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1.
Turk Neurosurg ; 31(1): 119-123, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33372261

RESUMO

AIM: To compare the efficacies of fluoroscopy- and ultrasound (US)-guided caudal epidural steroid injections (CESIs) in patients with chronic low back pain (LBP). MATERIAL AND METHODS: This study included patients with chronic LBP who underwent US- (Group U; n = 90) or fluoroscopyguided (Group F; n = 90) CESI. The procedure time, successful injection rate on the first attempt, complication rate, Oswestry Disability Index (ODI) score, and Numeric Rating Scale (NRS) score before CESI and after 3 weeks and 3 months of CESI were analyzed. RESULTS: NRS and ODI scores improved at 3 weeks (p < 0.001) and 3 months (p < 0.001) after CESIs. No significant differences were noted between the two groups for the NRS (p=0.22 and p=0.47) and ODI (p=0.58, p=0.22) scores. Moreover, the CESI procedure time was significantly shorter (p < 0.001) and the successful injection rate on the first attempt was significantly higher (p=0.002) in Group U than in Group F. The complication rate difference was statistically insignificant between the two groups (p > 0.05). CONCLUSION: Outcomes of US-guided CESI were superior than those of fluoroscopy-guided CESI considering the successful injection rate on the first attempt and procedure time. In addition, US-guided CESI was as effective as fluoroscopy-guided CESI and did not expose patients and practitioners to radiation.


Assuntos
Anestesia Epidural/métodos , Dor Crônica/diagnóstico por imagem , Dor Crônica/tratamento farmacológico , Dor Lombar/diagnóstico por imagem , Dor Lombar/tratamento farmacológico , Adulto , Idoso , Anestesia Epidural/normas , Feminino , Fluoroscopia/métodos , Fluoroscopia/normas , Seguimentos , Humanos , Injeções Epidurais/métodos , Injeções Epidurais/normas , Monitorização Neurofisiológica Intraoperatória/métodos , Monitorização Neurofisiológica Intraoperatória/normas , Masculino , Pessoa de Meia-Idade , Esteroides/administração & dosagem , Ultrassonografia/métodos , Ultrassonografia/normas
2.
PLoS One ; 15(12): e0243970, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33315932

RESUMO

Assessing chronic pain is a challenge given its subjective dimension. In humans, resting state electroencephalography (EEG) is a promising tool although the results of various studies are contradictory. Spontaneous chronic pain is understudied in animals but could be of the highest interest for a comparative study. Riding horses show a very high prevalence of back disorders thought to be associated with chronic pain. Moreover, horses with known back problems show cognitive alterations, such as a lower attentional engagement. Therefore, we hypothesized that the individual EEG power profiles resting state (i.e. quiet standing) of different horses could reflect the state of their back, that we measured using static sEMG, a tool first promoted to assess lower back pain in human patients. Results show that 1) EEG profiles are highly stable at the intra-individual level, 2) horses with elevated back tension showed resting state EEG profiles characterized by more fast (beta and gamma) and less slow (theta and alpha) waves. The proportion of theta waves was particularly negatively correlated with muscular tension along the spine. Moreover, elevated back tension was positively correlated with the frequency of stereotypic behaviours (an "addictive- like" repetitive behavior) performed by the horses in their stall. Resting state quantitative EEG appears therefore as a very promising tool that may allow to assess individual subjective chronic pain experience, beyond more objective measures of tension. These results open new lines of research for a multi-species comparative approach and might reveal very important in the context of animal welfare.


Assuntos
Dor Crônica/fisiopatologia , Disfunção Cognitiva/fisiopatologia , Eletroencefalografia , Coluna Vertebral/fisiopatologia , Bem-Estar do Animal , Animais , Atenção/fisiologia , Dor Crônica/complicações , Dor Crônica/diagnóstico por imagem , Dor Crônica/veterinária , Disfunção Cognitiva/complicações , Disfunção Cognitiva/diagnóstico por imagem , Feminino , Cavalos/fisiologia , Masculino , Coluna Vertebral/diagnóstico por imagem
3.
Medicine (Baltimore) ; 99(31): e21499, 2020 Jul 31.
Artigo em Inglês | MEDLINE | ID: mdl-32756184

