Low-level laser therapy, at 830 nm, for pain reduction in experimental model of rats with sciatica.

Chronic pain, resulting from nerve compression, is a common clinical presentation. One means of conservative treatment is low-level laser therapy, although controversial. The aim of this study was to evaluate the effects of two doses of low-level laser, at 830 nm, on pain reduction in animals subjected to sciatica. Eighteen rats were used, divided into three groups: GS (n=6), sciatica and simulated treatment; G4J (n=6), sciatica and treatment with 4 J/cm²; and G8J (n=6), sciatica and irradiation with 8 J/cm². The right sciatic nerve was exposed and compressed using catgut thread. Five days of treatment were started on the third postoperative day. Pain was assessed by means of the paw elevation time during gait: before sciatica, before and after the first and second therapies, and the end of the fifth therapy. Low-level laser was effective in reducing the painful condition.

Low-level laser therapy, at 830 nm, for pain reduction in experimental model of rats with sciatica / Laser de baixa potência, 830 nm, na redução da dor em ratos submetidos à modelo experimental de ciatalgia

Chronic pain, resulting from nerve compression, is a common clinical presentation. One means of conservative treatment is low-level laser therapy, although controversial. The aim of this study was to evaluate the effects of two doses of low-level laser, at 830 nm, on pain reduction in animals subjected to sciatica. Eighteen rats were used, divided into three groups: GS (n=6), sciatica and simulated treatment; G4J (n=6), sciatica and treatment with 4 J/cm²; and G8J (n=6), sciatica and irradiation with 8 J/cm². The right sciatic nerve was exposed and compressed using catgut thread. Five days of treatment were started on the third postoperative day. Pain was assessed by means of the paw elevation time during gait: before sciatica, before and after the first and second therapies, and the end of the fifth therapy. Low-level laser was effective in reducing the painful condition.

A dor crônica, resultante de compressão nervosa, é uma apresentação clínica frequente. Um dos meios de tratamento conservador, é o laser de baixa potência, apesar de controvérsias. O objetivo do estudo foi avaliar os efeitos de duas doses de laser de baixa potência, 830 nm, na redução da dor em animais submetidos à ciatalgia. Foram utilizados 18 ratos, divididos em 3 grupos: GS (n=6) ciatalgia e simulado o tratamento; G4J (n=6) ciatalgia e tratado com 4 J/cm², G8J (n=6) ciatalgia e irradiado com 8 J/cm². O nervo isquiático direito foi exposto e realizada a compressão com fio catgut. No 3º dia pós-operatório, iniciou-se o tratamento, durante 5 dias. Verificou-se a dor, por meio do tempo de elevação da pata, na marcha: anterior à ciatalgia, pré e pós 1ª e 2ª terapias, e ao final da 5ª terapia. O laser de baixa potência foi eficaz na redução do quadro álgico.

Ciática: tratamiento con ozono intradiscal y radiofrecuencia del ganglio de la raíz dorsal frente a cada una de estas dos técnicas / Sciatica: intradiscal ozone administration associated with pulsed radiofrequency of the dorsal root ganglia compared with the isolated use of each of these two techniques

Objetivo: Estudio prospectivo y comparativo que compara la eficacia de la administración intradiscal de ozono asociada a radiofrecuencia pulsada de la raíz lumbar comprometida con cada una de estas 2 técnicas, de forma aislada, en el tratamiento del dolor radicular secundario a hernia discal. Material y método: Se incluyó en el estudio a 30 pacientes con clínica de dolor lumbar severo, escala visual analógica (EVA) > 6, de más de 3 meses de duración, resistente al tratamiento conservador (medicación oral y fármacos epidurales), con signos de afectación radicular con o sin parestesia e hipoestesia y con distribución correspondiente al dermatoma afectado. Los criterios radiológicos de inclusión fueron: evidencia en la resonancia magnética (RM) de hernia discal contenida con o sin degeneración discal. Los pacientes se distribuyeron aleatoriamente en 3 grupos: grupo A (5-15 ml de ozono intradiscal a 27 mg/ml de concentración y radiofrecuencia pulsada del ganglio dela raíz dorsal correspondiente); grupo B (5-15 ml de ozono intradiscal a 27 mg/ml de concentración) y grupo C (radiofrecuencia pulsada del ganglio de la raíz dorsal al nivel comprometido). La eficacia analgésica se valoró a los 15 días, al mes, y a los 3 y 6 meses de la técnica, mediante EVA y se llevó a cabo una valoración radiológica con RM a los 3meses. El estudio estadístico se realizó mediante el programa SPSS 14.0 para Windows. Se consideró significativa una p < 0,05.Resultados: Los niveles afectados, por orden de frecuencia, fueron L4-L5 (16/53,3%),L5-S1 (10/33,3%) y L3-L4 (4/13,33%). El volumen medio de ozono administrado fue, en el grupo A, 8 ± 2,5 ml, y en el B, 6,5 ± 2,4 ml (...) (AU)

