scholarly journals Conservative treatment for patients with discogenic lumbosacral radiculopathy: results of a prospective follow-up

2018 ◽  
Vol 10 (3) ◽  
pp. 59-65 ◽  
Author(s):  
M. A. Ivanova ◽  
V. A. Parfenov ◽  
A. I. Isaikin
Keyword(s):  
Surgical Treatment ◽  
Conservative Treatment ◽  
Pain Intensity ◽  
Rating Scale ◽  
Short Form ◽  
Depression Scale ◽  
Leg Pain ◽  
Antiinflammatory Drugs ◽  
Lumbosacral Radiculopathy

Surgical treatment as accelerated functional recovery for discogenic radiculopathy has been proven to have advantages over medical treatment, the efficiency of which remains debatable. Objective: to investigate the efficiency of combination conservative treatment in patients with discogenic lumbosacral radiculopathy. Patients and methods. Thirty patients (12 men and 18 women; mean age, 39.5±2.2 years) with discogenic lumbosacral radiculopathy confirmed by magnetic resonance imaging were followed up. All the patients underwent combination conservative treatment (epidural glucocorticoid administration, analgesic therapy, and motor mode correction). They were surveyed using questionnaires (numeric pain rating scale (NPRS), Oswestry disability index, Hospital Anxiety and Depression Scale, the 12-Item Short Form (SF-12) of Quality of Life (QoL) Questionnaire on admission to the clinic, at 7-14 days after treatment (pain intensity and functional status), and in the long-term period (at 3, 6 and 12 months) after discharge. At baseline, the patients were severely disabled due to pain syndrome. The average Oswestry index was 57.9±3.7%, the back and leg pain intensity scores were 6.5±0.6 and 6.9±0.5, respectively, as evidenced by NPRC. The majority of patients were found to have the combined musculoskeletal sources of pain, such as a myofascial component in 56.7% and sacroiliac joint dysfunction in 43.3%. In these cases, nonsteroidal antiinflammatory drugs and muscle relaxants were additionally used. Results. The conservative treatment resulted in a statistically significant clinical improvement with a preserved positive effect in the long term: at 1 year, the average Oswestry index was equal to 16.6±3.9%, the back and leg pain intensity scores were 1.7±0.5 and 1.6±0.5, respectively, as shown by NPRC (p<0.001 vs baseline). Within a year, only one female patient required surgical treatment; regression of large extrusions and sequesters, the average initial size of which reached 11.1 mm, was observed in 9 cases. Conclusion. The findings reflect the efficiency of conservative treatment and the expediency of detecting mixed musculoskeletal disorders and their correction in discogenic radiculopathy.

scholarly journals A Randomized Clinical Trial Comparing the Effectiveness of Electroacupuncture versus Medium-Frequency Electrotherapy for Discogenic Sciatica

2017 ◽  
Vol 2017 ◽  
pp. 1-9 ◽  
Author(s):  
Xue Zhang ◽  
Yang Wang ◽  
Zhao Wang ◽  
Chao Wang ◽  
Wentao Ding ◽  
...  
Keyword(s):  
Low Back Pain ◽  
Back Pain ◽  
Pain Intensity ◽  
Rating Scale ◽  
Leg Pain ◽  
Secondary Outcome ◽  
Low Back ◽  
Medium Frequency

Objective. To investigate the short- and long-term effects of electroacupuncture (EA) compared with medium-frequency electrotherapy (MFE) on chronic discogenic sciatica.Methods. One hundred participants were randomized into two groups to receive EA (n=50) or MFE (n=50) for 4 weeks. A 28-week follow-up of the two groups was performed. The primary outcome measure was the average leg pain intensity. The secondary outcome measures were the low back pain intensity, Oswestry Disability Index (ODI), patient global impression (PGI), drug use frequency, and EA acceptance.Results. The mean changes in the average leg pain numerical rating scale (NRS) scores were 2.30 (1.86–2.57) and 1.06 (0.62–1.51) in the EA and MFE groups at week 4, respectively. The difference was significant (P<0.001). The long-term follow-up resulted in significant differences. The average leg pain NRS scores decreased by 2.12 (1.70–2.53) and 0.36 (−0.05–0.78) from baseline in the EA and MFE groups, respectively, at week 28. However, low back pain intensity and PGI did not differ significantly at week 4. No serious adverse events occurred.Conclusions. EA showed greater short-term and long-term benefits for chronic discogenic sciatica than MFE, and the effect of EA was superior to that of MFE. The study findings warrant verification. This trial was registered under identifierChiCTR-IPR-15006370.

