The effect of vitamin D treatment on quality of life in patients with fibromyalgia.

BACKGROUND: Fibromyalgia is a syndrome characterized by chronic widespread pain accompanied by fatigue, disrupted sleep quality, cognitive impairments, subjective soft tissue swelling, and somatic symptoms. There are conflicting results in the literature regarding the prevalence of vitamin D deficiency in fibromyalgia patients and the reduction of symptoms after supplementation. AIMS: Our study aims to evaluate the effectiveness and reliability of vitamin D supplementation in patients diagnosed with fibromyalgia. METHODS: In our cross-sectional clinical study, 180 female patients aged 18 to 65 diagnosed with fibromyalgia according to the 2010 American College of Rheumatology Diagnostic Criteria were included. Oral vitamin D3 replacement of 50,000 IU was administered for 12 weeks. Patients' Fibromyalgia Impact Questionnaire (FIQ)and Visual Analogue Scale (VAS) scores were evaluated before and after the study. RESULTS: Significant differences were observed in the FIQ scores of the 180 fibromyalgia patients before and after vitamin D supplementation (p < 0.05). There was also a significant improvement in VAS scores (p < 0.01). A negative correlation between vitamin D and VAS as well as FIQ scores was found in the study. CONCLUSION: We determined that vitamin D deficiency is significantly more prevalent in patients diagnosed with fibromyalgia. Vitamin D supplementation was observed to have a positive effect on quality of life and reduction of pain.

Comparison of transcutaneous electrical stimulation and suprascapular nerve blockage for the treatment of hemiplegic shoulder pain.

BACKGROUND: Hemiplegic shoulder pain (HSP) is a common morbidity of stroke. Different treatment modalities can be used for optimizing the results and limiting the possible side effects. This research compares the effects of two therapies used to reduce the pain and improve the quality of life of the patients with HSP. OBJECTIVE: This study aimed to compare the effects of transcutaneous electrical nerve stimulation (TENS) and suprascapular nerve blockage (SSNB) in patients with HSP. METHODS: In this clinical research, 24 patients with HSP who participated in a conventional rehabilitation program were randomized into TENS or SSNB treatment groups. A 100 mm visual analogue scale was used to assess the severity of pain. Passive range of motion (ROM) of the shoulder was measured. The Modified Ashworth Scale (MAS) was used to evaluate spasticity of the upper extremities, and the Modified Barthel Scale was used to assess activities of daily living (ADL). Quality of life was measured using the Stroke-specific Quality of Life (SS-QoL) questionnaire. RESULTS: The pain scores of the SSNB group decreased more significantly (p< 0.05) than in the TENS group. SS-QoL scores at the 3rd week in both groups were significantly higher than before treatment (p< 0.05). MAS scores and Barthel scores after treatment did not differ significantly between the groups. CONCLUSION: TENS and SSNB were beneficial in relieving pain and increasing passive shoulder ROM and ADL in all patients. The alleviating of pain was faster in patients who underwent SSNB.

Urinary system complications and long-term treatment compliance in chronic traumatic spinal cord injury patients with neurogenic lower urinary tract dysfunction.

Objectives: The aim of this study was to evaluate upper and lower urinary tract complications and the compliance of long-term treatment in patients with spinal cord injury (SCI) by urodynamic examination. Patients and methods: Between January 1997 and May 2007, a total of 89 patients with SCI (79 males, 19 females; mean age: 39.8±12.2 years; range, 19 to 72 years) who were admitted to physical medicine and rehabilitation clinic were retrospectively analyzed. Demographic, neurological, and urodynamic data of the patients with the diagnosis of neurogenic lower urinary tract dysfunction (NLUTD) in their initial urodynamic examination and without regular follow-up were recorded. Results: The mean time to the first urodynamic examination was 8.6±5.4 months. Sixty-seven patients who had neurogenic detrusor overactivity (NDO) in their first urodynamic tests were recommended anticholinergics. Clean intermittent catheterization (CIC) was recommended after initial urodynamic examination in all patients. Thirty-nine patients of 67 who had NDO were taking medications, while 28 were not. In the patients who continued anticholinergic treatment, bladder capacity was found to statistically significantly increase, compared to the initial measurement values and detrusor pressures significantly decreased (p<0.001). The compliance rate with CIC and anticholinergic treatment was 79.8% and 58.2%, respectively. Sixteen of the patients had calculus in the urinary system. Forty-two patients had infections more than once a year and used antibiotics. Conclusion: Neurogenic bladder should be evaluated at the beginning of SCI and, then, followed on a regular basis. Urodynamic tests should be performed immediately after spinal shock and can be repeated, as indicated.

