Effectiveness of intradiscal ozone injections for treating pain following herniated lumbar disc: A systematic review and meta-analysis.

BACKGROUND: Low back pain and sciatica caused by herniated lumbar discs (HLDs) are common complaints among patients visiting pain clinics. Among the various therapeutic methods, intradiscal ozone injections have emerged as an effective alternative or additional treatment option for HLDs. OBJECTIVE: This meta-analysis aimed to investigate the effectiveness of intradiscal ozone injections in the treatment of HLDs. METHODS: We searched the PubMed, Embase, Cochrane Library, and Scopus databases for relevant studies published until January 25, 2024. We included studies that investigated the efficacy of intradiscal ozone injections in patients with HLDs. We evaluated the methodological quality of individual studies using the Cochrane Collaboration tool. RESULTS: At ⩾ 6 months after treatment, the therapeutic effect of intradiscal ozone injections in patients with HLDs was greater than that of steroid injections (treatment success rate, 6 months: odds ratio = 3.95, 95% confidence interval [CI] [2.44, 6.39], P< 0.01) or conventional medications (changes in the Visual Analog Scale [VAS], 6 months: standardized mean difference [SMD] = 1.65, 95% CI [1.08, 2.22], P< 0.01; 12 months: SMD = 1.52, 95% CI [0.96, 2.08], P< 0.01) but similar to that of microdiscectomy (changes in VAS, 18 months: SMD =-0.05, 95% CI [-0.67, 0.57], P= 0.87). At < 6 months after treatment, the reduction in the VAS score after intradiscal ozone injections was higher than that after steroid injections (changes in VAS, 1 month: SMD = 2.53, 95% CI [1.84, 3.21], P< 0.01). CONCLUSION: Intradiscal ozone injections may be a useful therapeutic tool in patients with HLDs. Compared with other conventional treatment methods such as steroid injections and oral medications, intradiscal ozone injection has great long-term (⩾ 6 months) effectiveness.

Incidence and Risk Factors of Systemic Adverse Effects and Complications of Ultrasound- and Fluoroscopy-Guided Glucocorticoid Injections: A Retrospective Cohort Study.

OBJECTIVES: The aims of the study are to assess the incidence of systemic adverse effects and complications of ultrasound-guided and fluoroscopy-guided glucocorticoid injections and to identify associated risk factors. DESIGN: This retrospective cohort study compared participants who received a glucocorticoid injection at the outpatient clinic and participants who had an appointment but did not receive a glucocorticoid injection. Participants were called to verify whether they had experienced any of the predetermined systemic adverse effects and complications. Multiple binary logistic regression was used to identify systemic adverse effect and complication risk factors. RESULTS: There were 1010 participants in the glucocorticoid injection group and 328 in the nonglucocorticoid injection group. There was no statistically significant difference in the occurrence of systemic infection and decompensated heart failure between the two groups. More participants in the glucocorticoid injection group developed abnormal uterine bleeding and erectile dysfunction, but the differences did not reach statistical significance. Female participants were 1.9 times more likely to develop systemic adverse effects ( P < 0.001). Younger age ( P < 0.001), diabetes ( P = 0.012), and higher glucocorticoid injection doses ( P = 0.024) were also associated with an increased risk of developing systemic adverse effects. CONCLUSIONS: Identified risk factors for developing glucocorticoid injection systemic adverse effects were younger age, female sex, diabetes, tobacco use, and high glucocorticoid injection doses.

Ease of Use and Usefulness of a Newly Developed Mobile App to Monitor Pain and Adherence Among Individuals With an Achilles Tendinopathy Engaged in a Rehabilitation Program.

OBJECTIVE: Assess the perceived ease of use and perceived usefulness of a newly developed mobile app. DESIGN: Descriptive survey study. SETTING: Home-based rehabilitation program. PARTICIPANTS: A group of 31 adults with a symptomatic Achilles tendinopathy. INTERVENTION: A mobile app was developed to support the deployment of the 12-week active exercise-based rehabilitation program and facilitate the monitoring of exercise adherence twice daily and the assessment of localized Achilles tendon pain using a numeric pain rating scale on a weekly basis. MAIN OUTCOME MEASURES: Results of an online survey encompassing 10 questions, each rated on a 5-point Likert scale (5 = strongly agree; 1 = strongly disagree). RESULTS: Nearly all participants agreed that the mobile app was easy to install (96.4%) and easy to use (100%). Most participants confirmed that no technical issues were encountered (96.4%). The instructional videos were deemed helpful in properly performing the recommended exercises (85.7%), whereas the prompts sent via text message were found to promote adherence (88.9%). The design and appearance of the mobile app were appreciated by a lower percentage of participants (75%). CONCLUSION: Participants confirmed the ease of use and usefulness of the newly developed mobile app and demonstrated a positive attitude toward its use.

