Efficacy of a functional restoration program for chronic low back pain: Prospective 1-year study

ObjectiveTo evaluate the efficacy of a functional restoration program for patients with chronic low back pain, using overall disability and work ability as the primary evaluation criteria.Patients and methodsWe prospectively studied patients aged 18 years or older who had been on sick leave because of nonspecific low back pain for at least 3 months and whose job position was still open. The program was delivered on a day-hospital basis 5 days a week for 5 weeks. Patients were followed up for 1 year.ResultsWe included 39 patients, 11 females and 28 males with a mean (± SD) age of 43 ± 8 years and a mean sick-leave duration of 10 ± 7 months. After 1 year, 26 (67%) patients reported improvements and 25 (64%) had returned to work. Compared to the year before the program, the number of sick leave days was decreased by 51% (120 ± 140 vs. 244 ± 114, P < 0.05). The work-and-leisure-activities subscore of the validated French version of the Dallas Pain Questionnaire (DRAD) was significantly improved (57 ± 24 vs. 70 ± 17 at baseline, P < 0.05). The patients still on sick leave after 1 year were older and had greater alterations in baseline DRAD subscores for anxiety/depression and daily activities, compared to the patients who had returned to work.ConclusionsOur functional restoration program was effective and allowed two-thirds of patients to resume work. Factors associated with failure to resume work were well-known correlates of chronicity. Our results support the use of functional restoration programs in patients with incapacitating low back pain. They suggest that functional restoration may deserve to be started earlier, after only 3 months with chronic pain, in patients who are unable to work.     

Evaluation of the benefits of low back pain patients’ education workshops during spa therapy

ObjectivesTo evaluate the medium-term impact of education workshops on low back pain (LBP) in the setting of a thermal spa on: fear-avoidance beliefs, disability, pain, and satisfaction.MethodsRandomized prospective alternate-month design-type study including 360 individuals having thermal spa therapy for LBP: 188 in the intervention group (three standardized education workshops lasting 1 h 30 each and usual thermal therapy for 3 weeks), 172 in the control group (usual thermal therapy and non-standardized verbal information). The principal analysis criterion was the difference in the fear-avoidance beliefs (physical FABQ) score between baseline and 6 months after the therapy; secondary criteria were: evolution of disability (Quebec Scale) and pain intensity (Visual Analogue Scale), and satisfaction with the information received.ResultsThere was a significant reduction in the physical FABQ score at 6 months (P < 0.05), and this reduction was more marked in the intervention group (?5.8 ± 0.7 vs. ?2 ± 0.72 points out of 24; P < 0.0001). Disability and pain significantly decreased in both groups (P < 0.05), with no difference between groups. These workshops also had a significant effect on satisfaction with the information received.ConclusionStandardized education workshops have a beneficial impact on LBP and contribute to an improvement in the medical services provided during spa therapy by reducing the effect of fear-avoidance beliefs as well as relieving pain. Extending the use of such workshops could contribute to enhance the positive impact of spa therapy in the management of chronic disabling diseases.     

Prospective assessment of axial back pain symptoms before and after bariatric weight reduction surgery

