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1.
Medicine (Baltimore) ; 99(7): e19137, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-32049834

RESUMO

BACKGROUND: Huangqi Guizhi Wuwu Decoction (HGWD) is a common prescription for the treatment of cervical radiculopathy (CR). And the effectiveness and safety of HGWD for CR were assessed in this study. METHODS: Seven databases were searched. Randomized controlled trials involving HGWD alone or HGWD combined with conventional treatment were enrolled. The authors in pairs independently assessed the risk of bias and extracted the data. RESULTS: Eight studies involving 783 participants with CR were included. Meta-analysis revealed that the efficacy of HGWD for CR was significantly superior compared with control treatment (risk ratio = 1.12, 95% confidence interval [CI]:1.06-1.19, Z = 3.71; P = .0002). Compare with control group, there is an increase in visual analog scale (mean difference [MD] = 0.99; 95% CI: 0.83-1.14; Z = 12.57; P < .00001). There was also an improvement of neck disability index (MD = 9.2; 95% CI: 8.28-10.11; Z = 19.75; P < .00001). Adverse events were not mentioned in the 8 trials. CONCLUSION: HGWD alone or HGWD plus other treatment may be helpful to patients with CR. However, the methodological quality of the randomized controlled trials was generally low. Larger and better-designed randomized controlled trials are recommended.


Assuntos
Medicamentos de Ervas Chinesas/uso terapêutico , Radiculopatia/tratamento farmacológico , Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Ensaios Clínicos Controlados Aleatórios como Assunto , Resultado do Tratamento
2.
World Neurosurg ; 133: e443-e447, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31526885

RESUMO

BACKGROUND: S1 transforaminal epidural steroid injection (S1-TFESI) results in positive clinical outcomes for the treatment of pain associated with the S1 nerve root. S1-TFESI via the transforaminal approach is commonly performed under fluoroscopic guidance. Ultrasound guidance is an alternative to mitigate radiation exposure. However, performing spinal procedures under ultrasound guidance has some limitations in confirming the position of the needle tip and vascular uptake. New techniques are therefore needed to make ultrasound and fluoroscopy complementary. Our objective was to describe a novel technique for S1-TFESI and confirm its reproducibility. METHODS: Records of patients with S1 radiculopathy were reviewed retrospectively; those treated using the new S1-TFESI technique were selected. Initially, ultrasound was used to distinguish anatomy of the sacral foramen and guide initial placement of the needle entry point. Fluoroscopy was subsequently used to confirm needle tip position and vascular injection. The number of times the needle required reinsertion was recorded, and ultrasound and C-arm images were stored. RESULTS: Sixty-seven S1-TFESIs were performed in 56 patients. All injections exhibited epidural spread of contrast media, not only to the S1 nerve. The cephalad angle was 16.25 ± 6.75° (range, 5-27°), the oblique angle was 2.48 ± 2.62° (range, 0-7°), and the mean number of attempts was 1.24 ± 1.25. CONCLUSIONS: The new technique, involving the use of ultrasound to guide initial placement of the needle entry point, followed by confirmatory imaging and any needed adjustment with the use of fluoroscopy, can be a technique to complement the shortcomings of using ultrasound or fluoroscopy alone.


Assuntos
Corticosteroides/administração & dosagem , Fluoroscopia/métodos , Injeções Epidurais/métodos , Bloqueio Nervoso/métodos , Radiculopatia/tratamento farmacológico , Radiografia Intervencionista/métodos , Ultrassonografia de Intervenção/métodos , Corticosteroides/uso terapêutico , Adulto , Idoso , Idoso de 80 Anos ou mais , Anestésicos Locais/administração & dosagem , Anestésicos Locais/uso terapêutico , Meios de Contraste , Feminino , Humanos , Vértebras Lombares , Masculino , Pessoa de Meia-Idade , Reprodutibilidade dos Testes , Estudos Retrospectivos , Sacro , Adulto Jovem
3.
J Altern Complement Med ; 25(12): 1183-1192, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31634001

