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1.
Autops. Case Rep ; 10(3): e2020202, 2020. graf
Article in English | LILACS | ID: biblio-1131837

ABSTRACT

Radiation-induced brachial plexus neuropathy (RIBPN) is a rare and delayed non-traumatic injury to the brachial plexus, which occurs following radiation therapy to the chest wall, neck, and/or axilla in previously treated patients with cancer. The incidence of RIBPN is more common in patients treated for carcinoma of the breast and Hodgkin lymphoma. With the improvement in radiation techniques, the incidence of injury to the brachial plexus following radiotherapy has dramatically reduced. The currently reported incidence is 1.2% in women irradiated for breast cancer. The progression of symptoms is gradual in about two-thirds of cases; the patients may initially present with paresthesia followed by pain, and later progress to motor weakness in the affected limb. We present the case of a 68-year-old female patient with breast cancer submitted to surgery, chemotherapy, and radiotherapy in the year 2000. Eighteen years later, she developed symptoms and signs compatible with RIBPN and was successfully submitted to omentoplasty for pain control. Omentoplasty is an alternative treatment for RIBPN refractory to conservative treatment, which seems to be effective in improving neuropathic pain. However, postoperative worsening of the motor strength is a real possibility, and all candidates for this type of surgery must be informed about the risk of this complication.


Subject(s)
Humans , Female , Aged , Radiation Injuries/therapy , Brachial Plexus Neuropathies/therapy , Pain, Intractable/etiology , Postoperative Complications , Neurosurgery
2.
Annals of Surgical Treatment and Research ; : 296-301, 2019.
Article in English | WPRIM | ID: wpr-762718

ABSTRACT

PURPOSE: Chronic pancreatitis (CP) is progressive inflammatory disease that leads to irreversible destruction of the pancreatic parenchyma. The main indications for surgical intervention in cases involving CP are intractable pain, suspicion of malignancy, and failure of other methods. However, there is no report related to Frey's procedure in Korea; hence, we aimed to investigate and analyze our institution's experience and determine the benefits of surgical treatment for CP. METHODS: This was a retrospective study of 24 patients with CP who underwent Frey's procedure at Gangnam Severance Yonsei University between January 2007 and December 2017. Preoperative exocrine and endocrine pancreatic function, perioperative finding (blood loss, operation time), postoperative complications were evaluated. Statistical analytics were chi-square test, Fisher exact tests, and Wilcoxon signed-rank test and Mann-Whitney U-test. RESULTS: Surgery was performed due to alcohol-derived CP in 12 of 24 patients (50%) and due to pancreatic stones in 15 of 24 patients (62.5%). Two patients had postoperative complications which were managed conservatively. After surgery, 7 of 24 patients were prescribed with exocrine medication. Comparison of the preoperative and postoperative conditions showed that glycated hemoglobin had no significant differences. After surgery, only 5 patients (21%) complained of intermittent abdominal pain. CONCLUSION: In conclusion, Frey's procedure appears to be a less burdensome surgical procedure. Thus, it could be the first option for management of patients with large pancreatic stone.


Subject(s)
Humans , Abdominal Pain , Glycated Hemoglobin , Korea , Pain, Intractable , Pancreaticojejunostomy , Pancreatitis, Chronic , Postoperative Complications , Retrospective Studies
3.
Anesthesia and Pain Medicine ; : 208-210, 2019.
Article in Korean | WPRIM | ID: wpr-762249

ABSTRACT

Intercostal neuralgia is neuropathic pain that develops in the thorax and abdomen. It usually occurs as a result of injury or inflammation associated with the intercostal nerve triggered by trauma, surgery, or herpes zoster. Primary intercostal neuroma is a rare cause of intercostal neuralgia. A 69-year-old male patient without a history of thoracic trauma or surgery underwent repeated testing and intermittent treatment for refractory pain in the right chest and abdomen for several years. However, the treatment had limited effect. Abdominal computed tomography performed to diagnose recent pain aggravation revealed schwannoma of the 11th intercostal nerve. The patient's pain was relieved following surgical excision of the tumor.


