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1.
Medicine (Baltimore) ; 100(13): e25387, 2021 Apr 02.
Artigo em Inglês | MEDLINE | ID: mdl-33787646

RESUMO

BACKGROUND: Nerve root sciatica (NRS) is a common orthopedic disease, which usually occurs between 20 and 40 years of age, and the incidence rate is increasing year by year and is being younger. The disease has no special effect of treatment, clinically generally taking the symptomatic treatment, such as taking short-term glucocorticoids, sedatives, analgesics, and so on. Long-term use of drugs will adversely affect the patient's gastrointestinal tract, liver, and kidney function. The surgical treatment has a high risk of surgery, high cost, side effects, and other problems, so the choice of treatment method has always been a difficult problem in clinical and scientific research. The study shows that 90% of patients with sciatica can be cured by non-surgical treatment, so conservative therapy is often used in the treatment of sciatica, traditional Chinese medicine treatment methods in the treatment of NRS has been widely used, which has achieved good results, but there is no evidence of evidence-based medicine. Therefore, this study uses systematic evaluation to conduct the scientific evaluation of the clinical effectiveness and safety of traditional Chinese medicine acupoint catgut embedding guided by musculoskeletal ultrasound in the treatment of NRS, and provide evidence-based medical evidence support for the treatment of NRS. METHODS: Using the computer to retrieve the PubMed, ScienceDirect, Web of Science, Embase, Cochrane Library, CNKI, VIP, WANFANG Database, and CBM. Using the subject words and terminology words to retrieve the Chinese-English database and retrieve a randomized controlled study on the clinical effectiveness and safety of traditional Chinese medicine acupoint catgut embedding guided by musculoskeletal ultrasound in the treatment of NRS, and the range of search time is January 1990 to January 2021. The searched literature is screened and evaluated by two researchers respectively according to the inclusion and exclusion criteria. If there is disagreement, discussing it with the third researcher to determine the final inclusion of the literature. Using the RevMan 5.3 software to conduct the meta-analysis. RESULTS: This study will compare the effectiveness and safety of traditional Chinese medicine acupoint catgut embedding guided by musculoskeletal ultrasound in the treatment of NRS. CONCLUSION: The results of this study will be published in internationally influential academic journals to provide evidence-based medical evidence for the clinical effectiveness and safety of traditional Chinese medicine acupoint catgut embedding in the treatment of NRS. ETHICS AND DISSEMINATION: This study does not involve specific patients, and all research data comes from publicly available professional literature, so an ethics committee is not required to conduct an ethical review and approval of the study. OSF REGISTRATION NUMBER: DOI 10.17605/OSF.IO/Q492E.


Assuntos
Pontos de Acupuntura , Categute/efeitos adversos , Medicina Tradicional Chinesa/métodos , Ciática/terapia , Estudos de Avaliação como Assunto , Medicina Baseada em Evidências/instrumentação , Medicina Baseada em Evidências/métodos , Humanos , Medicina Tradicional Chinesa/efeitos adversos , Medicina Tradicional Chinesa/instrumentação , Metanálise como Assunto , Sistema Musculoesquelético/diagnóstico por imagem , Ensaios Clínicos Controlados Aleatórios como Assunto , Revisões Sistemáticas como Assunto , Resultado do Tratamento , Ultrassonografia de Intervenção
2.
Medicine (Baltimore) ; 100(8): e24551, 2021 Feb 26.
Artigo em Inglês | MEDLINE | ID: mdl-33663061

RESUMO

INTRODUCTION: This meta-analysis aims to assess the effectiveness and safety of warm acupuncture therapy for treating Primary sciatica. METHODS: The following 9 databases will be search from their inception to December 6, 2020: MEDLINE, EMBASE, the Cochrane Central Register of Controlled Trials (CENTRAL), the Chinese Biomedical Literature Database (CBM), the Chinese Medical Current Content (CMCC), the Wan-Fang Database and the China National Knowledge Infrastructure (CNKI). Randomized controlled trials (RCTs) of warm acupuncture for treating Primary sciatica, Chinese or Japanese without restriction of publication status will be included. Two researchers will independently undertake study selection, extraction of data and assessment of study quality. Meta-analysis will be conducted after screening of studies. Data will be analyzed using risk ratio for dichotomous data, and standardized mean difference or weighted mean difference for continuous data. DISSEMINATION: This meta-analysis will be disseminated electronically through a peer-reviewed publication or conference presentations. CONCLUSION: This study will provide evidence to judge whether warm acupuncture. TRIAL REGISTRATION NUMBER: INPLASY2020120109.


