scholarly journals Cervical Spinal Cord and Dorsal Nerve Root Stimulation for Neuropathic Upper Limb Pain

2016 ◽  
Vol 44 (1) ◽  
pp. 83-89 ◽  
Author(s):  
Adrian B. Levine ◽  
Andrew G. Parrent ◽  
Keith W. MacDougall
Keyword(s):  
Neuropathic Pain ◽  
Upper Limb ◽  
Analogue Scale ◽  
Visual Analogue Scale Pain ◽  
Limb Pain ◽  
Chronic Neuropathic Pain ◽  
Analogue Scale Pain ◽  
Dorsal Nerve ◽  
Upper Limb Pain ◽  
Root Stimulation

AbstractBackground: Spinal cord stimulation (SCS) is a well-established treatment for chronic neuropathic pain in the lower limbs. Upper limb pain comprises a significant proportion of neuropathic pain patients, but is often difficult to target specifically and consistently with paresthesias. We hypothesized that the use of dorsal nerve root stimulation (DNRS), as an option along with SCS, would help us better relieve pain in these patients. Methods: All 35 patients trialed with spinal stimulation for upper limb pain between July 1, 2011, and October 31, 2013, were included. We performed permanent implantation in 23/35 patients based on a visual analogue scale pain score decrease of ≥50% during trial stimulation. Results: Both the SCS and DNRS groups had significant improvements in average visual analogue scale pain scores at 12 months compared with baseline, and the majority of patients in both groups obtained ≥50% pain relief. The majority of patients in both groups were able to reduce their opioid use, and on average had improvements in Short Form-36 quality of life scores. Complication rates did not differ significantly between the two groups. Conclusions: Treatment with SCS or DNRS provides meaningful long-term relief of chronic neuropathic pain in the upper limbs.

scholarly journals THE PREVALENCE OF UPPER LIMB PAIN AMONG VEENA PLAYERS: A CROSS-SECTIONAL SURVEY

2017 ◽  
Vol 7 (3) ◽  
pp. 326-331
Author(s):  
Haari Haran Arumugam ◽  
Thirumalaya Balaraman ◽  
Balwant Singh Bains ◽  
Hassan Sadeghi
Keyword(s):  
Visual Analogue Scale ◽  
Upper Limb ◽  
Analogue Scale ◽  
Descriptive Analysis ◽  
Limb Pain ◽  
Cross Sectional Survey ◽  
Cross Sectional ◽  
Repetitive Motion ◽  
Upper Limb Pain ◽  
Low Prevalence

Background: Instrumental musicians are a special risk group for repetitive motion injuries. Sizable percentages of them develop physical upper limb problems related to playing their instruments. Objective: The objective of this study was to investigate the prevalence of Upper Limb pain among Veena players. Method: This study was a descriptive cross sectional survey and fifty Veena Players participated in this study from a Music Academy. Trained Veena players aged between 12-50 and players who practice at least 3 times a week were included in the study. The period of pain, types of pain and location of pain were investigated by a self-developed questionnaire. In addition, Visual Analogue Scale (VAS) was also used to record the intensity of pain. Results: Descriptive analysis was used to analysis the data. The results showed that most of player had pain on shoulder; in addition, according to Visual Analogue Scale (VAS) most of participants have dull aching pain and shooting pain. Conclusion: In conclusion, this study's results also show that there is a low prevalence of Upper Limb pain among Veena players. Multiple evidences show that Upper Limb pain is indeed prevalent predominantly among musicians of Western music. In most of the time the pain type is of dull aching and/or shooting pain.

scholarly journals Field testing of the revised neuropathic pain grading system in a cohort of patients with neck and upper limb pain

2019 ◽  
Vol 19 (3) ◽  
pp. 523-532 ◽  
Author(s):  
Brigitte Tampin ◽  
Rachel Elizabeth Broe ◽  
Lee Lee Seow ◽  
Shushana Gijohn George ◽  
Jiajie Tan ◽  
...  
Keyword(s):  
Neuropathic Pain ◽  
Diagnostic Accuracy ◽  
Upper Limb ◽  
Field Testing ◽  
Clinical Findings ◽  
Screening Tools ◽  
Grading System ◽  
Limb Pain ◽  
Medicine Physician ◽  
Upper Limb Pain

