Study of temperature logs of linseed, corn and chia seeds for the treatment of joint pain and inflammation

Thermal energy storage in the form of heat provides transient relief in inflammatory and traumatic, subacute and chronic disorders such as: sprains, muscle strains, muscle spasms, low back pain, cervical injuries, various forms of arthritis, arthralgia, neuralgia. Heat increases blood flow and connective tissue extensibility; it also decreases joint stiffness, pain and muscle spasm and helps relieve inflammation. The application of heat can be superficial and the intensity or duration of the physiological effects depends mainly on the temperature of the tissue, the rate of temperature elevation and the area treated. In this work a comparison of the capacity to absorb and contain sensible heat using a combination of linseed, corn and chia seeds in water is made in order to identify which combination is able to retain heat longer and to take advantage of this characteristic in the treatment of pain and inflammation.

A COMPARATIVE STUDY ON EFFICACY AND SAFETY OF TOLPERISONE VERSUS TIZANIDINE IN PATIENTS SUFFERING FROM ACUTE LOW BACK PAIN WITH MUSCLE SPASM

OBJECTIVES: The objectives of this study were to compare the efficacy and safety of Tolperisone tablets 50 mg three times daily versus Tizanidine 2 mg tablets thrice daily for the treatment of acute low back pain with muscle spasm. METHODS: The comparative study was carried out in 50 patients from orthopedics Dr. Pinnamaneni Siddhartha Institute of Medical Sciences and Research Foundation, Vijayawada. Only those patients fulfilling the inclusion/exclusion criteria were enrolled into the study. Participants suffering from acute low back pain with muscle spasm were divided into two groups. The participants were followed up on Day-14 as final analysis. RESULTS: Subjects receiving Tolperisone showed a mean value of 16.43±1.16 in the Roland Morris low back pain and disability questionnaire both groups on day 1 and was reduced to 7.82±1.15 (51.94%) on day 7 and 2.56±1.53 (84.46%) on day 14. Similarly, the patients in the tizanidine group had mean value of 15.93±1.61 on day 1, which was reduced to 6.77±1.68 (57.64%) on day 7, and 2.88±1.92 (81.95%) on day 14, as comparable to the Tolperisone group. There was no statistically significant difference between the two groups, (p>0.05) for pain at rest, pain at night, restrictions of movement, changes in stiffness, changes in numbness, and changes in tenderness. There was a statistically significant difference between the two groups, (p<0.05) for pain on movement and kinesalgia. CONCLUSIONS: Tolperisone was found comparable in efficacy to Tizanidine in improving the clinical symptoms of changes in pain Self-assessment by the patient on different applied parameters.

Clonazepam for pain due to muscle spasm in a patient with vertebral compression fractures caused by multiple myeloma: a case report

Background Vertebral compression fractures can cause severe back pain. Although many types of analgesics and interventional treatments are available, they are sometimes ineffective in mitigating the pain. We encountered a case where clonazepam was effective for the management of severe low back pain caused by lumbar vertebral compression fractures. Case presentation A 44-year-old male was diagnosed with multiple myeloma and had vertebral compression fractures of the first and second lumbar vertebrae. He had been suffering from severe low back pain on movement with muscle spasm and pain-associated anxiety. We considered this breakthrough low back pain to be caused by facet joint pain; thus, we prescribed clonazepam as a muscle relaxant and anxiolytic. Following this treatment, the intractable breakthrough pain was dramatically relieved. Conclusion Clonazepam, which has both muscle relaxant and anxiolytic effects, might be helpful in mitigating pain, associated anxiety, and muscle spasms due to vertebral compression fractures.