Subject(s)
Aged , Humans , Male , Abdomen , Herpes Zoster , Inflammation , Intercostal Nerves , Neuralgia , Neurilemmoma , Neuroma , Pain, Intractable , Thorax
4.
Journal of Korean Neurosurgical Society ; : 1-9, 2018.
Article in English | WPRIM | ID: wpr-788661

ABSTRACT

Posttraumatic delayed vertebral collapse, known as Kummell’s disease, is increasing in number of patients. This disease is already progressive kyphosis due to vertebral collapse at the time of diagnosis and it causes intractable pain or neurologic deficit due to intravertebral instability. Treatment is very difficult after progression of the disease, and the range of treatment, in hospital day, and cost of treatment are both increased. Clinical features, pathogenesis and radiologic findings of these disease groups were reviewed to determine risk factors for delayed vertebral collapse. The purpose of this article is to suggest appropriate treatment before vertebral collapse for patients with osteoporotic vertebral compression fracture who have risk factors for posttraumatic delayed vertebral collapse.


Subject(s)
Humans , Diagnosis , Fractures, Compression , Kyphosis , Neurologic Manifestations , Osteonecrosis , Osteoporosis , Pain, Intractable , Risk Factors
5.
Journal of Korean Society of Spine Surgery ; : 180-184, 2018.
Article in English | WPRIM | ID: wpr-765616

ABSTRACT

STUDY DESIGN: Case report OBJECTIVES: To document fistula formation between the disc and dura by an unrecognized dural tear after percutaneous endoscopic lumbar discectomy (PELD). SUMMARY OF LITERATURE REVIEW: The risk of durotomy is relatively low with PELD, but cases of unrecognized durotomies have been reported. An effective diagnostic tool for such situations has not yet been identified. MATERIALS AND METHODS: A patient twice underwent transforaminal PELD under the diagnosis of a herniated lumbar disc at L4-5. She still complained of intractable pain and motor weakness around the left lower extremity at 6 months postoperatively. Magnetic resonance imaging showed no specific findings suggestive of violation of the nerve root. However, L5 and S1 nerve root injury was noted on electromyography. An exploratory operation was planned to characterize damage to the neural structures. RESULTS: In the exploration, a dural tear was found at the previous operative site, along with a fistula between the disc and dura was also found at the dural tear site. The durotomy site was located on the ventrolateral side of the dura and measured approximately 5 mm. The durotomy site was repaired with Nylon 5-0 and adhesive sealants. The patient's preoperative symptoms diminished considerably. CONCLUSIONS: Fistula formation between the disc and dura can be caused by an unrecognized dural tear after PELD. Discography is a reliable diagnostic tool for fistulas formed by an unrecognized durotomy.


Subject(s)
Humans , Adhesives , Diagnosis , Diskectomy , Electromyography , Fistula , Lower Extremity , Magnetic Resonance Imaging , Nylons , Pain, Intractable , Tears
6.
Journal of Korean Neurosurgical Society ; : 1-9, 2018.
Article in English | WPRIM | ID: wpr-765231

ABSTRACT

Posttraumatic delayed vertebral collapse, known as Kummell’s disease, is increasing in number of patients. This disease is already progressive kyphosis due to vertebral collapse at the time of diagnosis and it causes intractable pain or neurologic deficit due to intravertebral instability. Treatment is very difficult after progression of the disease, and the range of treatment, in hospital day, and cost of treatment are both increased. Clinical features, pathogenesis and radiologic findings of these disease groups were reviewed to determine risk factors for delayed vertebral collapse. The purpose of this article is to suggest appropriate treatment before vertebral collapse for patients with osteoporotic vertebral compression fracture who have risk factors for posttraumatic delayed vertebral collapse.


