A patient with axial spondylarthritis who experienced pancytopenia while receiving anti-TNF therapy.

Aplastic anemia is a rare and heterogeneous disease that causes pancytopenia and aplasia of the bone marrow. It is characterized by a failure of hematopoiesis. It is believed that approximately 65% of cases of acquired aplastic anemia are idiopathic. In a subset of cases, a drug or infection is the cause of bone marrow failure. This case report presents a 38-year-old patient with axial spondylarthritis who developed pancytopenia and was diagnosed with aplastic anemia during anti-TNF-α treatment.

A randomized controlled trial of Eye Movement Desensitization and Reprocessing (EMDR) Therapy in the treatment of fibromyalgia.

Background: In addition to pharmacological treatment, psychotherapeutic approaches are recommended for the treatment of fibromyalgia. There is a suggestion that eye movement desensitization and reprocessing (EMDR) therapy may be effective. This study aimed to investigate the impact of EMDR therapy on fibromyalgia symptoms, depression, sleep quality, and traumatic stress in fibromyalgia patients through a randomized controlled study (RCT). Materials and methods: The sample for this study comprised 79 individuals diagnosed with fibromyalgia. Participants were randomly assigned to two groups: the "Treatment as Usual" (TAU) group and the TAU + EMDR group. Prior to the study and at six different time points (before starting the study, at the end of the 5th, 10th, and 15th sessions, 1 month later, and 3 months later), participants completed assessments, including the Fibromyalgia Impact Questionnaire (FIQ), Visual Analog Scale (VAS), Fibromyalgia ACR 2010 Diagnostic Criteria [Widespread Pain Index (WPI) and Symptom Severity Scale (SSS)], Beck Depression Inventory (BDI), Pittsburgh Sleep Quality Index (PSQI), and Trauma Symptom Checklist-40 (TSC-40). Results: There were no differences in the sociodemographic variables between the study and experimental groups. Analysis of variance revealed a statistically significant group effect on VAS (p = 0.019), WPI (p = 0.018), BDI (p = 0.019), and TSC-40 (p = 0.21). After applying Bonferroni correction, EMDR was found to be effective for VAS, WPI, SSS, BDI, PSQI, and TSC-40 (p <0.05). Conclusion: The results of the current study suggest that EMDR therapy is a viable alternative treatment for fibromyalgia. We believe these findings offer robust evidence supporting the efficacy of EMDR therapy in treating fibromyalgia, particularly in the context of a randomized controlled trial (RCT). The application of EMDR therapy for the treatment of patients with fibromyalgia is likely to be beneficial. Clinical trial registration: ClinicalTrials.gov, identifier NCT06265194.

Impact of central sensitization on clinical parameters in patients with rheumatoid arthritis.

OBJECTIVE: This study aimed to investigate the effects of central sensitization (CS) on pain sensitivity, disease activity, neuropathic symptoms and quality of life (QoL) in patients with rheumatoid arthritis (RA). METHODS: Sixty patients diagnosed with RA according to the American College of Rheumatology and the European League Against Rheumatism (ACR/EULAR) 2010 classification criteria were included in the study. Patient assessment tools included visual analog scale (VAS) for pain, algometer for pain pressure threshold (PPT), disease activity score in 28 joints (DAS-28) for disease activity (DA), central sensitization inventory (CSI) for CS and rheumatoid arthritis QoL questionnaire for QoL. RESULTS: Central sensitization was identified in 29 (48.3%) patients. Although erythrocyte sedimentation rate (ESR), C-reactive protein and swollen joint count were comparable between patients with or without CS, higher VAS, tender joint count and DAS-28 scores were observed in patients with CS (all p<0.05). Pain pressure thresholds (PPT) at the wrist (PPTW) and the trapezius muscle (PPTT) were lower in patients with CS (p=0.004, p=0.001, respectively). It was found that neuropathic pain components increased and quality of life decreased as CSI scores increased (all p=0.000). CONCLUSION: The presence of CS leads to pain sensitivity as well as overestimation of disease activity in RA patients. The presence of CS should not be overlooked in RA patients to avoid overtreatment for inflammation and to determine the treatment need for nociplastic pain.

