The physician as a success determining factor in CT-guided pain therapy

Abstract Background Back pain is a common problem and a burden for the patient. MR-morphologically proven pain-causing changes of the spine is often successfully treated utilizing CT-guided pain therapy. The CT-guided execution enables a controlled and reproducible therapy. Nevertheless, treatment results can differ even with the same patient; the physician is a possible influencing factor of the outcome. Accordingly, the present study analyzes the different behaviors and forms of communication of the treating physicians during the course of the intervention as factors influencing the outcome of treatment. Methods 67 patients suffering from specific back pain were included in this study. 5 treating physicians (2 female, 3 male) of different age (29–63 years), and experience and a total of 244 CT-guided treatments were included in this study. In every case a psychologist observed the treatment based on a standardized observation protocol. Observed were both the verbal and non-verbal interactions as well as the reaction of patient and physician. The success of the therapy was measured in the course of the treatment using the visual analogue pain scale. The technical comparability of the performed CT-guided periradicular therapy was ensured by the distribution of the drug mixture. Results The outcome is significantly better if the patient considers the treating physician to be competent (correlation coefficient: 0.24, p < 0.006) and feels understood (correlation coefficient: 0.29, p < 0.001). In addition, the outcome is better when the physician believes that the treatment brings a positive reduction of pain, underlining his belief with positive statements of affirmation before the intervention thus creating a positive atmosphere [correlation coefficient: 0.24 (p < 0.009)]. In contrast, the outcome is worse if the patient complains about pain during the intervention [average pain reduction M = 0.9 (pain group) vs. M = 2.0 (no-pain group)]. Conclusion Our study shows that with comparable implementation of CT-guided periradicular therapy, the outcome of the patient with specific back pain can be significantly improved by certain behavioral patterns of the performing physician and this without side effects and without significant additional time expenditure. Our findings indicate that there is a non-negligible psychological factor linking confidence in therapy to actual therapy success. Trial Registration: The study was designed as an observational study, therefore a trial registration was not necessary.

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Acute Effects of Global Postural Re-Education on Non-Specific Low Back Pain. Does Time-of-Day Play a Role?

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph18020713 ◽

2021 ◽

Vol 18 (2) ◽

pp. 713

Author(s):

David Merinero ◽

Manuel Rodríguez-Aragón ◽

Javier Álvarez-González ◽

Álvaro López-Samanes ◽

Joaquín López-Pascual

Keyword(s):

Low Back Pain ◽

Back Pain ◽

Physical Functioning ◽

Pain Scale ◽

Time Of Day ◽

Visual Analogue Pain Scale ◽

Low Back ◽

Acute Effects ◽

Education Session ◽

Visual Analogue Pain

Low back pain is one the most common forms of musculoskeletal disorders. Thus, several physiotherapeutic strategies (e.g., global postural re-education therapy) have been used for reducing low back pain. The aim of this study was to determinate if acute application of global postural re-education session associated effects are influenced by the time-of-day when this physical therapy is applied. Eight participants in a randomized, counterbalanced order were acutely tested both before and 24 h after a global postural re-education therapy session (10 min session) in three different time-of-day points; morning (i.e., AM; 7:00–9:00 h), midday (i.e., AM; 12:00–14:00 h) and afternoon (i.e., PM; 18:00–20:00 h). In each session, low back pain Visual Analogue Pain Scale [VAS]), flexibility, function capacity (Roland Morris Questionnaire [RMQ], and physical functioning Oswestry Disability Index [ODI]) were recorded. Results showed a pain reduction (VAS Scale) 24 h post Global postural re-education [GPR] session (p = 0.001) and increasing of flexibility pre-post GPR session in all the time-of-day points (morning, midday, and afternoon) (p = 0.001) while no differences were reported in RMQ (p = 0.969) and ODI (p = 0.767). Thus, acute GPR session produces the same effects on flexibility, low back pain, function capacity, and physical functioning values independently of time-of-day when it is applied.

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THE ROLE OF MANUAL THERAPY IN THE TREATMENT OF CHRONIC CERVICAL PAINS

SPORT AND SOCIETY ◽

10.36836/2020/1/6 ◽

2020 ◽

pp. 1-4

Author(s):

George-Sebastian Iacob ◽

Constantin Munteanu

Keyword(s):

