The emergency visits for back and neck pain during lockdowns

Purpose To assess the rate of visits to the emergency department of our medical center concerning low back or neck pain as a factor of COVID-19 confinement. Methods The study period was a 30-week interval during the COVID-19 pandemic contrasted by a similar stretch in the year preceding the epidemic. Visits to the emergency department prompted by low back or neck pain were recorded prior to and during lockdowns of the pandemic. The significance of the confinements for the development of pain syndromes was evaluated. Results A total of 1530 patients with newly diagnosed back or neck pain were enrolled. Most patients visited our emergency department for low back pain, commonly those older than 60 years. No significant gender variance was disclosed, although most visits of females were for low back pain. Low back pain presentations were curbed following confinement, but the rate of stays for neck pain swelled by more than 10%. Despite back pain predominance, visits for neck pain persisted. Before COVID-19, the average weekly number of emergency department visits was 38.5. This was followed by sharp drops during the COVID-19 lockdown (mean difference=-22.2, 95% CI=-28.7, -15.7, p<0.001) (not significant). Conclusions COVID-19 lockdowns have a significant impact on emergency department presentations due to back and neck pain. A higher rate of presentation for back pain compared to neck pain is probably related to COVID-19, without being affected directly by SARS-CoV-2: confinement-induced immobility might instigate musculoskeletal sequelae, which may be attributed to stress or other psychosocial afflictions.

Pain in Multiple Sclerosis: Understanding Pathophysiology, Diagnosis, and Management Through Clinical Vignettes

Neuropathic pain and other pain syndromes occur in the vast majority of patients with multiple sclerosis at some time during their disease course. Pain can become chronic and paroxysmal. In this review, we will utilize clinical vignettes to describe various pain syndromes associated with multiple sclerosis and their pathophysiology. These syndromes vary from central neuropathic pain or Lhermitte's phenomenon associated with central nervous system lesions to trigeminal neuralgia and optic neuritis pain associated with nerve lesions. Muscular pain can also arise due to spasticity. In addition, we will discuss strategies utilized to help patients manage these symptoms.

The Impact of COVID-19 On Emergency Visits For Back And Neck Pain

Purpose: To assess the rate of visits to the emergency department of our medical center concerning low back or neck pain, as a factor of COVID-19 confinements.Methods: The study period was a 30-weeks interval during the COVID-19 pandemic contrasted by a similar stretch in the year preceding the epidemic. The visits to the Emergency Department, prompted by low back or neck pain, were recorded prior and during lockdowns of the pandemic. The significance of the confinements for the development of the pain syndromes was evaluated.Results: A total of 1530 patients with newly diagnosed back or neck pain were enrolled. Most patients visited our emergency department for low back pain, commonly those older than 60 years. No significant gender variance was disclosed, though most visits of females were for low back pain. Low back pain presentations were curbed following confinement, but the rate of stays for neck pain had swelled by more than 10%. Despite back pain predominance, visits for neck pain persisted. Before COVID-19, the average weekly number of Emergency Department visits was 38.5. This was followed by sharp drops during COVID-19 lockdown (mean different=-22.2, 95%CI=-28.7, -15.7, p<0.001) (not significant).Conclusions: COVID-19 lockdowns have a significant impact on the Emergency Department’s presentations due to back and neck pain. A higher rate of presentation for back pain compared to neck pain is probably related to COVID-19, without being affected directly by the SARS-CoV-2: confinement-induced immobility might instigate musculoskeletal sequels, which may be attributed to stress or other psycho-social afflictions.

10 reasons, why to use naproxen – in the light of new scientific reports

Naproxen is a non-steroidal anti-inflammatory drug with a wide range of use, used in patients with various pain syndromes in the musculoskeletal system. It has anti-inflammatory, analgesic and antipyretic properties through non-selective and reversible inhibition of COX-1 and COX-2 isoforms. In Poland, it is registered in the treatment of rheumatic diseases and acute inflammations of the musculoskeletal system. Some naproxen preparations are also approved for the treatment of migraine and fever. The paper presents the characteristic features of the substance.

