scholarly journals The use of skeletal muscle relaxants in musculoskeletal injuries: what is the evidence?

2018 ◽  
Vol 60 (5) ◽  
pp. 7-16
Author(s):  
Dina C. Janse van Rensburg ◽  
Audrey Jansen van Rensburg ◽  
Gehart Kalmeier ◽  
Carel T. Viljoen ◽  
Dimakatso A. Ramagole ◽  
...  
Keyword(s):  
Skeletal Muscle ◽  
Sports Injuries ◽  
Case Reports ◽  
Pain Syndrome ◽  
Muscle Relaxants ◽  
Level Of Evidence ◽  
Ovid Medline ◽  
Lower Back ◽  
Exercise Muscle ◽  
Myofacial Pain

Skeletal muscle relaxants (SMRs) consist of a heterogeneous group of medications with a side effect profile of concern. The aim of this paper was to review the evidence of use of SMRs in the treatment of sports injuries. A literature search between 2005 – 2018 (Ovid MEDLINE, SPORTDiscus and SCOPUS) were conducted. In addition, citations within articles were searched, and the most commonly prescribed SMRs in South Africa were also used to explore the literature for additional publications. Relevant studies that met the inclusion criteria were selected. Clinical recommendations for general practitioners are given based on the Strength of Recommendation Taxonomy (SORT) level of evidence. Combination drugs rather than single agents are mostly used, however the effectiveness of SMR agents, single and in combination, as well as its significance as opposed to analgesics and non-steroidal anti-inflammatory drugs, still has to be evaluated. Evidence suggest SMRs to be probably effective for use in non-specific lower back pain (acute and chronic lower back muscle strains, ligament sprains, soft tissue contusions), as well as for whiplash associated disorder, mechanical neck disorders, piriformis syndrome, lateral epicondylosis, and plantar fasciitis. It does not appear if there is a role for SMRs as part of combination management for acute cervical strains, post-exercise muscle soreness or myofacial pain syndrome. However, substantial evidence to confirm the use of SMRs in the treatment of sports injuries have not been adequately investigated and is currently largely based on case reports and general reviews.

Additional Topics: Pain Management

2018 ◽  
pp. 255-260
Author(s):  
Ruchir Gupta
Keyword(s):  
Pain Management ◽  
Anesthetic Management ◽  
Stellate Ganglion ◽  
Stellate Ganglion Block ◽  
Pain Syndrome ◽  
Pregnant Patient ◽  
Trigger Points ◽  
Ganglion Block ◽  
Lower Back ◽  
Myofacial Pain

In this chapter several topics related to anesthesia for pain management are discussed. Subtopics include anesthetic management of patients with complex regional pain syndrome (CRPS) types 1 and 2, performing a stellate ganglion block, and prevention of local anesthetic toxicity. The chapter begins with a discussion of the mechanisms of pain onset. Next, evaluation and treatment of chronic pain are addressed. Trigger points in myofacial pain are outlined and the mechanism of transcutaneous electrical nerve stimulation (TENS) presented. A case involving a pregnant patient on chronic methadone therapy is presented. Management of cancer pain, post-amputation pain, and lower back pain and sciatica are also addressed. Each scenario is presented as a short, three- to four-question additional topic.

scholarly journals TREATMENT OF SPORT INJURIES WITH ACUPUNCTURE: A LITERATURE REVIEW

2018 ◽  
Vol 24 (4) ◽  
pp. 316-321 ◽  
Author(s):  
Luiza Borges Gentil
Keyword(s):  
Rating Scales ◽  
Sports Injuries ◽  
Case Reports ◽  
Control Group ◽  
Placebo Control ◽  
Level Of Evidence ◽  
Level Ii ◽  
Research Level ◽  
Evidence Rating ◽  
Acupuncture Research

