The Physiological Impact of Melatonin, Its Effect on the Course of Diseases and Their Therapy and the Effect of Magnetic Fields on Melatonin Secretion-Potential Common Pathways of Influence.

Melatonin is a relic, due to its millions-of-years-old presence in chemical reactions, found in evolutionarily diverse organisms. It has a multidirectional biological function. It controls diurnal rhythms, redox homeostasis, intestinal motor functions, mitochondrial biogenesis and fetal development and has antioxidant effects. It also has analgesic and therapeutic effects. The purpose of this paper is to describe the role of melatonin in vital processes occurring in interaction with the environment, with particular reference to various magnetic fields ubiquitous in the life of animate matter, especially radio frequency/extra low frequency (RF/ELF EMF) and static magnetic fields. The most important part of this article is to describe the potential effects of magnetic fields on melatonin secretion and the resulting possible health effects. Melatonin in some cases positively amplifies the electromagnetic signal, intensifying health effects, such as neurogenesis, analgesic effects or lowering blood pressure. In other cases, it is a stimulus that inhibits the processes of destruction and aggravation of lesions. Sometimes, however, in contrast to the beneficial effects of electromagnetic fields in therapy, they intensify pathogenic effects, as in multiple sclerosis by intensifying the inflammatory process.

The Role of Rehabilitation after Spinal Mesotherapy in a Three-Stage Treatment Concept.

Sedentary lifestyles, work overload, and lack of regular physical activity are risk factors for spinal pain syndrome. In everyday medical practice, spinal pain syndrome of a muscular or myofascial, or non-neurogenic, nature is diagnosed. This problem affects a large group of patients and reaches about 70-80% of spinal pain cases. Usually, one of the primary treatments is with NSAIDs (Non-steroidal Anti-Inflammatory Drugs). In this case, one treatment method that is safe and has no side effects is spinal mesotherapy. This method consists of performing multi-point intradermal microinjections with the administration of drugs or medical devices. Based on a new perspective on the treatment of spinal pathology-the so-called three-stage treatment concept-it is necessary to deal with the risk factor(s) of spinal pain syndrome and reduce or at least modify them (stage I). This is followed by a broadly understood medical therapy, in this case spinal mesotherapy (stage II), which aims to relax tense tissues, improve mobility in the spine and thus reduce pain. As a result, conditions are created for the necessary process, which is rehabilitation in the broadest sense (stage III). Movement therapy, which is crucial in spinal pain syndrome, is performed with less pain, after obtaining better patient mobility. The purpose of this article is to evaluate the role of rehabilitation of patients after spinal mesotherapy in terms of the three-stage treatment concept for spinal pathology.

A three-stage concept of spine pathology treatment - a different perspective.

Spinal pathologies develop in patients of all ages and may have various underlying factors. These factors include, among others, myofascial pain syndromes, disc herniation and spinal degeneration. Treatment alone, both causal and symptomatic, is not always sufficient in certain situations. The aim of this paper is to discuss the question of comprehensive treatment of spine pathologies focusing on a three-stage treatment concept. An important aspect is to determine the risk factors and their reduction, or at least modification, i.e. the first stage of the discussed treatment concept. Then, medical treatment aimed at a specific pathology, including both conservative and surgical methods, allows the cause of the pathology to be removed, i.e. the second stage of the discussed concept. And finally, timely and specialized, broadly understood rehabilitation allowing to maintain the effect of medical therapy. The implemented rehabilitation can be considered as the third stage of the discussed treatment concept.

Efficacy and Safety of Spinal Collagen Mesotherapy in Patients with Chronic Low Back Pain in a Three-Month Follow-Up-Retrospective Study.

