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1.
Rev. cuba. reumatol ; 23(1): e813, tab
Article in Spanish | LILACS, CUMED | ID: biblio-1280403

ABSTRACT

Introducción: El dolor lumbar es una de las afecciones que causa mayor índice de incapacidad, por lo que se ha señalado como una de las principales causas de invalidez laboral temporal o definitiva. Objetivo: Identificar las ventajas de la aplicación de ozono médico como terapia combinada en el tratamiento de pacientes con lumbalgia aguda. Métodos: Se realizó un estudio experimental de casos y controles donde cada grupo estuvo integrado por 50 pacientes mayores de 20 años de edad con diagnóstico de dolor lumbar, previo consentimiento informado. El grupo control recibió tratamiento con esquemas terapéuticos tradicionales según los consensos internacionales para el tratamiento del dolor lumbar agudo. En el caso de los pacientes del grupo de casos se adicionó ozono médico en tres sesiones semanales por vía rectal hasta completar 10 sesiones. Se utilizó la prueba de comparación de medias y de McNemar para identificar cambios en la intensidad del dolor y en la presencia y tipo de incapacidad. Resultados: Hubo un promedio de edad por encima de los 50 años, con predominio de pacientes femeninas. La intensidad del dolor al inicio del tratamiento se comportó como media de ambos grupos en 8,76 puntos, mientras que el 87 por ciento de los pacientes refirió algún tipo de discapacidad. Predominó la incapacidad moderada. Conclusiones: La aplicación de ozono médico combinado influyó positivamente en la disminución de la intensidad del dolor y en la presencia y tipo de incapacidad(AU)


Introduction: Low back pain is one of the conditions that generates the highest rate of disability, has been identified as one of the main causes of temporary and / or permanent work disability. Objective: To identify the advantages of the application of medical ozone as a combined therapy in the treatment of patients with acute low back pain. Methods: An experimental case-control study was carried out where each group consisted of 50 patients over 20 years of age with a diagnosis of low back pain. The control group received treatment with traditional therapeutic schemes according to international consensus for the treatment of acute low back pain, in the case of patients in the case group the use of medical ozone was added, in three weekly sessions rectally until completing 10 sessions. The comparison test of means and McNemar were used to identify changes in pain intensity and in the presence and type of disability. Results: Average age above 50 years with a predominance of female patients. The intensity of pain at the start of treatment behaved as an average of both groups at 8.76 points, while 87 percent of the patients reported some type of disability with a predominance of moderate disability. Conclusions: The application of combined medical ozone positively influenced the decrease in pain intensity and the presence and type of disability(AU)


Subject(s)
Humans , Ozone/therapeutic use , Low Back Pain/therapy , Combined Modality Therapy/methods , Case-Control Studies , Low Back Pain/drug therapy
2.
Rev. Assoc. Med. Bras. (1992) ; 66(8): 1146-1151, Aug. 2020. tab, graf
Article in English | LILACS, SES-SP | ID: biblio-1136340

ABSTRACT

SUMMARY INTRODUCTION Lumbar pain is one of the main reasons for medical consultation, causing the disruption of daily routines due to its disabling nature, thus resulting in social and personal damage. Among the complementary treatments, ozonotherapy offers analgesia to most patients, with reports of complications. However, great questions about its clinical effectiveness have not been answered yet, and there have been reports of serious complications. OBJECTIVE To describe the use of ozonotherapy in the treatment of lumbar pain, focusing on its favorable and unfavorable effects, and its analog profile. METHODS A cross-sectional bibliographic research was performed with scientific articles obtained from the Pubmed, LILACS and Scopus database, using the following descriptors: "Ozone", "Therapy", "Lumbar pain", "complication", "Disk herniation", "Guideline", "Protocol", "Standards", "Criteria". RESULTS The researched literature corroborates that, in clinical practice, there is safety in the use of oxygen-ozone therapy through percutaneous injections for the treatment of lumbar pain, especially when compared to surgeries and use of medicines, provided that strict criteria are followed. CONCLUSION The procedure is effective and has a favorable analgesic profile. However, it is necessary to produce a medical guideline that will help in its strict and systematic control.


RESUMO INTRODUÇÃO Dor lombar é um dos principais motivos de consultas médicas, provocando afastamento das rotinas diárias, por ser incapacitante, resultando em danos sociais e pessoais. Dentre os tratamentos complementares, a ozonioterapia oferece analgesia para a maioria dos pacientes e com mínimos relatos de complicações. Entretanto, grandes questionamentos sobre sua efetividade clínica ainda não foram respondidos, além de haver relatos de complicações graves. OBJETIVO Descrever o uso da ozonioterapia no tratamento da dor lombar, enfocando seus efeitos favoráveis e desfavoráveis, e seu perfil analgésico. MÉTODOS Foi realizada uma pesquisa bibliográfica transversal com artigos científicos obtidos das bases de dados PubMed, Lilacs e Scopus, utilizando os descritores: "Ozônio", "Terapia", "Dor lombar", "Complicação", "Hérnia de Disco","Diretriz", "Protocolo", "Padrões", "Critérios". RESULTADOS A literatura pesquisada corrobora que, na prática clínica, há segurança na utilização da terapia com a mistura oxigênio-ozônio por meio de injeções percutâneas para o tratamento de dor lombar, principalmente quando comparada às cirurgias e ao uso de medicamentos, desde que sejam seguidos critérios rígidos. CONCLUSÃO O procedimento é efetivo e tem perfil analgésico favorável. No entanto, é necessária a confecção de uma diretriz médica que auxiliará no controle rígido e sistemático do mesmo.


Subject(s)
Humans , Ozone/therapeutic use , Low Back Pain/drug therapy , Intervertebral Disc Displacement , Cross-Sectional Studies , Treatment Outcome , Injections , Lumbar Vertebrae
3.
Article in Chinese | WPRIM | ID: wpr-880800

ABSTRACT

OBJECTIVE@#To evaluate the efficacy of lumbar transforaminal epidural block (LTEB) for treatment of low back pain with radicular pain.@*METHODS@#We retrospectively analyzed the clinical data of 78 patients with low back pain and radicular pain admitted to the Department of Orthopedics of Beijing Chuiyangliu Hospital from March, 2017 to April, 2019. Thirty-three of the patients received treatment with LTEB (LTEB group), and 45 received comprehensive conservative treatment including traction, massage, acupuncture and physiotherapy (control group). The demographic and clinical data of the two groups were compared. The patients were followed up for 3 to 24 months, and numerical rating scale (NRS) and Oswestry disability index (ODI) scores of the patients were evaluated before the treatment and at 2 weeks, 1 month and 3 months after discharge to assess the efficacy of the treatment.@*RESULTS@#The mean operation time of LTEB was 25.7 7.5 min (15-45 min). After the operation, 5 patients developed weakness of the lower limbs but all recovered within 24-72 h. The patients receiving LTEB all showed significantly decreased NRS scores for low back and radicular pain and ODI scores after the operation (@*CONCLUSIONS@#As a minimally invasive approach, LTEB is effective for treatment of low back pain with radicular pain and can produce good short-term effects of pain relief and functional improvement.


