Comparison of 2 methods of neuropathic pain assessment in carpal tunnel syndrome and hand functions.

OBJECTIVE: To compare the effectiveness of the Leeds Assessment of Neuropathic Symptoms and Signs Scale (LANSS) to the painDETECT questionnaire (PD-Q) in Carpal Tunnel Syndrome (CTS), and determine if there are any differences between hand related functions in the 2 questionnaires. METHODS: This prospective clinical trial was conducted from April to July 2014. Ninety patients with a positive Tinel or Phalen sign were recruited. Hands were evaluated by electromyography and grouped according to mild, moderate or severe involvement. Neuropathic pain was analysed by the LANSS and the PD-Q; hand functions were evaluated by the Duruoz Hand Index (DHI), Semmes Weinstein monofilaments and grip strength. RESULTS: Electromyographic findings revealed 32.9% of hands had mild, 61.8% had moderate and 5.3% had severe CTS. There was a correlation between the LANSS scores and the Visual Analogue Scale (VAS) pain, while the PD-Q scores were correlated with the VAS pain, DHI and Semmes Weinstein Monofilaments (SWM). Comparison of the hand related parameters of the questionnaires showed there was a statistically significant difference between the 2 groups with respect to the DHI and SWM tests in the PD-Q. However, there was no difference in the LANSS. CONCLUSION: Although there was a significant correlation between the LANSS and PD-Q scores, the PD-Q scores revealed better correlation coefficients in VAS pain, DHI scores and SWM tests. In conclusion, the PD-Q seems to be better than the LANSS both in neuropathic pain and in detecting functions related to hand abilities.

Evaluation of the efficacy of pulsed radiofrequency therapy in patients with lumbosacral radicular pain: An analysis of single-center data.

OBJECTIVES: Lumbosacral radicular pain (LRP) is one of the most common causes of neuropathic pain. This pain often arises from inflammation in the dorsal root ganglia (DRG) or spinal nerves. Despite various treatment modalities, success rates are not very high in chronic LRP cases. Pulsed radiofrequency (PRF) therapy, frequently applied to the DRG, is widely used, but its effectiveness is often questioned in various studies. The primary aim of our study is to evaluate the effectiveness of PRF treatment in 154 patients. METHODS: Patients with LRP for longer than 3 months, treated with PRF, were included in this study. To assess the efficacy of PRF treatment, numerical rating scale (NRS) scores were evaluated at the 4th-week and 6th-month follow-ups. RESULTS: The NRS scores were significantly lower at the 4th-week and 6th-month follow-ups compared to pre-treatment levels (p<0.001). However, there was no significant difference between the mean NRS scores at the 4th week and 6th month. CONCLUSION: Success in interventional pain procedures is often considered as at least a 50% reduction in pain scores. The success rate for PRF treatment for LRP in the literature varies between 30% and 60%, which is similar to our findings at the 4th week and 6th month. PRF treatment is widely used due to its low side-effect profile and cost-effectiveness in the long term. There is no fully standardized practice regarding procedural aspects, such as the duration of the application, and prospective studies with larger participation are needed.

Effect of neuropathic pain on sphenopalatine ganglion block responses in persistent idiopathic facial pain.

OBJECTIVES: Management of persistent idiopathic facial pain (PIFP) can be challenging. Sphenopalatine ganglion (SPG) has been the target for the interventional treatment of many facial pain syndromes. However, possible factors that may affect SPG block success are unknown. It was aimed to investigate the effect of neuropathic pain on SPG block outcomes in PIFP, which includes a heterogeneous patient group. METHODS: All of the patients underwent fluoroscopy-guided SPG block with an injection of 40 mg of 2% lidocaine and 8 mg of dexamethasone. The patients were assigned to 2 groups according to existence of neuropathic pain determined with the DN4 questionnaire score: 19 patients with neuropathic pain (Group 1) and 15 patients without neuropathic pain (Group 2). Preprocedural and postprocedural Visual Analog Scale (VAS) scores were compared between the 2 groups. RESULTS: The mean age of the patients was 47.65 ± 6.50 years. The average pain duration was 52.95 ± 34.81 weeks. A significantly greater decrease was detected in the VAS scores at 1 week (p = 0.036) and 1 month (p < 0.001) in Group 1 when compared to Group 2. Moreover, the proportion of patients with >50% improvement in the VAS scores at 1 week (p = 0.012) and 1 month (P = 0.017) was significantly lower in Group 1 than in Group 2. DISCUSSION: SPG block appears as a safe, effective, and rapid method to treat PIFP, especially in cases with neuropathic pain. Neuropathic pain may be a predictor for pain relief in interventional procedures targeting SPG in the treatment of PIFP.

Effects of splinting and three injection therapies (corticosteroid, autologous blood and prolotherapy) on pain, grip strength, and functionality in patients with lateral epicondylitis.

