scholarly journals Clonazepam for pain due to muscle spasm in a patient with vertebral compression fractures caused by multiple myeloma: a case report

2021 ◽  
Vol 7 (1) ◽  
Author(s):  
Kazuki Akita ◽  
Yasutomo Kumakura ◽  
Emi Nakajima ◽  
Hiroki Ishiguro ◽  
Tetsuya Iijima
Keyword(s):  
Multiple Myeloma ◽  
Low Back Pain ◽  
Back Pain ◽  
Muscle Relaxant ◽  
Facet Joint ◽  
Lumbar Vertebrae ◽  
Muscle Spasm ◽  
Vertebral Compression Fractures ◽  
Low Back ◽  
Compression Fractures

Abstract Background Vertebral compression fractures can cause severe back pain. Although many types of analgesics and interventional treatments are available, they are sometimes ineffective in mitigating the pain. We encountered a case where clonazepam was effective for the management of severe low back pain caused by lumbar vertebral compression fractures. Case presentation A 44-year-old male was diagnosed with multiple myeloma and had vertebral compression fractures of the first and second lumbar vertebrae. He had been suffering from severe low back pain on movement with muscle spasm and pain-associated anxiety. We considered this breakthrough low back pain to be caused by facet joint pain; thus, we prescribed clonazepam as a muscle relaxant and anxiolytic. Following this treatment, the intractable breakthrough pain was dramatically relieved. Conclusion Clonazepam, which has both muscle relaxant and anxiolytic effects, might be helpful in mitigating pain, associated anxiety, and muscle spasms due to vertebral compression fractures.

scholarly journals CEMENT LEAKAGE FOLLOWING PERCUTANEOUS VERTEBRAL AUGMENTATION: CASE REPORT

2021 ◽  
Vol 506 (1-2) ◽  
Author(s):  
Tran Huy Hung ◽  
Nguyen Minh Tien
Keyword(s):  
Low Back Pain ◽  
Back Pain ◽  
Percutaneous Vertebroplasty ◽  
Clinical Signs ◽  
Cement Leakage ◽  
Vertebral Compression Fractures ◽  
Low Back ◽  
Urine Retention ◽  
Compression Fractures ◽  
Second Surgery

Background: Percutaneous vertebroplasty (PV) has become an important minimally invasive surgical technique for vertebral compression fractures. However, indications for PV in these cases due to trauma had many rivals and unclearly. These complications, especially cement leakage still common, has many severe consequent. Object and method research: A 60-years-old man, who underwent vertebroplasty in low medical level. He had complete paralised of two leg, urine retention, and severe low back pain. We examined clinical signs, imaging, find and compared with literatures. Case presentation and discussion: We present a case, 60-years-old man, had labor accident, after that he could returned to state of normality. At the second day, he went to local hospital, had diagnosis: compression fractures of L1-L2. He underwent percutaneous vertebroplasty of L1-2 under local anesthesia. Post-operative, he had complete paralised of two leg, urine retention, and severe low back pain. He had exmined again, MRI and took second surgery to removed part of cement leakage. After the second surgery, radiological showed they had complete removed cement leakage, but the patient’s recovery was uneventful and stable. The patient was hospitalized at our instituation after 03 day with complaints of severe low back pain, urine retention and complete paralised of two leg. Conclusion: This is basic technique, widely and rewarding; also has many severe incident, complications. Consequently, we suggest that this technique have to perform in right indications, in the modern medical centre and fully trained surgeon.

scholarly journals Treatment of low back pain in patients with vertebral compression fractures and superior cluneal nerve entrapment neuropathies

2015 ◽  
Vol 6 (25) ◽  
pp. 619 ◽  
Author(s):  
Kyongsong Kim ◽  
Toyohiko Isu ◽  
Yasuhiro Chiba ◽  
Naotaka Iwamoto ◽  
Kazuyoshi Yamazaki ◽  
...  
Keyword(s):  
Low Back Pain ◽  
Back Pain ◽  
Nerve Entrapment ◽  
Vertebral Compression Fractures ◽  
Low Back ◽  
Compression Fractures ◽  
Entrapment Neuropathies

