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3.
J Neurovirol ; 26(5): 800-801, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-32779108

RESUMO

A woman in her forties with asthma and COPD was admitted to a general medical floor with respiratory symptoms, body aches, and anosmia. Reverse transcription polymerase chain reaction detected severe acute respiratory syndrome coronavirus-2. Admission labs, including biomarkers of the systemic immunological dysfunction seen in many cases of coronavirus disease 2019 (COVID-19), were within normal ranges. On the second day of admission, she developed neck and back pain that was constant, burning in quality, and exacerbated by light touch and heat. Wearing clothing caused pain and interfered with her sleep. The area was tender to light finger stroke. The patient was given acetaminophen, NSAIDs, and opioids with no relief of pain. However, gabapentin was effective. At follow-up 1 month later, her symptoms were improved and still relieved by gabapentin. Neuropathic pain was seen in over 2% of COVID-19 patients in one observational study. The pain seen in our case was bilateral, involved an area innervated by multiple levels of spinal nerves, and was limited to the back. While it is rare, a significant number of COVID-19 patients are afflicted by neuropathic pain, and our case illustrates that gabapentin may be effective.


Assuntos
Síndrome de Sobreposição da Doença Pulmonar Obstrutiva Crônica e Asma/complicações , Dor nas Costas/complicações , Infecções por Coronavirus/complicações , Cervicalgia/complicações , Transtornos do Olfato/complicações , Dor/complicações , Pneumonia Viral/complicações , Acetaminofen/uso terapêutico , Analgésicos/uso terapêutico , Síndrome de Sobreposição da Doença Pulmonar Obstrutiva Crônica e Asma/tratamento farmacológico , Síndrome de Sobreposição da Doença Pulmonar Obstrutiva Crônica e Asma/patologia , Síndrome de Sobreposição da Doença Pulmonar Obstrutiva Crônica e Asma/virologia , Dor nas Costas/tratamento farmacológico , Dor nas Costas/patologia , Dor nas Costas/virologia , Betacoronavirus/patogenicidade , Infecções por Coronavirus/tratamento farmacológico , Infecções por Coronavirus/patologia , Infecções por Coronavirus/virologia , Feminino , Gabapentina/uso terapêutico , Humanos , Pessoa de Meia-Idade , Cervicalgia/tratamento farmacológico , Cervicalgia/patologia , Cervicalgia/virologia , Transtornos do Olfato/tratamento farmacológico , Transtornos do Olfato/patologia , Transtornos do Olfato/virologia , Dor/tratamento farmacológico , Dor/patologia , Dor/virologia , Pandemias , Pneumonia Viral/tratamento farmacológico , Pneumonia Viral/patologia , Pneumonia Viral/virologia , Resultado do Tratamento
4.
Pain Physician ; 23(4): 335-348, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-32709169

RESUMO

BACKGROUND: Chronic neck pain is reportedly considered the fourth leading cause of disability. Cervical interlaminar epidural injections are among the commonly administered nonsurgical interventions for managing chronic neck pain, secondary to disc herniation and radiculitis, spinal stenosis, or chronic neck pain of discogenic origin. OBJECTIVES: To systematically review the differences in the effectiveness of cervical epidural injections with local anesthetics with or without steroids for the management of chronic neck pain. STUDY DESIGN: Systematic review and meta-analysis. METHODS: A comprehensive search of the literature of randomized controlled trials (RCTs) that compared epidural injections with local anesthetic with or without steroids was performed, including a search of PubMed, EMBASE, and Cochrane databases for all years up to May 2019. Meta-analysis was done for pain relief based on the Numeric Rating Scale, functional status based on the Neck Disability Index, and opioid intake dosage. RESULTS: Four studies met the inclusion criteria. A total of 370 patients were divided into 2 groups: the experimental group received cervical epidural injection with steroid and local anesthetic, and the control group received injection with local anesthetic only. Regrading pain relief, no significant difference was observed between both groups (weighted mean difference [WMD], -0.006; 95% confidence interval (CI), -0.275 to 0.263; P = 0.963; I² = 0.0% at 12 months). There was also no significant difference in the improvement of the functional status (WMD, 0.159; 95% CI, -1.231 to 1.549; P = 0.823; I² = 9.8% at 12 months). Similarly, there was no significant difference in opioid dosage (WMD, -0.093; 95% CI, -5.952 to 5.766; P = 0.975; I² = 0.0% at 12 months). LIMITATIONS: Only a few studies on this premise were found in the literature. There was also a lack of heterogeneity of the included RCT studies. CONCLUSIONS: The addition of steroids to anesthetic injectates was not associated with better pain and functional score outcomes compared with anesthetic injectate alone in patients with chronic neck pain. KEY WORDS: Chronic neck pain, cervical radiculopathy, cervical disc disease, spinal stenosis, facet joint pathology, cervical epidural injections, steroid injections, local anesthetic injections, systematic review, meta-analysis, randomized control trial.


