Patients with neuropathic pain from lumbosacral radiculopathy demonstrate similar pressure pain thresholds and conditioned pain modulation to those with fibromyalgia.

OBJECTIVE: The purpose of the study was to evaluate pain thresholds, impairment of the endogenous pain modulatory system, and self-reported cognitive-emotional and central sensitization-related symptoms among three subject groups: a rarely studied patient cohort with neuropathic pain from lumbosacral radiculopathy (NPLSR), patients with fibromyalgia (FM) and healthy controls (HC). METHODS: Patient-reported pain-related symptomology was evaluated with psychometricallyvalidated questionnaires. Pressure pain threshold (PPT), heat pain threshold (HPT), and cold pain threshold (CPT) were assessed in the low back and contralateral forearm. Conditioned pain modulation (CPM) was evaluated with a recently introduced methodology that accounts for a standard error of measurement. RESULTS: Compared to the HC subjects, the FM and NPLSR subjects had significantly lower pain thresholds and more CPM impairment. No significant differences in PPT and CPM were observed between the FM and NPLSR groups. Significant group differences were found in self-reported symptoms of depression, anxiety, stress, and central sensitization. Self-reported symptom severity increased in a stair-step fashion, with the HC group scoring lowest and FM group scoring highest. CONCLUSION: The NPLSR group manifested CPM dysfunction and pressure hyperalgesia at similar levels to the FM group, indicating that these two chronic pain syndromes, likely based on different pathophysiological mechanisms, in fact share some common pain processing features. However, though both patient groups demonstrated similarities in pain processing, self-reported cognitive-emotional and central sensitization-related symptom severity was significantly higher in the FM cohort, which distinguished them from the chronic NPLSR cohort.

Efficacy of the lumbar stabilization and thoracic mobilization exercise program on pain intensity and functional disability reduction in chronic low back pain patients with lumbar radiculopathy: A randomized controlled trial.

BACKGROUND: Exercise programs in the treatment of chronic lumbar pain are quite diverse, but it has been proven that stabilization exercises are the most effective. OBJECTIVE: We compared the lumbar stabilization exercise program in a closed and open kinetic chain (LSCO) and lumbar stabilization exercises and thoracic mobilization program in a closed kinetic chain (LSTMC), and evaluated the clinical effectiveness of each program. METHODS: Prospective, randomized, controlled trial in 80 chronic low back pain (CLBP) patients with lumbar radiculopathy of both sexes (35 male, 45 female), average age (48.45 ± 10.22 years), divided in two groups that performed different sets of exercises. Participants were given laser therapy, transcutaneous electro-nerve stimulation and an eight-week kinesiotherapy that included exercises to strengthen the deep lumbar spine stabilizers. Retesting was done after four and eight weeks. RESULTS: Statistically significant (p< 0.05) superior recovery of the LSTMC group subjects compared to the LSCO group was achieved at all measurement intervals in the pain intensity and functional disability parameters. CONCLUSION: Patients who performed the lumbar stabilization and thoracic mobilization exercise program in a closed kinetic chain had the most effective reduction of pain intensity and functional disability.

Psychometric validation of the Serbian version of the Fear Avoidance Component Scale (FACS).

OBJECTIVE: The Fear Avoidance Components Scale (FACS) is a new patient-reported outcome (PRO) questionnaire designed to comprehensively evaluate fear avoidance (FA) beliefs and attitudes in persons with painful medical conditions. The original English version has demonstrated acceptable psychometric properties, including concurrent and predictive validity. Two factors have been identified: 1. general fear avoidance; and 2. types of activities that are avoided. METHODS: The FACS was first translated into Serbian, and then psychometrically validated. A cohort of 322 chronic musculoskeletal pain subjects completed the FACS-Serb and additional FA-related patient-reported outcome (PRO) measures. Their FACS-Serb scores were then compared to a cohort of 68 acute pain subjects. RESULTS: Test-retest reliability (ICC2,1 = 0.928) and internal consistency for both Factors (Cronbach α 0.904 and 0,880 respectively) were very good. An acceptable fit was found with a confirmatory factor analysis of the 2-factor model found with the original English version of the FACS. Strong associations were found among FACS-Serb scores and other PRO measures of pain catastrophizing, depressive/anxiety symptoms, perceived disability, and pain intensity (p<0.001 for all analyses). FACS-Serb total scores, separate Factor scores, and subjective pain ratings were significantly higher in the chronic vs. acute pain cohorts (p<0.001 for all analyses). CONCLUSIONS: The FACS-Serb demonstrated strong psychometric properties, including strong reliability and internal consistency, criterion validity (through associations with other FA-related PRO measures), and discriminant validity (through comparisons with a separate acute pain cohort). The FACS-Serb appears to be a potentially useful pain-related assessment tool.