Assuntos
Terapia por Acupuntura/métodos , Ciática/terapia , Terapia por Acupuntura/efeitos adversos , Humanos , Satisfação do Paciente , Qualidade de Vida , Ensaios Clínicos Controlados Aleatórios como Assunto , Projetos de Pesquisa
3.
Zhongguo Zhen Jiu ; 41(2): 183-8, 2021 Feb 12.
Artigo em Chinês | MEDLINE | ID: mdl-33788467

RESUMO

OBJECTIVE: To observe the effect of moxibustion at "Huantiao" (GB 30) on the expression of growth-associated protein-43 (GAP-43) in the sciatic nerve trunk and ventral horn of spinal cord (L4-L6) in rats with primary sciatica, and to explore the mechanism of moxibustion in improving primary sciatica. METHODS: A total of 48 healthy male SD rats were randomly divided into a normal group, a sham operation group, a model group and a moxibustion group, 12 rats in each group. The rat model of primary sciatic pain was established by chronic constriction injury (CCI) of the sciatic nerve in the model group and the moxibustion group. On the 8th day of the experiment, moxibustion was adopted at "Huantiao" (GB 30) in the moxibustion group for 5-10 min, once a day for 14 consecutive days. Sciatic nerve function index (SFI) was measured and compared in each group at day 1, 7, 14 and 21. On the 21st day of the experiment, HE staining was used to observe the morphology of ventral horn of rat spinal cord and sciatic nerve trunk. Immunohistochemical method and real-time PCR were used to detect mRNA and protein expressions of GAP-43 in the spinal cord and sciatic nerve trunk of rats. RESULTS: On day 7, 14 and 21, there was no statistical difference in SFI between the sham operation group and the normal group (P>0.05); compared with the sham operation group on day 7, 14 and 21, the SFI of the model group was reduced (P<0.01); compared with the model group on day 14 and 21, SFI in the moxibustion group was increased (P<0.01). In the normal group and the sham operation group, neuronal cells were in order in the ventral horn of the spinal cord, nissl bodies were spaced regularly, the myelin sheath structure of sciatic nerve axon was clearly visible. In the model group, neuronal cells were deformed and ruptured in the ventral horn of the spinal cord, the number of nissl bodies was less, and the demyelination of sciatic axons appeared. In the moxibustion group, neuronal cells were found in the ventral horn of spinal cord, and the number of nissl bodies was increased, and less demyelinating changes of axons appeared in sciatic nerve. Compared with the normal group, the expressions of GAP-43 mRNA and GAP-43 protein in the sciatic nerve trunk and GAP-43 protein in the ventral horn of spinal cord were increased in the sham operation group (P<0.01). Compared with the sham operation group, the expression of GAP-43 mRNA and GAP-43 protein in the spinal cord and sciatic nerve trunk of rats in the model group was increased. Compared with the model group, the expression of GAP-43 mRNA and GAP-43 protein in the spinal cord and sciatic nerve trunk of rats in the moxibustion group was increased (P<0.01). CONCLUSION: Moxibustion at "Huantiao" (GB 30) could improve the sciatic nerve function in rats with primary sciatica and its mechanism may be related to improving the expression of GAP-43 and enhancing the self-repair ability of the sciatic nerve after injury.


Assuntos
Eletroacupuntura , Moxibustão , Ciática , Animais , Proteína GAP-43/genética , Masculino , Ratos , Ratos Sprague-Dawley , Nervo Isquiático , Ciática/terapia , Medula Espinal
4.
Medicine (Baltimore) ; 100(1): e23951, 2021 Jan 08.
Artigo em Inglês | MEDLINE | ID: mdl-33429754

RESUMO

BACKGROUND: Sciatica is a common and frequent peripheral neuropathic pain disease, which causes a great burden on peoples life. Recently, acupoint catgut embedding (ACE) has been widely applied for treating sciatica in China, however, there is no enough evidence to prove the efficiency and safety of ACE for sciatica. Our study aims to evaluate the efficiency and safety of ACE for sciatica. METHODS AND ANALYSIS: Searches of the Cochrane Library, PubMed, Springer Medline, EMBASE, China National Knowledge Infrastructure (CNKI), Wan-Fang Data (WANFANG), Chinese Biomedical Literature Database (CBM), and Chinese Scientific Journal Database (VIP databases) will be performed from inception to November 2020. The main outcomes are the pain intensity and the whole efficiency assessment. The secondary outcomes will include Oswestry Disability Index (ODI), life quality, physical examination, and adverse events. Two reviewers will separately conduct the study selection, data extraction and study quality assessments. RevMan 5.3 software will be used for meta-analysis. RESULTS: This study will provide an evidence-based review of acupoint catgut embedding therapy for sciatica according to the pain intensity, the whole efficiency assessment, life quality, DOI index and adverse events. CONCLUSIONS: This systematic review will present the current evidence for acupoint catgut embedding therapy for sciatica. ETHICS AND DISSEMINATION: Ethical approval is unnecessary as this protocol is only for systematic review and does not involve privacy data. The findings of this study will be disseminated electronically through a peer-review publication or presented at a relevant conference. TRIAL REGISTRATION NUMBER: INPLASY2020110087.


