scholarly journals Differential Effects of Treatment Strategies in Individuals With Chronic Ocular Surface Pain With a Neuropathic Component

2021 ◽  
Vol 12 ◽  
Author(s):  
Sneh Patel ◽  
Rhiya Mittal ◽  
Elizabeth R. Felix ◽  
Konstantinos D. Sarantopoulos ◽  
Roy C. Levitt ◽  
...  
Keyword(s):  
Ocular Surface ◽  
Marked Improvement ◽  
Pain Treatment ◽  
Pain Clinic ◽  
Treatment Modalities ◽  
Autologous Serum ◽  
Ocular Pain ◽  
Post Traumatic ◽  
Pain Improvement

Background: Dysfunction at the ocular system via nociceptive or neuropathic mechanisms can lead to chronic ocular pain. While many studies have reported on responses to treatment for nociceptive pain, fewer have focused on neuropathic ocular pain. This retrospective study assessed clinical responses to pain treatment modalities in individuals with neuropathic component ocular surface pain.Methods: 101 individuals seen at the University of Miami Oculofacial Pain Clinic from January 2015 to August 2021 with ≥3 months of clinically diagnosed neuropathic pain were included. Patients were subcategorized (postsurgical, post-traumatic, migraine-like, and laterality) and self-reported treatment outcomes were assessed (no change, mild, moderate, or marked improvement). One-way ANOVA (analysis of variance) was used to examine relationships between follow up time and number of treatments attempted with pain improvement, and multivariable logistic regression was used to assess which modalities led to pain improvement.Results: The mean age was 55 years, and most patients were female (64.4%) and non-Hispanic (68.3%). Migraine-like pain (40.6%) was most common, followed by postsurgical (26.7%), post-traumatic (16.8%) and unilateral pain (15.8%). The most common oral therapies were α2δ ligands (48.5%), the m common topical therapies were autologous serum tears (20.8%) and topical corticosteroids (19.8%), and the most common adjuvant was periocular nerve block (24.8%). Oral therapies reduced pain in post-traumatic (81.2%), migraine-like (73%), and unilateral (72.7%) patients, but only in a minority of postsurgical (38.5%) patients. Similarly, topicals improved pain in post-traumatic (66.7%), migraine-like (78.6%), and unilateral (70%) compared to postsurgical (43.7%) patients. Non-oral/topical adjuvants reduced pain in postsurgical (54.5%), post-traumatic (71.4%), and migraine-like patients (73.3%) only. Multivariable analyses indicated migraine-like pain improved with concomitant oral α2δ ligands and adjuvant therapies, while postsurgical pain improved with topical anti-inflammatories. Those with no improvement in pain had a shorter mean follow-up (266.25 ± 262.56 days) than those with mild (396.65 ± 283.44), moderate (652 ± 413.92), or marked improvement (837.93 ± 709.35) (p < 0.005). Identical patterns were noted for number of attempted medications.Conclusion: Patients with migraine-like pain frequently experienced pain improvement, while postsurgical patients had the lowest response rates. Patients with a longer follow-up and who tried more therapies experienced more significant relief, suggesting multiple trials were necessary for pain reduction.

Chronic Plantar Heel Pain: Treatment with a Short Leg Walking Cast

1996 ◽  
Vol 17 (1) ◽  
pp. 41-42 ◽  
Author(s):  
Christopher L. Tisdel ◽  
Marion C. Harper
Keyword(s):  
Complete Resolution ◽  
Surgical Intervention ◽  
Pain Treatment ◽  
Heel Pain ◽  
Treatment Modalities ◽  
Plantar Heel Pain ◽  
Long Term Follow Up

The efficacy of a short leg walking cast in the treatment of chronic plantar heel pain was assessed for 32 patients with 37 involved extremities treated over a 2-year period. All patients had failed numerous other treatment modalities and had been symptomatic for an average of 1 year. Long-term follow-up for 24 patients with 28 involved extremities revealed complete resolution of pain for 7 extremities (25%), improvement for 17 (61%), and no improvement for 4 (14%). Ten (42%) patients were completely satisfied with cast treatment, 3 (12%) were satisfied with reservations, and 11 (46%) were dissatisfied. Casting appears to be a reasonable option for patients with recalcitrant heel pain and should be offered before surgical intervention.