Caudal epidural steroid injection for chronic low back pain: A prospective analysis of 107 patients.

BACKGROUND: Low back pain affects 80% of people worldwide at least once in a lifetime and reduces the quality of life and causes absence from work. OBJECTIVE: To evaluate the pain and functional status of patients with lumbar disc disease who received blind caudal epidural injections (CEI) for pain relief. METHODS: The records of 107 patients who had been given CEI between September 2017 and January 2018 were retrospectively analyzed. The inclusion criteria were age > 18 years, > 3-month history of low back pain, and diagnosis of lumbar disc disease by magnetic resonance imaging. The epidural injection solution consisted of 2 mL of betamethasone sodium and 8 mL saline. Follow-up examinations were conducted 3 and 6 months post-injection and the patients were evaluated using a visual analog scale (VAS) and the Oswestry Disability Index (ODI). RESULTS: The most common disc pathology was at the L4-L5 level. The VAS and ODI scores indicated significantly reduced pain at 3 and 6 months compared with the pre-injection baseline. Two patients experienced total anesthesia and paresis of the lower limbs, but recovered fully after 2 weeks. Blood was aspirated during the injection in two patients, but second-attempt injections were successful in both cases. No other complications were observed. CONCLUSION: Our results suggest that the blind method is safe for administering CEI to patients with chronic low back pain in the absence of radiological screening and results in significant pain relief with improved functional capacity.

Bone loss and bone turnover in acute and chronic spinal cord injured patients.

OBJECTIVE: To investigate bone loss and the rate of bone turnover in individuals with spinal cord injury (SCI), and to compare the results with those healthy controls. METHODS: This cross-sectional, controlled study was performed between January and December 2005, in the Istanbul Physical Medicine and Rehabilitation Training Hospital, Istanbul, Turkey. Forty-eight patients with SCI were included in the study. The control group consisted of 47 age and sex matched healthy subjects. Bone density was measured at the proximal hip region by dual-energy X-ray absorptiometry. Serum levels of osteocalcin (OC) and C telopeptide of type 1 collagen (CTX) were measured. RESULTS: Femur neck and femur total bone mineral density values in the SCI patients and control group were 0.894 (0.188), 0.911 (0.185), and 0.994 (0.116), 1.063 (0.132) (p<0.03, p<0.000). Serum levels of OC and CTX were significantly increased in patients (p<0.015, p<0.000). Femur bone density in both neck and total regions showed a significant decrease in the SCI patients with longer injury duration (p<0.001, p<0.000). Serum CTX levels were markedly elevated in the first year of SCI. However, serum OC level showed no difference for the injury duration. CONCLUSION: Significant bone loss was found at the proximal hip in SCI patients. Serum biochemical markers were also significantly higher in the patient group than the healthy controls. The bone density was lower in the long-standing SCI patients, although serum CTX levels were higher in the first 12 months after injury.

Reasons for rehospitalization in patients with spinal cord injury: 5 years' experience.

The aim of this study was to determine the causes of rehospitalization in patients with spinal cord injury (SCI) treated in Istanbul Physical Medicine and Rehabilitation Centre and to compare the data with previous studies. Patients who were rehospitalized after an initial phase of rehabilitation between 1 January 1996 and 31 December 2001 were enrolled into the study. SCI patients aged 17 years or over at the time of injury were included. This retrospective study was designed using our medical records. In 5 years, 733 SCI patients were treated and 56 of them experienced rehospitalization. We examined the demographic and injury characteristics of rehospitalized patients with SCI. The SPSS computer programme was used for statistical analysis. We found that the rate of rehospitalization was 7.6%, the length of stay (LOS) was 72.21 days and the average age was 34.25 years. The reasons for rehospitalization were, in descending order, spasticity 25%, additional rehabilitation 21.4%, pressure sores 17.9%, urinary infection 16.1%, spinal surgery 8.9%, urinary system surgery 5.4% and pain 5.4%. Statistical significance was found between mean age and causes. The patients who were rehospitalized because of spinal surgery had a lower mean age than those rehospitalized because of pain (P=0.04, F=2.4). The most frequent reasons for rehospitalization of patients over 25 years old were spasticity and pressure sores. In conclusion, SCI patients' LOS was longer than found in previous studies because of a lack of efficient home rehabilitation. The most frequent cause of rehospitalization was spasticity, because of uncontrolled medical therapy. The study demonstrates how education of the patients and their families is important, and that home-based rehabilitation services must be established and supported by government.