Alleviating Paravertebral Muscle Spasm after Radiofrequency Ablation Treatment of Hypersensitive Basivertebral and Sinuvertebral Nerves for Chronic Discogenic Back Pain

BACKGROUND: Paraspinal muscle spasm caused by pain from a lumbar degenerative disc is frequently investigated in patients with low back pain. Radiofrequency ablation (RFA) surgery could alleviate paraspinal muscle spasms. OBJECTIVES: We performed RFA surgery on the high-intensity zone (HIZ) and hypersensitive sinuvertebral and basivertebral nerves to evaluate its outcome. The paravertebral muscle cross-sectional area (CSA) was measured on magnetic resonance imaging (MRI) before and after surgery to evaluate the effect of RFA surgery on the paravertebral muscle. STUDY DESIGN: Prospective cohort study. SETTING: A single spine surgery center. METHODS: A comparative study was performed on 2 different uniportal spinal endoscopic surgery groups; 23 patients who underwent RFA surgery for chronic discogenic back pain and 45 patients who underwent posterior decompression surgery for lumbar spinal stenosis with 12 months of follow-up. Paravertebral muscle cross-sectional area, Schiza grade, Modic type, and HIZ size were measured on pre- and post-operative MRI. An endoscopic video review was performed to evaluate the presence of intraoperative twitching and grade the degree of epidural neovascularization and adhesion. Visual analog scale VAS, modified Oswestry Disability Index, ODI and MacNab’s criteria were evaluated for outcome measures. RESULTS: Intraoperative endoscopic video evaluation showed neovascularization and adhesion adjacent to the disc and pedicle. In the RFA surgery group, there were 7 patients (30.43%) with grade 2 and 16 (69.57%) with grade 3 neovascularization; intraoperative twitching was observed in 19 out of 23 patients (82.61%). After performing an RFA on the sinuvertebral and basivertebral nerves for the treatment of discogenic back pain, the results showed significant improvement in pain and disability scores. The mean CSA of the paraspinal muscle in the RFA surgery group was significantly increased after surgery at the L4–L5 and L5–S1 levels (L4–L5: 3901 ± 1096.7 mm² to 4167 ± 1052.1 mm², P = 0.000; L5-S1: 3059 ± 968.5 mm² to 3323 ± 1046.2 mm², P = 0.000) compared to preoperative CSA. LIMITATIONS: This study was limited by its small sample size. CONCLUSION: Hypersensitive sinuvertebral and basivertebral nerves are strongly associated with epidural neovascularization with adhesion and the pathological pain pathway in degenerative disc disease. Epidural neovascularization with adhesion reflects aberrant neurological connections, which are associated with reflex inhibitory mechanisms of the multifidus muscle, which induces spasm. RFA treatment of the region of epidural neovascularization with adhesion effectively treated chronic discogenic back pain and could induce paraspinal muscle spasm release. KEY WORDS: Discogenic back pain, high-intensity zone, sinuvertebral nerve, basivertebral nerve, radiofrequency ablation, multifidus muscle

CIS-ATRACURIUM WITH MASSETER MUSCLE SPASM: AN UNANTICIPATED DIFFICULT ENDOTRACHEAL INTUBATION AND TEMPOROMANDIBULAR JOINT DISPLACEMENT: A CASE REPORT

Masseter muscle spasm and displacement of temporomandibular joint under anaesthesia could be life threatening if an anaesthesiologist is not prepared. We present a case of 23 years old young lady, who otherwise healthy, having symptoms of abdominal pain and vomiting. Initial baseline workup showed a solitary gallstone and was then planned for urgent laparoscopic cholecystectomy. The challenges faced in the perioperative period were the management of unanticipated masseter muscle spasm and difficult endotracheal intubation after administration of cisatracurium, and temporomandibular joint displacement.

An unusual presentation of encephalitis which mimicked generalised tetanus

Movement disorders are frequent mimickers of more severe neurological presentations, whenever it is diagnosed one should suspect a central nervous system infection as an underlying cause. A 11 year old girl presented in casuality with intermittent generalised muscle spasm, clear sensorium, trismus and risus sardonicus. Initially managed as a case of tetanus, rapid resolution of spasms made suspicion of encephalitis as underlying cause of dystonia which mimicked tetanus. Blood investigation and CSF analysis were normal. CECT brain showed hyper dense lesions bilateral temporal lobes suggestive of viral encephalitis. Child was managed with intravenous acyclovir and dexamethasone after which child improved considerably. Acute dystonia is a close mimicker of tetanus. Any patient presenting with new onset movement disorder should be investigated for central nervous system infection even though it has been reported as a rare cause for the same.