RESUMO

Objective: Traditional Chinese Medicines (TCMs), as well as physiotherapy and chemical drugs, are recommended for the treatment of cervical spondylosis by Chinese guidelines for cervical spondylosis diagnosis and treatment. The aim of this study was to evaluate whether TCM Jingshu Granules are cost-effective in patients with cervical radiculopathy in China. Methods: A multicenter, double-blinded, randomized placebo-controlled trial was performed. A total of 480 patients were recruited from 14 tertiary hospitals in China and were randomly divided into an experimental group (Jingshu Granules) or control group (placebo) at a 3:1 ratio. All patients received 4 weeks of treatment. Clinical outcomes and cost data were collected during the trial, including the neck disability index (NDI), visual analog scale (VAS) of pain, VAS of numbness, 36-Item Short Form Health Survey (SF-36) score, willingness to pay (WTP) for VAS of pain, direct medical costs, and transport costs. From a social perspective, a decision-tree model and cost-effectiveness analysis were conducted. Results: The treatment group has a significant advantage in reducing NDI (9.41 ± 10.51 vs. 4.83 ± 8.43, p < 0.05), VAS of pain (22.72 ± 15.08 vs. 12.86 ± 13.45, p < 0.05), and VAS of numbness (16.96 ± 17.53 vs. 11.64 ± 16.54, p < 0.05), respectively, while there was no significant difference in the improvement of quality of life (QoL; SF-36 score, p > 0.05). The expected mean cost of the experimental group was 1144.34 yuan, and the effective rates were 57.9% for NDI and 72.9% for VAS of pain. The expected mean cost of the control group was 767.41 yuan, and the effective rates were 33.3% for NDI and 51.6% for VAS of pain. For the primary indicators (VAS of pain and NDI), the incremental cost-effectiveness ratio was 17.69 and 15.32, respectively. The WTP per efficacy for pain resolution of patients was 19.10 yuan. Setting the WTP as threshold, Jingshu Granules were found to be a cost-effectiveness strategy, and sensitivity analysis showed that the effective rates and inspection fees of both groups had a greater impact on the results of both groups. Conclusions: Jingshu Granules were shown to be effective for treating patients with cervical radiculopathy. This treatment was found to be cost-effective when considering VAS of pain and NDI as clinical outcome indicators compared to no treatment (placebo). A clinical study with longer duration or real world study is needed to determine the impact on QoL of patients in the future.


Assuntos
Vértebras Cervicais/fisiopatologia , Medicamentos de Ervas Chinesas/economia , Medicamentos de Ervas Chinesas/uso terapêutico , Radiculopatia/tratamento farmacológico , Análise Custo-Benefício , Método Duplo-Cego , Medicamentos de Ervas Chinesas/efeitos adversos , Feminino , Humanos , Masculino , Radiculopatia/fisiopatologia , Resultado do Tratamento
4.
World Neurosurg ; 132: 67-68, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31479794

RESUMO

Ehlers-Danlos syndrome can be associated with cerebrospinal fluid (CSF) disturbances including recurrent CSF leak and Chiari I malformations. Persistent pseudomeningoceles are known to be associated with raised intracranial pressure. We present an unusual case of a compressive epidural CSF collection occurring after a computed tomography-guided L5 nerve root block and describe an effective management strategy.


Assuntos
Vazamento de Líquido Cefalorraquidiano/etiologia , Síndrome de Ehlers-Danlos/complicações , Injeções Epidurais/efeitos adversos , Hipertensão Intracraniana/complicações , Compressão da Medula Espinal/etiologia , Adulto , Malformação de Arnold-Chiari/complicações , Vazamento de Líquido Cefalorraquidiano/diagnóstico por imagem , Vazamento de Líquido Cefalorraquidiano/cirurgia , Feminino , Humanos , Vértebras Lombares , Bloqueio Nervoso , Radiculopatia/tratamento farmacológico , Radiculopatia/etiologia , Compressão da Medula Espinal/diagnóstico por imagem , Compressão da Medula Espinal/cirurgia , Espondilolistese/complicações , Tomografia Computadorizada por Raios X
5.
Medicine (Baltimore) ; 98(33): e16842, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31415408

RESUMO

INTRODUCTION: Engorgement of the epidural venous plexus (EVP) is a rare cause of nerve root impingement. Dilated epidural veins cause compression of the thecal sac and spinal nerve roots, leading to lumbar radiculopathy. PATIENT CONCERNS: Here we describe a case of severe lumbar radiculopathy in a 15-year-old morbidly obese boy. DIAGNOSIS: Enhanced lumbar magnetic resonance imaging revealed left sided L1-L2 disc protrusion and engorgement of the lumbar EVP, resulting in narrowing of the thecal sac in the entire lumbar spine. There was no evidence of an intra-abdominal mass, thrombosis of the inferior vena cava, or vascular malformation. INTERVENTIONS: A caudal epidural block was administered under fluoroscopic guidance. The patient reported a 30% reduction in pain intensity for just 1 day. OUTCOMES: The patient has been followed up for 2 years. He continues to take medication, including morphine sulfate 15 mg, gabapentin 300 mg, and oxycodone 20 mg per day. He is on a diet with exercise for weight reduction. CONCLUSION: An engorged EVP should be considered in the differential diagnosis of radiculopathy in morbidly obese patients.