Subject(s)
Humans , Injections, Epidural , Low Back Pain/drug therapy , Lumbar Vertebrae , Radiculopathy/drug therapy , Retrospective Studies , Treatment Outcome
4.
Rev. bras. anestesiol ; 69(5): 493-501, Sept.-Oct. 2019. tab, graf
Article in English | LILACS | ID: biblio-1057452

ABSTRACT

Abstract Background and objectives: Low back pain is a prevalent disease in the adult population, whose quality of life is considerably affected. In order to solve this problem, several therapies have been developed, of which ozone therapy is an example. Our objective in this study was to determine the effectiveness of ozone therapy for lumbar pain relief in adult patients compared to other therapies (steroid and placebo). Method: We used randomized clinical trials to compare the effectiveness of ozone and other therapies for lumbar pain relief in adults (Prospero: CRD42018090807). Two independent reviewers searched the Medline (1966-April/2018), Scopus (2011-May/2018), Lilacs (1982-May/2018), and EMBASE (1974-March/2018) databases. We use the terms ozone and pain as descriptors. The primary variable was pain relief and the secondary ones were complication, degree of satisfaction, quality of life and recurrence of pain. Results: Of the 779 identified articles, six selected clinical trials show that ozone therapy is more effective for lumbar pain relief; however, they were mostly classified as having a high or uncertain risk of bias (Cochrane Handbook). The meta-analysis regarding the effectiveness of pain relief did not show a significant difference between groups in the three-month period (RR = 1.98, 95% CI: 0.46-8.42, p= 0.36; 366 participants). It also showed greater effectiveness of the ozone therapy at six months compared to other therapies (steroid and placebo) (RR = 2.2, 95% CI: 1.87-2.60, p< 0.00001; 717 participants). Conclusions: The systematic review has shown that ozone therapy used for six months for lumbar pain relief is more effective than other therapies; however, this result is not definitive as data from studies with moderate to high risk of bias were used.


Resumo Justificativa e objetivos: A lombalgia é uma enfermidade prevalente na população adulta, que tem sua qualidade de vida afetada consideravelmente. Com intuito de resolver este problema, desenvolveram-se várias terapias. Um exemplo é a ozonioterapia. Objetivamos neste estudo determinar a efetividade da ozonioterapia para alívio da dor lombar em pacientes adultos, quando comparada a outras terapias (esteroide e placebo). Método: Usamos de ensaios clínicos randomizados para comparar a efetividade do ozônio e de outras terapias para o alívio da dor lombar em adultos (Prospero: CRD42018090807). Dois revisores independentes analisaram as bases Medline (1966-Abril/2018), Scopus (2011-Maio/2018), Lilacs (1982-Maio/2018) e Embase (1974-Março/2018). Como descritores, usamos termos ozone e pain. Temos como variável primária o alívio da dor e como variáveis secundárias: complicação, grau de satisfação, qualidade de vida e recorrência da dor. Resultados: Os seis ensaios clínicos selecionados, de 779 artigos identificados, mostram que o grupo do ozônio é mais efetivo para o alívio da dor lombar, porém, foram classificados em sua maioria com alto ou incerto risco de viés (Handbook Cochrane). A metanálise referente à efetividade no alívio da dor não apresentou diferença significante entre os grupos no período de três meses (RR = 1,98; 95% IC: 0,46-8,42; p= 0,36; 366 participantes). Também denotou maior efetividade em seis meses do grupo ozônio em relação a outras terapias (esteroide e placebo) (RR = 2,2; 95% IC: 1,87-2,60; p< 0,00001; 717 participantes). Conclusões: A revisão sistemática demonstrou que ozonioterapia usada por seis meses para alívio da dor lombar é mais efetiva do que outras terapias. Entretanto, esse resultado não é definitivo, visto que foram usados dados de estudos com moderado a alto risco de viés.


Subject(s)
Humans , Ozone/therapeutic use , Randomized Controlled Trials as Topic , Low Back Pain/drug therapy , Treatment Outcome
5.
Revista Digital de Postgrado ; 8(3): e173, 2019. tab
Article in Spanish | LILACS, LIVECS | ID: biblio-1087901

ABSTRACT

El tratamiento de las patologías discales y degenerativas que afectan a las articulaciones interfacetarias de la columna vertebral representan entre ambas más del 95% de los objetivos curativos en esta área del cuerpo, en razón de esto, esta investigación evalúa los efectos de los factores de crecimiento ozonizados en pacientes con diagnóstico de síndrome facetario lumbar, así como también, valorar la intensidad del dolor en el síndrome facetario, determinando el grado de movilidad articular previo y posteriora la infiltración. Métodos: la presente investigación se considera un estudio descriptivo y prospectivo, con un diseño es preexperimental, en pacientes que acudieron a la consulta de terapia del dolor del Hospital Dr. Pedro García Clara, en Ciudad Ojeda, estado Zulia-Venezuela. Los resultados se expresaron como valores absolutos, en porcentajes, media ± desviación estándar (M±DE), analizando las diferencias de los resultados mediante la prueba "t" de Student, cuando fueron aplicables, tomando un valor de p<0.05. Resultados: se evidencia, que los factores de crecimiento ozonizados infiltrados en los pacientes con diagnóstico de síndrome facetario lumbar, tienen efectos clínicos significativos, en cuanto a la disminución de la intensidad del dolor y el aumento del grado de movilidad articular. Conclusiones: el uso del plasma rico ozonizado es una técnica efectiva para disminuir la intensidad del dolor cuando es utilizado en el síndrome facetario ya que permite una aumento significativo de los grados de movilidad articulares de la columna lumbar (flexión, extensión e inclinación. Es una técnica sencilla, eficaz, económica y con efectos adversos mínimos(AU)


The treatment of the disc and degenerative pathologies that affect the interfaceative joints of the spine represent between them more than 95% of the healing objectives in this area of the body, because of this, this research evaluates the effects of the growth factors Ozonized in patients with a diagnosis of lumbar facet syndrome, as well as assessing the intensity of pain in facet syndrome, determining the degree of joint mobility before and after infiltration. Methods: the present investigation is considered a descriptive and prospective study, with a pre-experimental design, in patients who attended the pain therapy consultation of the Dr. Pedro García Clara Hospital, in Ciudad Ojeda, Zulia-Venezuela state. thee results were expressed as absolute values, in percentages, mean ± standard deviation (M ± SD), analyzing the differences of the results by means of the Student "t" test, whenapplicable, taking a value of p <0.05. Results: it is evidenced that infiltrated ozonized growth factors in patients with a diagnosis of lumbar facet syndrome, have significant clinical effects, in terms of the decrease in pain intensity and the increase in the degree of joint mobility. Conclusions: the use of ozonated rich plasma is an effective technique to reduce the intensity of pain when used in facet syndrome because it allows a significant increase in the degrees of joint mobility of the lumbar spine (flexion, extension and tilt.) It is a simple, effective technique, economic and with minimal adverse effects(AU)


