Microacupuncture therapy of 80 cases of chronic fasciitis at neck and back

Backgroung:Etiology of fasciitis is that fasciitis in acute phase isn‘t cured timely or completely.Adhesion,hypertrophy,nodes and cords appear that pull peripheral tissue leading to local aching pain,spasm soft tissue,cervical intervertebral friction,and hyperosteogeny and protrusion of cervical intervertebal disc in the end,After that,a serie of clinical symptoms appear.Acupuncture,massage,physical therapy and adhesive plaster for external application are often used clinically,but therapeutic course is long.Objective: To investigate therapeutic effect of microacupuncture on chronic fasciitis at neck ad back.Unit: People‘s Hospital of Hebei.Subjects:80 cases of chronic fasciitis at neck and back from 1999 to 2002 were investigated to which modified needle was adopted,including 34 males,46 females,aged from 29-74 years old with disease courses from 2 months to 20 years.68 cases at shoulder and back,12 cases at lumbar region.Intervention: Microneedle was made from needle (Huatuobrand) that was grindded at oil whetstone,needle tip changed into flat blade,sterilized and prepaired for use,after routine sterilization,microneedle was stabbed longitudinally and swiftly into aching region,then separating,lifting and thrusting.When the sound that muscle fiber was cut was heared,cupping jar was used by Sanhuo.2-3 points were selected for each time,twice a week,4 weeks as a therapeutic course.Main prognosis index and result: Recovery:local pain dissappeared,nodes and cords disappeared or shrank,no touching pain,48 cases,60%;Effective:Focal pain alleviated,nodes or cords reduced,focal touching pain alleviated,32 cases,40%.Total effective rate was 100%.Conclusion: Microneedle therapy on chronic fasciitis could obviously alleviate pain.Because of the small size,microneedle therapy was fit for the weak or thin muscle tissue,but not for thicker muscle tissue.     

Successful treatment of obstructing colonic cancer by combining self-expandable stent and neoadjuvant chemotherapy: A case report

BACKGROUND Surgery 5-10 d after stent insertion was recommended by the European Society of Gastrointestinal Endoscopy for obstructing colonic cancer. For some obstructive patients, this may be not a good choice. Here, we report the successful treatment of obstructing colonic cancer by combining self-expandable stent and neoadjuvant chemotherapy.CASE SUMMARY The patient was a 72-year-old man who was admitted with a chief complaint of abdominal pain for more than 1 mo. Computed tomography(CT) scanning revealed that there was a mass in the descending colon, which led to intestinal obstruction. On admission, a series of therapeutic measures, such as fasting and water deprivation, gastrointestinal decompression, total parenteral nutrition, and octreotide acetate, were taken to improve the obstructive symptoms. At the same time, a self-expandable metal stent was successfully placed across the stenosis,and a biopsy was obtained and diagnosed as adenocarcinoma. CT scanning 14 d after insertion of the stent revealed that the intestine was swollen significantly.Systemic chemotherapy with modified FOLFOX6(mFOLFOX6) was administered. After two courses of mFOLFOX6, CT scanning showed clearly that swelling of the intestine was improved. Subsequently, the patient underwent left hemi-colectomy without stoma placement. The postoperative course was uneventful, and he has been disease-free for 6 mo after surgery.CONCLUSION This modified treatment strategy may provide an alternative therapy for patients with obstructing colonic cancers.     

