scholarly journals Surgical treatment of middle cluneal nerve entrapment neuropathy: technical note

2018 ◽  
Vol 29 (2) ◽  
pp. 208-213 ◽  
Author(s):  
Juntaro Matsumoto ◽  
Toyohiko Isu ◽  
Kyongsong Kim ◽  
Naotaka Iwamoto ◽  
Daijiro Morimoto ◽  
...  
Keyword(s):  
Local Anesthesia ◽  
Rating Scale ◽  
Numerical Rating Scale ◽  
Japanese Orthopaedic Association ◽  
Technical Note ◽  
Nerve Entrapment ◽  
Systemic Complications ◽  
Less Invasive ◽  
The Mean ◽  
Middle Cluneal Nerve

OBJECTIVEThe etiology of low-back pain (LBP) is heterogeneous and is unknown in some patients with chronic pain. Superior cluneal nerve entrapment has been proposed as a causative factor, and some patients suffer severe symptoms. The middle cluneal nerve (MCN) is also implicated in the elicitation of LBP, and its clinical course and etiology remain unclear. The authors report the preliminary outcomes of a less invasive microsurgical release procedure to address MCN entrapment (MCN-E).METHODSThe authors enrolled 11 patients (13 sites) with intractable LBP judged to be due to MCN-E. The group included 3 men and 8 women ranging in age from 52 to 86 years. Microscopic MCN neurolysis was performed under local anesthesia with the patient in the prone position. Postoperatively, all patients were allowed to walk freely with no restrictions. The mean follow-up period was 10.5 months. LBP severity was evaluated on the numerical rating scale (NRS) and by the Japanese Orthopaedic Association (JOA) and the Roland-Morris Disability Questionnaire (RDQ) scores.RESULTSAll patients suffered buttock pain, and 9 also had leg symptoms. The symptoms were aggravated by standing, lumbar flexion, rolling over, prolonged sitting, and especially by walking. The numbers of nerve branches addressed during MCN neurolysis were 1 in 9 patients, 2 in 1 patient, and 3 in 1 patient. One patient required reoperation due to insufficient decompression originally. There were no local or systemic complications during or after surgery. Postoperatively, the symptoms of all patients improved statistically significantly; the mean NRS score fell from 7.0 to 1.4, the mean RDQ from 10.8 to 1.4, and the mean JOA score rose from 13.7 to 23.6.CONCLUSIONSLess invasive MCN neurolysis performed under local anesthesia is useful for LBP caused by MCN-E. In patients with intractable LBP, MCN-E should be considered.

A Multicenter, Randomized, Double-Blind, Placebo-Controlled Trial of Nalbuphine ER Tablets for Uremic Pruritus

2017 ◽  
Vol 46 (6) ◽  
pp. 450-458 ◽  
Author(s):  
Vandana S. Mathur ◽  
Jayant Kumar ◽  
Paul W. Crawford ◽  
Howard Hait ◽  
Thomas Sciascia ◽  
...  
Keyword(s):  
Rating Scale ◽  
Numerical Rating Scale ◽  
Controlled Trial ◽  
Hemodialysis Patients ◽  
Opioid Antagonist ◽  
Opioid Agonist ◽  
Double Blind ◽  
Double Blind Placebo ◽  
Uremic Pruritus ◽  
The Mean