Manual Therapy ◽

Therapy Group ◽

Neck Disability Index ◽

Initial Assessment ◽

Visual Analogue Pain Scale ◽

Rehabilitation Protocol ◽

Visual Analogue Pain ◽

Therapeutic Exercises ◽

Group A ◽

Group B

Cervical back pain is one of the most important and common musculoskeletal disorders in medical recovery clinics and clinics. The main objective of the study was to highlight the effectiveness of an individualized therapeutic program adapted to the particularities of 22 subjects, which combines physical exercise with manual therapy. Subjects were randomly assigned to two equal groups. Group A - rehabilitation protocol consisting of therapeutic exercises (specific to the head, neck and upper limbs). Group B - rehabilitation protocol that included both therapeutic exercises and manual therapy (specific maneuvers of vertebral mobilization, massage, myofascial techniques, stretching and manipulations). The Visual Analogue Pain Scale (VAS) and the Neck Disability Index (NDI) were used to monitor the evolution of the research subjects, both of which have a specific applicability character to chronic pain. According to VAS (p <0.001), Group B showed mean values reduced to 2.2 ± 0.9 at week 12, compared to 7.3 ± 0.92, following the initial assessment. NDI values indicate better functional status after 12 weeks of treatment for both groups of subjects. NDI showed a beneficial decrease for Group B (13.2 ± 2.2 after 12 weeks, compared to 25.8 ± 2.3 in the first week). The mean results of VAS and NDI indicated a better evolution of symptoms in the case of the protocol that combined exercise and manual therapy (group B), but there were no statistically significant differences (compared to group A).

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Development of a Logic Model for a Programme to Reduce the Magnetic Resonance Imaging Rate for Non-Specific Lower Back Pain in a Tertiary Care Centre

Healthcare ◽

10.3390/healthcare9020238 ◽

2021 ◽

Vol 9 (2) ◽

pp. 238

Author(s):

Ahmed Alhowimel ◽

Faris Alodaibi ◽

Mazyad Alotaibi ◽

Dalyah Alamam ◽

Hana Alsobayel ◽

...

Keyword(s):

Magnetic Resonance Imaging ◽

Back Pain ◽

Magnetic Resonance ◽

Lower Back Pain ◽

Tertiary Care ◽

Logic Model ◽

Resonance Imaging ◽

Tertiary Care Centre ◽

Additional Time ◽

Lower Back

Tertiary care centres continue to experience over-utilisation of diagnostic imaging services for lower back pain cases that may not be required. Moreover, these services may require additional time and consequently delay access to services that offer conservative management, i.e., physiotherapy, and hence, increase the direct and indirect costs with no added quality of care. A logic model was developed based on qualitative and quantitative studies that explains the plan and process evaluation strategies to reduce imaging for lower back pain in tertiary hospitals. Logic models are useful tools for defining programme components. The delivery of the components is ensured by well-defined process evaluations that identify any needed modifications. The proposed logic model provides a road map for spine clinics in tertiary care hospitals to decrease the number of patient referrals for magnetic resonance imaging and waiting times for consultations and services and promote early access to physiotherapy services.

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Reliability, Stability and Validity of the Brazilian Adaptation of the Oliveira Questionnaire on Low Back Pain in Young People

Acta Médica Portuguesa ◽

10.20344/amp.8270 ◽

2017 ◽

Vol 30 (10) ◽

pp. 691 ◽

Cited By ~ 1

Author(s):

Debora Soccal Schwertner ◽

Raul Oliveira ◽

Ana Paula Ramos Marinho ◽

Magnus Benetti ◽

Thais Silva Beltrame ◽

...

Keyword(s):

Low Back Pain ◽

Back Pain ◽

Young People ◽

Correlation Coefficient ◽

Internal Consistency ◽

Low Back ◽

Intra Class Correlation ◽

Brazilian Version ◽

Spearman’S Correlation ◽

Intra Class Correlation Coefficient

Introduction: The objective of this study was to adapt the Brazilian version, and verify the validity, reliability and internal consistency of the Oliveira questionnaire on low back pain in young people.Material and Methods: The questionnaire was translated from European Portuguese into Brazilian Portuguese by means of translation and re-translation. The validity of the contents was determined by experts who analyzed the clarity and pertinence of the questions. Fifteen young people aged 15 to 18 took part in the pre-test step (qualitative analysis), 40 in the test-retest (reliability) and 679 in the evaluation of internal consistency. The intra-class correlation coefficient and Spearman’s correlation coefficient were used in the reliability analysis (test-retest), and Cronbach’s alpha to determine the internal consistency (stability).Results: In the translation phase the questionnaire was modified and considered suitable, observing similarity and equivalence of the two versions. After being corrected by the experts in the validation of the contents, the instrument was considered suitable and valid, and in the pre-test, the young people suggested some modifications to make the questionnaire more succinct. With respect to reliability, the values for the intra-class correlation coefficient were between 0.512 – acceptable and 1 – excellent and Spearman’s correlation coefficient varied between 0.525 and 1, classifying the instrument as reproducible. The internal consistency was considered acceptable with a 0.757 Cronbach’s alpha.Discussion: The Oliveira questionnaire was choosen since it has been used in several Portuguese studies; moreover, it addresses the need to raise data regarding low back pain and associated risk factors.Conclusions: The Brazilian version of the Oliveira questionnaire on low back pain in young people showed valid and reliable cultural adaptation, with good reliability and stability.