Modern Approaches to the Elimination of Visceral Pain

In modern medicine, one of the most common situations requiring emergency care is biliary or renal colic as a manifestation of abdominal pain syndrome. In both cases, smooth muscle spasm plays an important role in the pathogenesis of visceral pain syndrome. Taking into account the fact that, regardless of the chosen treatment tactics, at the first stage it is necessary to stop pain, the question arises about the choice of a drug strategy for the relief of these conditions. It used to be thought that the more intense the pain, the more indications for the prescription of narcotic drugs, which were considered reference analgesics. In recent years, the world has become embroiled in an «opioid crisis». This prompted clinicians to consider the use of drugs from other groups, namely, non-steroidal anti-inflammatory drugs and antispasmodics alone or in combination, which turned out to be no less effective and, often, safer in comparison with narcotic analgesics. New opportunities for effective treatment of visceral pain are opened by the drug Neospastil® (PJSC «Pharmaceutical Company «Darnitsa»), which combines the benefits of nonsteroidal anti-inflammatory drugs (ketorolac tromethamine) with antispasmodic effect of cholinolytics, ganglioblockers and phenytoin phenytoin. The drug increases the effectiveness of analgesia, as well as the control of muscle spasm.

Pseudomyopia with paradoxical accommodation: a case report

Background Pseudomyopia is caused by increased refractive power by ciliary muscle spasm. Most patients cannot overcome pseudomyopia spontaneously; therefore, treatment of pseudomyopia is fastidious and needs a multidisciplinary approach. We report a case of unusual pseudomyopia with paradoxical accommodation, straining eyes to induce emmetropia at far distance and relaxing eyes to focus at near objects, contrary to physiological accommodation. Case presentation A 33-year-old woman experienced intermittent distant vision discomfort. This occurred at least a few hundred times daily. She could see near objects clearly; however, distant objects could be seen clearly only when she strained her eyes. Uncorrected distance visual acuity was 20/20 and manifest refraction (MR) in both eyes in the relaxed state was approximately − 2.5 D. MR changed to approximately − 0.5 D when she grimaced and strained her eyes when attempting to focus on distant letters. Her response was contrary to the physiological accommodative response. Cycloplegic refraction was approximately 0.0 D. Binocular autorefractor/keratometer was used to objectively evaluate her refractive response and pupil reaction according to accommodative stimulation. The IOL Master was used to evaluate the anterior chamber depth (ACD), lens thickness (LT), and pupil diameter with relaxed and strained eyes. For stepwise static accommodative stimuli (1–5 D), the refractive responses were correspondingly stepwise, similar to those elicited by healthy individuals. However, contrary to physiological accommodation, she strained her eyes to see distant objects and relaxed them to see near objects. There was no change in pupil diameter despite the accommodative stimuli being maximum. Biometry results showed that ACD deepened and LT flattened with eye strain, which were contrary to those during physiological accommodation. Conclusions We report a rare case with reverse of physiological accommodative response. When patients complain of unusual distant visual discomfort, pseudomyopia with paradoxical accommodation should be considered.

