Neck pain: diagnostic and therapeutic features

Neck pain is a fairly common complaint when visiting a doctor, its occurrence frequency is 10–21% per year, and neck pain takes the 4th place among the causes of disability; almost 50% of patients continue to experience unpleasant sensations or repeated pain episodes. The elderly people are the most prone to the neck pain, this is associated with the progressive degenerative changes in the facet joints and intervertebral discs. However, reasons of this symptom can be of different kinds. Cervicalgia diagnosis is directed primarily to eliminate symptomatic pains associated with severe somatic pathology, immune diseases, infections and oncology. Comorbid diseases and risk factors can combine with each other causing the polyetiologic pain syndrome. Main steps of the cervicalgia diagnostic algorithm are the following: collection of complaints and anamnesis in detail, physical and neurological examination, and also use of visualization methods. Visualization and electrodiagnostic methods are not always informative for patients with chronic cervicalgia and in the degenerative etiology of the syndrome. MRI and the surgeon consultation must be recommended to patients with deteriorating neurological symptoms or with long-term constant pain. Conservative therapy of cervicalgia implies a combination of non-drug methods (compliance with regime, orthopedic treatment, leaf, physiotherapy, etc.) and pharmacotherapy. The last depends on the presence of a neuropathic component of pain and the duration of pain syndrome. The pain therapy with a nociceptive nature is usually implies a combination of non-steroidal anti-inflammatory remedies, non-opioid analgesics and muscle relaxants. Whereas neuropathic pains first-line preparations are tricyclic antidepressants, duloxetine, venlafaxine, pregabalin, gabapentine. The therapy success depends on the proper individual estimation of the pain factors, pain chronization and possible treatment complications. The therapeutic forecast of the acute nonspecific cervicalgia is usually good, but it becomes less predictable if the pain acquires chronic character.

The Impact of Quarantine on Pain Sensation among the General Population in China during the COVID-19 Pandemic

During the pandemic era, quarantines might potentially have negative effects and disproportionately exacerbate health condition problems. We conducted this cross-sectional, national study to ascertain the prevalence of constant pain symptoms and how quarantines impacted the pain symptoms and identify the factors associated with constant pain to further guide reducing the prevalence of chronic pain for vulnerable people under the pandemic. The sociodemographic data, quarantine conditions, mental health situations and pain symptoms of the general population were collected. After adjusting for potential confounders, long-term quarantine (≥15 days) exposures were associated with an increased risk of constant pain complaints compared to those not under a quarantine (Odds Ratio (OR): 1.26; 95% Confidence Interval (CI): 1.03, 1.54; p = 0.026). Risk factors including unemployment (OR: 1.55), chronic disease history (OR: 2.38) and infection with COVID-19 (OR: 2.15), and any of mental health symptoms including depression, anxiety, insomnia and PTSD (OR: 5.44) were identified by a multivariable logistic regression. Additionally, mediation analysis revealed that the effects of the quarantine duration on pain symptoms were mediated by mental health symptoms (indirect effects: 0.075, p < 0.001). These results advocated that long-term quarantine measures were associated with an increased risk of experiencing pain, especially for vulnerable groups with COVID-19 infection and with mental health symptoms. The findings also suggest that reducing mental distress during the pandemic might contribute to reducing the burden of pain symptoms and prioritizing interventions for those experiencing a long-term quarantine.

A patient with chronic pain syndrome

This article describes a clinical case of a patient with chronic pain syndrome on the background of osteoarthritis, with a history of joint replacement. The reason for hospitalization was a fall, after which a constant pain syndrome persisted and a neuropathic component joined, which the patient could not stop with anything.As a result of a comprehensive geriatric assessment, the patient was diagnosed with frailty and the following geriatric syndromes: mild dependence on outside help, chronic pain syndrome, balance disorders, falls, stress urinary incontinence. Non-drug methods of treatment and complex therapy (gabapentin + B vitamins + uridine) and antiosteoporetic therapy were recommended, against which the intensity of the pain syndrome decreased to a mild degree (according to the VAS scale of 2 points at the time of discharge) and a decrease in neuropathy copatterns was noted.