scholarly journals Surgical and medical treatments for discogenic low back radiculopathy

2019 ◽  
Vol 11 (2S) ◽  
pp. 40-45 ◽  
Author(s):  
M. A. Ivanova ◽  
V. A. Parfenov ◽  
A. O. Isaikin
Keyword(s):  
Quality Of Life ◽  
Back Pain ◽  
Surgical Treatment ◽  
Medical Treatment ◽  
Pain Intensity ◽  
Rating Scale ◽  
Leg Pain ◽  
Life Questionnaire ◽  
Low Back

Objective: to compare the efficiency of medical and surgical treatments for discogenic low back radiculopathy.Patients and methods. 32 patients (including 13 men; mean age, 39.1±11.8 years) received inpatient medical treatment with epidural glucocorticoids; 32 patients (including 19 men; mean age. 42.3±12.1 years) had surgical treatment (removal of a herniated disk). A questionnaire [numerical pain rating scale (NPRS), Oswestry disability index, and quality of life questionnaire (QOL), SF-12] survey was carried out on admission to the clinic, after 7–14 days during treatment (pain intensity and functional status), and after 3, 6, and 12 months.Results and discussion. There were no clinical differences between the patient groups at baseline. Both groups showed a significant decrease in pain intensity and reduced disability after 7–14 days of treatment, with a persistent positive effect over 12 months (p < 0.01). During a year, both groups exhibited better quality of life (p < 0.01). In the surgical treatment group, leg pain intensity was noted to become lower in the early stages (NPRS scores were 0.97 vs 2.41 after 7–14 days and 0.84 vs 1.56 scores after 3 months; p < 0.05); however, this advantage did not persist in the long-term. No significant differences were found between the groups in back pain intensity, disability, and QOL indicators throughout the follow-up period.Conclusion. There were no significant clinical differences between patients with discogenic low back radiculopathy who are referred to hospital for surgical or medical treatment. Surgery makes it possible to reduce more rapidly the intensity of leg pain; however, no benefits of surgical treatment in terms of back pain intensity, disability, and QOL are noted. It is advisable to inform patients about the favorable course of the disease and the possibility of natural regression of disc herniation. 

scholarly journals Tetrahydrocannabinol (Delta 9-THC) Treatment in Chronic Central Neuropathic Pain and Fibromyalgia Patients: Results of a Multicenter Survey

2009 ◽  
Vol 2009 ◽  
pp. 1-9 ◽  
Author(s):  
Janet Weber ◽  
Marcus Schley ◽  
Matthias Casutt ◽  
Helmut Gerber ◽  
Guido Schuepfer ◽  
...  
Keyword(s):  
Neuropathic Pain ◽  
Side Effects ◽  
Pain Intensity ◽  
Rating Scale ◽  
Short Form ◽  
Therapeutic Option ◽  
Depression Scale ◽  
Numeric Rating Scale ◽  
Central Neuropathic Pain ◽  
Multicenter Survey

Central neuropathic pain is difficult to treat, but delta 9-Tetrahydrocannabinol (delta 9-THC) may be a promising therapeutic agent. We administered in 172 patients on average 7.5 mg delta 9-THC over 7 months. Of these, 48 patients prematurely withdrew due to side effects, insufficient analgesia, or expense of therapy. Thus, 124 patients were assessed retrospectively in a multicenter telephone survey. Reported changes in pain intensity, recorded on a numeric rating scale (NRS), Pain Disability Index (PDI), Medical Outcomes Short-Form (SF-12), Quality of Life Impairment by Pain (QLIP), Hospital Anxiety Depression Scale (HADS), and amount of concomitant pain medication were recorded. Psychometric parameters (PDI, SF-12, QLIP, HADS) and pain intensity improved significantly during delta 9-THC treatment. Opioid doses were reduced and patients perceived THC therapy as effective with tolerable side effects. About 25% of the patients, however, did not tolerate the treatment. Therapy success and tolerance can be assessed by a transient delta 9-THC titration and its maintained administration for several weeks. The present survey demonstrates its ameliorating potential for the treatment of chronic pain in central neuropathy and fibromyalgia. A supplemental delta 9-THC treatment as part of a broader pain management plan therefore may represent a promising coanalgesic therapeutic option.