Assuntos
Analgésicos Opioides/administração & dosagem , Morfina/administração & dosagem , Oxicodona/administração & dosagem , Dor Intratável/tratamento farmacológico , Radiculopatia/tratamento farmacológico , Adolescente , Anestesia Caudal/métodos , Humanos , Vértebras Lombares/diagnóstico por imagem , Imagem por Ressonância Magnética , Masculino , Morfina/uso terapêutico , Obesidade/complicações , Medição da Dor , Radiculopatia/diagnóstico por imagem
8.
J Nepal Health Res Counc ; 17(2): 242-246, 2019 Aug 04.
Artigo em Inglês | MEDLINE | ID: mdl-31455942

RESUMO

BACKGROUND: Selective Nerve Root Block using steroid is a proven technique for management of lumbar radiculopathy. The aim of the study was to determine the effectiveness of selective nerve root block in lumbar radiculopathy. METHODS: A prospective observational study was conducted for duration of one year in patients diagnosed with lumbar radiculopathy. Patients with leg pain, positive straight leg raising test and single level disc prolapse were included in the study. The procedure was performed under fluoroscopic guidance and Visual Analogue Pain rating scale and Oswestry Disability Index score was used for assessment pre-injection, 1 week, 1 month, 6 months and 1-year post injection. RESULTS: Total 35 patient with mean age of 37.7± 9.31 years were included in the study. The pre-injection Visual Analogue Pain Score(Mean ± S.D:7.8±0.7) was significantly reduced at one week (4.2±1.47, p <0.00001), one month (2.74±1.06, p <0.00001), six months (2.31±0.75, p <0.00001) and one year (2.62±0.84, p <0.00001). Similarly, pre-injection Oswestry Disability Index score (Mean ± S.D: 32.09±5.95) was significantly reduced at one week (19.51±7.26, p <0.00001), one month (12.71±4.56, p <0.00001), six months (9.8±2.87, p <0.00001) and one year (10.09±2.97, p <0.00001) but not significantly improved when compared at 6 months and 1 year (p < 0.44). CONCLUSIONS: Selective Nerve Root Block in lumbar radiculopathy significantly reduces Visual Analogue Pain Score up to a year, however, the reduction in pain plateaus around six months.Disability index score only reduces for first 6 months but doesn't significantly reduce from six months to one year.


Assuntos
Deslocamento do Disco Intervertebral/complicações , Vértebras Lombares , Bloqueio Nervoso/métodos , Radiculopatia/tratamento farmacológico , Radiculopatia/etiologia , Esteroides/administração & dosagem , Adulto , Avaliação da Deficiência , Feminino , Fluoroscopia , Humanos , Masculino , Medição da Dor , Estudos Prospectivos
9.
Pain Physician ; 22(4): E287-E294, 2019 07.
Artigo em Inglês | MEDLINE | ID: mdl-31337170

RESUMO

BACKGROUND: Transforaminal epidural steroid injection (TFESI) can be administered with or without sedation in clinical practice. OBJECTIVES: The aim of this study was to compare both procedures in terms of patient and physician satisfaction, preoperative anxiety level, procedural pain level, and complications. STUDY DESIGN: A prospective randomized trial. SETTING: A university hospital interventional pain management center. METHODS: The study included patients scheduled for single-level unilateral TFESI. The patients were randomized into 2 groups. The first group underwent TFESI without sedation, whereas the second group underwent TFESI with sedation. The Likert scale was used to determine the patient and physician satisfaction, and the Numeric Rating Scale (NRS-11) was used to determine the procedural pain level. Cases in which the procedure was to be repeated, the patient was questioned if they desired to undergo the procedure with the same technique. RESULTS: A total of 64 patients, (31 [48.4%] in the sedation group) were included. In the sedation group, the patient and physician satisfaction were significantly higher (P = 0.0001), the periprocedural NRS-11 scores were significantly lower (P = 0.0001), and the rate of desire to have the intervention with the same technique was higher (P = 0.001). After the regression analysis, we reported that there was a significant correlation between being in the sedation group and NRS-11 procedure scores, the desire to have the same technique, and patient and physician satisfaction (odds ratio [OR], 0.341; OR, 0.648; OR, 0.329; OR, 0.514; P = 0.0001). LIMITATIONS: Both patients and physicians were unblinded. CONCLUSIONS: Coadministration of TFESI with sedation improves patient and physician satisfaction. Additionally, the low periprocedural pain level results in patients' demand for the intervention to be performed with sedation in the event of repetition of the procedure. KEY WORDS: Patient satisfaction, transforaminal epidural steroid injection, sedation, physician satisfaction.