Objectives: This study aims to compare the efficacy of the wrist splint and the injection of corticosteroid, autologous blood, and hypertonic dextrose in the treatment of lateral epicondylitis (LE). Patients and methods: A total of 120 patients (43 males, 77 females; mean age: 45.7±7.7 years; range, 18 to 65 years) diagnosed with LE between December 2013 and June 2015 were included in the study and randomized into four groups. The first group was administered 20 mg methylprednisolone acetate + 2 mL 2% prilocaine, the second group 2 mL venous blood + 0.5 mL prilocaine, and the third group 2 mL 30% dextrose + 0.5 mL prilocaine injections. A second injection was administered to the third group one month later. The fourth group was recommended to use only a wrist splint. Pre-treatment and post-treatment evaluations of the patients were carried out at one and six months by the Visual Analog Scale (VAS) in terms of pain, by Patient-Rated Tennis Elbow Evaluation (PRTEE) questionnaire in terms of functional level, and by the Jamar dynamometer in terms of grip strength. Results: In all groups, VAS values at one and six months after treatment were found to be lower in comparison to baseline. Except for the splint group, a significant improvement was observed in all three injection groups in terms of grip strength and PRTEE values at six months compared to the baseline values. In the comparison of the groups, no significant difference was observed in terms of improvement in VAS scores and grip strength. While corticosteroid injection was significantly effective in terms of PRTEE pain, function, and total scores only at one month, the autologous injection was effective in terms of PRTEE function and total scores at only six months after treatment. There were no significant differences for splint and prolotherapy groups in terms of PRTEE scores. Conclusion: Corticosteroid injection, autologous blood injection, and prolotherapy are effective and safe long-term methods in LE treatment.

Comparison of an epicondylitis bandage with a wrist orthosis in patients with lateral epicondylitis.

BACKGROUND:: Lateral epicondylitis is one of the most common causes of elbow pain. It is generally observed in people between the ages of 40 and 50 years, and the dominant extremity is more frequently affected. Various noninvasive methods are frequently used; however, studies investigating the effectiveness of the orthoses are limited and with controversial outcomes. OBJECTIVE:: To investigate the effectiveness of a hand-wrist resting orthosis and an epicondylitis bandage in lateral epicondylitis. STUDY DESIGN:: Randomized controlled trial. METHODS:: In total, 82 patients diagnosed with unilateral lateral epicondylitis were enrolled into the study. Hand-wrist resting orthosis was applied to 45 patients and epicondylitis bandage was applied to 41 patients. Patients were evaluated before treatment and at 6 weeks after treatment with a Visual Analogue Scale; Disabilities of the Arm, Shoulder, and Hand questionnaire; the Short Form 36; and a determination of hand grasping force. RESULTS:: Both groups were similar in terms of age, body mass index, gender, frequency of lateral epicondylitis on the dominant side, dominant extremity, and duration of complaints ( p > 0.05). A statistically significant recovery was detected in both groups between the pre-therapy values and the values at the sixth week in terms of Visual Analogue Scale scores; Disabilities of the Arm, Shoulder, and Hand questionnarie scores; hand grasping forces; and the Short Form 36 mental and physical component scores ( p < 0.05). However, there were no significant differences detected between the two therapy methods before the therapy and at the sixth week of treatment in all parameter values ( p > 0.05). CONCLUSION:: Our results suggest that both epicondylitis bandage and hand-wrist resting orthosis are effective treatment options for lateral epicondylitis-induced pain, functional status, muscle strength, and quality of life. Furthermore, neither treatment option was superior to the other. Large, randomized studies are necessary for more clear statements. CLINICAL RELEVANCE: Epicondylitis bandage and hand-wrist resting orthosis are equally effective treatment options for lateral epicondylitis-induced pain, functional status, muscle strength, and quality of life.

The comparative efficacy of kinesio taping and local injection therapy in patients with subacromial impingement syndrome.

OBJECTIVE: The aim of this study was to compare the therapeutic effects of kinesio taping (KT) and local subacromial injection in patients with subacromial impingement, syndrome (SIS) with regard to pain, range of motion (ROM) and disability. METHODS: Sixty-one patients (48 females and 13 males; mean age: 43.04 ± 6.31, years) with SIS were enrolled into the study. The patients were randomized into two treatment groups receiving either a single corticosteroid and local anesthetic (LA) injection, or kinesio taping performed three times by intervals of 3 day. Visual analog scale (VAS) was used to assess pain intensity, range of motion (ROM) degrees of, shoulder were recorded and Shoulder Pain and Disability Index (SPADI) was, performed to evaluate functional disability, before treatment, at the first and fourth, weeks after therapies. A exercise program was prescribed for both groups including pendulum, active range of motion (ROM) and strengthening exercises. RESULTS: Pain, functional outcome measures were determined to have improved significantly in both groups at the end of therapies at first and fourth weeks (p < 0.05), but these improvements were more significant in the injection group than in kinesio taping group (p < 0.05). The improvements in pain at rest, shoulder abduction degrees, and SPADI scores at first and fourth weeks were statistically higher in injection group than in kinesio taping group. CONCLUSION: Although the improvement in pain intensity at rest, ROM and disability were better with local injection, KT may be an alternative noninvasive method to local subacromial injection for patients suffering from subacromial impingement syndrome. LEVEL OF EVIDENCE: Level I, Therapeutic study.

Gabapentin Treatment for Neuropathic Pain in a Child with Sciatic Nerve Injury.

There are a restricted number of studies about usage of gabapentin for neuropathic pain treatment of pediatric patients. We shared a 12-year-old male case with severe neuropathic pain that hindered the rehabilitation programme for the loss of muscle power and movement limitation. Neuropathic pain developed after peripheral sciatic damage due to firearm traumatisation did not respond to other medical treatments but healed nearly completely after gabapentin usage.