The Impact of Comorbidity on Rehabilitation Outcome after Ischemic Stroke.

Comorbidity decreases survival but it still remains unknown to what extent functional recovery after ischemic stroke is affected. The aim of this research was to determine the prevalence of the most common comorbidities in patients with ischemic stroke and to examine their predictive value on the functional status and recovery. In order to obtain relevant information for this research, we conducted a prospective study over a two-year period. It included patients with acute/subacute ischemic stroke who had inhospital rehabilitation treatment in our institution. Functional status of the patients was evaluated by the following three aspects at the beginning and at the end of rehabilitation treatment: Rivermead Mobility Index was used for mobility, Barthel Index for independence in activities of daily living, and modified Rankin Scale for total disability. Modified Charlston Comorbidity Index was used to assess comorbidity. Multivariate analysis was applied to evaluate the impact of recorded comorbidities on the patient functional outcome. Independent predictors of rehabilitation success in our study were the value of modified Charlston Comorbidity Index, atrial fibrillation and myocardial infarction. Our study demonstrated that patients with more comorbidities had worse functional outcome after stroke, so it is important to consider the comorbidity status when planning the rehabilitation treatment.

Comparative assessment of fracture risk among osteoporosis and osteopenia patients: a cross-sectional study.

BACKGROUND: Both osteoporosis and osteopenia remain worldwide public health concerns. They both lead to bone fractures, which can lead to disability and burden on those who are afflicted. OBJECTIVES: To assess and compare fracture risk between these two groups of patients. PATIENTS AND METHODS: Our cross-sectional study included 82 patients (46 with osteoporosis and 36 with osteopenia) with an average age of 63±9.33 years, who received treatment at the Clinic for Medical Rehabilitation, Clinical Center of Vojvodina in Novi Sad, Serbia. The assessment of the fracture risk was executed by applying the Fracture Assessment Risk (FRAX) index (an algorithm developed by the World Health Organization) based on clinical fracture risks or combination of clinical fracture risks and bone mineral density. RESULTS: Patients with osteoporosis had significantly higher risk of major fracture compared to patients with osteopenia (p<0.01). Results from FRAX index in osteoporotic patients showed that more than half (58.70%) of patients had a low risk of fracture; less than one-third of patients (30.43%) had an intermediate risk of major osteoporotic fracture, while almost four out of every 10 (39.96%) had a high risk of hip fracture. The majority of patients with osteopenia (63.89%) had a low risk of major osteoporotic fracture, while 36.11% of them had an intermediate risk. The majority of patients with osteopenia (91.67%) had a low risk of hip fracture. Statistically significant differences in relation to specific fracture risks between patients with osteoporosis and osteopenia, in particular, weight (t=-2.250, p=0.027*) and previous fractures (t=2.985, p=0.004**), were established. CONCLUSION: Osteoporosis patients had a high risk of major osteoporotic fracture, while there was no association between the intermediate level for major osteoporotic fracture and osteo-penia. For patients suffering from an increased fracture risk, especially those who had already been diagnosed with osteoporosis, preventive measures such as designing individual therapeutic programs should be adopted.

Application of algometry in patients with cervical and lumbar radiculopathy.