Assuntos
Sedação Consciente/métodos , Injeções Epidurais/métodos , Deslocamento do Disco Intervertebral/tratamento farmacológico , Manejo da Dor/métodos , Satisfação do Paciente , Adulto , Idoso , Feminino , Humanos , Deslocamento do Disco Intervertebral/complicações , Masculino , Metilprednisolona/administração & dosagem , Pessoa de Meia-Idade , Estudos Prospectivos , Radiculopatia/tratamento farmacológico , Radiculopatia/etiologia
10.
Pain Physician ; 22(3): 265-270, 2019 05.
Artigo em Inglês | MEDLINE | ID: mdl-31151334

RESUMO

BACKGROUND: Cervical transforaminal epidural block (CTEB) is a useful option in the diagnosis and treatment of cervical radicular pain. However, inadvertent intravascular injection can lead to severe neurologic complications. Blunt needles are considered to displace instead of penetrate vessels because of their dull needle tip. OBJECTIVES: To investigate whether there is a difference between blunt and sharp needles in intravascular injection rates during CTEB. STUDY DESIGN: Prospective, randomized, clinical trial. SETTING: A tertiary hospital in South Korea. METHODS: After institutional review board approval, 108 patients undergoing CTEB for treatment of radicular pain resulting from spinal stenosis and herniated nucleus pulposus were randomly assigned to one of 2 needle groups (blunt needle or sharp needle). The needle position was confirmed using biplanar fluoroscopy, and 2 mL of nonionic contrast medium was injected to detect intravascular injection. Intravascular injection was defined as the contrast medium spreading out through the vascular channel during injection under real-time fluoroscopy. This study was registered in ClinicalTrials.gov. RESULTS: The intravascular injection rate was not significantly different between the blunt needle and sharp needle groups (35.2% vs. 33.3%, P > 0.05). The procedure time was longer in the blunt needle group than in the sharp needle group (101.00 ± 12.4 seconds vs. 56.67 ± 8.3 seconds, P < 0.001). LIMITATIONS: This was a single-center study. Additionally, the physicians could not be blinded to the type of needle used. CONCLUSIONS: In the present study, use of a blunt needle did not reduce the rate of intravascular injection during CTEB compared to use of a sharp needle. In addition, procedure time significantly increased with blunt needle use compared to sharp needle use. KEY WORDS: Analgesia, bleeding, blunt needle, cervical spine, clinical trials, complications, intravascular injection, radiculopathy, sharp needle, transforaminal epidural block.


Assuntos
Anestesia Epidural/instrumentação , Injeções Epidurais/instrumentação , Agulhas , Adulto , Anestesia Epidural/efeitos adversos , Anestesia Epidural/métodos , Feminino , Humanos , Injeções Epidurais/efeitos adversos , Injeções Epidurais/métodos , Masculino , Pessoa de Meia-Idade , Dor/tratamento farmacológico , Manejo da Dor/métodos , Estudos Prospectivos , Radiculopatia/tratamento farmacológico , República da Coreia
11.
Medicine (Baltimore) ; 98(22): e15896, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-31145351

RESUMO

Caudal block has limited injectate distribution to the desired lumbar level due to the relatively long distance from the injection site and reduction in the volume of injectate due to leakage into the sacral foramen. The objective of this study was to investigate the influence of needle gauge on fluoroscopic epidural spread and to assess the correlation between the spread level and analgesic efficacy in patients undergoing caudal block. We retrospectively analyzed data from 80 patients who received caudal block for lower back and radicular pain. We categorized patients based on the epidural needle gauge used into group A (23 gauge), group B (20 gauge), and group C (17 gauge). Fluoroscopic image of the final level of contrast injected through the caudal needle and pain scores before the block and 30 minutes after the block recorded using a numerical rating scale, were evaluated. Of the 80 patients assessed for eligibility, 7 were excluded. Thus, a total of 73 patients were finally analyzed. Age, sex, body mass index, diagnosis, lesion level, lesion severity, and duration of pain did not differ among the 3 groups. All patients showed cephalic spread of contrast. Contrast spread beyond L5 was seen in 26.9% of patients in group A, 41.7% in group B, 39.1% in group C, and 35.6% overall; there was no significant difference among the groups (P = .517). Analgesic efficacy was not significantly different among the groups (P = .336). The needle gauge did not influence the level of epidural spread or analgesic efficacy in caudal block.