Background: Pruritus is a distressing hallmark of the uremic condition, affecting approximately 60% of hemodialysis patients. Abnormal endogenous opioid ligand activity at μ and κ-opioid receptors has been postulated as a mechanism in uremic pruritus. Nalbuphine is a μ-opioid antagonist and κ-opioid agonist. Methods: In this multicenter, randomized, double-blind, placebo-controlled trial, 373 hemodialysis patients with moderate or severe uremic pruritus were randomized in a 1: 1:1 ratio to nalbuphine extended-release tablets 120 mg (NAL 120), 60 mg (NAL 60), or placebo and treated for 8 weeks. Three hundred seventy-one were analyzed for efficacy. The primary endpoint was the change from baseline to treatment weeks 7 and 8 in itching intensity on a Numerical Rating Scale (NRS, 0 [no itching]; 10 [worst possible itching]) using an intent-to-treat approach. The aim was to evaluate the safety and antipruritic efficacy of NAL. Results: The mean duration of itching was 3.2 years. From a baseline NRS of 6.9 (1.5), the mean NRS declined by 3.5 (2.4) and by 2.8 (2.2) in NAL 120 mg and the placebo groups, respectively (p = 0.017). There was no evidence of tolerance. A trend for less sleep disruption due to itching (p = 0.062, NAL 120 vs. placebo) was also observed. There were no significant differences between NAL 60 vs. placebo. Serious adverse events occurred in 6.7, 12.7, and 15.4% in the NAL 120, NAL 60, and placebo groups respectively. Conclusions: In this largest-to-date randomized controlled trial in uremic pruritus, NAL 120 durably and significantly reduced the itching intensity among hemodialysis patients.

scholarly journals Postendodontic Pain after Pulpotomy or Root Canal Treatment in Mature Teeth with Carious Pulp Exposure: A Multicenter Randomized Controlled Trial

2020 ◽  
Vol 2020 ◽  
pp. 1-14
Author(s):  
Mohammad Jafar Eghbal ◽  
Ali Haeri ◽  
Arash Shahravan ◽  
Ali Kazemi ◽  
Fariborz Moazami ◽  
...  
Keyword(s):  
Postoperative Pain ◽  
Pain Relief ◽  
Root Canal ◽  
Rating Scale ◽  
Numerical Rating Scale ◽  
Controlled Trial ◽  
Mineral Trioxide Aggregate ◽  
Preoperative Pain ◽  
Multicenter Randomized Controlled Trial ◽  
The Mean

This equivalence, randomized, clinical trial aimed to compare the postoperative pain of root canal therapy (RCT) with pulpotomy with mineral trioxide aggregate (PMTA) or calcium-enriched mixture (PCEM) in permanent mature teeth. In seven academic centers, 550 cariously exposed pulps were included and randomly allocated into PMTA (n = 188), PCEM (n = 194), or RCT (n = 168) arms. Preoperative “Pain Intensity” (PI) on Numerical Rating Scale and postoperative PIs until day 7 were recorded. Patients’ demographic and pre-/intra-/postoperative factors/conditions were recorded/analysed. The arms were homogeneous in terms of demographics. The mean preoperative PIs were similar (P=0.998), the mean sum PIs recorded during 10 postoperative intervals were comparable (P=0.939), and the trend/changes in pain relief were parallel (P=0.821) in all study arms. The incidences of preoperative moderate-severe pain in RCT, PMTA, and PCEM arms were 56.5%, 55.7%, and 56.7%, which after 24 hours considerably decreased to 13.1%, 10.6%, and 12.9%, respectively (P=0.578). The time span of endodontic procedures was statistically different; RCT = 69.73, PMTA = 35.37, and PCEM = 33.62 minutes (P<0.001). Patients with greater preoperative pain, symptomatic apical periodontitis, or presence of PDL widening suffered more pain (P=0.002, 0.035, and 0.023, resp.); however, other pre-/intra-/postoperative factors/conditions were comparable. Pulpotomy with MTA/CEM and RCT demonstrate comparable and effective postoperative pain relief.

scholarly journals Association between intermittent low-back pain and superior cluneal nerve entrapment neuropathy

2016 ◽  
Vol 24 (2) ◽  
pp. 263-267 ◽  
Author(s):  
Yasuhiro Chiba ◽  
Toyohiko Isu ◽  
Kyongsong Kim ◽  
Naotaka Iwamoto ◽  
Daijiro Morimoto ◽  
...  
Keyword(s):  
Low Back Pain ◽  
Back Pain ◽  
Rating Scale ◽  
Numerical Rating Scale ◽  
Symptom Relief ◽  
Japanese Orthopaedic Association ◽  
Entrapment Neuropathy ◽  
Low Back ◽  
Lumbar Extension