Abstract Background and aims In 2008, the International Association for the Study of Pain Special Interest Group on Neuropathic Pain (NeuPSIG) proposed a clinical grading system to help identify patients with neuropathic pain (NeP). We previously applied this classification system, along with two NeP screening tools, the painDETECT (PD-Q) and Leeds Assessment of Neuropathic Symptoms and Signs pain scale (LANSS), to identify NeP in patients with neck/upper limb pain. Both screening tools failed to identify a large proportion of patients with clinically classified NeP, however a limitation of our study was the use of a single clinician performing the NeP classification. In 2016, the NeuPSIG grading system was updated with the aim of improving its clinical utility. We were interested in field testing of the revised grading system, in particular in the application of the grading system and the agreement of interpretation of clinical findings. The primary aim of the current study was to explore the application of the NeuPSIG revised grading system based on patient records and to establish the inter-rater agreement of detecting NeP. A secondary aim was to investigate the level of agreement in detecting NeP between the revised NeuPSIG grading system and the LANSS and PD-Q. Methods In this retrospective study, two expert clinicians (Specialist Pain Medicine Physician and Advanced Scope Physiotherapist) independently reviewed 152 patient case notes and classified them according to the revised grading system. The consensus of the expert clinicians’ clinical classification was used as “gold standard” to determine the diagnostic accuracy of the two NeP screening tools. Results The two clinicians agreed in classifying 117 out of 152 patients (ICC 0.794, 95% CI 0.716–850; κ 0.62, 95% CI 0.50–0.73), yielding a 77% agreement. Compared to the clinicians’ consensus, both LANSS and PD-Q demonstrated limited diagnostic accuracy in detecting NeP (LANSS sensitivity 24%, specificity 97%; PD-Q sensitivity 53%, specificity 67%). Conclusions The application of the revised NeP grading system was feasible in our retrospective analysis of patients with neck/upper limb pain. High inter-rater percentage agreement was demonstrated. The hierarchical order of classification may lead to false negative classification. We propose that in the absence of sensory changes or diagnostic tests in patients with neck/upper limb pain, classification of NeP may be further improved using a cluster of clinical findings that confirm a relevant nerve lesion/disease, such as reflex and motor changes. The diagnostic accuracy of LANSS and PD-Q in identifying NeP in patients with neck/upper limb pain remains limited. Clinical judgment remains crucial to diagnosing NeP in the clinical practice. Implications Our observations suggest that in view of the heterogeneity in patients with neck/upper limb pain, a considerable amount of expertise is required to interpret the revised grading system. While the application was feasible in our clinical setting, it is unclear if this will be feasible to apply in primary health care settings where early recognition and timely intervention is often most needed. The use of LANSS and PD-Q in the identification of NeP in patients with neck/upper limb pain remains questionable.

scholarly journals Successful Long-term Nerve Root Stimulation for Chronic Neuropathic Pain: A Real World, Single Center Canadian Experience

2017 ◽  
Vol 2 (20;2) ◽  
pp. 95-106
Author(s):  
Keith W. MacDougall
Keyword(s):  
Neuropathic Pain ◽  
Nerve Root ◽  
Chronic Neuropathic Pain ◽  
Sf 36 ◽  
Permanent Implants ◽  
Dorsal Nerve ◽  
Root Stimulation

Background: Spinal cord stimulation (SCS) is a well-established treatment for chronic neuropathic pain in the lower limbs. However, some patients have pain in distributions that are difficult to target specifically and consistently with SCS. This often involves pain in the groin or upper limbs, or pain limited to a specific dermatome. We hypothesized that dorsal nerve root stimulation (DNRS) would provide similar pain relief for these patients, compared to our results using SCS. Objectives: In this study we report our experience treating patients with chronic neuropathic pain using SCS and DNRS. Study Design: Open label, prospective study that includes all patients treated with a new trial stimulator system at a single center between July 1, 2011, and October 31, 2013. Setting: Academic university neurosurgical pain center. Methods: One hundred thirty-two consecutive patients had trials of spinal stimulation. Seventy-six patients went on to permanent implants, of which 26 received only DNRS, 47 only SCS, and 3 both. The technique was selected based on clinical assessment and intraoperative test stimulation. Other than pain location and diagnosis, the DNRS and SCS groups had similar baseline characteristics. Follow-up is reported at 12 months. Patients were assessed using a visual analogue scale (VAS) for pain, the SF-36 for quality of life, and the morphine equivalent daily dose (MEDD). Results: At 12 months, the average VAS score for the DNRS group had decreased from 7.5 (SD 1.4) to 4.4 (SD 2.6) and 47% of patients with permanent implants achieved > 50% pain reduction. There were improvements in all subscores and component summary scores of the SF-36. The MEDD had been reduced in 55% of the patients with available data. There was no significant difference in complication or revision rates between the 2 groups. Limitations: Patients were not randomized to treatment groups, and instead were assigned to SCS or DNRS based on what was expected to provide superior pain coverage. There is incomplete follow-up data for some patients due to missed clinic visits. Conclusion: In our study, DNRS provided excellent pain reduction, quality of life improvement, and opioid medication use decreases. We conclude that it is an effective long-term treatment for chronic neuropathic pain. Key words: Spinal cord stimulation, dorsal nerve root stimulation, lumbar, thoracic, cervical, neuropathic pain, neuromodulation, clinical effectiveness, chronic pain, visual analogue scale