BackgroundThe prevalence of obesity in developed countries has reached alarming levels, doubling in the United States since 1980. Although obese patients with chronic low back pain are frequently advised to lose weight, the association between these medical conditions remains unproven.PurposeThis study prospectively assessed clinically reported changes in chronic axial low back pain symptoms after weight reduction from bariatric surgery for morbid obesity.Study designProspective longitudinal study.Patient sampleFifty-eight consecutive patients with morbid obesity and chronic axial low back pain undergoing bariatric surgery over a period of 6 months. Patients were considered morbidly obese if they were 50% to 100% above their ideal body weight or having a body mass index (BMI) greater than 40.Outcome measuresVisual Analog Scale (VAS) for axial low back pain, Short Form-36 (SF-36) Health Survey, and Oswestry Disability Index (ODI)MethodsPatients undergoing weight reduction surgery were assessed preoperatively and postoperatively at 12 months with validated clinical measures for axial back pain and disability (VAS, SF-36, and ODI). Bariatric surgery parameters included demographic data, weight, and BMI. Statistical analysis included paired t tests and multiple regression techniques.ResultsOf the initial 58 patients, 38 (65%) completed both preoperative (Pre-Op) and postoperative (Post-Op) questionnaires at 12 months. These 38 subjects included 30 women and 8 men, with an age range of 20 to 68 years (mean 48.4±10.1). Overall, these patients showed a decrease in mean weight from 144.52±41.21 kg Pre-Op to 105.59±29.24 Post-Op (p<.0001) and BMI from 52.25±12.61 kg/m² Pre-Op to 38.32±9.66 Post-Op (p<.0001).Patients demonstrated a statistically significant mean 44% decrease in axial back pain on the VAS scale (p=.006; 5.2±3.35 Pre-Op, to 2.9±3.1 Post-Op). Analysis of the SF-36 major components revealed that patients experienced significant increases in mean physical health by 58% (p<.0001; 44.5±20.09 to 70.24±26.84) and in median mental health by 6% (p=.03; 70±7.14 to 73.39±11.78). Patients also showed statistically significant 24% decrease in Post-Op ODI score for physical disability (p=.05) from 26.75±16.56 Pre-Op to 20.35±18.71 Post-Op (p=.05).ConclusionThis study suggests that the substantial weight reduction after bariatric surgery may be associated with moderate reductions in preexisting back pain at early-follow-up. This effect did not appear to be the result only of an overall improvement in well-being associated with weight loss. However, larger randomized controlled clinical studies with longer-term follow-up are needed to definitively determine a causal relationship.     

Effects of unstable shoes on chronic low back pain in health professionals: A randomized controlled trial

ObjectiveThe aim of this study was to evaluate the effectiveness of unstable shoes in reducing low back pain in health professionals.MethodsOf a volunteer sample of 144 participants, 40 with nonspecific chronic low back pain were eligible and enrolled in this study. Participants were randomized to an intervention group, who wore unstable shoes (model MBT Fora), or a control group, who wore conventional sports shoes (model Adidas Bigroar). The participants had to wear the study shoes during their work hours, and at least 6 hours per workday, over a period of 6 weeks. The primary outcome was low back pain assessed on a Visual Analog Scale. The secondary outcomes were patient satisfaction, disability evaluated using Roland-Morris questionnaire and quality of life evaluated using EQ-VAS.ResultsThe intervention group showed a significant decrease in pain scores compared to the control group. The rate of satisfaction was higher in the intervention group (79%) compared to the control group (25%). There was no significant difference for the Roland-Morris disability questionnaire score and the EQ-VAS scale.ConclusionsThe results of this clinical trial suggest that wearing unstable shoes for 6 weeks significantly decreases low back pain in patients suffering from chronic low back pain but had no significant effect on quality of life and disability scores.     

Femoral nerve block in a representative sample of elderly people with hip fracture: A randomised controlled trial

IntroductionThe number of elderly people with hip fracture and dementia is increasing, and many of these patients suffer from pain. Opioids are difficult to adjust and side effects are common, especially with increased age and among patients with dementia. Preoperative femoral nerve block is an alternative pain treatment.AimTo investigate whether preoperative femoral nerve block reduced acute pain and opioid use after hip fracture among elderly patients, including those with dementia.Patients and methodsIn this randomised controlled trial involving patients aged ≥70 years with hip fracture (trochanteric and cervical), including those with dementia, we compared femoral nerve block with conventional pain management, with opioid use if required. The primary outcome was preoperative pain, measured at five timepoints using a visual analogue scale (VAS). Preoperative opioid consumption was also registered.ResultsThe study sample comprised 266 patients admitted consecutively to the Orthopaedic Ward. The mean age was 84.1 (±6.9) years, 64% of participants were women, 44% lived in residential care facilities, and 120 (45.1%) had dementia diagnoses. Patients receiving femoral nerve block had significantly lower self-rated pain scores from baseline to 12 h after admission than did controls. Self-rated and proxy VAS pain scores decreased significantly in these patients from baseline to 12 h compared with controls (p < 0.001 and p = 0.003, respectively). Patients receiving femoral nerve block required less opioids than did controls, overall (2.3 ± 4.0 vs. 5.7 ± 5.2 mg, p < 0.001) and in the subgroup with dementia (2.1 ± 3.3 vs. 5.8 ± 5.0 mg, p < 0.001).ConclusionPatients with hip fracture, including those with dementia, who received femoral nerve block had lower pain scores and required less opioids before surgery compared with those receiving conventional pain management. Femoral nerve block seems to be a feasible pain treatment for elderly people, including those with dementia.     