Effectiveness of Neural Mobilization on Pain, Range of motion, and Disability in Cervical Radiculopathy: a Randomized Controlled Trial

2021 ◽  
Author(s):  
Shazia Rafiq ◽  
Hamayun Zafar ◽  
Prof. Dr. Syed Amir Gillani ◽  
Muhammad Sharif Waqas ◽  
Amna Zia ◽  
...  
Keyword(s):  
Conservative Treatment ◽  
Pain Intensity ◽  
Range Of Motion ◽  
Conventional Treatment ◽  
Rating Scale ◽  
Controlled Trial ◽  
Neck Disability Index ◽  
Sampling Technique ◽  
Cervical Radiculopathy ◽  
Neck Disability

Abstract Background: Cervical Radiculopathy (CR) is a disorder of the spinal nerve roots that is largely caused by space occupying lesion which can lead to nerve root inflammation and patient usually presents with radiating pain in his/her upper extremity known as cervical radiculopathy. The objective of the study was to compare the effectiveness of neural mobilization technique with conservative treatment on pain intensity, range of motion and disability.Methods: It was a double blinded randomized clinical trial; data was collected from Mayo Hospital, Lahore through convenience sampling technique. After taking consent from the patients, the patients fulfilling the inclusion and exclusion criteria were selected and randomized blindly and assigned through computer generated random number into two groups i.e. group 1 (neural mobilization), group 2 (conventional treatment). Pain intensity was measured on Numeric pain rating scale, range of motion measured with inclinometer and functional status with neck disability index (NDI). Data was analyzed using SPSS and difference in improvement before, after 02 and 04 weeks was noted and compared. Results: There was significant improvement in pain relief, neck disability and cervical ranges after the treatment in both groups compared to the pre-treatment status (p < 0.00) and when neural mobilization was compared , it was more effective technique than conventional treatment in reducing pain and neck disability (p < 0.00). But there was not statistical difference in mean score of cervical range of motion (p>0.05)Conclusions: The present study concluded that both neural mobilization and conservative treatment were effective as an exercise program for patient with cervical radiculopathy, however neural mobilization was more effective in reducing pain and neck disability in cervical radiculopathy.Trial registration: RCT20190325043109N1

Spontaneous intracranial haematoma

2019 ◽  
pp. 643-650
Author(s):  
Berk Orakcioglu ◽  
Andreas W. Unterberg
Keyword(s):  
Minimally Invasive Surgery ◽  
Surgical Treatment ◽  
Conservative Treatment ◽  
Minimally Invasive ◽  
Invasive Surgery ◽  
High Morbidity ◽  
Intracranial Haematoma ◽  
Randomized Controlled ◽  
Randomized Controlled Studies

Spontaneous intracranial haematomas remain a challenging pathology with high morbidity and mortality (60–80% of long-term disability). Despite decades of the search for specific treatments no evidence has yet been found for neither conservative nor surgical treatment in randomized controlled studies. While patients with space occupying infratentorial haematomas are more likely to benefit from surgery treatment of supratentorial haemorrhages remains controversial. Recent studies suggest that minimally invasive surgery including endoscopy to evacuate intracranial haematoma may be more effective than conservative treatment or standard surgical craniotomy (MISTIE II). Future studies (i.e. MISTIE III, MISTICH, SWITCH) will hopefully demonstrate evidence for individualized treatments.

scholarly journals The Effect of the Treatment at a Pain Clinic on the Patients’ Assessment of Their Pain Intensity and the Incidence of Mental Disorders in the form of Anxiety, Depression, and Aggression

2019 ◽  
Vol 16 (4) ◽  
pp. 586
Author(s):  
Dariusz Kosson ◽  
Marcin Kołacz ◽  
Robert Gałązkowski ◽  
Patryk Rzońca ◽  
Barbara Lisowska
Keyword(s):  
Mental Disorders ◽  
Pain Intensity ◽  
Rating Scale ◽  
Numerical Rating Scale ◽  
Depression Scale ◽  
Emotional Disturbances ◽  
Pain Clinic ◽  
Pain Clinics ◽  
Pain Symptoms ◽  
Anxiety Depression

The aim of the study was to analyze the effect of the treatment given to patients in a pain clinic on their assessment of pain intensity and the incidence of emotional disturbances in the form of anxiety, depression, and aggression. The study was conducted from January 2014 to April 2018 among patients under the care of two Warsaw pain clinics. The study tools were the Hospital Anxiety and Depression Scale—Modified Version (HADS-M) and the Numerical Rating Scale (NRS). The project enrolled 325 patients, with women comprising 60.62% of patients, and the age bracked of 65–79 years comprising 39.38% of patient. The major reasons for attending the pain clinic were osteoarticular pain (44.92%) and neuropathic pain (42.77%). The therapy applied lowered the patients’ pain intensity (4.98 vs. 3.83), anxiety (8.71 vs. 8.12), aggression (3.30 vs. 3.08), and the overall HADS-M score (18.93 vs. 17.90), which shows that the treatment of both the pain symptoms and the associated emotional disturbances in the form of anxiety and aggression was effective. Sex is a factor affecting pain intensity. The level of mental disorders was influenced by the sex and age of the patients and how long they had been treated in the pain clinics.

