis may deteriorate the symptoms of patients with SCEH, leading to worse sequelae or even death. We reported 3 SCEH patients who were initially suspected as IS in our center between Jun 2020 and April 2022 and analyzed their clinical characteristics together with 48 patients reported in the literature from Jan 1995 to April 2022. Two of the 3 SCEH patients had neck symptoms, while none of them presented cranial nerve symptoms. Cranial computed tomography (CT) scans were negative; however, abnormal signals in the cervical spinal canal were observed during cranial computed tomography angiography (CTA) and subsequent cervical CT confirmed the diagnosis of SCEH. All of them avoid mistreatment with recombinant tissue plasminogen activator (rt-PA). Subsequently, we analyzed the clinical characteristics of a total of 51 patients. Thirteen of them developed symptoms during activity. Neck pain was an important sign of SCEH because 35 patients had neck pain or neck discomfort. Sensory impairment was reported in a small proportion of patients (11/51), which varied a lot in the patients. Some special manifestations highly suggested spinal cord lesions and provided evidence for the early differential diagnosis of SCEH and stroke, but the incidence of which was quite low: ipsilateral Horner syndrome in 2 patients, Brown-Séquard syndrome in 2 cases, and Lhermitte's sign in 1 case. Only a minority (8/51) of the patients were correctly diagnosed at the emergency unit using cervical CT. Six patients were correctly diagnosed when performing CTA. A large portion of the cases (21/51) were first misdiagnosed as IS, but no responsible lesions were found on cranial magnetic resonance imaging (MRI), and subsequent cervical MRI confirmed the diagnosis. Sixteen patients were diagnosed with SCEH after the deterioration of symptoms. A total of 13 patients received rt-PA, and 10 of them had symptoms aggravation after thrombolysis. For patients with acute onset of hemiparesis but without cranial nerve symptoms, especially those accompanied by clinical features such as neck pain, ipsilateral Horner syndrome, Brown-Séquard syndrome, and Lhermitte's sign, SCEH should be highly suspected rather than stroke. Careful differential diagnosis should be performed with a comprehensive medical history and thorough physical examination. Cervical CT scan is a reasonable choice for quick differential diagnosis prior to administering potentially harmful therapy, especially rt-PA.
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Affiliation(s)
- Yaowen Hu
- Neurotoxin Research Center, Department of Neurology, Tongji Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Junhui Su
- Neurotoxin Research Center, Department of Neurology, Tongji Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Xinxin Cui
- Neurotoxin Research Center, Department of Neurology, Tongji Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Lizhen Pan
- Neurotoxin Research Center, Department of Neurology, Tongji Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Lingjing Jin
- Neurotoxin Research Center, Department of Neurology, Tongji Hospital, School of Medicine, Tongji University, Shanghai, China
- Department of Neurology and Neurological Rehabilitation, Shanghai Yangzhi Rehabilitation Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Fei Teng
- Neurotoxin Research Center, Department of Neurology, Tongji Hospital, School of Medicine, Tongji University, Shanghai, China
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Yang S, Chang MC. The effectiveness of corticosteroid injection into cervical facet joint for managing whiplash-related neck pain. Ann Palliat Med 2022; 11:2569-2573. [PMID: 35542974 DOI: 10.21037/apm-22-224] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Accepted: 04/14/2022] [Indexed: 10/13/2023]
Abstract
BACKGROUND Cervical facet joint (CFJ) pain is commonly seen after whiplash trauma, and is frequently refractory to physical therapy and oral medication. Previous studies have shown positive pain-reducing outcomes after intra-articular (IA) corticosteroid injection in patients with CFJ pain unrelated to injury. We evaluated the effectiveness of IA corticosteroid injection for managing whiplash-related CFJ pain. METHODS We prospectively recruited 32 patients with chronic and persistent CFJ pain after whiplash trauma [≥3 on the Numeric Rating Scale (NRS)] despite physical therapy and oral medication. Under fluoroscopy guidance, we injected 10 mg (0.25 mL) of triamcinolone acetonide, mixed with 0.25 mL of 0.125% bupivacaine and 0.5 mL of normal saline. At 1 and 2 months after the injection, pain intensity was reassessed using the NRS. RESULTS Thirty patients completed the study. The mean pretreatment NRS score was 5.4±1.7, while the mean NRS scores at 1 and 2 months after treatment were 3.9±1.7 and 4.0±1.6, respectively. The NRS scores at both follow-ups were significantly decreased compared to pretreatment scores (pretreatment vs. 1 month, P=0.002; pretreatment vs. 2 months, P=0.004). Furthermore, 8 patients (26.7%) reported pain relief of ≥50% 2 months after the treatment. CONCLUSIONS In clinical practice, whiplash-induced CFJ pain is often refractory to physical therapy and oral medication, and clinicians have limited options to alleviate pain. We think that IA corticosteroid injection may serve as a management option for whiplash-related CFJ pain.
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Affiliation(s)
- Seoyon Yang
- Department of Rehabilitation Medicine, Ewha Woman's University Seoul Hospital, Ewha Woman's University School of Medicine, Seoul, Republic of Korea
| | - Min Cheol Chang
- Department of Rehabilitation Medicine, College of Medicine, Yeungnam University, Daegu, Republic of Korea
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Jin MC, Jensen M, Zhou Z, Rodrigues A, Ren A, Barros Guinle MI, Veeravagu A, Zygourakis CC, Desai AM, Ratliff JK. Health Care Resource Utilization in Management of Opioid-Naive Patients With Newly Diagnosed Neck Pain. JAMA Netw Open 2022; 5:e2222062. [PMID: 35816312 PMCID: PMC9280399 DOI: 10.1001/jamanetworkopen.2022.22062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
IMPORTANCE Research has uncovered heterogeneity and inefficiencies in the management of idiopathic low back pain, but few studies have examined longitudinal care patterns following newly diagnosed neck pain. OBJECTIVE To understand health care utilization in patients with new-onset idiopathic neck pain. DESIGN, SETTING, AND PARTICIPANTS This cross-sectional study used nationally sourced longitudinal data from the IBM Watson Health MarketScan claims database (2007-2016). Participants included adult patients with newly diagnosed neck pain, no recent opioid use, and at least 1 year of continuous postdiagnosis follow-up. Exclusion criteria included prior or concomitant diagnosis of traumatic cervical disc dislocation, vertebral fractures, myelopathy, and/or cancer. Only patients with at least 1 year of prediagnosis lookback were included. Data analysis was performed from January 2021 to January 2022. MAIN OUTCOMES AND MEASURES The primary outcome of interest was 1-year postdiagnosis health care expenditures, including costs, opioid use, and health care service utilization. Early services were those received within 30 days of diagnosis. Multivariable regression models and regression-adjusted statistics were used. RESULTS In total, 679 030 patients (310 665 men [45.6%]) met the inclusion criteria, of whom 7858 (1.2%) underwent surgery within 1 year of diagnosis. The mean (SD) age was 44.62 (14.87) years among nonsurgical patients and 49.69 (9.53) years among surgical patients. Adjusting for demographics and comorbidities, 1-year regression-adjusted health care costs were $24 267.55 per surgical patient and $515.69 per nonsurgical patient. Across all health care services, $95 379 949 was accounted for by nonsurgical patients undergoing early imaging who did not receive any additional conservative therapy or epidural steroid injections, for a mean (SD) of $477.53 ($1375.60) per patient and median (IQR) of $120.60 ($20.70-$452.37) per patient. On average, patients not undergoing surgery, physical therapy, chiropractic manipulative therapy, or epidural steroid injection, who underwent either early advanced imaging (magnetic resonance imaging or computed tomography) or both early advanced and radiographic imaging, accumulated significantly elevated health care costs ($850.69 and $1181.67, respectively). Early conservative therapy was independently associated with 24.8% (95% CI, 23.5%-26.2%) lower health care costs. CONCLUSIONS AND RELEVANCE In this cross-sectional study, early imaging without subsequent intervention was associated with significantly increased health care spending among patients with newly diagnosed idiopathic neck pain. Early conservative therapy was associated with lower costs, even with increased frequency of therapeutic services, and may have reduced long-term care inefficiency.
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Affiliation(s)
- Michael C Jin
- Department of Neurosurgery, Stanford University School of Medicine, Stanford, California
| | - Michael Jensen
- Department of Neurosurgery, Stanford University School of Medicine, Stanford, California
| | - Zeyi Zhou
- Department of Neurosurgery, Stanford University School of Medicine, Stanford, California
| | - Adrian Rodrigues
- Department of Neurosurgery, Stanford University School of Medicine, Stanford, California
| | - Alexander Ren
- Department of Neurosurgery, Stanford University School of Medicine, Stanford, California
| | | | - Anand Veeravagu
- Department of Neurosurgery, Stanford University School of Medicine, Stanford, California
| | - Corinna C Zygourakis
- Department of Neurosurgery, Stanford University School of Medicine, Stanford, California
| | - Atman M Desai
- Department of Neurosurgery, Stanford University School of Medicine, Stanford, California
| | - John K Ratliff
- Department of Neurosurgery, Stanford University School of Medicine, Stanford, California
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Ward KL, Smith M. Association Between Chiropractic Utilization and Opioid Prescriptions Among People With Back or Neck Pain: Evaluation of the Medical Expenditure Panel Survey. J Manipulative Physiol Ther 2022; 45:315-322. [PMID: 36195475 DOI: 10.1016/j.jmpt.2022.08.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2020] [Revised: 07/23/2022] [Accepted: 08/17/2022] [Indexed: 10/06/2022]
Abstract
OBJECTIVE The purpose of this study was to assess the association between patients in the United States seeing a chiropractor and receiving an opioid prescription for back or neck pain. METHODS Medical Expenditure Panel Survey (Years 2012 to 2015) respondents for longitudinal panels 17 to 19 who participated in all 5 rounds were at least 18 years of age, did not have cancer, and reported back or neck pain. We defined chiropractic users as participants reporting at least 1 chiropractic visit for back or neck pain and opioid users as participants reporting purchase or receipt of a prescription classified as Multum Lexicon "60" and "191" for back or neck pain. We adjusted for socioeconomic and clinical variables using multiple logistic regression. RESULTS The sample contained 4686 people, 21% of whom reported an opioid prescription for back or neck pain. Among opioid users, 14% reported a chiropractic visit for back or neck pain compared to 31% of nonopioid users. The adjusted odds ratio for chiropractic use among opioid users compared to nonopioid users was 0.46 (95% confidence interval, 0.36-0.57). CONCLUSION Patients with back or neck pain who saw a chiropractor had approximately half the odds of reporting an opioid prescription compared to those who did not see a chiropractor.