Spontaneous Resorption of Spinal Disk Herniation and Its Adjacent-level Complications: A Case Report

Objectives: Symptoms associated with spinal disk herniation may heal without surgery. In some patients, imaging reveals a reduction in hernia size, too. This phenomenon is referred to as spontaneous regression of the herniated disk. It was first reported in 1984 and is widely covered in today’s research papers. Case Presentation: This paper describes a case of spontaneous regression of lumbar disk herniation at L5-S1, where another disk was herniated at L4-L5 after only 8 months. The patient (F) sought help complaining of pain in the lumbar region. An MRI scan revealed a 6.2-mm hernia at L5-S1. The patient was prescribed conservative treatment comprising non-steroidal anti-inflammatory drugs and kinesitherapy, to which she refused to adhere and decided to treat the condition on her own. Eight months later, the patient sought help again, reporting other symptoms of pronounced constant pain in the rear lateral surface of the left leg and lameness. A further MRI scan revealed spontaneous hernia resorption at L5-S1 with an emergent vacuum phenomenon and a different disk herniated at L4-L5 to 9.4 mm. Discussion: Since the symptoms were pronounced and non-steroidal anti-inflammatory drugs did not have a therapeutic effect, the patient required surgery.

Synovitis is associated with constant pain in knee osteoarthritis: a cross-sectional study of OMERACT knee ultrasound scores

Objective To examine the association between ultrasound (US)-detected knee inflammation and intermittent and constant pain experiences in patients with knee osteoarthritis (OA). Methods Participants with radiographically early- (KL ≤ 2) and late-stage (KL ≥ 3) disease and frequent symptoms underwent musculoskeletal US measures of inflammation using the OMERACT knee US scoring system. Pain experiences were captured using the Intermittent and Constant OA Pain (ICOAP) tool. We assessed the association between US-synovitis and ICOAP pain experiences using a series of linear, logistic, or multinomial logistic regression models (as appropriate for each variable), while adjusting for age, sex, body mass index (BMI), and radiographic stage. Secondary analyses were performed similarly by radiographic stage. Results Pain and synovitis measures from 248 patients (453 knees) were included. Worse synovitis was associated with higher ICOAP constant pain scores (β 8.05 [95%CI 0.67, 15.43]), but not intermittent pain scores. Moderate-to-severe synovitis was associated with a 4.73-fold increased relative risk [95%CI 1.06, 8.80] of a constant pain pattern. In secondary analyses, moderate-to-severe synovitis in early radiographic OA was associated with 2.70-higher odds [95%CI 1.04, 7.02] of any constant pain, 3.28-higher odds [95%CI 1.43, 7.52] of any intermittent pain, and with higher intermittent (β 10.47 [95%CI 1.03, 19.91]) and constant (β 12.62 [95%CI 3.02, 22.23]) pain scores. No associations identified for synovitis in those with late radiographic OA. Conclusion In patients with knee OA, moderate-to-severe synovitis is most strongly associated with constant pain. Inflammation may play context-specific roles across pain experiences, especially in earlier radiographic stages of knee OA.

Clinical and functional characteristics of disabled people due to diseases of the peripheral nervous system at working age

The dominant position among the reasons of working-age population’s health deterioration belongs to diseases of the peripheral nervous system (PNS), the peak prevalence of which occurs at the age of 35–40. PNS diseases are diagnosed in about 76.0% of industrial workers, and account for more than half of all occupational diseases. They are the main cause of incapacitation and long-term disability. Publications on disability due to PNS diseases are isolated.The aim of the work. Clinical and functional characteristics of PNS disorders that cause disability in the working-age population.Material and methods. Among 91 496 first recognized as disabled in the Republic of Bashkortostan in 2014–2018, all disabled people of working age were selected due to PNS diseases, in which the main independent diagnosis was radiculopathy, polyneuropathy, neuropathy and vibratory disease with indication to lumbar-sacral radiculopathy with polyneuropathy of the upper extremities. 107 people were identified to constitute a closed cohort for a comprehensive study of the clinical-functional state and patterns of disability formation in them. The clinical-functional characteristic is given on the basis of the results of studies set forth in the directional medical documents and the assessment by an expert neurologist of the Main Bureau of Medical and Social Expertise. Statistical analysis was performed in Microsoft Excel.Results. The prevalence of PNS diseases has been found to be increasing. Three of the newly diagnosed neurological patients have been the carriers of PNS disease. PNS diseases are formed and reach peak in working age. Characterized by a chronic, progressive course, they often cause temporary and persistent disability. On average, there are 0.1 ± 0.028 persons with disabilities per 10 thousand of the able-bodied population due to PNS diseases, the level of which in dynamics for 2014–2018 increased by 1.7 times. Persons with disabilities (69.0%) are mainly represented by men, every second (50.6%) is over 50 years old, with an average age of 48.7 ± 5.7 years. The clinical-functional state is characterized by constant pain, numbness, seizures, restriction of movements in the limbs, sensory disorders, vegetative-vascular disorders.Conclusion. The quantitative evaluation of the main types of the body functions and main categories of vital activity persistent disorders made it possible to detect that 69.3 ± 4.4% persons with disabilities have persistent moderate abnormalities of functions in the range 40–60% (II degree), another 24.4 ± 3.8 — persistent pronounced abnormalities in the range 70–80% (III degree) and 6.3 ± 6.0% — persistent significant abnormalities in the range 90–100% (IV degree). The severity of impaired functioning of the body is the basis for the level of persistent disability determination.