Tolerabilidad del paciente durante la cistoscopia y la cauterización de tumores vesicales en consulta: análisis multivariante de los factores de riesgo

ObjectiveCystoscopy and cauterization performed in the operating room is expensive and exposes patients to anesthesia risks. Patient tolerability during office cystoscopy and cauterization is critical to the office management of bladder cancer and other urologic diseases. We evaluated the risk factors for pain of flexible cystoscopy in the office-setting with emphasis on a sub-group of bladder cancer patients who underwent cauterization.Materials and methodsRetrospective analyses of 110 anonymous patient surveys completed after cystoscopy and/or cauterization. Survey information included age, gender, purpose of cystoscopy, number of prior cystoscopies, prior number of office-cauterizations, anxiety prior/during cystoscopy, and pain during cystoscopy and/or cauterization. Univariate/multivariate and linear-regression analyses were performed to evaluate the association of pain with clinical parameters.ResultsAverage pain during cystoscopy (1.75 ± 1.331) was not significantly different when cauterization was also performed (2.37 ± 2.214) (P < .001) (P = .2840). Patients in the lower age group (< 66 years) indicated higher anxiety (P = .0005), more pain at cystoscopy (P = .004) and cauterization (P < .001). Although the patient's overall anxiety level was low (1–3/10), it was associated with some pain during cystoscopy (P = .0005) and cauterization (P < .000). In multivariate analysis, anxiety was the only independent predictor of pain during cystoscopy (P = .03, OR: 6.52, 95%CI: 1.2-35.6) and cauterization (P = .0012, OR: 3.4, 95%CI: 1.6-7.0). In bladder cancer patients, pain scores during cystoscopy and cauterization were not significantly different (P = .4772) but associated with anxiety.ConclusionOffice cystoscopy and cauterization are tolerable with minimal pain. Higher pain during the cystoscopy was associated with procedure anxiety, and pain during cauterization was associated with procedure anxiety and younger age. Younger and more anxious patients may need more counseling before cystoscopy.     

Efficacy of ultrasound-guided transversus abdominis plane blocks for post-cesarean delivery analgesia: a double-blind,dose-comparison,placebo-controlled randomized trial

BackgroundThe analgesic benefit of TAP (transversus abdominis plane) blocks for cesarean delivery pain remains controversial. We compared the analgesic efficacy of two doses of local anesthetic for TAP blocks after cesarean delivery.MethodsSixty women having cesarean delivery under spinal anesthesia were randomized to receive ultrasound-guided TAP blocks using either high-dose ropivacaine (3 mg/kg), low-dose ropivacaine (1.5 mg/kg) or placebo. Patients received intrathecal 0.75% bupivacaine 10–12 mg, fentanyl 10 μg and morphine 150 μg and standard multimodal analgesia. The primary outcome was the difference in pain with movement using a numeric rating scale at 24 h. Other outcomes included time to first request for analgesia, pain scores at 6, 12, 36, 48 h and at 6 and 12 weeks, opioid consumption, adverse effects, quality of recovery, and satisfaction.ResultsThere were no differences between groups in the primary outcome. Mean ± SD pain scores (0–10) with movement at 24 h were: high-dose ropivacaine 3.6 ± 1.5, low-dose ropivacaine 4.6 ± 2.1 and placebo 4.1 ± 1.7. With respect to secondary outcomes, the mean ± SD pain scores at 6 h were lower in the high-dose group 2.0 ± 1.8 compared to the low-dose 3.4 ± 2.7 and placebo groups 4.2 ± 2.0 (P = 0.009). Pain scores at 12 h were also lower in the high-dose group 2.2 ± 2.0 compared to the low-dose group 4.1 ± 2.7 and placebo group 4.0 ± 1.3 (P = 0.011). There was no difference in other outcomes between groups.ConclusionsNeither high- or low-dose TAP blocks as part of a multimodal analgesia regimen including intrathecal morphine improved pain scores with movement at 24 h after cesarean delivery when compared to placebo TAP blocks. High-dose TAP blocks may improve pain scores up to 12 h after cesarean delivery.     

