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Objective:To examine the effect of minimally invasive radiofrequency(RF)thermocoagulation of the posterior medial branch of the spinal nerves on lumbar facet joint(LFJ)pain in the elderly.Methods:Patients over 60 years old with LFJ pain were randomly divided into an RF group and a control group.The primary outcome measures were the numerical rating scale(NRS)for pain assessment and the proportion of patients whose NRS decreased by 2 points or more, while the secondary outcome measures were the lumbar Oswestry dysfunction index(ODI), the proportion of patients whose ODI score decreased by 15 points or more, and the Macnab criteria.Results:Patients who met the inclusion criteria were divided into an RF group and a control group, with 135 patients in each group, including 171 women and 99 men.Compared with baseline values, changes in NRS scores in the RF group were significantly different from those in the control group at the 1st, 3rd and 6th months[(-2.3±1.1) vs.(-1.2±1.2), (-2.3±1.1) vs.(-1.2±1.2), (-2.3±1.1) vs.(-1.2±1.2), t=13.204, 16.366, 20.319, all P<0.001], and the proportions of patients whose NRS decreased by ≥2 at the 3rd and 6th months were higher in the RF group than in the control group[61.1%(80/131) vs.26.0%(32/123), 52.9%(64/121) vs.22.5%(25/111), χ2=18.287, 11.844, both P<0.001]. Compared with baseline values, there were also significant differences in ODI score changes between the RF group and the control group at the 1st, 3rd and 6th months[(-15.2±6.7) vs.(-10.1±7.4), (-14.6±6.8) vs.(-8.6±6.2), (-13.6±8.8) vs.(-7.7±9.2), t=5.563, 8.912, 7.721, all P<0.001], and the proportions of ODI reduction ≥15 were higher in the RF group than in the control group at the 3rd and 6th months[45.8%(60/131) vs.34.1%(42/123), 36.4%(44/121) vs.27.0%(30/111), χ2=6.668, 9.825, P=0.024, 0.031]. The proportions of patients achieving outcomes categorized as excellent and effective based on the Macnab criteria were significantly higher in the RF group than in the control group at the 6th month[60.3%(73/121) vs.36.0%(40/111), 81.0%(98/121) vs.54.1%(60/111), χ2=11.787, 8.890, both P<0.001)]. Conclusions:Minimally invasive radiofrequency thermocoagulation in the posterior medial branch of the spinal nerves can effectively reduce pain of the lumbar facet joints and improve movement disorders in the elderly, and the therapeutic effect is good 6 months after the procedure.
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Objective To investigate the efficacies and differences of spinal cord stimulation (SCS) and pulsed radiofrequency (PRF) in the treatment of herpes zoster neuralgia in the elderly. MethodsSixty-three patients with herpes zoster neuralgia over 50 years old, admitted to our hospital from January 2018 to January 2019, were divided into SCS group (n=31) and PRF group (n=32) by prospective, randomized and controlled study. The stimulating electrodes were placed in epidural spinal ganglion segment for two weeks after percutaneous puncture in SCS group. In the PRF group, the radiofrequency needles were percutaneously punctured to the dorsal root ganglion under the guidance of X-ray. After the location of contrast medium was confirmed, each target was treated by pulsed radiofrequency for 360 seconds, followed by anti-inflammatory compound liquid injection. Numeric Rating Scale (NRS) scores, effective rate (percentage of patients having pain relief>50％) and signficant differences were noted between the two group at each time point (P>0.05).The effective rates of pain treatment of patients from the two group reached to 56.67%-81.25%,and there was no significant difference between the two groups at each time point (P>0.05).The complete pain relief rate reached to 37%-71% in the two groups,and there was no significant difference between the two groups at each time point (P>0.05).Number of patients used analgesics and calcium channel antagonists before and after operation in the two groups showed significant differences (χ2=20.917,P=0.000; χ2=18.273,P=0.000),and number of patients used analgesics and calcium channel antagonists 4,12 and 24 weeks after operation in the two groups was significantly smaller than that before operation (P<0.05); but,there were no significant differences between the two groups at each time point (P>0.05).Conclusion SCS and PFR can effectively treat herpes zoster neuralgia and reduce the incidence of sequelae,without no significant difference in the clinical efficacy.
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Objective To examine the efficacy and safety of pregabalin in patients with neuropathic cancer pain (NCP).Methods A prospective randomized control multicenter trial was conducted in five hospitals;from January 2015 to January 2016,one hundred and twenty two eligible inpatients and outpatients were divided into pregablin treatment group (n=60) and control group (n=62).Patients in the pregablin group added pregablin to opiod background analgesia,while those in the control group raised opioid dose instead.The Numerical Pain Rating Scale (NRS) scores,paraesthesia scale scores,Hamilton's Depression (HAMD) scale scores,analgesia dose,patiends satisfaction,and adverse events were recorded 14 d after each treatment.Results After each treatment,the NRS scores were decreased by (2.3 ±1.1) and (1.3±1.5),the paraesthesia scale scores were decreased by (1.6±0.6) and (0.4±0.3),and the HAMD scale scores were decreased by (4.4±1.2) and (2.4±1.0) in the pregablin treatment group and control group,respectively,with significant differences (P＜0.05).Morphine dose for breakthrough pain in pregabalin group was statistically less than that in control group ([30.6±3.5] mg/d vs.[70.9±12.3] mg/d,P＜0.05).Patients satisfaction in the pregablin treatment group was significantly higher than that in the control group (P＜0.05).Pregabalin treatment group had less severe adverse effects (3/56,5％) as compared with control group (10/59,16.1％,P＜0.05).Conclusion Pregabalin has positive roles in patients with NCP already receiving opioid;pregabalin has better pain-control and mood improvement.
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<p><b>OBJECTIVE</b>To observe therapeutic effect of acupuncture combined with antiemetic on cisplatin-induced nausea and vomiting.</p><p><b>METHODS</b>By using paired, cross-controlled trial design, 66 cases of chemotherapy were divided into group A and B, 33 cases in each group. For the group A, chemotherapy, tropisetron and acupuncture therapy were adopted in the first chemotherapy cycle and the same chemotherapy program, tropisetron and sham acupuncture were used in the next cycle. For the group B, chemotherapy, tropisetron and sham acupuncture were given in the first chemotherapy cycle and the same chemotherapy program, tropisetron and acupuncture therapy were applied in the next cycle. Zusanli (ST 36), Neiguan (PC 6) and Gongsun (SP 4) and auricular point Wei (stomach) were selected for acupuncture therapy, and the points at 3 cm lateral to Zusanli (ST 36) , Neiguan (PC 6) and Gongaun (SP 4) and auricular point corresponding to scapha level were selected for sham acupuncture. Acupuncture treatment or sham-acupuncture was given for 6 consecutive days, once each day and antiemetic tropisetron 5 mg was given to the two groups as basic antiemetic prophylaxis for 6 days, once daily. The therapeutic effects on nausea and vomiting in the 6 days were compared between the acupuncture group and the sham-acupuncture group in the two chemotherapeutic cycles.</p><p><b>RESULTS</b>The effective rates for nausea in the 2nd day and the 4th day were 87.1% and 79.0% in acupuncture group, which were superior to 59.4% and 57.8% in the sham-acupuncture group, respectively (both P < 0.05); and the therapeutic effects on vomiting in the 3rd-6th day in the acupuncture group were better than those in the sham-acupuncture group (P < 0.05).</p><p><b>CONCLUSION</b>Acupuncture combined with antiemetic can effectively decrease the incidence and degree of cisplatin-induced delayed nausea and vomiting. The effect of acupuncture is better than that of sham acupuncture.</p>