RESUMO

BACKGROUND: Numerous studies using a variety of non-invasive neuroimaging techniques in vivo have demonstrated that chronic pain (CP) is associated with brain alterations. Cortical thickness (CTh) via surface-based morphometry (SBM) analysis of magnetic resonance imaging data is a valid and sensitive method to investigate the structure of brain gray matter. Many studies have employed SBM to measure CTh difference between patients with CP and pain-free controls and provided important insights into the brain basis of CP. However, the findings from these studies were inconsistent and have not been quantitatively reviewed. METHODS: Three major electronic medical databases: PubMed, Web of Science, and Embase were searched for eligible studies published in English on April 3, 2020. This protocol was prepared based on the Preferred Reporting Items for Systematic review and Meta-Analysis Protocols. The Seed-based d Mapping with Permutation of Subject Images software package will be employed to conducted a coordinate-based meta-analysis (CBMA) to identify consistent CTh differences between patients with CP and pain-free controls. Several complementary analyses, including sensitivity analysis, heterogeneity analysis, publication bias, subgroup analysis, and meta-regression analysis, will be further conducted to test the robustness of the results. RESULTS: This CBMA will tell us whether CP with different subtypes shares common CTh alterations and what the pattern of its characterized alterations is. CONCLUSIONS: To the best of our knowledge, this will be the first CBMA of SBM studies that characterizes brain CTh alterations in CP. The CBMA will provide the quantitative evidence of common brain cortical morphometry of CP. The findings will help us to understand the neural basis underlying CP. TRIAL REGISTRATION NUMBER: INPLASY202050069.


Assuntos
Córtex Cerebral/diagnóstico por imagem , Dor Crônica/diagnóstico por imagem , Substância Cinzenta/diagnóstico por imagem , Imagem por Ressonância Magnética/estatística & dados numéricos , Neuroimagem/estatística & dados numéricos , Dor Crônica/patologia , Feminino , Substância Cinzenta/patologia , Humanos , Imagem por Ressonância Magnética/métodos , Masculino , Metanálise como Assunto , Neuroimagem/métodos , Projetos de Pesquisa , Revisões Sistemáticas como Assunto
4.
Medicine (Baltimore) ; 99(31): e21378, 2020 Jul 31.
Artigo em Inglês | MEDLINE | ID: mdl-32756127

RESUMO

BACKGROUND: A number of studies have used regional homogeneity (ReHo) to depict local functional connectivity in chronic pain (CP). However, the findings from these studies were mixed and inconsistent. METHODS: A computerized literature search will be performed in PubMed, Web of Science, Embase, China National Knowledge Infrastructure (CNKI), WanFang, and SinoMed databases until June 15, 2019 and updated on March 20, 2020. This protocol will follow the Preferred Reporting Items for Systematic review and Meta-Analysis Protocols (PRISMA-P). The Seed-based d Mapping with Permutation of Subject Images (SDM-PSI) software will be used for this voxel-wise meta-analysis. RESULTS: This meta-analysis will identify the most consistent ReHo alterations in CP. CONCLUSIONS: To our knowledge, this will be the first voxel-wise meta-analysis that integrates ReHo findings in CP. This meta-analysis will offer the quantitative evidence of ReHo alterations that characterize brain local functional connectivity of CP. PROSPERO REGISTRATION NUMBER: CRD42019148523.


Assuntos
Encéfalo/diagnóstico por imagem , Dor Crônica/fisiopatologia , Imagem por Ressonância Magnética , Mapeamento Encefálico/métodos , Dor Crônica/diagnóstico por imagem , Humanos , Metanálise como Assunto , Revisões Sistemáticas como Assunto
5.
J Headache Pain ; 21(1): 78, 2020 Jun 19.
Artigo em Inglês | MEDLINE | ID: mdl-32560622