Assuntos
Pontos de Acupuntura , Categute/normas , Protocolos Clínicos , Ciática/terapia , Inclusão do Tecido/métodos , Terapia por Acupuntura/efeitos adversos , Terapia por Acupuntura/métodos , Terapia por Acupuntura/normas , Categute/efeitos adversos , Humanos , Metanálise como Assunto , Revisões Sistemáticas como Assunto , Inclusão do Tecido/normas
5.
Medicine (Baltimore) ; 100(2): e24126, 2021 Jan 15.
Artigo em Inglês | MEDLINE | ID: mdl-33466184

RESUMO

BACKGROUND: Sciatica is a syndrome characterized by sciatic nerve path and distribution area pain. Many kinds of literature reported the definite effect of warm needle acupuncture (WNA) on sciatica. However, there is no systematic review or meta-analysis on WNA for sciatica. Therefore, this study will design a protocol to comprehensively and systematically evaluate the effectiveness and safety of WNA on sciatica. METHODS: The two researchers in this study will search the electronic database for randomized controlled trials, (RCTs) of WNA on sciatica, The databases we will search include PubMed, EMBASE, Cochrane Library, Web of Science, Chinese national knowledge infrastructure (CNKI), China Science and Technology Journal Database (VIP), Wanfang Database, and Chinese biomedical literature database (CBM). Review Manager 5.4 software and Cochrane risk bias tool will be us used for data analysis and to evaluate research quality. The main clinical indicators will include visual analogue scale (VAS) and Oswestry Disability Index (ODI). RESULTS: This study will evaluate the efficacy and safety of WNA for sciatica. CONCLUSION: This study will provide a reliable scheme for objectively and comprehensively evaluating the efficacy and safety of WNA on sciatica. TRIAL REGISTRATION NUMBER: INPLASY2020110074.


Assuntos
Terapia por Acupuntura/normas , Protocolos Clínicos , Moxibustão/normas , Ciática/terapia , Terapia por Acupuntura/métodos , Humanos , Metanálise como Assunto , Moxibustão/métodos , Revisões Sistemáticas como Assunto
6.
Medicine (Baltimore) ; 99(21): e20083, 2020 May 22.
Artigo em Inglês | MEDLINE | ID: mdl-32481274

RESUMO

We developed a protocol for a prospective registry to prove the effectiveness and safety of integrative Korean medicine treatment for inpatients with sciatica due to lumbar intervertebral disc herniation. We plan on recruiting 1000 inpatients receiving integrative Korean medicine treatment for lumbar intervertebral disc herniation at four spine specialized Korean medical hospitals. Patients enrolled in the registry will be evaluated at the time of hospitalization, 2 weeks after hospitalization, at discharge, and 6 months after hospitalization on predefined outcome variables such as intensity of back and leg pain, Oswestry Disability Index, quality of life, Patient Global Impression of Change, and adverse effects. The protocol of this study was registered in CRIS (KCT0003709) and Clinical trial gov (NCT03750591). This study is significant in that it cannot only be a basis for safety-related evidence of complementary alternative medicine, which has been lacking, but it also gives clear evidence on the effectiveness and validity of treatment effects such as accompaniment of stenosis, sex, age, and type of disc herniation.


Assuntos
Medicina Integrativa/métodos , Deslocamento do Disco Intervertebral/terapia , Medicina Tradicional Coreana/métodos , Ciática/terapia , Terapia por Acupuntura/métodos , Adulto , Idoso , Humanos , Deslocamento do Disco Intervertebral/complicações , Pessoa de Meia-Idade , Estudos Observacionais como Assunto , Estudos Prospectivos , Sistema de Registros , República da Coreia , Ciática/etiologia , Resultado do Tratamento , Adulto Jovem
7.
Bone Joint J ; 102-B(5): 556-567, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-32349600