Effect comparison between sacral blocking and massage combined with traction on protrusion of lumbar intervertebral disc

Background:Epidural injection is an important method in treatment of protrusion of lumbar intervertebral disc.Especially in the recent decade sacral injection is adopted more and more often.Objective:To compare the clinical effects of sacral blocking and massage combined with traction.Unit:Yinhe Hospital of Beijing.Subjects:290 outpatients with grade Ⅱ of ASAI were selected from May,1994 to July,2000.Patients were randomly divided into observation group(n=145)and control group(n=145).Sacral blocking was adopted in observation group and 80 males and 65 females aged 20-78(mean:46.4)years old were included with disease course 3 days to 30 years.Massage combined with treaction was adopted in control group and 74 males and 71 females aged 22-74(mean:44.9)years oled were inmcluded with disease course 2 days to 10 years.Interention:Sacral blocking:Operation was according to sacral blocking and druge(dexamethasone injection,2 mg;0.75% bupivavaine hydrochloride,5 ml;saline,50ml) were injected slowly after success of puncture.Patient rested for 0.5h after injection and left treatment room if no adverse effects occurred.Massage combined with traction:Massage was adopted after traction to every patients.(1)Massage:Patient was seated at square stool and lower limbs separated naturally with same width of shoulders.Doctors sit behind patient.First,thubs of both hands were pressed on projecting part near spinous process(pressing points were selected according to different projecting part).Flexing and extending forward and backward were taken at the same time and extent was ddecided addording to patients‘ maximal endurable degree,5-10 timmes.Upper part of body was turned 45 degrees to left and right.Massage was still taken to affected part,3-t times.(2)Traction:Pelvis was extracted with general physical therapy and massage table.Supine position,chest and treaction bandage were fixed,tractiron wheel was turned slowly until patient felt comfortable with maximal endurance as limit(traction force,20-40kg),After extracting for 5 minutes,massagee switch was turned on to take rolling massage to bck and both lower libmbs.Traction force was increased every5 minutes and limit was still according to patient‘s maximal endurance,30 minutes for every time,once a day and ten times as a therapeutic course.Cohclusion:Effect of sacral blocking on protrusion of lumbar intervertebral disc was positive and fewer therapeutic time were needed.Massage combined with traction was also effective,safe and no adverse effects wer observed,but more therapeutic times were neeeded and inconveinient.     

Nerve coblation for treatment of trigeminal neuralgia: A case report

BACKGROUND Trigeminal neuralgia(TN) is a severe type of neuropathic pain which is often inadequately managed using conventional therapies. In this report, we present the first case of TN treated with gasserian ganglion nerve coblation(NC).CASE SUMMARY A 58-year-old man presented with right facial pain, mostly localized in the right zygomatic zone, alveolar region, and jaws. Similar to acupuncture and shock pain, the pain lasted about five seconds after each attack before resolving unaided. A diagnosis of TN was made, after which treatment with acupuncture therapy and oral carbamazepine was given. However, the pain was not satisfactorily controlled. Subsequently, gasserian ganglion NC of the right trigeminal nerve guided by computed tomography(CT) was performed on the patient. Following this procedure, the right zygomatic, alveolar, submandibular,and cheek pain disappeared completely. The right zygomatic and alveolar areas experienced mild numbness(level II). At 1-, 2-, 3-, and 6-mo follow-ups after surgery, the patient was painless and the numbness score was level I.CONCLUSION CT-guided gasserian ganglion(NC) is an effective treatment for TN and is associated with less or no postoperative numbness or hypoesthesia in comparison with current standard-of-care approaches.     

Combined surgical and interventional treatment of tandem carotid artery and middle cerebral artery embolus: A case report

BACKGROUND The 2018 American Heart Association/American Stroke Association guidelines for early management of acute ischemic stroke recommend the use of retrievable stents for mechanical thrombectomy in patients with acute internal carotid artery or middle cerebral artery M1 occlusion that can be treated within 6 h from onset.For cases of carotid artery with ipsilateral middle cerebral artery tandem embolization, the operation is more complicated and challenging. We here report a case of a tandem embolism, and the anatomy of the aortic arch was complex.Direct carotid artery incision and thrombectomy can not only prevent the escape of the carotid embolus but also save time during establishment of the thrombectomy access.CASE SUMMARY The patient was a 70-year-old man. He was admitted to hospital due to sudden inability to speak and inability to move his right limb for 3 h. Imaging confirmed a diagnosis of a tandem embolism in the left carotid artery with left M1 occlusion.Carotid artery incision thrombectomy combined with stent thrombectomy was performed. The operation was successful, and 24 h later the patient was conscious and mentally competent but had motor aphasia. His bilateral limb muscle strength level was 5, and his neurologic severity scores score was 2.CONCLUSION Carotid artery incision thrombectomy combined with stenting for carotid artery plus cerebral artery tandem embolization is clinically feasible. For patients with a complicated aortic arch and an extremely tortuous carotid artery, carotid artery incision can be chosen to establish the interventional path.     