Comparison of Dry Needling and Cold-Spray-Stretching Treatments by Ultrasonography and Electrophysiology: Prospective, Randomized Controlled Trial.

OBJECTIVES: To compare the efficacy of dry needling (DN) and cold-spray-stretching treatments using surface electromyography (sEMG) and ultrasound (US) in the treatment of patients with myofascial pain syndrome (MPS) with active trigger point (ATrP) in the upper trapezius muscle. METHODS: This prospective randomized single-blind study included 60 MPS patients aged 18-65 years who have ATrP in the upper trapezius muscle. Patients were randomized into two treatment groups as DN and cold spray stretching. Both treatment groups received 1 treatment per week and totally 3 sessions. Evaluation parameters were pain level assessed by Numeric Rating Scale and algometer, neck range of motion angles, neck disability index (NDI). The effects of the treatments on ATrP were evaluated by sEMG and US histogram. All parameters were evaluated at the beginning of the treatment and at the end. Algometer and sEMG were performed also before and after the first and third sessions. RESULTS: There was no significant difference between the two groups regarding demographic data. The mean age of the participants was 39.7 ± 11.6 years. Fifty-one patients were female. Significant improvement in terms of pain level, functionality, sEMG, and US histogram were achieved in both groups (P < .05). When comparing the two groups, algometer scores and the NDI score were statistically higher in the cold-spray-stretching group than in the DN group (P < .008 and P < .028, respectively). CONCLUSION: Both treatment options should be preferred. The efficacy of both treatments was observed via sEMG and US histograms.

Deep Gluteal syndrome: An underestimated cause of posterior hip pain.

Deep gluteal syndrome (DGS) is a significant cause of posterior hip pain resulting from the compression of the sciatic or other peripheral nerves in the deep gluteal space. Understanding the anatomy of the deep gluteal space and the kinematics of the sciatic nerve, as it passes through this region is crucial for understanding DGS. Despite increasing awareness, DGS is still often overlooked. This review focuses on conditions that specifically contribute to posterior hip pain as a consequence of DGS. Predominantly addressing piriformis syndrome, gemelli-obturator internus syndrome, ischiofemoral impingement syndrome, and proximal hamstring syndrome, the review also touches upon rare cases such as inferior and superior gluteal nerve entrapment.

Effects of trunk stabilization exercises on balance, functionality and abdominal muscle thickness in hemiplegic patients.

Objectives: This study aims to investigate the effects of trunk stabilization exercises (TSEs) in addition to conventional exercises in patients with stroke on balance, functionality and abdominal muscle thickness as measured by ultrasonography (USG) and to compare the patients' non-paretic side abdominal muscle thickness with healthy population. Patients and methods: Between April 2019 and June 2019, a total of 26 hemiparesis/hemiplegic patients with stroke (15 males, 11 females; mean age: 62.3±7.8 years; range, 52 to 71 years) confirmed by neurological examination or computed tomography (CT) / magnetic resonance imaging (MRI) and 20 age-matched healthy volunteers (12 males, 8 females; mean age: 62.3±7.2 years; range, 53 to 70 years) were included in the study. The patients were randomized into two groups. In the first group (n=13), TSE were performed in addition to conventional neurorehabilitation program, five times/week for a total of four weeks. The second group (n=13) was given conventional neurorehabilitation program, five times/week for a total of four weeks. Also, healthy volunteers as the third group were compared with the patient population. The evaluations were made at the beginning and end of the treatment. The Berg Balance Scale (BBS), Barthel Index (BI), Postural Assessment Scale for Stroke Patients (PASS), and Functional Reach Test (FRT) were used. Abdominal muscle thickness at rest and contraction were evaluated using USG. Results: Ten patients in Group 1 and 10 patients in Group 2 completed study. A significant improvement was observed in all abdominal muscles in both groups (p<0.05), indicating no significant difference between the groups (p>0.05). There was a statistically significant improvement for BBS and FRT in both groups. The PASS and BI scores showed a significant improvement only in TSE group. Conclusion: Both the TSE and conventional neurorehabilitation program provided significant improvements in abdominal muscle thickness, balance and trunk control. For postural control and functionality, additional TSE seems to be more effective.