Background: Low back pain syndrome is associated with muscular and myofascial pain and is linked with muscle overstrain or a lack of regular physical activity as well as a habitual bad posture, which cause the overload of perispinal soft tissues. One of the forms of therapy of LBP is the mesotherapy of the spine, which consists of multi-point micro-injections of drugs or medicine mixtures, which include preparations of collagen type I. The aim of the study was to assess the efficacy and safety of mesotherapy with collagen type I. Methods: A retrospective analysis of the results of the treatment of patients with chronic low back pain syndrome using mesotherapy was performed. A total of 130 patients (83 women and 47 men; mean age: 51 ± 14 years) were divided into two groups: group I (n = 65), treated with collagen type I, and group II (n = 65), treated with lignocaine 1%. Mesotherapy was performed weekly over five weeks. Patients were assessed using the following scales: the VAS, Laitinen Scale, and Revised Oswestry Low Back Pain Disability Scale before the start of the treatment, after five treatments, and at the three-month follow-up visit. Results: A statistically significant improvement was observed after the use of spinal mesotherapy both with collagen type I and lignocaine, with the collagen treatment having better results at the three-month follow-up visit. No adverse effects were observed after the procedures. Conclusions: Spinal mesotherapy using collagen type I and lignocaine seems to be an effective method in the treatment of chronic LBP. Collagen mesotherapy gives better results in the long term. Mesotherapy is a safe form of therapy.

Changes in Melatonin Concentration in a Clinical Observation Study under the Influence of Low-Frequency Magnetic Fields (Magnetic Stimulation in Men with Low Back Pain)-Results of Changes in an Eight-Point Circadian Profile.

The aim of this study was to assess the changes in melatonin concentration under the influence of magnetic stimulation in men with low back pain. A total of 15 men were used in this study, divided into two groups. In Group 1, consisting of seven men, the M1P1 Viofor JPS program was used twice a day for 8 min, at 08:00 and 13:00. In Group 2, consisting of eight men, the M2P2 Viofor JPS program was used once a day for 12 min at 10:00. The application was subjected to the whole body of patients. The treatments in both groups lasted 3 weeks, for 5 days each week, with breaks on weekends. The diurnal melatonin profile was determined the day before exposure and the day after the last treatment, as well as at one-month follow-up. Blood samples were collected eight times a day. In both programs, magnetic stimulation did not reduce the nocturnal peak of melatonin concentration. After exposure, prolonged secretion of melatonin was observed until the morning hours. The impact of the magnetic field was maintained 1 month after the end of the application. The effect of the magnetic field was maintained for 1 month from the end of the application, which confirms the thesis about the occurrence of the phenomenon of biological hysteresis. The parameters of the magnetic fields, the application system, and the time and length of the application may affect the secretion of melatonin.

Relationship between Cervical Instability in the Course of Rheumatoid Arthritis and Pelvic Parameters of Sagittal Balance.

BACKGROUND: The aim of the study is to search for a relationship between cervical instability in the course of rheumatoid arthritis (RA) and pelvic parameters of sagittal balance and lumbar lordosis (LL). METHODS: The study included 47 patients with rheumatoid arthritis with instability of the cervical segment, who were referred for a consultation to assess indications for surgical treatment. The patients underwent a radiological functional examination of the cervical region and postural examination of the entire spine. The basic parameters of the lumbar section and pelvis of these patients were compared with the population values. Then, using statistical methods, the correlation between radiological parameters of various types of instability and lumbar lordosis (LL), pelvic parameters (PI, SS, PT), as well as the patient's age and duration of the disease was assessed. RESULTS: A statistical correlation was found between the instability in the cervical spine C2-C3 level and the value of the PT and PI angles. A statistically significant correlation was discovered between C1-C2 instability and younger patient age. There was no significant difference in the values of the pelvic parameters and lumbar lordosis in patients with rheumatoid arthritis compared to the population values. CONCLUSIONS: Preliminary results suggest that there is a relationship between selected pelvic parameters and the development of instability in patients with rheumatoid arthritis. This may be important in planning treatment and assessing disease progression. Further studies on a larger group of patients are needed, as well as studies evaluating the correlation between other sagittal balance parameters and cervical instability in patients with RA.

Analgesic Effectiveness of Physical Therapy Combining the Use of Electromagnetic Fields with Light Radiation Emitted by LEDs along with the Use of Topical Herbal Ointment in Patients with Gonarthrosis.