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Affiliation(s)
- Krista L Ward
- Research Department, Life Chiropractic College West, Hayward, California.
| | - Monica Smith
- Research Department, Life Chiropractic College West, Hayward, California
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Schultz DM, Hagedorn JM, Abd-Elsayed A, Stayner S. Safety of Interlaminar Cervical Epidural Injections: Experience With 12,168 Procedures in a Single Pain Clinic. Pain Physician 2022; 25:49-58. [PMID: 35051144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
BACKGROUND Cervical epidural steroid injections have long been utilized to treat intraspinal inflammation causing cervicalgia and/or cervical radiculopathy, and much has been written about safety and efficacy. There are published opinions, without evidence basis, that these injections should not be performed above C7-T1 for fear of dural puncture, spinal cord injury, and other complications that might occur more frequently at higher spinal levels. However, many experienced interventional pain physicians believe that epidural injections targeted to the level of spinal inflammation may be more effective. Although medication injected at the lowest cervical level C7-T1 may ascend to higher spinal levels, it often does not since inflammation and swelling at the cervical level of pathology may increase epidural pressure causing the injectate to move caudally down the path of least resistance. OBJECTIVES We sought to provide evidence for safety of posterior interlaminar epidural steroid injections at spinal levels at and above C7-T1 and to outline a 'best practices' approach to posterior cervical epidural injection based on experience with over 12,000 injections over 2 decades. We provide a discussion of cervical spinal anatomy, preferred technique for injection, and briefly review published literature to date regarding safety and efficacy of this procedure. STUDY DESIGN Retrospective case series. SETTING Single center, private practice institution. METHODS To document safety of interlaminar cervical epidural injections at levels above C7-T1, we conducted a retrospective study where we queried our electronic medical record database for information regarding 12,168 interlaminar cervical epidural steroid injections performed on 6,158 unique patients during a 14-year period by 5 different board-certified interventional pain physicians using similar technique within a single medical practice. Each injection was performed using fluoroscopic guidance with cervical epidurography routinely performed prior to injection of a therapeutic steroid and local anesthetic mixture. We found 129 minor complications (complications that did not require medical care beyond the post-anesthesia care unit [PACU] and 7 complications which we considered serious (required care beyond PACU stay), although no patients suffered paralysis or death. There was no correlation between spinal level of injection and complication rates. RESULTS Our most common spinal level for injection was C5-6, followed closely by C6-7. Hundreds of injections were performed at spinal levels above C5-6 with the most cephalad level C2-3. LIMITATIONS Retrospective design. CONCLUSION Our article supports the contention that interlaminar cervical epidural injections above C7-T1 are safe. Complication rates were not increased with cervical injections cephalad to C7-T1.
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Affiliation(s)
- David M Schultz
- Nura Pain Clinic, Minneapolis, MN; Department of Anesthesia, Critical Care and Pain Medicine, University of Minnesota, Twin Cities, MN
| | - Jonathan M Hagedorn
- Department of Anesthesiology and Perioperative Medicine, Division of Pain Medicine, Mayo Clinic, Rochester, MN
| | - Alaa Abd-Elsayed
- Department of Anesthesiology, University of Wisconsin School of Medicine and Public Health, Madison, WI
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Manchikanti L, Kosanovic R, Pampati V, Sanapati MR, Hirsch JA. Outcomes of Cervical Therapeutic Medial Branch Blocks and Radiofrequency Neurotomy: Clinical Outcomes and Cost Utility are Equivalent. Pain Physician 2022; 25:35-47. [PMID: 35051143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
BACKGROUND Cervical facet joint pain is often managed with either cervical radiofrequency neurotomy, cervical medial branch blocks, or cervical intraarticular injections. However, the effectiveness of each modality continues to be debated. Further, there is no agreement in reference to superiority or inferiority of facet joint nerve blocks compared to radiofrequency neurotomy, even though cervical facet joint radiofrequency neurotomy has been preferred by many and in fact, has been mandated by the Centers for Medicare and Medicaid Services (CMS), except when radiofrequency cannot be confirmed. Each procedure has advantages and disadvantages in reference to clinical utility, outcomes, cost utility, and side effect profile. However, comparative analysis has not been performed thus far in the literature in a clinical setting. STUDY DESIGN A retrospective, case-control, comparative evaluation of outcomes and cost utility. SETTING The study was conducted in an interventional pain management practice, a specialty referral center, a private practice setting in the United States. OBJECTIVE To evaluate the clinical outcomes and cost utility of therapeutic medial branch blocks with radiofrequency neurotomy in managing chronic neck pain of facet joint origin. METHODS The study was performed utilizing Strengthening the Reporting of Observational Studies in Epidemiology Analysis (STROBE) criteria. Only the patients meeting the diagnostic criteria of facet joint pain by means of comparative, controlled diagnostic local anesthetic blocks were included.The main outcome measure was pain relief measured by Numeric Rating Scale (NRS) evaluated at 3, 6, and 12 months. Significant improvement was defined as at least 50% improvement in pain relief. Cost utility was calculated with direct payment data for the procedures with addition of estimated indirect costs over a period of one year based on highly regarded surgical literature and previously published interventional pain management literature. RESULTS Overall, 295 patients met inclusion criteria with 132 patients receiving cervical medial branch blocks and 163 patients with cervical radiofrequency neurotomy. One hundred and seven patients in the cervical medial branch group and 105 patients in the radiofrequency group completed one year follow-up. There was significant improvement in both groups from baseline to 12 months with pain relief and proportion of patients with >= 50% pain relief. Average relief of each procedure for cervical medial branch blocks was 13 to 14 weeks, whereas for radiofrequency neurotomy, it was 20 to 25 weeks. Significant pain relief was recorded in 100%, 94%, and 81% of the patients in the medial branch blocks group, whereas it was 100%, 69%, and 64% in the radiofrequency neurotomy group at 3, 6, and 12 month follow-up, with significant difference at 6 and 12 months.Cost utility analysis showed average cost for quality-adjusted life year (QALY) of $4,994 for cervical medial branch blocks compared to $5,364 for cervical radiofrequency neurotomy. Six of 132 patients (5%) in the cervical medial branch group and 53 of 163 (33%) patients in the cervical radiofrequency neurotomy group were converted to other treatments, either due to side effects (6 patients or 4%) or inadequate relief (47 patients or 29%). CONCLUSION In this study, outcomes of cervical therapeutic medial branch blocks compared to radiofrequency neurotomy demonstrated significantly better outcomes with significant pain relief with similar costs for both treatments over a period of one year.
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Affiliation(s)
| | - Radomir Kosanovic
- Pain Management Centers of America, Paducah, KY
- Pain Management Centers of America, Evansville, IN
| | | | | | - Joshua A Hirsch
- Massachusetts General Hospital and Harvard Medical School, Boston, MA
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Kamalaksha S, Wilkinson L, Ghosh S. Crowned dens syndrome: a key differential for acute neck pain in the elderly. N Z Med J 2021; 134:130-133. [PMID: 34531604] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Affiliation(s)
- Sujatha Kamalaksha
- Consultant Physician and Rheumatologist, Whangarei Hospital, New Zealand
| | | | - Sanjib Ghosh
- Consultant Physician and Rheumatologist, Whangarei Hospital, New Zealand
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Hu S, Belcaro G, Cesarone MR, Feragalli B, Cotellese R, Dugall M, Scipione C, Scipione V, Maione C, Maramaldi G, Togni S, Riva A. A sport cream (Harpago-Boswellia-ginger-escin) for localized neck/shoulder pain. Minerva Med 2021; 112:255-260. [PMID: 32880419 DOI: 10.23736/s0026-4806.20.06819-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Neck/shoulder, sudden pain, or muscular pain (not associated to structural or bone/joints components), due to fascial or muscular strain is common in active subjects, in non-professional athletes and sports performers. The aim of this supplement registry was the evaluation of a cream based on natural, active ingredients for topical application in supporting the improvement of pain and improving head/neck mobility, possibly minimizing the use of systemic drugs. METHODS The cream includes standardized active ingredients of natural origin as an extract of Harpagophytum procumbes, an extract from Boswellia serrata, a CO2 extract of ginger and escin. Subjects were divided into three groups, all using the standard management (SM) in combination with the Sport Cream or in addition to Flector (diclofenac) patch. RESULTS The groups were comparable and homogeneous at the baseline. No side effects or skin tolerability issues were observed with the Sport Cream nor with the SM or diclofenac patches. Subjects receiving sport cream + SM reported a significant improvement in pain, stiffness, altered mobility and altered working capacity, with a reduced need for rescue medication (diclofenac) compared to subjects in the other two groups. CONCLUSIONS Finally, subjects receiving sport cream + SM reported a more remarkable decrease in skin temperature in the affected area associated to an improvement in clinical symptoms.