Foot orthoses in the management of chronic subtalar and talo crural joint pain in rheumatoid arthritis

BackgroundThis pilot study investigated whether semi-rigid and soft orthoses had an effect on pain, disability and functional limitation in participants with chronic rheumatoid hindfoot involvement.MethodsParticipants with chronic hindfoot pain were randomly assigned to 2 groups, commencing either with semi-rigid Subortholene orthoses or soft EVA orthoses. The Foot Function Index and the Ritchie Articular Index were administered pre- and post-intervention, which lasted for 3 months. Following a 2 week washout period, each group was switched over to the other type of orthoses.ResultsNine female participants (mean age 52.2 years (SD 9.1); mean weight 71 kg (SD 12.64); mean height 160 cm (SD 5.18)) with a mean RA duration of 11.7 years (SD 7.83), and a mean ankle/subtalar joint pain duration of 5.7 years (SD 2.62), completed the programme. Mean improvement in FFI score for both orthoses resulted in the same statistical significance (p = 0.001). Statistically significant reduction in pain, disability and functional limitation was observed for both interventions, together with improvement in the Ritchie Articular Index score.ConclusionBoth Subortholene and EVA orthoses significantly reduced pain, disability and functional limitations in participants with chronic ankle/subtalar joint pain in rheumatoid arthritis.     

The effect of epidural methylprednisolone acetate injection on the hypothalamic-pituitary-adrenal axis

Study ObjectiveTo evaluate the effect of an epidural corticosteroid injection of 80 mg and 40 mg of methylprednisolone acetate on the hypothalamic-pituitary-adrenal axis and on back pain.DesignRandomized, single-blinded prospective study.SettingOperating room of a university-affiliated hospital.Patients42 patients with low back pain due to radiculopathy.InterventionsGroup 1 received an epidural corticosteroid injection of 80 mg of methylprednisolone acetate, and Group 2 received an epidural corticosteroid injection of 40 mg of methylprednisolone acetate. All study patients underwent a stimulation test of one μg of adrenocorticotropin hormone (ACTH), and their pain levels were graded just prior to and following the epidural corticosteroid injection on weeks one, 3, and 4.MeasurementsSerum cortisol of the ACTH stimulation tests and back pain levels were rated using a visual analog scale (VAS). Serum cortisol levels lower than 18 ng/mL 30 minutes following the ACTH stimulation test were considered to be secondary adrenal insufficiency.Main Results21 patients were enrolled in each group. The rate of secondary adrenal insufficiency in Group 1 was ~ 86%, ~ 22%, and ~ 17% of patients versus ~ 53% (P = 0.024), 15% (P = 0.874), and ~ 12% (P = 0.715) of Group 2 patients at weeks one, 3, and 4, respectively. About 62%, 56%, and 39% of Group 1 patients had a favorable clinical response as opposed to ~ 47% (P = 0362), 35% (P = 0.21), and ~ 6% (P = 0.049) of Group 2 patients at weeks one, 3, and 4, respectively.ConclusionsEpidural corticosteroid injection of methylprednisolone acetate in both groups was associated with very high rates of secondary adrenal insufficiency, but significantly more so in Group 1 at week one. This suppression was transient, with recovery of the gland in most patients noted over the ensuing weeks. An epidural corticosteroid injection of 80 mg had higher rates of favorable clinical response than a 40 mg injection, but significantly more so at week 4 only. This favorable response waned over a few weeks in both groups.     

Intrathecal morphine 100 and 200 μg for post-cesarean delivery analgesia: a trade-off between analgesic efficacy and side effects

IntroductionIntrathecal morphine is highly effective for post-cesarean analgesia; however, the optimal dose is yet to be established. The aim of this study was to compare analgesia and side effects after a change in institutional practice to give 200 μg rather than 100 μg.MethodsWe conducted a retrospective chart review of 241 patients who had an elective cesarean delivery and received either 100 or 200 μg of intrathecal morphine. The primary outcome variables were mean and peak verbal pain scores (0–10) and analgesic use (milligram-morphine equivalents). Postoperative administration of antiemetics, antipruritics and episodes of nausea or vomiting were recorded. Data are reported as mean ± SD or percentages with P < 0.05 considered statistically significant.ResultsWomen receiving intrathecal morphine 200 μg had lower pain scores and opioid use compared with morphine 100 μg. Mean verbal pain scores were 1.6 ± 1.1 versus 2.0 ± 1.1 (P = 0.01) and peak verbal pain scores were 4.9 ± 2.0 versus 5.6 ± 1.8, respectively (P = 0.008). The group receiving 200 μg used less opioids in the first 24 h after surgery (44 ± 35 versus 54 ± 35 milligram-morphine equivalents, respectively, P = 0.04) and received less intravenous opioids (18% versus 30%, P = 0.02). However, women receiving intrathecal morphine 200 μg had more nausea (mean number of episodes of nausea 1.9 ± 1.3 versus 1.6 ± 1.3, P = 0.037) and used more antiemetics (52% versus 24%, P < 0.0001).ConclusionsIntrathecal morphine 200 μg provided better analgesia but with more nausea compared with morphine 100 μg. Our results can be used to help guide intrathecal morphine dosing in cesarean delivery based on patient preference for analgesia versus side effects.     

