Confirmatory study of the usefulness of quantum molecular resonance and microdissectomy for the treatment of lumbar radiculopathy in a prospective cohort at 6 months follow-up.

OBJECTIVES: Low back pain is a common musculoskeletal complaint and while prognosis is usually favorable, some patients experience persistent pain despite conservative treatment and invasive treatment to target the root cause of the pain may be necessary. The aim of this study is to evaluate patient outcomes after treatment of lumbar radiculopathy (LR) with quantum molecular resonance radiofrequency coblation disc decompression and percutaneous microdiscectomy with grasper forceps (QMRG). METHODS: This prospective cohort study was carried out in two Spanish hospitals on 58 patients with LR secondary to a contained hydrated lumbar disc hernia or lumbar disc protrusion of more than 6 months of evolution, which persisted despite conservative treatment with analgesia, rehabilitation, and physiotherapy, and/or epidural block, in the previous 2 years. Patients were treated with QMRG and the outcomes were measured mainly using the Douleur Neuropathique en 4 Questions, Numeric Rating Scale, Oswestry Disability Index, SF12: Short Form 12 Health Survey, Patient Global Impression of Improvement, Clinical Global Impression of Improvement, and Medical Outcomes Study Sleep Scale. RESULTS: Patients who received QMRG showed significant improvement in their baseline scores at 6 months post-treatment. The minimal clinically important difference (MCID) threshold was met by 26-98% of patients, depending on the outcome measure, for non-sleep-related outcomes, and between 17 and 62% for sleep-related outcome measures. Of the 14 outcome measures studied, at least 50% of the patients met the MCID threshold in 8 of them. CONCLUSION: Treatment of LR with QMRG appears to be effective at 6 months post-intervention.

Quantum Molecular Resonance Radiofrequency Disc Decompression and Percutaneous Microdiscectomy for Lumbar Radiculopathy.

Within the practice of pain management, one of the most commonly encountered events is low back pain. Lumbar radiculopathy (LR) is a pain syndrome caused by the compression or irritation of the nerve roots in the lower back due to lumbar disc herniation, vertebra degeneration, or foramen narrowing. Symptoms of LR include low back pain that propagates toward the legs, numbness, weakness, and loss of reflexes. The aim of this study is to assess the long-term effectiveness of quantum molecular resonance disc decompression and its combination with a percutaneous microdiscectomy using Grasper© forceps (QMRG) in patients with persistent lumbar radiculopathy (LR) in relation to patient physical stress status. The main outcome measures of this prospective observational study were DN4, NRS, ODI, SF12, PGI, CGI, and MOS Sleep Scale. An improvement 12 months post-intervention was observed in patients without physical stress, presenting better overall results. The mean change was over the minimal clinically important difference in 64.3% of outcome measures studied for the whole sample. QMRG appears to be an effective treatment option for LR, but a reduction in physical stress is needed to ensure long-term effectiveness.

Preliminary evaluation of the efficacy of quantum molecular resonance coablative radiofrequency and microdiscectomy.

Aims: The aim of this study was to determine whether there exists a difference in efficacy in the treatment of lumbar radiculopathy with quantum molecular resonance coablative radiofrequency and quantum molecular resonance coablative radiofrequency and percutaneous microdiscectomy with grasper forceps (QMRG). Patients & methods: A total of 28 patients from La Fe University and Polytechnic Hospital in Valencia were enrolled in a retrospective cohort. Results: Treatment with QMRG significantly improved non-sleep-related and sleep-related outcome measures. At 6 months post-intervention, treatment with QMRG resulted in significantly better scores in numeric rating scale, Oswestry Disability Index, Short Form 12 Health Survey Physical and Total, Patient Global Impression of Improvement, sleep disturbance and the two sleep problems indexes. Conclusion: Treatment of lumbar radiculopathy with QMRG appears to be more effective at 6 months post-intervention.

La naturaleza biopsicosocial del dolor crónico de suelo pélvico: una revisión narrativa / The biopsychosocial nature of chronic pelvic floor pain: a narrative review

En 2020, la International Association for de Study of Pain reconceptualiza el dolor crónico (DC) como experiencia sensorial y emocional desagradable asociada, o similar, a un daño tisular real o potencial añadiendo mayor complejidad y ciertos matices a las definiciones previas, con la finalidad de que esta modificación conduzca a una mejor evaluación, diagnóstico y tratamiento de las personas que sufren DC. De esta nueva definición debemos resaltar que el dolor no es provocado únicamente por una experiencia nociceptiva (sensorial), sino que también abarca la esfera emocional. En este sentido, el dolor crónico de suelo pélvico (DCSP) representa un desafío para los profesionales sanitarios en cuanto al diagnóstico y manejo terapéutico. Las patologías de suelo pélvico, de compleja etiopatogenia, se han asociado con frecuencia con fenómenos psicopatológicos en la aparición, mantenimiento y exacerbación de los síntomas, además de las repercusiones personales, sociales y familiares que pueden determinar un importante deterioro en la calidad de vida de la persona que lo sufre.Se ha realizado una revisión no sistemática de carácter narrativo en Pubmed, Scholar Google y búsqueda manual desde 2012 hasta 2022. Se analiza la experiencia de dolor de suelo pélvico desde la dimensión psicológica (experiencias adversas en la infancia, abuso y violencia; estrés y ansiedad, catastrofismo y depresión; kinesofobia, autoestima y personalidad; funcionamiento sexual) y la dimensión sociocultural (estigma, sesgos de género, apoyo social, limitaciones laborales y económicas). Se incorporan también aquellas variables emocionales positivas que han sido consideradas como moduladoras de la percepción dolorosa, como la resiliencia, la autoeficacia percibida y la empatía.(AU)