Assuntos
Anestésicos Locais/administração & dosagem , Dor Crônica/tratamento farmacológico , Cervicalgia/tratamento farmacológico , Manejo da Dor/métodos , Esteroides/administração & dosagem , Dor Crônica/diagnóstico , Quimioterapia Combinada , Humanos , Injeções Epidurais/métodos , Cervicalgia/diagnóstico , Manejo da Dor/efeitos adversos , Radiculopatia/diagnóstico , Radiculopatia/tratamento farmacológico , Resultado do Tratamento
5.
Arch Phys Med Rehabil ; 101(8): 1407-1413, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32437688

RESUMO

OBJECTIVE: To determine whether the initial care provider for neck pain was associated with opioid use for individuals with neck pain. DESIGN: Retrospective cohort study. SETTING: Marketscan research databases. PARTICIPANTS: Patients (N=427,966) with new-onset neck pain from 2010-2014. MAIN OUTCOME MEASURES: Opioid use was defined using retail pharmacy fills. We performed logistic regression analysis to assess the association between initial provider and opioid use. Adjusted odds ratios (ORs) with 95% confidence intervals (CIs) were calculated using bootstrapping logistic models. We performed propensity score matching as a robustness check on our findings. RESULTS: Compared to patients with neck pain who saw a primary health care provider, patients with neck pain who initially saw a conservative therapist were 72%-91% less likely to fill an opioid prescription in the first 30 days, and between 41%-87% less likely to continue filling prescriptions for 1 year. People with neck pain who initially saw emergency medicine physicians had the highest odds of opioid use during the first 30 days (OR, 3.58; 95% CI, 3.47-3.69; P<.001). CONCLUSIONS: A patient's initial clinical contact for neck pain may be an important opportunity to influence subsequent opioid use. Understanding more about the roles that conservative therapists play in the treatment of neck pain may be key in unlocking new ways to lessen the burden of opioid use in the United States.


Assuntos
Analgésicos Opioides/uso terapêutico , Prescrições de Medicamentos/estatística & dados numéricos , Cervicalgia/tratamento farmacológico , Modalidades de Fisioterapia/estatística & dados numéricos , Atenção Primária à Saúde/estatística & dados numéricos , Terapia por Acupuntura/estatística & dados numéricos , Adulto , Quiroprática/estatística & dados numéricos , Bases de Dados Factuais , Medicina de Emergência/estatística & dados numéricos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Cervicalgia/terapia , Neurologia/estatística & dados numéricos , Ortopedia/estatística & dados numéricos , Padrões de Prática Médica/estatística & dados numéricos , Estudos Retrospectivos
6.
World Neurosurg ; 134: e855-e865, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31733395

RESUMO

BACKGROUND: Thus study was a retrospective cohort analysis. Anterior cervical discectomy and fusion (ACDF) has been the gold-standard procedure for single-level degenerative disc disease (DDD). Recently, cervical disc arthroplasty (CDA) has become increasingly prevalent as an alternative intervention. OBJECTIVE: To examine the long-term costs and reoperation rates associated with CDA and ACDF for the treatment of single-level DDD. METHODS: In the present study, we performed a retrospective cohort analysis using the MarketScan database of patients who underwent either ACDF or CDA between 2007 and 2011 and had 5 years postsurgery follow-up. Outcomes related to the health care utilization, cost, and reoperation were analyzed after propensity score matching (PSM). RESULTS: Of 12,434 patients, 12,099 underwent ACDF and 335 CDA. Length of hospital stay and initial hospitalization cost was higher after ACDF compared with CDA. More patients undergoing CDA had early physical therapy compared with patients undergoing ACDF (CDA 30.15% vs. ACDF 22.39%; P = 0.0176). Five years after surgery, there was no significant difference in overall payments between patients undergoing ACDF and patients undergoing CDA. Reoperation rates were comparable at 5 years after the index procedure (CDA 8.06% vs. ACDF 9.25%; P = 0.5862). Patients who underwent ACDF showed decreased use of tramadol after surgery (15.09% before surgery vs. 9.55% after surgery; P < 0.0001). CONCLUSIONS: We found no difference in health care utilization between ACDF and CDA procedures for DDD 5 years after surgery. Also, there was no difference in reoperation rates during the study period. ACDF resulted in significant reduction in overall opioid use after versus before procedure.


Assuntos
Vértebras Cervicais/cirurgia , Discotomia/estatística & dados numéricos , Degeneração do Disco Intervertebral/cirurgia , Reoperação/estatística & dados numéricos , Fusão Vertebral/estatística & dados numéricos , Substituição Total de Disco/estatística & dados numéricos , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Analgésicos Opioides/uso terapêutico , Estudos de Coortes , Discotomia/economia , Utilização de Instalações e Serviços/estatística & dados numéricos , Feminino , Custos de Cuidados de Saúde/estatística & dados numéricos , Humanos , Degeneração do Disco Intervertebral/complicações , Tempo de Internação/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Cervicalgia/tratamento farmacológico , Cervicalgia/etiologia , Cervicalgia/cirurgia , Modalidades de Fisioterapia/estatística & dados numéricos , Estudos Retrospectivos , Fusão Vertebral/economia , Substituição Total de Disco/economia , Adulto Jovem
7.
Pain Physician ; 22(6): E627-E633, 2019 11.
Artigo em Inglês | MEDLINE | ID: mdl-31775416