ABSTRACT As acupuncture is growing in popularity in Brazil and worldwide, it is necessary to study the benefits and possibilities of this type of treatment more in depth, especially as it is believed to produce fast results with few side effects and does not involve substances banned in sports. Thus, it seems like a good option to be considered as main or adjuvant therapy in sports-related injuries. In order to gain more knowledge about this subject, this article is an integrative review analyzing the publications of the period between January 2012 and January 2017 on the Cochrane and Pubmed platforms that analyzed acupuncture in the treatment of sports injuries. We found 49 articles, 11 of which fulfilled the inclusion criteria: two case reports, three clinical trials and six literature reviews. Although all the articles analyzed produced favorable results with the use of the therapeutic technique in question, flaws in the designs of the studies and the difficulty of creating a placebo control group in acupuncture hinder the qualification of the articles on evidence rating scales. Therefore, it is suggested to the researchers that further studies be published with experimental animal models and observational studies, and that STRICTA recommendations be followed to improve the level of evidence of acupuncture research. Level of Evidence II; Systematic review of level II studies.

Interventional treatment of lower back pain

2020 ◽  
pp. 44-53 ◽  
Author(s):  
A. Yu. Novikov ◽  
M. B. Tsykunov
Keyword(s):  
Low Back Pain ◽  
Back Pain ◽  
Pain Syndrome ◽  
Main Group ◽  
Muscle Relaxants ◽  
Control Group ◽  
Interventional Treatment ◽  
Low Back ◽  
Treatment Needs ◽  
Lower Back

Introduction. Low back pain takes one of the leading places among all non-communicable diseases, reaching 70 % of outpatient visits. In 90 % of cases the non-specific nature of back pain is observed. The most common causes of low back pain are myofascial pain syndrome, facet joint arthrosis, spinal stenosis, spondylolisthesis, discal hernias. If NSAIDs and muscle relaxants are the «gold standard» in the treatment of low back pain, interventional treatment needs further studies. This trial was conducted in order to determine the effectiveness of therapeutic blockades. The goal of research — to study the effectiveness of selective injections of pharmaceuticals into pain sources in case of low back pain based on clinical and instrumental studies.Materials and methods. The prospective, controlled, randomized trial was conducted from January 2018 to January 2019 at the Department of Neurosurgery and Medical Rehabilitation of the Bashkir State Medical University. 42 patients with low back pain, aged from 24 to 54 years, of which 28 (66,7 %) were men and 14 (33,3 %) were women took part in the research and were randomly divided into 2 groups. Patients of the main group (30 people) underwent interventional therapy, from 2 to 7 injections, depending on the severity of the pain syndrome and the duration of the disease. Patients of the control group — 12 people, received treatment in accordance with the standard of medical care in low back pain (analgesics, NSAIDs, muscle relaxants), as well as physiotherapy for 2 weeks daily. The study of the effectiveness of therapy included, along with the neurological examination, a neuroorthopedic instrumental examination. The depth of the lumbar lordosis, flexion and extension restrictions were measured using a curvimeter-goniometer, which also allows measuring the angle of tension symptoms (Lasegue, Wasserman). In order to study rotation and lateroflexion, instruments with a graduated scale were used. Muscle tone and tenderness of the structures of the spine were examined using a myotonometer-tensoalgimeter and a visual analogue scale (VAS). To interpret the data of a comprehensive neuroorthopedic examination, the results were converted into comparable units with the calculation of the integral indicator.Results. After selective intervention therapy in the main group, a more rapid relief of pain, a regression of neurological symptoms, manifested by the complete elimination or significant reduction of biomechanical and tonus disorders in the lower back were noted.Conclusion. Selective injections of pharmaceuticals into pain sources in low back pain are more effective than treatment with the use of analgesics, NSAIDs, muscle relaxants and physiotherapy, which allows to recommend them for wider use in clinical practice.