Subject(s)
Humans , Diagnosis , Fractures, Compression , Kyphosis , Neurologic Manifestations , Osteonecrosis , Osteoporosis , Pain, Intractable , Risk Factors
7.
Yeungnam University Journal of Medicine ; : 130-134, 2018.
Article in English | WPRIM | ID: wpr-787081

ABSTRACT

Heterotopic ossification (HO) around the hip joint is not uncommon following neurological injury. Often, surgical treatment is performed in patients with restricted motion and/or refractory pain due to grade III or IV HO according to Brooker classification. The major complication that occurs as a result of surgical HO removal is perioperative bleeding due to hyper-vascularization of the lesion. Here, we report a case of preoperative embolization in a 51-year-old male patient presenting with restricted bilateral hip range of motion (ROM) due to HO following a spinal cord injury. In the right hip without preoperative arterial embolization, massive bleeding occurred during surgical removal of HO. Thus, the patient received a transfusion postoperatively due to decreased serum hemoglobin levels. For surgery of the left hip, preoperative embolization of the arteries supplying HO was performed. Surgical treatment was completed without bleeding complications, and the patient recovered without a postoperative transfusion. This case highlights that, while completing surgical removal for ROM improvements, orthopedic surgeons should consider preoperative arterial embolization in patients with hip HO.


Subject(s)
Humans , Male , Middle Aged , Arteries , Classification , Hemorrhage , Hip Joint , Hip , Orthopedics , Ossification, Heterotopic , Pain, Intractable , Range of Motion, Articular , Spinal Cord Injuries , Surgeons
8.
The Korean Journal of Pain ; : 155-173, 2018.
Article in English | WPRIM | ID: wpr-742191

ABSTRACT

Chronic postsurgical pain (CPSP) is an unwanted adverse event in any operation. It leads to functional limitations and psychological trauma for patients, and leaves the operative team with feelings of failure and humiliation. Therefore, it is crucial that preventive strategies for CPSP are considered in high-risk operations. Various techniques have been implemented to reduce the risk with variable success. Identifying the risk factors for each patient and applying a timely preventive strategy may help patients avoid the distress of chronic pain. The preventive strategies include modification of the surgical technique, good pain control throughout the perioperative period, and preoperative psychological intervention focusing on the psychosocial and cognitive risk factors. Appropriate management of CPSP patients is also necessary to reduce their suffering. CPSP usually has a neuropathic pain component; therefore, the current recommendations are based on data on chronic neuropathic pain. Hence, voltage-dependent calcium channel antagonists, antidepressants, topical lidocaine and topical capsaicin are the main pharmacological treatments. Paracetamol, NSAIDs and weak opioids can be used according to symptom severity, but strong opioids should be used with great caution and are not recommended. Other drugs that may be helpful are ketamine, clonidine, and intravenous lidocaine infusion. For patients with failed pharmacological treatment, consideration should be given to pain interventions; examples include transcutaneous electrical nerve stimulation, botulinum toxin injections, pulsed radiofrequency, nerve blocks, nerve ablation, neuromodulation and surgical management. Physical therapy, cognitive behavioral therapy and lifestyle modifications are also useful for relieving the pain and distress experienced by CPSP patients.


Subject(s)
Humans , Acetaminophen , Analgesics, Opioid , Anti-Inflammatory Agents, Non-Steroidal , Antidepressive Agents , Botulinum Toxins , Calcium Channel Blockers , Capsaicin , Chronic Pain , Clonidine , Cognitive Behavioral Therapy , Drug Therapy , Incidence , Ketamine , Lidocaine , Life Style , Nerve Block , Neuralgia , Pain Management , Pain, Intractable , Pain, Postoperative , Perioperative Period , Physical Therapy Modalities , Psychological Trauma , Risk Factors , Surgical Procedures, Operative , Transcutaneous Electric Nerve Stimulation
9.
Anesthesia and Pain Medicine ; : 201-206, 2018.
Article in English | WPRIM | ID: wpr-714054

ABSTRACT

Intrathecal baclofen (ITB) pump implantation can be used to control dystonia and severe pain associated with complex regional pain syndrome (CRPS) with or without a spinal cord stimulator (SCS). A 45-year-old female patient had gotten an SCS to control the pain of CRPS. However, she suffered from chronic intractable pain in her left ankle and foot despite paresthesia in the entire painful area because the effectiveness of the SCS gradually diminished over time. In a trial of intrathecal drug administration, baclofen was superior to morphine for pain relief, had fewer side effects, and was superior in terms of patient satisfaction. To achieve the greatest degree of pain relief from the ITB pump, the tip of the intrathecal catheter was carefully placed in relation to the SCS. Over a one-year follow-up period, the patient experienced mild pain without any adverse effects.


