Acute Cervical Radiculopathy Outcomes: Soft Disc Herniations vs Osteophytes

Abstract Objective Prospectively evaluate the clinical outcomes of acute cervical radiculopathy with respect to soft disc herniations vs osteophytes. Methods Sixty consecutive patients who had had cervical radiculopathy for ≤1 month were enrolled in the study. Inclusion criteria were radicular pain greater than axial pain and a pain score ≥4 out of 10 on a numerical rating scale. Patients had at least one positive clinical finding: motor, sensory, or reflex changes. Plain films and magnetic resonance imaging were ordered. Follow-up was at 6 weeks and 3, 6, and 12 months. Outcomes included pain scores (neck and upper limb), neck disability index, medication use, opioid use, and need for surgery. Two attending musculoskeletal radiologists reviewed imaging findings for osteophytes vs soft disc herniations at the symptomatic level. Results More than 75% reduction in pain was seen in 77% of patients with soft disc herniations and 66% of patients with osteophytes (P > 0.05) at 12 months. A pain score ≤2 out of 10 within 6 to 12 months was seen in 86% of patients with soft disc herniations and 81% of patients with osteophytes (P > 0.05). Moderate or marked improvement at 12 months was seen in 85% of patients with soft discs and 77% of patients with osteophytes (P > 0.05). Baseline–to–12-month numerical rating scale pain scores of patients with soft discs vs osteophytes had overlapping confidence intervals at each follow-up. At 12 months, very few had undergone surgery (7% of patients with soft discs, 11% of patients with osteophytes; P > 0.05) or were on opioids (7% of patients with soft discs, 9% of patients with osteophytes; P > 0.05). Conclusions The majority of patients, but not all patients, with acute radiculopathies improved with time. This was seen with both soft disc herniations and osteophytes.

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High revision rates with the metal-on-metal Motec carpometacarpal joint prosthesis

Journal of Hand Surgery (European Volume) ◽

10.1177/1753193415595527 ◽

2015 ◽

Vol 41 (3) ◽

pp. 322-327 ◽

Cited By ~ 16

Author(s):

J. K. Thillemann ◽

T. M. Thillemann ◽

B. Munk ◽

K. Krøner

Keyword(s):

Rating Scale ◽

Revision Rate ◽

Numerical Rating Scale ◽

Elevated Serum ◽

Consecutive Series ◽

Dash Score ◽

Level Of Evidence ◽

Pain Scores ◽

Thumb Carpometacarpal

We retrospectively evaluated a consecutive series of 42 Motec thumb carpometacarpal total joint arthroplasties. The primary endpoint was revision with implant removal and trapeziectomy. At follow-up the disability of the arm shoulder and hand (DASH) score, pain on numerical rating scale at rest and with activity and serum chrome and cobalt concentrations were assessed for both unrevised and revised patients. At a mean follow-up of 26 months, 17 patients had been revised. The 2 year cumulative revision rate was 42% (95% CI, 28–60%). The DASH score and pain scores at rest and with activity were comparable between the patients whose thumbs remained unrevised and those revised. Patients with elevated serum chrome and cobalt levels had significantly higher DASH and pain scores, but elevated levels were not associated with revision. The revision rate in this study is unacceptably high. However, pain and DASH scores after revision are acceptable and comparable with patients with non-revised implants. Level of evidence: IV

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Clinical Efficacy of Scalene Injection for Thoracic Outlet Syndrome

Archives of Hand and Microsurgery ◽

10.12790/ahm.20.0064 ◽

2021 ◽

Author(s):

Samuel Baek ◽

Seok Kim ◽

Myung Ho Shin ◽

Tae Min Kim ◽

Seoung-Joon Lee ◽

...

Keyword(s):