Vitamin B6 Deficiency can Reduce Fuel Storage and Utilization in Physically Trained Rats

2008 ◽  
Vol 78 (2) ◽  
pp. 64-69 ◽  
Author(s):  
Choi ◽  
Cho
Keyword(s):  
Skeletal Muscle ◽  
Fatty Acid ◽  
Muscle Protein ◽  
Plasma Free Fatty Acid ◽  
Vitamin B ◽  
Liver Protein ◽  
Protein Levels ◽  
Before And After ◽  
Fuel Storage ◽  
Exercise Muscle

This study investigated the effect of vitamin B6 deficiency on the utilization and recuperation of stored fuel in physically trained rats. 48 rats were given either vitamin B6-deficient (B6–) diet or control (B6+) diet for 4 weeks and were trained on treadmill for 30 minutes daily. All animals were then subdivided into 3 groups: before-exercise (BE); during-exercise (DE); after-exercise (AE). The DE group was exercised on treadmill for 1 hour just before being sacrificed. Animals in the AE group were allowed to take a rest for 2 hours after being exercised like the DE group. Glucose and free fatty acids were compared in plasma. Glycogen and triglyceride were compared in liver and skeletal muscle. Protein levels were compared in plasma, liver, and skeletal muscle. Compared with the B6+ group, plasma glucose levels of the B6– group were significantly lower before and after exercise. Muscle glycogen levels of the B6– group were significantly lower than those of the B6+ group regardless of exercise. The liver glycogen level of the B6– group was also significantly lower than that of B6+ group during and after exercise. Before exercise, plasma free fatty acid levels were not significantly different between the B6+ and B6– groups, and plasma free fatty acid levels of the B6– group were significantly lower during and after exercise. The muscle triglyceride level of the B6– group was significantly lower than that of the B6+ group before exercise, and there were no differences between B6+ and B6– groups during and after exercise. Liver triglyceride levels were not significantly different between B6+ and B6– groups. Plasma protein levels of the B6– group were lower than those of B6+ before and after exercise. Muscle protein levels of the B6– group were not significantly different from those of the B6+ group. Liver protein levels of the B6– group were significantly lower than that of the B6+ group after exercise. Liver protein levels of both B6+ and B6– groups were not significantly changed, regardless of exercise. Thus, it is suggested that vitamin B6 deficiency may reduce fuel storage and utilization with exercise in physically trained rats.

scholarly journals Combined Hip Abductor and External Rotator Strengthening and Hip Internal Rotator Stretching Improves Pain and Function in Patients With Patellofemoral Pain Syndrome: A Randomized Controlled Trial With Crossover Design

2021 ◽  
Vol 9 (4) ◽  
pp. 232596712198972
Author(s):  
Anis Jellad ◽  
Amine Kalai ◽  
Mohamed Guedria ◽  
Mahbouba Jguirim ◽  
Sana Elmhamdi ◽  
...  
Keyword(s):  
Randomized Controlled Trial ◽  
Controlled Trial ◽  
Pain Syndrome ◽  
Patellofemoral Pain Syndrome ◽  
Patellofemoral Pain ◽  
Level Of Evidence ◽  
Randomized Controlled ◽  
Group Standard ◽  
Hip Muscle ◽  
And Function

Background: Active rehabilitation has an important role in the management of patellofemoral pain syndrome (PFPS). Although some studies have shown the benefit of hip-muscle strengthening, the effect of combining hip-muscle stretching with strengthening has not yet been defined. Purpose: To evaluate the effect of combined strengthening of the hip external rotators and abductors and stretching of the hip internal rotators on pain and function in patients with PFPS. Study Design: Randomized controlled trial; Level of evidence, 2. Methods: A total of 109 patients with PFPS (75 female and 34 male; mean age, 31.6 ± 10.8 years) were first randomly assigned to protocol A (n = 67) of the A-B arm (AB group; standard rehabilitation) or protocol B (n = 42) of the B-A arm (BA group; standard rehabilitation with strengthening of the hip external rotators and abductors and stretching of the hip internal rotators). Each protocol consisted of 3 sessions a week for 4 weeks. After a washout period, corresponding to a symptom-free period, rehabilitation programs were crossed over. A visual analog scale (VAS) evaluating perceived pain, the Functional Index Questionnaire (FIQ), and the Kujala score were administered at baseline, the end of each rehabilitation protocol, and 12 weeks after the completion of the second protocol for each group. Results: Until the final follow-up, VAS, FIQ, and Kujala scores were significantly improved in both the A-B and B-A arms ( P < .05 for all). Compared with protocol A, protocol B provided significant improvement in terms of pain and function in both the BA (VAS and Kujala; P < .001) and AB (VAS and Kujala; P < .001) groups. Conclusion: Combined strengthening of the hip abductors and external rotators with stretching of the hip internal rotators provided better outcomes, which were maintained for at least 12 weeks, in terms of pain and function in patients with PFPS.