Subject(s)
Female , Humans , Middle Aged , Ankle , Baclofen , Catheters , Dystonia , Follow-Up Studies , Foot , Morphine , Pain, Intractable , Paresthesia , Patient Satisfaction , Spinal Cord Stimulation , Spinal Cord
10.
The Ewha Medical Journal ; : 82-85, 2018.
Article in English | WPRIM | ID: wpr-717368

ABSTRACT

Postherpetic neuralgia (PHN) is a chronic and refractory pain disease. It requires longterm treatment and follow-up. Comorbid diseases can change or aggravate the pain condition and responsiveness of patients to PHN treatment. In such cases, the cause of pain should be identified through proper testing, and appropriate treatment should be administered. Herein, we report the case of a 67-year-old man with PHN in the maxillary nerve. As the pain was being controlled with medication and infraorbital nerve block, the patient experienced deterioration of pain caused by a newly worn upper complete denture. The patient's pain was relieved following correction of the upper complete denture.


Subject(s)
Aged , Humans , Denture, Complete , Follow-Up Studies , Maxillary Nerve , Nerve Block , Neuralgia, Postherpetic , Pain, Intractable , Trigeminal Nerve
11.
Rev. bras. hematol. hemoter ; 39(3): 216-222, July-Sept. 2017. tab, graf
Article in English | LILACS | ID: biblio-898924

ABSTRACT

Abstract Background Despite all the scientific progress that has been made on understanding the disease, prognosis for patients with relapsed and refractory Hodgkin's lymphoma remains poor and the treatment is palliative in the majority of the cases. Thus, the aim of this study was to present the results on the compassionate use of everolimus in a group of patients who were monitored at nine different centers in Brazil. Methods A 10-mg oral dose of everolimus was given to each patient daily. Response time was evaluated from the beginning of medication use until loss of response, toxicity or medical decision to cease treatment. Results Thirty-three patients were evaluated. The median age at the beginning of medication administration was 29 years. Patients had received a median of five prior therapies. Overall response rate was 45.4%, with 13 patients achieving partial response, two achieved clinical response, 14 remained with stable disease, two had disease progression, and two were not evaluated. Patients received a median of 14 cycles. Progression-free survival was nine months, and overall survival was estimated to be 36 months. Three patients used the medication for more than four years. The most frequently reported adverse events were thrombocytopenia and hypercholesterolemia. Three patients had pulmonary toxicity. Grade III and IV adverse events occurred in 39% of the patients. Conclusion Everolimus was found to provide a response in a group of patients with refractory or relapsed Hodgkin's lymphoma who had adequate tolerability to the drug.


Subject(s)
Humans , Male , Female , Pain, Intractable , Hodgkin Disease/therapy , Everolimus
12.
The Journal of the Korean Orthopaedic Association ; : 125-137, 2017.
Article in Korean | WPRIM | ID: wpr-646048

ABSTRACT

The distal radioulnar joint (DRUJ) is a complex structure that enables sufficient, painless forearm rotation and provides weight-bearing capabilities of the upper extremity. Arthritis of DRUJ is multifactorial; the most common causes are trauma, congenital anomalies, as well as degenerative and inflammatory diseases. Congenital etiologies, as well as degenerative and inflammatory causes of arthritis are more common in women. Conventionally, initial management of symptomatic DRUJ arthritis is nonsurgical; surgery is generally reserved for patients with refractory pain. Moreover, advanced arthritis arising from trauma can be prevented by early interventions in the form of corrective osteotomy for malunited distal radius and distal ulna fractures, repair/reconstruction of the triangular fibrocartilage complex, and ulnar shortening osteotomy. Although the outcomes are typically positive following excision of the distal ulna in definitive arthritis, postoperative complications, such as instability and impingement of the residual distal ulna stump, can be serious. Procedures managing unstable residual ulna include soft tissue stabilization techniques and DRUJ implant arthroplasty.