Why do manuscripts submitted to the Turkish Journal of Physical Medicine and Rehabilitation get rejected?

Objectives: The study aimed to examine the reasons for the rejection of manuscripts, considering the increased rejection rates of our journal of up to 73% in 2022, and help authors realize what the editors and referees are paying attention to while assessing the manuscript. Materials and methods: In this retrospective study, original articles, case reports, systematic reviews, and meta-analyses submitted and rejected to the Turkish Journal of Physical Medicine Rehabilitation were searched between January 1, 2016, and June 30, 2022. After reviewing the referee's evaluations and editorial opinions for all rejected articles, the reasons for rejection were classified under three main headings: journal, manuscript, and ethical issues. The manuscript issues were detailed under 11 subheadings. Results: A total of 1,293 rejected submissions were reviewed. Of these, 35% were rejected at the editorial stage, while 65% were rejected after peer review. Thirty-three submissions were rejected for ethical reasons, 168 were out of the journal's field of interest, and 1,092 (84%) submissions were rejected for reasons related to the manuscript. The three most common reasons for rejection were protocol/methodology errors (44%), lack of contribution to the literature (41%), and lack of adequate discussion (40%). Conclusion: Before starting the studies, supporting the hypotheses with the current literature review, planning with the right protocol, and interpreting the findings in the discussion will facilitate the acceptance of the manuscripts to our journal.

An Uncommon Presentation of a Rare Syndrome: Parsonage-Turner Syndrome Presenting With C8 Root Involvement.

Parsonage-Turner syndrome or neuralgic amyotrophy is a rare syndrome that presents with sudden and severe pain in the shoulder girdle and may cause loss of muscle strength, atrophy, and sensory deficits. We discuss the clinical and electroneuromyographic findings in a young woman who presented with left-sided arm pain and was diagnosed with Parsonage-Turner syndrome with C8 root involvement, which is a rare presentation of the disease.

The effects of spasticity on glucose metabolism and soft tissue body composition in patients with spinal cord injury.

Objectives: The aim of this study was to assess the effects of spasticity on glucose metabolism and percentage of fat-free mass (FFM%) in patients with spinal cord injury (SCI). Patients and methods: A total of 33 patients (22 males, 11 females; mean age: 38.6±12.5 years; range, 20 to 64 years) with SCI defined by the American Spinal Injury Association Impairment Scale Grades A to D were included between September 2014 and May 2018. We assessed spasticity with the Modified Ashworth Scale (MAS) and evaluated spasms with the Penn Spasm Frequency Scale (PSFS). We assessed the glucose metabolism by calculating the Matsuda and HOMA-IR index, and measured FFM% by dual-energy X-ray absorptiometry. Results: Fourteen patients had motor complete, and 19 had motor incomplete SCI. The neurological injury levels of the patients were C4-T12. There was a positive correlation between hip adductor muscle MAS and trunk, android, and gynoid FFM% and between hip extensor muscle MAS and android FFM% in patients with motor complete SCI. Hip extensor and knee flexor muscle MAS showed a negative correlation with the HOMA-IR. Hip adductor and extensor muscle MAS, as well as knee flexor and extensor muscle MAS, had a positive correlation with the Matsuda index in these patients. There was a positive correlation between knee extensor muscle MAS and gynoid FFM% and between PSFS and arms, trunk, gynoid, and total FFM% in patients with motor incomplete SCI. There was a negative correlation between hip adductor and extensor muscle MAS, PSFS, and level of fasting glucose in these patients. Conclusion: This study supports the notion that spasticity has positive effects on the FFM% and glucose metabolism in patients with motor complete and incomplete SCI.

Demographic and clinical characteristics of inpatient stroke patients in Turkey.