Subject(s)
Humans , Male , Female , Adult , Aged , Low Back Pain/pathology , Low Back Pain/drug therapy , Chronic Pain/therapy , Lumbar Vertebrae/injuries , Infiltration-Percolation/adverse effects , Prospective Studies
6.
Dolor ; 28(69): 22-24, jul. 2018.
Article in Spanish | LILACS | ID: biblio-1117585

ABSTRACT

INTRODUCCIÓN: El dolor lumbar crónico genera alta disfuncionalidad, su tratamiento es complejo y en algunos casos se presenta refractariedad a tratamientos convencionales. El síndrome de sensibilización central por dolor lumbar involucra presencia de síntomas ansiosos, depresivos, trastorno del sueño, fatiga, alteraciones del apetito y disfuncionalidad en actividades de la vida diaria. El manejo del dolor lumbar crónico con síndrome de sensibilización central es dificultoso, requiere de intervenciones multidimensionales y esquemas farmacológicos atípicos. OBJETIVO: Se describe el uso de topiramato como fármaco coadyuvante en el manejo de pacientes con dolor lumbar crónico resistente a tratamiento standard en 25 pacientes. MATERIALES Y MÉTODO: Seguimiento a 12 semanas y evaluación de funcionalidad, sintomatología ansiosa-depresiva, control del dolor y fatiga a través de múltiples escalas. Resultados: La dosis mediana fue de 300mg. El 72 por ciento (18 pacientes) presenta mejoría estadística en síntomas angustiosos, depresivos, sueño, EVA de dolor y fatiga y funcionalidad. Solo el 16 por ciento (4 pac) presentan reacciones adversas que obligan a suspensión del fármaco. El 12 por ciento (3 pacientes) no presentaron respuesta terapéutica. DISCUSIÓN: El topiramato podría ser una opción coadyuvante para el manejo del síndrome de dolor lumbar crónico con síndrome de sensibilización central.


INTRODUCTION: The chronic low back pain causes severe dysfunction, treatment is complex and in some cases it can be refractory to usual treatment. Central Sensitivity syndrome secondary to chronic low back pain is characterized by anxious, depressive, sleep disorders, fatigue, eating disorders and damage in daily activities life. Management of this syndrome must be integrative and multidimensional. OBJECTIVES: Describe the use of topiramate in 25 patients with chronic low back pain for pain relief in refractory patients to standard treatment, during 12 weeks. MATERIALS AND METHODS: Following during 12 weeks, multiples Assessments about anxiety, depression, functionality, sleep quality, VAS pain and fatigue. Results: Median doses 300mg. 72 percent got pain relief, and decrease in anxious depressive symptoms, improve sleep quality, daily function. 16 percent didn't get pain relief and suffered adverse effects forcing suspension of the drug. 12 percent didn't get pain relief without adverse effects. DISCUSSION: Topiramate might be a treatment option for pain relief in these patients.


Subject(s)
Humans , Male , Female , Low Back Pain/psychology , Low Back Pain/drug therapy , Topiramate/therapeutic use , Anticonvulsants/therapeutic use , Anxiety , Pain Measurement , Adjuvants, Pharmaceutic , Follow-Up Studies , Depression , Chronic Pain , Central Nervous System Sensitization/drug effects , Topiramate/administration & dosage , Anticonvulsants/administration & dosage
7.
Evid. actual. práct. ambul ; 21(4): 124-126, 2018.
Article in Spanish | LILACS | ID: biblio-1015690

ABSTRACT

La lumbociatalgia es un problema clínico común, que en la mayoría de los casos se autolimita y se puede tratar en forma conservadora, usando medidas no farmacológicas y analgésicos como paracetamol o los antiinflamatorios no esteroi-deos. Otro medicamento muy utilizado en nuestro medio es la pregabalina, a pesar de que no se encuentra aprobada para dicha indicación. En este trabajo, el autor se pregunta acerca de la utilidad clínica de la pregabalina y luego de hacer una búsqueda bibliográfica sobre la evidencia más actualizada y de mejor calidad acerca del tema, concluye que no es efectiva para lumbociatalgia y que se acompaña de efectos adversos significativos. Esto coincide con las recomenda-ciones de las guías internacionales, que en su mayoría desaconsejan el uso de anticonvulsivantes para la lumbalgia. (AU)


Sciatica is a common clinical situation, in most cases self-limited and which can be managed conservatively with nonpharmaco-logic treatment and analgesics, such as paracetamol or nonsteroidal anti-inflammatory drugs. Pregabalin is also commonly used, despite not being approved for this indication. In this article, the author queries about the clinical usefulness of pregabalin, and after carrying out a bibliographic search of the most recent and best-quality evidence, concludes that it is not effective in sciatica while it causes significant adverse effects. This is in line with the recommendations of most international guidelines,that do not recommend the use of anticonvulsivants drugs for the treatment of lumbalgia. (AU)


Subject(s)
Humans , Male , Female , Adult , Middle Aged , Young Adult , Sciatica/drug therapy , Low Back Pain/drug therapy , Evidence-Based Practice/trends , Pregabalin/adverse effects , Anticonvulsants/adverse effects , Sciatica/surgery , Sciatica/therapy , Anti-Inflammatory Agents, Non-Steroidal/therapeutic use , Low Back Pain/surgery , Low Back Pain/therapy , Pregabalin/administration & dosage , Pregabalin/therapeutic use , Analgesics/therapeutic use , Nerve Block/trends
9.
Rev. Assoc. Med. Bras. (1992) ; 63(4): 355-360, Apr. 2017. tab, graf
Article in English | LILACS | ID: biblio-842550

ABSTRACT

Summary Introduction: Low back pain is one of the painful disorders of higher prevalence. It has several etiologies and surgery may be indicated in the presence of neurological deficits or compression syndromes. However, in up to 40% of cases, patients develop worsening of pain and failed back surgery syndrome (FBSS), which is an important cause of chronic pain with high morbidity and disability. In the last two decades, ozone has been shown to be a new therapeutic option for FBSS due to its analgesic and anti-inflammatory properties. Objective: To evaluate the effect of ozone therapy on pain and disability in patients with failed back surgery syndrome. Method: We selected 19 patients undergoing epiduroscopy and injection of ozone. Patients were evaluated preoperatively and 21 days after the procedure, using the following instruments: Visual Analogue Scale (VAS), Brief Pain Inventory, Roland-Morris Questionnaire Disability, Oswestry Disability Index (ODI), Neuropathic Pain Symptom Inventory and Douleur Neuropathique 4. Results: The patients showed significant pain relief, but no improvement was observed in the functional scales. Conclusion: Our results suggest that epidural ozone therapy can be a treatment option in FBSS to reduce the intensity of the pain.