Subject(s)
Female , Humans , Arthritis , Arthroplasty , Early Intervention, Educational , Forearm , Joints , Osteotomy , Pain, Intractable , Postoperative Complications , Radius , Triangular Fibrocartilage , Ulna , Ulna Fractures , Upper Extremity , Weight-Bearing
13.
Journal of Liver Cancer ; : 144-152, 2017.
Article in English | WPRIM | ID: wpr-120518

ABSTRACT

BACKGROUND/AIMS: To retrospectively compare conventional and drug-eluting beads transarterial chemoembolization (C-TACE and DEB-TACE) for treatment of hepatocellular carcinoma (HCC) at very early and early stages. METHODS: We retrospectively compared patients treated with C-TACE (n=115) or DEB-TACE (n=103) from September 2009 to May 2016. All patients were in a very early (stage 0) or early stage (stage A) of the Barcelona Clinic Liver Cancer (BCLC) staging system, and all had Child–Pugh class A and ≤B7 liver status. Approval by the institutional review board was waived because the study was retrospective. The following parameters were evaluated: severe pain and bradycardia during TACE, post-embolization syndrome (PES), liver function change, complications, target tumor response, and conversion to another treatment modality. Numeric differences were assessed by the independent Student's t-test for continuous variables and by chi-square test for categorical variables. RESULTS: Severe intractable pain and bradycardia during the TACE procedure were significantly more frequent in the C-TACE group than in the DEB-TACE group (P<0.001). The incidence and duration of PES were significantly higher in the C-TACE group than in the DEB-TACE group (P<0.001). The increase in liver enzymes was significantly higher in the C-TACE group than in the DEB-TACE group (P<0.001). The deterioration of the Child-Pugh class was significantly higher in the C-TACE group than in the DEB-TACE group (P =0.006). There was no significant difference in serious complications except localized bile duct dilatation between the groups. There was no significant difference between the groups in tumor response at both immediate and 1-year assessment. The conversion rate to other treatment modalities was significantly higher in the DEB-TACE group than in the C-TACE group (P<0.001). CONCLUSIONS: DEB-TACE is better than C-TACE in terms of procedural safety as initial treatment in a very early or early stage of HCC.


Subject(s)
Humans , Bile Ducts , Bradycardia , Carcinoma, Hepatocellular , Dilatation , Ethics Committees, Research , Incidence , Liver , Liver Neoplasms , Pain, Intractable , Retrospective Studies
14.
Clinics in Orthopedic Surgery ; : 50-56, 2017.
Article in English | WPRIM | ID: wpr-71101

ABSTRACT

BACKGROUND: Persistent pain after total knee arthroplasty (TKA) is dissatisfying to the patient and frustrating to the surgeon. The purpose of this study is to evaluate the aseptic causes and clinical course of intractable pain following TKA. METHODS: Of the total 2,534 cases of primary TKA reviewed, 178 cases were classified as having aseptic persistent pain that was not resolved within 1 year after surgery. Except for the cases with periprosthetic fracture (56 knees), 122 cases of aseptic painful TKA were divided into two groups: intra-articular group (83 knees) and extra-articular group (39 knees). RESULTS: In the intra-articular group, the main reasons for pain were aseptic loosening (n = 40), polyethylene wear (n = 16), instability (n = 10), recurrent hemarthrosis (n = 5), patellar maltracking (n = 4), tendon ruptures (n = 4), and stiffness (n = 2). In the extraarticular group, 10 knees (25.6%) were found to have nerve entrapment in the spine, 6 knees (15.4%) were found to have hip osteoarthritis or femoral head avascular necrosis. The reasons for persistent knee pain in the remaining 23 knees (59.0%) still remain elusive. CONCLUSIONS: Persistent pain after TKA originated from pathology of extra-articular origin in a considerable number of cases in this study. Therefore, it is important to perform thorough preoperative evaluations to reduce pain resulting from extra-articular causes. Furthermore, meticulous surgical procedures and optimal alignment are required to reduce pain of intra-articular origin related to implant wear, instability, and patellar maltracking.