scholarly journals Identification of neuropathic pain in patients with neck/upper limb pain: Application of a grading system and screening tools

Pain ◽  
2013 ◽  
Vol 154 (12) ◽  
pp. 2813-2822 ◽  
Author(s):  
Brigitte Tampin ◽  
Noelle Kathryn Briffa ◽  
Roger Goucke ◽  
Helen Slater
Keyword(s):  
Neuropathic Pain ◽  
Upper Limb ◽  
Screening Tools ◽  
Grading System ◽  
Limb Pain ◽  
Upper Limb Pain

scholarly journals Successful application of burst spinal cord stimulation for refractory upper limb pain: a case series

2021 ◽  
Vol 49 (3) ◽  
pp. 030006052110040
Author(s):  
Kuen Su Lee ◽  
Yoo Kyung Jang ◽  
Gene Hyun Park ◽  
In Jae Jun ◽  
Jae Chul Koh
Keyword(s):  
Spinal Cord ◽  
Upper Limb ◽  
Spinal Cord Stimulation ◽  
Therapeutic Potential ◽  
Case Series ◽  
Limb Amputation ◽  
Intractable Pain ◽  
Limb Pain ◽  
Cord Injury ◽  
Upper Limb Pain

Spinal cord stimulation (SCS) has been used to treat sustained pain that is intractable despite various types of treatment. However, conventional tonic waveform SCS has not shown promising outcomes for spinal cord injury (SCI) or postamputation pain. The pain signal mechanisms of burst waveforms are different to those of conventional tonic waveforms, but few reports have presented the therapeutic potential of burst waveforms for the abovementioned indications. This current case report describes two patients with refractory upper limb pain after SCI and upper limb amputation that were treated with burst waveform SCS. While the patients could not obtain sufficient therapeutic effect with conventional tonic waveforms, the burst waveforms provided better pain reduction with less discomfort. However, further studies are necessary to better clarify the mechanisms and efficacy of burst waveform SCS in patients with intractable pain.

scholarly journals The Minimum Clinically Significant Difference in Visual Analogue Scale Pain Score in a Local Emergency Setting

2009 ◽  
Vol 16 (4) ◽  
pp. 233-236 ◽  
Author(s):  
MSM Mark ◽  
TTS Au ◽  
YF Choi ◽  
TW Wong
Keyword(s):  
Visual Analogue Scale ◽  
Pain Score ◽  
Analogue Scale ◽  
Education Level ◽  
Chinese Patients ◽  
Visual Analogue Scale Pain ◽  
Emergency Setting ◽  
Significant Difference ◽  
Analogue Scale Pain ◽  
Clinically Significant

Objectives To determine whether the minimum clinically significant difference (MCSD) in visual analogue scale (VAS) pain score varies with age, gender, education level and cause of pain (trauma versus non-trauma) in Chinese patients. Methods This was a prospective descriptive study of local Chinese patients 15 years of age or older who presented with pain to the accident & emergency department. On presentation, patients were asked to indicate their current pain severity with a single mark through a standard 100–mm visual analogue scale. Then they would be offered an analgesic for pain-relief. After 30–45 minutes, the patients were asked to give a verbal categorical rating of their pain as ‘a lot better’, ‘a little better’, ‘much the same’, ‘a little worse’, or ‘much worse’ and to mark the level of pain on a VAS of the same type as used previously. The MCSD in VAS pain score was defined as the mean difference between the current and preceding scores when the subject reported ‘a little worse’ or ‘a little better’ in pain. Data were compared based on gender, age, education level, and traumatic versus non-traumatic causes of pain. Results 186 patients were enrolled in the study, yielding 77 evaluable comparisons where pain was rated as ‘a little better’ or ‘a little worse’. Overall, the MCSD in VAS pain score in the group was 17 mm (95%CI 13.6 mm to 20.6 mm). There were statistically significant differences between the MCSD in VAS pain score between genders and causes of pain (trauma versus non-trauma). Conclusions The MCSD in VAS pain scores was found to be 17 mm. There was significant differences in MCSD in VAS pain score in different genders and between trauma and non-trauma cases.