Side Effects ◽

Clinical Efficacy ◽

Rating Scale ◽

Numerical Rating Scale ◽

Neck Disability Index ◽

Vital Signs ◽

Treatment Technique ◽

The Novel ◽

Numerical Rating ◽

Neck Disability

Purpose: We introduce the novel treatment technique, scalene injection, and study its clinical efficacy for diagnosis, treatment, and pain control for patients with thoracic outlet syndrome.Methods: Between November 2001 and October 2018, 266 patients were studied retrospectively. To evaluate the efficacy and sustainability, we checked the numerical rating scale (NRS) for pain relief and neck disability index (NDI) for functional improvements, prior to and 1, 12 weeks after the injection. The safety was evaluated by examining side effects for at least 24 hours from the point of injection.Results: NRS was improved from 7.12 to 3.11 at 1 week, and to 3.05 at 12 weeks (p<0.05). NDI was improved from 15.87 to 6.15 at 1 week, and to 6.19 at 12 weeks (p<0.05). There were two cases of convulsion immediately after the injection and were treated with prompt oxygen supply and sedatives. Transient side effects included two cases of dyspnea and one case of nausea and were resolved within 1 hour after. All five cases showed symptoms of side effects on the day of injection and were resolved within a day. A total of 242 patients (91.0%) experienced immediate declines in NRS and 161 patients experienced persistent declines for more than 12 weeks. However, 24 patients (9.0%) showed no improvement and 20 patients (7.5%) experienced increases in NRS.Conclusion: Scalene injection is also effective as a therapeutic method. However, this study suggests that it must be done with monitoring of vital signs in an operating room for any possible complications and side effects.

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Percutaneous Osteoplasty under Fluoroscopy and Cone-Beam CT guidance for Painful Sternal Metastases

10.21203/rs.3.rs-576606/v1 ◽

2021 ◽

Author(s):

Xun-wei Liu ◽

Zhi-guo Wang ◽

Jin Peng ◽

Gang Sun

Keyword(s):

Rating Scale ◽

Numerical Rating Scale ◽

Cone Beam Ct ◽

Tumor Location ◽

Cone Beam ◽

Ct Guidance ◽

Numerical Rating ◽

Cement Distribution ◽

Painful Bone Metastases

Abstract Background: Although percutaneous osteoplasty (POP) has been widely accepted and is now being performed for the treatment of painful bone metastases outside the spine, there are only scarced reports regarding osteoplasty in painful sternal metastases.Case presentation: The paper reported four patients with painful sternal metastasis who underwent POP under fluoroscopic and cone-beam CT guidance. The patients were three men and one woman (mean age, 66.25 years). Primary tumor location in lung is 3 cases, in thyroid is 1 case. In these cases, Pain was measured using a numerical rating scale (NRS), with scores ranging from 0 (no pain) to 10 (worst pain imaginable). The scores on the NRS in the four patients before POP were 9, 8, 8, and 9. After POP, the NRS scores decreased to 2, 3, 2, and 2, respectively, in follow-up at 6 months. Conclusions: POP is a safe and effective treatment for pain caused by metastatic bone tumors in the sternum. However, care and at tention should be paid to the insertion of a needle and cement distribution for better treatment effect

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Consumptive Disease and Chronic Fatigue Improved by Nokyonggunbi-tang and Other Korean Medical Treatments: A Case Report

The Journal of Internal Korean Medicine ◽

10.22246/jikm.2021.42.5.738 ◽

2021 ◽

Vol 42 (5) ◽

pp. 738-745

Author(s):

Mu-jin Park ◽

So-ri Jin ◽

Eun-jae Oh ◽

Woo-sub Song ◽

Hyun-seok Lee ◽

...

Keyword(s):

Rating Scale ◽

Numerical Rating Scale ◽

Neck Disability Index ◽

Chronic Fatigue ◽

Medical Treatments ◽

Five Dimensions ◽

Numerical Rating ◽

Fatigue Severity ◽

Neck Disability

Objective: This study investigated the efficacy of using Nokyonggunbi-tang and other Korean medical treatments for a patient with consumptive disease and chronic fatigue.Methods: A 59-year-old female patient with fatigue, headache, dizziness, and neck pain due to consumptive disease and chronic fatigue was treated with herbal medicine (Nokyonggunbi-tang), together with acupuncture, pharmacopuncture, cupping, and chuna manual therapy, for 22 days. The treatment effects on the pain were evaluated using the scores for the Fatigue Severity Scale (FSS), European Quality of Life Five Dimensions (EQ-5d) Scale, Neck Disability Index (NDI), and Numerical Rating Scale (NRS).Results: Following treatment, the patient showed a decrease in the FSS, NDI, and NRS scores and an improvement in the EQ-5d score.Conclusions: Nokyonggunbi-tang and Korean medical treatment significantly improved fatigue symptoms in a patient with no substrate disease.