MRI RESEARCH OF THE CAUSES OF PAIN SYNDROMES IN THE BACK AND OSTEOCHONDROSIS OF THE SPINE

The aim of the study was to search for organic changes in the tissues of the spine that are the cause of pain syndromes in the back and spine. With the help of MRI, the state of the muscular corset of the spine was diagnosed and the violations found were compared with the localization of pain syndromes in the back and the localization of dystrophic manifestations in the vertebrae and intervertebral discs. In 70 patients who underwent MRI examinations of areas with pain syndromes in the back, it was shown that osteochondrosis of the spine is preceded by spastic conditions of the intervertebral muscles, leading to disruption of trophism of the vertebrae and intervertebral discs, as well as to the development of pain syndromes.

PSYCHO-EMOTIONAL ASPECTS IN THE FORMATION OF PAIN SYNDROME CHARACTERISTICS IN PATIENTS WITH MULTIPLE SCLEROSIS

Introduction: Pain syndromes, anxiety, and depression are common syndromes in multiple sclerosis (MS). Comorbidity of pain and depression or pain and anxiety exists in up to one-third of MS patients. Based on the biopsychosocial model of pain, given the high prevalence of these symptoms and their frequent combination in MS, which is significantly higher than in the general population, we can hypothesize the relationship between the characteristics of pain and anxiety and depression in patients with MS. Objectives: To assess the prevalence of anxiety and depression among MS patients with pain syndromes and analyze the relationship between anxiety and depression with pain syndromes' characteristics in patients with MS. Methods: Data were collected prospectively at Lviv Regional Multiple Sclerosis Center. 120 randomly selected patients with a confirmed diagnosis of multiple sclerosis were examined. 104 of them had pain syndromes during the last month. Complaints and medical history, analysis of medical records, neurological and general medical examination of the patients were collected. Depressive symptoms and anxiety were assessed in all patients using the Hospital Anxiety and Depression Scale (HADS) questionnaire. In patients with pain syndromes, the Visual analogue scale (VAS), Short-form McGill Pain Questionnaire 2 (SF-MPQ-2), Pain Detect were used to assess pain characteristics. Results: The levels of anxiety and depression were higher in the group of MS patients with pain. The level of anxiety was 9.0 [6,0; 12,75] in the group with pain and 7.0 [4,0; 9,25] in the group without pain (p=0.04). The level of depression was 7.0 [4,0; 10,0] in the group with pain and 4.0 [1,75; 6,0] in the group without pain (p<0,01). It was found that part of MS patients with pain syndromes with anxiety was 36.5%, and 29.8% had a subclinical level of anxiety; part of MS patients with pain syndromes with depression was 19.23%. The proportion of patients with anxiety was highest in patients with neuropathic pain: 56.3% ± 8.8% vs. 22.4% ± 6.0% with nociceptive, p<0.01. A similar situation is observed in patients with depression. The share of patients with depression was higher in the group with neuropathic pain 37.5% ± 8.6%, compared to 14.3% ± 5.0% with nociceptive, p=0.02. The proportion of patients with MS without signs of anxiety and depression is significantly higher among patients with nociceptive pain (p<0,05). Also, the correlational relationship between the level of anxiety and depression with the level of the neuropathic type of pain manifestation was found (r=0,40; p<0,01 and r=0,30; p<0,01). Levels of anxiety and depression correlated with the average pain intensity per month (r = 0,21; p=0,03) and did not have a statistically significant relationship with pain intensity at the time of examination and the strongest pain for the last month. The anxiety and depression had correlations with all components of the structure of pain syndromes (according to sfMPQ-2), but the most pronounced direct correlation was found between anxiety and the affective component of pain (r=0,57; p<0,01). It was also found that the level of anxiety was proved to be higher in patients who have 2-3 pain syndromes, than in patients with one pain syndrome: 12.0 [8,0; 14,0] points against 8.0 [5,0; 11,0] points, p<0.01. Besides, this localization of pain in the arms, shoulders and back was related to higher levels of anxiety (r=0.22; p=0.03). Conclusion: Pain syndromes, anxiety, and depression are widespread among patients with MS and there is a relationship between them. MS patients with pain have higher levels of anxiety and depression than MS patients without pain. It is also noteworthy that among MS patients with pain syndromes, high levels of anxiety are detected. Anxiety and depression also have a pronounced relationship with a neuropathic component of pain in patients with MS. Besides this, the presence of more than one pain syndrome, high average pain intensity per month is associated with higher levels of anxiety and depression. The localization of pain in the arms, shoulders and back is related to higher anxiety levels. These discoveries, combined with modern neuroimaging technologies used in the next step of our study, will provide a better understanding of both pain and its structure, as well as anxiety and depression