RESUMO

BACKGROUND: Cervical vertigo commonly concurs in patients with neck pain, but the concurrent mechanism of these 2 symptoms still remains unclear. We previously reported a bidirectional segmental nerve fiber connection between cervical spinal and sympathetic ganglia, which provided a hypothesis that this connection between the 2 ganglia may be the anatomic basis for the concurrence of neck pain and cervical vertigo. However, this concurrent mechanism needs biochemical and functional evidence. OBJECTIVES: This study aimed to investigate a possible noradrenergic pathway between cervical spinal and sympathetic ganglia. STUDY DESIGN: We performed both clinical and laboratory research. Clinical observation was a prospective case-control study. SETTING: Clinical study took place in our hospital; laboratory study was in an orthopedic laboratory. METHODS: Cervical lamina block therapy used in patients with cervical vertigo was clinically evaluated; norepinephrine (NE) expressions in cervical sympathetic ganglia were analyzed using immunohistochemical staining after electrical stimulation to the cervical spinal ganglia; the influence of phentolamine local injection to the vertebrobasilar artery flow was experimentally measured. RESULTS: Cervical lamina block therapy could significantly shorten the clinical hospital stays of patients with cervical vertigo (P = 0.000) and improve vertebral artery flow (P < 0.05). NE expressions in superior cervical sympathetic ganglia (SCG) or inferior cervical sympathetic ganglia (ICG) increased significantly when ipsilateral C2 to C3 or C6 to C8 spinal ganglia were electrically stimulated, respectively. Adrenergic receptor block with phentolamine significantly inhibited the decrease of basilar artery (BA) flow induced by electrical stimulation of the cervical spinal ganglia. The change range of BA flow caused by stimulations of C2 to C3 and C6 to C8 spinal ganglia was more than that of C4 and C5. LIMITATIONS: The inpatients observed in this clinical study might be influenced by some factors including emotion, diet, sleep, and others. The limitations of the laboratory study included animal species and small sample size. CONCLUSIONS: Adrenergic system could play a part in cervical spinal ganglia altering the vertebrobasilar artery system. It could provide a neurochemical foundation between neck pain and vertigo, and that segmental functional connections exist between cervical spinal and sympathetic ganglia. KEY WORDS: Cervical vertigo, neck pain, cervical sympathetic ganglia, cervical spinal ganglia, noradrenaline.


Assuntos
Bloqueio Nervoso Autônomo/métodos , Gânglios Espinais/fisiologia , Gânglios Simpáticos/fisiologia , Cervicalgia/tratamento farmacológico , Vertigem/tratamento farmacológico , Adulto , Animais , Estudos de Casos e Controles , Vértebras Cervicais/efeitos dos fármacos , Vértebras Cervicais/inervação , Vértebras Cervicais/fisiologia , Feminino , Gânglios Espinais/efeitos dos fármacos , Gânglios Simpáticos/efeitos dos fármacos , Humanos , Masculino , Pessoa de Meia-Idade , Cervicalgia/epidemiologia , Cervicalgia/fisiopatologia , Estudos Prospectivos , Coelhos , Distribuição Aleatória , Vertigem/epidemiologia , Vertigem/fisiopatologia
8.
Perm J ; 232019.
Artigo em Inglês | MEDLINE | ID: mdl-31496497

RESUMO

INTRODUCTION: The association between vitamin D deficiency or insufficiency and pain in the musculoskeletal system, especially in the neck and/or back regions, and/or muscle spasm is not well studied. The results of the limited studies have been mixed. CASE PRESENTATION: The goal of this report is to examine the association between vitamin D deficiency and insufficiency and chronic neck and back pain and muscle spasm and the role of correction of vitamin D deficiency and insufficiency in the treatment of chronic pain and muscle spasm, especially in the neck and back regions. This case series reviewed medical records to identify patients with chronic pain (lasting from 6 months to 1 year) in the neck and back regions that improved significantly through the correction of the vitamin D deficiency or insufficiency. Patients were referred to the spine clinic of a tertiary hospital in a major metropolitan area in the Northwest by their primary care physicians after physical therapy and after first-tier pain medications, including nonsteroidal anti-inflammatory drugs, had failed. Some of the patients had epidural steroid injections without significant relief. The blood vitamin D level was tested at the clinical laboratory, and patients were given 50,000 IU of oral vitamin D once a week for 12 weeks. The main outcome measures were patient self-reported visual analog scale score and degree of muscle spasm. The 4 patients included in this series all had more than 70% improvement in their symptoms after taking 50,000 IU of vitamin D once a week for 12 weeks. DISCUSSION: Vitamin D deficiency and insufficiency can cause or worsen neck and back pain and muscle spasm. The correction of vitamin D deficiency and insufficiency plays an important role in the treatment of chronic neck and back pain and muscle spasm among patients having concurrent vitamin D deficiency and insufficiency because it can be prevented and treated easily.Given the high health care expenditure on the treatment of chronic neck and back pain, prompt and accurate diagnosis and treatment of vitamin D deficiency and insufficiency not only increase the quality of care but also reduce the cost.


