Frequency, character, intensity and impact of neuropathic pain in a cohort of spinal cord injury patients

The purpose of this study was to determine frequency, character, approximate location and intensity of neuropathic pain in spinal cord injury and its impact on the quality of life. A cross-sectional survey. Armed Forces Institute of Rehabilitation Medicine [AFIRM], Rawalpindi from Feb 2009 to Feb 2010. Through non-probability convenience sampling 87 patients of both genders diagnosed with spinal cord injury based on American Spinal Injury Association criteria and admitted within a year of injury were included. Those in spinal shock, having poor cognition, inability to communicate, concurrent brain injury and history of chronic pain before injury were excluded. The history, localization and characteristics of the pain and interference with life activities were recorded. Neuropathic pain of patients was evaluated with Leeds Assessment of Neuropathic Symptoms and Signs Pain Scale. Visual analogue scale was used to measure the severity of pain. Out 87 [mean age 36.9 years] seventy four were male and 13 were female. Seventy patients [80%] were AIS-A, 6 [7%] were AIS-B and 11 [13%] were AIS-C. Neuropathic pain was present in 57.5% [n=50]. Most of the patients localized their pain below the neurological Ievel of injury [78%] and rated pain intensity as [moderate pain] [54%]. Majority [48%] described the pain as burning fallowed by electric shock like [42%], stabbing [8%] and pricking [2%]. 48% patients reported that their quality of life was affected due to pain. 52% required two analgesics of different groups to relieve pain followed by 40% requiring three Analgesics and 8% requiring one analgesic. Neuropathic pain is prevalent in people with spinal cord injury and adversely affects life quality. Neuropathic pain is primarily described as a burning sensation of moderate intensity mostly referred to below the neurological level of injury

pattern of peripheral nerve injuries among Pakistani soldiers in the War against terror

To determine the pattern of peripheral nerve injuries in Pakistani soldiers in the War against terror. Case series. Department of Electrodiagnosis at Armed Forces Institute of Rehabilitation Medicine [AFIRM], Rawalpindi, Pakistan, from June 2008 to June 2011. All new cases of war wounded soldiers with peripheral nerve injuries were consecutively enrolled. Physical examination and electrodiagnostic study was carried out by experienced physiatrists. Data was entered in pretested especially designed questionnaire which was analysed using SPSS version 17.0. Seddon's classification system was used to assess the severity of injury. There were 418 cases of peripheral nerve injuries with 504 different nerve segments. Mean age was 29.41 +/- 8 years. Blast was the main cause of nerve injury in 244 [48.5%] cases followed by gunshot in 215 [42.7%] and 45 [8.9%] cases had nerve injuries secondary to fall, burial under debris and motor vehicle accidents. Eighty six [17%] cases had multiple nerve injuries. Most commonly injured nerve was ulnar [20.6%] followed by sciatic [16.7%], median [16.5%], radial [16.3%], peroneal [8.7%], brachial plexus [8.5%], axillary [4.8%], tibial [2%], femoral [1.8%], long thoracic [0.4%] and others [3.8%]. Axonotmesis was seen in 459 [91.1%] cases, 44 [8.7%] cases revealed neurotmesis and 1 [0.2%] case had neuropraxia. Peripheral nerve injuries are a major component of war related injuries mainly involving the upper limbs. Electrodiagnostic studies help in assessing severity and determining prognosis. Precise documentation of severity of nerve injuries is important to estimate the burden on our resources and to extend rehabilitation services

Comparison of electromyography / nerve conduction studies and magnetic resonance imaging in diagnosis of lumbosacral radiculopathy

To compare EMG/NCS with MRI in diagnosis of lumbosacral radiculopathy. Cross-sectional comparative. The study was carried out at Armed Forces Institute of Rehabilitation Medicine, for a period of six months, from January 2007 to June 2007. Fifty consenting patients with clinical lumbosacral radiculopathy were included, they underwent MRI and NCS/EMG, and then both procedures were compared for diagnosis of radiculopathy. MRI and NCS/EMG had comparable sensitivity but MRI was less accurately correlated with clinical estimated level of radiculopathy. Both NCS/EMG and MRI are time sensitive investigations which provide different information regarding the pathology. NCS/EMG reveal physiological etiology of radiculopathy, compared to MRI, which gives the anatomical information. Every patient with clinical lumbosacral radiculopathy should undergo NCS/EMG for confirmation of diagnosis. However, when anatomical lesion is suspected, or surgical intervention is planned, MRI should complement it