Dorsopathy: back pain management

Background. Dorsopathy is a group of diseases of the musculoskeletal system and connective tissue associated with degenerative diseases of the spine. Risk groups for the development of dorsopathies include people with a sedentary lifestyle, people working in difficult conditions, athletes, military personnel, people with obesity. Clinical classification of dorsopathies involves their division according to the affected level (cervical, thoracic, lumbosacral). Objective. To describe the management of patients with back pain. Materials and methods. Analysis of literature data on this topic. Results and discussion. Cervicocranialgias, related to dorsopathies, include vertebral artery syndrome (VAS) and extravasal artery compression (EAC). VAS is a complex of cerebral, vascular and autonomic disorders that occur due to the damage of the sympathetic plexus of vertebral artery, deformation of the wall or changes in its lumen. In turn, EAC involves the compression of blood vessels by bone abnormalities, muscles, osteophytes of the cervical vertebrae, scars, tumors, and so on. Lower back pain (LBP) is one of the most common dorsopathies. Its prevalence has doubled in the last decade. The mechanism of aseptic inflammation in dorsopathies includes such links as the release of proinflammatory mediators, activation of peripheral nociceptors, production of cyclooxygenase-2 and the formation of prostaglandins. Pain in dorsopathies is classified into nociceptive (caused by the excitation of nociceptors in damaged tissues), neuropathic (caused by damage to the central or peripheral nervous system) and psychogenic (caused by primary mental disorders). By duration, LBP is classified into acute (<6 weeks), subacute (6-12 weeks) and chronic (>3 months). According to the etiology, the following subspecies are distinguished: radicular (disc herniation, spondylosis, vertebral canal stenosis), specific (cancer, infection, fracture, equine tail syndrome) and nonspecific (myogenic disorders, facet syndrome). In the presence of so-called symptoms of red flags, it is recommended to conduct imaging examinations according to the indications. Such symptoms include pain development at the age of <20 years or >55 years, recent back injury, progressive character, deterioration or lack of dynamics after keeping horizontal position, prolonged use of glucocorticoids, history of malignant tumors, osteoporosis, intravenous drugs injection, immunodeficiency, weight loss, fever, focal neurological symptoms, pain on palpation of the spine, spinal deformity. The symptoms of yellow flags predict pain chronization. The latter include certain work-related circumstances, beliefs, behaviors, and affective symptoms. The main causes of non-specific back pain include muscular-tonic pain syndrome (MTPS), myofascial pain syndrome (MFPS), arthropathies. Microcirculatory disorders, caused primarily by the reflex muscle spasm, play a significant role in the development of pain in these conditions. MTPS develops on the background of degenerative-dystrophic changes in the spine, ligaments and muscles as a result of exposure to provoking factors (significant physical exertion, injuries, sudden movements, prolonged stay in a static position, general or local hypothermia). Chronization of MTPS leads to the development of MTFS. Ischemic muscle spasm leads to the spasm of arteries and dilation of venules with impaired microcirculation and accumulation of inflammatory mediators. In turn, radicular ischemia develops with radicular pain. Venous plexus, which is compressed at the stage of stenosis without signs of direct compression of the root, is the most vulnerable structure of the intervertebral space. Treatment of LBP includes bed rest, sleep on a hard surface, the use of non-specific anti-inflammatory drugs, local administration of local anesthetics, muscle relaxants, B vitamins, therapeutic exercises and surgical treatment. Restoration of microcirculation makes it possible to influence the pathogenesis of radiculoischemia. Drugs that improve microcirculation and hemodynamics are included in the domestic clinical protocol for the treatment of dorsalgia. Reosorbilact (“Yuria-Pharm”) improves substance exchange between blood and tissues and helps to remove metabolic products. These effects are based on the opening of precapillary sphincters on the background of this solution use. For dorsalgia, it is also advisable to prescribe Latren (“Yuria-Pharm”) – a combination of pentoxifidine and Ringer’s lactate. Latren inhibits the aggregation of blood cells, increases the elasticity of erythrocytes, promotes vasodilation, normalizes the electrolyte composition of blood plasma. To eliminate endothelial dysfunction, Tivortin (“Yuria-Pharm”) is prescribed, which promotes vasodilation. The use of the listed above infusion drugs influences the pathogenesis of the process, eliminating dorsalgia. Conclusions. 1. LBP is one of the most common dorsopathies. 2. Pain in dorsopathies is classified into nociceptive, neuropathic and psychogenic. 3. Microcirculatory disorders play a significant role in the development of nonspecific LBP. 4. Combined use of Reosorbilact, Latren and Tivortin influences the pathogenesis of the process, eliminating dorsalgia.