NUMERICAL RATING SCALE AS A PREDICTOR OF AN UNDERLYING PATHOLOGY IN PEDIATRIC BACK PAIN USING MAGNETIC RESONANCE IMAGE AS DIAGNOSTIC TOOL

Background & Objectives: Recently, constant and night pain has been discarded as adequate clinical markers to predict the presence of an underlying pathology in pediatric back pain. The pain intensity has been recognized as an important domain in the pain assessment. Numerical Rating Scale (NRS) is one of the most common validated tools to assess pediatric pain intensity in children above 8 years of age. The aim of this study is to assess NRS as a predictor of underlying pathologies found by magnetic resonance image (MRI) in pediatric back pain. We hypothesize that a higher NRS score is associated with a high sensitivity, specificity and likelihood ratio to identify the present of organic pathology in pediatric chronic back pain. Methodology: After obtaining Institutional Review Board approval, a retrospective electronical medical record review was conducted. All pediatric patients who reported back pain lasting > 4 weeks between 2009 to 2018 were enrolled in the study. As per regular protocol, a pediatric orthopedic surgeon evaluated all patients who presented with back pain. After a non-diagnostic history, physical examination and spinal x-ray; spine MRI was order. Pain was graded with the use of NRS from 0 to 10. Patients were divided in two groups: NRS (1-5) & NRS (6-10). Variables such as gender, age, pain frequency, night pain, neurological exam, and the presence of an underlying pathology were compared between both groups. Patients that presented with injury due to trauma, previous diagnosis of back pain or cervical pain were excluded. Results: A total of 467 patients were evaluated in the study. Mean age of subjects was 15 years; 69% being female. An underlying pathology was identified in 131/315 (41.6%) patients with NRS (6-10), and 55/152 (36.2%) patients with NRS (1-5) (P=0.27). Patients with NRS (6-10) had two times more probability of suffering constant pain (P<0.03) and three times more likely of having an abnormal neurological examination (P<0.05). See table 1. Conclusion: Evaluation and treatment of children and adolescent with chronic back pain is challenging. Our study shows a strong association between NRS high (6-10) and constant pain and/or abnormal neurological exam. However, the use of NRS of (6-10) was not found as adequate predictor for the presence of an underlying organic pathology in children and adolescent patients. Therefore, physicians should not rely only high NRS score to recommend advance imaging study to assess chronic back pain in children and adolescent patients. Summary [Table: see text]

Percutaneous Full-Endoscopic C2 Ganglionectomy for the Treatment of Intractable Occipital Neuralgia: Technical Note

ABSTRACT BACKGROUND The C-2 dorsal root ganglionectomy procedure can provide effective treatment for intractable occipital neuralgia (ON). However, the traditional microsurgery of C2 ganglionectomy needs a wide incision and significant paraspinous muscle dissection for adequate visualization. The indications of endoscopic spine surgery are ever expanding, with the development of endoscopic armamentaria and technological innovations. OBJECTIVE To validate the feasibility of the approach and describe several operative nuances based on the authors’ experience. In this paper, the authors describe a patient with intractable ON who was successfully treated with a percutaneous full-endoscopic C2 ganglionectomy. METHODS We describe the case of an 83-yr-old female with a 2-yr history of left ON who did not respond to a series of treatments, including physical therapy, drug therapy, injection therapy, and radiofrequency therapy. After careful examination, we performed a percutaneous, full-endoscopic left C2 ganglionectomy. RESULTS The patient was successfully treated with a percutaneous full-endoscopic ganglionectomy. Afterwards, her intractable and constant pain was relieved. There was no cerebrospinal fluid leakage, incision infection, neck deformity, or other complications. CONCLUSION C2 ganglionectomy can be accomplished successfully using a full-endoscopic uniportal surgical technique under continuous irrigation, which has the advantages of excellent illumination and visualization, reduced surgery-related trauma, and reduced bleeding.