Objectives: This study aims to assess the stroke rehabilitation facilities provided by university hospitals (UHs) and training and research hospitals (TRHs) and to evaluate the geographical disparities in stroke rehabilitation. Patients and methods: Between April 2013 and April 2014 a total of 1,529 stroke patients (817 males, 712 females; mean age: 61.7±14.0 years; range, 12 to 91 years) who were admitted to the physical medicine and rehabilitation clinics in 20 tertiary care centers were retrospectively analyzed. Demographic, regional and clinical characteristics, details of rehabilitation period, functional status, and complications were collected. Results: The median duration of stroke was five (range, 1 to 360) months. The ratio of the patients treated in the TRH in the Marmara region was 77%, but only 25% of the patients were living in the Marmara region. Duration of hospitalization was longer in the TRHs with a median of 28 days compared to those of UHs (median: 22 days) (p<0.0001). More than half of the patients (55%) were rehabilitated in the Marmara region. Time after stroke was the highest in the Southeast region with a median of 12 (range, 1 to 230) months and the lowest in the Aegean region with a median of four (range, 1 to 84) months. Conclusion: This study provides an insight into the situation of stroke rehabilitation settings and characteristics of stroke patients in Turkey. A standard method of patient evaluation and a registry system may provide data about the efficacy of stroke rehabilitation and may help to focus on the problems that hinder a better outcome.

Poor Accuracy of Clinical Diagnosis in Pes Anserine Tendinitis Bursitis Syndrome.

OBJECTIVES: To investigate the characteristics of the patients who are clinically diagnosed with pes anserine tendinitis bursitis syndrome (PATBS), and to determine the sensitivity and specificity of clinical diagnose based on magnetic resonance imaging (MRI). METHODS: Included in this cross-sectional clinical study were 156 patients who were evaluated based on the clinical presence or absence of PATBS. All patients underwent Q-angle measurement, knee osteoarthritis (OA) grading according to the Kellgren-Lawrence classification, and medial joint space measurement, and their cartilage thickness, and any periarticular and intraarticular knee pathologies were recorded from an assessment of knee MRIs. RESULTS: Of the total, 64 cases (41%) were diagnosed clinically with PATBS and 92 (59%) were not. There was no difference in the Q angles of the two groups (p > 0.05), while the medial joint spaces were significantly lower in the PATBS patients (p < 0.05). There were no significant differences between the two groups in an MRI assessment of meniscus and ligament lesions, chondromalacia patella, cyst, bursitis, effusion and synovial pathologies (p > 0.05). The sensitivity and specificity of the PATBS clinical diagnoses relative to the MRI findings were determined as 41.2% and 59.5%, respectively. CONCLUSION: The medial joint space was found to be significantly lower in patients with PATBS, while there was no difference in any other knee pathologies between the two groups. The sensitivity and specificity of a PATBS clinical diagnosis were found to be low, and so it was concluded that clinical PATBS diagnoses may be inaccurate, particularly in the presence of such invasive therapies as injection, and that diagnoses based on imaging methods would be more accurate.

Evaluation of the physical and emotional effects of the COVID-19 pandemic on patients with fibromyalgia and chronic low back pain: A multicenter cross-sectional controlled study.

Objectives: This study aimed to investigate the physical and emotional effects of the coronavirus disease 2019 pandemic in patients with fibromyalgia syndrome (FMS) and chronic low back pain (CLBP) patients. Patients and methods: The cross-sectional controlled study was performed with 1,360 participants (332 males, 1,028 females; mean age: 42.3±12.5 years; range, 18 to 65 years) between September 2020 and February 2021. The participants were evaluated in three groups: the FMS group (n=465), the CLBP group (n=455), and the healthy control group (n=440). Physical activity, pain levels, and general health status before and during the pandemic were evaluated in all participants. Stress levels were analyzed with the perceived stress scale (PSS) in all groups, and disease activity was analyzed with the fibromyalgia impact questionnaire (FIQ) in patients with FMS. Results: Patients with FMS had worsened general health status and pain levels during the pandemic compared to the other groups (p<0.01). The FMS group showed significantly higher PSS scores than those in other groups (p<0.01). There was a weak-positive correlation between FIQ and PSS parameters in patients with FMS (p<0.05, r=0.385). Conclusion: The general health status, pain, and stress levels of the patients with FMS and CLBP tended to worsen during the pandemic. This high-stress level appeared to affect disease activity in patients with FMS.