Resumo Introdução: A dor lombar é um dos distúrbios dolorosos de maior prevalência. Tem diversas etiologias e, na presença de déficits neurológicos ou síndromes compressivas, pode ser indicada cirurgia. Entretanto, em até 40% dos casos os pacientes podem evoluir com piora da dor e síndrome dolorosa pós-laminectomia (SDPL), que se constitui em uma importante causa de dor crônica com grande morbidade e incapacidade. Nas últimas duas décadas, o ozônio tem se mostrado uma nova opção terapêutica para a SDPL em virtude das suas propriedades analgésicas e anti-inflamatórias. Objetivo: Avaliar o efeito da ozonioterapia na dor e na incapacidade de pacientes com SDPL. Método: Foram selecionados 19 pacientes, submetidos a epiduroscopia e aplicação de ozônio. Os pacientes foram avaliados no pré-operatório e 21 dias após o procedimento, por meio de Escala Visual Analógica, Inventário Breve de Dor, Questionário Roland-Morris de Incapacidade, Oswestry Disability Scale, Inventário de Sintomas de Dor Neuropática e Questionário de Dor Neuropática. Resultados: Os pacientes apresentaram redução significante nos escores das escalas de avaliação de dor; porém, essa redução não foi observada na avaliação da incapacidade funcional. Conclusão: Os dados obtidos sugerem que a ozonioterapia epidural pode ser uma opção de manejo da SDPL na diminuição da intensidade da dor.


Subject(s)
Humans , Male , Female , Adult , Aged , Young Adult , Ozone/therapeutic use , Low Back Pain/drug therapy , Disability Evaluation , Failed Back Surgery Syndrome/drug therapy , Analgesics/therapeutic use , Time Factors , Injections, Epidural , Pain Measurement , Surveys and Questionnaires , Reproducibility of Results , Retrospective Studies , Analysis of Variance , Treatment Outcome , Low Back Pain/physiopathology , Sickness Impact Profile , Failed Back Surgery Syndrome/physiopathology , Middle Aged
10.
Rev. bras. anestesiol ; 67(1): 21-27, Jan.-Feb. 2017. tab, graf
Article in English | LILACS | ID: biblio-843363

ABSTRACT

Abstract Study design: A cross-sectional study. Objective: We compared the 12 month outcomes of fluoroscopically guided transforaminal epidural steroid injections with interlaminar epidural steroid injections for the treatment of chronic lumbar spinal pain. Chronic lower back pain is a multifactorial disorder with many possible etiologies. The lifetime prevalence of spinal pain is reportedly 65-80% in the neck and lower back. Epidural injection of corticosteroids is a commonly used intervention for managing chronic spinal pain. Methods: Patients who did not benefit from previous treatments were included in this study. Injections were performed according to magnetic resonance imaging findings at the nearest level of lumbar pathology; 173 patients received interlaminar epidural steroid injections and 126 patients received transforaminal epidural steroid injections. All of the patients were regularly followed up for 12 months using a verbal numeric rating scale. Magnetic resonance imaging findings, complications, verbal numeric rating scale, and satisfaction scores were recorded. Results: Lumbar disk pathology was the most frequently encountered problem. The interlaminar epidural steroid injections were preferred at the L4-L5 intervertebral level. Verbal numeric rating scale scores significantly decreased during the 12-month period compared to basal scores (p < 0.001). Significant differences between the two groups according to verbal numeric rating scale and satisfaction scores were not observed (p > 0.05). There were no major complications; however, the interlaminar epidural steroid injections group had 22 (12.7%) minor complications, and the transforaminal epidural steroid injections group had 12 (9.5%) minor complications. Conclusions: This study showed that interlaminar epidural steroid injections can be as effective as transforaminal epidural steroid injections when performed at the nearest level of lumbar pathology using fluoroscopy in 12-month intervals.


Resumo Desenho do estudo: Estudo transversal. Objetivo: Comparamos os desfechos de 12 meses de injeções peridurais de esteroides usando a técnica transforaminal (IPETF) guiada por fluoroscopia com as injeções peridurais de esteroides usando a técnica interlaminar (IPEIL) para o tratamento da dor lombar crônica. A dor lombar crônica é uma doença multifatorial com muitas etiologias possíveis. Relata-se que a prevalência de dor na coluna durante a vida é de 65%-80% no pescoço e parte inferior das costas. A injeção peridural de corticosteroides é uma intervenção comumente usada para controlar a dor crônica da coluna vertebral. Métodos: Pacientes que não obtiveram benefício de tratamentos anteriores foram incluídos neste estudo. As injeções foram realizadas de acordo com os achados em Ressonância Magnética (RM) ao nível mais próximo da patologia lombar; 173 pacientes receberam IPEIL e 126 pacientes receberam IPETF. Todos os pacientes foram acompanhados regularmente por 12 meses, usando uma escala numérica verbal (ENV) para a classificação. Achados em RM, complicações, escores ENV e índices de satisfação foram registrados. Resultados: Patologia em disco lombar foi o problema mais frequentemente encontrado. IPEIL foi preferido ao nível intervertebral de L4-L5. Os escores da ENV diminuíram significativamente durante o período de 12 meses em comparação com os valores basais (p < 0,001). Não houve diferenças significativas entre os dois grupos de acordo com a ENV e os índices de satisfação (p > 0,05). Não houve grandes complicações, mas houve complicações menores em 22 (12,7%) no grupo IPEIL e 12 (9,5%) no grupo IPETF. Conclusões: Este estudo mostrou que IPEIL pode ser tão eficaz como IPETF quando realizadas ao nível mais próximo da patologia lombar usando a fluoroscopia em intervalos de 12 meses.