RESUMO

Chronic pain surrounding the temporomandibular joints and masticatory muscles is often the primary chief complaint of patients with temporomandibular disorders (TMD) seeking treatment. Yet, the neuro-pathophysiological basis underlying it remains to be clarified. Neuroimaging techniques have provided a deeper understanding of what happens to brain structure and function in TMD patients with chronic pain. Therefore, we performed a systematic review of magnetic resonance imaging (MRI) studies investigating structural and functional brain alterations in TMD patients to further unravel the neurobiological underpinnings of TMD-related pain. Online databases (PubMed, EMBASE, and Web of Science) were searched up to August 3, 2019, as complemented by a hand search in reference lists. A total of 622 papers were initially identified after duplicates removed and 25 studies met inclusion criteria for this review. Notably, the variations of MRI techniques used and study design among included studies preclude a meta-analysis and we discussed the findings qualitatively according to the specific neural system or network the brain regions were involved in. Brain changes were found in pathways responsible for abnormal pain perception, including the classic trigemino-thalamo-cortical system and the lateral and medial pain systems. Dysfunction and maladaptive changes were also identified in the default mode network, the top-down antinociceptive periaqueductal gray-raphe magnus pathway, as well as the motor system. TMD patients displayed altered brain activations in response to both innocuous and painful stimuli compared with healthy controls. Additionally, evidence indicates that splint therapy can alleviate TMD-related symptoms by inducing functional brain changes. In summary, MRI research provides important novel insights into the altered neural manifestations underlying chronic pain in TMD.


Assuntos
Encéfalo/diagnóstico por imagem , Dor Crônica/diagnóstico por imagem , Dor Facial/diagnóstico por imagem , Imagem por Ressonância Magnética/métodos , Transtornos da Articulação Temporomandibular/diagnóstico por imagem , Encéfalo/fisiopatologia , Dor Crônica/epidemiologia , Dor Crônica/fisiopatologia , Dor Facial/epidemiologia , Dor Facial/fisiopatologia , Feminino , Humanos , Masculino , Neuroimagem/métodos , Transtornos da Articulação Temporomandibular/epidemiologia , Transtornos da Articulação Temporomandibular/fisiopatologia
7.
Proc Natl Acad Sci U S A ; 117(18): 10015-10023, 2020 05 05.
Artigo em Inglês | MEDLINE | ID: mdl-32312809

RESUMO

Chronic pain is a highly prevalent disease with poorly understood pathophysiology. In particular, the brain mechanisms mediating the transition from acute to chronic pain remain largely unknown. Here, we identify a subcortical signature of back pain. Specifically, subacute back pain patients who are at risk for developing chronic pain exhibit a smaller nucleus accumbens volume, which persists in the chronic phase, compared to healthy controls. The smaller accumbens volume was also observed in a separate cohort of chronic low-back pain patients and was associated with dynamic changes in functional connectivity. At baseline, subacute back pain patients showed altered local nucleus accumbens connectivity between putative shell and core, irrespective of the risk of transition to chronic pain. At follow-up, connectivity changes were observed between nucleus accumbens and rostral anterior cingulate cortex in the patients with persistent pain. Analysis of the power spectral density of nucleus accumbens resting-state activity in the subacute and chronic back pain patients revealed loss of power in the slow-5 frequency band (0.01 to 0.027 Hz) which developed only in the chronic phase of pain. This loss of power was reproducible across two cohorts of chronic low-back pain patients obtained from different sites and accurately classified chronic low-back pain patients in two additional independent datasets. Our results provide evidence that lower nucleus accumbens volume confers risk for developing chronic pain and altered nucleus accumbens activity is a signature of the state of chronic pain.


Assuntos
Dor nas Costas/fisiopatologia , Dor Crônica/fisiopatologia , Giro do Cíngulo/fisiopatologia , Núcleo Accumbens/fisiopatologia , Adulto , Dor nas Costas/diagnóstico por imagem , Encéfalo/diagnóstico por imagem , Encéfalo/fisiopatologia , Mapeamento Encefálico/métodos , Dor Crônica/diagnóstico por imagem , Feminino , Giro do Cíngulo/diagnóstico por imagem , Humanos , Imagem por Ressonância Magnética , Masculino , Rede Nervosa/fisiopatologia , Vias Neurais/fisiopatologia , Núcleo Accumbens/diagnóstico por imagem , Fatores de Risco
8.
Am J Trop Med Hyg ; 102(6): 1208-1209, 2020 06.
Artigo em Inglês | MEDLINE | ID: mdl-32314699

RESUMO

The early shortage of novel coronavirus disease (COVID-19) tests in the United States led many hospitals to first screen for common respiratory pathogens, and only if this screen was negative to proceed with COVID-19 testing. We report a case of a 56-year-old woman with severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2) coinfection with group A Streptococcus. The initial testing strategy resulted in delays in both diagnosis and implementation of appropriate precautions. Underlined is the importance of testing for both SARS-CoV-2 and other common respiratory pathogens during the current pandemic.


