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Objective:To observe the efficacy and safety of repetitive transcranial magnetic stimulation (rTMS) in frequencies of 5 Hz and 10 Hz for post-herpetic neuralgia (PHN). Methods:From March, 2017 to March, 2018, 60 PHN patients were randomly divided into groups A (n = 20), B (n = 20) and C (n = 20), who accepted sham rTMS, 5 Hz rTMS and 10 Hz rTMS, respectively, ten times for two weeks. They were assessed with Visual Analogue Scale (VAS) of pain, Pittsburgh Sleep Quality Index (PSQI), Patients' Global Impression of Change Scale (PGIC), medication regulation (MR) and incidence of adverse events, before treatment (T0), immediately after stimulation (T1-T10), one month after treatment (T11) and three months after treatment (T12). Results:Compared with group A, VAS scores reduced in groups B and C at T3-T12 (P < 0.05), and reduced more in group C than in group B at T7-T12 (P < 0.05). The average VAS reduction was less in group B than in group C (χ2 = 5.347, P < 0.05). The PSQI and PGIS scores were less in groups B and C than in group A at T12 (P < 0.05), while it was less in group C than in group B (P < 0.05). There was no significant difference among three groups in MR and the incidence of adverse events. Conclusions:rTMS in either frequencies of 5 Hz or 10 Hz may relieve pain, and improve sleep for PHN patients, while 10 Hz rTMS seems more effective in terms of pain and sleep.
ABSTRACT
Objective:To observe the efficacy and safety of repetitive transcranial magnetic stimulation (rTMS) in frequencies of 5 Hz and 10 Hz for post-herpetic neuralgia (PHN). Methods:From March, 2017 to March, 2018, 60 PHN patients were randomly divided into groups A (n = 20), B (n = 20) and C (n = 20), who accepted sham rTMS, 5 Hz rTMS and 10 Hz rTMS, respectively, ten times for two weeks. They were assessed with Visual Analogue Scale (VAS) of pain, Pittsburgh Sleep Quality Index (PSQI), Patients' Global Impression of Change Scale (PGIC), medication regulation (MR) and incidence of adverse events, before treatment (T0), immediately after stimulation (T1-T10), one month after treatment (T11) and three months after treatment (T12). Results:Compared with group A, VAS scores reduced in groups B and C at T3-T12 (P < 0.05), and reduced more in group C than in group B at T7-T12 (P < 0.05). The average VAS reduction was less in group B than in group C (χ2 = 5.347, P < 0.05). The PSQI and PGIS scores were less in groups B and C than in group A at T12 (P < 0.05), while it was less in group C than in group B (P < 0.05). There was no significant difference among three groups in MR and the incidence of adverse events. Conclusions:rTMS in either frequencies of 5 Hz or 10 Hz may relieve pain, and improve sleep for PHN patients, while 10 Hz rTMS seems more effective in terms of pain and sleep.