Subject(s)
Humans , Arthroplasty, Replacement, Knee , Chronic Pain , Head , Hemarthrosis , Knee , Necrosis , Nerve Compression Syndromes , Osteoarthritis, Hip , Pain, Intractable , Pathology , Periprosthetic Fractures , Polyethylene , Rupture , Spine , Tendons
15.
Anesthesia and Pain Medicine ; : 91-94, 2017.
Article in English | WPRIM | ID: wpr-21256

ABSTRACT

The fibromyalgia syndrome (FMS) could be approached by various treatments modalities including education, aerobic exercise, cognitive behavioral therapy, tricyclic antidepressants, serotonin norepinephrine reuptake inhibitors, pregabalin, and so on. If other treatments fail, opioids including morphine should be considered. In this case report, we describe the case of a 44-year-old woman who was diagnosed with FMS three years ago, and suffered from severe intractable pain, side effects from other drugs, and opioid tolerance. Administration of morphine via an implantable drug delivery system resulted in significant improvement in the patient's pain intensity, fibromyalgia impact questionnaire score, and sleep disturbance. Our case demonstrates that an implantable drug delivery system with morphine can be a potential treatment option for refractory fibromyalgia patients.


Subject(s)
Adult , Female , Humans , Analgesics, Opioid , Antidepressive Agents, Tricyclic , Cognitive Behavioral Therapy , Drug Delivery Systems , Education , Exercise , Fibromyalgia , Injections, Spinal , Morphine , Norepinephrine , Pain, Intractable , Pregabalin , Serotonin
16.
Rev. bras. enferm ; 69(5): 927-932, set.-out. 2016. tab, graf
Article in Portuguese | LILACS, BDENF | ID: lil-798029

ABSTRACT

RESUMO Objetivo: verificar se pacientes em coma sentem dor durante a intervenção de enfermagem banho no leito. Método: 19 pacientes com 61 ± 17,39 anos de idade participaram do estudo. Realizou-se, pelo método ELISA, a análise quantitativa de substância P (SP) na saliva coletada antes e durante o banho no leito. Utilizou-se o programa Graph Pad Prisma 6 para análise dos dados. A verificação da normalidade foi feita pelo teste de Shapiro Wilk que determinou a escolha do teste não paramétrico de Wilcoxon. Resultados: o estudo apresentou aumento estatístico significativo (∆= 5.62%, p<0,001) no nível de SP dos pacientes estudados durante a intervenção de enfermagem. Conclusão: conclui-se que quando cuidamos de pacientes em coma, durante o banho no leito, provocamos ou acrescentamos estímulos dolorosos, logo, eles sentem dor.


RESUMEN Objetivo: verificar si pacientes en coma sienten dolor durante la intervención de enfermería baño en el lecho. Método: 19 pacientes de 61±17,39 años de edad participaron del estudio. Se realizó, por método ELISA, el análisis cuantitativo de substancia P (SP) en saliva colectada antes y durante baño en el lecho. Se utilizó el programa Graph Pad Prisma 6 para analizar los datos. La verificación de normalidad fue efectuada por test de Shapiro Wilk, que determinó elección del testeo no paramétrico de Wilcoxon. Resultados: se demostró aumento estadístico significativo (∆=5.62%; p<0,001) en nivel de SP de los pacientes estudiados durante la intervención de enfermería. Conclusión: se concluye en que cuando cuidamos a pacientes en coma, durante el baño en el lecho, provocamos o incrementamos estímulos dolorosos. Es decir, ellos sienten dolor.