Pallidal deep brain stimulation in primary Meige syndrome: clinical outcomes and psychiatric features

2020 ◽  
Vol 91 (12) ◽  
pp. 1343-1348
Author(s):  
Qingpei Hao ◽  
Dongliang Wang ◽  
Jia OuYang ◽  
Hu Ding ◽  
Gaungyong Wu ◽  
...  
Keyword(s):  
Deep Brain Stimulation ◽  
Sleep Quality ◽  
Brain Stimulation ◽  
Rating Scale ◽  
Short Form ◽  
Depression Scale ◽  
Motor Symptoms ◽  
Meige Syndrome ◽  
Sf 36 ◽  
Deep Brain

ObjectivesTo study the efficacy and safety of bilateral globus pallidus internus deep brain stimulation (GPi-DBS) in refractory Meige syndrome (MS) and evaluate the psychiatric disorders before and after surgery.MethodsTwenty-two patients with MS treated with bilateral GPi-DBS were retrospectively analysed before surgery and after continuous neurostimulation. Before surgery, patients were assessed by the Burke-Fahn-Marsden Dystonia Rating Scale (BFMDRS), Self-Rating Depression Scale, Medical Outcomes Study 36-Item Short-Form General Health Survey (SF-36) and Pittsburgh Sleep Quality Index (PQSI), which corresponded to motor symptoms, depressive state, quality of life and sleep quality, respectively. The implantable pulse generator of each patient was activated at 1 month after surgery. At 1 month, 3 months, 6 months and 12 months after continuous neurostimulation, all patients were evaluated by the same scales above.ResultsThe BFMDRS movement scores decreased from 15.0±5.3 before surgery to 3.5±4.5 at 12 months after neurostimulation, with a mean improvement of 78% (p<0.001). The BFMDRS disability scores improved from 7.4±4.9 before surgery to 4.0±4.6 at 12 months after neurostimulation, with a mean improvement of 56% (p<0.001). The postoperative SF-36 scores had the remarkable improvement compared with baseline scores. Impaired sleep quality was found in 82% of patients and depression in 64% before surgery, which didn’t neither obtained amelioration after continuous neurostimulation.ConclusionsBilateral pallidal neurostimulation is a beneficial therapeutic option for refractory MS, which could improve the motor symptoms except for depression and sleep quality.

scholarly journals Sustained Long-Term Effectiveness of an Energy Management Training Course on Employee Vitality and Purpose in Life

2019 ◽  
Vol 34 (2) ◽  
pp. 177-188 ◽  
Author(s):  
Sai Krupa Das ◽  
Shawn T. Mason ◽  
Taylor A. Vail ◽  
Caroline M. Blanchard ◽  
Meghan K. Chin ◽  
...  
Keyword(s):  
Physical Activity ◽  
Blood Pressure ◽  
Repeated Measures ◽  
Short Form ◽  
Depression Scale ◽  
Purpose In Life ◽  
Well Being ◽  
Sf 36

Purpose: Programs designed to sustainably improve employee well-being are urgently needed but insufficiently researched. This study evaluates the long-term effectiveness of a commercial well-being intervention in a worksite setting. Design: A pre/postintervention repeated analysis with follow-up at 6, 12, and 18 months. Setting: Office-based worksites (for-profit, nonprofit, and mixed work-type; n = 8). Participants: One hundred sixty-three employees with a mean age of 47 (11) years (57% female). Intervention: A 2.5-day group-based behavioral program emphasizing vitality and purpose in life (PiL). Measures: Rand Medical Outcomes Survey (MOS) 36-Item Short Form (SF-36) with a focus on vitality (primary outcome), Ryff PiL Scale, Center for Epidemiologic Studies Depression Scale, Profile of Mood States, Rand MOS Sleep Scale, physical activity, body weight, blood pressure, and blood measures for glucose and lipids at baseline, 6, 12, and 18 months. Analysis: General linear models with repeated measures for mean values at baseline and follow-up. Results: At 18-month follow-up, sustained improvements were observed for vitality, general health, and mental health domains of SF-36 and PiL ( P < .001 for all measures). Sleep, mood, vigor, physical activity, and blood pressure were also improved at 18 months ( P < .05 for all measures). Conclusions: An intensive 2.5-day intervention showed sustained improvement in employee quality of life, PiL, and other measures of well-being over 18 months.

scholarly journals Long-Term Evolution of Quality of Life and Symptoms Following Surgical Treatment for Endometriosis: Different Trajectories for Which Patients?

