scholarly journals Greater Trochanteric Pain Syndrome (GTPS): A clinical prospective study of treatment options

2022 ◽  
Vol 1 (1) ◽  
pp. 1-14
Author(s):  
Oluseun Olufade
Keyword(s):  
Corticosteroid Injection ◽  
Treatment Options ◽  
Pain Syndrome ◽  
Treatment Modalities ◽  
Post Intervention ◽  
Significant Difference ◽  
Observational Prospective Cohort Study ◽  
Operative Strategies ◽  
Greater Trochanter Pain Syndrome ◽  
Clinically Significant

Background: There are few prospective studies evaluating the efficacy of various non-operative strategies for treatment of greater trochanter pain syndrome (GTPS). There is a diversity of available interventions and lack of clear consensus for the best modality thus far. Design: Observational prospective cohort study performed during the period of October 2017 and March 2019. Methods: The main objective was to determine if there is a difference in outcome of the Lower Extremity Functional Scale (LEFS) for subjects treated with conservative management (PT), corticosteroid injection (CSI), or percutaneous ultrasonic tenotomy (PUT). Participants were assigned based on physician treatment in a non-randomized manner to PT, a single CSI, or the PUT treatment arm. Subjects participated in outcome assessments at baseline and at 1-, 3-, 6-, and 12-months post intervention. Results: 112 individuals with unilateral GTPS were recruited for this study with 69 PT patients, 31 CSI patients, and 12 PUT patients. The adjusted mean LEFS scores averaged across all time periods remained statistically different between PT, CSI, and PUT (p = 0.0093), indicating significant difference between each treatment arm. PT group saw the greatest improvements from baseline score starting at 1 month and up to 1 year (p = .0004). CSI group did not see significant LEFS improvement until 6 months (p = 0.04) and did not maintain clinically significant improvement by 1 year. PUT group saw significant LEFS improvement at 3 months (p = 0.0001) and maintained clinically significant improvements (≥ 9 LEFS points) throughout the course of the study. Conclusion: PT patients over the study period showed the greatest improvements in LEFS scores compared to CSI and PUT patients. We believe that PT is the best indicated course of treatment for GTPS. PUT may be considered as an additional option if patients have failed other treatment modalities. CSI shows benefit at 6 months, but overall inferior to PT and PUT.

scholarly journals Retrospective Analysis of Reoperation Rate After Standard Lumbar Discectomy and Microdiscectomy - Single Center Experience

2019 ◽  
Vol 0 (0) ◽  
Author(s):  
Vojin Kovacevic ◽  
Nemanja Jovanovic
Keyword(s):  
Lumbar Disc ◽  
Reoperation Rate ◽  
Neurological Deficits ◽  
Treatment Modalities ◽  
Single Center Experience ◽  
Group 4 ◽  
Significant Difference ◽  
Recurrent Herniation ◽  
Clinically Significant

Abstract Discectomy is a surgical procedure in the treatment of lumbar disc herniation (LDH) if sciatica or neurological deficits occur and still persist after a course of conservative therapy. Standard discectomy (SD) and microdiscectomy (MD) are still equal in curent clinical practice. Many retrospective and prospective studies have shown that there is no clinically significant difference in the functional outcome after two treatment modalities. The aim of our study was to determine whether there are differences in the incidence of reoperation after performing SD and MD. The research included 545 patients with average period of postoperative follow-up of approximately 5.75 years. Standard discectomy was performed in 393 patients (72.11%), and micro-discectomy in 152 (27.8%) patients. The total number of reoperated patients was 37/545, or 6.78%. In the SD group, the number of reoperated patients was 33/393 (8.39%) and in the MD group 4/152 or 2.63%. Statistically significant difference (p <0.05) was recorded in favor of the MD group. Although it has been proven that both SD and MD give good endpoints of treatment and similar functional recovery, the advantage is given to microdiscectomy due to statistically significantly lower rates of recurrent herniation. This result is attributed to better visualization of neural structures and pathological substrates, as well as their mutual relationship.

scholarly journals Spinal Cord Stimulation for Complex Regional Pain Syndrome: A Case Study of a Pregnant Female

2016 ◽  
Vol 3;19 (3;3) ◽  
pp. E487-E493
Author(s):  
Shaik Ahmed
Keyword(s):  
Spinal Cord ◽  
Complex Regional Pain Syndrome ◽  
Spinal Cord Stimulation ◽  
Treatment Options ◽  
Pain Syndrome ◽  
Conclusive Evidence ◽  
Treatment Modalities ◽  
Child Bearing ◽  
The Impact