scholarly journals Tracheal surgery

2016 ◽  
Vol 73 (3) ◽  
Author(s):  
A. D'Andrilli ◽  
E.A. Rendina ◽  
F. Venuta
Keyword(s):  
Surgical Resection ◽  
Surgical Techniques ◽  
Treatment Modalities ◽  
Malignant Neoplasms ◽  
New Techniques ◽  
Multidisciplinary Cooperation ◽  
Post Traumatic ◽  
Post Intubation ◽  
Near Future

Surgical resection and reconstruction of the trachea can be performed both for benign and malignant diseases. The main indications for surgery include inflammatory (generally post-intubation), congenital or post-traumatic stenoses, degenerative lesions, benign or malignant neoplasms. Success can be pursued only by accurate patient selection and timing, meticulous surgical techniques, careful follow up and, when required, multidisciplinary cooperation. Although surgical resection has now become part of our surgical practice, other treatment modalities are approaching a new clinical application era, in particular tracheal transplantation and bioengineering. These new techniques will certainly offer, in the near future, improved chances to treat difficult cases.

scholarly journals CLINICAL EFFICACY OF ARDHAMATRIKA BASTI IN GRIDHRASI

2022 ◽  
Vol 12 (6) ◽  
pp. 50-55
Author(s):  
Aiyanna PP ◽  
Vishnu Prasad V ◽  
Pradeep JM
Keyword(s):  
Clinical Trial ◽  
Sample Size ◽  
Clinical Efficacy ◽  
Study Design ◽  
Marked Improvement ◽  
Selection Criteria ◽  
Assessment Criteria ◽  
Treatment Modalities ◽  
Practical Utility

Gridhrasi, one among the Nanatmaja Vikara, specific Nidana and Samprapti is not explained in classics so that the general Vata Vyadi Nidhana Samprapthi can be considered. The Chikitsa of Gridhrasi includes Sneha, Sweda, Bastikarma and Agni karma. Generally, Basti is the best line of treatment for Vata dosa. References from Acharya Charaka also explain Basti as one of the treatment modalities. With the support of Niruhadikara in Chakradhatta, we have the reference of Ardhamatrika Basti, which is one among Kashaya Basti, here he explains the practical utility along with many added benefits of Bala, Varna, Vrushatha and Pumsavanathva which gifted by Atreya Maharshi. Ardhamatrika Basti, one among Madhutailika Basti (having an equal quantity of Madhu and Taila), can be clinically explored where neither Parihara Kala nor Purva karma like Sneha, Sweda are necessary. The study design selected for the study was a comprehensive clinical trial. The sample size for the present study was 30 patients suffering from Gridrasi as per the selection criteria. Patients were randomly selected irrespective of sex and were treated with Ardhmatrika Basti as a yoga Basti for eight days. Among 30 patients taken for study, marked improvement in the symptomatology of the disease is obtained. 26.7% of patients got complete Shamana, 36.7% achieved Prayika shamana, 30% reported Amsika shamana, and 6.6% had Kinchit shamana. In the assessment criteria taken in patients, Ruja BT - 2.68 after follow up reduced to 1.8, Spandana BT - 2.38 after follow up reduced to 1.73, Sakthana Utksepa-nigraha BT - 2.82 after follow up reduced to 1.58, Gourava BT - 2.5 after follow up reduced to 1.7, Arochaka BT - 2.22 after follow up reduced to 1.87. This result shows that the present study of Ardhamatrika Basti has given a marked improvement in treating Gridhrasi.

scholarly journals What Do the Parents of Children Who Have Chronic Pain Expect from Their First Visit to a Pediatric Chronic Pain Clinic?

2010 ◽  
Vol 15 (3) ◽  
pp. 158-162 ◽  
Author(s):  
Kathy Reid ◽  
Janice Lander ◽  
Shannon Scott ◽  
Bruce Dick
Keyword(s):  
Chronic Pain ◽  
Pain Treatment ◽  
Treatment Options ◽  
Tertiary Care ◽  
Pain Clinic ◽  
Treatment Modalities ◽  
Care Providers ◽  
Treatment Needs ◽  
Pediatric Chronic Pain ◽  
Pain Clinics