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Affiliation(s)
- Shu Hu
- Irvine3 Labs, Department of Medical, Oral and Biotechnological Sciences, Chieti-Pescara University, IAPSS, Pescara, Italy
- Indena, Milan, Italy
| | - Gianni Belcaro
- Irvine3 Labs, Department of Medical, Oral and Biotechnological Sciences, Chieti-Pescara University, IAPSS, Pescara, Italy -
- Indena, Milan, Italy
| | - Maria R Cesarone
- Irvine3 Labs, Department of Medical, Oral and Biotechnological Sciences, Chieti-Pescara University, IAPSS, Pescara, Italy
- Indena, Milan, Italy
| | - Beatrice Feragalli
- Irvine3 Labs, Department of Medical, Oral and Biotechnological Sciences, Chieti-Pescara University, IAPSS, Pescara, Italy
- Indena, Milan, Italy
| | - Roberto Cotellese
- Irvine3 Labs, Department of Medical, Oral and Biotechnological Sciences, Chieti-Pescara University, IAPSS, Pescara, Italy
- Indena, Milan, Italy
| | - Mark Dugall
- Irvine3 Labs, Department of Medical, Oral and Biotechnological Sciences, Chieti-Pescara University, IAPSS, Pescara, Italy
- Indena, Milan, Italy
| | - Claudia Scipione
- Irvine3 Labs, Department of Medical, Oral and Biotechnological Sciences, Chieti-Pescara University, IAPSS, Pescara, Italy
- Indena, Milan, Italy
| | - Valeria Scipione
- Irvine3 Labs, Department of Medical, Oral and Biotechnological Sciences, Chieti-Pescara University, IAPSS, Pescara, Italy
- Indena, Milan, Italy
| | - Claudia Maione
- Irvine3 Labs, Department of Medical, Oral and Biotechnological Sciences, Chieti-Pescara University, IAPSS, Pescara, Italy
- Indena, Milan, Italy
| | - Giada Maramaldi
- Irvine3 Labs, Department of Medical, Oral and Biotechnological Sciences, Chieti-Pescara University, IAPSS, Pescara, Italy
- Indena, Milan, Italy
| | - Stefano Togni
- Irvine3 Labs, Department of Medical, Oral and Biotechnological Sciences, Chieti-Pescara University, IAPSS, Pescara, Italy
- Indena, Milan, Italy
| | - Antonella Riva
- Irvine3 Labs, Department of Medical, Oral and Biotechnological Sciences, Chieti-Pescara University, IAPSS, Pescara, Italy
- Indena, Milan, Italy
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de Sire A, Agostini F, Lippi L, Mangone M, Marchese S, Cisari C, Bernetti A, Invernizzi M. Oxygen-Ozone Therapy in the Rehabilitation Field: State of the Art on Mechanisms of Action, Safety and Effectiveness in Patients with Musculoskeletal Disorders. Biomolecules 2021; 11:biom11030356. [PMID: 33652804 PMCID: PMC7996934 DOI: 10.3390/biom11030356] [Citation(s) in RCA: 47] [Impact Index Per Article: 15.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2020] [Revised: 02/11/2021] [Accepted: 02/22/2021] [Indexed: 12/15/2022] Open
Abstract
In recent years, the interest in oxygen–ozone (O2O3) therapy application has considerably increased in the field of rehabilitation. Despite its widespread use in common clinical practice, the biochemical effects of O2O3 are still far from being understood, although its chemical properties seem to play a pivotal role in exerting its positive effects on different pathological conditions. Indeed, the effectiveness of O2O3 therapy might be partly due to the moderate oxidative stress produced by O3 interactions with biological components. O2O3 therapy is widely used as an adjuvant therapeutic option in several pathological conditions characterized by chronic inflammatory processes and immune over-activation, and most musculoskeletal disorders share these pathophysiological processes. The present comprehensive review depicts the state-of-the-art on the mechanisms of action, safety and effectiveness of O2O3 therapy in the complex scenario of the management of musculoskeletal disorders. Taken together, our findings suggest that O2O3 therapy seems to reduce pain and improve functioning in patients affected by low back pain and knee osteoarthritis, as reported by several studies in the literature. However, to date, further studies are warranted to clearly investigate the therapeutic effects of this promising therapy on other musculoskeletal disorders in the field of rehabilitation.
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Affiliation(s)
- Alessandro de Sire
- Department of Medical and Surgical Sciences, University of Catanzaro “Magna Graecia”, 88100 Catanzaro, Italy
- Correspondence: ; Tel.: +39-096-136-9768
| | - Francesco Agostini
- Department of Anatomy, Histology, Forensic Medicine and Orthopedics, Sapienza University, 00185 Rome, Italy; (F.A.); (M.M.); (S.M.); (A.B.)
| | - Lorenzo Lippi
- Department of Health Sciences, University of Eastern Piedmont, 28100 Novara, Italy; (L.L.); (C.C.); (M.I.)
| | - Massimiliano Mangone
- Department of Anatomy, Histology, Forensic Medicine and Orthopedics, Sapienza University, 00185 Rome, Italy; (F.A.); (M.M.); (S.M.); (A.B.)
| | - Simone Marchese
- Department of Anatomy, Histology, Forensic Medicine and Orthopedics, Sapienza University, 00185 Rome, Italy; (F.A.); (M.M.); (S.M.); (A.B.)
| | - Carlo Cisari
- Department of Health Sciences, University of Eastern Piedmont, 28100 Novara, Italy; (L.L.); (C.C.); (M.I.)
| | - Andrea Bernetti
- Department of Anatomy, Histology, Forensic Medicine and Orthopedics, Sapienza University, 00185 Rome, Italy; (F.A.); (M.M.); (S.M.); (A.B.)
| | - Marco Invernizzi
- Department of Health Sciences, University of Eastern Piedmont, 28100 Novara, Italy; (L.L.); (C.C.); (M.I.)
- Infrastruttura Ricerca Formazione Innovazione (IRFI), Azienda Ospedaliera SS. Antonio e Biagio e Cesare Arrigo, 15121 Alessandria, Italy
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Marcos Alonso C, Batista Cruzado J. Case Report: Back Pain as a Presenting Symptom of Systemic Mastocytosis. Am Fam Physician 2021; 103:200-201. [PMID: 33587582] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
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28
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Lee MY, Chang MC. Chemical meningitis after cervical transforaminal epidural steroid injection: a case report. J Int Med Res 2021; 49:300060521993974. [PMID: 33616459 PMCID: PMC7903832 DOI: 10.1177/0300060521993974] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2020] [Accepted: 01/20/2021] [Indexed: 11/15/2022] Open
Abstract
We herein report a case of chemical meningitis that developed after cervical transforaminal steroid injection. A 49-year-old man presented with symptoms of meningitis (severe headache and neck stiffness) after cervical transforaminal steroid injection at the right C5-6 level. The injection solution was a mixture of lidocaine (0.3 mL), hyaluronidase (1 mL), placenta hydrolysate (2 mL), and normal saline (1 mL). The patient developed symptoms of meningitis 2.5 hours after the cervical epidural injection. Cerebrospinal fluid (CSF) analysis was performed 1 day after the injection, and the results showed an elevated white blood cell count at 7106 cells/µL. The patient's CSF analysis findings and symptoms did not differ from those of bacterial meningitis. However, considering that his symptoms developed 2.5 hours after the epidural injection, we believe that the patient developed chemical meningitis; therefore, he was symptomatically treated with an analgesic. Three days after the cervical transforaminal epidural injection, the patient experienced complete relief from the headache and neck stiffness. A Gram stain of the CSF revealed no organisms. Hence, the diagnosis of chemical meningitis was confirmed. Clinicians should be knowledgeable about the risk of this complication.
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Affiliation(s)
- Min Young Lee
- Department of Physical Medicine and Rehabilitation, College of Medicine, Yeungnam University, Namku, Taegu, Republic of Korea
| | - Min Cheol Chang
- Department of Physical Medicine and Rehabilitation, College of Medicine, Yeungnam University, Namku, Taegu, Republic of Korea
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Mesregah MK, Feng W, Huang WH, Chen WC, Yoshida B, Mecum A, Mandalia K, Van Halm-Lutterodt N. Clinical Effectiveness of Interlaminar Epidural Injections of Local Anesthetic with or without Steroids for Managing Chronic Neck Pain: A Systematic Review and Meta-Analysis. Pain Physician 2020; 23:335-348. [PMID: 32709169] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
BACKGROUND Chronic neck pain is reportedly considered the fourth leading cause of disability. Cervical interlaminar epidural injections are among the commonly administered nonsurgical interventions for managing chronic neck pain, secondary to disc herniation and radiculitis, spinal stenosis, or chronic neck pain of discogenic origin. OBJECTIVES To systematically review the differences in the effectiveness of cervical epidural injections with local anesthetics with or without steroids for the management of chronic neck pain. STUDY DESIGN Systematic review and meta-analysis. METHODS A comprehensive search of the literature of randomized controlled trials (RCTs) that compared epidural injections with local anesthetic with or without steroids was performed, including a search of PubMed, EMBASE, and Cochrane databases for all years up to May 2019. Meta-analysis was done for pain relief based on the Numeric Rating Scale, functional status based on the Neck Disability Index, and opioid intake dosage. RESULTS Four studies met the inclusion criteria. A total of 370 patients were divided into 2 groups: the experimental group received cervical epidural injection with steroid and local anesthetic, and the control group received injection with local anesthetic only. Regrading pain relief, no significant difference was observed between both groups (weighted mean difference [WMD], -0.006; 95% confidence interval (CI), -0.275 to 0.263; P = 0.963; I² = 0.0% at 12 months). There was also no significant difference in the improvement of the functional status (WMD, 0.159; 95% CI, -1.231 to 1.549; P = 0.823; I² = 9.8% at 12 months). Similarly, there was no significant difference in opioid dosage (WMD, -0.093; 95% CI, -5.952 to 5.766; P = 0.975; I² = 0.0% at 12 months). LIMITATIONS Only a few studies on this premise were found in the literature. There was also a lack of heterogeneity of the included RCT studies. CONCLUSIONS The addition of steroids to anesthetic injectates was not associated with better pain and functional score outcomes compared with anesthetic injectate alone in patients with chronic neck pain. KEY WORDS Chronic neck pain, cervical radiculopathy, cervical disc disease, spinal stenosis, facet joint pathology, cervical epidural injections, steroid injections, local anesthetic injections, systematic review, meta-analysis, randomized control trial.