Background: Spinal cord stimulation (SCS) is a form of neuromodulation, used to treat chronic neuropathic pain refractory to conventional medical management. Spinal cord stimulators are treatment options when intractable chronic pain has not responded to more conventional treatment modalities. Currently, the use of SCS is contraindicated in pregnancy. Nevertheless, many SCS/ neuromodulation recipients are women of child bearing age who may become pregnant. There are no published reports that focus on the possible side effects of SCS or neuromodulation therapy on human fertility, fetal development, pregnancy, delivery, or lactation. Objectives: The purpose of this current report is to present a case study on the use of SCS/ neuromodulation during pregnancy. Study Design: Presentation of the case of a 24 year old female who became pregnant after receiving an SCS implantation for pain control secondary to complex regional pain syndrome (CRPS). The SCS was in use at the time of conception but deactivated when patient became aware of her pregnancy and intermittently reactivated for five minute intervals throughout the entire pregnancy. Results: Currently very little documented evidence is available regarding the safety of using a SCS/ neuromodulator during pregnancy; therefore its use during pregnancy is contraindicated. Available literature suggests that, women who have chosen to keep the SCS/neuromodulator activated during pregnancy have delivered healthy babies without any life threatening complications. Limitations: Case presentations do not provide conclusive evidence of treatment effectiveness. This data is only preliminary and future studies should be used to assess outcomes and measures to provide quantification of the SCS implantation during pregnancy. Conclusions: Women of child bearing age who are recipients of SCS/neuromodulation implantation should be informed of the limited knowledge available regarding the impact of SCS/ neuromodulation use during pregnancy. For current recipients, decisions about ongoing use during pregnancy should be an individual decision based on the potential risks and benefits. Key words: Pregnancy and complex regional pain syndrome, pregnancy and reflex sympathetic dystrophy, pregnancy and spinal cord stimulators, pregnancy and electromagnetic fields, and pregnancy and neuromodulator.

scholarly journals Effectiveness of joint mobilization and dry needling in myofascial pain syndrome with neck pain

2019 ◽  
Vol 02 (02) ◽  
pp. 096-097
Author(s):  
Martín Pérez S. ◽  
Montaño Ocaña J. ◽  
Barragán Carballar C. ◽  
Arribas Pérez H.
Keyword(s):  
Myofascial Pain ◽  
Pain Syndrome ◽  
Myofascial Pain Syndrome ◽  
Dry Needling ◽  
Post Intervention ◽  
Joint Mobilization ◽  
Upper Trapezius ◽  
Pain Pressure Threshold ◽  
Clinically Significant

Abstract Background and Aim Almost 70% of the population has suffered from cervical pain of a mechanical origin (CPM) at some point in their life. In myofascial pain syndrome (MPS), besides the zygapophyseal joint, the myofascial trigger point (MTrP) is involved as the main source of CPM. Manual therapy (MT) based on joint mobilization (JM) in combination with dry needling (DN), are the most used treatments in these patients. Aims 1) To compare the pain and range of motion (ROM) between the MT interventions using JM and deep DN and MT using JM and sham DN in patients with CPM and activation of MTrP 2 of the upper trapezius (UT). 2) To assess the changes in the active cervical ROM, pain pressure threshold (PPT), intensity of pain at rest and with movement (measured using the Visual Analog Scale) and post-needling soreness in these patients. Material and Methods An experimental, double blind randomized pilot study in which the effects produced by the interventions were compared among two groups: a first group (n = 5) received a treatment based on sham DN of the UT and MT using JM of C2 and a second group (n = 6) who received deep DN of the MTrP 2 of the UT and the same mobilization technique. Three prospective measurements were performed: pre-intervention, post-intervention and follow-up (1 month after the post-intervention measurement). Results 11 subjects participated in this study (7 women and 4 men; mean age: 49.9 ±  10.8 years) who completed both the four interventions (1 session/week) as well as the follow-up. According to the PPT, measured on the MTrP 2 of the UT, none of the two groups presented clinically significant changes, and only 3 patients presented increases beyond the MDC (MDC) in the follow-up measurement (1.11 kg/cm2). Regarding the VAS measured at rest, only the first group (sham DN) obtained a clinically significant post intervention improvement (56%) and at follow-up (150%). The VAS in response to movement decreased significantly with treatment in both groups for all movement planes and axes; however, the active cervical ROM did not display significant changes in any of the two groups; lastly, the mean, maximum and minimum values of post-needling soreness in the group with placebo DN were lesser to those of the group who received the real deep DN technique, for the entire treatment. Conclusion Deep DN combined with MT improved the intensity of pain in response to cervical movement, whereas sham dry needling combined with MT caused a greater decrease of intensity at rest. Although both techniques are similar for improving active cervical ROM, sham DN combined with MT increased post-needling soreness both during treatment as well as at follow-up. Further research is necessary to deepen our information of the effects of the combination of these two techniques in the treatment of MPS.

scholarly journals Implementation of a multidisciplinary infections conference improves the treatment of spondylodiscitis