(1) Background: The aim of the study is to evaluate the analgesic effectiveness of a physical therapy regimen that combines the use of an electromagnetic field with light radiation emitted by LEDs, along with the use of Traumeel S ointment, in patients with gonarthrosis. (2) Methods: The study included 90 patients with knee osteoarthritis (grade 2 Kellgren and Lawrence osteoarthritis). They were divided into three groups: Group I, 30 patients treated with magnetic stimulation plus LED therapy; Group II, 30 patients treated with Traumeel S ointment; and Group III, 30 patients treated with magnetic stimulation plus LED therapy with Traumeel S ointment. Pain intensity was assessed using the VAS and Laitinen scales before and after a series of treatments. (3) Results: Significant results in terms of pain reduction before and after treatment were obtained in each of the study groups, as there were significant differences in the VAS pain intensity scores before and after the procedures between the groups. In group I, with electromagnetic field and LED light treatment, the difference was 35.5; in group II, which received Traumeel S® ointment, the difference was 18.5; and in group III, with electromagnetic field and LED light treatment as well as Traumeel S ointment, the difference was 26.5. In the Laitinen scale, the differences were insignificant, although the size distribution was similar. (4) Conclusions: The therapy used in this study showed that magnetic stimulation plus LED therapy and the use of Traumeel S ointment gave positive results in terms of pain reduction in each of the study groups. The strongest analgesic factor seems to be magnetic and LED therapies used separately. Traumeel S in magnetoledophoresis does not work synergistically with the magnetic field of LED light, and even worsens the effect of the therapy used.

Ultrasound-Guided Blocks for Spine Surgery: Part 1-Cervix.

Postoperative pain is common following spine surgery, particularly complex procedures. The main anesthetic efforts are focused on applying multimodal analgesia beforehand, and regional anesthesia is a critical component of it. The purpose of this study is to examine the existing techniques for regional anesthesia in cervical spine surgery and to determine their effect and safety on pain reduction and postoperative patient's recovery. The electronic databases were searched for all literature pertaining to cervical nerve block procedures. The following peripheral, cervical nerve blocks were selected and described: paravertebral block, cervical plexus clock, paraspinal interfascial plane blocks such as multifidus cervicis, retrolaminar, inter-semispinal and interfacial, as well as erector spinae plane block and stellate ganglion block. Clinicians should choose more superficial techniques in the cervical region, as they have been shown to be comparably effective and less hazardous compared to paravertebral blocks.

Age and Sex in Back Pain Intensity-Retrospective Study of Conservatory vs. Surgical Discopathy Treatment.

(1) Background: The frequency of back pain diagnosis and treatment has markedly increased in recent years. Back pain may be caused by many factors and discopathy is one of them. The aim of the study was to assess the impact of age and sex on back pain intensity in rehabilitated patients with discopathy treated conservatively and surgically; (2) Methods: The study included 137 patients: 96 undergoing conservative therapy and 41 after back surgery due to discopathy. VAS and the Laitinen scale were used for pain assessment. All patients underwent a multidirectional rehabilitation program at the Department of Rehabilitation and Physical Medicine of the Medical University in Lódz; (3) Results: No statistically significant effect of age and sex was observed on the level of pain intensity on VAS and the Laitinen scale; (4) Conclusions: Age and sex do not seem to affect back pain intensity in rehabilitated patients treated conservatively and surgically for discopathy. The problem requires further research on a larger group of patients.

Retrospective Analysis of FED Method Treatment Results in 11-17-Year-Old Children with Idiopathic Scoliosis.

(1) Background: Idiopathic scoliosis is a major treatment problem due to its unknown origin and its three-dimensional nature. Attempts to cure it and search for new methods of physiotherapeutic treatment that would lead to its correction are one of the key issues of modern medicine. One of them is the fixation, elongation, de-rotation method (FED), used in the conservative treatment of idiopathic scoliosis. The aim of the study was evaluation of the short-term effectiveness of the FED method in the treatment of patients with idiopathic scoliosis. (2) Methods: Each patient underwent therapy based on the guidelines of the FED method. Patients were tested with the Bunnell scoliometer and the Zebris computer system. The treatment period was three weeks, after which the examinations were repeated. (3) Results: The results appeared to be statistically significant for all tested variables. (4) Conclusions: The examinations showed that the FED method had a statistically significant effect on the improvement of all parameters of posture examination, regardless of the size of the scoliotic deformation angle and bone maturity.