Experience of comprehensiye rehabili-tation treatment on 60 cases of muscle strain at neck and shoulder

BACKGROUND: In treatment of muscle strain at neck and shoulder, dynamic balance disturbance must be dealed with and needle can detach adhesion, relax muscle, resume local blood circulation. Combined physiotherapy can improve local circulation and promote absortion of exudation.OBJECTIVE: To explore the effects of needle combined with physiotherapy on muscle strain at neck and shoulder.UNIT: Department of Physiotherapy, 285th Hospital of PLASUBJECTS: 60 patients with muscle strain at neck and shoulder were investigated including 16 males and 44 females aged 35 - 56 (mean: 45) years old with diseases course, 3 months to 10 years. Patients with disease course over 3 months were selected as treatment subjects by needle.     

Facial nerve palsy,headache, peripheral neuropathy and Kaposi’s sarcoma in an elderly man

We present a case of an elderly man, who initially presented with right facial nerve palsy, ipsilateral headache, elevated erythrocyte sedimentation rate(ESR) and no fever. A presumptive diagnosis of giant cell arteritis was made and the patient was treated with highdose steroids. A temporal artery biopsy was negative. Several months later, while on 16 mg of methylprednisolone daily, he presented with severe sensorimotor peripheral symmetric neuropathy, muscle wasting and inability to walk, uncontrolled blood sugar and psychosis. A work-up for malignancy was initiated with the suspicion of a paraneoplastic process. At the same time a biopsy of the macular skin lesions that had appeared on the skin of the left elbow and right knee almost simultaneously was inconclusive, whereas a repeat biopsy from the same area of the lesions that had become nodular, a month later, was indicative of Kaposi'ssarcoma. Finally, a third biopsy of a similar lesion, after spreading of the skin process, confirmed the diagnosis of Kaposi's sarcoma. He was treated with interferon α and later was seen in very satisfactory condition, with no clinical evidence of neuropathy, normal muscle strength, no headache, normal electrophysiologic nerve studies, involution of Kaposi's lesions and a normal ESR.     

Scaphoid metastasis as the first sign of occult gastroesophageal junction cancer:A case report

BACKGROUND Metastatic tumors of the hand are very rare.They are usually late manifestations of massive advanced malignancies.However,a small portion of acrometastases are indications of occult primary cancer.Here,we report an extremely rare case in which a scaphoid bone lesion was the initial manifestation and was found to be a metastasis from gastroesophageal junction(GEJ)cancer.CASE SUMMARY A 57-year-old male patient presented with ongoing left wrist pain and swelling after trauma.He was initially misdiagnosed with infection of the scaphoid bone and treated with antibiotics and anti-inflammatory drugs.Further radiographic investigations showed a scaphoid pathological fracture,indicating a metastatic tumor derived from the GEJ and/or right lung malignancies.Gastroscopy failed to identify the pathology of the mass at the GEJ,which grew in an exophytic pattern.A lung puncture biopsy was not performed because the patient refused the procedure.To relieve his wrist pain and obtain a definite pathology,we resected the scaphoid lesion.Based on the clinical and pathological results,the patient was finally diagnosed with multiple metastases of advanced GEJ adenocarcinoma.He underwent chemotherapy and died 6 mo after his initial presentation.CONCLUSION Despite the rareness of the disease,orthopedic surgeons should consider the possibility of metastasis to the bones of the hand when patients complain of persistent and progressive pain in the hand.     