Perineal infiltration with lidocaine 1%, ropivacaine 0.75%, or placebo for episiotomy repair in parturients who received epidural labor analgesia: a double-blind randomized study

BackgroundEpisiotomies are performed in approximately 20% of vaginal deliveries and may result in postpartum pain. Perineal infiltration with lidocaine during the episiotomy is widely used, despite an early study showing no difference when compared with saline. Ropivacaine has increasingly been used in the obstetric setting, although not for episiotomies. We sought to compare the analgesic efficacy of ropivacaine, lidocaine or saline for perineal infiltration before repair of a mediolateral episiotomy in patients who delivered with epidural labor analgesia.MethodsIn this double-blind randomized prospective study, infiltration with 15 mL of 0.75% ropivacaine, 1% lidocaine, or saline was performed immediately before initiating the perineal repair. During the first 24 h, the time to the first oral analgesic, analgesic intake, visual analog scale scores for pain, and patient satisfaction scores were recorded.ResultsA total of 154 patients were included. Demographic data were comparable between the groups. Time to first oral analgesic request was 13.9 h with 0.75% ropivacaine, 17.0 h with 1% lidocaine, and 16.6 h with saline (P = 0.104); the proportion of patients who did not request oral analgesics were 35%, 54% and 53%, respectively (P = 0.09). Visual analog pain scores were low and not different between the three groups (ropivacaine 16.8 ± 11.6, lidocaine 12.4 ± 9.7; and saline 16.2 ± 11.5, P = 0.08).ConclusionFor the first 24 h, perineal infiltration of ropivacaine, lidocaine, and saline were equivalent in producing post-episiotomy analgesia.     

The contribution of periapical nerve block in transrectal ultrasound-guided prostate biopsy: Results from a prospective randomized trial

ObjectivePeriprostatic nerve block has been shown to be the most effective method to reduce pain during transrectal ultrasound (TRUS) guided prostate biopsy, but the ideal technique remains controversial. The aim of this study was to compare pain control between bilateral basal block (BBB) alone and BBB combined with periapical nerve block (PNB).Patients and methodsFrom November 2007 to May 2009, 182 consecutive patients with abnormally elevated serum prostate-specific antigen (PSA) or suspicious digital rectal examination (DRE) underwent TRUS-guided needle biopsy of the prostate. The patients were prospectively randomized after informed consent had been obtained. Group 1 (n = 90) underwent bilateral basal block (BBB) with periprostatic infiltration of 8 ml 1% lidocaine into the neurovascular bundle at the prostate-seminal vesicle junction on each side. Group 2 (n = 92) underwent BBB with the addition of periapical nerve block (PNB) using 2 ml 1% lidocaine per side. A visual analog scale (VAS) was used to evaluate the patient's perception of pain during the biopsy.ResultsThe mean patient age was 64.6 ± 8.2 years and the average VAS was 1.9 ± 2.0. The mean VAS was lower in Group 2 compared with Group 1, 1.6 ± 1.9 versus 2.2 ± 2.0 (p = 0.026). In the subgroup aged 56–65 years the mean VAS was 1.26 ± 0.6 in Group 1 versus 2.46 ± 0.5 in Group 2 (p = 0.001), and in the subgroup aged 66–87 years it was 1.41 ± 0.5 in Group 1 versus 1.66 ± 0.75 in Group 2 (p = 0.554).ConclusionsBBB combined with PNB seems to be more effective to BBB alone to reduce pain during TRUS-guided prostate biopsy and may be of maximum benefit for younger patients.     