RESUMO

Deep gluteal syndrome is an increasingly recognized disease entity, caused by compression of the sciatic or pudendal nerve due to non-discogenic pelvic lesions. It includes the piriformis syndrome, the gemelli-obturator internus syndrome, the ischiofemoral impingement syndrome, and the proximal hamstring syndrome. The concept of the deep gluteal syndrome extends our understanding of posterior hip pain due to nerve entrapment beyond the traditional model of the piriformis syndrome. Nevertheless, there has been terminological confusion and the deep gluteal syndrome has often been undiagnosed or mistaken for other conditions. Careful history-taking, a physical examination including provocation tests, an electrodiagnostic study, and imaging are necessary for an accurate diagnosis. After excluding spinal lesions, MRI scans of the pelvis are helpful in diagnosing deep gluteal syndrome and identifying pathological conditions entrapping the nerves. It can be conservatively treated with multidisciplinary treatment including rest, the avoidance of provoking activities, medication, injections, and physiotherapy. Endoscopic or open surgical decompression is recommended in patients with persistent or recurrent symptoms after conservative treatment or in those who may have masses compressing the sciatic nerve. Many physicians remain unfamiliar with this syndrome and there is a lack of relevant literature. This comprehensive review aims to provide the latest information about the epidemiology, aetiology, pathology, clinical features, diagnosis, and treatment. Cite this article: Bone Joint J 2020;102-B(5):556-567.


Assuntos
Síndrome do Músculo Piriforme/diagnóstico , Síndrome do Músculo Piriforme/terapia , Ciática/diagnóstico , Ciática/terapia , Terapia Combinada , Diagnóstico Diferencial , Diagnóstico por Imagem , Eletrodiagnóstico , Humanos , Anamnese , Exame Físico , Síndrome do Músculo Piriforme/fisiopatologia , Nervo Pudendo/fisiopatologia , Nervo Isquiático/fisiopatologia , Ciática/fisiopatologia
8.
9.
N Engl J Med ; 382(12): 1093-1102, 2020 03 19.
Artigo em Inglês | MEDLINE | ID: mdl-32187469

RESUMO

BACKGROUND: The treatment of chronic sciatica caused by herniation of a lumbar disk has not been well studied in comparison with acute disk herniation. Data are needed on whether diskectomy or a conservative approach is better for sciatica that has persisted for several months. METHODS: In a single-center trial, we randomly assigned patients with sciatica that had lasted for 4 to 12 months and lumbar disk herniation at the L4-L5 or L5-S1 level in a 1:1 ratio to undergo microdiskectomy or to receive 6 months of standardized nonoperative care followed by surgery if needed. Surgery was performed by spine surgeons who used conventional microdiskectomy techniques. The primary outcome was the intensity of leg pain on a visual analogue scale (ranging from 0 to 10, with higher scores indicating more severe pain) at 6 months after enrollment. Secondary outcomes were the score on the Oswestry Disability Index, back and leg pain, and quality-of-life scores at 6 weeks, 3 months, 6 months, and 1 year. RESULTS: From 2010 through 2016, a total of 790 patients were screened; of those patients, 128 were enrolled, with 64 in each group. Among the patients assigned to undergo surgery, the median time from randomization to surgery was 3.1 weeks; of the 64 patients in the nonsurgical group, 22 (34%) crossed over to undergo surgery at a median of 11 months after enrollment. At baseline, the mean score for leg-pain intensity was 7.7 in the surgical group and 8.0 in the nonsurgical group. The primary outcome of the leg-pain intensity score at 6 months was 2.8 in the surgical group and 5.2 in the nonsurgical group (adjusted mean difference, 2.4; 95% confidence interval, 1.4 to 3.4; P<0.001). Secondary outcomes including the score on the Owestry Disability Index and pain at 12 months were in the same direction as the primary outcome. Nine patients had adverse events associated with surgery, and one patient underwent repeat surgery for recurrent disk herniation. CONCLUSIONS: In this single-center trial involving patients with sciatica lasting more than 4 months and caused by lumbar disk herniation, microdiskectomy was superior to nonsurgical care with respect to pain intensity at 6 months of follow-up. (Funded by Physicians' Services Incorporated Foundation; ClinicalTrials.gov number, NCT01335646.).


Assuntos
Tratamento Conservador , Discotomia , Glucocorticoides/administração & dosagem , Deslocamento do Disco Intervertebral/cirurgia , Modalidades de Fisioterapia , Ciática/terapia , Adulto , Tratamento Conservador/métodos , Estudos Cross-Over , Discotomia/efeitos adversos , Feminino , Seguimentos , Humanos , Injeções Epidurais , Análise de Intenção de Tratamento , Deslocamento do Disco Intervertebral/complicações , Deslocamento do Disco Intervertebral/tratamento farmacológico , Masculino , Dor/etiologia , Medição da Dor , Satisfação do Paciente , Complicações Pós-Operatórias , Qualidade de Vida , Ciática/etiologia , Ciática/cirurgia , Resultado do Tratamento
10.
Rev. argent. cir. plást ; 26(1): 41-44, ene-mar 2020. fig, tab
Artigo em Espanhol | LILACS | ID: biblio-1120508