BACKGROUND: Algometry, as a highly sensitive method, provides an objective insight into the degree of pain, while the use of questionnaires can estimate the patient's psychological status in a simple way. OBJECTIVE: This study was conducted in order to measure the pressure pain threshold in patients with cervical and lumbar radiculopathy and to find a possible association of pain with the anxiety and depression. METHODS: The study examined 60 hospitalized patients with cervical radiculopathy and 60 patients with lumbar radiculopathy before starting and after finishing kinesitherapy. The research was conducted using the digital algometry device and Hospital Anxiety and Depression Scale. RESULTS: There was no statistically significant difference in algometric values between the patients with cervical radiculopathy and the patients with lumbar radiculopathy. The program of rehabilitation did not lead to significant improvement in the level of pain. Females have a lower pressure pain threshold than males. Psychological factors greatly affect the pain. CONCLUSIONS: The applied methods will provide the implementation of appropriate therapy and would achieve better verification of the results in a rehabilitation program. Radiculopathy in conservative therapy should be treated in cervical-thoracic and lumbar region together. Rehabilitation period for patients with radiculopathy have to be longer.

Cross-Cultural Adaptation and Psychometric Validation of the Serbian Version of the Central Sensitization Inventory.

OBJECTIVES: It has been increasingly recognized that many chronic pain conditions are associated with central sensitization (CS). The Central Sensitization Inventory (CSI) is a potentially useful tool for screening patients whose presenting symptoms are suspected of being related to CS, so that additional diagnostic evaluation can be performed and appropriate treatment can be initiated. The original English version is currently not available in Serbian. METHODS: The CSI was translated into Serbian (CSI-Serb) and then psychometrically evaluated in a sample of 363 chronic pain subjects. RESULTS: The CSI-Serb showed a high degree of internal consistency (Cronbach's α = 0.909), excellent test-retest reliability (intraclass correlation coefficient type 2.1 = 0.947), and a significant goodness of fit test result (χ2  = 888.44; P < 0.001). A factor analysis confirmed a 4-factor solution, as found by the original authors of the CSI, with all items retained. Higher CSI-Serb scores were associated with higher pain severity and longer pain duration. Total CSI scores distinguished between 3 subject groups with presumably different levels of CS, including fibromyalgia (53.3, SD = 11.2), chronic regional pain only (29.7, SD = 11.6), and a pain-free control group (20.9, SD = 9.1). CONCLUSIONS: The results of the present study indicate strong psychometric properties, including evidence of convergent and discriminant validity, of the CSI-Serb. These results correspond with those of other translated versions of the CSI that have been psychometrically evaluated and published. Due to the current interest in CS, and its relationship with many chronic pain conditions, it is anticipated that the CSI-Serb will benefit Serbian-speaking clinicians in the evaluation of patients with chronic pain conditions.

Factors that predict walking ability with a prosthesis in lower limb amputees.

Introduction: Identification of predictive factors for walking ability with a prosthesis, after lower limb amputation, is very important in order to define patient's potentials and realistic rehabilitation goals, however challenging they are. Objective: The objective of this study was to investigate whether variables determined at the beginning of rehabilitation process are able to predict walking ability at the end of the treatment using support vector machines (SVMs). Methods: This research was designed as a retrospective clinical case series. The outcome was defined as three-leveled ambulation ability. SVMs were used for predicting model forming. Results: The study included 263 patients, average age 60.82 ± 9.27 years. In creating SVM models, eleven variables were included: age, gender, cause of amputation, amputation level, period from amputation to prosthetic rehabilitation, Functional Comorbidity Index (FCI), presence of diabetes, presence of a partner, restriction concerning hip or knee extension, residual limb hip extensor strength, and mobility at admission. Six SVM models were created with four, five, six, eight, 10, and 11 variables, respectively. Genetic algorithm was used as an optimization procedure in order to select the best variables for predicting the level of walking ability. The accuracy of these models ranged from 72.5% to 82.5%. Conclusion: By using SVM model with four variables (age, FCI, level of amputation, and mobility at admission) we are able to predict the level of ambulation with a prosthesis in lower limb amputees with high accuracy.