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Minimal Clinically Important Change of the Neck Disability Index and the Numerical Rating Scale for Patients With Neck Pain

Spine ◽

10.1097/brs.0b013e31815cf75b ◽

2007 ◽

Vol 32 (26) ◽

pp. 3047-3051 ◽

Cited By ~ 209

Author(s):

Jan J. M. Pool ◽

Raymond W. J. G. Ostelo ◽

Jan L. Hoving ◽

Lex M. Bouter ◽

Henrica C. W. de Vet

Keyword(s):

Neck Pain ◽

Rating Scale ◽

Numerical Rating Scale ◽

Neck Disability Index ◽

Important Change ◽

Numerical Rating ◽

Neck Disability ◽

Clinically Important Change

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EUS-Guided Versus Percutaneous Celiac Neurolysis for the Management of Intractable Pain Due to Unresectable Pancreatic Cancer: A Randomized Clinical Trial

Journal of Clinical Medicine ◽

10.3390/jcm9061666 ◽

2020 ◽

Vol 9 (6) ◽

pp. 1666

Author(s):

Won Jae Yoon ◽

Yul Oh ◽

Changhoon Yoo ◽

Sunguk Jang ◽

Seong-Sik Cho ◽

...

Keyword(s):

Pancreatic Cancer ◽

Abdominal Pain ◽

Back Pain ◽

Cancer Patients ◽

Rating Scale ◽

Numerical Rating Scale ◽

Intractable Pain ◽

Point Reduction ◽

Pain Scores ◽

Numerical Rating

Although endoscopic ultrasound-guided celiac neurolysis (EUS-CN) and percutaneous celiac neurolysis (PCN) are utilized to manage intractable pain in pancreatic cancer patients, no direct comparison has been made between the two methods. We compared the efficacy and safety of EUS-CN and PCN in managing intractable pain in such patients. Sixty pancreatic cancer patients with intractable pain were randomly assigned to EUS-CN (n = 30) or PCN (n = 30). The primary outcomes were pain reduction in numerical rating scale (NRS) and opioid requirement reduction. Secondary outcomes were: successful pain response (NRS decrease ≥50% or ≥3-point reduction from baseline); quality of life; patient satisfaction; adverse events; and survival rate at 3 months postintervention. Both groups reported sustained decreases in pain scores up to 3 months postintervention (mean reductions in abdominal pain: 0.9 (95% confidence interval (CI): −0.8 to 4.2) and 1.7 (95% CI: −0.3 to 2.1); back pain: 1.3 (95% CI: −0.9 to 3.4) and 2.5 (95% CI: −0.2 to 5.2) in EUS-CN, and PCN groups, respectively). The differences in mean pain scores between the two groups at baseline and 3 months were −0.5 (p = 0.46) and −1.4 (p = 0.11) for abdominal pain and 0.1 (p = 0.85) and −0.9 (p = 0.31) for back pain in favor of PCN. No significant differences were noted in opioid requirement reduction and other outcomes. EUS-CN and PCN were similarly effective and safe in managing intractable pain in pancreatic cancer patients. Either methods may be used depending on the resources and expertise of each institution.

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The Role of Testosterone Supplemental Therapy in Opioid-Induced Hypogonadism: A Retrospective Pilot Analysis

American Journal of Men s Health ◽

10.1177/1557988316672396 ◽

2016 ◽

Vol 11 (4) ◽

pp. 1208-1213 ◽

Cited By ~ 15

Author(s):

Omer A. Raheem ◽

Sunil H. Patel ◽

David Sisul ◽

Tim J. Furnish ◽

Tung-Chin Hsieh

Keyword(s):

Chronic Pain ◽

Rating Scale ◽

Numerical Rating Scale ◽

Opioid Therapy ◽

Total Testosterone ◽

Chronic Noncancer Pain ◽

Numerical Rating ◽

Noncancer Pain ◽

Supplemental Therapy

Chronic opioid therapy for pain management is known to induce several endocrine changes. The authors examined the effect of testosterone supplemental therapy (TST) in patients with chronic, noncancer pain undergoing opioid therapy. It was hypothesized that treatment of opioid-induced hypogonadism (OIH) can reduce opioid requirements in patients suffering from chronic pain and approve their quality of life. Over 18 months period, patients with OIH were identified in a tertiary referral pain center, Numerical Rating Scale (NRS) pain scores and daily morphine equivalent dose (MED) were the primary outcomes measured. Data were collected and comparative analysis performed between men undergoing TST versus nontreatment group. Twenty-seven OIH patients (total testosterone <300 ng/dL) were identified during the study period. TST group consists of 11 patients, while non-TST group consists of 16 patients as control cohort. Mean patient age (55 and 54.4, p = .4) and basic metabolic index (28.5 and 31.9, p = .07) in TST and non-TST groups, respectively. Mean follow-up total testosterone (ng/dL) was significantly higher after TST compared with the non-TST group (497.5 vs. 242.4 ng/dL, p = .03). Median follow-up NRS was 0 and 2 in the TST and non-TST groups ( p = .02). Mean MED (mg) decreased by 21 mg in TST group and increased by 2.5 mg in non-TST group ( p < .05). This study reports that treatment of OIH with TST can reduce opioid requirements in men with chronic pain as quantified by MED. It also confirms previous reports on the potential effects of OIH and that TST is effective in correcting opioid-induced endocrine abnormalities.