RESUMO

Antecedentes. El colgajo Hamstring es una opción válida para la reconstrucción de úlceras isquiáticas. Las úlceras por presión representan un verdadero desafío para el cirujano plástico. Requieren un tratamiento especializado y multidisciplinario por su alta probabilidad de recidiva y las complicaciones en su manejo. Por lo general, ocurren por presión sostenida sobre la tuberosidad isquiática. Caso clínico. Se presenta el caso de un paciente parapléjico desde el nacimiento secundario a mielomeningocele con diagnóstico actual de úlcera isquiática. Se le realizaron durante 3 años múltiples intentos de cierre quirúrgico alternando medidas conservadoras, sin éxito. A la exploración física presenta una úlcera isquiática izquierda de 6x6 cm a la que se le realizó aseo y desbridación quirúrgica más cierre por medio de un colgajo Hamstring modificado. A los 7 días presentó dehiscencia de herida la cual se manejó de manera conservadora y cierre primario diferido a las 4 semanas. A 8 meses de posoperatorio el paciente se encuentra con buena evolución y con resultado estético y funcional aceptable, por otra parte, se encuentra sin recidiva, lo que ha permitido su reinserción laboral y un buen equilibrio físico-psico-emocional. Conclusión. El objetivo de este colgajo es brindar cobertura al área isquiática sin afectar estructuras adyacentes, lo cual requiere de un amplio conocimiento de la anatomía de la región femoral, así como de los colgados tanto locales como regionales que podemos utilizar para la reconstrucción. Actualmente este colgajo es una opción terapéutica efectiva para el tratamiento de úlceras isquiáticas refractarias en centros que cuentan con cirujanos plásticos no especializados en microcirugía.


Background. The Hamstring fl ap is an adequate option for ischial ulcers reconstruction. Pressure ulcers represent a real challenge for the plastic surgeon. They require specialized and multidisciplinary treatment due to their high recurrence probability and complications in their management. Regularly, pressure ulcers occur when sustained pressure is applied on the ischial tuberosity. Case report. We report a case of a 23-year-old paraplegic male with myelomeningocele complaining for an ischial ulcer. Multiple attempts to surgical closure were made during three years along with conservative management, without success. Physical examination revealed a 6x6 cm left ischial ulcer, which was managed with surgical debridement and closure with a modifi ed Hamstring fl ap. After 7 days, the patient presented wound dehiscence, which was managed conservatively and primary delayed closure after 4 weeks. 8 months postoperatively the patient has a good evolution and an acceptable functional and aesthetic result, without recurrence, which has allowed his reintegration into work and a good physical-psycho-emotional balance. Conclusion. The objective of this fl ap is to provide coverage to the ischial area without aff ecting adjacent structures, which requires a broad knowledge of the anatomy of the femoral region, as well as the local and regional fl aps that can be used for reconstruction. Nowadays this fl ap is an eff ective therapeutic option for the treatment of refractary ischial ulcers in plastis suergery centers without microsurgery.


Assuntos
Humanos , Masculino , Adulto , Ciática/terapia , Retalhos Cirúrgicos/cirurgia , Lesão por Pressão/cirurgia , Músculos Isquiossurais/patologia , Indicadores Básicos de Saúde
11.
Eur J Phys Rehabil Med ; 56(2): 220-227, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-31556510

RESUMO

Low back pain (LBP) and radicular pain are very common health problems. They are rarely caused by serious underlying pathology and will usually recover spontaneously in time. In about one third of the cases however, the pain and functional impairment will persist one year after onset, being responsible for high health care costs and work absence. The management of LBP and radicular pain should focus therefore on excluding signs and symptoms of serious underlying pathology, on an active approach and on the prevention of chronicity. In 2017 the Belgian Health Care Knowledge Centre (KCE) published a guideline on LBP and radicular pain. This guideline formed the basis for a national pathway on LBP and radicular pain and is the first step to change and optimize our daily clinical practice. In this Belgian guideline the importance is stressed of a comprehensive clinical assessment and a tailored rehabilitation. Pharmacological and invasive treatments have a more doubtful effect or should only be considered under certain conditions. Implementing these recommendations in an interdisciplinary pathway necessitates a central role for Physical and Rehabilitation Medicine (PRM) especially in giving advice on and/or coordinating the tailored rehabilitation to prevent chronicity. To do this, the PRM specialist should perform a medical and functional assessment according to the ICF framework and taking into account the risk for chronicity or persistent impairment and the rehabilitation potential.