Efficacy of comprehensive rehabilitation therapy for checkrein deformity: A case report

BACKGROUND In clinical practice, checkrein deformity is usually found in patients with calf injuries after ankle fracture or distal tibial fracture. The patients with checkrein deformity mainly report distending pain in toe tips, pain when walking or wearing shoes, and gait instability. Previous studies have mainly reported surgical treatments for checkrein deformity, while few studies have reported using comprehensive rehabilitation alone to improve the checkrein deformity.CASE SUMMARY A 28-year-old woman was admitted to the hospital due to unstable gait caused by pain in the right hallux, for which she was unable to stretch for over three months. The patient had undergone "resection of ameloblastoma at the right mandible, mandibulectomy, and autogenous right fibula grafting". The patient’s hallux toe, as well as the second and third toes of the right foot could not be stretched, with pain in all the toes during walking. Based on the medical records of the patient, as well as the results of physical and auxiliary examinations, the main diagnosis was checkrein deformity in the right foot. Since the patient refused surgical treatment, rehabilitation was the only treatment option. At discharge, the patient reported evident improvement in the pain in the toes, gait stability, as well as increased ability to climb up and downstairs.CONCLUSION Comprehensive rehabilitation therapy could effectively alleviate the manifestations of checkrein deformity and improve the walking ability of the patients.     

Sustained complete response to erlotinib in squamous cell carcinoma of the head and neck:A case report

BACKGROUND Squamous cell carcinoma of head and neck(SCCHN) is the fifth most common cancer worldwide. Inhibition of epidermal growth factor receptor signaling has been shown to be a critical component of therapeutic option. Herein, we report a case of durable complete response to erlotinib.CASE SUMMARY An 81-year-old Caucasian male who presented with metastatic poorly differentiated squamous cell carcinoma of right cervical lymph nodes(levels 2 and 3). Imaging studies including(18)F-fluorodeoxyglucose positron emission tomography/computed tomography(CT) and contrast-enhanced CT scan of neck and chest did not reveal any other disease elsewhere. Panendoscopic examination with random biopsy did not reveal malignant lesion in nasopharynx,oropharynx, and larynx. He underwent modified neck dissection and postoperative radiation. Within 2 mo after completion of radiation, he developed local recurrence at right neck, which was surgically removed. Two mo after the salvage surgery, he developed a second recurrence at right neck. Due to suboptimal performance status and his preference, he started erlotinib treatment.He achieved partial response after first 2 mo of erlotinib treatment, then complete response after total 6 mo of erlotinib treatment. He developed sever skin rash and diarrhea including Clostridium difficile infection during the course of erlotinib treatment requiring dose reduction and eventual discontinuation. He remained in complete remission for more than two years after discontinuation of erlotinib.CONCLUSION We report a case of metastatic SCCHN achieving durable complete response from erlotinib. Patient experienced skin rash and diarrhea toxicities which were likely predictors of his treatment response.     

激痛点缺血性压迫治疗颈肩肌筋膜疼痛综合征疗效观察

目的:观察激痛点缺血性压迫法治疗颈肩肌筋膜疼痛综合征的疗效。方法:选择颈肩肌筋疼痛膜综合征患者20例,按照随机数字表法分为对照组和治疗组,每组10例。对照组仅接受健康宣教;治疗组在对照组基础上实施激痛点缺血性压迫疗法。首先通过Booster Pro3筋膜枪渐次提高振动频率的方法松解斜方肌上束,提高痛阈,达到放松并激活上斜方肌的目的,随后使用缺血性压迫激痛点的方法进行干预,治疗1次/d,连续治疗2周。分别在治疗前、后,采用肌力与脊柱活动度测量仪测量颈部关节活动度与肌力,采用疼痛视觉模拟评分法(VAS)评价颈肩部的疼痛程度,采用颈椎功能障碍指数(NDI)评价颈部功能障碍水平。结果:与治疗前比较,治疗第1次结束即刻治疗组左右侧肌力明显增加,治疗后2周治疗组颈部关节活动度(前屈方向)、左右侧肌力明显增加,左屈、右屈、右旋方向上的VAS评分与NDI评分明显降低,差异有统计学意义(P<0.05);与对照组比较,治疗后2周治疗组颈部关节活动度(前屈方向)、左右侧肌力更高,左屈、右屈、右旋方向上的VAS评分与NDI评分更低,差异有统计学意义(P<0.05)。结论:激痛点缺血性压迫疗法治疗颈肩肌筋膜疼痛综合征,可以有效提高MPS患者颈部关节活动度、左右侧肌力,缓解颈部肌肉僵硬不适和疼痛,改善颈椎功能障碍状态,值得临床推广应用。     