Chronic-Exposure Low-Frequency Magnetic Fields (Magnetotherapy and Magnetic Stimulation) Influence Serum Serotonin Concentrations in Patients with Low Back Pain-Clinical Observation Study.

(1) Background: The influence of serotonin on many regulatory mechanisms has not been sufficiently studied. The use of a physical method, assuming the possibility of its action on increasing the concentration of serotonin, may be the direction of therapy limiting the number of antidepressants used. The aim of the research was to study the effects of low-frequency magnetic fields of different characteristics on the circadian profile of serotonin in men with low back pain. (2) Methods: 16 men with back pain syndrome participated in the study. The patients were divided into two groups. In group 1, magnetotherapy (2.9 mT, 40 Hz, square wave, bipolar) was applied at 10.00 a.m. In group 2, the M2P2 magnetic stimulation program of the Viofor JPS device was used. Treatments in each group lasted 3 weeks, 5 days each, with breaks for Saturday and Sunday. The daily serotonin profile was determined the day before the exposure and the day after the last treatment. Blood samples (at night with red light) were collected at 8:00, 12:00, 16:00, 24:00, and 4:00. The patients did not suffer from any chronic or acute disease and were not taking any medications. (3) Results: In group 1, a significant increase in serotonin concentration was observed after 15 treatments at 4:00. In group 2, a significant increase in serotonin concentration was observed at 8:00 after the end of the treatments. In comparison between magnetotherapy and magnetic stimulation, the time points at which differences appeared after the application of serotonin occurred due to the increase in its concentrations after the application of magnetic stimulation. (4) Conclusions: Magnetotherapy and magnetic stimulation, acting in a similar way, increase the concentration of serotonin. Weak magnetic fields work similarly to the stronger ones used in TMS. It is possible to use them in the treatment of mental disorders or other diseases with low serotonin concentrations.

Analysis of Posture Parameters in Patients with Idiopathic Scoliosis with the Use of 3D Ultrasound Diagnostics-Preliminary Results.

(1) Background: Idiopathic scoliosis occurs in 2 to 4% of children between 10 and 16 years of age. Due to the harmfulness of radiological examination, non-invasive devices, including the 3D ultrasound technology and Scolioscan apparatus, are more and more frequently used for postural diagnostics. The aim of the study was to analyze the parameters of posture in patients with idiopathic scoliosis with the use of 3D ultrasound diagnostics. (2) Methods: The study included 20 girls, aged 10 to 16 years, with double-curve idiopathic scoliosis (the value of primary curve ranged from 25-50°), types I and II according to King-Moe classification. On the basis of X-ray scan, the Cobb angle of primary and secondary curves was assessed, the skeletal maturity was evaluated with the Risser test, and the type of scoliosis was determined. The girls participated in a 3-week rehabilitation program. The examinations were performed before and after therapy. A scoliometer was used for measurements. Each of the participants underwent individual therapy. The three-plane approach to asymmetric exercises was based largely on positions that included primary curve correction with hypercorrection of the secondary curve. (3) Results: After the therapy, values of trunk rotation angles and the angle of scoliotic curvature of secondary curve were significantly lower than before the therapy, except for the value of the primary curve angle. The parameters measured by X-ray were significantly and positively related to the results obtained with the scoliometer and the scolioscan. (4) Conclusions: The application of therapy that takes into account summing parameters may prevent the deterioration of the secondary curve when treating patients with idiopathic scoliosis. The observed correlations between the parameters of the radiological examination, the scoliometer, and the scolioscan prove the possibility of their interchangeable application in the assessment of effects of the therapy. Three-dimensional ultrasound diagnostics may become an alternative to radiological examination in assessing the treatment effects of patients with idiopathic scoliosis.