Assuntos
Anestesia Caudal/instrumentação , Fluoroscopia/métodos , Injeções Epidurais/instrumentação , Agulhas , Bloqueio Nervoso/instrumentação , Idoso , Anestesia Caudal/métodos , Espaço Epidural/diagnóstico por imagem , Espaço Epidural/efeitos dos fármacos , Feminino , Humanos , Injeções Epidurais/métodos , Dor Lombar/tratamento farmacológico , Região Lombossacral/diagnóstico por imagem , Masculino , Pessoa de Meia-Idade , Bloqueio Nervoso/métodos , Radiculopatia/tratamento farmacológico , Estudos Retrospectivos , Resultado do Tratamento
12.
J Med Case Rep ; 13(1): 130, 2019 May 05.
Artigo em Inglês | MEDLINE | ID: mdl-31054576

RESUMO

BACKGROUND: Thoracic radiculopathy is a rare etiology of vague abdominal pain. There are few reports of neurosarcoidosis manifesting as a thoracic radiculopathy, which highlights the diagnostic challenge. CASE PRESENTATION: A 54-year-old Caucasian man was being investigated for right upper quadrant abdominal pain and was found to have diffuse lymphadenopathy on imaging. He was eventually diagnosed with sarcoidosis. Over time, his abdominal pain progressed to neuropathic pain along his T7-T11 dermatome. Magnetic resonance imaging revealed findings consistent with a thoracic radiculopathy due to neurosarcoidosis. The patient received corticosteroids for treatment of neurosarcoidosis and immunosuppressant therapy to manage neuropathic pain. CONCLUSIONS: This case report highlights the importance of considering thoracic radiculopathies in the differential diagnosis of vague abdominal pain and explores guidelines in diagnosing neurosarcoidosis in the absence of neural tissue biopsy.


Assuntos
Dor Abdominal/diagnóstico por imagem , Doenças do Sistema Nervoso Central/diagnóstico , Linfadenopatia/diagnóstico por imagem , Imagem por Ressonância Magnética , Radiculopatia/diagnóstico , Sarcoidose/diagnóstico , Vértebras Torácicas/patologia , Dor Abdominal/fisiopatologia , Corticosteroides/uso terapêutico , Doenças do Sistema Nervoso Central/tratamento farmacológico , Doenças do Sistema Nervoso Central/fisiopatologia , Humanos , Imunossupressores/uso terapêutico , Linfadenopatia/etiologia , Linfadenopatia/fisiopatologia , Masculino , Pessoa de Meia-Idade , Radiculopatia/tratamento farmacológico , Radiculopatia/fisiopatologia , Sarcoidose/tratamento farmacológico , Sarcoidose/fisiopatologia , Vértebras Torácicas/diagnóstico por imagem , Resultado do Tratamento
13.
Medicina (Kaunas) ; 55(5)2019 May 18.
Artigo em Inglês | MEDLINE | ID: mdl-31109045

RESUMO

Background and Objectives: The purpose of this retrospective study was to identify predictors of short-term outcomes associated with a lumbosacral transforaminal epidural steroid injection (TFESI). Materials and Methods: The medical records of 218 patients, who were diagnosed with lumbosacral radiculopathy and treated with a TFESI, were reviewed in this retrospective study. A mixture of corticosteroid, lidocaine, and hyaluronidase was injected during TFESI. Patients with >50% pain relief on the numerical rating scale compared with the initial visit constituted the good responder group. Demographic, clinical, MRI, and electrodiagnostic data were collected to assess the predictive factors for short-term outcomes of the TFESI. Results: A multivariate logistic regression analysis demonstrated that a shorter duration of symptoms and a positive sharp wave (PSW)/fibrillation (Fib) observed in electrodiagnostic study (EDx) increased the odds of significant improvement 2-4 weeks after the TFESI. Conclusions: Shorter duration of symptoms and PSW/Fib on EDx were predictors of favorable short-term response to TFESI.