Use of botulinum toxin type A on orthopedics: a case report

Botulinum toxin type A is effective in treating neurologic entities with increased muscle tone. Few reports show the benefits of this treatment for orthopedic conditions. We present the case of a 54-year-old man who manifested bilateral pectoralis major stiffness and bilateral shoulder pain; he had a score of 6 on a visual analog scale (VAS). Complex regional pain syndrome (type I) after cardiac surgery, which had already been resolved, was significant in the patient's clinical background. On examination, neither increases in muscle tone nor signs of tendinous or joint pathology was found. However, the patient experienced significant pain when both pectorals were stretched. The patient's Constant score, a validated scale of shoulder function, was 45/100 on the right shoulder and 41/100 on the left. The patient's shoulder stiffness and pain neither responded to rehabilitation (stretching exercises, passive mobilization, electrostimulation) nor to oral medication (alprazolam, gabapentin). Despite the lack of increased muscle tone, we decided to administer botulinum toxin type A to control pain. Subsequently, pain intensity was reduced to 4 on a VAS on both sides, and functionality improved (Constant scale score, 62 on the right side; 60 on the left). This improvement enabled the patient to resume his job as a building supervisor, which required active involvement in physical construction work.     

The local and referred pain from myofascial trigger points in the temporalis muscle contributes to pain profile in chronic tension-type headache

OBJECTIVE: To assess the local and referred pain areas and pain characteristics evoked from temporalis muscle trigger points (TrPs) in chronic tension-type headache (CTTH). METHODS: Thirty CTTH patients and 30 age and sex-matched controls were studied. A headache diary was kept for 4 weeks to substantiate the diagnosis and record the pain history. Both temporalis muscles were examined for the presence of myofascial TrPs in a blinded fashion. The local and referred pain intensities, referred pain pattern, and pressure pain threshold were recorded. RESULTS: Referred pain was evoked in 87% and 54% on the dominant and nondominant sides in CTTH patients, which was significantly higher (P<0.001) than in controls (10% vs. 17%, respectively). Referred pain spread to the temple ipsilateral to the stimulated muscle in both patients and controls, with additional referral behind the eyes in most patients, but none in controls. CTTH patients reported a higher local [visual analog scale (VAS): 5.6+/-1.2 right side, 5.3+/-1.4 left side] and referred pain (VAS: 4.7+/-2 right side, 3.5+/-2.8 left side) intensity than healthy controls (VAS: 0.8+/-0.7 right side, 0.7+/-0.7 left side for local pain; and 0.3+/-0.2 right side, 0.4+/-0.3 left side for referred pain) in both temporalis muscles (both, P<0.001). The local and referred pain areas were larger in patients than in controls (P<0.001). Twenty-three out of 30 CTTH patients (77%) had active TrPs in the temporalis muscle leading to their usual headache (17 patients on the right side; 12 on the left side, whereas 6 with bilateral active TrPs). CTTH patients with active TrPs in either right or left temporalis muscle showed longer headache duration than those with latent TrPs (P=0.004). CTTH patients showed significantly (P<0.001) lower pressure pain threshold (1.1+/-0.2 right side, 1.2+/-0.3 left side) as compared with controls (2.5+/-0.5 right side, 2.6+/-0.4 left side). CONCLUSIONS: In CTTH patients, the evoked local and referred pain from active TrPs in the temporalis muscle and its sensory characteristics shared similar patterns as their habitual headache pain. Local and referred pain from active TrPs in the temporalis muscles may constitute one of the sources contributing to the pain profile of CTTH.     

