Outcomes following the conservative management of patients with non-radicular peripheral neuropathic pain.

STUDY DESIGN: Prospective cohort. INTRODUCTION: There is limited evidence for conservative management of patients with non-radicular peripheral neuropathic pain (PNP). PURPOSE: To investigate the effectiveness of a comprehensive treatment approach on pain and disability in patients with non-radicular PNP and to determine if improvements are maintained following the discontinuation of therapy. METHODS: Patients received a multi-modal therapeutic intervention. Outcome measures were the shortened version of the Disabilities of the Arm, Shoulder and Hand questionnaire (QDASH), Numeric Pain Rating Scale (NPRS), and grip strength. Follow-up data were collected 5 ± 2 months post-discharge. RESULTS: There was a significant improvement in the QDASH and mean pain (p < .001). There was no significant change in grip strength (p > .13). Follow-up data suggest that pain and disability scores are maintained (p < .001). CONCLUSION: A comprehensive, conservative treatment program has a positive and lasting effect on pain and disability scores in patients with non-radicular PNP. LEVEL OF EVIDENCE: IIIa.

Splinting the hand to enhance motor control and brain plasticity.

Theoretical constructs on the values of splinting the hand are reviewed. Therapists treating poststroke patients face a fast changing technology environment. This new technology allows scientists and physicians the opportunity to evaluate brain function. Scientists can increase understanding of the effects of stroke on function based upon location and severity. Physicians can evaluate the effects of medication and their interaction with the brain. Technology is unmasking the brain's vast ability to adapt and restore function due to its plasticity. Therapists must be diligent to gain knowledge of this everchanging science. Current research challenges the efficacy of splinting patients who are post stroke. If muscle and joint systems are allowed to become stiff and nonfunctional, what becomes of the sensory input to the brain? Now more than ever, therapists have an opportunity to apply motor reeducation with functionally based tasks and demonstrate the value of rehabilitation. This will only be realized if the peripheral muscle and joint systems are kept at a functional length. Custom splints applied after careful evaluation and as a adjunct prior to treatment will maximize functional outcomes.