Assuntos
Injeções Epidurais/normas , Região Lombossacral , Radiculopatia/tratamento farmacológico , Adulto , Idoso , Distribuição de Qui-Quadrado , Currículo/normas , Feminino , Humanos , Injeções Epidurais/métodos , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Razão de Chances , Medição da Dor/métodos , Radiculopatia/complicações , República da Coreia , Estudos Retrospectivos
14.
Eur Radiol ; 29(7): 3379-3389, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-30887207

RESUMO

OBJECTIVES: To compare pain relief after CT-guided lumbar epidural steroid injections (ESI) using particulate (triamcinolone) and non-particulate (dexamethasone) steroids, and to explore factors affecting the effectiveness of both steroid types. METHODS: This retrospective observational study included 806 patients with lumbar radiculopathy and corresponding MRI or CT abnormalities of the lumbar spine, who were matched using the propensity score method, yielding two cohorts of 209 patients each. Pain intensity was evaluated prior to the procedure using a pain numerical rating scale (NRS) with range 0-10. Reevaluation took place 1 day and 4 weeks post-injection. Logistic regression analysis and cubic splines applied to generalized additive models were implemented to assess the differences in pain reduction after ESI in the analyzed patient groups. RESULTS: Four weeks post-injection, the overall chance of ≥ 50% pain reduction was lower in the dexamethasone group than that in the triamcinolone group (odds ratio [OR] = 0.55; p < 0.012). In the dexamethasone cohort, the intensity of baseline pain and the presence of a herniated intervertebral disc in the infiltrated segment were both significant and independent predictors of ≥ 50% pain relief. Patients with baseline NRS score ≥ 7 points had markedly less chance of ≥ 50% pain relief than patients with NRS score < 7 (OR = 0.53; p < 0.032), whereas disc herniation increased the chances more than twofold (OR = 2.29; p < 0.044). There was no significant correlation between the effectiveness of triamcinolone and any analyzed concomitant variables. CONCLUSIONS: Triamcinolone was superior for lumbar radiculopathy of severe intensity. For mild to moderate pain, no benefit of using triamcinolone over dexamethasone was found. The effectiveness of dexamethasone was lower for stenotic spinal lesions than for disc herniation. KEY POINTS: • Triamcinolone is superior to dexamethasone for epidural treatment of severe lumbar radiculopathy. • For mild to moderate pain, dexamethasone could be equally effective. • Dexamethasone reduces pain caused by disc herniation much better than it does to pain caused by fixed stenotic spinal lesions.


Assuntos
Dor nas Costas/tratamento farmacológico , Dexametasona/análogos & derivados , Glucocorticoides/administração & dosagem , Radiculopatia/tratamento farmacológico , Triancinolona Acetonida/administração & dosagem , Adulto , Idoso , Dor nas Costas/etiologia , Bupivacaína/administração & dosagem , Dexametasona/administração & dosagem , Dexametasona/uso terapêutico , Feminino , Glucocorticoides/uso terapêutico , Humanos , Injeções Epidurais/métodos , Deslocamento do Disco Intervertebral/complicações , Lidocaína/administração & dosagem , Vértebras Lombares/diagnóstico por imagem , Masculino , Pessoa de Meia-Idade , Manejo da Dor/métodos , Medição da Dor/métodos , Radiculopatia/complicações , Radiografia Intervencionista/métodos , Estudos Retrospectivos , Estenose Espinal/complicações , Tomografia Computadorizada por Raios X/métodos , Resultado do Tratamento , Triancinolona Acetonida/uso terapêutico
15.
JAMA Intern Med ; 179(5): 695-701, 2019 05 01.
Artigo em Inglês | MEDLINE | ID: mdl-30907944

RESUMO

Background: The gabapentinoid drugs gabapentin and pregabalin were originally developed as antiseizure drugs but now are prescribed mainly for treatment of pain. For gabapentin, the only pain-related indication approved by the US Food and Drug Administration (FDA) is postherpetic neuralgia. For pregabalin, FDA-approved indications related to pain are limited to postherpetic neuralgia, neuropathic pain associated with diabetic neuropathy or spinal cord injury, and fibromyalgia. Despite these limited indications, gabapentin and pregabalin are widely prescribed off-label for various other pain syndromes. Such use is growing, possibly because clinicians are searching increasingly for alternatives to opioids. Observations: This report summarizes the limited published evidence to support off-label gabapentinoid uses, describes clinical cases in which off-label use is problematic, and notes how review articles and guidelines tend to overstate gabapentinoid effectiveness. Conclusions: Clinicians who prescribe gabapentinoids off-label for pain should be aware of the limited evidence and should acknowledge to patients that potential benefits are uncertain for most off-label uses.