Assuntos
Dor nas Costas/tratamento farmacológico , Dor Crônica/tratamento farmacológico , Cervicalgia/tratamento farmacológico , Espasmo/tratamento farmacológico , Deficiência de Vitamina D/complicações , Deficiência de Vitamina D/tratamento farmacológico , Vitamina D/uso terapêutico , Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade
9.
Pain Physician ; 22(5): 421-431, 2019 09.
Artigo em Inglês | MEDLINE | ID: mdl-31561644

RESUMO

BACKGROUND: Neck pain is one of the major conditions attributing to overall disability in the United States. There have been multiple publications assessing clinical and cost effectiveness of multiple modalities of interventions in managing chronic neck pain. Even then, the literature has been considered sparse in relation to cervical interlaminar epidural injections in managing chronic neck pain. In contrast, cost utility studies of lumbar interlaminar injections, caudal epidural injections, cervical and lumbar facet joint nerve blocks, percutaneous adhesiolysis demonstrated costs of less than $3,500 for quality-adjusted life year (QALY). OBJECTIVES: To assess the cost utility of cervical interlaminar epidural injections in managing chronic neck and/or upper extremity pain secondary to cervical disc herniation, post-surgery syndrome in neck, and axial or discogenic neck pain. STUDY DESIGN: Analysis based on 3 previously published randomized trials of the effectiveness of cervical interlaminar epidural injections assessing their role in disc herniation, cervical post-surgery syndrome, and axial or discogenic pain. SETTING: A contemporary, private, specialty referral interventional pain management center in the United States. METHODS: Cost utility of cervical interlaminar epidural injections with or without steroids in managing cervical disc herniation, cervical post-surgery syndrome, and cervical discogenic or axial neck back pain was conducted with data derived from 3 randomized controlled trials (RCTs) that included a 2-year follow-up, with inclusion of 356 patients. The primary outcome was significant improvement defined as at least 50% in pain reduction and disability status. Direct payment data from all carriers from 2018 was utilized for the assessment of procedural costs. Overall costs, including drug costs, were determined by multiplication of direct procedural payment data by a factor of 1.67 to accommodate for indirect payments respectively for disc herniation, discogenic pain, and cervical post-surgery syndrome. RESULTS: The results of the 3 RCTs showed direct cost utility for one year of QALY of $2,412.31 for axial or discogenic pain without disc herniation, $2,081.07 for disc herniation, and $2,309.20 for post surgery syndrome, with an average cost per one year QALY of $2,267.57, with total estimated overall costs with addition of indirect costs of $3,475.38, $4,028.55, $3,856.36, and $3,785.89 respectively. LIMITATIONS: The limitation of this cost utility analysis includes that it is a single center evaluation. Indirect costs were extrapolated. CONCLUSION: This cost utility analysis of cervical interlaminar epidural injections in patients nonresponsive to conservative management in the treatment of disc herniation, post surgery syndrome and axial or discogenic neck pain shows $2,267.57 for direct costs with a total cost of $3,785.89 per QALY. KEY WORDS: Cervical interlaminar epidural injections, chronic neck pain, cervical disc herniation, cervical discogenic pain, post surgery syndrome, cost utility analysis, cost effectiveness analysis, quality-adjusted life years.


Assuntos
Injeções Epidurais/economia , Cervicalgia/tratamento farmacológico , Manejo da Dor/economia , Manejo da Dor/métodos , Vértebras Cervicais , Dor Crônica/tratamento farmacológico , Análise Custo-Benefício , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Cervicalgia/etiologia , Anos de Vida Ajustados por Qualidade de Vida , Ensaios Clínicos Controlados Aleatórios como Assunto
11.
Spine (Phila Pa 1976) ; 44(16): 1154-1161, 2019 08 15.
Artigo em Inglês | MEDLINE | ID: mdl-31373999

RESUMO

STUDY DESIGN: A descriptive analysis of secondary data. OBJECTIVE: The aim of this study was to estimate health care costs and opioid use for those with high-impact chronic spinal (back and neck) pain. SUMMARY OF BACKGROUND DATA: The US National Pain Strategy introduced a focus on high-impact chronic pain-that is, chronic pain associated with work, social, and self-care restrictions. Chronic neck and low-back pain are common, costly, and associated with long-term opioid use. Although chronic pain is not homogenous, most estimates of its costs are averages that ignore severity (impact). METHODS: We used 2003 to 2015 Medical Expenditures Panel Survey (MEPS) data to identify individuals with chronic spinal pain, their health care expenditures, and use of opioids. We developed prediction models to identify those with high- versus moderate- and low-impact chronic spinal pain based on the variables available in MEPS. RESULTS: We found that overall and spine-related health care costs, and the use and dosage of opioids increased significantly with chronic pain impact levels. Overall and spine-related annual per person health care costs for those with high-impact chronic pain ($14,661 SE: $814; and $5979 SE: $471, respectively) were more than double that of those with low-impact, but still clinically significant, chronic pain ($6371 SE: $557; and $2300 SE: $328). Those with high-impact chronic spinal pain also use spine-related opioids at a rate almost four times that of those with low-impact pain (48.4% vs. 12.4%), and on average use over five times the morphine equivalent daily dose (MEDD) in mg (15.3 SE: 1.4 vs. 2.7 SE: 0.6). Opioid use and dosing increased significantly across years, but the increase in inflation-adjusted health care costs was not statistically significant. CONCLUSION: Although most studies of chronic spinal pain do not differentiate participants by the impact of their chronic pain, these estimates highlight the importance of identifying chronic pain levels and focusing on those with high-impact chronic pain. LEVEL OF EVIDENCE: 3.