Narrative Review of the Pathophysiology of Headaches and Photosensitivity in Mild Traumatic Brain Injury and Concussion.

The most common symptom of post-concussive syndrome (PCS) is post-traumatic headache (PTH) accompanied by photophobia. Post-traumatic headache is currently categorized as a secondary headache disorder with a clinical phenotype described by its main features and resembling one of the primary headache disorders: tension, migraine, migraine-like cluster. Although PTH is often treated with medication used for primary headache disorders, the underlying mechanism for PTH has yet to be elucidated. The goal of this narrative literature review is to determine the current level of knowledge of these PTHs and photophobia in mild traumatic brain injury (mTBI) in order to guide further research and attempt to discover the underlying mechanism to both symptoms. The ultimate purpose is to better understand the pathophysiology of these symptoms in order to provide better and more targeted care to afflicted patients. A review of the literature was conducted using the databases CINAHL, EMBASE, PubMed. All papers were screened for sections on pathophysiology of PTH or photophobia in mTBI patients. Our paper summarizes current hypotheses. Although the exact pathophysiology of PTH and photophobia in mTBI remains to be determined, we highlight several interesting findings and avenues for future research, including central and peripheral explanations for PTH, neuroinflammation, cortical spreading depolarization and the role of glutamate excitotoxicity. We discuss the possible neuroanatomical pathways for photophobia and hypothesize a possible common pathophysiological basis between PTH and photophobia.

Revue non systématique de la pathophysiologie des céphalées et de la photosensibilité dans le cas de traumatismes crânio-cérébraux légers. Les symptômes les plus courants du syndrome post-commotionnel (SPC) sont des céphalées post-traumatiques (CPT) accompagnées de photophobie. Ce type de céphalée est à l'heure actuelle considéré comme un trouble de nature secondaire dont le phénotype clinique et les caractéristiques ressemblent à ceux des céphalées dites primaires: tensions, migraines, maux de tête qui ressemblent à des migraines, algies vasculaires du visage, etc. Bien que les CPT soient souvent traitées par une médication utilisée dans le cas des céphalées dites primaires, il nous reste encore à élucider le mécanisme sous-jacent des CPT. L'objectif de cette revue non-systématique est de déterminer, chez des patients victimes de traumatismes crânio-cérébraux (TCC) légers, l'état actuel des connaissances concernant ce type de maux de tête et la photophobie qui y est associée, et ce, afin d'orienter les recherches ultérieures et de pouvoir découvrir les mécanismes qui président à l'apparition de ces deux symptômes. L'objectif ultime qui est le nôtre est de mieux comprendre la pathophysiologie de ces symptômes en vue de pouvoir offrir aux patients qui en sont atteints des soins mieux ciblés et de meilleure qualité. Nous avons ainsi mené une revue de la littérature au moyen des bases de données suivantes: CINAHL, Embase et PubMed. Tous les articles ont été passés au peigne fin en vue d'identifier, dans le cas de patients victimes de TCC légers, des passages portant sur la pathophysiologie des CPT ou sur la photophobie. Notre article entend aussi résumer les hypothèses actuelles qui portent sur cette question. Quoique la pathophysiologie précise des CPT et de la photophobie associée aux TCC légers restent à déterminer, nous avons mis en lumière plusieurs pistes et constats intéressants en vue d'activités de recherche futures, ce qui inclut des facteurs explicatifs d'origine centrale et périphérique, de la neuro-inflammation, des ondes lentes de dépolarisation (OLD) et le rôle de l'excitotoxicité du glutamate. Nous avons aussi abordé les possibles voies neuro-anatomiques de la photophobie en plus d'émettre l'hypothèse qu'il existe une pathophysiologie commune entre les CPT et la photophobie.