Assuntos
Dor Lombar/terapia , Modalidades de Fisioterapia , Ciática/terapia , Bélgica , Humanos , Dor Lombar/fisiopatologia , Exame Físico , Guias de Prática Clínica como Assunto , Ciática/fisiopatologia
12.
Eur J Phys Rehabil Med ; 56(2): 228-236, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-31556511

RESUMO

INTRODUCTION: High level evidence on management of spinal disorders is scarce, which results in guidelines being of limited practical use for practitioners. Care pathways are complex interventions intended for the mutual decision making of organization of care processes for a well-defined group of patients. The goal of this project was to design a pathway for the management of low back pain and radicular pain for national implementation in Belgium. EVIDENCE ACQUISITION: An international and Belgian study on characteristics of low back pain care pathways was performed along with a literature study and focus group interrogation. Based on essential building elements identified and a consensus approach among all relevant stakeholders in primary, hospital and reintegration care, a national pathway was constructed. The process was endorsed by the Belgian Health Care Knowledge Center, Belgian National Institute of Health and Disability Insurance and the Spine Society of Belgium. EVIDENCE SYNTHESIS: Eleven international pathways were identified, varying in implementation width from hospital-based to region/province-based. Seven Belgian pathway initiatives were detected. Notwithstanding differences, consistent building elements were identified. Three groups of caregivers, divided in primary care, hospital care and reintegration and including all relevant medical/paramedical disciplines, worked on integrating the essential building elements into a single concrete patient pathway of direct use to any caregiver and patient and based on a consensus model including reference to the 2017 Belgian adaptation of the 2016 NICE guidelines. The resulting pathways on management of low back pain and radicular pain underpin the importance of multidisciplinary teamwork. CONCLUSIONS: Essential building elements were identified from literature and established pathways and were successfully integrated in a Belgian national low back pain and radicular pain pathway using an integrative consensus approach. The pathways are consultable at www.lowbackpain.kce.be.


Assuntos
Dor Lombar/terapia , Programas Nacionais de Saúde , Equipe de Assistência ao Paciente , Ciática/terapia , Bélgica , Humanos , Dor Lombar/fisiopatologia , Ciática/fisiopatologia
14.
BMC Musculoskelet Disord ; 20(1): 438, 2019 Sep 29.
Artigo em Inglês | MEDLINE | ID: mdl-31564252

RESUMO

BACKGROUND: The aim of this study was to find out whether the shear wave elastography (SWE) findings of patients with unilateral lumbar disc herniation (LDH) were related to clinical characteristics. METHODS: For this purpose, the study group included patients (N = 20; 13 male, 7 female) with complaints of unilateral sciatica, with foraminal stenosis caused by one level of LDH (L4-L5 or L5-S1). An gender-and age-matched control group (N = 27; 16 male, 11 female) was included. All the patients were examined on both the axial and longitudinal planes bilaterally at the same level using a convex array probe (1- 6 MHz, Supersonic Imagine, Aix en Provence, France). RESULTS: The sciatic nerve stiffness measured on longitudinal planes of the affected side was significantly higher than unaffected side (p < 0.001) and the control group (P < 0.05). Furthermore, the symptom duration of unilateral LDH is positively correlated with the stiffness the sciatic nerve (r = 0.52, p = 0.019). CONCLUSION: According to these findings, ultrasound imaging can be considered as a useful tool to detect changes in the sciatic nerve due to disc herniation. This technique will have a promising prospect for many patients with unilateral LDH in monitoring stiffness during rehabilitation and before or after surgery.


Assuntos
Técnicas de Imagem por Elasticidade/métodos , Deslocamento do Disco Intervertebral/diagnóstico por imagem , Nervo Isquiático/diagnóstico por imagem , Ciática/diagnóstico por imagem , Adulto , Estudos de Casos e Controles , Feminino , Humanos , Disco Intervertebral/diagnóstico por imagem , Deslocamento do Disco Intervertebral/complicações , Deslocamento do Disco Intervertebral/terapia , Vértebras Lombares/diagnóstico por imagem , Imagem por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Ciática/etiologia , Ciática/terapia , Resultado do Tratamento
16.
BMC Neurol ; 19(1): 216, 2019 Sep 03.
Artigo em Inglês | MEDLINE | ID: mdl-31481010