Assuntos
Analgésicos/uso terapêutico , Gabapentina/uso terapêutico , Uso Off-Label , Dor/tratamento farmacológico , Pregabalina/uso terapêutico , Neuropatias Diabéticas/tratamento farmacológico , Aprovação de Drogas , Fibromialgia/tratamento farmacológico , Humanos , Dor Lombar/tratamento farmacológico , Diferença Mínima Clinicamente Importante , Neuralgia/tratamento farmacológico , Neuralgia/etiologia , Neuralgia Pós-Herpética/tratamento farmacológico , Medição da Dor , Radiculopatia/tratamento farmacológico , Ciática/tratamento farmacológico , Traumatismos da Medula Espinal/complicações
16.
Clin Orthop Surg ; 11(1): 131-136, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-30838118

RESUMO

The approach we suggest was developed for cases in which the fourth and fifth lumbar and first sacral spinal nerves were affected in lumbar degenerative disc disease. Retrodiscal transforaminal epidural injection is known to be very effective for lumbar radiculopathy because of excellent access to primary pathology; however, access below L5 is often restricted by the anatomic characteristics of the L5-S1. In the translateral recess approach (TLR), proper final needle placement (i.e., in the axillary portion between the exiting and traversing nerve roots) can be achieved by setting the direction of the needle laterally and superiorly from the distal tip of the infra-adjacent spinous process toward the medial wall of the pedicle and neural foramen of the given level without neural injury. This approach is possible because of the wide interlaminar space in the L5-S1. Preganglionic epidural injection through TLR is an effective and safe spinal intervention for lumbosacral radiculopathy.


Assuntos
Injeções Epidurais/métodos , Radiculopatia/tratamento farmacológico , Esteroides/administração & dosagem , Humanos , Degeneração do Disco Intervertebral/complicações , Vértebras Lombares , Masculino , Pessoa de Meia-Idade , Radiculopatia/etiologia , Sacro
17.
J Med Imaging Radiat Oncol ; 63(3): 300-306, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-30859711

RESUMO

INTRODUCTION: Computed tomography-guided cervical nerve root corticosteroid injections are a commonly performed procedure for cervical radiculopathy. There have been major complications such as spinal cord infarction and posterior circulation stroke reported mostly with X-ray fluoroscopic-guided methods, however, there is relatively little data on the safety of newer CT-guided methods. The purpose of this study was to identify any major complications and evaluate the rate of minor complications from CT-guided cervical nerve root corticosteroid injections performed in a tertiary public hospital. METHODS: Four hundred and three CT-guided cervical nerve root injection procedures were identified over a period from July 2015 to January 2018 using the radiology information system (RIS) and data collected about the technique and any immediate complications. Patient follow-up and delayed complications were then reviewed, either via outpatient clinic records or telephone consultation. RESULTS: Two hundred and eighty-six procedures were performed by radiology registrars or fellows, and 117 by radiologists, most commonly via an anterolateral approach and injecting 4 mg (in 1 mL) of dexamethasone. Follow-up data were obtained for all 403 procedures and identified 16 minor complications, but no major neurovascular complications. CONCLUSION: The overall recorded rate of minor complications with CT-guided nerve root injection was 4.0% with no major neurovascular complications, suggesting that CT-guided transforaminal cervical corticosteroid injection is a safe procedure.


Assuntos
Corticosteroides/administração & dosagem , Segurança do Paciente , Radiculopatia/tratamento farmacológico , Radiografia Intervencionista/métodos , Raízes Nervosas Espinhais/efeitos dos fármacos , Tomografia Computadorizada por Raios X/métodos , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade
18.
Pain Res Manag ; 2019: 4905013, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30863474