MRI RESEARCH OF THE CAUSES OF DYSTROPHIC PROCESSES IN THE SPINE

The aim of the study was to search for organic changes in the tissues of the spine, which are the cause of pain syndromes in the back and spine. Method. MRI was used to diagnose the condition of the muscular corset of the spine and conditions of the identified disorders with the localization of pain syndromes in the back and the localization of dystrophic manifestations in the vertebrae and intervertebral discs. Results. In 70 patients who underwent MRI of areas with pain syndromes in the back, it was shown that dystrophic manifestations in the spine are preceded by spastic conditions of the intervertebral muscles, leading to disruption of trophism (nutrition and regeneration) of the vertebrae and intervertebral discs, as well as the spine, the development of pain syndromes. The localization of spastic conditions of the intervertebral muscles coincides with the areas in which people experience pain, caused, according to most neurologists, by osteochondrosis of the spine. Osteochondrosis of the spine as a dystrophic process is a consequence of the spastic conditions of the muscles that cause disturbances in the trophism of the vertebrae and intervertebral discs. Conclusions: Spinal osteochondrosis is not a disease, but an irreversible dystrophic process in the vertebrae and intervertebral discs. The reasons for the development of dystrophic processes and back pain are spastic conditions in the intervertebral muscles.

The experience of successful use of melatonin, L‑arginine and L‑carnitine in treatment post-COVID‑19 pain syndromes in persons with cystic transformation of the pineal gland

As an introduction, the article presents a small review of the literature devoted to the problem of clinical variants of postovoid syndrome and, in particular, headaches and back pain. There are 6 cases with various headaches and 1 case with back pain in patients with cystic transformation of the pineal gland after a verified COVID-19 infection. All patients were diagnosed with melatonin, L‑arginine and L‑carnitine deficiency before treatment. After the replacement therapy, the pain syndrome was stopped in all patients within 10 days, and a month after the start of treatment, the indicators of melatonin, L‑arginine and l‑carnitine returned to the reference values of the norm.

Do chronic pain syndromes in lower limb amputees have an effect on the use of prostheses?

BACKGROUND: The use of a prosthesis is critical to regain the ability to walk in lower limb amputees but the relationship between the use of a prosthesis and chronic pain syndromes (PLS, PLP, RLP), common in amputees patients, is still poorly understood. OBJECTIVE: This long-term follow-up study investigates the possible correlation between prosthesis use and the presence of PLP, PLS and RLP in lower limb amputees. METHODS: Patients undergoing transtibial, transfemoral or hemipelvectomy amputation of any aetiology at the Rizzoli Orthopaedic Institute from 2008 to 2018 were included. The Houghton scale was used to assess functional use of the prosthesis. RESULTS: The results show that, in lower limb amputees, prosthesis use is greater in individuals with below-the-knee amputation and in those who were younger at the time of amputation. No significant correlation between the presence of pain syndromes (PLS, PLP, RLP) and the various items on the Houghton scale was found. CONCLUSIONS: The study found no significant correlation indicating that phantom limb pain syndromes affect amputee use of a prosthesis.