Procedural Pain During Lumbar Medial Branch Blocks With and Without Skin Wheal Anesthesia: A Prospective Comparative Observational Study.

OBJECTIVE: To determine if skin wheals reduce procedural pain associated with lumbar medial branch blocks (MBBs) performed with 25-gauge needles. DESIGN: Prospective comparative observational study. SETTING: Outpatient Physical Medicine & Rehabilitation and interventional pain practice within an academic tertiary care center. SUBJECTS: Ninety-nine consecutive patients who underwent lumbar MBBs for facet pain were included. Patients who were obese or required larger-diameter needles were excluded. METHODS: One to three facet joints were targeted per side, with some patients receiving bilateral procedures. All injections were performed with 25-gauge, 3.5-inch Quincke tip needles under fluoroscopic guidance. A total of 306 needle sticks were recorded. MBBs were performed without skin wheals or any other type of local anesthesia (35 patients, 108 needle sticks), with skin wheals (30 patients, 94 needle sticks), and in mixed groups (34 patients, 47 needle sticks with skin wheals, 57 needle sticks without skin wheals or other type of local anesthesia). Patients rated the pain of each needle placement immediately after the multilevel MBB procedure. RESULTS: Considering all 306 needle sticks, needles that were placed using skin wheals caused slightly more pain than those placed without skin wheals or any other type of local anesthesia (P = 0.007). CONCLUSIONS: Skin wheals do not reduce and may increase procedural pain associated with lumbar MBBs performed with 25-gauge needles.

The influence of resting blood pressure on muscle strength in healthy adults.

Adverse alterations in the skeletal muscle response to exercise have been noted among adults with hypertension. The influence of resting blood pressure (BP) on muscle strength is unknown. We hypothesized that adults with high BP would exhibit lower muscular strength than adults with normal BP. An isokinetic dynamometer tested 21 measures of isometric and isokinetic muscle strength. BP was measured by auscultation. Patients were categorized into having normal (<120 and <80 mmHg) or high (≥120 and/or ≥80 mmHg) BP. Height (cm) and weight (kg) were measured to calculate BMI (kg/m). Analysis of covariance tested differences in muscle strength between BP groups with sex, age, and height as covariates. Patients [420 (49%) men] were middle-aged (44.1±16.1 years) and overweight (26.4±4.8 kg/m) with 187 having normal (107.7±7.3/68.3±6.3 mmHg) and 233 having high (127.8±9.8/80.8±8.1 mmHg) BP. For upper body, three of five extension measures and five of five flexion measures, as well as handgrip, were greater in the high than the normal BP group (P≤0.05). For lower body, five of five extension measures were greater in the high than the normal BP group, whereas there were no differences between BP groups for the five flexion measures (P>0.05). Contrary to our hypothesis, adults with high BP displayed greater muscle strength than adults with normal BP. Reasons for our findings are unclear, but may be because of shifts in muscle fiber type from type I to type IIb/x and oxidative to glycolytic metabolism; alterations may result in a more strength-adapted phenotype among adults with high BP such as we observed.

Aspirin is an effective pretreatment for exercise in multiple sclerosis: A double-blind randomized controlled pilot trial.

Exercise benefits multiple sclerosis (MS) patients, but exercise-induced overheating is a deterrent for many. We conducted a double-blind crossover-design placebo-controlled pilot of aspirin to increase time-to-exhaustion (TTE) and reduce exercise-induced body temperature increase. A total of 12 patients participated. At enrollment, 8 of 12 reported heat sensitivity during exercise. After 650 mg of aspirin or placebo, participants performed lower body cycle ergometer exercise test. TTE increased after aspirin compared to placebo: t(11) = 2.405, p = 0.035 (Cohen's d = 1.45). Body temperature increase after exercise with acetylsalicylic acid (ASA) was reduced by 56% in heat-sensitive patients, although limited power precluded statistical significance. Aspirin may represent an effective pretreatment for exercise in MS.