Assuntos
Analgésicos Opioides/uso terapêutico , Dor Crônica/tratamento farmacológico , Dor Crônica/economia , Custos de Cuidados de Saúde/estatística & dados numéricos , Adulto , Feminino , Humanos , Masculino , Morfina/uso terapêutico , Cervicalgia/tratamento farmacológico , Estados Unidos
12.
Pain Physician ; 22(4): E295-E302, 2019 07.
Artigo em Inglês | MEDLINE | ID: mdl-31337171

RESUMO

BACKGROUND: The atlantoaxial joint (AAJ) plays a pivotal role in the cervical spine motion. Unfortunately, it is the most common cervical spine joint that is affected in patients with rheumatoid arthritis. Inflammation of the AAJ results in neck disability, nerve root compression, and finally spinal cord compression. OBJECTIVES: We aim to evaluate the efficacy of intraarticular triamcinolone injection of the AAJ on neck pain and disability. STUDY DESIGN: A prospective randomized, controlled clinical trial. SETTING: An interventional pain unit in a tertiary center at a university hospital in Egypt. METHODS: Sixty patients with rheumatoid arthritis complaining of AAJ arthritis were randomized into 2 groups. Group AAJI (n = 30) received AAJ injection with 1.0 mL of a mixture of 0.5 mL of bupivacaine 0.5% and 0.5 mL of 20 mg of triamcinolone, in addition to oral placebo tablets (2 tablets every 8 hours for one week). Group SS (n = 30) received systemic steroids, oral prednisolone tablets (5 mg, 2 tablets every 8 hours for one week), in addition to AAJ injection with 1.0 mL of a mixture of 0.5 mL of bupivacaine 0.5% and 0.5 mL of normal saline solution. The percentage of patients who showed >/= 50% reduction of their visual analog scale (VAS) pain score (measured at 1, 2, and 3 months postoperatively), VAS pain score and neck disability index (NDI) (measured at 2, 4, 6, 8, and 12 weeks postoperatively), and the magnetic resonance imaging (MRI) changes of AAJ (assessed 4 weeks postoperatively) were all evaluated. RESULTS: There was significant reduction in the percentage of patients who showed ≥50% reduction of their VAS pain score postoperatively in group AAJI compared with group SS at one month (75% vs. 46.45%; P = 0.033), 2 months (60.7% vs. 25%; P = 0.009), and 3 months (53.6% vs. 17.9%; P = 0.007). There was significant reduction in overall VAS and overall NDI in group AAJI compared with group SS (mean ± standard error) (41.5 ± 2.6 vs. 52.1 ± 2.6; P = 0.005) and (43.7 ± 3.1 vs. 52.4 ± 3.1; P = 0.040), respectively. Analysis of postoperative MRI findings revealed significant improvement of bone marrow edema in group AAJI (AAJI vs. SS) (71.4% vs. 42.9%; P = 0.033), also the synovial enhancement disappeared significantly in group AAJI compared with group SS, (16/22 [72.7%] vs. 10/23 [43.5%]; P = 0.026), moreover, there was a significant reduction in pannus size in group AAJI compared with group SS, (6/10 [60%] vs. 1/9 [11%]; P = 0.041). LIMITATIONS: The study follow-up period was limited to only 3 months. CONCLUSIONS: For acutely inflamed AAJ due to rheumatoid arthritis, AAJ steroid injection is a potential therapeutic option; it decreased cervical neck pain, improved neck mobility, and hastened recovery of the joint from an acute inflammatory stage. KEY WORDS: Rheumatoid arthritis, atlantoaxial joint injection.


Assuntos
Artrite Reumatoide/tratamento farmacológico , Articulação Atlantoaxial/efeitos dos fármacos , Glucocorticoides/administração & dosagem , Manejo da Dor/métodos , Triancinolona/administração & dosagem , Adulto , Bupivacaína/administração & dosagem , Feminino , Humanos , Injeções Intra-Articulares , Masculino , Pessoa de Meia-Idade , Cervicalgia/tratamento farmacológico , Estudos Prospectivos , Amplitude de Movimento Articular/efeitos dos fármacos , Resultado do Tratamento
13.
Pain Pract ; 19(7): 762-766, 2019 09.
Artigo em Inglês | MEDLINE | ID: mdl-31165535

RESUMO

BACKGROUND: Cervical epidural steroid injection (CESI) with local anesthetics is commonly used to treat neck pain and radicular pain of the upper extremity. Local anesthetic systemic toxicity (LAST) occurs shortly after injection as a complication; however, delayed onset is a very rare event, especially in central nervous system (CNS) block. CASE REPORT: We present a case in which delayed onset of LAST occurred in a patient who received CESI for cervical and arm radiating pain due to a cervical disc protrusion. We performed the interlaminar approach for CESI using fluoroscopic guidance. After confirming the location of the epidural space using the loss of resistance technique and spreading of contrast agent (Telebrix® 30), a mixture of 0.25% levobupivacaine 12.5 mg (5 mL in volume), hyaluronidase 1,500 IU (1 mL), dexamethasone 5 mg (1 mL), and normal saline 3 mL was administrated. After 50 minutes of injection, the patient showed CNS toxicity (unconsciousness, seizure) with normal blood pressure and tachycardia; therefore, she was immediately sedated with intravenous midazolam (3 mg), and 15 L/min of oxygen was administered. The patient fully recovered after 30 minutes of sedation without any sequelae. CONCLUSION: Delayed onset of LAST is a rare complication of a common procedure in CESI, so it is important to be aware of this complication and the presentation of toxicity.