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Affiliation(s)
- Mohamed Kamal Mesregah
- Department of Orthopedics and Neurosurgery, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA; Department of Orthopaedic Surgery, Menoufia University Faculty of Medicine, Shebin El-Kom, Menoufia, Egypt
| | - Wei Feng
- Department of Statistics and Epidemiology, School of Public Health, Capital Medical University, Beijing, China
| | - Wei-Hsun Huang
- Department of Clinical Sciences, Beijing Friendship Hospital Affiliated-Capital Medical University, Beijing, China
| | - Wei-Cheng Chen
- Department of Clinical Sciences, Beijing Tongren Hospital Affiliated-Capital Medical University, Beijing, China
| | - Brandon Yoshida
- Department of Orthopedics and Neurosurgery, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Andrew Mecum
- Department of Psychology, Emory University, Atlanta, GA, USA
| | - Krishna Mandalia
- Department of Orthopedics and Neurosurgery, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA; Dornsife College of Letters Arts and Sciences, University of Southern California, Los Angeles, CA, USA
| | - Nicholas Van Halm-Lutterodt
- Department of Orthopedics and Neurosurgery, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA; Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
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Coluzzi F, Pergolizzi JV, Giordan E, Locarini P, Boaro A, Billeci D. Tapentadol prolonged release for managing moderate to severe chronic neck pain with or without a neuropathic component. Curr Med Res Opin 2020; 36:651-659. [PMID: 31983248 DOI: 10.1080/03007995.2020.1722083] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Background: Despite the high prevalence of neck pain, few studies have addressed the pharmacological treatment of this condition.Purpose: We evaluated the effectiveness of tapentadol prolonged-release (PR) in patients with or without a neuropathic pain component, with a focus on functional movements, disability and Quality of Life (QoL).Study design/setting: Observational, retrospective study.Patient sample: Ninety-four adult patients with severe neck pain not responsive to opioid step III treatment.Outcome measures: The primary endpoint was a ≥ 30% improvement of pain intensity at 4 weeks (W4). Several secondary outcomes were evaluated, including neck disability index (NDI), range of motion (ROM), and QoL.Methods: Patients received tapentadol PR at the starting dose of 100 mg/day. Dose titration was allowed in 50 mg increments, up to 500 mg daily.Results: At W4, the primary endpoint of ≥30% improvement of pain was reported in 70% (n = 35; 95% confidence interval [CI]: 55-82%) of patients with a neuropathic pain component and in 69% (n = 20; 95% CI: 49-85%) of those without a neuropathic component. The percentage of patients reporting a neuropathic pain component significantly decreased from baseline (64.2%) to W4 (27.8%). NDI significantly improved in both groups at W12. ROM significantly improved in all three planes of motion (p < .01), with no difference between the two groups. Interference of pain with sleep and QoL also improved.Conclusions: The reduction in pain provided by tapentadol is associated with functional recovery, which may in turn be linked to an improvement in QoL.
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Affiliation(s)
- Flaminia Coluzzi
- Department of Medical and Surgical Sciences and Biotechnologies, Unit Anaesthesiology, Intensive Care Medicine and Pain Therapy, Sapienza University of Rome, Latina, Italy
| | | | - Enrico Giordan
- Division of Neurosurgery, Ca'Foncello Hospital, ASL Marca Trevigiana, University of Padova, Treviso, Italy
| | - Pamela Locarini
- Department of Medical and Surgical Sciences and Biotechnologies, Unit Anaesthesiology, Intensive Care Medicine and Pain Therapy, Sapienza University of Rome, Latina, Italy
| | - Alessandro Boaro
- Division of Neurosurgery, Ca'Foncello Hospital, ASL Marca Trevigiana, University of Padova, Treviso, Italy
| | - Domenico Billeci
- Division of Neurosurgery, Ca'Foncello Hospital, ASL Marca Trevigiana, University of Padova, Treviso, Italy
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Liu YC, Lee WJ. Lemierre's syndrome: a possible cause of neck pain. Intern Emerg Med 2019; 14:1339-1340. [PMID: 31535288 DOI: 10.1007/s11739-019-02194-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2019] [Accepted: 09/07/2019] [Indexed: 10/26/2022]
Affiliation(s)
- Yu-Chang Liu
- Department of Emergency Medicine, Chi-Mei Medical Center, 901 Zhonghua Road, Yongkang District, Tainan, 710, Taiwan
| | - Wei-Jing Lee
- Department of Emergency Medicine, Chi-Mei Medical Center, 901 Zhonghua Road, Yongkang District, Tainan, 710, Taiwan.
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Zhu X, Han J, Zang R, Qiu S, Chang G, Zuo J. Functional Pathway Between Cervical Spinal and Sympathetic Ganglia: A Neurochemical Foundation Between Neck Pain and Vertigo. Pain Physician 2019; 22:E627-E633. [PMID: 31775416] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
BACKGROUND Cervical vertigo commonly concurs in patients with neck pain, but the concurrent mechanism of these 2 symptoms still remains unclear. We previously reported a bidirectional segmental nerve fiber connection between cervical spinal and sympathetic ganglia, which provided a hypothesis that this connection between the 2 ganglia may be the anatomic basis for the concurrence of neck pain and cervical vertigo. However, this concurrent mechanism needs biochemical and functional evidence. OBJECTIVES This study aimed to investigate a possible noradrenergic pathway between cervical spinal and sympathetic ganglia. STUDY DESIGN We performed both clinical and laboratory research. Clinical observation was a prospective case-control study. SETTING Clinical study took place in our hospital; laboratory study was in an orthopedic laboratory. METHODS Cervical lamina block therapy used in patients with cervical vertigo was clinically evaluated; norepinephrine (NE) expressions in cervical sympathetic ganglia were analyzed using immunohistochemical staining after electrical stimulation to the cervical spinal ganglia; the influence of phentolamine local injection to the vertebrobasilar artery flow was experimentally measured. RESULTS Cervical lamina block therapy could significantly shorten the clinical hospital stays of patients with cervical vertigo (P = 0.000) and improve vertebral artery flow (P < 0.05). NE expressions in superior cervical sympathetic ganglia (SCG) or inferior cervical sympathetic ganglia (ICG) increased significantly when ipsilateral C2 to C3 or C6 to C8 spinal ganglia were electrically stimulated, respectively. Adrenergic receptor block with phentolamine significantly inhibited the decrease of basilar artery (BA) flow induced by electrical stimulation of the cervical spinal ganglia. The change range of BA flow caused by stimulations of C2 to C3 and C6 to C8 spinal ganglia was more than that of C4 and C5. LIMITATIONS The inpatients observed in this clinical study might be influenced by some factors including emotion, diet, sleep, and others. The limitations of the laboratory study included animal species and small sample size. CONCLUSIONS Adrenergic system could play a part in cervical spinal ganglia altering the vertebrobasilar artery system. It could provide a neurochemical foundation between neck pain and vertigo, and that segmental functional connections exist between cervical spinal and sympathetic ganglia. KEY WORDS Cervical vertigo, neck pain, cervical sympathetic ganglia, cervical spinal ganglia, noradrenaline.
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Affiliation(s)
- Xinwei Zhu
- Department of Orthopedics, The 4th People's Hospital of Jinan, Jinan, China
| | - Jianlong Han
- Department of Orthopedics, The 4th People's Hospital of Jinan, Jinan, China
| | - Rui Zang
- Jinan Central Hospital, Jinan, China
| | - Siqiang Qiu
- Department of Orthopedics, The 4th People's Hospital of Jinan, Jinan, China
| | - Gang Chang
- The First Affiliated Hospital of Harbin Medical University, Nangang, Harbin, P.R. China
| | - Jinliang Zuo
- Department of Orthopedics, The 4th People's Hospital of Jinan, Jinan, China
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Simon D, Cailleux-Talbot N, Armengol G, Benhamou Y, Lévesque H, Monnot A, Miranda S. [A neck mass]. Rev Med Interne 2019; 41:348-349. [PMID: 31662231 DOI: 10.1016/j.revmed.2019.09.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2019] [Revised: 09/19/2019] [Accepted: 09/26/2019] [Indexed: 11/18/2022]
Affiliation(s)
- D Simon
- UNIROUEN, service de médecine interne, Normandie université, 76000 Rouen, France.
| | - N Cailleux-Talbot
- UNIROUEN, service de médecine interne, Normandie université, 76000 Rouen, France
| | - G Armengol
- UNIROUEN, service de médecine interne, Normandie université, 76000 Rouen, France
| | - Y Benhamou
- UNIROUEN, service de médecine interne, Normandie université, 76000 Rouen, France; UNIROUEN, U1096, service de médecine interne, Normandie université, 76000 Rouen, France
| | - H Lévesque
- UNIROUEN, service de médecine interne, Normandie université, 76000 Rouen, France; UNIROUEN, U1096, service de médecine interne, Normandie université, 76000 Rouen, France
| | - A Monnot
- UNIROUEN, service de chirurgie vasculaire, Normandie université, 76000 Rouen, France
| | - S Miranda
- UNIROUEN, service de médecine interne, Normandie université, 76000 Rouen, France; UNIROUEN, U1096, service de médecine interne, Normandie université, 76000 Rouen, France
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Manchikanti L, Pampati V, Parr Iii A, Manchikanti MV, Sanapati MR, Kaye AD, Hirsch JA. Cervical Interlaminar Epidural Injections in the Treatment of Cervical Disc Herniation, Post Surgery Syndrome, or Discogenic Pain: Cost Utility Analysis from Randomized Trials. Pain Physician 2019; 22:421-431. [PMID: 31561644] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
BACKGROUND Neck pain is one of the major conditions attributing to overall disability in the United States. There have been multiple publications assessing clinical and cost effectiveness of multiple modalities of interventions in managing chronic neck pain. Even then, the literature has been considered sparse in relation to cervical interlaminar epidural injections in managing chronic neck pain. In contrast, cost utility studies of lumbar interlaminar injections, caudal epidural injections, cervical and lumbar facet joint nerve blocks, percutaneous adhesiolysis demonstrated costs of less than $3,500 for quality-adjusted life year (QALY). OBJECTIVES To assess the cost utility of cervical interlaminar epidural injections in managing chronic neck and/or upper extremity pain secondary to cervical disc herniation, post-surgery syndrome in neck, and axial or discogenic neck pain. STUDY DESIGN Analysis based on 3 previously published randomized trials of the effectiveness of cervical interlaminar epidural injections assessing their role in disc herniation, cervical post-surgery syndrome, and axial or discogenic pain. SETTING A contemporary, private, specialty referral interventional pain management center in the United States. METHODS Cost utility of cervical interlaminar epidural injections with or without steroids in managing cervical disc herniation, cervical post-surgery syndrome, and cervical discogenic or axial neck back pain was conducted with data derived from 3 randomized controlled trials (RCTs) that included a 2-year follow-up, with inclusion of 356 patients. The primary outcome was significant improvement defined as at least 50% in pain reduction and disability status. Direct payment data from all carriers from 2018 was utilized for the assessment of procedural costs. Overall costs, including drug costs, were determined by multiplication of direct procedural payment data by a factor of 1.67 to accommodate for indirect payments respectively for disc herniation, discogenic pain, and cervical post-surgery syndrome. RESULTS The results of the 3 RCTs showed direct cost utility for one year of QALY of $2,412.31 for axial or discogenic pain without disc herniation, $2,081.07 for disc herniation, and $2,309.20 for post surgery syndrome, with an average cost per one year QALY of $2,267.57, with total estimated overall costs with addition of indirect costs of $3,475.38, $4,028.55, $3,856.36, and $3,785.89 respectively. LIMITATIONS The limitation of this cost utility analysis includes that it is a single center evaluation. Indirect costs were extrapolated. CONCLUSION This cost utility analysis of cervical interlaminar epidural injections in patients nonresponsive to conservative management in the treatment of disc herniation, post surgery syndrome and axial or discogenic neck pain shows $2,267.57 for direct costs with a total cost of $3,785.89 per QALY. KEY WORDS Cervical interlaminar epidural injections, chronic neck pain, cervical disc herniation, cervical discogenic pain, post surgery syndrome, cost utility analysis, cost effectiveness analysis, quality-adjusted life years.