Objective: We performed a prospective, comparative study that evaluated the effectiveness of intradiscal ozone administration associated with pulsed radiofrequency of the compromised lumbar root versus the isolated use of each of these two techniques in the management of radicular pain secondary to a herniated disc. Materials and method: The study included 30 patients with severe back pain, visual analog scale (VAS) > 6 and onset more than 3 months previously, who were resistant to conservative treatment (oral medication and epidural drugs) and showed signs of radicular involvement with or without paresthesia and hypoesthesia in the region of the affected dermatomes. The radiological inclusion criteria were magnetic resonance imaging (MRI) evidence of acontained herniated disc with or without disc degeneration. The patients were randomly distributed into three groups: group A (5-15 ml intradiscal ozone concentration at 27 mg/ml and pulsed radiofrequency of the compromised dorsal root ganglia); group B (5-15 ml of intradiscal ozone concentration at 27mg/ml) and group C (pulsed radiofrequency of the dorsal root ganglia at the level of the hernia). Analgesic efficacy was assessed at 15 days,1 month, 3 months and 6 months of the technique, using the VAS. Radiological assessment with MRI was performed after 3 months. The statistical analysis was conducted using SPSS14.0 for Windows. Values of P < 0.05 were considered significant. Results: the levels affected, in order of frequency, were L4-L5 (16/53.3%), L5-S1(10/33.3%) and L3-L4 (4/13.33%). The mean amount of ozone administered was 8 ± 2.5ml in group A and 6.5 ± 2.4 ml in group B. In group A, 90% of the patients showed significant improvement (p < 0.05) in all follow-up evaluations. In 80% of the patients in group B, improvement occurred later, but was maintained at 6 months after the technique (...) (AU)

Discólisis con ozono intradiscal en el tratamiento de la ciática por hernia discal. Seguimiento de 100 pacientes en 24 meses / Ozone discolysis in the treatment of sciatica due to a herniated disc. A 24-month follow-up of 100 patients

Objetivo: Estudio retrospectivo para evaluar la efectividad y la seguridad del uso de ozono para la discólisis en cuadros de ciática por hernia discal contenida. Material y método: Se incluyó en el estudio a 100 pacientes con clínica de lumbociática con dolor intenso, escala visual analógica (EVA) > 6, de más de 3 meses de duración, que no respondieron al tratamiento de analgésicos y corticoides, por vía sistémica, durante un período mínimo de 1 mes, con signos de dolor radicular e irradiación al dermatoma afectado. Los criterios radiológicos de inclusión fueron: evidencia en la resonancia magnética (RM) de hernia discal contenida. El tratamiento aplicado fue: primera sesión, administración epidural de 10 ml de ozono a 30 mg/ml, triamcinolona 4 mg y 5 ml de bupivacaína al 0,25%, más administración paravertebral 10 ml de O3 a 30 mg/ml, triamcinolona 4 mg y 5 ml de bupivacaína al 0,25% en el lado afectado. Segunda sesión, entre 7y 10 días de la primera, el mismo tratamiento. Segunda sesión, administración intradiscalde 10-20 ml de O3 a 50 mg/ml más antibioterapia profiláctica. La eficacia analgésica se valoró, a: 1, 3, 6, 12 y 24 meses, mediante EVA y valoración radiológica con RM a los 3, 12 y 24 meses. Se consideraron los resultados: a) excelente: cuando: no hay síntomas, y hay una completa incorporación al trabajo y la actividad deportiva. La EVA descendió > 70%; b) bueno: cuando el paciente presenta dolores ocasionales de espalda o ciática, con completa incorporación al trabajo, usan ocasionalmente analgésicos y hay un descenso de la EVA > 40%, y c) malo: insuficiente mejoría de síntomas, toma diaria de medicamentos, limitaciones en la actividad física, cambio de trabajo y descenso de la EVA < 40% sobre el previo. Se consideró significativo una p < 0,05. Resultados: De los 100 pacientes, 91 pacientes pudieron ser valorados a los 24 meses y de estos 52 fueron varones y 39 fueron mujeres (AU)

Objective: We performed a retrospective study to evaluate the safety and effectiveness of ozone discolysis in sciatica due to a contained herniated disc. Material and method: This study included 100 patients with symptoms of intense lumbosciatic pain, visual analog scale (VAS) > 6 and onset more than 3 months previously, who were unresponsive to analgesics and systemic corticosteroids for a minimum period of 1 month and who showed signs of radicular pain and radiation to the affected dermatome. The radiological inclusion criteria consisted of magnetic resonance imaging (MRI) evidence of a contained herniated disc. The treatment applied consisted of the following: a first session with epidural administration of 10 ml of ozone at 30 mg/ml, 4 mg of triamcinolone and 5 ml of bupivacaine 0.25% plus paravertebral administration of 10ml of O3 at 30 mg/ml, 4 mg of triamcinolone and 5 ml bupivacaine 0.25% on the affected side; a second session between 7 and 10 days after the first, consisting of the same treatment; and a third session with intradiscal administration of 10-20 ml of O3 at 50 mg/ml plus prophylactic antibiotic therapy. Analgesic efficacy was evaluated at 1, 3, 6, 12 and24 months through VAS and radiological evaluation with MRI at 3, 12 and 24 months. A result was considered: a) excellent when the patient was asymptomatic and able to fully return to work and resume physical exercise and VAS decreased > 70%; b) good when the patient had occasional back or sciatic pain, with complete return to work, occasional use of analgesics and VAS decreased > 40%, and c) poor when there was insufficient symptom improvement, daily medication intake, limitation of physical activity, change of work and VAS decreased by > 40%. P values of < 0.05 were considered significant. Results: Of the 100 patients, 91 could be evaluated at 24 months (52 men and 39 women) (...) (AU)

The longer term effect of pulsed radiofrequency for neuropathic pain.

Pulse radiofrequency has been recently described as a technique to apply a relatively high voltage near a nerve but without the usual effects of a rise in temperature or subsequent nerve injury. In this set of case reports, the effect of pulsed radiofrequency (PRF) is described in patients with neuropathic pain syndromes which have been poorly controlled with other oral and invasive treatments. Whilst anecdotal, the results have been remarkable and should encourage further research into this technique. Observations from the basic science tend to support the concept that PRF may induce some sort of long-term depression in the spinal cord.