ABSTRACT Objective: to verify whether comatose patients feel pain during the bed bath nursing procedure. Method: nineteen patients aged 61 ± 17.39 years participated in the study. A quantitative analysis was conducted on the P substance (PS) in the saliva collected before and during a bed bath, using the ELISA method. Program Graph Pad Prisma 6 was used to analyze the data. The verification of normality was made through the Shapiro Wilk test, which determined the choice for the Wilcoxon nonparametric test. Results: the study showed a statistically significant increase (∆= 5.62%, p<0.001) in the PS level of the patients studied during the nursing procedure. Conclusion: when caring for comatose patients during a bed bath, professionals cause or add painful stimuli; therefore, they feel pain.


Subject(s)
Humans , Male , Female , Pain, Intractable/diagnosis , Nursing Diagnosis , Coma , Pain, Intractable/nursing , Baths , Pain Measurement , Brazil , Clinical Nursing Research , Glasgow Coma Scale , Intensive Care Units , Middle Aged
17.
Annals of Rehabilitation Medicine ; : 592-599, 2016.
Article in English | WPRIM | ID: wpr-48634

ABSTRACT

OBJECTIVE: To evaluate the beneficial effect of botulinum toxin A (Botox) injection into the subscapularis muscle on intractable hemiplegic shoulder pain. METHODS: Six stroke patients with intractable hemiplegic shoulder pain were included. Botulinum toxin A was injected into the subscapularis muscle. Intractable hemiplegic shoulder pain was evaluated using an 11-point numerical rating scale. Pain-free range of motion was assessed for shoulder abduction and external rotation. The spasticity of the shoulder internal rotator was measured using the modified Ashworth scale. Assessments were carried out at baseline and at 1, 2, 4, and, if possible, 8 weeks. RESULTS: Intractable hemiplegic shoulder pain was improved (p=0.004) after botulinum toxin injection into the subscapularis muscle. Restricted shoulder abduction (p=0.003), external rotation (p=0.005), and spasticity of the shoulder internal rotator (p=0.005) were also improved. Improved hemiplegic shoulder pain was correlated with improved shoulder abduction (r=–1.0, p<0.001), external rotation (r=–1.0, p<0.001), and spasticity of the internal rotator (r=1.0, p<0.001). CONCLUSION: Botulinum toxin A injection into the subscapularis muscle appears to be valuable in the management of intractable hemiplegic shoulder pain.


Subject(s)
Humans , Botulinum Toxins , Hemiplegia , Injections, Intramuscular , Muscle Spasticity , Pain, Intractable , Range of Motion, Articular , Shoulder Pain , Shoulder , Stroke
18.
The Korean Journal of Sports Medicine ; : 1-9, 2016.
Article in Korean | WPRIM | ID: wpr-26605

ABSTRACT

The treatment of sports injuries traditionally has included the use of the PRICE principle (protection, rest, ice/cold, compression, and elevation), analgesics/nonsteroidal anti-inflammatory drugs (NSAIDs), and, commonly, corticosteroids. Although NSAIDs, modalities, and corticosteroids may be helpful for short-term pain reduction and early recovery of function, they do not typically reverse the structural changes associated with degenerative conditions and may contribute to even worse long-term outcomes by potentially interfering with tissue healing. Regenerative interventions, including prolotherapy and extracorporeal shock wave therapy, recently have been used to treat refractory painful conditions such as chronic tendinopathies because of the potential of these interventions to facilitate tissue healing. The true utility of prolotherapy and regenerative medicine for sports injuries will become clearer as more high-quality research is published.


Subject(s)
Adrenal Cortex Hormones , Anti-Inflammatory Agents, Non-Steroidal , Athletic Injuries , Pain, Intractable , Recovery of Function , Regenerative Medicine , Shock , Sports , Tendinopathy , Wound Healing
19.
Asian Spine Journal ; : 136-142, 2016.
Article in English | WPRIM | ID: wpr-28503