Preemptive analgesia by peritonsillar ketamine versus ropivacaine for post-tonsillectomy pain in children

BackgroundPostoperative pain relief is a desired goal after tonsillectomy. Respiratory depression from opioid, bleeding from nonsteroidal antiinflammatory drugs, and airway edema all these factors make pain control is judges. Peritonsillar infiltration of a local anesthetic has been used for reduction of post-tonsillectomy pain.ObjectiveThis study aims to compare the postoperative analgesic efficacy and side-effects of preincisional peritonsillar infiltration of either ketamine or ropivacaine in children undergoing tonsillectomy.MethodsIn this prospective randomized double blind study, 60 children 7–12 years scheduled to tonsillectomy were divided into three groups: the tonsils were infiltrated by 0.2 ml kg⁻¹ ropivacaine, 0.75% in ropivacaine group R (=21), group 0.5 mg kg⁻¹ ketamine in the ketamine group K (n = 20), and 0.2 ml kg⁻¹ normal saline in the control group S (n = 19). All drugs were prepared in normal saline (3 ml per tonsil) infiltrated 3 min after induction of anesthesia and before surgical incision. Surgery was performed by a single otolaryngology fellow using the same dissection and snare technique. Postoperative pain was compared during 8-h period using a visual analog scale (VAS). The fast-tracking score was used to determine the post-anesthesia care unit discharge criteria. Patients were evaluated for: time of first request and the total analgesic requirement, time of first oral intake, nausea, vomiting, bleeding, and hallucination.ResultsIn the post-anesthesia care unit, groups K and R had comparable pain scores that were significantly lower than S group (P < 0.04). Pain scores in the postoperative ward at 2, 6, and 8 h were significantly higher in group S than in K and R groups (P < 0.05). The time of first analgesic demand was significantly longer in R group (5.52 ± 1.7) h than in K group (3.83 ± 0.16) h p = 0.003. It was the shortest in S group (2.57 ± 0.84) h p = 0.001. The time of first oral intake was significantly longer in S than in R and K groups (5 ± 1.72 versus 3.2 ± 1.97 and 3.65 ± 1.72 h) respectively = 0.006. Total analgesic consumption (mg) was significantly higher in S group than in R and K (12. ± 5.3 versus 8, 2 ± 2.3 and 8.6 ± 3.1) p = 0.004. There were no significant differences between groups regarding nausea, vomiting, or bleeding, and there was no other side-effect recorded.ConclusionPerincisional peritonsillar infiltration of both ropivacaine and ketamine was effective in reduction of post-tonsillectomy pain. Ropivacaine was superior to ketamine in reduction of time to first analgesic demand.     

Entheses ultrasound assessment in primary Sjogren's syndrome

ObjectiveMusculoskeletal pain is a common complaint among patients with primary Sjogren's syndrome (pSS). Joints clinical examination is oftenly normal. A periarticular origin of this pain may be possible. Since clinical examination lacks sensitivity and precision, the use of musculoskeletal ultrasound (US) is more interesting in the evaluation of the entheses involvement, as it is shown to be a more sensitive tool. Our objective was to assess, by an ultrasonographic study, the entheses involvement in the widespread pain of patients with pSS.MethodsThis is a prospective study including 25 women with pSS and 25 age and sex matched healthy controls. An ultrasound examination, using grey scale and Doppler US, of five enthesitic sites (distal quadricipital, proximal patellar, distal patellar, distal Achillian and distal brachial tricipital) sought bilaterally the following lesions: hypoechogenicity, thickening, loss of fibrillar structure, erosions, enthesophytes, calcifications or Doppler hypervascularisation. A final score was calculated by summing the abnormalities scores of all entheses.ResultsThe mean age was 53.2 ± 11.3 years in the pSS group and 50.6 ± 9.7 years in the control group. The mean number of pathological entheses on ultrasound was 3.92 ± 1.93 in the pSS group versus 4.52 ± 2.27 in the control group (P > 0.05). The total score for enthesitis abnormalities was 4.96 ± 2.59 versus 5.72 ± 2.92 (P > 0.05), respectively. There was a positive correlation between total score of ultrasound enthesitic abnormalities and age in both groups.ConclusionIn patients with pSS, clinically painful sites were more frequently found than in US. Musculoskeletal pain was not due to enthesitis.     