The effect of smoking on back pain intensity in rehabilitated patients treated conservatively and surgically for discopathy.

INTRODUCTION: Back pain is now a very common phenomenon. It is caused by various pathologies in the area of the motor unit of the spine. These changes can cause pressure on the nerve structures within the spinal canal, resulting in various ailments. Pain is the most common symptom. In most cases, patients are qualified for conservative management. In the case of neurological deficits, the patient is qualified for spinal surgery. Unfortunately, surgical treatment is not always 100% effective therapy method. Moreover, many external factors, such as smoking for instance, can affect the process of tissue healing and decide on the time of recovery. OBJECTIVE: The aim of the study was to assess the impact of smoking on back pain intensity in rehabilitated patients with discopathy treated conservatively and surgically. MATERIAL AND METHODS: The study included 41 patients after surgical treatment (9 smokers) and 96 patients (20 smokers) undergoing conservative therapy for back pain due to discopathy. All patients underwent a multidirectional rehabilitation programme at the Department of Rehabilitation and Physical Medicine of the Medical University in Lódz. RESULTS: The Laitinen scale was used to assess the patients' pain. Rehabilitation of patients with back pain due to discopathy had a significant analgesic effect (p <0.0001). Furthermore, there was observed a statistically significant effect of smoking on the level of pain intensity on the Laitinen scale in the group of patients who underwent surgery (p <0.0469). The smokers operated on had significantly worse results. CONCLUSIONS: 1) Complex rehabilitation of patients with back syndrome pain due to discopathy demonstrated significant analgesic effectiveness. 2) Smoking significantly worsens the results of the therapy in patients who underwent surgery.

Effectiveness of the FED Method in the Treatment of Idiopathic Scoliosis of Girls Aged 11-15 Years.

(1) Background: The unknown etiology of idiopathic scoliosis and its three-dimensional nature make the cause-and-effect therapeutic management difficult. A tendency to progression of scoliosis and the failure of many methods of conservative treatment have prompted the search for new methods that would stop and correct deformations. One of them is the FED method, used in the conservative treatment of idiopathic scolioses, in which all scoliotic curves are corrected. The aim of this study was a comparative analysis of the effectiveness of idiopathic scoliosis treatment with the FED and FITS methods. (2) Methods: The study included 60 randomly selected girls, aged 11 to 15 years, treated with the FED and FITS methods. They were diagnosed with idiopathic scoliosis grade II according to Cobb and double-curve scoliosis type I and II according to King-Moe classification. The results of the therapy were assessed with the use of the Bunnell scoliometer. The examinations were performed before the start of the therapy-on the first day of the child's stay-and 3 weeks after the therapy. The angle of trunk rotation and the sum of two rotations were assessed using a scoliometer. (3) Results: The performed statistical analysis demonstrated significant changes in the examined parameters in both therapeutic groups. (4) Conclusions: 1. The obtained results indicate that the FED therapy may prove to be an effective method of treating idiopathic scoliosis; however, it requires further research in a larger group of patients; 2. both methods significantly improved trunk rotation in primary and secondary scoliosis, but after using summing parameters (SDR parameter), the FED method appeared to be statistically more effective.

[An assessment of the effectiveness of comprehensive neurorehabilitation in patients after ischemic stroke].

OBJECTIVE: Introduction: Comprehensive rehabilitation after stroke is to help the patient recover optimal physical and mental condition. The multidirectional approach to the patient implemented by a multidisciplinary team: physicians, physiotherapists, neurologopedians and neuropsychologists allows the best use of the patient's potential. The aim: To evaluate the effectiveness of comprehensive neurological rehabilitation of patients after ischemic stroke. PATIENTS AND METHODS: Materials and methods: The 90 patients after ischemic stroke were examined. The first examined group (45 people) consisted of patients rehabilitated at the Department of Rehabilitation and Physical Medicine of the WAM University Hospital in Lodz. The second examined group number (45 people) consisted of patients waiting for admission to the Department of Rehabilitation, who were rehabilitated in environmental conditions. The patients were examined twice: first before the rehabilitation (study I) and then at the end of rehabilitation program (study II). The ADL Index by Barthel was used to assess the functional status of the patients. In addition, speech disorders (SODA scale) and emotional state (Beck Depression Scale) were assessed in patients. RESULTS: Results: Both individuals after stroke rehabilitated in hospital and those rehabilitated in environmental conditions achieved a significant improvement in activities of daily living and improvement in speech - symptoms of aphasia were withdrawn. However, only stroke patients rehabilitated in hospital conditions achieved a significant improvement in the emotional state. CONCLUSION: Conclusions: Stroke patients rehabilitated in hospital conditions have significantly improved their functional status and emotional state compared to patients rehabilitated in environmental conditions.