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Affiliation(s)
- Laxmaiah Manchikanti
- Pain Management Centers of America, Paducah, KY and Evansville, IN; LSU Health Science Center, New Orleans, LA
| | | | - Allan Parr Iii
- Louisiana State University School of Medicine, Shreveport, LA
| | | | | | | | - Joshua A Hirsch
- Massachusetts General Hospital and Harvard Medical School, Boston, MA
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Hetta DF, Elawamy AM, Hassanein MM, Aljohi AS, Hasan RAR, Mohammed NAA, Seifeldein GS. Efficacy of Atlantoaxial Joint Glucocorticoid Injection in Patients with Rheumatoid Arthritis: A Randomized Trial. Pain Physician 2019; 22:E295-E302. [PMID: 31337171] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
BACKGROUND The atlantoaxial joint (AAJ) plays a pivotal role in the cervical spine motion. Unfortunately, it is the most common cervical spine joint that is affected in patients with rheumatoid arthritis. Inflammation of the AAJ results in neck disability, nerve root compression, and finally spinal cord compression. OBJECTIVES We aim to evaluate the efficacy of intraarticular triamcinolone injection of the AAJ on neck pain and disability. STUDY DESIGN A prospective randomized, controlled clinical trial. SETTING An interventional pain unit in a tertiary center at a university hospital in Egypt. METHODS Sixty patients with rheumatoid arthritis complaining of AAJ arthritis were randomized into 2 groups. Group AAJI (n = 30) received AAJ injection with 1.0 mL of a mixture of 0.5 mL of bupivacaine 0.5% and 0.5 mL of 20 mg of triamcinolone, in addition to oral placebo tablets (2 tablets every 8 hours for one week). Group SS (n = 30) received systemic steroids, oral prednisolone tablets (5 mg, 2 tablets every 8 hours for one week), in addition to AAJ injection with 1.0 mL of a mixture of 0.5 mL of bupivacaine 0.5% and 0.5 mL of normal saline solution. The percentage of patients who showed >/= 50% reduction of their visual analog scale (VAS) pain score (measured at 1, 2, and 3 months postoperatively), VAS pain score and neck disability index (NDI) (measured at 2, 4, 6, 8, and 12 weeks postoperatively), and the magnetic resonance imaging (MRI) changes of AAJ (assessed 4 weeks postoperatively) were all evaluated. RESULTS There was significant reduction in the percentage of patients who showed ≥50% reduction of their VAS pain score postoperatively in group AAJI compared with group SS at one month (75% vs. 46.45%; P = 0.033), 2 months (60.7% vs. 25%; P = 0.009), and 3 months (53.6% vs. 17.9%; P = 0.007). There was significant reduction in overall VAS and overall NDI in group AAJI compared with group SS (mean ± standard error) (41.5 ± 2.6 vs. 52.1 ± 2.6; P = 0.005) and (43.7 ± 3.1 vs. 52.4 ± 3.1; P = 0.040), respectively. Analysis of postoperative MRI findings revealed significant improvement of bone marrow edema in group AAJI (AAJI vs. SS) (71.4% vs. 42.9%; P = 0.033), also the synovial enhancement disappeared significantly in group AAJI compared with group SS, (16/22 [72.7%] vs. 10/23 [43.5%]; P = 0.026), moreover, there was a significant reduction in pannus size in group AAJI compared with group SS, (6/10 [60%] vs. 1/9 [11%]; P = 0.041). LIMITATIONS The study follow-up period was limited to only 3 months. CONCLUSIONS For acutely inflamed AAJ due to rheumatoid arthritis, AAJ steroid injection is a potential therapeutic option; it decreased cervical neck pain, improved neck mobility, and hastened recovery of the joint from an acute inflammatory stage. KEY WORDS Rheumatoid arthritis, atlantoaxial joint injection.
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Affiliation(s)
| | | | - Manal Mohamed Hassanein
- Department of Rheumatology and Rehabilitation, Faculty of Medicine, Assiut University, Assiut, Egypt
| | - Arwa Saaed Aljohi
- Department of Rheumatology and Rehabilitation, Faculty of Medicine, Assiut University, Assiut, Egypt
| | - Raouf Abdel-Razek Hasan
- Department of Rheumatology and Rehabilitation, Faculty of Medicine, Assiut University, Assiut, Egypt
| | | | - Gehan S Seifeldein
- Department of Diagnostic Radiology, Faculty of Medicine, Assiut University, Assiut, Egypt
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Ben Ayed H, Yaich S, Trigui M, Ben Hmida M, Ben Jemaa M, Ammar A, Jedidi J, Karray R, Feki H, Mejdoub Y, Kassis M, Damak J. Prevalence, Risk Factors and Outcomes of Neck, Shoulders and Low-Back Pain in Secondary-School Children. J Res Health Sci 2019; 19:e00440. [PMID: 31133629 PMCID: PMC6941626] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2018] [Revised: 02/16/2019] [Accepted: 03/04/2019] [Indexed: 11/08/2022] Open
Abstract
BACKGROUND Musculoskeletal pain (MSP) is a public health problem among school-adolescents. This study aimed to identify the prevalence, risk factors and consequences of neck, shoulders and low-back pain among school-adolescents. STUDY DESIGN A cross-sectional study. METHODS School-adolescents aged from 12 to 18 years between October 2017 and February 2018 in South of Tunisia were recruited. Eligible participants were randomly selected and were asked to respond a four-section questionnaire. Factors independently associated with MSP were determined through multivariate logistic regression analysis. RESULTS Among 1221 enrolled subjects, shoulders, low-back and neck pain were reported in 43%, 35.8% and 32%, respectively. Multivariate analysis showed that independent risk factors of neck pain were female gender (Adjusted odds ratio AOR=1.55; P=0.002), using computer ≥4 hours/week (AOR=1.50; P=0.010), too low desk (AOR=2.30; P<0.001) and carrying schoolbag ≥60 minutes (AOR=1.58; P=0.008). Female gender (AOR=3.30; P<0.001), BMI ≥25 Kg/m2 (AOR=1.6; P=0.018), playing videogames ≥2 hours/day (AOR=2.37; P<0.001) and schoolbag weight to body weight ≥10% (AOR=1.46; P=0.026) were independently associated with shoulders pain. For low back-pain, independent risk factors were high-school grade (AOR=2.70; P<0.001), playing videogames ≥2 hours/day (AOR=1.83; P<0.001), watching TV≥12 hours/week (AOR=1.5; P=0.016), too low seat backrest (AOR=1.4; P=0.005) and too far seat-to-black (board) distance (AOR=1.5; P=0.041). School-adolescents consumed drugs for MSP in 19.5%, had sleep disturbance in 34% and aggressive behaviors in 22.8%. CONCLUSIONS The prevalence of MSP was substantially high among school-adolescents and their associated risk factors included sociodemographic factors, leisure activities and classroom furniture. An ergonomic specific and behavior-based school program is urgently needed.
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Affiliation(s)
- Houda Ben Ayed
- Department of Community Health and Epidemiology, Hedi Chaker University Hospital, Sfax, Tunisia.
| | - Sourour Yaich
- Community Health and Epidemiology Department, Hedi Chaker University Hospital, University of Sfax, Tunisia
| | - Maroua Trigui
- Preventive medicine and hygiene department, Hedi Chaker University Hospital, University of Sfax, Tunisia
| | - Mariem Ben Hmida
- Community Health and Epidemiology Department, Hedi Chaker University Hospital, University of Sfax, Tunisia
| | - Maissa Ben Jemaa
- Community Health and Epidemiology Department, Hedi Chaker University Hospital, University of Sfax, Tunisia
| | - Achraf Ammar
- High institute of sport and physical education, University of Sfax, Tunisia
| | - Jihene Jedidi
- Community Health and Epidemiology Department, Hedi Chaker University Hospital, University of Sfax, Tunisia
| | - Raouf Karray
- Community Health and Epidemiology Department, Hedi Chaker University Hospital, University of Sfax, Tunisia
| | | | - Yosra Mejdoub
- Community Health and Epidemiology Department, Hedi Chaker University Hospital, University of Sfax, Tunisia
| | - Mondher Kassis
- Community Health and Epidemiology Department, Hedi Chaker University Hospital, University of Sfax, Tunisia
| | - Jamel Damak
- Community Health and Epidemiology Department, Hedi Chaker University Hospital, University of Sfax, Tunisia
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Seo J, Lee JW, Kang Y, Lee E, Ahn JM, Kim DH, Kang HS. Evaluation of the responsiveness of outcome measures after spine injection: A retrospective study. PLoS One 2019; 14:e0211763. [PMID: 30811428 PMCID: PMC6392275 DOI: 10.1371/journal.pone.0211763] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2017] [Accepted: 01/21/2019] [Indexed: 11/25/2022] Open
Abstract
Discrepancies in patients’ responses to various outcome measures challenge clinicians’ evaluation of treatment outcomes. Therefore, we aimed to 1) evaluate the concordance of outcome measures after spine injection, 2) determine the patient variables that lead to discordant responses, and 3) suggest practical outcome measure for spine injections with good responsiveness. From October 2014 to November 2014, 164 patients with neck or low back pain who visited our outpatient clinics and had spine injections on the previous visit were enrolled. We asked patients to report changes in their symptom in the form of outcome measures: numeric rating scale, Oswestry disability index, neck disability index, residual symptom percentage and global perceived effect. The responses were categorized into three groups according to the degree of change; not improved, minimally improved, and significantly improved. The concordances of these categorized answers were evaluated. When “significantly improved” was considered as true improvement, 46 (28%) of the 164 patients had discordant responses to the four measures. There was no significant patients’ variable that affects discordance in the outcome measures. Good agreement was shown between the global perceived effect and residual symptom percentage, while the Oswestry disability index had poor agreement with the other measurements. The calculated numeric rating scale and residual symptom percentage also had low levels of agreement. However, patients with severe pre-treatment pain tended to have better agreement. In conclusion, this result suggest that the residual symptom percentage may be a more practical for clinicians and better represent patients’ improvements after spine injection.