Use of orthopedic manual physical therapy to manage chronic orofacial pain and tension-type headache in an adolescent

Temporomandibular dysfunction (TMD) is frequently associated with multiple headache types. While the efficacy of orthopedic manual physical therapy (OMPT) intervention for TMD with/without headache symptoms has been investigated, it has received less attention than other musculoskeletal conditions. This case describes the OMPT treatment and outcome of a 14 year-old female with a 2-year history of facial pain surrounding the right temporomandibular joint (TMJ), and bilateral occipital and temporal tension-type headaches (TTHs). Intervention included manual mobilization of the TMJ and surrounding cervical/facial soft tissue structures, postural re-education, and patient/family education on prevention, self-treatment, and postural adaptations.Outcomes included pain free and maximal mouth opening (MMO), pressure pain threshold (PPT) over the masseter muscle belly, fear avoidance beliefs questionnaire-physical activity subscale (FABQ-PA), jaw pain and function questionnaire (JPFQ), visual analog pain scale (VAS) for facial pain, and headache frequency, duration, and intensity on a VAS. Results included increased pain free and MMO by 22 mm, improved PPT bilaterally by 403.05 kPa on the affected, and 360.88 kPa on the unaffected side, and decreased reported headache frequency, duration, and intensity. Score decreases of 5 points on VAS with MMO, 8 points on FABQ-PA, and 5 points on JPFQ were also noted. Further research is warranted to investigate the effects of OMPT on pain processing and functional outcomes in patients with TMD and headache.     

氟比洛酚酯治疗术后镇痛的临床观察

目的观察氟比洛酚酯治疗手术后疼痛的效果。方法 200例患者ASAⅠ～Ⅱ级,随机分为两组:氟比洛酚酯组(n=100)和对照组(n=100)。腰椎硬膜外联合麻醉,术后镇痛用自控静脉用镇痛泵。记录术后1、2、4、6、12、24 h的VAS和术后24 h的曲马多用量,记录BP、HR、SPO2和不良反应及患者镇痛评价。结果术后24 h的BP、HR、SPO2两组间差异无统计学意义(P>0.05);与氟比洛酚酯组相比,对照组差异有统计学意义(P>0.05),术后24 h两组曲马多用量差异有统计(P<0.05)。结论氟比洛酚酯适用于围手术期疼痛的患者。     