BACKGROUND: Chronic pain in childhood is increasingly recognized as a significant clinical problem. Best-practice management of pediatric chronic pain in a multidisciplinary pain clinic involves a variety of treatment modalities. It is important that parents of children treated in these settings understand the different treatment options available for their children. By involving parents more effectively, care providers may more efficiently address unmet treatment needs and improve tailoring of treatment programs aimed at increasing function, reducing pain-related disability and improving quality of life.OBJECTIVES: To explore the expectations held by parents for their first visit to a pediatric multidisciplinary pain clinic.METHODS: Fourteen parents completed a paper-based survey exploring their expectations immediately before their first visit to a multidisciplinary pediatric pain clinic in a tertiary care children’s hospital.RESULTS: Responses from parents suggest a clear desire for information about the causes of their child’s pain, treatment options available at the pain clinic, effective strategies to enhance children’s ability to cope with pain, and the effects of pain on both body and mood. Most parents rated the various treatment options as important for their child. All parents indicated it was very important to have the pain team ‘be there’ for them.CONCLUSIONS: These findings indicate that parents want more information about chronic pain and treatment options. Pediatric chronic pain clinics have the ability to assist children with chronic pain and their families considerably by providing information about chronic pain and the various treatment options available to them.

Radiosurgery for dural carotid-cavernous sinus fistulas: Gamma Knife compared with XKnife radiosurgery

2010 ◽  
Vol 113 (Special_Supplement) ◽  
pp. 9-20 ◽  
Author(s):  
Hung-Chuan Pan ◽  
Ming-Hsi Sun ◽  
Jason Sheehan ◽  
Meei-Ling Sheu ◽  
Clayton Chi-Chang Chen ◽  
...  
Keyword(s):  
Clinical Improvement ◽  
Gamma Knife ◽  
Temporal Lobe ◽  
Treatment Modalities ◽  
Conformity Index ◽  
Index Number ◽  
The Mean ◽  
Instrument Accuracy ◽  
Group 1

Object In the modern era, stereotactic radiosurgery is an important part of the multidisciplinary and multimodality approach used to treat dural carotid-cavernous fistulas (DCCFs). Based on the ease of performance of techniques to fuse cerebral angiography studies with MR images or CT scans during the radiosurgical procedure, the Gamma Knife and XKnife are 2 of the most popular radiosurgical instruments for patients with DCCF. In this study, the authors compared the efficacy, neurological results, and complications associated with these 2 radiosurgical devices when used for DCCF. Methods Records for 41 patients with DCCF (15 treated using the XKnife and 26 with Gamma Knife surgery [GKS]) were retrieved from a radiosurgical database encompassing the period of September 2000 to August 2008. Among these patients, at least 2 consecutive MR imaging or MR angiography studies obtained after radiosurgery were available for determining radiological outcome of the fistula. All patients received regular follow-up to evaluate the neurological and ophthalmological function at an interval of 1–3 months. The symptomatology, obliteration rate, radiation dose, instrument accuracy, and adverse effects were determined for each group and compared between 2 groups. The data were analyzed using the Student t-test. Results The mean age of the patients was 63 ± 2.6 years, and the mean follow-up period was 63.1 ± 4.4 months (mean ± SD). Thirty-seven patients (90%) achieved an obliteration of the DCCF (93% in the XKnife cohort and 88% for the GKS cohort). In 34 of 40 patients (85%) with chemosis and proptosis of the eyes, these symptoms were resolved after treatment (4 had residual fistula and 2 had arterializations of sclera). All 5 patients with high intraocular pressure demonstrated clinical improvement. Ten (71%) of 14 patients with cranial nerve palsy demonstrated improvement following radiosurgery. Significant discrepancies of treatment modalities existed between the XKnife and GKS groups, such as radiation volume, conformity index, number of isocenters, instrument accuracy, peripheral isodose line, and maximum dosage. The XKnife delivered significantly higher radiation dosage to the lens, optic nerve, optic chiasm, bilateral temporal lobe, and brainstem. Few adverse events occurred, but included 1 patient with optic neuritis (GKS group), 1 intracranial hemorrhage (XKnife group), 1 brainstem edema (XKnife), and 3 temporal lobe radiation edemas (XKnife). Conclusions Radiosurgery affords a substantial chance of radiological and clinical improvement in patients with DCCFs. The Gamma Knife and XKnife demonstrated similar efficacy in the obliteration of DCCFs. However, a slightly higher incidence of complications occurred in the XKnife group.