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Translation, Cross-Cultural Adaptation, and Validation of the Portuguese Version of the Rotterdam Elderly Pain Observation Scale

Dementia and Geriatric Cognitive Disorders Extra ◽

10.1159/000520455 ◽

2021 ◽

pp. 314-323

Author(s):

Julieta Seixas-Moizes ◽

Anneke Boerlage ◽

Érica Negrini Lia ◽

Lucas Emmanuel Lopes e Santos ◽

Miriane Lucindo Zucoloto ◽

...

Keyword(s):

Low Back Pain ◽

Back Pain ◽

Correlation Coefficient ◽

Health Professionals ◽

Cultural Adaptation ◽

Healthcare Professionals ◽

Rating Scale ◽

Low Back ◽

Portuguese Version ◽

Observation Scale

Introduction: This study reports on the translation, cultural adaptation, and validation of a Portuguese version of the Rotterdam Elderly Pain Observation Scale (REPOS), a Dutch scale to assess pain in patients who cannot communicate, with or without dementia. Methods: This is a multicenter study in pain and neurological units involving Brazil (clinical phase) and the Netherlands (training phase). We performed a retrospective cross-sectional, 2-staged analysis, translating and culturally adapting the REPOS to a Portuguese version (REPOS-P) and evaluating its psychometric properties. Eight health professionals were trained to observe patients with low back pain. REPOS consists of 10 behavioral items scored as present or absent after a 2-min observation. The REPOS score of ≥3 in combination with the Numerical Rating Scale (NRS) of ≥4 indicated pain. The Content Validity Index (CVI) in all items and instructions showed CVI values at their maximum. According to the higher correlation coefficient found between NRS and REPOS-P, it may be suggested that there was an adequate convergent validity. Results: The REPOS-P was administered to 80 patients with a mean age of 60 years (SD 11.5). Cronbach’s alpha coefficient showed a moderate internal consistency of REPOS-P (α = 0.62), which is compatible with the original study of REPOS. All health professionals reached high levels of interrater agreement within a median of 10 weeks of training, assuring reproducibility. Cohen’s kappa was 0.96 (SD 0.03), and the intraclass correlation coefficient was 0.98 (SD 0.02), showing high reliability of REPOS-P scores between the trainer (researcher) and the trainees (healthcare professionals). The Pearson correlation coefficient was 0.95 (95% confidence interval 0.94–0.97), showing a significant correlation between the total scores of REPOS-P and NRS. Conclusion: The REPOS-P was a valuable scale for assessing elderly patients with low back pain by different healthcare professionals. Short application time, ease of use, clear instructions, and the brief training required for application were essential characteristics of REPOS-P.

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Incidence and management of inguinodynia after inguinal plasty

International Journal of Research in Medical Sciences ◽

10.18203/2320-6012.ijrms20204211 ◽

2020 ◽

Vol 8 (10) ◽

pp. 3432

Author(s):

Juan J. Granados-Romero ◽

Jesus C. Ceballos-Villalva ◽

Israel García-Olivo ◽

Cruz Escobar Jonathan E. ◽

María J. Corona-Torres ◽

...

Keyword(s):

Hospital Costs ◽

Laparoscopic Approach ◽

Systematic Investigation ◽

Pain Scale ◽

Diagnostic Methods ◽

Visual Analogue Pain Scale ◽

Open Approach ◽

Cross Sectional ◽

Visual Analogue Pain ◽

Quality Life

Background: Hernia is defined as a defect of fascial and muscle-aponeurotic structures, allowing the protrusion of elements. The most frequent is inguinal region, prevailing in men 3:1 vs female. The most frequent complications are persistent chronic pain.Methods: A descriptive, prospective and cross-sectional study was performed in postoperative inguinal plasty patients, using a laparoscopic approach and open approach, the presence or absence of inguinodynia was studied using the visual analogue pain scale (VAS) and the Semmes-Weinstein monofilament, in addition to a systematic investigation in the following PubMed, Medline, Clinical Key and Index Medicus databases, with articles from July 2019 to April 2020.Results: Inguinodynia was present in laparoscopic surgery and open approach, 58 patients had inguinodynia at two weeks associated with the inflammatory response of the tissues and the presence of a foreign body (mesh), 77% of the patients with persistence of pain at 3 months reported mild pain (VAS 1-4), 21% moderate pain that did not limit their daily activities (VAS 5-8) and 2% of the patients reported severe pain which limited physical activity and effort (VAS 9-10).Conclusions: Inguinodynia has an impact on hospital costs and quality life, we consider it is essential to domain the anatomical variants of the region. We propose an extensive follow-up of this group of patients, to make a comparison of diagnostic methods, as well as conservative management vs. modern techniques for pain control.