OBJECT Superior cluneal nerve (SCN) entrapment neuropathy (SCNEN) is a cause of low-back pain (LBP) that can be misdiagnosed as a lumbar spine disorder. The clinical features and etiology of LBP remain poorly understood. In this study, 5 patients with intermittent LBP due to SCNEN who had previously received conservative treatment underwent surgery. The findings are reported and the etiology of LBP is discussed to determine whether it is attributable to SCNEN. METHODS Intermittent LBP is defined as a clinical condition in which pain is induced by standing or walking but is absent at rest. Between April 2012 and March 2013, 5 patients in this study who had intermittent LBP due to SCNEN underwent surgery. The patients included 3 men and 2 women, with a mean age of 66 years. The affected side was unilateral in 2 patients and bilateral in 3 (total sites, 8). The interval from symptom onset to treatment averaged 51.4 months; the mean postoperative follow-up period was 17.6 months. The clinical outcomes were assessed using the numerical rating scale (NRS) for LBP, the Japanese Orthopaedic Association (JOA) scale, and the Roland-Morris Disability Questionnaire (RDQ) preoperatively and at the last follow-up; these data were analyzed statistically. RESULTS None of the 5 patients reported LBP at rest. Intermittent LBP involving the iliac crest and buttocks was induced by standing or walking an average of 136 m. In 2 patients with unilateral involvement, LBP was improved only by SCN block. Surgeries were performed on 6 sites in 5 patients because the SCN block was only transiently effective. Patients’ SCNs penetrated the orifice of the thoracolumbar fascia. SCN kinking at the orifice was exacerbated at the lumbar-extension provocation posture, and radiating pain increased upon manual intraoperative compression of the SCN in this posture. After releasing the SCN surgically, disappearance of the pain was intraoperatively confirmed by manual compression of the SCN with the patients in the lumbar-extension posture. Surgery was effective in all 5 patients, and all clinical outcome scores indicated significant improvement (p < 0.05). CONCLUSIONS To the authors’ knowledge, this is the first report of patients with intermittent LBP due to SCNEN. Clinical and surgical evidence presented suggests that their LBP was exacerbated by lumbar extension and that symptom relief was obtained by SCN block or surgical release of the SCN entrapment. These results suggest that SCNEN should be considered as a causal factor in patients for whom walking elicits LBP.

scholarly journals Cervical Single-Level Pincer Stenosis Causing Myelopathy: A Technical Note and Medium-term Results of a One-Session Microsurgical 360-Degree Treatment

2021 ◽  
Author(s):  
Luca Papavero ◽  
Markus Pietrek ◽  
Carlos Joan Marques ◽  
Gregor Schmeiser
Keyword(s):  
Plate Fixation ◽  
Japanese Orthopaedic Association ◽  
Technical Note ◽  
X Rays ◽  
Medium Term ◽  
Improvement Rate ◽  
Single Level ◽  
Postoperative Mri ◽  
The Mean ◽  
Degenerative Cervical Myelopathy

Abstract Background and Study Aims Single-level circumferential or pincer stenosis (PS) affects few patients with degenerative cervical myelopathy (DCM). The surgical technique and medium-term results of a one-session microsurgical 360-degree (m360°) procedure are presented. Patients Between 2013 and 2018, the data of 23 patients were prospectively collected out of 371 patients with DCM. The m360° procedure comprised a microsurgical anterior cervical decompression and fusion (ACDF), with additional plate fixation, followed by flipping the patient and performing a microsurgical posterior bilateral decompression via a unilateral approach in crossover technique. Results The mean age of the patients was 72 years (range: 50–84); 17 patients were males. The mean follow-up time was 12 months (range: 6–31). The patients filled in the patient-derived modified Japanese Orthopaedic Association (P-mJOA) questionnaire on average 53 months after surgery. One patient received a two-level ACDF. Lesions were mostly (92%) located at the C3/C4 (8/24), C4/C5 (7/24), and C5/C6 (7/24) levels. Functional X-rays showed segmental instability in 10 of 23 patients (44%). All preoperative T2-weighted magnetic resonance imaging (MRI) showed an intramedullary hyperintensity. The median preoperative mJOA score was 13 (range 3), and it improved to 16 (range 3) postoperatively. The mean improvement rate in the mJOA score was 73%. When available, postoperative MRI confirmed good circumferential decompression with persistent intramedullary hyperintensity. There were two complications: a long-lasting radicular paresthesia at C6 and a transient C5 palsy. No revision surgery was required. Conclusion The one-session m360° procedure was found to be a safe surgical procedure for the treatment of PS, and the medium-term clinical outcome was satisfactory.

