Pain Drawing in the Assessment of Nerve Root Compression in the Degenerative Spondylosis / 대한척추외과학회지

STUDY DESIGN: A retrospective study. OBJECTIVES: To explore the pattern of pain distribution in HNP and spinal stenosis with or without degenerative spondylolisthesis (DS), and to evaluate the diagnostic value of pain drawings in predicting the presence of a painful nerve root. SUMMARY OF LITERATURE REVIEW: The usefulness of pain drawing as a tool to predict the presence of painful nerve root compression is unclear. MATERIALS AND METHODS: Fifty-seven patients (27 HNP, 21 pure spinal stenosis, and 9 spinal stenosis with DS) with leg pain were recruited. The presence of painful nerve root compression was judged based on MRI and clinical findings. Each grid of the pain drawing is assigned an area code, and discriminant analysis was performed to explore indications of painful nerve root. Diagnostic values were evaluated by calculating sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV). RESULTS: Pain distribution was characterized by a dermatomal pattern in HNP and variable in the spinal stenosis group. Paresthesia on the sole was extracted as a discriminant factor indicating painful compression of the S1 nerve root. In HNP, the sensitivity, specificity, PPV, and NPV of this factor were 62%, 100%, 100%, and 74% respectively. In the spinal stenosis group, they were 80%, 56%, 27%, and 93%, respectively. CONCLUSIONS: The pain drawing can help assess painful nerve root compression as well as confirm the pattern of pain distribution.

The attitude and behavior if primary physicians in seoul toward alternative medicine

BACKGROUND: Alternative medicine is defined as a non-orthodox therapeutic practices including chiropractic, acupunture, herbal medicine, faith, spiritual therapy or as all sorts of medical care that do not follow the medical community standards. Patients do not think of modern medicine as the absolute solution to their health problems and they will sometimes ask for complementary therapy and in want of referral to alternative practitioner. We have investigated the primary physicians' attitude and behavior towards alternative medicine. METHODS: Randomly selected 770 practitioners, in primary care practice in Seoul, were questioned from July to September in 1996 about the attitude to wards alternative medicine, the reasons and symptoms when referring, and experience in alternative medicine practice. RESULTS: 150 questionnaires were returned and among them 139 completed ones (18.1%) were analyzed. Among 770 doctors, 35 (25.2%) have referred patients to alternative practitioner before and more referrals were made when they worked together closely or had some prior training. The belief of special effect of alternative medicine on certain disease was the first reason to refer. Other reasons were for herbal medicine, acupunture, and chiropractice in the order of seguence. The standard way to learn alternative medicine was to attend seminars available through certain institutions. On referral either chronic pain or musculoskeletal disease were the most chief complaints or main diseases of patients. 15 doctors (10.8% ) had some experience in practicing an alternative approach and the patient subjeccts were more likely to be women, and there was increased tendency to be working with another doctor, and to have been trained for such practice. The items used by alternative practitioners were acupunture, herbs in the order of seguence. CONCLUSIONS: Alternative medicine is accepted somewhat by primary physicians in Seoul although the rate of referral and practice is lower than 54% compared to 16% in Canada.