RESUMO

BACKGROUND: Sciatica is a condition that is characterised by radicular pain in the leg and primarily caused by a herniated lumbar intervertebral disk. In addition to leg pain, patients can experience back pain, leg numbness and leg weakness resulting in decreased productivity and social activity. The majority of sciatica cases recovers spontaneously and therefore patients are initially treated conservatively with oral pain medication. However, some patients experience intractable pain that severely impedes them and no consensus exists on the optimal conservative treatment to reduce this discomfort in the acute phase of sciatica. The aim of the TEIAS trial is to assess the effectiveness, cost-effectiveness and predictive capability on patient outcome of transforaminal epidural injection (TEI) compared to treatment with standard pain medication. METHODS: This study is designed as a prospective, open-label, mono-centered, randomized controlled trial. Patients that visit their general practitioner with complaints of radicular leg pain and meet the selection criteria are asked to participate in this study. Eligible patients will be randomized to treatment with TEI or to treatment with standard oral pain medication. Treatment of TEI will comprise lidocaine with methylprednisolone acetate for L3 and below and lidocaine with dexamethasone above L3. A total of 142 patients will be recruited and follow-up will occur after 1, 2, 4, 10 and 21 weeks for assessment of pain, functionality, patient received recovery and cost-effectiveness. The primary outcome will be the average score for leg pain at 2 weeks. For this outcome we defined a clinically relevant difference as 1.5 on the 11-point NRS scale. DISCUSSION: Adequate conservative treatment in the acute phase of sciatica is lacking, particularly for patients with severe symptoms. Focusing on effectiveness, cost-effectiveness and predictive capability on patient outcome of TEI will produce useful information allowing for more lucid decision making in the conservative treatment of sciatica in the acute phase. TRIAL REGISTRATION: This trial is registered in the ClinicalTrials.gov database under registry number NCT03924791 on April 23, 2019.


Assuntos
Degeneração do Disco Intervertebral/complicações , Deslocamento do Disco Intervertebral/complicações , Dor/etiologia , Ciática/terapia , Análise Custo-Benefício , Dexametasona/uso terapêutico , Humanos , Injeções Epidurais , Vértebras Lombares , Medição da Dor , Estudos Prospectivos
17.
Scand J Pain ; 20(1): 69-75, 2019 12 18.
Artigo em Inglês | MEDLINE | ID: mdl-31527299

RESUMO

Background and aims Recovery in patients hospitalised with severe sciatica is unpredictable. Prognostic tools to aid clinicians in the early identification of patients at risk of developing chronic sciatic pain are warranted. Conditioned pain modulation (CPM) is a psychophysical measure of the endogenous pain modulatory pathways. Several studies have suggested CPM as a potentially important predictive biomarker for the development of chronic pain. The aim of the study was to determine whether CPM effect in patients still suffering from leg pain 6 weeks after hospital discharge for severe sciatica is associated with persistent leg pain at 12 months. A potential association would suggest that measuring CPM effect could be a valuable prognostic tool in the hospital management of sciatica. Methods A prospective cohort study in which CPM effect was measured 6 weeks after hospital discharge following an acute admission with sciatica as the main complaint. The impact of CPM effect on the outcome was analysed using logistic regression. The outcome measured was self-reported leg pain score of ≥1 in the past week on a 0-10 numeric rating scale (NRS) at 12 months post discharge. Results A total of 111 patients completed the entire study, 51 of whom received non-randomised surgical treatment. Crude and confounder adjusted analyses showed no significant association between CPM effect and leg-pain measured at 12 months, crude Odds Ratio 0.87, 95% CI 0.7-1.1, p = 0.23. Conclusions Our results suggest that CPM assessment has limited prognostic value for the long-term outcome in severe sciatica when measured 6 weeks after hospital discharge. Implications The present study adds important knowledge concerning the limited clinical use of late CPM testing in sciatica patients. The heterogeneity in patients, the wide range of treatments received and a generally favourable outcome are factors that may affect CPM's clinical value as a prognostic factor for severe sciatica.


Assuntos
Medição da Dor , Dor/complicações , Prognóstico , Ciática , Adulto , Feminino , Hospitalização , Humanos , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Ciática/cirurgia , Ciática/terapia , Inquéritos e Questionários
18.
Pain Med ; 20(11): 2303-2310, 2019 11 01.
Artigo em Inglês | MEDLINE | ID: mdl-31369674

RESUMO

OBJECTIVE: To evaluate the efficacy and safety of acupuncture for discogenic sciatica. DESIGN: Single-center, parallel, randomized controlled sham acupuncture trial. METHODS: Twelve sessions of acupuncture or sham acupuncture at the same traditional acupoints over four weeks. The primary outcome was change from baseline in weekly mean leg pain, measured by the visual analog scale (VAS) over the four-week treatment period. The secondary outcomes were determined by the change from baseline in mean VAS scores for leg pain, VAS scores for low back pain, Oswestry Disability Index (ODI) scores, and 36-Item Short Form Health Survey (SF-36) scores. Patients were followed for 28 weeks. RESULTS: Forty-six patients were enrolled in this study between June 2017 and January 2018, of which 23 were in the acupuncture group and 23 were in the sham acupuncture group. The between-group difference in weekly mean leg pain measured by the VAS over the four-week treatment period was -7.28 mm (95% confidence interval = -13.76 to -0.80, P = 0.029), which is larger than the minimum clinically important difference of 5 mm. The between-group differences in mean VAS scores for low back pain, ODI scores, and SF-36 scores were not significant in the study period (P > 0.05 for all). The proportion of acupuncture-related adverse events was 4.3%, and all adverse events were mild and transient. CONCLUSIONS: Twelve sessions of acupuncture showed short-term clinical benefits in relieving the symptoms of leg pain for patients with chronic discogenic sciatica compared with sham acupuncture. Acupuncture is safe in treating chronic discogenic sciatica. Further studies with larger sample sizes, a longer treatment period, and long-term follow-up should be conducted to verify these results.