Modeling the Microbial Shelf-Life of Chicken Mince Added Rosemary Extract

Abstract Using the non-linear regression model, the present study aims to develop sample mathematical models for the microbial flora by utilization of the antimicrobial effects of rosemary (Rosmarinus officinalis) extracts at different concentrations (0.5, 1, 1.5, and 2%) on the raw chicken mince. For this purpose, 5 experimental groups were established for each plant extract. The samples (100 g each) treated with plant extract at different concentrations were vacuum-packaged under aseptic conditions. The packaged samples were kept in refrigerator (4ºC). The microbiological analyses of (total mesophilic aerobic bacteria, total coliform group bacteria, S. aureus, total yeast-mold, and total psychrophilic bacteria) were performed on 0th, 1st, 3rd, 5th, 7th, and 10th days of storage. When compared to the control group the treatment with RE resulted in a decrease in the microbial numbers by 2.5 log units for TMAB number, by 3.5 log units for S. aureus number, by 3,5 log units for TMY number and by 1.5 log units for TP bacteria on the final day of storage. In establishing the model, the plant extract and storage period were used as variable parameters, whereas the shelf-life was used as output parameter. The changes in shelf-life of raw chicken minces by storage period and extract concentration were modeled, the compliance of obtained mathematical models was tested using Variance Analysis Method (ANOVA) and regression and determination coefficients (R2) were determined. After determining their compliance of models based on R2 values, the estimated values and real values were compared. As a result of study, it was determined that R2 values of raw chicken mince models by total mesophilic aerobic bacteria, S. aureus, total coliform bacteria, total yeast/mold, and total psychrophilic bacteria during the storage period were found to range between 0.743 and 0.978 and the models representing the microbial change were found to have a high level of compliance.

Effectiveness of pregabalin treatment for trigger points in patients with comorbid myofascial pain syndrome and fibromyalgia syndrome: a randomized controlled trial.

AIM OF THE STUDY: Myofascial pain syndrome (MPS) is a common problem in the general population. MPS should not be a local/peripheral painful syndrome and considered to be a syndrome of central sensitivity. We aimed to investigate the effect of pregabalin in patients with MPS in this study. MATERIALS AND METHODS: We randomized 40 patients into two groups, and 17 patients per group completed the study. Female patients in group I received pregabalin and exercise therapy, whereas those in group II received exercise therapy alone. All patients were evaluated as follows: for pain by visual analog scale (VAS); trigger-point pressure pain threshold-(PPT) by algometry; neuropathic pain using the Douleur Neuropathique en 4 Questions (DN4) and quality of life with the Short Form-36 (SF36). Evaluations were performed pre-treatment and at the end of the first and third months of treatment. Clinical trial ID: NCT04600037, retrospectively registered 20/10/2020. RESULTS: In group I, significant improvements were observed in VAS, trigger-point-PPT, physical component summary-SF-36, at the first and third months. In group II, statistically significant improvements were observed in VAS, trigger-point-PPT after the first and third months. Group I showed statistically better improvements in VAS, trigger points-PPT, physical component summary-SF36 compared with group II by the third month. CONCLUSION: Pregabalin treatment is effective for controlling trigger points. Pregabalin treatment is also more effective than exercise treatment at improving quality of life in patients with MPS.

Effectiveness of Repetitive Transcranial Magnetic Stimulation in Patients With Failed Back Surgery Syndrome: A Double-Blind Randomized Placebo-Controlled Study.