Subject(s)
Humans , Male , Female , Adult , Aged , Aged, 80 and over , Young Adult , Low Back Pain/drug therapy , Adrenal Cortex Hormones/administration & dosage , Analgesics/administration & dosage , Injections, Epidural , Magnetic Resonance Imaging , Fluoroscopy , Cross-Sectional Studies , Analysis of Variance , Treatment Outcome , Patient Satisfaction , Chronic Pain/drug therapy , Middle Aged
11.
Rev. cuba. med. gen. integr ; 32(4): 1-10, oct.-dic. 2016. tab
Article in Spanish | LILACS | ID: biblio-960503

ABSTRACT

Introducción: en el primer nivel de atención, las lumbalgias representan el 5 por ciento de las consultas. Se utiliza un abordaje racional, siendo tratados con técnicas como la Auriculoterapia. Objetivo: evaluar el uso de la técnica de Auriculoterapia en el tratamiento del síndrome lumbálgico agudo. Métodos: estudio exploratorio, prospectivo, en pacientes con síndrome lumbálgico que asistieron al cuerpo de guardia del Policlínico María Emilia Alfonzo de Madruga, en el período de enero del 2015 a enero del 2016. Universo constituido por 120 pacientes, se seleccionó una muestra no probabilística de tipo intencionada de 60 pacientes diagnosticados por ortopedia, divididos en dos grupos para el tratamiento: grupo I: fisioterapia convencional indicada más medicamentos según la sintomatología del proceso, grupo II: fisioterapia convencional indicada más medicamentos según la sintomatología del proceso más Auriculoterapia según el diagnóstico asiático y la exploración del pabellón auricular. Se utilizó la hoja de cargo y la historia clínica individual, se tuvieron en cuenta variables como edad, sexo, diagnóstico según causa, síntomas asociados y evolución del tratamiento en ambos grupos. Resultados: predominó el grupo de edades de 56 a 65 años para un 37 por ciento, del sexo femenino para un 65 por ciento, diagnóstico de artrosis con 49 pacientes para un 82 por ciento, síntomas asociados de dolor en 60 para un 100 por ciento, con evolución buena en 42 para un 70 por ciento. Conclusiones: los pacientes con síndrome lumbálgico evolucionaron satisfactoriamente con el tratamiento convencional, siendo más efectivo el tratamiento convencional más Auriculoterapia(AU)


Introduction: In the first level of health care, lumbagos represent 5 percent of the consultations. A rational approach is used, being treated with techniques such as auriculotherapy. Objective: Assess the use of the technique auriculotherapy to treat the acute lumbar syndrome. Methods: Exploratory, prospective study on patients with lumbar syndrome who attended the emergency room of María Emilia Alfonzo Polyclinic of Madruga, in the period from January 2015 to January 2016. The universe was made up by 120 patients, we chose a nonprobabilistic and nontargeted sample of 60 patients diagnosed by orthopaedics, divided into two groups for treatment: group I: conventional physiotherapy and medication indicated for the process symptoms; group II: conventional physiotherapy and medication indicated for the process symptoms, and auriculotherapy, for the Asian diagnostic and the auricular pavilion exploration. The chart and person's clinical record were used, and variables such as age, sex, cause diagnosis, associated symptoms and treatment evolution were considered in both groups. Results: The predominating age group was 56-65 years (37 percent), female sex (65 percent), arthrosis diagnosed with 49 patients (82 percent), pain-associated symptoms in 60 (100 percent), with good evolution (70 percent). Conclusions: The patients with lumbar syndrome evolved satisfactorily with the conventional treatment, being more effective the conventional treatment plus auriculotherapy(AU)


Subject(s)
Humans , Male , Female , Physical Examination/methods , Clinical Evolution , Low Back Pain/drug therapy , Auriculotherapy/methods , Prospective Studies
13.
Article in English | WPRIM | ID: wpr-216509

ABSTRACT

BACKGROUND: Although both pregabalin and gabapentin are known to be useful for treating lumbar radiating pain and reducing the incidence of surgery, the oral corticosteroids sometimes offer a dramatic effect on severe radiating pain despite the lack of scientific evidence. METHODS: A total of 54 patients were enrolled among 703 patients who complained of lumbar radiating pain. Twenty patients who received an oral corticosteroid was classified as group A and 20 patients who received the control drugs (pregabalin or gabapentin) as group B. Oswestry Disability Index (ODI), Revised Roland Morris disability questionnaire (RMDQ), Short Form 36 (SF-36) questionnaire, lumbar radiating pain, objective patient satisfaction, and objective improvement of patients or physicians were assessed at 2, 6, and 12 weeks after medication. RESULTS: No difference in the sex ratio and age was observed between the groups (p = 0.70 and p = 0.13, respectively). Group A showed greater improvement in radiating pain after 2, 6, and 12 weeks than group B (p < 0.001, p = 0.001, and p < 0.001, respectively). No differences were observed between the groups in satisfaction at the beginning and 12 weeks after taking the medication (p = 0.062 and p = 0.061, respectively) and in objective improvement of patients and physicians (p = 0.657 and p = 0.748, respectively). Group A was less disabled and had greater physical health scores than group B (p = 0.014 and p = 0.017, respectively). CONCLUSIONS: Oral corticosteroids for the treatment of lumbar radiating pain can be more effective in pain relief than gabapentin or pregabalin. The satisfaction of patients and physicians with the drug and objective improvement status were not inferior to that with gabapentin or pregabalin.


Subject(s)
Adolescent , Adrenal Cortex Hormones/therapeutic use , Adult , Aged , Amines/therapeutic use , Analgesics/therapeutic use , Cyclohexanecarboxylic Acids/therapeutic use , Female , Humans , Low Back Pain/drug therapy , Lumbosacral Region/physiopathology , Male , Middle Aged , Patient Satisfaction/statistics & numerical data , Pregabalin/therapeutic use , Quality of Life , Radiculopathy/drug therapy , Surveys and Questionnaires , Young Adult , gamma-Aminobutyric Acid/therapeutic use
14.
Rev. cuba. farm ; 49(2)abr.-jun. 2015. ilus, tab
Article in Spanish | LILACS, CUMED | ID: lil-776404

ABSTRACT

Objetivo: determinar la eficacia y la tolerabilidad de la combinación a dosis fija, en una sola tableta, de tiocolchicósido 4 mg más diclofenaco potásico 50 mg en la reducción de la contractura muscular aguda estriada dolorosa comparado contra placebo y el uso de paracetamol tabletas de 500 mg como medicación de rescate. Métodos: fueron reclutados 97 pacientes de 2 ciudades ecuatorianas, Quito y Guayaquil, en tres centros de investigación, públicos y privados, con cervicalgia, dorsalgia y lumbalgia, principalmente de causa funcional. Los pacientes fueron asignados al azar en dos grupos: 1) grupo medicación activa, tiocolchicósido más diclofenaco potásico, 50 pacientes, 2) grupo placebo 47 pacientes. La eficacia en ambos grupos se evaluó por la reducción de la contractura muscular apreciada por inspección, palpación y reducción del dolor medido por una escala visual análoga, después de 5 días de tratamiento. Resultados: la evolución del grado de contractura muscular en el grupo medicación activa por evaluación visual pasó de un 100 por ciento con contractura visible con o sin actividad antiálgica fija a 96 por ciento sin signos visibles de contractura; de un 82 por ciento de contractura moderada a severa con o sin dolor evocado por palpación a un 74 por ciento de contractura leve sin dolor y 26 por ciento de ausencia de contractura. El promedio de dolor según la escala visual análoga disminuyó de 6,66 cm antes del tratamiento a 0,86 cm al finalizar el quinto día de tratamiento. Los efectos adversos fueron leves en el grupo tratado. Conclusiones: la combinación fija de tiocolchicósido 4 mg más diclofenaco potásico 50 mg en una sola tableta, administrado dos veces al día, es eficaz en el manejo de la contractura muscular aguda dolorosa de diversa etiología de manera estadísticamente significativa, bien tolerada y no altera el rendimiento psicomotor(AU)