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
D. Ntalos ◽  
B. Schoof ◽  
D. M. Thiesen ◽  
L. Viezens ◽  
H. Kleinertz ◽  
...  
Keyword(s):  
Treatment Plan ◽  
Treatment Strategies ◽  
Autologous Bone Graft ◽  
Treatment Modalities ◽  
Post Intervention ◽  
Operative Revision ◽  
Significant Difference ◽  
Spinal Segments ◽  
Patient Groups ◽  
Single Discipline

AbstractEstablishing a multidisciplinary approach regarding the treatment of spondylodiscitis and analyzing its effect compared to a single discipline approach. 361 patients diagnosed with spondylodiscitis were included in this retrospective pre-post intervention study. The treatment strategy was either established by a single discipline approach (n = 149, year 2003–2011) or by a weekly multidisciplinary infections conference (n = 212, year 2013–2018) consisting of at least an orthopedic surgeon, medical microbiologist, infectious disease specialist and pathologist. Recorded data included the surgical and antibiotic strategy, complications leading to operative revision, recovered microorganisms, as well as the total length of hospital and intensive care unit stay. Compared to a single discipline approach, performing the multidisciplinary infections conference led to significant changes in anti-infective and surgical treatment strategies. Patients discussed in the conference showed significantly reduced days of total antibiotic treatment (66 ± 31 vs 104 ± 31, p < 0.001). Moreover, one stage procedures and open transpedicular screw placement were more frequently performed following multidisciplinary discussions, while there were less involved spinal segments in terms of internal fixation as well as an increased use of intervertebral cages instead of autologous bone graft (p < 0.001). Staphylococcus aureus and Staphylococcus epidermidis were the most frequently recovered organisms in both patient groups. No significant difference was found comparing inpatient complications between the two groups or the total in-hospital stay. Implementation of a weekly infections conference is an effective approach to introduce multidisciplinarity into spondylodiscitis management. These conferences significantly altered the treatment plan compared to a single discipline approach. Therefore, we highly recommend the implementation to optimize treatment modalities for patients.

scholarly journals Descriptive epidemiology and survival analysis of acromegaly in Korea

2021 ◽  
Author(s):  
Soo Jin Yun ◽  
Jung Kuk Lee ◽  
Jinsun Park ◽  
So Young Park ◽  
Sang Ouk Chin
Keyword(s):  
Treatment Options ◽  
Population Data ◽  
Population Based ◽  
Annual Incidence ◽  
Treatment Modalities ◽  
Newly Diagnosed ◽  
Korean Patients ◽  
Significant Difference ◽  
Average Annual Incidence ◽  
Using Data

Abstract Acromegaly is a rare, slowly progressive disease. Its mechanism is not fully understood, and epidemiological research on Korean patients with acromegaly is scarce. To determine the incidence and prevalence of acromegaly and assess the comorbidities and survival benefits based on treatment options. This nationwide population-based cohort study was conducted using data of the Korean Health Insurance Review and Assessment claims database to evaluate the incidence of newly diagnosed acromegaly cases during 2013–2017. During the 5-year period, 1,093 patients were newly diagnosed with acromegaly. The average annual incidence was 4.2 cases per million per year, and the prevalence was 32.1 cases per million during this period. The incidence of hypertension was low after medical treatment (hazard ratio 0.257, 95% confidence interval: 0.082–0.808, P = 0.0201), but the incidence of diabetes showed no significant difference across treatment modalities. Over a period of 6 years since diagnosis, we found that patients treated for acromegaly had a significantly higher survival rate than those untreated (P = 0.0003). The annual incidence rate of Korean patients with acromegaly was similar to that reported in previous studies. Using nationwide population data, our study emphasized the importance of treatment in acromegaly patients.

scholarly journals Non-Pharmacological Treatment Options for Patients with Fibromyalgia

2018 ◽  
Vol 8 (3) ◽  
pp. 165-169
Author(s):  
Md Shahidur Rahman
Keyword(s):  
Pharmacological Treatment ◽  
Soft Tissues ◽  
Behavioral Therapy ◽  
Treatment Options ◽  
Pain Syndrome ◽  
Chronic Fatigue ◽  
Treatment Modalities ◽  
Pharmacological Interventions ◽  
Beneficial Effects