[The assessment of the impact of rehabilitation on the pain intensity level in patients with herniated nucleus pulposus of the intervertebral disc]. / Wplyw rehabilitacji na poziom natezenia dolegliwosci bólowych u chorych z zespolem bólowym kregoslupa po nieskutecznym zabiegu operacyjnym.

Back disorders are very common phenomena in modern society. One of the methods of spinal pain treatment is performing surgery. Unfortunately, this method is not one hundred percent effective. Some patients show no improvement after surgery, the pain persists and even increases. In these cases, it is reasonable to use the term Failed Back Surgery Syndrome (FBSS), i.e. back pain syndrome after unsuccessful spine surgery. AIM: The aim of the study is to assess the impact of rehabilitation on the pain intensity level in patients with FBSS. MATERIALS AND METHODS: The study was conducted in a group of 38 patients aged from 32 to 87 (mean age 61 years), including 20 women and 18 men. All patients were operated for spinal pain syndrome. Afterwards, they underwent rehabilitation because of persisting pain after the surgery. For the pain assessment was used The Visual- Analogue Scale and The Laitinen Modified Questionnaire Indicators of Pain. The results were statistically analyzed. RESULTS: The study showed the high efficacy of specialized rehabilitation in patients with FBSS. CONCLUSIONS: The rehabilitation in patients with FBSS has a significant analgesic effect. Rehabilitation should be a gold standard in patients with FBSS.

[The assessment of the impact of rehabilitation on the pain intensity level in patients with herniated nucleus pulposus of the intervertebral disc]. / Ocena wplywu rehabilitacji na poziom natezenia dolegliwosci bólowych u chorych z przepuklina jadra miazdzystego krazka miedzykregowego.

Back pain may be caused by many factors. In many cases it is difficult to unambiguously determine a cause of the pathology, which can involve various structures in the spine. In this paper we will discuss the symptoms associated with the degenerative changes of the intervertebral disc, which involve, among others, its bulging, dislocation and pressure on the surrounding structures. These problems require an adequate clinical and imaging diagnostics in order to implement an appropriate treatment. In the first place, it should be based on the conservative methods (such as: pharmacotherapy, rehabilitation and lifestyle changes). Only in the absence of improvement it is recommended to consider a surgical treatment. AIM: The aim of the study is to assess the impact of rehabilitation on the pain intensity level in patients with herniated nucleus pulposus of the intervertebral disc. MATERIALS AND METHODS: The study was performed in 46 patients (age range: 19-85), including 26 women and 20 men. On the basis of imaging, all patients showed the presence of a slipped disc with disc herniation. The patients were treated conservatively. For pain assessment was used the The Laitinen Modified Questionnaire Indicators of Pain and The Visual- Analogue Scale. The results were statistically analyzed. RESULTS: The results clearly demonstrate the analgesic efficacy of specialized rehabilitation in the spinal pain syndrome in a discopathy with a spinal disc herniation of an intervertebral disc. CONCLUSIONS: The rehabilitation of patients with a back pain due to the presence of herniated nucleus pulposus has a significant analgesic effect. In the case of a presence of the herniated nucleus pulposus, the rehabilitation should be considered in a first place. If no improvement, a possible surgery should be considered. An important element of a conservative treatment is an effective rehabilitation, which is of vital economic importance, because a therapy including surgery usually requires subsequent rehabilitation and is much more expensive.