Objective: to determine the efficacy and tolerability of a combination at a set dose in a single tablet of thiocolchicoside 4 mg plus potassium diclofenac 50 mg in the reduction of painful acute muscle spasm compared with the placebo and the use of 500 mg paracetamol as rescue medication. Methods: ninety seven patients from two Ecuador cities, named Quito and Guayaquil, were recruited in three research centers, both public and private. They suffered cervical pain, low back pain and dorsal pain, mainly of functional cause. The patients were randomly assigned in two groups 1) active medication group with 50 patients treated with thiocolchicoside plus potassium diclofenac and 2) placebo group with 47 patients. The efficacy of both groups was evaluated by the reduction of muscle spams observed in checking, palpation and pain reduction measured in an analogue visual scale after 5 days of treatment. Results: the progress of the muscle spasm degree in the active medication group according to visual evaluation went from 100 percent with visible spasm with or without fixed antialgic activity to 96 percent with no visible signs of spasm; from 82 percent of moderate spasm to severe with or without evoked pain by palpation to 74 percent of mild spasm without pain and 26 percent of spasm-free muscle. The pain average according to the visual scale decreased from 6.66 cm before treatment to 0,86 cm after the 5th day. The adverse effects were mild in t he treated group. Conclusions: the fixed combination of thiocolchicoside 4mg plus potassium diclofenac 50 mg in a single tablet, administered two times a day is efficacious in the painful acute muscle spasm of diverse etiology in a statistically significant way, well-tolerated and with no alteration of the psychomotor performance(AU)


Subject(s)
Humans , Diclofenac/therapeutic use , Low Back Pain/drug therapy , Neck Pain/drug therapy , Acetaminophen/therapeutic use , Muscle Contraction , Multicenter Study , Ecuador
15.
Article in English | WPRIM | ID: wpr-183056

ABSTRACT

OBJECTIVE: To estimate and compare radiation exposure during transforaminal fluoroscopy-guided epidural steroid injection (TFESI) at different vertebral levels. MATERIALS AND METHODS: Fluoroscopy-guided TFESI was performed in 181 patients. The patients were categorized into three groups according to the injected lumbosacral nerve level of L2-4, L5, or S1. Fluoroscopy time (FT) and dose area product (DAP) were recorded for all patients; correlations between FT and DAP were determined at each level, and both FT and DAP were compared between the different vertebral levels. RESULTS: The numbers of patients who received ESI at L2-4, L5, and S1 were 29, 123, and 29. Mean FT was 44 seconds at L2-4, 33.5 seconds at L5, and 37.7 seconds at S1. Mean DAP was 138.6 microGy.m2 at L2-4, 100.6 microGy.m2 at L5, and 72.1 microGy.m2 at S1. FT and DAP were positively correlated in each group (p values < 0.001). FT was significantly shorter at L5 than that at L2-4 (p = 0.004) but was not significantly different between S1 and L2-4 or L5 (p values = 0.286 and 0.532, respectively). DAP was significantly smaller at L5 and S1 than that at L2-4, but L5 and S1 were not significantly different. After correcting for FT, DAP was significantly smaller at S1 than that at either L2-4 or L5 (p values = 0.001 and 0.010). CONCLUSION: The radiation dose was small during a single procedure of ESI and showed differences between different lumbosacral spine levels.


Subject(s)
Adult , Aged , Aged, 80 and over , Female , Fluoroscopy/methods , Humans , Injections, Epidural , Low Back Pain/drug therapy , Lumbosacral Region/innervation , Male , Middle Aged , Radiation Dosage , Young Adult
16.
Dolor ; 23(62): 10-14, dic.2014. ilus, tab
Article in Spanish | LILACS | ID: lil-779252

ABSTRACT

El inventario breve de valoración del dolor o Brief Pain Inventory (BPI) es una escala desarrollada por The Pain Research Group de la Universidad de Wisconsin para la valoración del dolor oncológico y no oncológico en su intensidad, repercusión emocional y funcional, validada en español. El objetivo de nuestro estudio fue valorar el efecto de los procedimientos intervencionistas sobre el dolor en pacientes con lumbalgia a través del BPI. La evaluación se realizó en la Policlínica de Terapia del Dolor del Departamento de Anestesiología del Hospital de Clínicas, Montevideo, Uruguay, desde octubre de 2013 a septiembre de 2014 a pacientes que recibieron inyecciones epidurales o facetarias de corticoides a nivel lumbar, mediante la aplicación de BPI antes y luego de un mes de realizado el procedimiento. Un total de 60 pacientes que recibieron procedimientos intervencionistas como parte de la terapia multimodal de su lumbalgia fueron evaluados. Más del 50 por ciento de los pacientes estudiados presentaron una respuesta exitosa en cada ítem del BPI al mes de haberse realizado los procedimientos mencionados, entendiendo como tal a una reducción en cada ítem de un 50 por ciento o más, comparado con la evaluación basal. El BPI resultó ser útil en la evaluación de los efectos de los procedimientos intervencionistas sobre distintos aspectos del dolor en pacientes con lumbalgia. Estos efectos fueron aceptables a corto plazo...


The Brief Pain Inventory (BPI) is a scale to evaluated cancer and non-cancer pain developed by The Pain Research Group of the University of Wisconsin, validated in Spanish. It includes evaluation of pain intensity, emotional and functional repercussion of pain. The aim of our study was to evaluate the effect of interventional pain procedures in back pain using the BPI. The study was performed in the Pain Clinic Service of the University Anesthesiolgy Department, Hospital de Clínicas, Montevideo, Uruguay, from October 2013 to March 2014. Sixty patients with back pain received epidural and facet joint steroid injections as part of a multimodal treatment approach. The BPI was performed before and 1 month after receiving the procedures. More than 50 percent of the patients had a successful response to procedures, defined this as a 50 percent improvement in BPI scale items, comparing control measures with baseline ones. The BPI was considered a useful tool to evaluate the effects of interventional procedures in back pain treatment. These effects were considered moderate in a short term follow-up...