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Affiliation(s)
- Jiwoon Seo
- Department of Radiology, Seoul National University Bundang Hospital, Seongnam-si, Gyeonggi-do, Korea
| | - Joon Woo Lee
- Department of Radiology, Seoul National University Bundang Hospital, Seongnam-si, Gyeonggi-do, Korea
- * E-mail:
| | - Yusuhn Kang
- Department of Radiology, Seoul National University Bundang Hospital, Seongnam-si, Gyeonggi-do, Korea
| | - Eugene Lee
- Department of Radiology, Seoul National University Bundang Hospital, Seongnam-si, Gyeonggi-do, Korea
| | - Joong Mo Ahn
- Department of Radiology, Seoul National University Bundang Hospital, Seongnam-si, Gyeonggi-do, Korea
| | - Dong Hyun Kim
- Department of Radiology, Seoul National University Boramae Medical Center, Seoul, Korea
| | - Heung Sik Kang
- Department of Radiology, Seoul National University Bundang Hospital, Seongnam-si, Gyeonggi-do, Korea
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Henry SG, Paterniti DA, Feng B, Iosif AM, Kravitz RL, Weinberg G, Cowan P, Verba S. Patients' Experience With Opioid Tapering: A Conceptual Model With Recommendations for Clinicians. J Pain 2019; 20:181-191. [PMID: 30243859 PMCID: PMC6349552 DOI: 10.1016/j.jpain.2018.09.001] [Citation(s) in RCA: 57] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/30/2018] [Revised: 08/23/2018] [Accepted: 09/02/2018] [Indexed: 11/25/2022]
Abstract
Clinical guidelines discourage prescribing opioids for chronic pain, but give minimal advice about how to discuss opioid tapering with patients. We conducted focus groups and interviews involving 21 adults with chronic back or neck pain in different stages of opioid tapering. Transcripts were qualitatively analyzed to characterize patients' tapering experiences, build a conceptual model of these experiences, and identify strategies for promoting productive discussions of opioid tapering. Analyses revealed 3 major themes. First, owing to dynamic changes in patients' social relationships, emotional state, and health status, patients' pain and their perceived need for opioids fluctuate daily; this finding may conflict with recommendations to taper by a certain amount each month. Second, tapering requires substantial patient effort across multiple domains of patients' everyday lives; patients discuss this effort superficially, if at all, with clinicians. Third, patients use a variety of strategies to manage the tapering process (eg, keeping an opioid stash, timing opioid consumption based on planned activities). Recommendations for promoting productive tapering discussions include understanding the social and emotional dynamics likely to impact patients' tapering, addressing patient fears, focusing on patients' best interests, providing anticipatory guidance about tapering, and developing an individualized tapering plan that can be adjusted based on patient response. Perspective: This study used interview and focus group data to characterize patients' experiences with opioid tapering and identify communication strategies that are likely to foster productive, patient-centered discussions of opioid tapering. Findings will inform further research on tapering and help primary care clinicians to address this important, often challenging topic.
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Affiliation(s)
- Stephen G Henry
- Division of General Medicine, Geriatrics, and Bioethics; Center for Healthcare Policy and Research, University of California, Davis, Sacramento, California.
| | - Debora A Paterniti
- Department of Sociology, Sonoma State University, Rohnert Park, California
| | | | - Ana-Maria Iosif
- Department of Public Health Sciences, University of California, Davis, Davis, California
| | - Richard L Kravitz
- Division of General Medicine, Geriatrics, and Bioethics; Center for Healthcare Policy and Research, University of California, Davis, Sacramento, California
| | - Gary Weinberg
- Department of Sociology, Sonoma State University, Rohnert Park, California
| | - Penney Cowan
- American Chronic Pain Association, Rocklin, California
| | - Susan Verba
- Center for Design in the Public Interest, University of California, Davis, Davis, California
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Slostad JA, Wild EM, Anderson CM, Ingram C. Intractable Neck Pain in a Patient With Newly Diagnosed AML: An Underrecognized Cause of a Treatable Syndrome. J Pain Symptom Manage 2019; 57:e3-e5. [PMID: 30316808 DOI: 10.1016/j.jpainsymman.2018.10.490] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2018] [Revised: 10/02/2018] [Accepted: 10/03/2018] [Indexed: 10/28/2022]
MESH Headings
- Aged
- Atlanto-Axial Joint/diagnostic imaging
- Chondrocalcinosis/complications
- Chondrocalcinosis/diagnosis
- Chondrocalcinosis/drug therapy
- Diagnosis, Differential
- Humans
- Leukemia, Myeloid, Acute/complications
- Leukemia, Myeloid, Acute/diagnosis
- Leukemia, Myeloid, Acute/drug therapy
- Male
- Neck Pain/diagnosis
- Neck Pain/drug therapy
- Neck Pain/etiology
- Pain, Intractable/diagnosis
- Pain, Intractable/drug therapy
- Pain, Intractable/etiology
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Affiliation(s)
- Jessica A Slostad
- Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota, USA.
| | - Ellen M Wild
- Center for Palliative Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | | | - Cory Ingram
- Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota, USA; Center for Palliative Medicine, Mayo Clinic, Rochester, Minnesota, USA
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Lee DW, Huston C. Fluoroscopically-Guided Cervical Zygapophyseal Therapeutic Joint Injections May Reduce the Need for Radiofrequency. Pain Physician 2018; 21:E661-E665. [PMID: 30508997] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
BACKGROUND There is a paucity of literature studying therapeutic intraarticular zygapophyseal (commonly referred to as facet) joint injections in the atraumatic patient population. As a result of this, intraarticular injections have been dismissed as a possible treatment for cervical zygapophyseal joint-mediated pain. Radiofrequency neurotomy (RFN) is currently the accepted treatment for facet joint neck pain. OBJECTIVE This prospective observational study investigated injection response in an atraumatic population to determine treatment viability and whether injections reduce the need for RFN in neck pain patients. STUDY DESIGN Observational case series study. SETTING This study took place in the outpatient clinic of a private practice. METHODS The double-block paradigm (DBP) was used to determine if symptoms were zygapophyseal joint-mediated. Lidocaine and bupivacaine diagnostic injections were used. Participants passing the DBP underwent fluoroscopically-guided cervical zygapophyseal joint injections (betamethasone and 1% lidocaine) and 1 year of follow-up. Outcomes were a Verbal Numeric Scale score (VNS) > 2, 50% decrease in VNS, patient-reported improvement, and opioid use at the 1-year follow-up. RESULTS One hundred and eighteen patients were enrolled; 51 passed the DBP. These 51 patients underwent injections. Forty-four patients (59 joints) were surveyed 1 year later with 7 follow-up losses. Thirty-four of 59 joints showed ≥2-point VNS reductions or ≥ 50% overall symptomatic improvement after 1 year. Twenty-four of 44 ceased narcotics use. LIMITATIONS The limitations of this research included the lack of randomization and blinding, smaller sample size, and reliance on subjective reporting from the participants both immediately after the procedures and at follow-up. As this was a prospective observational study, there is the possibility of unintended bias by both patients as well as the authors. CONCLUSION Cervical zygapophyseal joint injections may reduce the need for RFN; additional studies are required. KEY WORDS Neck pain, facet joint, cervical zygapophyseal joint injections, radiofrequency neurotomy.
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Affiliation(s)
- David W Lee
- Centers of Rehabilitation and Pain Medicine, Placentia, CA
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41
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Horvath A, Westin O, Samuelsson K, Brisby H. [Not Available]. Lakartidningen 2018; 115:E7ET. [PMID: 30351871] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Affiliation(s)
- Alexandra Horvath
- Goteborgs universitet Institutionen for medicin - Invärtesmedicin och klinisk nutrition Goteborg, Sweden Goteborgs universitet Institutionen for medicin - Invärtesmedicin och klinisk nutrition Goteborg, Sweden
| | - Olof Westin
- Sahlgrenska universitetssjukhuset - Ortopedkliniken Goteborg, Sweden Goteborgs universitet Institutionen for kliniska vetenskaper - Avd för Ortopedi Goteborg, Sweden
| | - Kristian Samuelsson
- Sahlgrenska universitetssjukhuset - Ortopedkliniken Göteborg, Sweden Sahlgrenska universitetssjukhuset - Ortopedkliniken Göteborg, Sweden
| | - Helena Brisby
- Sahlgrenska Akademin, Göteborgs Universitet - Avd för ortopedi Göteborg, Sweden Univ of Gothenburg - Dept of Orthopaedics Gothenburg, Sweden
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42
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Beyaz SG, Sayhan H. Six-Month Results of Cervical Intradiscal Oxygen-Ozone Mixture Therapy on Patients with Neck Pain: Preliminary Findings. Pain Physician 2018; 21:E449-E456. [PMID: 30045611] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
BACKGROUND Numerous techniques have been developed for the treatment of disc herniation. Oxygen-ozone (O2-O3) mixture therapy is a minimally invasive percutaneous treatment for disc herniation. OBJECTIVE The aim of the study is to investigate the 6-month efficacy and safety of O2-O3 mixture therapy in patients with cervical disc herniation (CDH) and chronic neck pain. STUDY DESIGN This is a cross-sectional, single-center study. SETTING The study was conducted from January 2012 to May 2016 on patients visiting Sakarya University Training and Research Hospital's pain clinic. METHODS Each patient was evaluated before the procedure (baseline) and at 2 weeks (W2), 6 weeks (W6), and 6 months (M6) after the procedure using the visual analog scale (VAS) and the Oswestry Disability Index scores. RESULTS A total of 44 patients with CDH underwent the same treatment with an O2-O3 mixture. Significant pain relief was observed compared with preoperative pain at W2, W6, and M6 according to patient self-evaluation (P = 0.01). The mean VAS score was 7.89 ± 1.13 before the procedure, 4.22 ± 1.62 at W2, 3.03 ± 1.66 at W6, and 2.27 ± 1.25 at the end of M6. No significant complications or side effects were reported during or after the procedure. LIMITATIONS Our study was conducted retrospectively, which resulted in problems obtaining follow-up data. In addition, this study was performed in a small patient group. CONCLUSION Based on our results, intradiscal injection of an O2-O3 mixture treatment showed a beneficial long-term effect. KEY WORDS Cervical disc herniation, chemonucleolysis, injection, intradiscal, oxygen-ozone mixture, percutaneous treatment.
