[Comparing the effect of acupuncture and oral piroxicam in reduced pain and improved function of patient with chronic mechanical low back pain]

Low Back pain [LBP] is extremely common. Studies have shown life time prevalence as high as 84%. Mechanical chronic LBP [mechanical CLBP] is the leading cause of LBP that have a multifactorial cause, which includes functional instability, abnormal posture and emotional stress. Treatment of these patients is aimed to reduced pain, maintaining mobility, and minimizing disability. This study compares acupuncture vs. oral prioxicam in the reduced pain and Active Daily living [ADL] improvement in mechanical CLBP. In a randomized trial, 52 patients with mechanical CLBP were recruited using strict inclusion and exclusion criteria from Shiraz medical university clinics. All patients classified two groups: A group received acupuncture [2 sessions per week] and B group received Oral piroxicam [30 mg/day] for 2 weeks respectively. Evaluation tools were pain intensity [VAS] and ADLs at baseline, after and 4 weeks after treatment. The analyses of variance showed that means VAS of group A was 7.39 +/- 0.42, 3.88 +/- 0.96 and 3.02 +/- 0.52, and group B was 7.12 +/- 0.61, 4.55 +/- 0.93 and 3.91 +/- 0.28 at baseline, after and 4 weeks after treatment, respectively [p<0.005]. Acupuncture was more effective than oral piroxicam in the reduced pain intensity and ADLs improvement of patients. However, preliminary results suggest that Long- term continuous treatment with acupuncture sustains the effectiveness in pain reduction

[Prevalence of shoulder pain after stroke and associated factors]

Shoulder pain is a common complication of stroke that can cause some rehabilitation limits to achieve functional goals. The information about its prevalence and associated factors is limited. This study was conducted to detect more details about its associated factors. This study was performed on 191 stroke patients at Physical Medicine and Rehabilitation ward at Shiraz-Medical School from 2001 to 2004. Each patient was followed up for one year. A questionnaire was prepared containing information about shoulder pain compliant, thorough history and physical examination previous history of open heart surgery, scoliosis, limited neck range of motion, type of stroke [based on MRI and brain CT], osteoporosis [based on bone mineral density and X ray], shoulder adductor muscles and biceps spasticity [based on ashworth scale]. In the follow-up visits bi-monthly for one year, the questionnaire was filled out again and if present, shoulder pain was recorded. Most patients developed shoulder pain between 2 and 6 months following their stroke. Forthy-nine patients [32.2%] developed shoulder pain, 39[79.6%] of whom had spastic tone and 8 [16.3%] had flaccid tone. In both groups, with shoulder pain and without shoulder pain respectively, 6.7% and 1.9% had a history of open heart surgery, 6.1% and 1% had scoliosis, 67.3% and 35.1% had Intracranial hemorrhage, 73.5% and 23.3% had limited neck range of motion and 24.5% and 35% had osteopenia. Spasticity was significantly more common in the shoulder pain group, which can be due to capsulitis, soft tissue inflammation [especially ligament and rotator cuff muscle] and anteroinferior subluxation of the shoulder. There was a significant statistical correlation between Intracranial hemorrhage, reduced neck range of motion, and hemiplegic shoulder pain. It appears that treatment and rehabilitation of spasticity and underlying cervical area problems are helpful in preventing hemiplegic shoulder pain