Lumbar Facet–Mediated Pain

2016 ◽  
Author(s):  
Vikram B Patel
Keyword(s):  
Low Back Pain ◽  
Back Pain ◽  
Lower Back Pain ◽  
Joint Pain ◽  
Facet Joint ◽  
Low Back ◽  
Lower Back ◽  
Facet Joint Pain ◽  
And Function ◽  
Lumbar Facet

Lumbar or lower back pain is a very debilitating condition that affects  almost one fifth of the adult population during a given year. Almost everyone walking on two feet is bound to suffer from some back pain during their lifetime. The health care burden for treating low back pain is enormous, especially if the lost work hours are combined with the amount used in diagnosing and treating low back pain. Lumbar facet (zygapophysial) joints are one of the major components involved in causing lower back pain. Diagnosing the pain generator is more of an art than a science. Combining various parameters in the patient’s history, physical examination, and diagnostic studies is not much different from solving a murder mystery. Although facet joint pain may be accompanied by other pain generators, that is, lumbar intervertebral disks, nerve roots, and vertebral bodies, once treated, the relief in pain is more helpful in performing proper rehabilitation and improving further deterioration in low back pain. Muscles are almost always painful due to myofascial pain syndrome that accompanies the facet joint–related pain. Treating one without addressing the other leads to failure in management and optimization of patient’s pain and function. Several treatments are available for treatment of facet joint–mediated pain, including steroid injections using a miniscule amount and radiofrequency ablation of the nerves supplying the facet joints (medial branches of the dorsal primary ramus of the lumbar nerve root). With proper diagnosis and treatment, a patient’s pain and function can be optimized to a level where it may not impact the day-to-day activities or even resumption of the patient’s routine job function. The following review describes the anatomy, pathophysiology, diagnosis, and treatment of lumbar facet joint–mediated pain.   Key words: facet joint pain, facet joint syndrome, low back pain, medial branch radiofrequency, spondylolisthesis

scholarly journals Lumbar Facet Joint Nerve Blocks in Managing Chronic Facet Joint Pain: One-Year Follow-up of a Randomized, Double-Blind Controlled Trial: Clinical Trial NCT00355914

2008 ◽  
Vol 2;11 (3;2) ◽  
pp. 121-132
Author(s):  
Laxmaiah Manchikanti
Keyword(s):  
Low Back Pain ◽  
Back Pain ◽  
Pain Relief ◽  
Local Anesthetic ◽  
Chronic Low Back Pain ◽  
Facet Joint ◽  
Low Back ◽  
Lumbar Facet Joint ◽  
Nerve Blocks ◽  
Lumbar Facet

Background: Lumbar facet joints have been implicated as the source of chronic pain in 15% to 45% of patients with chronic low back pain. Various therapeutic techniques including intraarticular injections, medial branch blocks, and radiofrequency neurotomy of lumbar facet joint nerves have been described in the alleviation of chronic low back pain of facet joint origin. Objective: The study was conducted to determine the clinical effectiveness of therapeutic local anesthetic lumbar facet joint nerve blocks with or without steroid in managing chronic function-limiting low back pain of facet joint origin. Design: A randomized, double-blind, controlled trial. Setting: An interventional pain management setting in the United States. Methods: This study included 60 patients in Group I with local anesthetic and 60 patients in Group II with local anesthetic and steroid. The inclusion criteria was based on the positive response to the diagnostic controlled comparative local anesthetic lumbar facet joint blocks. Outcome measures: Numeric pain scores, Oswestry Disability Index, opioid intake, and work status. All outcome assessments were performed at baseline, 3 months, 6 months, and 12 months. Results: Significant improvement with significant pain relief (> 50%) and functional improvement (> 40%) were observed in 82% and 85% in Group I, with significant pain relief in over 82% of the patients and improvement in functional status in 78% of the patients. Based on the results of the present study, it appears that patients may experience significant pain relief 44 to 45 weeks of 1 year, requiring approximately 3 to 4 treatments with an average relief of 15 weeks per episode of treatment. Conclusion: Therapeutic lumbar facet joint nerve blocks, with or without steroid, may provide a management option for chronic function-limiting low back pain of facet joint origin. Key words: Chronic low back pain, lumbar facet or zygapophysial joint pain, facet joint nerve or medial branch blocks, comparative controlled local anesthetic blocks, therapeutic lumbar facet joint nerve blocks

scholarly journals An Update of the Systematic Assessment of the Diagnostic Accuracy of Lumbar Facet Joint Nerve Blocks