scholarly journals Effectiveness of Al-Quran Auditory Therapy and Music Therapy on Pain Quality in Coronary Heart Disease Patients at Ulin General Hospital

2021 ◽  
pp. 827-835
Author(s):  
. Milasari ◽  
. Hamzah ◽  
. Solikin
Keyword(s):  
Coronary Heart Disease ◽  
Heart Disease ◽  
Music Therapy ◽  
Quantitative Research ◽  
Rating Scale ◽  
Numerical Rating Scale ◽  
Therapy Group ◽  
Left Shoulder ◽  
The Mean

Heart disease is the number one cause of death globally; an estimation shows that 17.7 million people die because of cardiovascular disease. 7.4 million deaths are caused by coronary heart disease. The main symptoms of coronary heart disease are chest pain (angina), feeling depressed, squeezed or choked with the location of the pain at the back of the left breastbone spreading from the bottom of the upper arm, left shoulder, to the neck or lower jaw. Pain management can be done with non-pharmacological techniques of Al-Quran auditory therapy and music therapy. The purpose of this study is to determine the effectiveness of Al-Quran auditory therapy and music therapy on the quality of pain in patients with coronary heart disease. This research is a quantitative research with Quasy Experimental research design using two pre and post design approach involving 28 respondents. Measurement of pain level by using Numerical Rating Scale. The results showed that both therapy had an effect on the quality of pain of coronary heart disease patients. The mean decreasing of pain in the group of auditory therapy Al-Quran is bigger than the music therapy group the results of the mean 1.286. So it can be deduced that Al-Quran auditory therapy is more effective in reducing pain in patients with coronary heart disease. The suggestion of this study may provide additional information for response-related pain relief.   Keywords: CHD, Pain, Al-Quran, Music

scholarly journals Long-term evolution of calcific tendinitis of the rotator cuff: clinical and radiological evaluation 10 years after diagnosis

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Riccardo Compagnoni ◽  
Alessandra Menon ◽  
Simone Radaelli ◽  
Francesco Lanzani ◽  
Mauro B. Gallazzi ◽  
...  
Keyword(s):  
Rotator Cuff ◽  
Rating Scale ◽  
Numerical Rating Scale ◽  
Calcific Tendinitis ◽  
Rotator Cuff Tears ◽  
Radiological Evaluation ◽  
Glenohumeral Osteoarthritis ◽  
The Mean

Abstract Background Calcific tendinitis of the shoulder has a tendon involvement that could evolve to rotator cuff tear and shoulder osteoarthritis. This study aimed to evaluate the prevalence of glenohumeral osteoarthritis and rotator cuff tears in patients affected by calcific tendinitis at a minimum follow-up of 10 years after diagnosis. Methods Patients diagnosed with calcific tendinitis of the shoulder with a minimum follow-up of 10 years were contacted and invited for a clinical and radiological evaluation. Information on the demographics, affected and dominant side, bilateral shoulder pain, type of treatment, habits, systemic or musculoskeletal diseases, reoperation of the index shoulder, and subjective satisfaction was collected. The clinical evaluation was performed using Constant–Murley score (CMS), American Shoulder and Elbow Surgeons Score (ASES), and numerical rating scale (NRS); isometric strength in forwarding flexion and abduction was also measured. Each patient also underwent an ultrasound examination to evaluate rotator cuff tendon integrity and a shoulder radiograph to evaluate osteoarthritis. Results Seventy-nine patients were available for a phone interview, and 35 agreed to be examined. The mean age was 58.89 (± 7.9) years at follow-up. The prevalence of glenohumeral osteoarthritis was 17.14% in the study population, with significant progression in 14.29% of the cases, without rotator cuff full-thickness tears. x-Ray examination showed residual calcifications in 31 patients, with a mean diameter of 5.54 mm. In 30 cases, there was a reduction of the diameter; in 4 cases, the calcification increased in size; and in 1 case, the size did not change. The mean ASES score was 74.1 (± 22.7) in the group with calcifications larger than 2 mm and 89.4 (± 8.2) in patients with smaller calcifications (p = 0.08) without correlation with the type of treatment performed. Conclusions Calcific tendinitis is a self-resolving disease without rotator cuff tears at long-term follow-up or degenerative glenohumeral progression. Level of Evidence: 3, cohort study.