ABSTRACT
<p><b>BACKGROUND</b>Visceral pain is a common cause for seeking medical attention. Afferent fibers innervating viscera project to the central nervous system via sympathetic nerves. The lumbar sympathetic nerve trunk lies in front of the lumbar spine. Thus, it is possible for patients to suffer visceral pain originating from sympathetic nerve irritation induced by anterior herniation of the lumbar disc. This study aimed to evaluate lumbar discogenic visceral pain and its treatment.</p><p><b>METHODS</b>Twelve consecutive patients with a median age of 56.4 years were enrolled for investigation between June 2012 and December 2012. These patients suffered from long-term abdominal pain unresponsive to current treatment options. Apart from obvious anterior herniation of the lumbar discs and high signal intensity anterior to the herniated disc on magnetic resonance imaging, no significant pathology was noted on gastroscopy, vascular ultrasound, or abdominal computed tomography (CT). To prove that their visceral pain originated from the anteriorly protruding disc, we evaluated whether pain was relieved by sympathetic block at the level of the anteriorly protruding disc. If the block was effective, CT-guided continuous lumbar sympathetic nerve block was finally performed.</p><p><b>RESULTS</b>All patients were positive for pain relief by sympathetic block. Furthermore, the average Visual Analog Scale of visceral pain significantly improved after treatment in all patients (P < 0.05). Up to 11/12 patients had satisfactory pain relief at 1 week after discharge, 8/12 at 4 weeks, 7/12 at 8 weeks, 6/12 at 12 weeks, and 5/12 at 24 weeks.</p><p><b>CONCLUSIONS</b>It is important to consider the possibility of discogenic visceral pain secondary to anterior herniation of the lumbar disc when forming a differential diagnosis for seemingly idiopathic abdominal pain. Continuous lumbar sympathetic nerve block is an effective and safe therapy for patients with discogenic visceral pain.</p>
Subject(s)
Adult , Aged , Female , Humans , Male , Middle Aged , Young Adult , Intervertebral Disc , Pathology , Intervertebral Disc Displacement , Low Back Pain , Drug Therapy , Lumbar Vertebrae , Pathology , Lumbosacral Region , Prospective Studies , Visceral Pain , Drug TherapyABSTRACT
PURPOSE: To investigate the efficacy and the feasibility of application of percutaneous lysis of epidural adhesions in failed back surgery syndrome (FBSS) using a stiff type guide wire and 4F vascular catheter. METHODS: Ninety two patients with FBSS were randomly divided into two groups, the control group (treated by injection dexamethasone only) and percutaneous lysis of epidural adhesions group. Visual analog scale scores (VAS) and therapeutic evaluation were observed in the preoperative, seven days postoperative, one month and six months postoperative. RESULTS: VAS scores for pain were significantly reduced in both groups at seven days. The VAS scores were in controlled group at one month, six months was significantly higher than that in epidural lysis group. However, there was no statistical difference in VAS scores of one month and six months when respectively compared to that of before operation in controlled group. Patients on epidural lysis reported clinical effectiveness rate was 50%. Patients on control was 5.26%, there was a statistical difference between two groups. CONCLUSION: Percutaneous lysis of epidural adhesions by using a stiff type guide wire and 4F vascular catheter is an effective method in the treatment of FBSS and it has a value in clinical application.
OBJETIVO: Investigar a eficácia e a exequibilidade da aplicação da lise percutânea de aderências epidurais na síndrome pós-laminectomia usando um fio-guia tipo Stiff e um cateter vascular 4F. MÉTODOS: Noventa e dois pacientes com síndrome pós-laminectomia foram randomizados em dois grupos: grupo controle (tratado somente com injeção de dexametazona) e grupo lise percutânea de aderências epidurais. Escores de escala visual analógica (VAS) e avaliação terapêutica foram observadas no pré-operatório, no sétimo dia de pós-operatório, um mês e seis meses de pós-operatório. RESULTADOS: Escores VAS para dor foram significantemente reduzidos em ambos os grupos aos sete dias. Os escores VAS foram mais altos no grupo controle comparado ao da lise epidural nos tempos de um mês e seis meses. Entretanto, não há diferença estatística nos escores VAS de um mês e seis meses quando comparados, respectivamente, àqueles de antes da operação do grupo controle. Pacientes com a lise epidural relataram taxa de eficiência de 50%. Nos pacientes do grupo controle foi 5,26%, havendo diferença estatística entre os dois grupos. CONCLUSÃO: A lise percutânea de aderências epidemias usando um fio-guia tipo Stiff e um cateter vascular 4F mostrou-se um método efetivo no tratamento de FBSS e tem valor na aplicação clínica.