2012 ◽  
Vol 6;15 (6;12) ◽  
pp. E869-E907
Author(s):  
Frank J.E. Falco
Keyword(s):  
Low Back Pain ◽  
Back Pain ◽  
Pain Relief ◽  
Diagnostic Accuracy ◽  
Chronic Low Back Pain ◽  
Facet Joint ◽  
Low Back ◽  
Lumbar Facet Joint ◽  
Nerve Blocks ◽  
Lumbar Facet

Background: Lumbar facet joints are a well recognized source of low back pain and referred pain in the lower extremity in patients with chronic low back pain. Conventional clinical features and other non-invasive diagnostic modalities are unreliable in diagnosing lumbar zygapophysial joint pain. Controlled diagnostic studies with at least 80% pain relief as the criterion standard have shown the prevalence of lumbar facet joint pain to be 16% to 41% of patients with chronic low back pain without disc displacement or radiculitis, with a false-positive rate of 17% to 49% with a single diagnostic block. Study Design: A systematic review of the diagnostic accuracy of lumbar facet joint nerve blocks. Objective: To determine and update the diagnostic accuracy of lumbar facet joint nerve blocks in the assessment of chronic low back pain. Methods: A methodological quality assessment of included studies was performed using Quality Appraisal of Reliability Studies (QAREL). Only diagnostic accuracy studies meeting at least 50% of the designated inclusion criteria were utilized for analysis. Studies scoring less than 50% are presented descriptively and analyzed critically. The level of evidence was classified as good, fair, and limited or poor based on the quality of evidence developed by the United States Preventive Services Task Force (USPSTF). Data sources included relevant literature identified through searches of PubMed and EMBASE from 1966 to June 2012, and manual searches of the bibliographies of known primary and review articles. Outcome Measures: Studies must have been performed utilizing controlled local anesthetic blocks. Pain relief was categorized as at least 50% pain relief from baseline pain and the ability to perform previously painful movements. Results: A total of 25 diagnostic accuracy studies were included. Of these, one study evaluated 50% to 74% relief as criterion standard with a single block with prevalence of 48%, 4 studies evaluated 75% to 100% relief as the criterion standard with a single block with a prevalence of 31% to 61%, 5 studies evaluated 50% to 74% relief as the criterion standard with controlled blocks with a prevalence of 15% to 61%, and 13 studies evaluated 75% to 100% relief as the criterion standard with controlled blocks with a prevalence of 25% to 45% in heterogenous populations. False-positive rates ranged from 17% to 66% in the 50% to 74% pain relief group and 27% to 49% with at least 75% relief as the criterion standard. Based on this evaluation, the evidence showed that there is good evidence for diagnostic facet joint nerve blocks with 75% to 100% pain relief as the criterion standard with dual blocks and fair evidence with 50% to 74% pain relief as the criterion standard with controlled diagnostic blocks; however, the evidence is poor with single diagnostic blocks of 50% to 74%, and limited for 75% or more pain relief as the criterion standard. Limitations: The shortcomings of this systematic review of the accuracy of diagnostic lumbar facet joint nerve blocks include a paucity of literature and continued debate on an appropriate gold standard. Conclusion: There is good evidence for diagnostic facet joint nerve blocks with 75% to 100% pain relief as the criterion standard with dual blocks, with fair evidence with 50% to 74% pain relief. Key words: Chronic low back pain, lumbar facet or zygapophysial joint pain, facet joint nerve blocks, medial branch blocks, controlled comparative local anesthetic blocks

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