浮针灌注疗法联合关节松动术对脑卒中偏瘫肩痛的影响

目的:观察浮针灌注疗法联合关节松动术对脑卒中偏瘫肩痛的影响。方法:选取2019年2—12月在山东省立第三医院康复医学科住院治疗的脑卒中偏瘫肩痛患者90例,按随机数字表法分为对照组、浮针组和综合组,每组30例。对照组仅给予常规康复训练,包括良肢位摆放、预防二次损伤、主动或助动的功能锻炼、低频电刺激、上肢日常生活活动能力模拟训练等,25 min/次,1次/d,5次/周,持续治疗4周。浮针组在对照组基础上给予浮针灌注治疗,肩关节前部疼痛明显时,患肌一般在肘关节远心端5 cm处,肩关节中间或后侧疼痛明显时,患肌一般在三角肌后下缘附近;以患肌作为进针点,针尖朝向肩关节,针体刺入疏松结缔组织后进行弧形扫散,频率100次/min,每组扫散1 min,每次做3组;每组扫散后要求患者主动或助动活动肩关节10次,活动方向和范围以引起轻度疼痛为佳,留针24 h,2次/周,持续治疗4周。综合组在浮针组基础上给予肩关节松动治疗,25 min/次,1次/d,5次/周,肩关节松动治疗先以1~2级手法改善肩关节疼痛,再以3~4级手法松解粘连,包括沿长轴分离和牵拉肩关节以缓解疼痛,滑动以松解关节囊,摆动以维持和扩大关节活动度,采取达到而不超过痛点的原则,每种手法重复3~4次。于治疗前、治疗4周后,分别采用疼痛视觉模拟评分(VAS)评定肩关节疼痛程度,采用Fugl-Meyer运动功能评分量表(FMA)评定上肢运动功能,采用改良Barthel指数(MBI)评定日常生活活动能力,采用量角器测量患者肩关节被动关节活动度(PROM)。结果:治疗前,3组VAS评分、FMA评分、MBI评分和肩关节PROM比较,差异无统计学意义(P>0.05)。与治疗前比较,3组治疗4周后VAS评分明显降低,FMA评分、MBI评分和肩关节PROM均明显升高,差异均有统计学意义(P<0.05)。与对照组比较,浮针组和综合组的VAS评分明显降低,FMA评分、MBI评分和肩关节PROM均明显升高,差异均有统计学意义(P<0.05)。与浮针组比较,综合组VAS评分明显更低,FMA、MBI评分和肩关节PROM均明显更高,差异均有统计学意义(P<0.05)。结论:浮针灌注疗法联合关节松动术能有效减轻脑卒中后偏瘫肩痛,改善上肢运动功能和日常生活活动能力,值得临床推广。     

A psychophysical analysis of acupuncture analgesia

A psychophysical analysis of acupuncture analgesia was carried out in which low back pain patients made visual analogue scale (VAS) responses both to their chronic pain and to different levels of experimental heat pain (5 sec exposures to 43–51 °C) before and after electroacupuncture. VAS (sensory) responses to chronic pain, direct temperature matches to chronic pain, and VAS (sensory) responses to experimental pain were reduced in an internally consistent manner 1–2 h after treatment. The magnitude of this analgesic response was similar for dermatomes within the region of chronic pain and acupuncture needle placement (lower back) as well as for dermatomes remote from needle placement and chronic pain (forearm). Individual patients manifested either (1) a central-inhibitory pattern of analgesia wherein experimental and chronic pain in back regions and experimental pain in forearm regions were reduced, or (2) an origin-specific pattern wherein only the chronic low back pain was reduced. Patients tested several days after treatment all manifested the latter pattern of analgesia. VAS sensory and VAS affective analgesic responses to electroacupuncture treatment showed a delayed onset (1–24 h) to maximum effect and a duration of 10–14 days. Cumulative sensory and affective analgesic effects were observed at the end of 4 months of biweekly acupuncture treatments. The results of this analysis reveal the unique spatial and temporal properties of electroacupuncture analgesia and the extent to which it is mediated by at least two different mechanisms.     

经皮穿刺圆孔射频治疗上颌神经痛的临床研究

目的:探讨经皮穿剌圆孔射频治疗上颌神经痛的疗效。方法:对21例内科治疗失败或有创治疗后复发的上颌神经痛患者,在X线引导下,将头端塑形的普通射频穿刺针,以前下方入路经皮经翼腭窝穿刺圆孔,对上颌神经干行射频温控热凝处理。以视觉模拟评分法(visual analoguescale,VAS)记录患者术前、术后72小时以及术后随访期内疼痛程度来评价治疗疗效。结果:对21患者成功施行23次上颌神经干射频热凝术。21例患者术前VAS评分7.4±1.6分。术后72小时所有患者VAS评分均为0分。手术后随访时间4周到9周(平均31周),未出现上颌神经痛复发。术后上颌神经分布区面部麻木感发生率95.2%(20/21),面部肿胀发生率38.1%(8/21),无角膜感觉神经功能损伤病例发生。结论:经皮穿刺圆孔射频温控热凝处理上颌神经干治疗三叉神经上颌支痛是安全和有效的。     