scholarly journals Common challenges in managing neck and upper limb pain in office workers

2019 ◽  
Vol 48 (11) ◽  
pp. 746-750
Author(s):  
Brendan Mouatt ◽  
Steven J Kamper
Keyword(s):  
Upper Limb ◽  
Office Workers ◽  
Limb Pain ◽  
Upper Limb Pain

scholarly journals Superior vena cava obstruction with thrombolytic therapy in primary antiphospholipid syndrome

2021 ◽  
Author(s):  
Manal Adel ◽  
Marwa Mashaal ◽  
Kareem Mahmoud ◽  
Shady Mashhour ◽  
Haytham Soliman
Keyword(s):  
Thrombolytic Therapy ◽  
Superior Vena Cava ◽  
Antiphospholipid Syndrome ◽  
Upper Limb ◽  
Superior Vena ◽  
Vena Cava ◽  
Primary Antiphospholipid Syndrome ◽  
Superior Vena Cava Obstruction ◽  
Limb Pain ◽  
Upper Limb Pain

We report a case of superior vena cava obstruction of a 39 years old female patient with primary antiphospholipid syndrome presented with upper limb pain and swelling ,which improved on thrombolytic therapy ,we review patients with Antiphospholipid syndrome and management with thrombolytic therapy .

scholarly journals Surveillance case definitions for work related upper limb pain syndromes

1998 ◽  
Vol 55 (4) ◽  
pp. 264-271 ◽  
Author(s):  
J. M. Harrington ◽  
J. T. Carter ◽  
L. Birrell ◽  
D. Gompertz
Keyword(s):  
Upper Limb ◽  
Limb Pain ◽  
Case Definitions ◽  
Work Related ◽  
Pain Syndromes ◽  
Upper Limb Pain

scholarly journals Analgesic efficacy of meloxicam with or without a buprenorphine patch in cats after ovariohysterectomy

2018 ◽  
Vol 63 (No. 6) ◽  
pp. 279-286
Author(s):  
SY Heo ◽  
SJ Kim ◽  
NS Kim
Keyword(s):  
Visual Analogue Scale ◽  
Analogue Scale ◽  
Small Sample Size ◽  
Analgesic Efficacy ◽  
Small Sample ◽  
Visual Analogue Scale Pain ◽  
Pain Scores ◽  
Analogue Scale Pain ◽  
Group A ◽  
Group B

The purpose of this prospective double blind clinical study was to evaluate the analgesic efficacy of meloxicam with/without a buprenorphine patch for pain management after ovariohysterectomy in cats. Cats were randomly divided into two groups: ten cats were treated with meloxicam s.c. after ovariohysterectomy (Group A), and eight cats were treated with s.c. meloxicam and a 20 µg/h buprenorphine transdermal patch (Group B). For patch treatment, the cat’s hair was clipped on the left side in the thoracic area. Pain scores were assessed at 0.5, 1, 2, 4, 6, 8, 24 and 30 h post-ovariohysterectomy extubation. To evaluate postoperative pain, 4A-VET pain scale and visual analogue scale pain scores were used. In addition, blood was collected from all cats to determine the cortisol levels at –2 h and at 0.5, 4, 6 and 24 h after extubation. The 4A-VET scores for Group B were significantly lower at 1, 4, 6, 8, 24 and 30 h than the scores for Group A. The visual analogue scale pain scores for Group B were significantly lower at 4, 6, 24 and 30 h than the scores for Group A. Serum cortisol concentrations were not significantly different between Groups A and B at any of the measured intervals. There was a significant positive correlation between postoperative visual analogue scale and 4A-VET pain scores in both groups. Our results should be subject to careful interpretation as the study was limited by its small sample size and by observer subjectivity.

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