Assuntos
Terapia por Acupuntura , Dor Crônica/terapia , Dor Lombar/terapia , Ciática/terapia , Pontos de Acupuntura , Terapia por Acupuntura/métodos , Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Medição da Dor , Ciática/diagnóstico , Fatores de Tempo , Resultado do Tratamento
19.
Occup Environ Med ; 76(10): 772-779, 2019 10.
Artigo em Inglês | MEDLINE | ID: mdl-31296665

RESUMO

Sciatica impacts on the ability to work and may lead to a reduced return to work. This study reviewed and summarised prognostic factors of work participation in patients who received conservative or surgical treatment for clinically diagnosed sciatica. We searched MEDLINE, CINAHL, EMBASE and PsycINFO until January 2018. Cohort studies, using a measure of work participation as outcome, were included. Two independent reviewers performed study inclusion and used the Quality In Prognosis Studies tool for risk of bias assessment and GRADE to rate the quality of the evidence. Based on seven studies describing six cohorts (n=1408 patients) that assessed 21 potential prognostic factors, favourable factors for return to work (follow-up ranging from 3 months to 10 years) included younger age, better general health, less low back pain or sciatica bothersomeness, better physical function, negative straight leg raise-test, physician expecting surgery to be beneficial, better pain coping, less depression and mental stress, less fear of movement and low physical work load. Study results could not be pooled. Using GRADE, the quality of the evidence ranged from moderate to very low, with downgrading mainly for a high risk of bias and imprecision. Several prognostic factors like pain, disability and psychological factors were identified and reviewed, and these could be targeted using additional interventions to optimise return to work. PROSPERO registration number: CRD42016042497.


Assuntos
Retorno ao Trabalho/estatística & dados numéricos , Ciática/terapia , Resultado do Tratamento , Fatores Etários , Estudos de Coortes , Avaliação da Deficiência , Feminino , Humanos , Masculino , Dor , Prognóstico , Ciática/reabilitação , Ciática/cirurgia
20.
BMC Musculoskelet Disord ; 20(1): 313, 2019 Jul 04.
Artigo em Inglês | MEDLINE | ID: mdl-31272439

RESUMO

BACKGROUND: Sciatica is a painful condition managed by a stepped care approach for most patients. Currently, there are no decision-making tools to guide matching care pathways for patients with sciatica without evidence of serious pathology, early in their presentation. This study sought to develop an algorithm to subgroup primary care patients with sciatica, for initial decision-making for matched care pathways, including fast-track referral to investigations and specialist spinal opinion. METHODS: This was an analysis of existing data from a UK NHS cohort study of patients consulting in primary care with sciatica (n = 429). Factors potentially associated with referral to specialist services, were identified from the literature and clinical opinion. Percentage of patients fast-tracked to specialists, sensitivity, specificity, positive and negative predictive values for identifying this subgroup, were calculated. RESULTS: The algorithm allocates patients to 1 of 3 groups, combining information about four clinical characteristics, and risk of poor prognosis (low, medium or high risk) in terms of pain-related persistent disability. Patients at low risk of poor prognosis, irrespective of clinical characteristics, are allocated to group 1. Patients at medium risk of poor prognosis who have all four clinical characteristics, and patients at high risk of poor prognosis with any three of the clinical characteristics, are allocated to group 3. The remainder are allocated to group 2. Sensitivity, specificity and positive predictive value of the algorithm for patient allocation to fast-track group 3, were 51, 73 and 22% respectively. CONCLUSION: We developed an algorithm to support clinical decisions regarding early referral for primary care patients with sciatica. Limitations of this study include the low positive predictive value and use of data from one cohort only. On-going research is investigating whether the use of this algorithm and the linked care pathways, leads to faster resolution of sciatica symptoms.


Assuntos
Procedimentos Clínicos , Técnicas de Apoio para a Decisão , Seleção de Pacientes , Ciática/diagnóstico , Adulto , Idoso , Tomada de Decisão Clínica , Estudos de Coortes , Estudos de Viabilidade , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Medição da Dor , Valor Preditivo dos Testes , Atenção Primária à Saúde , Encaminhamento e Consulta , Ciática/terapia , Sensibilidade e Especificidade , Fatores de Tempo
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