A Study on Frozen Shoulder and its clinical management through Nasaapana and Nasya

2016 ◽  
Vol 1 (1) ◽  
Author(s):  
Praveenkumar H. Bagali ◽  
A. S. Prashanth
Keyword(s):  
Medical Science ◽  
Frozen Shoulder ◽  
Signs And Symptoms ◽  
Treatment Modalities ◽  
Animal Kingdom ◽  
Shoulder Joints ◽  
Group A ◽  
Group B

The unique position of man as a master mechanic of the animal kingdom is because of skilled movements of his hands and when this shoulder joints get obstructed, we call it as Apabahuka (Frozen shoulder), we do not find satisfactory management in modern medical science. Various effective treatment modalities have been mentioned which reverse the pathogenesis, Shodhana is advised initially followed by Shamana therapies. In the present study 30 patients were selected incidentally and placed randomly into two groups A and B, with 15 subjects in each group. Group A received Amapachana with Panchakola Churna, Jambeera Pinda Sweda and Nasya Karma. Group B received Amapachana with Panchakola Churna, Jambeera pinda Sweda and Nasaapana. In both the groups two months follow up was done. Both groups showed significant improvement in the signs and symptoms of Apabahuka as well as the activities of daily livings, thereby improving the quality of life of the patients. Nasya Karma and Nasaapana provided highly significant results in all the symptoms of Apabahuka. In the present study as per the clinical data, Nasaapana is found to be more effective than Nasya Karma.

Desmoid tumour of the distal forearm involving the distal radioulnar joint

2020 ◽  
Vol 13 (11) ◽  
pp. e237097
Author(s):  
Apoorv Sehgal ◽  
Pratyush Shahi ◽  
Avijeet Prasad ◽  
Manoj Bhagirathi Mallikarjunaswamy
Keyword(s):  
Distal Radioulnar Joint ◽  
Treatment Modalities ◽  
Desmoid Tumour ◽  
X Rays ◽  
Distal Forearm ◽  
Left Wrist ◽  
Radioulnar Joint ◽  
Magnetic Resonance Imaging Mri ◽  
Epidemiology Investigation

A 32-year-old woman presented with progressive pain and swelling of the left wrist for 6 months. Physical examination revealed a firm, tender, oval swelling over the left wrist. X-rays showed a pressure effect on the distal radius and ulna. Magnetic Resonance Imaging (MRI) revealed a well-defined, asymmetrical, dumbbell-shaped soft-tissue lesion involving the interosseous region of the distal forearm and extending until the distal radioulnar joint (DRUJ). Core needle biopsy confirmed the diagnosis of desmoid tumour. Marginal excision of the tumour was done. At the 2-year follow-up, the patient was doing well and had painless and improved left wrist motion. Desmoid tumour involving the DRUJ has not been previously reported. We, through this case, report new observation and discuss the epidemiology, investigation of choice, treatment modalities, and the need for a regular follow-up for appendicular desmoid tumours.

scholarly journals Use of Acellular Umbilical Cord-Derived Tissues in Corneal and Ocular Surface Diseases

Medicines ◽  
2021 ◽  
Vol 8 (2) ◽  
pp. 12
Author(s):  
Arianna A. Tovar ◽  
Ian A. White ◽  
Alfonso L. Sabater
Keyword(s):  
Cord Blood ◽  
Umbilical Cord ◽  
Umbilical Cord Blood ◽  
Ocular Surface ◽  
Cellular Proliferation ◽  
Mononuclear Cells ◽  
Autologous Serum ◽  
High Concentration ◽  
Ocular Surface Diseases ◽  
Natural Healing

Blood derived products have become a valuable source of tissue for the treatment of ocular surface diseases that are refractory to conventional treatments. These can be obtained from autologous or allogeneic sources (patient’s own blood or from healthy adult donors/umbilical cord blood, respectively). Allogeneic cord blood demonstrates practical advantages over alternatives and these advantages will be discussed herein. Umbilical cord blood (UCB) can be divided, generally speaking, into two distinct products: first, mononuclear cells, which can be used in regenerative ophthalmology, and second, the plasma/serum (an acellular fraction), which may be used in the form of eyedrops administered directly to the damaged ocular surface. The rationale for using umbilical cord serum (UCS) to treat ocular surface diseases such as severe dry eye syndrome (DES), persistent epithelial defects (PED), recurrent epithelial erosions, ocular chemical burns, graft versus host disease (GVHD), among others, is the considerably high concentration of growth factors and cytokines, mimicking the natural healing properties of human tears. Allogeneic serum also offers the opportunity for therapeutic treatment to patients who, due to poor heath, cannot provide autologous serum. The mechanism of action involves the stimulation of endogenous cellular proliferation, differentiation and maturation, which is highly efficient in promoting and enhancing corneal epithelial healing where other therapies have previously failed.

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