Assuntos
Betacoronavirus/patogenicidade , Dor Crônica/diagnóstico por imagem , Infecções por Coronavirus/diagnóstico por imagem , Hipertensão/diagnóstico por imagem , Pulmão/diagnóstico por imagem , Pneumonia Viral/diagnóstico por imagem , Infecções Estreptocócicas/diagnóstico por imagem , Anticorpos Monoclonais Humanizados/uso terapêutico , Azitromicina/uso terapêutico , Betacoronavirus/efeitos dos fármacos , Betacoronavirus/isolamento & purificação , Ceftriaxona/uso terapêutico , Chicago , Dor Crônica/imunologia , Dor Crônica/patologia , Dor Crônica/terapia , Coinfecção , Infecções por Coronavirus/imunologia , Infecções por Coronavirus/patologia , Infecções por Coronavirus/terapia , Oxigenação por Membrana Extracorpórea , Feminino , Humanos , Hidroxicloroquina/uso terapêutico , Hipertensão/imunologia , Hipertensão/patologia , Hipertensão/terapia , Pulmão/efeitos dos fármacos , Pulmão/patologia , Pulmão/virologia , Pessoa de Meia-Idade , Pandemias , Pneumonia Viral/imunologia , Pneumonia Viral/patologia , Pneumonia Viral/terapia , Infecções Estreptocócicas/imunologia , Infecções Estreptocócicas/patologia , Infecções Estreptocócicas/terapia , Streptococcus pyogenes/efeitos dos fármacos , Streptococcus pyogenes/isolamento & purificação , Streptococcus pyogenes/patogenicidade , Tomografia Computadorizada por Raios X , Resultado do Tratamento
11.
Int J Mol Sci ; 21(4)2020 Feb 21.
Artigo em Inglês | MEDLINE | ID: mdl-32098249

RESUMO

Degenerative disc disease is a leading cause of chronic back pain in the aging population in the world. Sinuvertebral nerve and basivertebral nerve are postulated to be associated with the pain pathway as a result of neurotization. Our goal is to perform a prospective study using radiofrequency ablation on sinuvertebral nerve and basivertebral nerve; evaluating its short and long term effect on pain score, disability score and patients' outcome. A review in literature is done on the pathoanatomy, pathophysiology and pain generation pathway in degenerative disc disease and chronic back pain. 30 patients with 38 levels of intervertebral disc presented with discogenic back pain with bulging degenerative intervertebral disc or spinal stenosis underwent Uniportal Full Endoscopic Radiofrequency Ablation application through either Transforaminal or Interlaminar Endoscopic Approaches. Their preoperative characteristics are recorded and prospective data was collected for Visualized Analogue Scale, Oswestry Disability Index and MacNab Criteria for pain were evaluated. There was statistically significant Visual Analogue Scale improvement from preoperative state at post-operative 1wk, 6 months and final follow up were 4.4 ± 1.0, 5.5 ± 1.2 and 5.7 ± 1.3, respectively, p < 0.0001. Oswestery Disability Index improvement from preoperative state at 1week, 6 months and final follow up were 45.8 ± 8.7, 50.4 ± 8.2 and 52.7 ± 10.3, p < 0.0001. MacNab criteria showed excellent outcomes in 17 cases, good outcomes in 11 cases and fair outcomes in 2 cases Sinuvertebral Nerve and Basivertebral Nerve Radiofrequency Ablation is effective in improving the patients' pain, disability status and patient outcome in our study.


Assuntos
Dor nas Costas , Ablação por Cateter , Dor Crônica , Degeneração do Disco Intervertebral , Vértebras Lombares , Nervos Espinhais , Adolescente , Adulto , Idoso , Dor nas Costas/diagnóstico por imagem , Dor nas Costas/fisiopatologia , Dor nas Costas/cirurgia , Dor Crônica/diagnóstico por imagem , Dor Crônica/fisiopatologia , Dor Crônica/cirurgia , Feminino , Humanos , Degeneração do Disco Intervertebral/diagnóstico por imagem , Degeneração do Disco Intervertebral/fisiopatologia , Degeneração do Disco Intervertebral/cirurgia , Vértebras Lombares/diagnóstico por imagem , Vértebras Lombares/fisiopatologia , Vértebras Lombares/cirurgia , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Nervos Espinhais/diagnóstico por imagem , Nervos Espinhais/fisiopatologia , Nervos Espinhais/cirurgia
12.
Sensors (Basel) ; 20(3)2020 Jan 27.
Artigo em Inglês | MEDLINE | ID: mdl-32012763