运用毫火针与针推治疗TKA术后疼痛及关节运动障碍等疗效的对比观察

目的 对比运用毫火针与针推治疗TKA术后疼痛及关节障碍等并发症的临床疗效差异。方法 分为观察组（常规康复训练+毫火针，30例）和对照组（常规康复训练+普通针刺及推拿，30例），在治疗前和治疗后，分别给予关节活动范围（ROM）、视觉模拟评分（VAS）、骨关节指数（WOMAC）及WOMAC 量表评分。并比较两组间疗效差异。 结果 与治疗前比较，两组患者在治疗后 1周、2周的VAS 、 HSS、ROM、WOMAC均较治疗前有明显改善（均P ＜ 0.05）；组间比较 治疗1周后，VAS、HSS评分观察组优于对照组，差异有统计学意义（均P ＜ 0.05）；治疗2周后，VAS、ROM、HSS评分观察组优于对照组，差异有统计学意义（P ＜ 0.05、P ＜ 0.01、P ＜ 0.05）； 从WOMAC 量表里得出的各项评分可以看出，治疗后的评分均较治疗前明显下降(P＜0.05),两组患者的疼痛、僵硬、肿胀均得到了改善；组间比较：治疗第1周完成及第2周治疗完成后WOMAC 量表得出各项评分，观察组均优于对照组，差异具有明显的统计学意义（P＜0.01）。 火针组总有效率为96.7%,针推组为 90.0%,差异有统计学意义(P＞0.05)。 结论 毫火针与针推治疗TKA术后疼痛及关节运动障碍等并发症的疗效相当, 毫火针在改善TKA术后患者的疼痛，肿胀及僵硬感的临床疗效优于针推，在临床上值得推广应用。     

Comparison of 3 Needle Sizes for Trigger Point Injection in Myofascial Pain Syndrome of Upper- and Middle-Trapezius Muscle: A Randomized Controlled Trial

Yoon S-H, Rah UW, Sheen SS, Cho KH. Comparison of 3 needle sizes for trigger point injection in myofascial pain syndrome of upper- and middle-trapezius muscle: a randomized controlled trial.

Objectives

To investigate (1) the relation between needle diameter and treatment efficacy of myofascial pain syndrome and (2) the relation between needle diameter and pain intensity during injection.

Design

Randomized controlled trial.

Setting

University-affiliated tertiary-care hospital.

Participants

Volunteers (N=77) with myofascial pain syndrome affecting upper- and middle-trapezius muscles with at least 3 months' duration of pain.

Intervention

Participants were randomly assigned to receive trigger point injections on 1 side of the trapezius with a 21-, 23-, or 25-gauge needle. After a 1-time injection, participants were followed up for 14 days. Participants and the assessor were blinded for group assignment.

Main Outcome Measures

Treatment efficacy was measured with the visual analog scale (VAS; at pretreatment, and posttreatment on days 1, 4, 7, 14) for neck and upper-back pain, the Neck Disability Index (NDI; at pretreatment, and posttreatment on days 7, 14), and the Medical Outcomes Study 36-Item Short-Form Health Survey (SF-36, at pretreatment and posttreatment on days 7, 14) for health-related quality of life. Pain intensity during injection was evaluated immediately after injection with VAS.

Results

VAS scores for posttreatment on days 4, 7, and 14 decreased significantly compared with pretreatment scores in all groups; NDI scores on days 7 and 14 decreased significantly compared with pretreatment scores in all groups; SF-36 scores on days 7 and 14 decreased significantly compared with pretreatment scores in the 21- and 23-gauge needle groups; and SF-36 score on day 14 showed significant difference between the 21- and 25-gauge needle groups. For pain intensity during injection, VAS scores indicated no significant difference between the 3 groups.

Conclusions

No difference between the needle types was observed in terms of VAS or NDI, or in terms of pain intensity felt by patients during injection. In terms of SF-36 scores, injections with 21- or 23-gauge needles were found to be more effective. However, a well-controlled investigation is needed to explore the effect of needle thickness on health-related quality of life.