In 2020 the International Association for the Study of Pain reconceptualized chronic pain as an unpleasant sensory and emotional experience associated or similar to actual or potential tissue damage, adding greater complexity and certain nuances to the previous definitions, with the aim that this modification will lead to a better assessment and diagnosis and treatment of people suffering from CD. From this new definition, we must emphasize that pain is not only caused by a nociceptive (sensory) experience, but also encompasses the emotional sphere. In this sense, Chronic Pelvic Floor Pain (hereafter referred to as CPP) represents a challenge for healthcare professionals in terms of diagnosis and therapeutic management. Pelvic floor pathologies, of complex etiopathogenesis, have been frequently associated with psychopathological phenomena in the onset, maintenance and exacerbation of symptoms in addition to the personal, social and family repercussions that can determine a significant deterioration in the quality of life of the sufferer.A non-systematic narrative review has been performed in Pubmed, Scholar Google and manual search from 2012 to 2022. The experience of pelvic floor pain is analyzed from the psychological dimension (adverse childhood experiences, abuse and violence; stress and anxiety, catastrophizing and depression; kinesophobia, self-esteem and personality; sexual functioning) and the sociocultural dimension (stigma, gender bias, social support, labor and economic limitations). Positive emotional variables that have been considered as modulators of pain perception, such as resilience, perceived self-efficacy and empathy, are also incorporated.(AU)

Randomized Prospective Study in Patients With Complex Regional Pain Syndrome of the Upper Limb With High-Frequency Spinal Cord Stimulation (10-kHz) and Low-Frequency Spinal Cord Stimulation.

OBJECTIVE: The objective of this prospective randomized study of cases and controls was to evaluate the efficacy of treatment with low-frequency spinal cord stimulation (LF-SCS) and 10 kHz spinal cord stimulation (10-kHz SCS) in patients diagnosed with complex regional pain syndrome type I (CRPS) with upper limb involvement. MATERIALS AND METHODS: Fifty patients were randomized to receive conventional treatment or SCS with a commercially available low-frequency or 10-kHz system. Patients were assessed at 1, 3, 6, and 12 months. The primary endpoint was at 12-months post permanent implantation of the SCS devices. Outcome measures assessed included: Numerical Rating Scale (NRS), 12-Item Short-Format Health Survey (SF-12), Oswestry Disability Index (ODI), Study Sleep Scale medical outcomes (MOS-SS), Douleur Neuropathique 4 questions pain questionnaire (DN4), Patient Global Impression Scale on the impact of treatment improvement (PGI-I), Clinician Global Impression Scale on the impact of improving the patient (CGI-I). RESULTS: Forty-one patients were finally included in the analysis, 19 patients in the conventional treatment group, 12 in the LF-SCS group, and 10 in the 10-kHz SCS group. At the primary endpoint, patients treated with LF-SCS presented improvements in the NRS and DN4 outcomes around 2.4 and 1.5 times above the minimal clinically important difference (MCID) thresholds. At the primary endpoint, patients treated with 10-kHz SCS presented improvements in the NRS and DN4 outcomes around 2 and 1.4 times above the MCID thresholds. CONCLUSIONS: Patients experienced considerable improvement after SCS. The results show that LF-SCS has very good results when compared with conventional treatment. The results obtained with 10-kHz SCS are encouraging, with the advantages of the absence of paresthesia making it an alternative in the treatment of CRPS.

Diabetes does not affect outcome of symptomatic carotid stenosis treated with endovascular techniques.

BACKGROUND: The influence of diabetes on carotid revascularization techniques is controversial, with few data regarding angioplasty and stenting (CAS). Our purpose was to analyze whether its presence constitutes a risk factor for poor outcome of patients with carotid stenosis treated with CAS. METHODS: We compared 30-day and long term morbidity and mortality, as well as restenosis rates, of non diabetic and diabetic patients with symptomatic carotid stenosis treated with endovascular techniques. RESULTS: 318 consecutive patients, 116 (36.5%) of them diabetics, were followed for a median of 56 months. Cumulative 30-day stroke, ischemic cardiopathy and death rate was 4% for non diabetics and 5.2% for diabetics (non significant). Long term stroke and mortality rate was 26.4% for the first group and 34.3% for the second (non significant). The most frequent causes of death were myocardial infarction (17.5% non diabetics, 44% diabetics, p = 0.04), ischemic stroke (12.5% non diabetics, 4% diabetics, non significant) and cancer (30% non diabetics, 16% diabetics, non significant). Twelve patients (6.4%) had restenosis ≥ 50%, 5.9% non diabetic, 7.4% diabetic, also without statistical significance. CONCLUSIONS: In our series, endovascular treatment is both efficient and safe in diabetic patients with symptomatic carotid stenosis; therefore, the presence of diabetes mellitus did not increase the risks linked to CAS procedure.