Methylcobalamin as an adjuvant medication in conservative treatment of lumbar spinal stenosis.

To find out the clinical effects of methylcobalamin on the conservative treatment of degenerative lumbar spinal stenosis, the study was carried out as a control single blind trial with 2 year follow-up in 152 patients, 68 males and 84 females, whose ages ranged from 55 to 85 years, average 67 +/- 18.1 years. They were randomly allocated into 2 groups, the control group, 82 patients, and the methylcobalamin group, 70 patients. All had classical history, and physical and radiographic findings which confirmed the diagnosis of spinal stenosis. Conventional management, including patient education, physical therapy and medication, were carried out in every patient and in addition methylcobalamin 0.5 mg was given orally three times a day in the methylcobalamin group for 6 months. All patients were followed up periodically for 2 years. Most of the patients in both groups showed improvement but there was no significant difference between the 2 groups in terms of pain improvement and neurological signs, except neurogenic claudication distance which was better in the M-group.

Brachial plexus injury and pain: incidence and the effects of surgical reconstruction.

A prospective study of pain after brachial plexus injury was carried out on 246 patients with at least 2 years follow-up. All of them had closed traction injury from motorcycle accidents. There were 16 females and 230 males aged from 16 to 44 years old. The patients' biodata, onset of pain, characteristics of pain and treatment were recorded. Changes in pain after conservative and operative treatment and the outcome of treatment were analysed. Two hundred and nineteen patients (89%) had significant pain and 182 patients (74%) had severe pain. Most of them had continuous pain with 2 to 20 peaks of severe pain per day. Crushing type of pain was the most common but mixed type of pain caused the most distress. Conservative treatment before surgery could relieve the pain in 39 patients (15.8%). Surgical reconstruction could further relieve the pain in 176 patients (80.36%). However, 21 patients (8.5%) still had severe pain. Improvement in sensory function had more effect on pain reduction than motor function.

A post marketing survey on the side-effects of loxoprofen.

A survey study of the efficacy and side-effects of loxoprofen in orthopaedic outpatient clinics was carried out from January 1995 to December 1997. There were 1206 patients (569 males and 637 females) with an average age of 56.4 +/- 14.9 years. The youngest was 43 and the oldest was 79 years. About 36 per cent of the patients had underlying diseases and 31 per cent were receiving other medications as well as loxoprofen. About 91 per cent of the patients were satisfied with loxoprofen in terms of pain control and decreased inflammation. However, 8.4 per cent had side-effects, the most common being GI and CNS disturbances. Some patients (0.24%) had GI bleeding and needed hospitalization. The high risk patients were female older than 60 years who had used loxoprofen continuously for more than 6 weeks. However, we conclude that loxoprofen is an effective NSAID with few side-effects.

Direct epidural morphine injection during lumbar discectomy for postoperative analgesia.

A double-blind controlled study was done on 42 patients to test the analgesic activity of epidural morphine after lumber laminectomy for single level disc herniation. Sixteen patients received 3 mg preservative-free morphine. Twenty-six patients received normal saline. The patients given epidural morphine had a longer postoperative pain-free period (6.28 vs 2.37 hours) and needed less postoperative analgesia (0.2 vs 0.9 times for paracetamol, and 0.16 vs 0.51 times for morphine). Epidural morphine injection under direct vision during discectomy operation is an effective and safe method for postoperative pain relief.