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Affiliation(s)
- Serbulent Gokhan Beyaz
- Department of Anesthesiology and Pain Medicine, Sakarya University Faculty of Medicine, Turkey
| | - Havva Sayhan
- Sakarya University Faculty of Medicine, Department of Anesthesiology and Pain Medicine, Sakarya
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Abstract
RATIONALE Spinal epidural abscess is an uncommon complication in clinical practice. If the abscess is large enough, the patient will rapidly develop neurologic signs of spinal injury, and urgent neurosurgical intervention may be required. PATIENT CONCERNS Rapid and correct diagnosis and treatment is important for spinal epidural abscess complication. DIAGNOSES This report describes a cervical epidural abscess (CEA) caused by epidural analgesia, wherein the patient was punctured twice. A CEA was suspected based on the patient's significant neck pain and elevated white blood cell and neutrophil counts. A CEA from C6 to T8 was confirmed by magnetic resonance imaging scan. INTERVENTIONS The patient was treated with a combination of intravenous vancomycin and imipenem/cilastatin for more than 4 weeks. OUTCOMES After more than 2 weeks of intensive antibiotic treatment, the epidural abscess gradually diminished in size, the white blood cell count, neutrophil count, hyperallergic C-reactive protein (CRP), and general CRP decreased, and the patient's neck and back pain resolved. After more than 4 weeks of anti-inflammation therapy, the epidural abscess was completely absorbed, and there was no relapse during the 3-month follow-up period. LESSONS Although an effective combination of intravenous antibiotics can cure an epidural abscess, caution is warranted when performing epidural steroid injections in immunocompromised patients.
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Affiliation(s)
- Jun-Hui Zhang
- 903 Hospital, Jiangyou City, Sichuan Province
- The Second Affiliated Hospital, State Key Clinical Specialty in Pain Medicine, Guangzhou Medical University, Guangzhou, Guangdong, P.R. China
| | - Zhi-Li Wang
- 903 Hospital, Jiangyou City, Sichuan Province
| | - Li Wan
- The Second Affiliated Hospital, State Key Clinical Specialty in Pain Medicine, Guangzhou Medical University, Guangzhou, Guangdong, P.R. China
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Lim JW, Cho YW, Lee DG, Chang MC. Comparison of Intraarticular Pulsed Radiofrequency and Intraarticular Corticosteroid Injection for Management of Cervical Facet Joint Pain. Pain Physician 2017; 20:E961-E967. [PMID: 28934800] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
BACKGROUND Disorders of the facet joints are some of the most common sources of chronic spinal pain. Facet joint pain is responsible for approximately 50% of patients with chronic neck pain. Pulsed radiofrequency (PRF) stimulation, after placing needle electrodes into the joint space, has been recently reported for the management of joint pain. OBJECTIVE The aim of this study was to evaluate the effect of intraarticular (IA) PRF for the management of cervical facet joint (CFJ) pain. In addition, we compared the effect of IA PRF to IA corticosteroid injection. STUDY DESIGN Prospective observational study. SETTING University hospital. METHODS Forty patients with CFJ pain were included in the study and randomly assigned to one of 2 groups: the IA PRF group and the IA corticosteroid (ICI) group. There were 20 patients in each group. Pain intensity was evaluated using a numeric rating scale (NRS) at pre-treatment, and one, 3, and 6 months after treatment. RESULTS When compared to the pretreatment NRS scores, patients in both groups showed a significant decrease in NRS scores at one, 3, and 6 months after treatment (P = 0.000). Changes in the NRS scores over time were not significantly different between the groups (P = 0.227). Six months after treatment, 10 patients (50.0%) in the PRF group and 12 patients (60.0%) in the ICI group reported successful pain relief (pain relief of = 50%). LIMITATIONS A small number of participants. CONCLUSION IA PRF stimulation is as effective as IA corticosteroid injection in attenuating CFJ pain. The use of PRF could decrease CFJ pain, while avoiding the adverse effects of steroids.Key words: Cervical facet joint pain, pulsed radiofrequency, intraarticular stimulation, chronic pain, corticosteroid injection, numeric rating scale.
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Affiliation(s)
- Ji Woon Lim
- Department of Physical Medicine and Rehabilitation, College of Medicine, Yeungnam University, Korea
| | - Yun-Woo Cho
- Yeungnam University School of Medicine and College of Medicine, Korea
| | - Dong Gyu Lee
- Department of Physical Medicine and Rehabilitation, College of Medicine, Yeungnam University, Korea
| | - Min Cheol Chang
- Department of Physical Medicine and Rehabilitation, College of Medicine, Yeungnam University, Korea
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Abstract
BACKGROUND AND OBJECTIVE A comparison of sick leave in pregnancy between countries is difficult as most studies have been conducted in single countries in Scandinavia. The objective of this study was to explore patterns of and reasons for sick leave during pregnancy on a multinational level, focusing on medication use but also differences in sick leave policies. DESIGN AND SETTING Cross-sectional, web-based study in 12 European countries from October 2011 to February 2012. Data were collected via an electronic questionnaire. PARTICIPANTS Pregnant women and mothers of children under the age of 1 year. PRIMARY OUTCOME MEASURE Sick leave prevalence in pregnancy. RESULTS Of 6686 women included, 3385 (50.6%) had been on sick leave during pregnancy. The rates of sick leave varied across countries, ranging from 31.7%-34.8% in Sweden and the UK to 62.4%-71.3% in Norway, Serbia, Croatia and Poland. The most common reasons for being on sick leave were pregnancy complications (26.5%); pain in the neck, back or pelvic girdle (16.2%); and nausea and vomiting (NVP, 16.0%). Women using medications for acute illnesses were more likely to be on sick leave than their non-medicated counterparts, while an opposite trend was observed for women with chronic disorders, where non-medicated women were more likely to be on sick leave. Women from countries with 'low' sick leave policies were less likely to have extensions of sick leaves compared with women from countries with 'medium' policies (adjusted OR 0.63, 95% CI 0.49 to 0.82). CONCLUSION The rates of sick leave in pregnancy vary greatly across European countries. Women using medications were more likely to be on sick leave, especially for acute illnesses. The differences in sick leave patterns across countries only partially reflected differences in sick leave policies, which implies that sick leave in pregnancy is also affected by other national differences.
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Affiliation(s)
- Bich Thuy Truong
- PharmacoEpidemiology and Drug Safety Research Group, Department of Pharmacy, School of Pharmacy, University of Oslo, Oslo, Norway
| | - Angela Lupattelli
- PharmacoEpidemiology and Drug Safety Research Group, Department of Pharmacy, School of Pharmacy, University of Oslo, Oslo, Norway
| | - Petter Kristensen
- Department of Occupational Medicine and Epidemiology, National Institute of Occupational Health, Oslo, Norway
- Preventive Medicine and Epidemiology Research Group, Institute of Health and Society, University of Oslo, Oslo, Norway
| | - Hedvig Nordeng
- PharmacoEpidemiology and Drug Safety Research Group, Department of Pharmacy, School of Pharmacy, University of Oslo, Oslo, Norway
- Department of Child Health, Norwegian Institute of Public Health, Oslo, Norway
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Trosch RM, Espay AJ, Truong D, Gil R, Singer C, LeWitt PA, Lew MF, Tagliati M, Adler CH, Chen JJ, Marchese D, Comella CL. Multicenter observational study of abobotulinumtoxinA neurotoxin in cervical dystonia: The ANCHOR-CD registry. J Neurol Sci 2017; 376:84-90. [PMID: 28431634 DOI: 10.1016/j.jns.2017.02.042] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2017] [Accepted: 02/17/2017] [Indexed: 11/19/2022]
Abstract
BACKGROUND The ANCHOR-CD prospective observational registry study evaluated the effectiveness of abobotulinumtoxinA in adult idiopathic cervical dystonia (CD) in clinical practice. METHODS Adults with CD were eligible. Treating physicians determined abobotulinumtoxinA dose and treatment interval. The primary endpoint was patient response rate (Toronto Western Spasmodic Torticollis Rating Scale [TWSTRS] score reduction≥25% and Patient Global Impression of Change [PGIC] score of +2 or +3 at Week 4 of Cycle 1). RESULTS 350 patients enrolled (75% women; mean age 59±13.6years; 27.4% botulinum neurotoxin-naive) and 347 received at least 1 treatment. The median abobotulinumtoxinA dose for Cycle 1 was 500 Units. At Week 4, the responder rate was 30.6% (n=304) and the TWSTRS total score decreased 27.4% from baseline. PGIC of at least "Much improved" was documented in 43.6% of patients and maintained in Cycles 2 through 4 (43.3%, 48.9%, and 52.8%, respectively). A total of 39 adverse events (31 study drug-related) were reported in 17 patients (5%); the most common were dysphagia (n=6), muscle weakness (n=4), and neck pain (n=3). CONCLUSION This study confirmed the beneficial effect of abobotulinumtoxinA on CD in routine clinical practice as measured by improvements in TWSTRS and PGIC. No new safety concerns were identified.