Cerebral palsy in preterm infants.

Background/Aim: Cerebral palsy (CP) is one of the leading causes of neurological impairment in childhood. Preterm birth is a significant risk factor in the occurrence of CP. Clinical outcomes may include impairment of gross motor function and intellectual abilities, visual impairment and epilepsy. The aim of this study was to examine the relationships among gestational age, type of CP, functional ability and associated conditions. Methods: The sample size was 206 children with CP. The data were obtained from medical records and included gestational age at birth, clinical characteristics of CP and associated conditions. Clinical CP type was determined according to Surveillance of Cerebral Palsy in Europe (SCPE) and topographically. Gross motor function abilities were evaluated according to the Gross Motor Function Classification System (GMFCS). Results: More than half of the children with CP were born prematurely (54.4%). Statistically significant difference was noted with respect to the distribution of various clinical types of CP in relation to gestational age (p < 0.001). In the group with spastic bilateral CP type, there is a greater proportion of children born preterm. Statistically significant difference was noted in the functional classification based on GMFCS in terms of gestational age (p = 0.049), children born at earlier gestational age are classified at a higher GMFCS level of functional limitation. The greatest percentage of children (70.0%) affected by two or more associated conditions was found in the group that had extremely preterm birth, and that number declined with increasing maturity at birth. Epilepsy was more prevalent in children born at greater gestational age, and this difference in distribution was statistically significant (p = 0.032). Conclusion: The application of antenatal and postnatal protection of preterm children should be a significant component of the CP prevention strategy.

FUNCTIONAL STATUS OF PATIENTS AFTER STROKE.

INTRODUCTION: Patients who have suffered from stroke become disabled and have specific problems due to the physical and mental disability that requires the implementation of rehabilitation and the creation of conditions for independent living, economic and social reintegration. The aim of this study was to evaluate the functional recovery of patients after ischemic stroke, during the subacute phase of medical rehabilitation. MATERIAL AND METHODS: The study was organized as a prospective study, which included 74 patients (44 men, 30 women) treated after stroke at the Department of Medical Rehabilitation, Clinical Center of Vojvodina during 2013. Motor recovery was assessed by Signe-Brunnstrom scale, and Barthel Index, Rivermead Mobility Index, and modified Rankin scale were applied to assess the function. RESULTS: The average age of patients after stroke was 66.59 ± 9.607 years. The mean hospital stay was 34.35 days. The majority of patients in this study had right-hand hemiparesis 47 (63.5%), and 27 (36.5%) had left-hand hemiparesis. By analyzing the average valueof motor recovery of the affected limb by S.Brunnstrom's scale during rehabilitation at the Department of Medical Rehabilitation, it was found that the value at the end of subacute rehabilitation phase was significantly increased (p<0.01). The results of this testing showed a statistically significant improvement (p<0.0l) in the average values of Barthel Index, Rivermead Mobility Index and modified Rankin scale during the rehabilitation treatment of stroke patients. CONCLUSION: The obtained results showed that the rehabilitation treatment resulted in better functional and motor recovery in the patients who had had ischemic stroke.

ASSESSMENT OF QUALITY OF LIFE IN PATIENTS AFTER LOWER LIMB AMPUTATION.

INTRODUCTION: Lower extremity amputation is a surgical procedure resulting in important anatomical, functional, psychological, and social consequences that can influence the quality of life of these patients. The aim of this research was to compare the quality of life of patients with lower extremity amputation and people without amputation taking into account gender differences as well as the amputation level. MATERIAL AND METHODS: The study was designed as a cross-sectional study which included 56 subjects. The patients from the experimental group underwent prosthetic rehabilitation treatment at the Department of Medical Rehabilitation, Clinical Centre of Vojvodina. The experimental group included 28 patients (21 male, 7 female) with lower extremity amputation, their average age being 65.36±13.64. The control group consisted of 28 age and gender matching subjects without amputation. Research ANd Development (RAND) 36--Item Health Survey 1.0 (SF-36) was used to measure the quality of life. RESULTS: The results showed that patients with lower extremity amputation scored lower than the control group on all SF-36 variables (p<0.05). None of the SF-36 variables differed between the genders (p>0.05). Seventeen (61%) patients were with transfemoral, and 11 (39%) with transtibial level of amputation. The patients with transtibial amputations scored higher on physical functioning and general health status variables (p<0.05). CONCLUSION: The patients with lower extremity amputations have numerous limitations compared to the control group, regardless of gender, while the patients with lower level of amputation have a higher level of physical functioning.