Fibromyalgia is a generalized chronic pain syndrome characterized by widespread pain and tenderness to palpation at multiple anatomically defined soft tissues and associated with depression, anxiety, insomnia, cognitive dysfunction, chronic fatigue, and autonomic dysfunction. In 2010, American College of Rheumatology modified classification criteria defined in 1990. This is one of the most common musculoskeletal complaints in physician’s chambers. For lack of specific pharmacological treatment options, non-pharmacological treatment modalities are found to have some immediate efficacy and a variable efficacy in the long term. We searched literatures and reviewed randomized controlled trials for possible predictors of outcome in fibromyalgia. The effects of non-pharmacological interventions are limited and positive outcomes largely disappear in the long term. However, within the various populations with fibromyalgia, treatment outcomes showed considerable individual variations. Subgroups of patients with high levels of psychological distress may benefit from non-pharmacological interventions. Some of the relevant published articles demonstrated the beneficial effects of non-pharmacological treatment options, specially exercise, cognitive behavioral therapy and alternative and complementary medicine, in the context of non-availability of specific pharmacotherapy.J Enam Med Col 2018; 8(3): 165-169

scholarly journals Effect of Agility and Perturbation Training on Pain, Balance and Functional Ability in Subjects with Patellofemoral Pain Syndrome

2021 ◽  
Vol 11 (7) ◽  
pp. 204-226
Author(s):  
Kalpana . ◽  
Mohan Kumar Muniyan ◽  
A M R Suresh
Keyword(s):  
Pain Syndrome ◽  
Patellofemoral Pain Syndrome ◽  
Patellofemoral Pain ◽  
Composite Score ◽  
Functional Abilities ◽  
Post Intervention ◽  
Balance Test ◽  
Perturbation Training ◽  
Kujala Score ◽  
Significant Difference

Background: Agility and Perturbation training have been advocated to improve pain, balance and functional abilities in subjects with osteoarthritis of knee but effect of same on Patellofemoral pain have not been explored in studies. The above techniques would be helpful along with standard rehabilitation programs in reducing dynamic knee instability or improving dynamic stability upon return to high level physical activity and have an additive effect of reducing pain in OA knee. Objective: The purpose of the study is to find the effect of Agility and Perturbation training on improvement of pain, balance and functional abilities in subject with Patellofemoral Pain Syndrome. Method: A randomized controlled study with 40 individuals has been taken with patellofemoral pain syndrome. 20 subjects have been selected for control group and 20 subjects for study group. Outcome measures includes Kujala function scale, Y balance test and Numeric pain rating scale were measured before and immediately after the treatment. Results: Analysis using Mann Whitney U Test and Independent t between the groups found that when pre intervention means of NPRS, Composite score YBT and Kujala Score were compared there is a statistically significant difference between the groups. When post intervention means of NPRS and Kujala score were compared between the groups there is no statistically significant difference between the groups. When post intervention means of Composite score YBT were compared there is a statically significant difference. Conclusion: The present study concludes that Agility and Perturbation training shown significant improvement of pain, function and balance in subject with Patellofemoral Pain Syndrome. Key words: Patellofemoral Pain Syndrome, Kujala function Scale, Y balance test.

scholarly journals Mirabegron as adjuvant treatment for patients with interstitial cystitis/bladder pain syndrome

2017 ◽  
Vol 12 (3) ◽  
pp. E100-4 ◽  
Author(s):  
Michael Di Lena ◽  
Victoria Tolls ◽  
Kerri-Lynn Kelly ◽  
J. Curtis Nickel
Keyword(s):  
Interstitial Cystitis ◽  
Adjuvant Treatment ◽  
Treatment Options ◽  
Pain Syndrome ◽  
Bladder Pain Syndrome ◽  
Post Treatment ◽  
Symptom Scale ◽  
Symptom Index ◽  
Bladder Pain ◽  
Significant Difference

Introduction: Interstitial cystitis/bladder pain syndrome (IC/BPS) patients represent a heterogeneous group with pain and urinary storage symptoms and varying responses to current treatment options. The novel beta-3 agonist, mirabegron, has been shown to improve storage symptoms of patients with bladder overactivity; however, its effect on symptoms in the IC/BPS population has yet to be studied.Methods: Patients diagnosed at a single IC centre with IC/BPS undergoing standard therapy were treated with additional daily mirabegron 25 mg and seen in followup post-treatment. Patients completed the Interstitial Cystitis Symptom Index and Problem Index (ICSI/ICPI), and the Pelvic Pain and Urgency/Frequency Patient Symptom Scale (PUF) prior to and following mirabegron treatment. Global (NRS) and symptom-specific outcomes were assessed by comparing the pre- and post-treatment mean scores using tailed-t test (p<0.05 considered statistically significant).Results: A total of 23 patients were available for review pre- and post-mirabegron treatment. There was no significant difference in ICSI (p=0.448), ICPI (p=0.352), or PUF (p=0.869) pre- and post-treatment. Analysis of symptom-specific outcomes show statistically significant improvements in urgency (p=0.048); however, no statistically significant improvements in frequency (p=0.951) or pain (p=0.952) were observed with mirabegron therapy.Conclusions: IC/BPS patients treated with mirabegron had improvement of urinary urgency, but no significant benefit in terms of pain or urinary frequency. This data suggests that mirabegron’s role in the IC/BPS patient should be that of adjuvant treatment to ameliorate urgency.

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