Clinical evaluation of post-operative analgesia comparing suprascapular nerve block and interscalene brachial plexus block in patients undergoing shoulder arthroscopic surgery

BackgroundShoulder arthroscopic surgeries have a high incidence of severe post-operative pain significant enough to interfere with recovery and rehabilitation. A regional anaesthetic technique combined with general anaesthesia reduces intra-operative requirements of anaesthesia and provides a better post-operative pain relief. As the commonly employed technique of interscalene brachial plexus block (ISB) is associated with potential serious complications, suprascapular nerve block (SSB) can be used as a safer alternative.Methods and materialIn this prospective study, 60 ASA 1 or 2 adult patients undergoing shoulder arthroscopic surgery were randomised into two groups – ISB and SSB. In group ISB, ISB with 20 ml of 0.5% bupivacaine mixed with 75 μg clonidine was given. In the SSB group SSB was given with 15 ml of 0.5% bupivacaine with 75 μg clonidine. Pain was assessed using visual analogue scale and verbal pain scale scores and time to first rescue analgesia was noted. We used Student's t test and Chi-square/Fisher Exact test and used a statistical software to compare data.ResultsIn the present study, the mean duration of analgesia was 2.53 ± 2.26 h in SSB group compared to 7.23 ± 6.83 h in group ISB (p value < 0.05). Overall rescue analgesic requirements were higher in SSB group compared to ISB group (63.3% versus 40.0%) but this was statistically not significant (p value > 0.05).ConclusionBoth interscalene and SSB can be used to provide intra-operative and post-operative analgesia in patients undergoing shoulder arthroscopy.     

Cave-in decompression technique in percutaneous endoscopic transforaminal discectomy for ossification occupation in lumbar spinal canal: A retrospective analysis of 23 cases

ObjectivePercutaneous endoscopic transforaminal discectomy (PETD) for the treatment of ossification occupation of the lumbar spinal canal is technically demanding. The purpose of this study was to describe an endoscopic cave-in decompression technique in PETD for ossification occupation of the lumbar spinal canal and to report the clinical results.MethodsFrom May 2018 to June 2020, 23 consecutive cases, diagnosed in our institution as ventral ossification in the lumbar spinal canal and treated with PETD, were evaluated. The endoscopic cave-in decompression technique was performed. We analyzed the clinical outcomes on a visual analogue scale (VAS) and the Oswestry Disability Index (ODI). Perioperative data and complications rate were also recorded.ResultsMean follow-up was 15.7 ± 2.8 months. Mean preoperative VAS score for low-back pain was 5.65 ± 1.43, and decreased to 0.57 ± 0.5 at final follow-up. Mean preoperative VAS score for leg pain was 5.48 ± 1.38, and decreased to 0.56 ± 0.5 at final follow-up. Mean preoperative ODI score decreased from 33.04 ± 5.28 preoperatively to 8.7 ± 2.54 at last follow-up. One patient experienced transient postoperative hypoesthesia, and one developed a mild transient decline in muscle strength; both recovered progressively. Postoperative CT and MRI showed that the ossification was effectively removed and the nerve root and dural mater was completely decompressed in all cases.ConclusionThe endoscopic cave-in decompression technique in PETD is a safe and effective treatment method for selected patients with ossification occupation of the lumbar spinal canal.     

Clinical relevance of diffusion tensor imaging parameters in lumbar disco-radicular conflict

PurposeTo measure the fractional anisotropy (FA) and the mean diffusivity (MD) values of L4, L5 and S1 nerve roots using diffusion tensor imaging (DTI) and to correlate them with four different clinical patterns.Patients and methodsFifty-six human participants were prospectively included and divided between four groups: healthy subjects, patients with clinical symptomatic nerve root pain with and without anatomical discoradicular conflict and patients with incidental anatomical discoradicular conflict seen on magnetic resonance imaging (MRI). MRI protocol included anatomical sequences (sagittal T1- and T2-weighted, axial T2-weighted) and a 25 directions DTI sequence. FA and MD values were measured in consensus by two readers and compared between the four groups.ResultsMean FA and MD values were significantly different for patients with clinically symptomatic nerve root pain (n = 27) both with (n = 16) (FA = 0.187 ± 0.015; MD = 510 ± 40) and without (n = 11) (FA = 0.193 ± 0.011; MD = 490 ± 30.5) anatomical discoradicular conflict compared to healthy subjects (n = 29) (FA = 0.221 ± 0.011; MD = 460.9 ± 35.5) including 2 subjects with incidental anatomical discoradicular conflict (FA = 0.211 ± 0.013; MD = 450.8 ± 41.2) on MRI (P = 0.003).ConclusionMeasurement of FA and MD values of L4, L5 and S1 nerve roots using DTI could be useful in lumbar nerve root pain assessment. Further studies with different image processing methods are needed.     