scholarly journals The association of pain and stiffness with fatigue in incident polymyalgia rheumatica: baseline results from the polymyalgia rheumatica cohort study

2019 ◽  
Vol 20 ◽  
Author(s):  
J.A. Prior ◽  
S. Muller ◽  
T. Helliwell ◽  
S.L. Hider ◽  
K. Barraclough ◽  
...  
Keyword(s):  
General Practice ◽  
Cohort Study ◽  
Polymyalgia Rheumatica ◽  
Symptom Severity ◽  
Rating Scale ◽  
Numerical Rating Scale ◽  
Newly Diagnosed ◽  
Fatigue Score ◽  
Numerical Rating ◽  
The Mean

AbstractWe aimed to examine the association between pain, stiffness and fatigue in newly diagnosed polymyalgia rheumatica (PMR) patients using baseline data from a prospective cohort study. Fatigue is a known, but often ignored symptom of PMR. Newly diagnosed PMR patients were recruited from general practice and mailed a baseline questionnaire. This included a numerical rating scale for pain and stiffness severity, manikins identifying locations of pain and stiffness and the FACIT-Fatigue questionnaire. A total of 652 PMR patients responded (88.5%). The mean age of responders was 72.6 years (SD 9.0) and the majority were female (62.0%). Manikin data demonstrated that bilateral shoulder and hip pain and stiffness were common. The mean fatigue score (FACIT) was 33.9 (SD 12.4). Adjusted regression analysis demonstrated that a higher number of pain sites (23–44 sites) and higher pain and stiffness severity were associated with greater levels of fatigue. In newly diagnosed PMR patients, fatigue was associated with PMR symptom severity.

scholarly journals Balanced Suspension versus Pillow on Preoperative Pain for Proximal Femur Fractures: A Randomized Controlled Trial

2020 ◽  
Vol 2020 ◽  
pp. 1-5
Author(s):  
Varah Yuenyongviwat ◽  
Chonthawat Jiarasrisatien ◽  
Khanin Iamthanaporn ◽  
Theerawit Hongnaparak ◽  
Boonsin Tangtrakulwanich
Keyword(s):  
Proximal Femur ◽  
Rating Scale ◽  
Numerical Rating Scale ◽  
External Rotation ◽  
Controlled Trial ◽  
Preoperative Pain ◽  
Proximal Femur Fractures ◽  
Femur Fractures ◽  
Group A ◽  
The Mean

Introduction. To evaluate the efficacy of a balanced suspension system, using the Thomas splint, with Pearson attachment, compared with a pillow for preoperative pain in patients with proximal femoral fractures. Materials and Methods. Sixty patients with proximal femur fractures were randomized into two groups: a balanced suspension group and a pillow group. In the first group, a balanced suspension was applied after length adjustment, to match the patient’s leg and thigh. In the pillow group, a pillow was placed below the patient’s leg, to position the patient’s hip in a semiflexion and external rotation position. Preoperative pain severity, by using a verbal numerical rating scale (VNRS), the amount of morphine consumed, and complication were recorded. Results. There were no differences in patient characteristics between the groups. The mean VNRS for pain was not statistically different between the groups, from the start of the study up to 48 hours. The mean of morphine consumption was not different between the groups at the start of the study, on day 1, and on day 2 (p=0.25, 0.89, and 0.053, respectively). Conclusions. A balanced suspension did not improve patient outcome to the same level as other tractions in previous studies. Hence, other methods for reducing pain, while waiting for definite operations, should be focused on. The clinical trial is registered with TCTR20150514002.