RESUMO

BACKGROUND: The RGB-D camera is an alternative to asses kinematics in order to obtain objective measurements of functional limitations. The aim of this study is to analyze the validity, reliability, and responsiveness of the motion capture depth camera in sub-acute and chronic low back pain patients. METHODS: Thirty subjects (18-65 years) with non-specific lumbar pain were screened 6 weeks following an episode. RGB-D camera measurements were compared with an inertial measurement unit. Functional tests included climbing stairs, bending, reaching sock, lie-to-sit, sit-to-stand, and timed up-and-go. Subjects performed the maximum number of repetitions during 30 s. Validity was analyzed using Spearman's correlation, reliability of repetitions was calculated by the intraclass correlation coefficient and the standard error of measurement, and receiver operating characteristic curves were calculated to assess the responsiveness. RESULTS: The kinematic analysis obtained variable results according to the test. The time variable had good values in the validity and reliability of all tests (r = 0.93-1.00, (intraclass correlation coefficient (ICC) = 0.62-0.93). Regarding kinematics, the best results were obtained in bending test, sock test, and sit-to-stand test (r = 0.53-0.80, ICC = 0.64-0.83, area under the curve (AUC) = 0.55-84). CONCLUSION: Functional tasks, such as bending, sit-to-stand, reaching, and putting on sock, assessed with the RGB-D camera, revealed acceptable validity, reliability, and responsiveness in the assessment of patients with low back pain (LBP). TRIAL REGISTRATION: ClinicalTrials.gov NCT03293095 "Functional Task Kinematic in Musculoskeletal Pathology" September 26, 2017.


Assuntos
Dor Crônica/diagnóstico por imagem , Dor Lombar/diagnóstico por imagem , Amplitude de Movimento Articular/fisiologia , Gravação em Vídeo/métodos , Adolescente , Adulto , Idoso , Fenômenos Biomecânicos , Dor Crônica/diagnóstico , Dor Crônica/fisiopatologia , Avaliação da Deficiência , Feminino , Humanos , Dor Lombar/diagnóstico , Dor Lombar/fisiopatologia , Masculino , Pessoa de Meia-Idade , Movimento , Medição da Dor , Postura/fisiologia , Adulto Jovem
13.
J Orthop Sports Phys Ther ; 50(4): 179-188, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-31905095

RESUMO

OBJECTIVE: Utilizing shear wave elastography, we compared the stiffness of the neck extensor muscles and the stiffness in muscle-specific regions between women with chronic nonspecific neck pain and asymptomatic controls. DESIGN: Cross-sectional observational study. METHODS: We measured the average muscle stiffness over multiple neck extensor muscles and in regions corresponding approximately to the trapezius, splenius capitis, semispinalis capitis, semispinalis cervicis, and multifidus muscles using ultrasound shear wave elastography in 20 women with chronic nonspecific neck pain and 18 asymptomatic women during multiple tasks. The measurements were automatically quality controlled and computer processed over the complete visible neck region or a large muscle-specific region. RESULTS: Pooled over all tasks, neck muscle stiffness was not significantly different between those with neck pain and asymptomatic controls (neck pain median, 11.6 kPa; interquartile range, 8.9 kPa and control median, 13.3 kPa; interquartile range, 8.6 kPa; P = .175). The measure of neck muscle stiffness was not correlated with the intensity of neck pain or perceived disability. CONCLUSION: Shear wave elastography revealed similar muscle stiffness in people with and without chronic neck pain, despite the sensation of increased neck stiffness in those with chronic neck pain. Therapeutic interventions aiming to reduce neck muscle tone are often based on the assumption that perceived neck stiffness corresponds to objective muscle stiffness. The current results question this assumption. J Orthop Sports Phys Ther 2020;50(4):179-188. Epub 6 Jan 2020. doi:10.2519/jospt.2020.8821.