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Affiliation(s)
- Richard M Trosch
- Oakland University William Beaumont School of Medicine, 32255 Northwestern Highway, Suite 40, Farmington Hills, MI 48334, United States.
| | - Alberto J Espay
- Department of Neurology, UC Neuroscience Institute, University of Cincinnati, 260 Stetson Street, Cincinnati, OH 45267, United States.
| | - Daniel Truong
- The Parkinson's and Movement Disorder Institute, 9940 Talbert Avenue, Fountain Valley, CA 92708, United States.
| | - Ramon Gil
- Parkinson's Disease Treatment Center of Southwest Florida, 4235 King Highway, Port Charlotte, FL 33980, United States.
| | - Carlos Singer
- Center for Parkinson's Disease and Movement Disorders, Department of Neurology, University of Miami, Leonard M. Miller School of Medicine, 1150 NW 14th Street, Miami, FL 33136, United States.
| | - Peter A LeWitt
- Parkinson's Disease and Movement Disorders Program, Henry Ford Hospital, Wayne State University School of Medicine, 6777 W Maple Road, West Bloomfield, MI 48322, United States.
| | - Mark F Lew
- Division of Movement Disorders, Department of Neurology, University of Southern California, Keck School of Medicine, 1520 San Pablo Street #3000, Los Angeles, CA 90033, United States.
| | - Michele Tagliati
- Department of Neurology, Cedars-Sinai Medical Center, 8631 W 3rd St #215e, Los Angeles, CA 90048, United States.
| | - Charles H Adler
- Department of Neurology, Mayo Clinic, 13400 E Shea Blvd, Scottsdale, AZ 85259, United States.
| | - Jack J Chen
- College of Pharmacy, Marshall B. Ketchum University, 2575 Yorba Linda Blvd, Fullerton, CA 92831, United States.
| | - Dominic Marchese
- Ipsen Biopharmaceuticals, Inc., 106 Allen Rd, Basking Ridge, NJ 07920, United States.
| | - Cynthia L Comella
- Department of Neurological Sciences, Rush University Medical Center, 1725 West Harrison Street, Chicago, IL 60612, United States.
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Joswig H, Neff A, Ruppert C, Hildebrandt G, Stienen MN. The value of short-term pain relief in predicting the 1-month outcome of 'indirect' cervical epidural steroid injections. Acta Neurochir (Wien) 2017; 159:291-300. [PMID: 27796650 DOI: 10.1007/s00701-016-2997-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2016] [Accepted: 10/13/2016] [Indexed: 11/25/2022]
Abstract
BACKGROUND Clinical management after epidural steroid injections (ESI) of patients with radiculopathy secondary to a cervical disc herniation (CDH) is uncertain. This study aims to determine whether short-term arm pain alleviation following computed tomography-guided 'indirect' cervical ESI can predict the 1-month outcome. METHODS We conducted a prospective observation of 45 consecutive patients at a tertiary radiological department. Study components were visual analog scale arm and neck pain at baseline, 15, 30, and 45 min, 1, 2, and 4 h, on days 1-14, 1 month, and at 1 year. Health-related quality of life and functional impairment were assessed using the short form-12 and Neck Pain and Disability Scale. Patients who reported ≥80 % persisting arm pain, as well as patients who underwent a second injection or an operation within 1 month were defined as 'non-responders'. Logistic regression was used to analyze the effect size of the relationship between >50 % pain relief at any given study visit and responder status. RESULTS Patients experiencing a >50 % pain reduction 4 h after the injection were four times as likely to be responders as those experiencing ≤50 % pain reduction (OR 4.04, 95 % CI 1.10-14.87). The effect was strongest on days 5-6 (OR 18.37, 95 % CI 3.39-99.64) and remained significant until day 14. CONCLUSIONS The results of this study can guide physicians in managing patients with CDH: a ≤50 % arm pain relief within 1 week after an 'indirect' cervical ESI predicts an unfavorable 1-month outcome and suggests that other treatment options may be considered at an earlier point in time.
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Affiliation(s)
- Holger Joswig
- Department of Neurosurgery, Cantonal Hospital St. Gallen, Rorschacher Strasse 95, 9007, St. Gallen, Switzerland.
| | - Armin Neff
- Department of Radiology, Cantonal Hospital St. Gallen, St. Gallen, Switzerland
| | | | - Gerhard Hildebrandt
- Department of Neurosurgery, Cantonal Hospital St. Gallen, Rorschacher Strasse 95, 9007, St. Gallen, Switzerland
| | - Martin Nikolaus Stienen
- Department of Neurosurgery and Faculty of Medicine, University Hospital of Geneva, Geneva, Switzerland
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Faour M, Anderson JT, Haas AR, Percy R, Woods ST, Ahn UM, Ahn NU. Neck Pain, Preoperative Opioids, and Functionality After Cervical Fusion. Orthopedics 2017; 40:25-32. [PMID: 27755643 DOI: 10.3928/01477447-20161013-02] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2015] [Accepted: 08/23/2016] [Indexed: 02/03/2023]
Abstract
The use of opioids among patients with workers' compensation claims is associated with tremendous costs, especially for patients who undergo spinal surgery. This study compared return-to-work rates after single-level cervical fusion for degenerative disk disease between patients who received opioids before surgery and patients who underwent fusion with no previous opioid use. All study subjects qualified for workers' compensation benefits for injuries sustained at work between 1993 and 2011. The study population included 281 subjects who underwent single-level cervical fusion for degenerative disk disease with International Classification of Diseases, Ninth Revision, and Current Procedural Terminology code algorithms. The opioid group included 77 subjects who received opioids preoperatively. The control group included 204 subjects who had surgery with no previous opioid use. The primary outcome was meeting return-to-work criteria within 3 years of follow-up after fusion. Secondary outcome measures after surgery, surgical details, and presurgical characteristics for each cohort also were collected. In 36.4% of the opioid group, return-to-work criteria were met compared with 56.4% of the control group. Patients who took opioids were less likely to meet return-to-work criteria compared with the control group (odds ratio, 0.44; 95% confidence interval, 0.26-0.76; P=.0028). Return-to-work rates within the first year after fusion were 24.7% for the opioid group and 45.6% for the control group (P=.0014). Patients who used opioids were absent from work for 255 more days compared with the control group (P=.0001). The use of opioids for management of diskogenic neck pain, with the possibility of surgical intervention, is a negative predictor of successful return to work after fusion in a workers' compensation population. [Orthopedics. 2017; 40(1):25-32.].
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Park JY, Kim DH, Lee K, Choi SS, Leem JG. Optimal volume of injectate for fluoroscopy-guided cervical interlaminar epidural injection in patients with neck and upper extremity pain. Medicine (Baltimore) 2016; 95:e5206. [PMID: 27787378 PMCID: PMC5089107 DOI: 10.1097/md.0000000000005206] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/30/2023] Open
Abstract
There is no study of optimal volume of contrast medium to use in cervical interlaminar epidural injections (CIEIs) for appropriate spread to target lesions. To determine optimal volume of contrast medium to use in CIEIs. We analyzed the records of 80 patients who had undergone CIEIs. Patients were divided into 3 groups according to the amount of contrast: 3, 4.5, and 6 mL. The spread of medium to the target level was analyzed. Numerical rating scale data were also analyzed. The dye had spread to a point above the target level in 15 (78.9%), 22 (84.6%), and 32 (91.4%) patients in groups 1 to 3, respectively. The dye reached both sides in 14 (73.7%), 18 (69.2%), and 23 (65.7%) patients, and reached the ventral epidural space in 15 (78.9%), 22 (84.6%), and 30 (85.7%) patients, respectively. There were no significant differences of contrast spread among the groups. There were no significant differences in the numerical rating scale scores among the groups during the 3 months. When performing CIEIs, 3 mL medication is sufficient volume for the treatment of neck and upper-extremity pain induced by lower cervical degenerative disease.
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Affiliation(s)
| | | | | | | | - Jeong-Gil Leem
- Department of Anesthesiology and Pain Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
- Correspondence: Jeong-Gil Leem, Department of Anesthesiology and Pain Medicine, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul 05505, Republic of Korea (e-mail: )
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Lin CWC, McLachlan AJ, Latimer J, Day RO, Billot L, Koes BW, Maher CG. OPAL: a randomised, placebo-controlled trial of opioid analgesia for the reduction of pain severity in people with acute spinal pain. Trial protocol. BMJ Open 2016; 6:e011278. [PMID: 27558901 PMCID: PMC5013345 DOI: 10.1136/bmjopen-2016-011278] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
INTRODUCTION Low back pain and neck pain are extremely prevalent and are responsible for an enormous burden of disease globally. Strong analgesics, such as opioid analgesics, are recommended by clinical guidelines for people with acute low back pain or neck pain who are slow to recover and require more pain relief. Opioid analgesics are widely and increasingly used, but there are no strong efficacy data supporting the use of opioid analgesics for acute low back pain or neck pain. Concerns regarding opioid use are further heightened by the risks of adverse events, some of which can be serious (eg, dependency, misuse and overdose). METHODS AND ANALYSIS OPAL is a randomised, placebo-controlled, triple-blinded trial that will investigate the judicious use of an opioid analgesic in 346 participants with acute low back pain and/or neck pain who are slow to recover. Participants will be recruited from general practice and randomised to receive the opioid analgesic (controlled release oxycodone plus naloxone up to 20 mg per day) or placebo in addition to guideline-based care (eg, reassurance and advice of staying active) for up to 6 weeks. Participants will be followed-up for 3 months for effectiveness outcomes. The primary outcome will be pain severity. Secondary outcomes will include physical functioning and time to recovery. Medication-related adverse events will be assessed and a cost-effectiveness analysis will be conducted. We will additionally assess long-term use and risk of misuse of opioid analgesics for up to 12 months. ETHICS AND DISSEMINATION Ethical approval has been obtained. Trial results will be disseminated by publications and conference presentations, and via the media. TRIAL REGISTRATION NUMBER ACTRN12615000775516: Pre-results.
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Affiliation(s)
- Chung-Wei Christine Lin
- The George Institute for Global Health and Sydney Medical School, The University of Sydney, Sydney, New South Wales, Australia
| | - Andrew J McLachlan
- Faculty of Pharmacy and The Centre for Education and Research on Ageing (CERA), The University of Sydney and Concord Hospital, Sydney, New South Wales, Australia
| | - Jane Latimer
- The George Institute for Global Health and Sydney Medical School, The University of Sydney, Sydney, New South Wales, Australia
| | - Ric O Day
- Department of Clinical Pharmacology & Toxicology, St Vincent's Hospital Sydney and Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia
| | - Laurent Billot
- The George Institute for Global Health and Sydney Medical School, The University of Sydney, Sydney, New South Wales, Australia
| | - Bart W Koes
- Department of General Practice, Erasmus MC, Rotterdam, The Netherlands
| | - Chris G Maher
- The George Institute for Global Health and Sydney Medical School, The University of Sydney, Sydney, New South Wales, Australia
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