2020 ◽  
Vol 9 (8) ◽  
pp. 2461
Author(s):  
Aurélie Comptour ◽  
Céline Lambert ◽  
Pauline Chauvet ◽  
Claire Figuier ◽  
Anne-Sophie Gremeau ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Surgical Treatment ◽  
Short Form ◽  
Complete Information ◽  
Long Term Evolution ◽  
Epidemiological Methods ◽  
Multicenter Cohort Study ◽  
Term Evolution

Many studies have shown a global efficacy of laparoscopic surgery for patients with endometriosis in reducing painful symptoms and improving quality of life (QoL) in the short and long-term. The aim of this study was to analyze the different trajectories of long-term evolution in QoL and symptoms following surgical treatment for endometriosis, and to identify corresponding patient profiles. This prospective and multicenter cohort study concerned 962 patients who underwent laparoscopic treatment for endometriosis. QoL was evaluated using the Short Form (SF)-36 questionnaire and intensity of pain was reported using a visual analog scale prior to surgery and at 6, 12, 18, 24 and 36 months after surgery. Distinctive trajectories of pain and QoL evolution were identified using group-based trajectory modeling, an approach which gathers individuals into meaningful subgroups with statistically similar trajectories. Pelvic symptom trajectories (models of the evolution of dysmenorrhea, dyspareunia and chronic pelvic pain intensity over years) correspond to (1) patients with no pain or pain no longer after surgery, (2) patients with the biggest improvement in pain and (3) patients with continued severe pain after surgery. Our study reveals clear trajectories for the progression of symptoms and QoL after surgery that correspond to clusters of patients. This information may serve to complete information obtained from epidemiological methods currently used in selecting patients eligible for surgery.

scholarly journals Increased Psychopathology and Maladaptive Personality Traits, But Normal Cognitive Functioning, In Patients after Long-Term Cure of Acromegaly

2010 ◽  
Vol 31 (5) ◽  
pp. 778-779
Author(s):  
Jitske Tiemensma ◽  
Nienke R. Biermasz ◽  
Roos C. van der Mast ◽  
Moniek J. E. Wassenaar ◽  
Huub A. M. Middelkoop ◽  
...  
Keyword(s):  
Cognitive Function ◽  
Personality Traits ◽  
Cognitive Dysfunction ◽  
Short Form ◽  
Depression Scale ◽  
Cross Sectional Study ◽  
Cross Sectional ◽  
Personality Changes ◽  
Irreversible Effects

ABSTRACT Objective Active acromegaly is associated with psychopathology, personality changes, and cognitive dysfunction. It is unknown whether, and to what extent, these effects are present after long-term cure of acromegaly. Aim The aim of the study was to assess psychopathology, personality traits, and cognitive function in patients after long-term cure of acromegaly. Design This was a cross-sectional study. Patients and Methods We studied 68 patients after long-term cure (13 ± 1 yr) of acromegaly and 68 matched controls. We compared these data with 60 patients treated for nonfunctioning pituitary macroadenomas (NFMAs) and 60 matched controls. Psychopathology was assessed using the Apathy Scale, Irritability Scale, Hospital Anxiety and Depression Scale, and Mood and Anxiety Symptoms Questionnaire short-form and personality by the Dimensional Assessment of Personality Pathology short-form (DAPP). Cognitive function was assessed by 11 tests. Results Compared with matched controls, patients cured from acromegaly scored significantly worse on virtually all psychopathology questionnaires and on several subscales of the DAPP. Compared with NFMA patients, patients cured from acromegaly scored worse on negative affect (P = 0.050) and somatic arousal (P = 0.009) and seven of 18 subscales of the DAPP (P &lt; 0.05). Cognitive function in patients cured from acromegaly did not differ from matched controls or patients treated for NFMA. Conclusion Patients with long-term cure of acromegaly show a higher prevalence of psychopathology and maladaptive personality traits but not cognitive dysfunction, compared with matched controls and patients treated for NFMA. These results suggest irreversible effects of previous GH excess, rather than effects of pituitary adenomas per se and/or their treatment, on the central nervous system.

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