Assuntos
Anestésicos Locais/efeitos adversos , Meios de Contraste/efeitos adversos , Injeções Epidurais , Levobupivacaína/efeitos adversos , Esteroides/efeitos adversos , Vértebras Cervicais , Meios de Contraste/uso terapêutico , Espaço Epidural , Feminino , Fluoroscopia , Humanos , Masculino , Pessoa de Meia-Idade , Cervicalgia/tratamento farmacológico
14.
Cancer Radiother ; 23(4): 312-315, 2019 Jul.
Artigo em Francês | MEDLINE | ID: mdl-31147172

RESUMO

PURPOSE: To report the results of Botulinum Toxin A (BTA) for radiation-induced head and neck pain. MATERIALS AND METHODS: This single-center retrospective study included all the patients treated at our institution with botulinum toxin A injections for radiation-induced head and neck pain between 2006 and 2017. Pain was evaluated by each patient on a visual analogue scale (VAS) (between 0 and 10) before, and 1 month after the injection. RESULTS: Sixteen patients were included in this series. The mean value of the pain was 8.5 before and 8 after the first injection. The difference was statistically significant (p<0.01). Major response occurred in 15 patients (VAS≤3 after BTA) and complete response in 11 patients (VAS=0 after BTA). CONCLUSION: Botulinum toxin is an effective treatment for radiation-induced head and neck pain.


Assuntos
Toxinas Botulínicas Tipo A/uso terapêutico , Cervicalgia/tratamento farmacológico , Fármacos Neuromusculares/uso terapêutico , Radioterapia/efeitos adversos , Adulto , Idoso , Eletromiografia , Feminino , Neoplasias de Cabeça e Pescoço/radioterapia , Humanos , Injeções Intramusculares , Masculino , Pessoa de Meia-Idade , Cervicalgia/etiologia , Estudos Retrospectivos , Escala Visual Analógica
15.
J Res Health Sci ; 19(1): e00440, 2019 Mar 26.
Artigo em Inglês | MEDLINE | ID: mdl-31133629

RESUMO

BACKGROUND: Musculoskeletal pain (MSP) is a public health problem among school-adolescents. This study aimed to identify the prevalence, risk factors and consequences of neck, shoulders and low-back pain among school-adolescents. STUDY DESIGN: A cross-sectional study. METHODS: School-adolescents aged from 12 to 18 years between October 2017 and February 2018 in South of Tunisia were recruited. Eligible participants were randomly selected and were asked to respond a four-section questionnaire. Factors independently associated with MSP were determined through multivariate logistic regression analysis. RESULTS: Among 1221 enrolled subjects, shoulders, low-back and neck pain were reported in 43%, 35.8% and 32%, respectively. Multivariate analysis showed that independent risk factors of neck pain were female gender (Adjusted odds ratio AOR=1.55; P=0.002), using computer ≥4 hours/week (AOR=1.50; P=0.010), too low desk (AOR=2.30; P<0.001) and carrying schoolbag ≥60 minutes (AOR=1.58; P=0.008). Female gender (AOR=3.30; P<0.001), BMI ≥25 Kg/m2 (AOR=1.6; P=0.018), playing videogames ≥2 hours/day (AOR=2.37; P<0.001) and schoolbag weight to body weight ≥10% (AOR=1.46; P=0.026) were independently associated with shoulders pain. For low back-pain, independent risk factors were high-school grade (AOR=2.70; P<0.001), playing videogames ≥2 hours/day (AOR=1.83; P<0.001), watching TV≥12 hours/week (AOR=1.5; P=0.016), too low seat backrest (AOR=1.4; P=0.005) and too far seat-to-black (board) distance (AOR=1.5; P=0.041). School-adolescents consumed drugs for MSP in 19.5%, had sleep disturbance in 34% and aggressive behaviors in 22.8%. CONCLUSIONS: The prevalence of MSP was substantially high among school-adolescents and their associated risk factors included sociodemographic factors, leisure activities and classroom furniture. An ergonomic specific and behavior-based school program is urgently needed.