ABSTRACT

STUDY DESIGN: Cross-sectional. PURPOSE: To develop a strategy to determine a sound method for decision-making based on postoperative clinical outcome satisfaction. OVERVIEW OF LITERATURE: The ideal management of thoracolumbar and lumbar burst fractures (TLBF) without neurological compromise remains controversial. METHODS: This was a prospective study. Patients with thoracolumbar injury severity and classification score (TLICS) <4 were treated nonoperatively, with bed rest and bracing until the pain decreased sufficiently to allow mobilization. Surgery was undertaken in patients with intractable pain despite an appropriate nonoperative treatment (surgery group). The Oswestry disability index (ODI) measure was observed at baseline and at the last follow-up. Clinically success was defined at least a 30% improvement from the baseline ODI scores in both the conservative and surgery groups. All case records were assessed for gender, age, residual canal and angulations at the site of the fracture in order to determine which patients benefited from surgery or conservative treatment and which did not. RESULTS: In all 113 patients with T11-L5, TLBFs were treated. The patients' mean age was 49.2 years. Patients successfully completed either nonoperative (n=99) or surgical (n=14) treatment based on ODI. Clinical examinations revealed that all of the patients had intact neurology. The mean follow-up period was 29.5 months. There was a significant difference between the two groups based on age and residual canal. The mean ODI score significantly improved for both groups (p <0.01). According to the findings, a decision matrix was proposed. CONCLUSIONS: The findings confirm that TLICS <4, age, and residual canal can be used to guide the treatment of TLBF in conservative decision-making.


Subject(s)
Humans , Bed Rest , Braces , Classification , Follow-Up Studies , Neurology , Pain, Intractable , Prospective Studies
20.
Acta fisiátrica ; 22(1): 43-50, mar. 2015.
Article in English, Portuguese | LILACS | ID: lil-771299

ABSTRACT

Pacientes difíceis - ou de personalidade difícil - são frequentemente encontrados na clínica da dor crônica não-oncológica, impondo à relação médico-paciente sobrecargas que vão além das complexidades da doença e do tratamento. Esta revisão/relato de experiência discute o papel que o processo psicológico e comunicacional da identificação projetiva exerce sobre as relações entre pacientes e médicos (e outros profissionais) nas equipes de dor crônica. São revisados os conceitos de identificação projetiva, na sua forma benigna e maligna. Duas vinhetas clínicas são dadas como exemplos de cada uma. São apresentadas situações no cenário da comunicação médico-paciente em que a identificação projetiva opera complicando a relação terapêutica. Ao final, recomendações são dadas sobre o manejo do paciente difícil que se comunica maciçamente por identificação projetiva, assim como às equipes multiprofissionais que lidam com estes pacientes. Os pacientes difíceis de nossa clínica de dor crônica têm em comum o fato de se comunicarem pela forma maligna de identificação projetiva e terem organizações imaturas de personalidade. Nas equipes de dor crônica, as relações entre pacientes e profissionais (assim como as relações entre os profissionais), podem ser otimizadas se a equipe for capaz de identificar precocemente o fenômeno da identificação projetiva e manejá-lo de forma terapêutica. Para o paciente, a psicoterapia de longo prazo é o tratamento de eleição


Difficult patients - or those with difficult personalities - are frequently encountered in the treatment of chronic non-oncologic pain, overburdening the doctor-patient relationship far beyond the complexities of their illness and treatment. The present review/experiential report discusses the role that projective identification, as a psychological process of communication, puts the doctor-patient relationship in within the multi-professional chronic pain team. The concepts of projective identification are reviewed both in their benign and their malignant forms. Two clinical vignettes exemplify each of them. Some situations in the setting of doctor-patient communication are presented in which projective identification appears and complicates the therapeutic relationship. Some recommendations are offered regarding the handling of patients that communicate mainly by means of projective identification, and some ideas are offered to the multi-professional team. In our chronic pain clinic, difficult patients as a whole seem to prefer to communicate by means of a malignant form of projective identification and present with immature types of personality organizations. Within the chronic pain teams, doctor-patient relationships (as well as relations among the professionals) can be enriched if projective identification is detected early and appropriately handled. Long-term psychotherapy is the treatment that should be chosen for such patients


Subject(s)
Humans , Pain, Intractable/physiopathology , Personality Disorders , Projection , Chronic Pain/physiopathology , Identification, Psychological
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