Long-Term Analgesia following a Single Application of Fentanyl Transdermal Solution in Pigs

<b><i>Introduction:</i></b> In animal research, obtaining efficient and constant pain control is regulatory but challenging. The gold standard pain management consists of opioid analgesic administration, such as buprenorphine or fentanyl extended-release patches. However, as in all drugs with a short half-life time, repeated buprenorphine administrations are needed, leading to multiple injections that affect the research protocol. On the other hand, fentanyl patch efficacy is discussed in some species. These elements highlight the need of an optimal formulation of analgesic drugs for laboratory animals. In this study, we investigated how Recuvyra®, a fentanyl transdermal solution (FTS), validated in dog perioperative pain management, could provide sustained analgesia after a single topical administration in pigs in a surgical context. <b><i>Methods:</i></b> A total of 11 minipigs were used in this study. As a preliminary experiment, two different doses were tested as a single application on five pigs: two pigs at full dose (2.6 mg/kg) and three pigs at half dose (1.3 mg/kg). Plasma fentanyl dosages were performed during 4 consecutive days, using liquid chromatography with tandem mass spectrometry detection. The efficacy of FTS was then evaluated in a perioperative period. Six minipigs benefited from a surgical intervention comprising a laparotomy. The FTS was blotted on the skin in a single application 20 min before the surgical incision and plasma fentanyl dosages, clinical examination (body weight, food intake, heart rate, and body temperature) and pain assessment were performed for 7 consecutive days. <b><i>Results:</i></b> During the preliminary experiment, all fentanyl concentrations reached the minimum effective concentration (MEC) extrapolated in pigs (fentanylemia ≥0.2 ng/mL) throughout the 4 days. The half dose was chosen for the next step of the study. After the surgical intervention, all plasma fentanyl concentrations remained above the MEC up to 7 days post administration. Pig clinical examinations and pain evaluations showed efficient and constant pain control at the half dose, and few adverse events were observed. <b><i>Discussion and Conclusion:</i></b> This study confirms the pharmacological and clinical efficacy of FTS at 1.3 mg/kg in pigs throughout at least 7 postoperative days following laparotomy. The clinical analgesic effect of FTS appears more efficient and well-tolerated than the one observed with repeated injections of buprenorphine. This analgesic drug formulation could be universally used in animal research to provide optimal perioperative pain management and long-term analgesia.

Pain syndrome patterns and their characteristics in multiple sclerosis patients

Aim of the research is to analyze the patterns of pain syndromes and their characteristics in multiple sclerosis patients. Materials and Methods. A total of 104 multiple sclerosis patients complaining of pain during the last month were examined in Lviv Regional Multiple Sclerosis Center. We analyzed medical records, performed general medical and neurological examinations and compiled history of lifestyle, illness and pain. The VAS and PainDetect questionnaires were used to assess the characteristics of pain syndromes. The patients were asked to choose one of the 4 typical patterns of pain, which best described their feelings. Then the analysis of pain syndrome patterns and their characteristics was carried out. Results and Discussions. All 4 typical patterns of pain syndromes were registered in multiple sclerosis patients. However, only 26.92% of the participants experienced an intermittent pain pattern. The rest of patients suffered from patterns characterized by persistent pain. The evaluation of the patterns and their characteristics revealed typical features. The highest intensity of the severest and average pain during the last month was present in the patients suffering from constant pain with distinct attacks: 8.0 [7.0; 9.0] points (p<0.05) and 7.0 [5.0; 8.0] points (p<0.05), respectively. Persistent paroxysmal pain was more common in the multiple sclerosis patients with neuropathic pain (43.8±8.8% vs 20.4±5.8%, p<0.05). Irradiating pain is also characteristic to this pattern in 52.9±8.6% of patients (p<0.05). The head is the most common pain localization in the patients experiencing persistent pain with severe attacks - 82.4±9.2% of cases (p<0.05). Conclusions. Pain is a permanent symptom in a significant number of multiple sclerosis patients. It can have different patterns of progression. However, it has typical characteristics and their understanding will aid in the diagnosis, prognosis and treatment of pain syndromes in multiple sclerosis patients