Assuntos
Dor Lombar/etiologia , Dor Musculoesquelética/etiologia , Cervicalgia/etiologia , Instituições Acadêmicas , Dor de Ombro/etiologia , Estudantes , Adolescente , Dorso , Índice de Massa Corporal , Criança , Estudos Transversais , Ergonomia , Feminino , Humanos , Atividades de Lazer , Modelos Logísticos , Dor Lombar/tratamento farmacológico , Dor Lombar/epidemiologia , Masculino , Dor Musculoesquelética/tratamento farmacológico , Dor Musculoesquelética/epidemiologia , Pescoço , Cervicalgia/tratamento farmacológico , Cervicalgia/epidemiologia , Prevalência , Fatores de Risco , Tempo de Tela , Ombro , Dor de Ombro/tratamento farmacológico , Dor de Ombro/epidemiologia , Inquéritos e Questionários , Tunísia/epidemiologia
16.
Rom J Intern Med ; 57(3): 266-269, 2019 Sep 01.
Artigo em Inglês | MEDLINE | ID: mdl-31075087

RESUMO

BACKGROUND: Deposition of calcium pyrophosphate crystals in the cervical spine around the odontoid process may lead to neck pain and fever. This condition is called crowned dens syndrome (CDS). CASE REPORT: An 89-year-old female presented with complaints of fever for one-month duration and recent onset neck pain. During her admission, she developed right knee pain with evidence of chondrocalcinosis on X-ray. Considering her clinical presentation in setting of pseudogout, she had a CT scan of her neck that revealed erosion of the dens and hyperdense soft tissue surrounding the odontoid process. Based on her clinical and radiologic presentation, she was diagnosed with crowned dens syndrome and started on NSAIDs. Unfortunately, she did not respond to NSAIDs and was switched to Colchicine, which resulted in immediate improvement in her symptoms. CONCLUSIONS: We present this case to stress the importance of keeping crowned dens syndrome as one of the differentials in an elderly patient presenting with fever and neck pain.


Assuntos
Condrocalcinose/diagnóstico por imagem , Febre de Causa Desconhecida/diagnóstico , Cervicalgia/diagnóstico por imagem , Idoso de 80 Anos ou mais , Anti-Inflamatórios não Esteroides/uso terapêutico , Colchicina/uso terapêutico , Feminino , Supressores da Gota/uso terapêutico , Humanos , Articulação do Joelho/diagnóstico por imagem , Cervicalgia/tratamento farmacológico , Processo Odontoide , Síndrome
17.
Biomed Res Int ; 2019: 2193436, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31001552

RESUMO

Background: Percutaneous DiscoGel® (Gelscom SAS, France), introduced in 2007 as a promising new minimal invasive technique, showed efficacy and safety in lumbar spine surgery, with limited use and scientific reports with regard to the cervical spine. Since the first publication of its use on the cervical spine (2010), less than 100 cases have been published. We introduce an initial experience with this relatively new procedure. We hypothesized that percutaneous DiscoGel® is a safe and effective option for chronic neck pain of cervical discogenic origin. Method: This was a clinical study on 10 patients with chronic discogenic pain operated on for 18 cervical discs with percutaneous DiscoGel®. Inclusion criteria were patients with chronic axial or referred neck pain with MRI showing a cervical disc that is consistent with patient symptoms and failed conservative treatment. Exclusion criteria were clinical myelopathy, motor deficit, severe stenosis or reduced disc height by more than 50%, or previous cervical spine surgery. Results: A total of 10 cases consisting of 6 females and 4 males underwent treatment with percutaneous DiscoGel® for 18 cervical discs. C5/C6 was the most affected level. The mean preoperative VAS score was 8; the postoperative VAS scores at 6 weeks and 3 months were 2.2 and 2.9, respectively. There were no postoperative complications or neurological deficits. Conclusion: The present study has the limitation of the small number of cases; however, with the limited number of studies and less than 100 published cases in the literature, this initial work shows that cervical percutaneous DiscoGel® is an effective minimally invasive bridging option between conservative and open surgical treatment for cervical discogenic pain, with a high success rate. The differentiation of pain types (nociceptive, referred, radicular, and trapezius myalgia) that can coexist is crucial for procedure selection and improving treatment outcome.


Assuntos
Dor Crônica/tratamento farmacológico , Etanol/administração & dosagem , Cervicalgia/tratamento farmacológico , Adolescente , Adulto , Vértebras Cervicais/patologia , Vértebras Cervicais/fisiopatologia , Dor Crônica/patologia , Dor Crônica/fisiopatologia , Feminino , Humanos , Disco Intervertebral/patologia , Disco Intervertebral/fisiopatologia , Masculino , Pessoa de Meia-Idade , Cervicalgia/patologia , Cervicalgia/fisiopatologia
18.
Ear Nose Throat J ; 98(8): 500-503, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-30995862

RESUMO

Superior laryngeal nerve neuralgia (SLNN) is an anterior neck pain syndrome that is underrecognized and, as a result, is often misdiagnosed. We present a series of patients who were diagnosed with and subsequently treated for SLNN. Nineteen patients were treated with oral nonsteroidal anti-inflammatory drugs (NSAIDs) and/or a therapeutic neck injection with 2% lidocaine and 40% triamcinolone acetonide. All patients completed a visual analog scale (VAS) to rate the level of pain before and after treatment. Four patients rated their pain as mild, 14 as moderate, and 1 as severe according to the VAS. Of the 19 patients, 8 chose to proceed with a 2-week course of NSAIDs and only 1 of them had complete resolution of their symptoms. A total of 18 patients underwent therapeutic neck injections, with a complete response to injection therapy in 10 patients. Five patients described a minimal residual foreign body sensation and 3 patients complained of mild residual pain. In this study, we found that therapeutic neck injections are effective not only in confirming the diagnosis but also in treating pain.