Subject(s)
Adult , Female , Humans , Male , Middle Aged , Epidural Space , Failed Back Surgery Syndrome/therapy , Vascular Access Devices , Treatment Outcome , Tissue Adhesions/therapyABSTRACT
<p><b>BACKGROUND</b>With economic growth and urbanization there have been significant changes in the life style and diet of urban residents in large cities of China, which is experiencing a rapid increase in the prevalence of diabetes. While high prevalence of diabetes has been reported, little is known of the long-term effects of diabetes in such a large population. The aim of this study was to estimate the morbidity rate of diabetic peripheral neuropathy (DPN) in a Chinese urban diabetic population with more than 10 years' disease duration, and evaluate the relevant risk factors. The clinical manifestation of DPN and pain status was also assessed.</p><p><b>METHODS</b>Five hundred and sixty-five diabetes patients were recruited into the study. Symptoms and examination helped diagnose neuropathy. The clinical manifestation of DPN was assessed with a visual analog pain score (VAS). Diabetic complication status was determined from medical records. Serum lipids and lipoproteins, glycosylated hemoglobin (HbA1c), and the urinary albumin excretion rate were measured.</p><p><b>RESULTS</b>The morbidity rate of DPN was 46.6%. HbA1c, hyperlipidemia, and retinopathy were significantly associated with neuropathy, and these risk factors were correlated with other diabetic micro and/or macrovascular complications. The average VAS pain score of the DPN patients was 4.12 ± 2.07. Severe and moderate pain was experienced by 11.4% and 40.5% respectively of DPN patients. About 3.7% of diabetic subjects had lower limb ulcer or amputation.</p><p><b>CONCLUSIONS</b>The morbidity rate of DPN for diabetic patients with > 10 years duration is very high compared to the range reported for other populations in the world. The risk factors for DPN include HbA1c, hyperlipidemia, and retinopathy. In long-standing diabetic patients, DPN was not associated with diabetic duration, and half of the DPN patients experienced considerable daily suffering.</p>
Subject(s)
Aged , Female , Humans , Male , Middle Aged , China , Diabetic Neuropathies , Epidemiology , Metabolism , Glycated Hemoglobin , Metabolism , Hyperlipidemias , Epidemiology , Metabolism , Pain , Risk Factors , Urban PopulationABSTRACT
<p><b>BACKGROUND</b>Cervicogenic headache (CEH) is caused by a structural abnormality in the cervical spine. Available treatments for CEH include medical therapy, local botulinum toxin injection, cervical epidural corticosteroid injection, and surgery. The objective of this study was to investigate the safety and efficacy of a continuous epidural block of the cervical vertebra.</p><p><b>METHODS</b>Medical records were retrospectively analyzed for 37 patients diagnosed with CEH treated by a continuous epidural block of the cervical vertebra with lidocaine, dexamethasone, and saline (5 ml/min) for 3 - 4 weeks and triamcinolone acetonide 5 mg once weekly for 3 - 4 weeks. Pain was measured via the visual analogue scale (VAS) in combination with quality of life assessment. Outcome measures were patient-reported days with mild or moderate pain, occurrence of severe pain, and the daily oral dosages of non-steroidal anti-inflammatory drug use (NSAID).</p><p><b>RESULTS</b>In the 3 months immediately preceding placement of the epidural catheter, the mean number of days with mild or moderate pain was 22.0 +/- 4.3. The mean occurrence of severe pain was (3.20 +/- 0.75) times and the mean oral dosage of NSAID was (1267 +/- 325) mg. During the first 6 months after epidural administration of lidocaine and corticosteroids, the mean number of days with mild or moderate pain, the mean occurrence of severe pain, and the mean daily oral dosages of NSAIDs were significantly decreased compared to 3-month period immediately preceding treatment (P < 0.01). By 12 months post-treatment, no significant difference in these three outcome measures was noted.</p><p><b>CONCLUSIONS</b>Continuous epidural block of the cervical vertebra for patients with CEH is effective for at least six months. Further research is needed to elucidate mechanisms of action and to prolong this effect.</p>