Subject(s)
Humans , Pain Measurement/methods , Low Back Pain/drug therapy , Steroids/administration & dosage , Injections
17.
Rev. bras. anestesiol ; 64(4): 278-280, Jul-Aug/2014.
Article in English | LILACS | ID: lil-720473

ABSTRACT

BACKGROUND: Osteoarthrosis is a common cause of low back pain. The diagnosis is clinical and can be confirmed by imaging studies. Pain treatment and confirmation of diagnosis are made by intra-articular injection of corticosteroid and by local anesthetic use, due to clinical improvement. A direct monitoring of the procedure can be done under fluoroscopy, a classic technique, or else by an ultrasound-guided procedure. CASE REPORT: Female patient, 88 years old, 1.68 m and 72 kg, with facet osteoarthrosis at L2-L3, L3-L4 and L4-L5 for two years. On physical examination, she exhibited pain on lateralization and spinal extension. We opted in favor of an ultrasound-guided facet joint block. A midline spinal longitudinal scan was obtained, with identification of the desired joint space at L3-L4. A 25 G needle was inserted into the skin by the echographic off-plane ultrasound technique. 1 mL of contrast was administered, with confirmation by fluoroscopy. After aspiration of the contrast, 1 mL of solution containing 0.25% bupivacaine hydrochloride and 10 mg of methylprednisolone acetate was injected. Injections into L3-L4, L2-L3 and L1-L2 to the right were applied. CONCLUSIONS: The visualization of the facet joint by ultrasound involves minimal risk, besides reduction of radiation. This option is suitable for a large part of the population. However, fluoroscopy and computed tomography remain as monitoring techniques indicated for patients with specific characteristics, such as obesity, severe degenerative diseases and anatomical malformations, in which the ultrasound technique is still in need of further study. .


JUSTIFICATIVA: a osteoartrose facetária é causa frequente de dor lombar. O diagnóstico é clínico e pode ser confirmado por imagem. O tratamento da dor e a confirmação do diagnóstico são feitos pela injeção intra-articular de corticosteroide e anestésico local, por causa da melhoria clínica. A monitoração direta do procedimento pode ser feita por fluoroscopia, técnica clássica, ou guiada por ultrassom. RELATO DE CASO: paciente do sexo feminino, 88 anos, 1,68 m e 72 kg, com osteoartrose facetária em L2-L3, L3-L4 e L4-L5 havia dois anos. No exame físico, dor à lateralização e à extensão da coluna. Optou-se pelo bloqueio da articulação facetária guiado por ultrassom. Foi feito escaneamento longitudinal na linha média da coluna vertebral e identificado o espaço articular desejado em L3-L4. Uma agulha 25G foi introduzida na pele pela técnica fora de plano ecográfico. Foi administrado 1 mL de contraste, confirmado com fluoroscopia. Após aspiração do contraste, foi injetado 1 mL de solução contendo cloridrato de bupivacaína 0,25% e 10 mg de acetato de metilprednisolona. Foram feitas injeções nos espaços L3-L4, L2-L3 e L1-L2 à direita. CONCLUSÕES: a visualização da articulação facetária pelo ultrassom determina mínimo risco e redução da radiação e é indicada para grande parte da população. Ainda assim a fluoroscopia e a tomografia computadorizada permanecem como monitoração indicada para pacientes com características específicas, como obesidade, doenças degenerativas intensas e malformações anatômicas, nas quais o ultrassom ainda necessita de mais estudos. .


JUSTIFICACIÓN: la osteoartrosis facetaria es causa frecuente de dolor lumbar. El diagnóstico es clínico y puede ser confirmado por imagen. El tratamiento del dolor y la confirmación del diagnóstico se hacen mediante la inyección intraarticular de corticosteroides y anestésico local para la mejoría clínica. La monitorización directa del procedimiento puede hacerse por fluoroscopia, técnica clásica, o guiada por ultrasonido. CASO CLÍNICO: paciente del sexo femenino, de 88 años, de 1,68 m y 72 kg, con osteoartrosis facetaria en L2-L3, L3-L4 y L4-L5 hacía ya 2 años. En el examen físico se constató dolor a la lateralización y a la extensión de la columna. Optamos por el bloqueo de la articulación facetaria guiado por ultrasonido. Se hizo un escaneo longitudinal en la línea media de la columna vertebral y se identificó el espacio articular deseado en L3-L4. Una aguja 25G se introdujo en la piel por la técnica fuera del plano ecográfico. Se administró 1 mL de contraste, confirmado con la fluoroscopia. Después de la aspiración del contraste, se inyectó 1 mL de solución conteniendo clorhidrato de bupivacaína al 0,25% y 10 mg de acetato de metilprednisolona. Se administraron inyecciones en los espacios L3-L4, L2-L3 y L1-L2 a la derecha. CONCLUSIONES: la visualización de la articulación facetaria por el ultrasonido determina un mínimo riesgo y una reducción de la radiación y está indicada para gran parte de la población. Pero incluso así, la fluoroscopia y la tomografía computadorizada permanecen como la monitorización indicada para pacientes con características específicas, como obesidad, enfermedades degenerativas intensas y malformaciones anatómicas, para las cuales el ultrasonido todavía necesita más estudios. .


Subject(s)
Aged, 80 and over , Female , Humans , Bupivacaine/administration & dosage , Low Back Pain/etiology , Nerve Block/methods , Osteoarthritis, Spine/drug therapy , Anesthetics, Local/administration & dosage , Fluoroscopy/methods , Low Back Pain/drug therapy , Methylprednisolone/administration & dosage , Methylprednisolone/analogs & derivatives , Osteoarthritis, Spine/diagnosis , Tomography, X-Ray Computed , Ultrasonography, Interventional , Zygapophyseal Joint
18.
Coluna/Columna ; 13(1): 20-22, Jan-Mar/2014. graf
Article in English | LILACS | ID: lil-709632

ABSTRACT

OBJECTIVE: The objective was to assess the improvement of chronic low back pain in osteoporotic patients treated with teriparatide (TPTD). METHODS: This was an observational study with a convenience sample of 21 patients with osteoporosis using TPTD, 20 mcg/day, between 2006 and 2010, with chronic low back pain (more than three months). Dorsolumbar radiographs and bone densitometry (DXA) were performed before and after treatment. For pain measurement the VAS pain scale was used. Data were entered in Excel and processed in STATA/SE 8.0 with Chi2 square or Fisher (p < 0.05). RESULTS: twenty-one patients aged 40-90 (mean 70 years), eight (40%) had senile osteoporosis and thirteen (60%) had osteoporosis secondary to medications. Seventeen (80%) had previous dorsolumbar fractures. Ten (47.5%) used TPTD for 24 months, six (27.5 %) used the medication for 18 months, four (20%) for 12 months and one (5%) for six months. Eight patients (40%) received previous anti-reabsortive therapy. Thirteen patients (60%) exhibited bone mass gain between 0% and 9% while eight (40%), between 10% and 15%. The final average VAS was 2.6 representing an improvement of 4.7 (p< 0.05). CONCLUSION: There was a significant reduction in the severity of low back pain with the use of TPTD (initial mean VAS: 7.3, final VAS: 2.6, improvement: 4.7). .