Clinical and radiological outcomes of the Ivory arthroplasty for trapeziometacarpal joint osteoarthritis with a minimum of 5 years of follow-up: a prospective single-centre cohort study

2013 ◽  
Vol 38 (8) ◽  
pp. 866-874 ◽  
Author(s):  
J. F. Goubau ◽  
C. K. Goorens ◽  
P. Van Hoonacker ◽  
B. Berghs ◽  
D. Kerckhove ◽  
...  
Keyword(s):  
Functional Outcome ◽  
Rating Scale ◽  
Numerical Rating Scale ◽  
Survival Rates ◽  
Trapeziometacarpal Joint ◽  
Term Survival ◽  
Numerical Rating ◽  
Trapeziometacarpal Joint Osteoarthritis ◽  
The Mean

We present the results of a 5 year prospective follow-up study on the functional outcome after total replacement of the trapeziometacarpal joint with the Ivory prosthesis (Memometal, Stryker Corporate, Kalamazoo, Michigan, USA) in 22 patients. The female to male ratio was 21:1 and the mean age was 66 (range 54–78) years. The mean follow-up period was 67 (range 60–77) months after operation. Patient satisfaction was high. The mobility of the operated thumb was restored to a range of motion comparable to the contralateral thumb. Key pinch and grip strength improved by 13% and 31%, respectively. Overall function, according to Quick Disabilities of the Arm, Shoulder and Hand (QuickDASH) score, improved by 59%. Pain decreased by 85% according to the numerical rating scale. Radiological evaluation revealed no loosening of the implant after 5 years except in one patient who required revision due to polythene wear with secondary joint instability. Another patient had asymptomatic polythene wear that required no revision but remains in follow-up. The 5 year overall survival of the prosthesis was 95%. These medium-term results suggest that the Ivory arthroplasty is a reliable option for treating advanced trapeziometacarpal arthritis, because it appears to give a very good functional outcome and has the potential for long-term survival rates.

scholarly journals Strategy to prevent nerve injury and deep vein thrombosis in radiofrequency segmental thermal ablation of the saphenous veins using a new objective pain scale

2021 ◽  
pp. 026835552110105
Author(s):  
Kenji Yamamoto ◽  
Senri Miwa ◽  
Tomoyuki Yamada ◽  
Shuji Setozaki ◽  
Mamoru Hamuro ◽  
...  
Keyword(s):  
Deep Vein Thrombosis ◽  
Nerve Injury ◽  
Rating Scale ◽  
Numerical Rating Scale ◽  
Pain Scale ◽  
Vein Thrombosis ◽  
Numerical Rating ◽  
Endovenous Ablation ◽  
The Mean ◽  
Deep Vein

Objective We evaluated the benefit of local anesthesia including tumescent anesthesia and active walking soon after surgery in preventing nerve injury and deep vein thrombosis caused during endovenous ablation. Methods Endovenous ablation was performed in 1334 consecutive patients. Varicectomy was performed using the stab avulsion technique. After surgery, patients were encouraged to walk 100–200 m inside the ward for 3–5 times/h. The pain was evaluated objectively using the Okamura pain scale and subjectively using the numerical rating scale. Results Stab avulsion was performed at 11.8 ± 8.0 sites and the mean operative time was 33.9 ± 15.2 min. The mean Okamura pain scale and numerical rating scale scores were 1.6 ± 1.3 and 3.0 ± 2.0, respectively. Deep vein thrombosis and pulmonary embolism were absent. The incidence of nerve injury was 0.3%. Conclusions Endovenous ablation should be performed with the patients under local anesthesia to prevent nerve injury and deep vein thrombosis.

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