Assuntos
Anestésicos Locais/administração & dosagem , Anti-Inflamatórios/uso terapêutico , Nervos Laríngeos , Lidocaína/administração & dosagem , Cervicalgia/tratamento farmacológico , Neuralgia/diagnóstico , Neuralgia/tratamento farmacológico , Triancinolona Acetonida/uso terapêutico , Adulto , Idoso , Anti-Inflamatórios não Esteroides/uso terapêutico , Combinação de Medicamentos , Feminino , Humanos , Ibuprofeno/uso terapêutico , Injeções , Masculino , Pessoa de Meia-Idade , Cervicalgia/etiologia , Neuralgia/complicações , Medição da Dor , Retratamento , Síndrome , Adulto Jovem
19.
Pain Med ; 20(12): 2349-2359, 2019 12 01.
Artigo em Inglês | MEDLINE | ID: mdl-30789640

RESUMO

OBJECTIVE: To assess the prevalence and characteristics of chronic neck pain, chronic low back pain, and migraine or frequent headaches among Spanish adults in 2014 according to gender, to identify predictors for each of these types of pains, and to compare the prevalence with those found in 2009. DESIGN: Cross-sectional study. SETTING: Spain. METHODS: We used data collected from the 2014 European Health Interview Survey (N = 22,842). Sociodemographic features, self-rated health status, lifestyle habits, comorbid conditions, pain characteristics, and self-reported use of medications were analyzed. RESULTS: The prevalence of all types of pain was significantly higher among women than men. For chronic neck pain, the figures were 25.68% vs 12.54%, for chronic low back pain, 27.03% vs 18.83%, and for migraine or frequent headaches, 15.93% vs 6.74%, in women and men, respectively. Predictors of these types of pain included female gender, advanced age, poor self-rated health, psychological distress, comorbidities, and obesity. The prevalence of neck pain and low back pain increased from 2009 to 2014 for both sexes, and the prevalence of migraine or frequent headaches remained stable over time. CONCLUSIONS: The prevalence and intensity of all the forms of chronic pain were higher among women. Women experiencing pain used prescribed medications for pain, anxiety, and/or depression and sleeping pills more than men. The prevalence of chronic neck and low back has increased in the last five years in Spain, and the prevalence of migraine or frequent headaches has remained stable.


Assuntos
Dor Crônica/epidemiologia , Dor Lombar/epidemiologia , Transtornos de Enxaqueca/epidemiologia , Cervicalgia/epidemiologia , Adolescente , Adulto , Idoso , Analgésicos/uso terapêutico , Ansiolíticos/uso terapêutico , Antidepressivos/uso terapêutico , Transtornos de Ansiedade/tratamento farmacológico , Transtornos de Ansiedade/epidemiologia , Dor Crônica/tratamento farmacológico , Estudos Transversais , Transtorno Depressivo/tratamento farmacológico , Transtorno Depressivo/epidemiologia , Feminino , Transtornos da Cefaleia/epidemiologia , Humanos , Dor Lombar/tratamento farmacológico , Masculino , Pessoa de Meia-Idade , Transtornos de Enxaqueca/tratamento farmacológico , Cervicalgia/tratamento farmacológico , Medição da Dor , Prevalência , Fatores Sexuais , Medicamentos Indutores do Sono/uso terapêutico , Espanha/epidemiologia , Adulto Jovem
20.
PLoS One ; 14(2): e0211763, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30811428

RESUMO

Discrepancies in patients' responses to various outcome measures challenge clinicians' evaluation of treatment outcomes. Therefore, we aimed to 1) evaluate the concordance of outcome measures after spine injection, 2) determine the patient variables that lead to discordant responses, and 3) suggest practical outcome measure for spine injections with good responsiveness. From October 2014 to November 2014, 164 patients with neck or low back pain who visited our outpatient clinics and had spine injections on the previous visit were enrolled. We asked patients to report changes in their symptom in the form of outcome measures: numeric rating scale, Oswestry disability index, neck disability index, residual symptom percentage and global perceived effect. The responses were categorized into three groups according to the degree of change; not improved, minimally improved, and significantly improved. The concordances of these categorized answers were evaluated. When "significantly improved" was considered as true improvement, 46 (28%) of the 164 patients had discordant responses to the four measures. There was no significant patients' variable that affects discordance in the outcome measures. Good agreement was shown between the global perceived effect and residual symptom percentage, while the Oswestry disability index had poor agreement with the other measurements. The calculated numeric rating scale and residual symptom percentage also had low levels of agreement. However, patients with severe pre-treatment pain tended to have better agreement. In conclusion, this result suggest that the residual symptom percentage may be a more practical for clinicians and better represent patients' improvements after spine injection.


Assuntos
Injeções Espinhais , Dor Lombar , Cervicalgia , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Dor Lombar/tratamento farmacológico , Dor Lombar/fisiopatologia , Masculino , Pessoa de Meia-Idade , Cervicalgia/tratamento farmacológico , Cervicalgia/fisiopatologia , Medição da Dor , Estudos Retrospectivos
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