OBJETIVO: Avaliar a melhora da lombalgia crônica nos pacientes osteoporóticos em tratamento com teriparatida (TPTD). MÉTODOS: Trata-se de um estudo observacional, com amostra por conveniência de 21 pacientes com osteoporose em uso de TPTD, 20 mcg/dia, entre 2006 e 2010, portadores de lombalgia crônica (mais de três meses). Foram realizadas radiografias dorso-lombares e densitometria óssea (DXA), antes e após o tratamento e, para a mensuração da dor, foi usada a Escala EVA. Os dados foram aplicados no Excel e as análises processadas no STATA / SE 8.0, com Qui2 ou Fisher (p < 0,05). RESULTADOS: De vinte e um pacientes, com idade entre 40 e 90 anos (média 70 anos), oito deles (40%) apresentavam osteoporose senil e treze (60%) osteoporose secundária a medicações. Dezessete (80%) tinham fraturas dorso-lombares prévias. Dez (47,5%) utilizaram TPTD por 24 meses, seis (27,5%) por 18, quatro (20%) por 12 e um (5%) por seis. Oito (40%) usaram previamente antirreabsortivos. Treze pacientes (60%) apresentaram ganho de massa óssea entre 0% e 9% e oito (40%), entre 10% e 15%. A média final da EVA foi de 2,6, correspondendo a uma melhora de 4,7 (p< 0,05). CONCLUSÃO: Ocorreu uma redução significativa na severidade da lombalgia com uso de TPTD (EVA inicial média: 7,3; final: 2,6; melhora: 4,7). .


OBJETIVO: Evaluar la mejoría del dolor lumbar crónico en pacientes con osteoporosis tratados con teriparatida (TPTD). MÉTODOS: Se realizó un estudio observacional, con una muestra de conveniencia de 21 pacientes con osteoporosis en uso de TPTD, 20 mcg/día, entre 2006 y 2010, portadores de dolor lumbar crónico (más de tres meses). Se realizaron radiografías dorsolumbares y densitometría ósea (DXA) antes y después del tratamiento y, para la mensuración del dolor, se utilizó la Escala EVA. Los datos fueron exportados al Excel y el análisis procesado en STATA/SE 8.0, con Qui² o Fisher (p < 0,05). RESULTADO: De veintiún pacientes, con edad entre 40 y 90 años (media 70 años), ocho (40%) presentaban osteoporosis senil y trece (60%) osteoporosis secundaria a medicaciones. Diecisiete (80%) tuvieron fracturas dorsolumbares previas. Diez (47,5%) utilizaron TPTD por 24 meses, seis (27,5%) por 18, cuatro (20%) por 12 y uno (5%) por seis meses. Ocho (40%) usaron previamente antirreabsortivos. Trece pacientes (60%) presentaron aumento de masa ósea entre 0% y 9 % y ocho (40%), entre 10% y 15%. La media final del EVA fue de 2,6, correspondiendo a una mejora de 4,7 (p< 0,05). CONCLUSIÓN: Una reducción significativa en la gravedad del dolor lumbar se produjo con el uso de TPTD (EVA inicial media: 7,3; final: 2,6; mejora: 4,7). .


Subject(s)
Humans , Low Back Pain/drug therapy , Osteoporosis , Teriparatide/therapeutic use , Chronic Pain
19.
Article in English | IMSEAR | ID: sea-157496

ABSTRACT

Low back pain is a problem that is common and costly to society and its effective management remains a challenge. Major cause of morbidity due to low back pain is prolapsed intervertebral disc which mostly affects young adults in their fourth decade of life. Epidural steroid injection (ESI) is a low-risk alternative to surgical intervention in the treatment of lumbar disc herniation. This follow up study was planned to know the results of epidural injections with corticosteroids in symptomatic patients of lumbar disc prolapse. Out of 159 patients who were evaluated before and after the ESI for pain relief, 78% had positive response. No major post-injection complications were reported in this study. Carefully administered epidural steroid injection is a safe and effective modality in the treatment of pain in lumbar disc herniation.


Subject(s)
Adult , Analgesia, Epidural/methods , Female , Humans , Injections, Spinal , Intervertebral Disc Degeneration/complications , Intervertebral Disc Degeneration/drug therapy , Intervertebral Disc Degeneration/epidemiology , Low Back Pain/drug therapy , Low Back Pain/etiology , Male , Middle Aged , Steroids/administration & dosage , Steroids/therapeutic use , Young Adult
20.
Yonsei Medical Journal ; : 999-1005, 2013.
Article in English | WPRIM | ID: wpr-121788

ABSTRACT

PURPOSE: The pathological mechanism of lumbar spinal stenosis is reduced blood flow in nerve roots and degeneration of nerve roots. Exercise and prostaglandin E1 is used for patients with peripheral arterial disease to increase capillary flow around the main artery and improve symptoms; however, the ankle-brachial index (ABI), an estimation of blood flow in the main artery in the leg, does not change after treatment. Lumbar spinal nerve roots contain somatosensory, somatomotor, and unmyelinated autonomic nerves. Improved blood flow by medication with prostaglandin E1 and decompression surgery in these spinal nerve roots may improve the function of nerve fibers innervating muscle, capillary, and main vessels in the lower leg, resulting in an increased ABI. The purpose of the study was to examine whether these treatments can improve ABI. MATERIALS AND METHODS: One hundred and seven patients who received conservative treatment such as exercise and medication (n=56) or surgical treatment (n=51) were included. Low back pain and leg pain scores, walking distance, and ABI were measured before treatment and after 3 months of conservative treatment alone or surgical treatment followed by conservative treatment. RESULTS: Low back pain, leg pain, and walking distance significantly improved after both treatments (p<0.05). ABI significantly increased in each group (p<0.05). CONCLUSION: This is the first investigation of changes in ABI after treatment in patients with lumbar spinal stenosis. Improvement of the spinal nerve roots by medication and decompression surgery may improve the supply of blood flow to the lower leg in patients with lumbar spinal stenosis.


Subject(s)
Adult , Aged , Aged, 80 and over , Alprostadil/therapeutic use , Ankle Brachial Index , Decompression, Surgical/methods , Female , Humans , Low Back Pain/drug therapy , Lumbar Vertebrae/physiopathology , Male , Middle Aged , Pain/surgery , Spinal Nerve Roots/physiopathology , Spinal Stenosis/physiopathology , Treatment Outcome
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