[Assessment of memory in patients with rheumatoid arthritis].

UNLABELLED: BACKGROUND/AIM. The diagnosis of emotional and cognitive dysfunction in patients with rheumatoid arthritis is often not noticed, regardless of their importance and frequency. The aim of this research was to assess memory function in patients with rheumatoid arthritis with respect to its emotional manifestation, pain intensity, the duration and degree of disease activity, and functional and anatomical stages of the disease. METHODS. The study involved 60 patients with rheumatoid arthritis and 30 healthy subjects of both sexes, aged up to 55, who were examined and tested in the Special Hospital for Rheumatic Diseases in Novi Sad. Depression was diagnosed by using the Beck's scale for depression (Beck Depression Inventory--BDI), anxiety by using the Spielberger Trait Anxiety Inventory--State and Traite; we evaluated the cognitive status (by the Wechsler scale-based memory -WBsp), the functional status (Health Assesment Questionnaire, HAQ) and disease activity by analyzing the index of disease activity (DAS 28). RESULTS: Depressive symptoms were registered in 38 (63.33%) patients, and anxiety symptoms in 22 (36.67%) patients. The average values of the memory coefficient were significantly lower in the group of patients with rheumatoid arthritis compared with the control group. CONCLUSION: High frequency of emotional dysfunction and damaged memory abilities in patients with rheumatoid arthritis requires in time diagnosis and adequate treatment.

[Fibromyalgia-up to date aspects of pathophysiology diagnosis and treatment].

INTRODUCTION: Fibromyalgia (FM) is a chronic pain condition with spontaneous, chronic, widespread musculoskeletal pain and tenderness accompanied by a number of nonspecific symptoms. The low prevalence of FM is considered an underestimation and results from insufficient knowledge about FM In order to increase the general awareness of the unique nature of pain in fibromyalgia and the right of patients to receive specific attention, EFIC (European Federation of the IASP Chapters) launched the European campaign against pain in fibromyalgia. PATHOPHYSIOLOGICAL MECHANISMS: The pathogenesis of fibromyalgia is not yet clear. An altered processing of pain is probably the main contributor to the pathogenesis, arising from a number of neuroendocrine, neurotransmitter and neurosensory disturbances in genetically predisposed patients. According to numerous findings. FM originates in the central nervous system and indicates a state of central sensitization in fibromyalgia. There are many reasons for considering that FM and neuropathic pain share similar mechanisms. DIAGNOSTIC CRITERIA AND FIBROMYALGIA ASSESSMENT: The ACR criteria (1990) are currently a "gold standard" applied for FM diagnosing, but a number of scoring systems and scales are valid tools for fibromyalgia assessment, differential diagnosis. treatment evaluation and estimation of patient's quality of life. TREATMENT: According, to multiple pathophysiological mechanisms, the treatment involves multidisciplinary and multimodal approach, including a combination of pharmacological and non-pharmacological interventions based on EULAR (European League Against Rheumatism) recommendations from 2007. Pharmacological treatment (antidepressants, anticonvulsants and conventional analgesics) is directed toward the control of pain and other symptoms, but nonpharmacological management (aerobic exercise, strength training and cognitive behavioural therapy) is directed to functional consequences of the symptoms. Although the treatment rarely relieves the symptoms completely the active role of an educated FM patient and supportive surrounding are secondary necessary to provide beneficial clinical effects on this complex painful condition.