Assuntos
Dor Crônica/diagnóstico por imagem , Técnicas de Imagem por Elasticidade , Tono Muscular , Músculos do Pescoço/diagnóstico por imagem , Cervicalgia/diagnóstico por imagem , Dor Crônica/fisiopatologia , Dor Crônica/terapia , Estudos Transversais , Feminino , Humanos , Pessoa de Meia-Idade , Músculos do Pescoço/fisiopatologia , Cervicalgia/fisiopatologia , Cervicalgia/terapia , Modalidades de Fisioterapia
15.
J Orthop Surg Res ; 15(1): 4, 2020 Jan 03.
Artigo em Inglês | MEDLINE | ID: mdl-31900227

RESUMO

BACKGROUND: Chronic lumbar zygapophysial joint pain is a common cause of chronic low back pain. Percutaneous radiofrequency ablation (RFA) is one of the effective management options; however, the results from the traditional RFA need to be improved in certain cases. The aim of this study is to investigate the effect of percutaneous radiofrequency ablation under endoscopic guidance (ERFA) for chronic low back pain secondary to facet joint arthritis. METHODS: This is a prospective study enrolled 60 patients. The cases were randomized into two groups: 30 patients in the control group underwent traditional percutaneous radiofrequency ablation, others underwent ERFA. The lumbar visual analog scale (VAS), MacNab score, and postoperative complications were used to evaluate the outcomes. All outcome assessments were performed at postoperative 1 day, 1 month, 3 months, 6 months, and 12 months. RESULTS: There was no difference between the two groups in preoperative VAS (P > 0.05). VAS scores, except the postoperative first day, in all other postoperative time points were significantly lower than preoperative values each in both groups (P < 0.05). There was no significant difference between the two groups in VAS at 1 day, 1 month, and 3 months after surgery (P > 0.05). However, the EFRA demonstrated significant benefits at the time points of 3 months and 6 months (P > 0.05). The MacNab scores of 1-year follow-up in the ERFA group were higher than that in the control group (P < 0.05). The incidence of complications in the ERFA group was significantly less than that in the control group (P < 0.05). CONCLUSIONS: ERFA may achieve more accurate and definite denervation on the nerves, which leads to longer lasting pain relief.


Assuntos
Artralgia/cirurgia , Dor Crônica/cirurgia , Dor Lombar/cirurgia , Neuroendoscopia/métodos , Rizotomia/métodos , Articulação Zigapofisária/cirurgia , Idoso , Artralgia/diagnóstico por imagem , Dor Crônica/diagnóstico por imagem , Feminino , Seguimentos , Humanos , Dor Lombar/diagnóstico por imagem , Vértebras Lombares/diagnóstico por imagem , Vértebras Lombares/cirurgia , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Articulação Zigapofisária/diagnóstico por imagem
16.
Spine (Phila Pa 1976) ; 45(7): 483-490, 2020 Apr 01.
Artigo em Inglês | MEDLINE | ID: mdl-31658235

RESUMO

STUDY DESIGN: Prospective cohort study. OBJECTIVE: The aims of this study were to evaluate the outcome of surgical and nonsurgical treatment for patients with lumbar herniated disc (LHD) or lumbar spinal stenosis (LSS) after 2 years and to identify predictors for nonsuccess. SUMMARY OF BACKGROUND DATA: Studies regarding the clinician's ability to identify patients with a poor prognosis are not in concurrence and further studies are warranted. METHODS: This study included 390 patients with LHD or LSS referred for surgical evaluation after unsuccessful conservative treatment. Nonsuccess was defined as a Roland-Morris Disability score above 4 (0-23) or a Numeric Rating Scale back and leg pain score above 20 (0-60). Uni- and multivariate logistic regression analyses were used to investigate potential predictive factors including sociodemographic characteristics, history findings, levels of pain and disability, and magnetic resonance imaging findings. RESULTS: Rates of nonsuccess at 2 years were approximately 30% in surgically treated patients with LHD, approximately about 60% in patients with LSS for disability, and 30% and 40%, respectively for pain. For the main outcome variable, disability, in the final multiple logistic regression model, nonsuccess after surgery was associated with male sex (odds ratio [OR] 2.04, 95% confidence interval [CI]: 1.02-4.11, P = 0.04), low level of education (OR 2.60, 95% CI: 1.28-5.29, P = 0.01), high pain intensity (OR 3.06, 95% CI: 1.51-6.21, P < 0.01), and widespread pain (OR 3.59, 95% CI: 1.36-9.46, P = 0.01). CONCLUSION: The results indicate that the prognosis for patients referred for surgery with persistent LHD or LSS and unsuccessful conservative treatment is substantially better when surgery is performed as opposed to not performed. The predictive value of the variables male sex, low level of education, high pain intensity, and widespread pain location found in our study are partly in accordance with results of previous studies. Thus, our results warrant further investigation until firm conclusions can be made. LEVEL OF EVIDENCE: 3.