RESUMO

A number of studies have been published proposing various approaches to the treatment of neuropathic pain; however, to our knowledge, no attempts have been made to compare gabapentin and fentanyl in patients with lumbar radiculopathy. We evaluated the relative efficacy and safety of fentanyl matrix and gabapentin for the treatment of chronic neuropathic pain of radicular origin. The study was designed as a randomized blind multicentered parallel-group noninferiority trial. A total of 108 patients with moderate-to-severe pain (≥4 intensity on an 11-point numeric rating scale) were randomly prescribed either fentanyl matrix or gabapentin over a period of 56 days. In the primary analysis, the noninferiority of fentanyl matrix treatment was evaluated in relation to the efficacy of gabapentin based on the pain intensity difference (PID) at 56 days after the first dose of the drugs. Secondary endpoints included pain relief, improvement in functional status (the Korean-Oswestry Disability Index (K-ODI)), improvement in depressive symptoms (Korean-Beck Depression Index (K-BDI)) between the 28th and 56th day, and adverse events (AEs). Analysis of the primary efficacy endpoint established the noninferiority of fentanyl matrix compared with gabapentin, with no statistically significant difference observed in the PID after 56 days for the two treatment groups. Similarly, analysis of pain relief revealed no significant differences between the groups on days 28 and 56. There was no difference in the K-ODI and K-BDI between the groups during the study period. The overall incidence of at least one AE was similar for fentanyl matrix (67.3%) and gabapentin (69.6%). The most commonly reported AEs for patients treated with fentanyl matrix and gabapentin included dizziness (30.8% vs. 44.6%, respectively), somnolence (26.9% vs. 35.7%), and constipation (15.4% vs. 17.9%). This study demonstrated that the analgesic effect of fentanyl matrix is noninferior in comparison with gabapentin and supports the use of fentanyl matrix as an effective and safe treatment for moderate-to-severe chronic neuropathic pain. This trial is registered with NCT01127100.


Assuntos
Analgésicos/uso terapêutico , Fentanila/administração & dosagem , Gabapentina/uso terapêutico , Neuralgia/tratamento farmacológico , Administração Cutânea , Adulto , Método Duplo-Cego , Feminino , Humanos , Dor Lombar/tratamento farmacológico , Masculino , Pessoa de Meia-Idade , Medição da Dor , Radiculopatia/tratamento farmacológico , Adesivo Transdérmico
19.
BMJ Case Rep ; 12(2)2019 Feb 21.
Artigo em Inglês | MEDLINE | ID: mdl-30796074

RESUMO

Caudal epidural injections and facet joint injections using steroids and local anaesthetic are widely used methods of pain control in patients suffering from radicular leg pain. In the vast majority of cases this is low risk. We present an interesting case of a patient who suffered from symptomatic adrenal suppression following a caudal epidural injection, and thus wish to draw this rare but significant complication to the attention of orthopaedic practitioners.


Assuntos
Insuficiência Adrenal/induzido quimicamente , Anestesia Caudal/efeitos adversos , Anestesia Epidural/efeitos adversos , Anti-Inflamatórios/uso terapêutico , Hidrocortisona/uso terapêutico , Radiculopatia/tratamento farmacológico , Feminino , Humanos , Doença Iatrogênica , Injeções Intra-Articulares , Pessoa de Meia-Idade , Radiculopatia/fisiopatologia , Resultado do Tratamento , Articulação Zigapofisária
20.
Neuroscience ; 404: 510-518, 2019 04 15.
Artigo em Inglês | MEDLINE | ID: mdl-30731156

RESUMO

Brachial plexus root avulsion (BPRA) results in the complete loss of motor function in the upper limb, mainly due to the death of spinal motoneurons (MNs). The survival of spinal MNs is the key to the recovery of motor function. Neuregulin-1 (Nrg1) plays fundamental roles in nervous system development and nerve repair. However, its functional role in BPRA remains unclear. On the basis of our findings that Nrg1 is down-regulated in the ventral horn in a mouse model of BPRA, Nrg1 may be associated with BPRA. Here, we investigated whether recombinant Nrg1ß (rNrg1ß) can enhance the survival of spinal MNs and improve functional recovery in mice following BPRA. In vitro studies on primary cultured mouse MNs showed that rNrg1ß increased the survival rate in a dose-dependent manner, reaching a peak at 5 nM, which increased the survival rate and enhanced the pERK levels in MNs under H2O2-induced oxidative stress. In vivo studies revealed that rNrg1ß improved the functional recovery of elbow flexion, promoted the survival of MNs, enhanced the re-innervation of biceps brachii, and decreased the muscle atrophy. These results suggest that Nrg1 may provide a potential therapeutic strategy for root avulsion.


Assuntos
Plexo Braquial/efeitos dos fármacos , Neurônios Motores/efeitos dos fármacos , Neuregulina-1/uso terapêutico , Radiculopatia/tratamento farmacológico , Recuperação de Função Fisiológica/efeitos dos fármacos , Animais , Plexo Braquial/fisiopatologia , Sobrevivência Celular/efeitos dos fármacos , Células Cultivadas , Masculino , Camundongos , Camundongos Endogâmicos C57BL , Neurônios Motores/fisiologia , Neuregulina-1/farmacologia , Radiculopatia/fisiopatologia , Recuperação de Função Fisiológica/fisiologia
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