[An estimate of functional state in patients with rheumatoid arthritis].

INTRODUCTION: Rheumatoid arthritis is an inflammatory chronic disease that affects 0.5-1% of the population, many of whom develop disease as working-age adults. MATERIAL AND METHODS: The aim of examination was to estimate functional disability in patients with rheumatoid arthritis and relationship between radiological damage, disease duration, disease activity, functional disability. The examination involved 60 patients with rheumatoid arthritis, aged (53.92 +/- 7.06) of both genders (48 female, 12 male). The following variables were assessed at one time point: swollen and tender joint count, visual analogue scale for pain, erythrocite sedimentation rate, health assessment questionnaire (HAQ) score, anatomical stage and functional class according to Stenbrocker's criteria. Disease activity was expressed as 28 joint disease activity score (DAS28). Correlations were calculated by Spearman's coefficient of correlation. RESULTS: In our study 82% of the patients had II and III anatomical stage and 80% of the patients had II and III functional class according to Steinbrocker's criteria. The median HAQ score was 1.25 +/- 0.70, and the median DAS28 was 5.74 +/- 0.98. Poor functional status was observed in 37 (61.66%) of the patients with an HAQ score of = 2. Functional disability in patients with rheumatoid arthritis was most strongly related to the presence of pain (rs=0.338, p<0.01) and to a lesser extent to anatomical and functional stage, disease duration, disease activity. DISCUSSION AND CONCLUSION: The results of the study show that functional disability significantly correlated with subjective pain score (rs=0.338, p<0.01). We observed strong correlation between functional disability presented by HAQ score and pain but no significant correlation with other common clinical variables used for rheumatoid arthritis patients evaluation such as disease duration, disease activity, radiological damage.

Clinical characteristics of infectious spondylodiscitis.

Spondylodiscitis represents an inflammatory process, localized in the vertebrae body and in the intervertebral discs. The goals of this research were to identify subjective complaints, clinical findings, and laboratory characteristics in patients with spondylodiscitis, as well as to establish the importance of magnetic resonance imaging in diagnosing this disease. The data of 40 patients treated at the Clinic for Infectious diseases of the Clinical Center of Vojvodina from 2003 till 2007 were reviewed. Majority of the patients had low back pain (90%). Fever was present in 37.5% of patients (chi2 = 2.5; p > 0.05). Laboratory parameters of inflammation were higher than normal in most of the patients before the treatment. Diagnosis of spondylodiscitis was made using MRI in 97.5% of the patients. Keeping in mind unspecific subjective complaints and clinical findings in patients with spondylodiscitis, a health professional should always suspect spondylodiscitis when back pain occurs, in order to diagnose and treat this severe disease as early as possible. Magnetic resonance imaging is the most advantageous method in diagnosing spondylodiscitis.

[Assessment of life quality in surgically treated patients with lumbar radiculopathy]. / Procjena kvaliteta zivota operisanih pacijenata sa lumbalnom radikulopatijom.

INTRODUCTION: Assessment of life quality in surgically treated patients with lumbar radiculopathy is defined by changes in physical, functional, mental and social status. The aim of the study was evaluation the quality of life in surgically treated patients with chronic lumbar radiculopathy. MATERIAL AND METHODS: We examined 50 (24 female, 26 male, mean age 43.5 years) surgically treated patients who had low back pain. The patients were multidisciplinary examined and treated on Medical Rehabilitation Clinic in Novi Sad. Medical Outcomes Study Short Form 36 (SF-36) was used to evaluate the quality of life at beginning and after 6 months of rehabilitation treatment. RESULTS: Results of the exploring showed that all aspects quality of life in surgically treated patients with lumbar radiculopathy are bed, especially in domains physical functioning, role functioning physical and bodily pain at the beginning of treatment. During six months of the treatment all dimensions of quality of life were more importantly improved in surgically treated patients. CONCLUSION: Adequate assessment of life quality is important and demands greater period of time to evaluate.