BACKGROUND: Failed back surgery syndrome (FBSS) is the term of persistent back and/or leg pain after lumbar surgery. Repetitive transcranial magnetic stimulation (r-TMS) is a technique that allows noninvasive and relatively painless stimulation of cerebral cortex. It can reduce the experience of chronic pain by producing the small electrical currents in the cortex via magnetic field. OBJECTIVES: The aim of this study is to determine the effectiveness of r-TMS treatment on patients with FBSS. STUDY DESIGN: A double-blind, randomized, placebo-controlled trial. SETTING: The Physical Medicine and Rehabilitation Clinic of Istanbul Fatih Sultan Mehmet Training and Research Hospital, Istanbul, Turkey. METHODS: In this double-blinded, randomized, placebo-controlled trial, 20 patients (aged 34-65 years) clinically diagnosed as FBSS who had a history of surgery for lumbar disc herniation with persistent back and leg pain were reviewed. Only patients with no root compression and/or spinal stenosis in postoperative magnetic resonance imaging of lumbar spine were included. Patients were randomly assigned to r-TMS (n:10) and sham (n:10) groups. Patients in the r-TMS group received 5 Hz of r-TMS as a 20-minute (1,000 pulses) daily session, 5 days per week, for a total of 10 sessions. r-TMS was applied with MagVenture device (MagPro X100, Denmark, 2009) and figure 8 coil (MMC 140 parabolic, MagVenture). Control group received sham r-TMS with the same protocol. Each patient was evaluated at baseline, days 5 and 10 of treatment, and 1 and 3 months after treatment. Visual Analog Scale (VAS), DN4 (Douleur Neuropathique en 4 Questions), Oswestry Disability Index (ODI), Beck Depression Inventory (BDI), and the Pittsburgh Sleep Quality Index (PSQI) were used for evaluation. RESULTS: There were no statistically significant differences between the groups for age, gender, number of surgeries, pain duration, working status, and drug usage. Significant improvements were achieved in DN4, ODI, BDI, and PSQI scores in the r-TMS group in comparison to the sham group. Both groups displayed improvements in VAS scores, whereas improvement in the sham group was limited to the first month. Achieved improvements in the r-TMS group in terms of VAS, DN4, ODI, BDI, and PSQI scores were sustained at the third month. LIMITATIONS: The limited number of patients and the short follow-up periods are the main limitations of our study. Further placebo-controlled studies with longer follow-up periods and greater number of cases would be beneficial for examining r-TMS application as a new treatment option in patients with FBSS. CONCLUSIONS: r-TMS might be an effective alternative treatment in patients with FBSS, further studies with larger groups are needed.

Effect of Pilates mat exercise and home exercise programs on pain, functional level, and core muscle thickness in women with chronic low back pain.

BACKGROUND: To investigate the effects of Pilates exercise in patients with chronic non-specific low back pain (CNLBP) by training core stabilization muscles in aspects such as: pain, functional level, depression, quality of life, and muscle thickness measured by Ultrasound Imaging (UI) and to compare it with home based exercise. METHODS: A prospective, randomized-single blinded study included 60 female patients with CNLBP. Patients were randomized into Pilates (group 1) or home exercise group (group 2) three times/week for eight weeks. The evaluations were made at the beginning and end of the treatment. Outcome parameters were VAS, Oswestry Disability Index, Qubec Disability Scale, Short Form-36, Beck Depression Questionnaire, sit and reach, Modified Schöber and sit up tests. Multifidus and abdominal muscle thickness were measured by UI. RESULTS: Significant improvement has been observed in all parameters in both groups. It was found that Group 1 was more effective in terms of all parameters (p < 0.05). CONCLUSIONS: Both Pilates and home exercises are effective in treating patients with chronic low back pain. UI can be useful for evaluating the core muscle thickness progression of chronic low back pain patients who are undergoing exercise therapy.

A rare cause of insidious shoulder pain in a young female: A soft tissue aneurysmal bone cyst in supraspinatus muscle.

Aneurysmal bone cyst (ABC) is an expansile cystic lesion which may affect any bone of the skeleton. Although extremely rare, lesions with histomorphological characteristics of an ABC occur in the soft tissue. Herein, we report the first case of ABC involving the supraspinatus muscle and mimicking common pathologies, such as myofascial pain syndrome or subacromial impingement syndrome.

Clinical and radiological outcomes of kinesiotaping in patients with chronic neck pain: A double-blinded, randomized, placebo-controlled study.