Pit falls in stroke rehabilitation: a Pakistani perspective

To identify short comings in the stroke rehabilitation referral and consultation in Pakistan. Observational study. Stroke Clinic at Armed Forces Institute of Rehabilitation Medicine [AFIRM] Rawalpindi from March 2005 to September 2005. 171 patients of stroke fulfilling the inclusion criteria were enrolled in the study. Detailed history was obtained and a thorough examination with emphasis on neurological and musculoskeletal system was performed. Medical records and radiological investigations were reviewed. There were 132 [77.2%] males and 39 [22.8%] female patients. Radiological investigations were not available in some patients. In the remaining patients the frequency of Ischemic vs Hemorrhagic was 82% and 18% respectively .Involvement of right and left cerebral hemisphere was almost equal with 53% and 47% respectively. Majority, i.e 153 [89.5%] of the patients were referred as OPD cases while indoor rehabilitation consultation was made only for 18 [10.5%] patients. Only 04 [2.3%] patients were seen within 48 hours of stroke onset. In 39 [22.8%] cases consultation was made between one week to one month and for 116 [67.8%] between one to six months, while it was delayed beyond six months in 12 [7%] patients. Important shortcomings identified were non availability of physicians in rehabilitation medicine, late/ no referrals, inadequate referrals, long term placement of indwelling catheters and lack of patient and family education. Stroke is an important cause of long-term disability. Timely and comprehensive stroke rehabilitation minimizes the impairments and leads to successful reintegration of individual into the society. It is a poorly understood concept in Pakistan. Physicians are either not aware of the concept and significance of stroke rehabilitation or often confuse it with physiotherapy alone. There is a need to improve the stroke rehabilitation services in the country

Uro-dynamic evaluation

drsaqii1711@hotmail.com To describe the pattern of Urodynamic evaluation at Armed Forces Institute of Rehab Medicine, Rawalpindi. Descriptive study. This study was conducted on 466 patients reporting for urodynamic evaluation at Urodynamic/Incontinence Clinic at A F Institute of Rehab Medicine from Feb 2003 to Dec 2006. We considered the age, gender, etiology, reason for referral, and presenting complaints whereas results were formulated according to Classification of voiding disorders by International society of Incontinence. Data was analyzed using statistical package for Social Science version 10. In all [466] patients, 58% were males and 42% were females. Mean age was 46.8 years. Increased frequency [61%] and incontinence [52%] were the most common presenting complaints, 158[34%] had spinal cord injuries, 58 were cases of myelodysplasias and 128 reported with stress incontinence. Urodynamic studies showed that 152[33%] had hyperactive bladders, 110[24%] had a contractile/hypo-contractile bladders, 104[22%] had stress incontinence and 56[12%] cases had normal results. Urodynamics helps in diagnosis of potentially life threatening urinary problems. The availability of this equipment and trained staff must be encouraged at tertiary care hospital. More research is required in this regard in Pakistan, which shall help in formulating better management protocols in future

Electrodiagnosis of thoracic outlet syndrome

This is a prospective study of 50 patients of suspected neurogneic thoracic outlet syndrome [TOS] who were referred to Armed Forces Institute of Rehabilitation Medicine [AFIRM], Rawalpindi. In this article we have presented our 2 years experience [Jul 1998 to Jun 2000] of clinical evaluation and electrophysiological studies of patients between 14 -75 years of age [mean age 39.72]. Nerve conduction studies [NCS] were performed on MS6 system [MEDELEC] and needle electromyography [NEMG] was performed with NEUROPACK electromyography model MEM -7102 K. Final diagnosis made on electrophysiological studies showed 30 cases of TOS, CTS, ulnar tardy syndorme, ulnar compression at canal of Guyon, C8 radiculopathy and normal study. TOS was twice more common in women. It most commonly affected patients in the 3'd and 4"' decade. Most frequent symptoms were pain, paraesthesia and weakness of hand muscles. Roos test was positive in 92% patients. Electrophysiological studies are very useful to confirm the diagnosis, rule out other entrapment neuropathies and decide the mode of treatment in neurogenic TOS

Electrodiagnostic evaluation of diabetic polyneuropathy

In this prospective study, 47 cases of diabetes mellitus [IDDM and NIDDM] suspected of diabetic neuropathy were studied to delineate the underlying pathology and localize lesion. Nerve conduction studies [NCS] were performed with MS 6 [MEDLEC] using surface electrodes. Concentric needle electromyography was done using Neuropack electromyographic model MEM7102K. On the basis of electrophysiological studies 39 patients had diabetic neuropathy, rest of patients had radiculopathies, thoracic outlet syndrome [TOS] and other abnormalities. Electrodiagnostic studies were helpful in confirming the diagnosis, localizing the entrapment neuropathies and in segregating the axonal/demyelinating neuropathies