Assuntos
Dor Crônica/cirurgia , Tomada de Decisão Clínica/métodos , Degeneração do Disco Intervertebral/cirurgia , Deslocamento do Disco Intervertebral/cirurgia , Dor Lombar/cirurgia , Vértebras Lombares/cirurgia , Raízes Nervosas Espinhais/cirurgia , Adulto , Idoso , Dor Crônica/diagnóstico por imagem , Dor Crônica/epidemiologia , Estudos de Coortes , Dinamarca/epidemiologia , Feminino , Humanos , Degeneração do Disco Intervertebral/diagnóstico por imagem , Degeneração do Disco Intervertebral/epidemiologia , Deslocamento do Disco Intervertebral/diagnóstico por imagem , Deslocamento do Disco Intervertebral/epidemiologia , Dor Lombar/diagnóstico por imagem , Dor Lombar/epidemiologia , Vértebras Lombares/diagnóstico por imagem , Imagem por Ressonância Magnética/métodos , Masculino , Pessoa de Meia-Idade , Medição da Dor/métodos , Estudos Prospectivos , Raízes Nervosas Espinhais/diagnóstico por imagem
17.
J Back Musculoskelet Rehabil ; 33(1): 29-33, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-31282399

RESUMO

BACKGROUND: Spinal sagittal imbalance caused by degenerative changes or iatrogenic factors in the elderly can cause symptoms such as anteversion and low back pain (LBP). There are different and conflicting opinions about the relationship between the degree of lumbar lordosis and functional status of patients with chronic low back pain (CLBP). OBJECTIVE: This study aimed to determine the relationships among the lumbar lordosis index, sacral horizontal angle, and CLBP in the elderly. METHODS: Subject data were collected from Lishui City, Zhejiang Province, China, using cluster sampling according to the background information provided by national physical fitness monitoring. The 207 subjects were urban and rural individuals, 60-69 years old. Radiographs were evaluated according to a standardized protocol. The lumbar lordosis index and sacral horizontal angle were recorded. Data on the prevalence and functional status of CLBP were collected through field investigations. Statistical correlations between the radiographic parameters and the prevalence and functional status of CLBP measurements were evaluated. RESULTS: No significant difference was observed in the sacral horizontal angles among the subjects with and without CLBP; however, the lumbar lordosis index of CLBP subjects was significantly higher than that of those without CLBP (P= 0.028) and showed a significant association with CLBP (P= 0.013). Neither the sacral horizontal angle nor the lumbar lordosis index showed significant correlations with the Oswestry Disability Index in CLBP subjects. CONCLUSIONS: The lumbar lordosis index, but not the sacral horizontal angle, was significantly associated with CLBP in the subjects.


Assuntos
Dor Crônica/diagnóstico por imagem , Lordose/diagnóstico por imagem , Dor Lombar/diagnóstico por imagem , Vértebras Lombares/diagnóstico por imagem , Idoso , China , Dor Crônica/fisiopatologia , Estudos Transversais , Feminino , Humanos , Lordose/fisiopatologia , Dor Lombar/fisiopatologia , Vértebras Lombares/fisiopatologia , Masculino , Pessoa de Meia-Idade , Radiografia
18.
Neuromodulation ; 23(1): 96-101, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31157949