Antiarrhythmic Effects of Skeletal Muscle Relaxants

1971 ◽  
Vol 34 (8) ◽  
pp. 458-462 ◽  
Author(s):  
K C Wong ◽  
Steven R. Wyte ◽  
Wayne E. Martin ◽  
Edward W. Crawford
Keyword(s):  
Skeletal Muscle ◽  
Muscle Relaxants ◽  
Antiarrhythmic Effects

scholarly journals Physical activity and health, novel concepts and new targets: report from the 12th Conference of the International Research Group on the Biochemistry of Exercise

2004 ◽  
Vol 63 (2) ◽  
pp. 189-197 ◽  
Author(s):  
Matthijs K. C. Hesselink ◽  
Marleen A. van Baak
Keyword(s):  
Physical Activity ◽  
Skeletal Muscle ◽  
Physical Exercise ◽  
Health Effects ◽  
Research Group ◽  
International Research ◽  
Biochemical Basis ◽  
International Research Group ◽  
Exercise Muscle ◽  
Exercise Induced

The present paper is the introductory paper to a series of brief reviews representing the proceedings of a recent conference on ‘The biochemical basis for the health effects of exercise’ organized by the International Research Group on the Biochemistry of Exercise in conjunction with the Nutrition Society. Here the aim is to briefly review and highlight the main innovations presented during this meeting. The following topics were covered during the meeting: exercise signalling pathways controlling fuel oxidation during and after exercise; the fatty acid transporters of skeletal muscle; mechanisms involved in exercise-induced mitochondrial biogenesis in skeletal muscle; new methodologies and insights in the regulation of fat metabolism during exercise; muscle hypertrophy: the signals of insulin, amino acids and exercise; adipose tissue–liver–muscle interactions leading to insulin resistance. In these symposia state-of-the-art knowledge on how physical exercise exerts its effects on health was presented. The fast-growing number of identified pathways and processes involved in the health effects of physical exercise, which were discussed during the meeting, will help to develop tailored physical-activity regimens in the prevention of inactivity-induced deterioration of health.

Ketamine Infusions for Complex Regional Pain Syndrome

2016 ◽  
Author(s):  
Roy K. Esaki
Keyword(s):  
Chronic Pain ◽  
Complex Regional Pain Syndrome ◽  
Hepatic Dysfunction ◽  
Case Reports ◽  
Pain Syndrome ◽  
Nmda Receptor Antagonist ◽  
Treatment Resistant ◽  
Urinary Tract Symptoms ◽  
Chronic Pain Conditions ◽  
Lower Urinary

Ketamine is an N-methyl-d-aspartate (NMDA) receptor antagonist that has been increasingly used in the management of treatment-resistant chronic pain conditions, particularly representing neuropathic involvement or central sensitization. Complex regional pain syndrome (CRPS) is a prototypical condition often treated with ketamine infusions. Although the analgesic benefits of ketamine as an opioid-sparing adjunct in the preoperative period have been well studied, the use of ketamine to mitigate chronic pain conditions remains largely anecdotal, composed largely of case reports and uncontrolled small studies. The limited evidence and published reports support the use of ketamine infusions as one aspect of a comprehensive, multimodal approach for CRPS. Although ketamine infusions are relatively safe when titrated appropriately, with minimal respiratory depression, side effects include sympathetic activation, unpleasant psychomimetic effects, lower urinary tract symptoms, and hepatic dysfunction. 

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