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Evaluating the Efficacy of the Treatment with Benfotiamine and Alpha-lipoic Acid in Distal Symmetric Painful Diabetic Polyneuropathy

Revista de Chimie ◽

10.37358/rc.19.9.7498 ◽

2019 ◽

Vol 70 (9) ◽

pp. 3108-3114 ◽

Cited By ~ 5

Author(s):

Amorin Remus Popa ◽

Simona Bungau ◽

Cosmin Mihai Vesa ◽

Andrei Cristian Bondar ◽

Carmen Pantis ◽

...

Keyword(s):

Diabetic Neuropathy ◽

Lipoic Acid ◽

Combined Therapy ◽

Visual Analogue Pain Scale ◽

Alpha Lipoic Acid ◽

Painful Diabetic Neuropathy ◽

Disability Score ◽

Visual Analogue Pain ◽

Hexosamine Pathway ◽

Lower Limb Pain

Distal symmetric painful diabetic neuropathy is the most frequent clinical form of diabetic neuropathy. The condition appears as a result of alteration of the structure and function of nervous fibres as a consequence of hyperglycaemia. Hyperglycaemia determines the metabolism of glucose on alterative pathways and generates increased oxidative stress, mechanisms that cause an accelerated apoptosis of the neurons and a high intensity of lipid peroxidation. Pathogenic treatment of diabetic neuropathy includes limited options, two of them are: Benfotiamine (inhibits the metabolism of glucose on hexosamine pathway, reducing the formation of advanced glycosylation end products) and alpha-lipoic acid (has a scavenger effect on free radical species). The study included 120 patients with distal symmetric painful diabetic neuropathy randomized in 3 treatment groups. We evaluated the effect of oral administration for 8 weeks of Benfotiamine in a dosage of 300mg/day in monotherapy, of alpha-lipoic acid in a dosage of 600 mg/day in monotherapy, respectively of both -in combined therapy - on the parameters that are used to determine the severity of distal symmetric painful diabetic neuropathy: Diabetic Neuropathy Symptoms score, Neuropathy Disability Score and the intensity of lower limb pain on the visual analogue pain scale. All the three therapies were effective with a statistically significant improvement of these parameters, but the combined therapy with alpha-lipoic acid and Benfotiamine was superior to the monotherapy with alpha-lipoic acid or Benfotiamine.

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Obstructive sleep apnea as an independent predictor of postoperative delirium and pain: protocol for an observational study of a surgical cohort

F1000Research ◽

10.12688/f1000research.14061.2 ◽

2018 ◽

Vol 7 ◽

pp. 328 ◽

Cited By ~ 2

Author(s):

Patricia Strutz ◽

William Tzeng ◽

Brianna Arrington ◽

Vanessa Kronzer ◽

Sherry McKinnon ◽

...

Keyword(s):

Obstructive Sleep Apnea ◽

Sleep Apnea ◽

Observational Study ◽

Postoperative Delirium ◽

Pain Perception ◽

Independent Predictor ◽

Pain Severity ◽

Visual Analogue Pain Scale ◽

Visual Analogue Pain ◽

Obstructive Sleep

Introduction: Postoperative delirium and pain are common complications in adults, and are difficult both to prevent and treat. Obstructive sleep apnea (OSA) is prevalent in surgical patients, and has been suggested to be a risk factor for postoperative delirium and pain. OSA also might impact pain perception, and alter pain medication requirements. This protocol describes an observational study, with the primary aim of testing whether OSA is an independent predictor of postoperative complications, focusing on (i) postoperative incident delirium and (ii) acute postoperative pain severity. We secondarily hypothesize that compliance with prescribed treatment for OSA (typically continuous positive airway pressure or CPAP) might decrease the risk of delirium and the severity of pain. Methods and analysis: We will include data from patients who have been enrolled into three prospective studies: ENGAGES, PODCAST, and SATISFY-SOS. All participants underwent general anesthesia for a non-neurosurgical inpatient operation, and had a postoperative hospital stay of at least one day at Barnes Jewish Hospital in St. Louis, Missouri, from February 2013 to May 2018. Patients included in this study have been assessed for postoperative delirium and pain severity as part of the parent studies. In the current study, determination of delirium diagnosis will be based on the Confusion Assessment Method, and the Visual Analogue Pain Scale will be used for pain severity. Data on OSA diagnosis, OSA risk and compliance with treatment will be obtained from the preoperative assessment record. Other variables that are candidate risk factors for delirium and pain will also be extracted from this record. We will use logistic regression to test whether OSA independently predicts postoperative delirium and linear regression to assess OSAs relationship to acute pain severity. We will conduct secondary analyses with subgroups to explore whether these relationships are modified by compliance with OSA treatment.

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