RESUMO

BACKGROUND: "Traditional" spinal cord stimulation (SCS) trials with percutaneous electrodes externalized to a pulse generator (PG) are typically limited in duration due to risk of infection. Newer miniaturized wireless SCS technology eliminates the percutaneous extension (as well as PGs implanted for chronic use), thus facilitating a single-stage implantation after which the device can remain indefinitely. OBJECTIVE: To evaluate fully implanted wireless SCS devices during a 30-day screening trial in subjects with chronic low back pain and leg pain and a history of lumbosacral spine surgery. METHODS: In a randomized controlled trial of single-stage wireless SCS using a wireless percutaneous system, 99 subjects received either 10 kHz high frequency stimulation (HFS) or lower frequency stimulation (LFS) below 1500 Hz (Bolash R, Creamer M, Rauck R, et al. Wireless high frequency spinal cord stimulation (10 kHz) compared to multi-waveform low frequency spinal cord stimulation in the management of chronic pain in failed back surgery syndrome subjects: preliminary results of a multicenter, prospective, randomized controlled study. Pain Med 2019, https://doi.org/10.1093/pm/pnz019). In this report, we assess the 30-day trial success rate (≥50% pain relief from baseline) and complications. RESULTS: The overall trial success rate was 88% (87/99): 92% (46/50) for HFS and 84% (41/49) for LFS (NS). The trial success rate in the 64 subjects with predominant low back pain was 92% (59/64) vs. 80% (28/35) in those with leg pain ≥ low back pain (NS). During the screening trial, one infection occurred (1%) and one subject withdrew and was explanted (1%). Electrode migrations were seen on routine follow-up x-rays in 10 cases (10%). CONCLUSION: Using wireless SCS devices that allow for an extended trial period and evaluation of various waveforms, we observed a high rate trial success rate with both HFS and LFS waveforms, with minimal incidence of infection. Long-term follow-up will address the cost-effectiveness and morbidity associated with this technology, which facilitates single-stage treatment.


Assuntos
Dor nas Costas/terapia , Dor Crônica/terapia , Neuroestimuladores Implantáveis/tendências , Estimulação da Medula Espinal/tendências , Tecnologia sem Fio/tendências , Idoso , Dor nas Costas/diagnóstico por imagem , Dor Crônica/diagnóstico por imagem , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estimulação da Medula Espinal/instrumentação , Estimulação da Medula Espinal/métodos , Tecnologia sem Fio/instrumentação
19.
Front Neural Circuits ; 13: 74, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31849617

RESUMO

Human brain imaging studies have revealed several regions that are activated in patients with chronic pain. In rodent brains, functional changes due to chronic pain have not been fully elucidated, as brain imaging techniques such as functional magnetic resonance imaging and positron emission tomography (PET) require the use of anesthesia to suppress movement. Consequently, conclusions derived from existing imaging studies in rodents may not accurately reflect brain activity under awake conditions. In this study, we used quantitative activation-induced manganese-enhanced magnetic resonance imaging to directly capture the previous brain activity of awake mice. We also observed and quantified the brain activity of the spared nerve injury (SNI) neuropathic pain model during awake conditions. SNI-operated mice exhibited a robust decrease of mechanical nociceptive threshold 14 days after nerve injury. Imaging on SNI-operated mice revealed increased neural activity in the limbic system and secondary somatosensory, sensory-motor, piriform, and insular cortex. We present the first study demonstrating a direct measurement of awake neural activity in a neuropathic pain mouse model.


Assuntos
Encéfalo/diagnóstico por imagem , Dor Crônica/diagnóstico por imagem , Hiperalgesia/diagnóstico por imagem , Imagem por Ressonância Magnética/métodos , Neuralgia/diagnóstico por imagem , Animais , Modelos Animais de Doenças , Masculino , Manganês , Camundongos
20.
Best Pract Res Clin Anaesthesiol ; 33(4): 465-486, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31791564

RESUMO

Chronic pain management techniques have evolved in recent years. With regard to this, ultrasound (US) technology has become a standard for most acute pain procedures and essential for postsurgical pain relief and enhanced recovery after surgery protocols. This manuscript summarizes clinical studies evaluating US use for chronic pain management and compares efficacy with standard techniques including fluoroscopy (FL). US possesses several unique benefits when compared with FL, including elimination of radiation exposure while providing similar clinical outcomes. In summary, US use for chronic pain procedures is emerging as a viable, safe, and effective modality. Additional studies are needed to best appreciate US and its role in chronic pain management.


Assuntos
Dor Crônica/diagnóstico por imagem , Dor Crônica/terapia , Bloqueio Nervoso/métodos , Manejo da Dor/métodos , Ultrassonografia de Intervenção/métodos , Anestésicos Locais/administração & dosagem , Humanos , Bloqueio Nervoso/instrumentação , Manejo da Dor/instrumentação , Medição da Dor/instrumentação , Medição da Dor/métodos , Ultrassonografia de Intervenção/instrumentação
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