OBJECTIVES: In this study, we aimed to evaluate the efficacy of kinesiotaping (KT) in patients with chronic non-specific neck pain (NSNP) in terms of pain, disability, cervical range of motion (ROM), and cervical lordosis. PATIENTS AND METHODS: Between October 2013 and March 2014, a total of 50 patients (10 males, 40 females; mean age 35.1±9.9 years; range, 17 to 62 years) with chronic NSNP were randomized into the KT (n=25) or the sham KT intervention (n=25) groups. Both groups were additionally given a therapeutic exercise (TE) program. The Visual Analog Scale (VAS) and Neck Disability Index (NDI) scores and ROM measurements were recorded at baseline, at the end of treatment, and at one month. Lateral cervical digital radiographs were analyzed by the Cobb, posterior tangent and effective lordosis methods at baseline and at one month after the treatment. RESULTS: There was a statistically significant decrease in the VAS scores compared to baseline in the KT group. The NDI scores significantly decreased in both groups. The patients in the KT group experienced a significant increase in all planes of cervical ROM after the treatment. Cervical radiographs revealed a significant increase in the Cobb and posterior tangent angles only in the KT group. CONCLUSION: Our study results suggest that KT significantly improves VAS, NDI scores, ROM and cervical lordosis angles. The combination of TE and KT is useful in reducing pain and disability and improving ROM and cervical lordosis loss in patients with chronic NSNP.

Conservative Treatment Versus Ultrasound-Guided Injection in the Management of Meralgia Paresthetica: A Randomized Controlled Trial.

BACKGROUND: Meralgia paresthetica (MP) is an entrapment mononeuropathy of the lateral femoral cutaneous nerve (LFCN), in which conservative treatment options are not always sufficient. OBJECTIVES: The aim of this study was to evaluate the efficacy of ultrasound (US)-guided LFCN injection in the management of MP by comparing with transcutaneous electrical nerve stimulation (TENS) therapy and sham TENS therapy. STUDY DESIGN: A prospective, randomized, sham-controlled study. SETTING: Health Sciences University Training and Research Hospital in Turkey. METHODS: Patients diagnosed with LFCN compression with clinical and electrophysiological findings were included in this study. Patients were randomly assigned to 3 groups: (1) US-guided injection group, (2) TENS group, and (3) sham TENS group. The blockage of the LFCN was performed for therapeutic MP management in group 1. Ten sessions of conventional TENS were administered to each patient 5 days per week for 2 weeks, for 20 minutes per daily session in group 2, and sham TENS was applied to group 3 with the same protocol. Visual Analog Scale (VAS), painDETECT questionnaire, Semmes-Weinstein monofilament test (SWMt), Pittsburgh Sleep Quality Index (PSQI), and health-related quality of life (36-Item Short Form Health Survey [SF-36]) at onset (T1), 15 days after treatment (T2), and 1 month after treatment (T3) were used for evaluation. Patients and the investigator who evaluated the results were blinded to the treatment protocol during the study period. RESULTS: A total of 54 of the 62 patients (group 1 n = 17, group 2 n = 16, group 3 n = 21) completed the study, 3 patients from group 1, 4 patients from group 2, and 1 patient from group 3 dropped out during the follow-up period. The mean changes in painDETECT and SWMt scores showed a statistically significant difference between groups in favor of group 1 at T2 and T3 compared with T1 (P < 0.05). There was no statistically significant difference between groups in terms of VAS, SF-36, and PSQI scores (P > 0.05). In-group analysis of VAS scores showed a statistically significant decrease in T2 and T3 compared with T1 in group 1 (P < 0.05). In-group analysis of the VAS scores statistically significant decrease was shown in T2 compared with T1 in group 2 (P < 0.05). In-group analysis of painDETECT scores statistically significant decrease was shown in T2 and T3 compared with T1 in all groups (P < 0.05). In-group analysis of SWMt scores statistically significant decrease was shown in T2 and T3 compared with T1 in group 1 (P < 0.05). In-group analysis of SF-36 and PSQI scores, there was no statistically significant decrease in all groups (P > 0.05). LIMITATIONS: The limitation of the study was a short follow-up period. CONCLUSIONS: US-guided LFCN injection and TENS may be therapeutic options for MP treatment, however, for patients with neuropathic pain symptoms, US-guided LFCN injection may be a safe and alternative method to conservative treatment. KEY WORDS: Meralgia paresthetica, ultrasound-guided injection, transcutaneous electrical nerve stimulation.