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Determinants of Pain Severity Changes in Ambulatory Patients With Cancer: An Analysis From Eastern Cooperative Oncology Group Trial E2Z02

Journal of Clinical Oncology ◽

10.1200/jco.2013.50.6071 ◽

2014 ◽

Vol 32 (4) ◽

pp. 312-319 ◽

Cited By ~ 19

Author(s):

Fengmin Zhao ◽

Victor T. Chang ◽

Charles Cleeland ◽

James F. Cleary ◽

Edith P. Mitchell ◽

...

Keyword(s):

Pain Management ◽

Pain Score ◽

Rating Scale ◽

Numerical Rating Scale ◽

Eastern Cooperative Oncology Group ◽

Pain Severity ◽

Initial Assessment ◽

Pain Level ◽

Ambulatory Patients

Purpose To understand changes in pain severity over time and to explore the factors associated with pain changes in ambulatory patients with solid tumors. Patients and Methods We enrolled 3,106 patients with invasive cancer of the breast, prostate, colon/rectum, or lung from multiple sites. At baseline and 4 to 5 weeks later, patients rated their pain level on a 0 to 10 numerical rating scale. A 2-point change in pain score was defined as a clinically significant change in pain. Multivariable logistic models were fitted to examine the effects of pain management and demographic and clinical factors on change in pain severity. Results We analyzed 2,761 patients for changes in pain severity. At initial assessment, 53.0% had no pain, 23.5% had mild pain, 10.3% had moderate pain, and 13.2% had severe pain. Overall, one third of patients with initial pain had pain reduction within 1 month of follow-up, and one fifth had an increase, and the improvement and worsening of pain varied by baseline pain score. Of the patients without pain at initial assessment, 28.4% had pain (8.9% moderate to severe) at the follow-up assessment. Logistic regression analysis showed that inadequate pain management was significantly associated with pain deterioration, as were lower baseline pain level, younger age, and poor health status. Conclusion One third of patients have pain improvement and one fifth experience pain deterioration within 1 month after initial assessment. Inadequate pain management, baseline pain severity, and certain patient demographic and disease characteristics are associated with pain deterioration.

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Effect of Complex Korean Medicine Treatment on Sacral Insufficiency Fracture: A Case Report

Journal of Acupuncture Research ◽

10.13045/jar.2020.00129 ◽

2020 ◽

Vol 37 (3) ◽

pp. 187-192

Author(s):

Ga Hyeon Jung ◽

Hyun Lee ◽

Hwa Yeon Ryu ◽

Jae Hui Kang

Keyword(s):

Rating Scale ◽

Numerical Rating Scale ◽

Insufficiency Fracture ◽

Sacral Insufficiency Fracture ◽

Korean Medicine ◽

Numerical Rating ◽

Numerical Rating Scale Score ◽

History Of ◽

Sacral Insufficiency Fractures

Sacral insufficiency fractures (SIF) are a common, but often underdiagnosed source of lower back pain without apparent trauma. This report presents the clinical outcome of a 75-year-old female with SIF, and an underlying medical history of osteoporosis and rheumatoid arthritis. She was treated non-operatively, in-hospital, with Korean medicine. Patient progress was assessed using the numerical rating scale and selfreported symptoms. Post-treatment, the numerical rating scale score for pain in her hip decreased from 7 to 2. At admission, the patient was unable to sit, and could only walk 3 m with assistance. At discharge, she could sit for longer than 1 hour and walk further than 200 m unassisted. On the follow-up visit, the patient was asymptomatic, and x-ray scans showed ossification of the sacral and pubic fractures. These results suggest that, Korean medicine can effectively reduce pain and aid rehabilitation in patients with SIF, without the need for surgery.

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