High pain catastrophizing scores in one-fourth of patients on biotherapy for spondylarthritis or rheumatoid arthritis

ObjectivesTo measure catastrophizing scores in patients on biotherapy for spondyloarthritis (SpA) or rheumatoid arthritis (RA).MethodsThe first 140 outpatients or day-hospital patients seen at a teaching hospital rheumatology department for biotherapy administration completed the validated French version of the Pain Catastrophizing Scale (PCS, total score ranging from 0 to 52); a questionnaire on perceived support and past, current, and future disease activity; and a questionnaire on perceived understanding of their disease by family and co-workers.ResultsPCS scores were significantly higher in the 54 SpA patients than in the 86 RA patients (20.8 ± 12.1 versus 17.0 ± 13.6; P = 0.08), as a result of a higher helplessness subscore (10.0 ± 6.2 versus 7.8 ± 6.2; P = 0.046). The PCS score was ≥ 30 in 14/54 (26%) SpA patients and in 19/86 (22%) RA patients; physicians identified catastrophizing in only 17 of these 33 patients. PCS scores showed moderate correlations with the AS-DAS and DAS-28 and slightly stronger correlations with the overall pain score (Pearson, +0.431; P = 0.0001). SpA patients reported significantly worse understanding by their co-workers than did RA patients (33.9 ± 33.4 versus 53.9 ± 36.3; P = 0.007).ConclusionOne-fourth of patients with SpA or RA had very high pain catastrophizing scores despite biotherapy. Pain catastrophizing was missed by the physicians in half the cases and was relatively independent from other follow-up parameters. Pain catastrophizing can jeopardize treatment outcomes and deserves specific management.     

Dor lombar inespecífica em adultos jovens: fatores de risco associados

ObjectiveThe aim of the study was to evaluate potential risk factors related to low back pain in the daily routines of two sets of youths: individuals complaining of chronic low back pain and a control group.MethodsThe sample consisted of 198 university‐age students (male and female) aged between 18 and 29. In accordance with back pain diagnoses, they were separated into two groups: with or without nonspecific chronic low back pain. Both groups were evaluated by a “blinded” observer with no knowledge to the presence or otherwise of lower back pain. Questionnaires concerning clinical‐demographic characteristics, life style, quality of life (SF‐36 questionnaire), pain visual analogical scales (VAS), and physical examination were applied.ResultsA univariate analysis showed a statistically significant association (P < 0.05) with the presence of low back pain and some factors. There was a negative association between low back pain and the following variables: BMI, health self‐assessment, VAS and some SF‐36 domains (physical functioning, body pain, general health, vitality, social functioning). There was a positive correlation with the following variables: global pain by VAS, presence of diffuse pain and number of tender points. However, the multivariate analysis showed statistically significant correlations (P < 0.05) between low back pain and few variables: global pain VAS and number of tender points.ConclusionSome variables related to chronic diffuse pain and lower quality of life might be associated to chronic low back pain in young adults. However, longitudinal studies are necessary.     

Outcomes of lower limb amputees at Cotonou

BackgroundLimb amputations are responsible for disability. We studied the outcomes of lower limb amputees in our daily practice.MethodsThis prospective analytical study over 7 years (January 2009–December 2015) included 70 amputees of lower limb. They were mainly male (73%), aged on average of 42.4 ± 18.8 years. The mean time of follow- up was 3.2 ± 1.9 years. We assessed disability on balance, walking, disability in daily life for patients with prosthesis, and the socio-economic impact of the amputation. Statistical analysis was performed with Chi² and Mann-Whitney tests; a p-value ≤ 0.05 was considered statistically significant.ResultsThe average Timed Up and Go Test was 18.5 s. Class II of Pohjolainen subjects were the most recovered (37%). The mean Houghton score in the 17 fitted patients was 6.2 ± 2.0. Socially, 90% of the patients no longer practiced leisure activities, and 4/53 patients were no longer in a couple. At the economic level, 87% of patients had a decreased monthly income. Factors that bear direct correlation to functional outcome of patients were the level of amputation, and the prosthesis fitting.ConclusionLower limbs amputations entail adverse consequences at the functional and socio-economic level. Our country must review its policy on prosthetic fittings for amputees, and vote laws that involve private firms and government in socio-economic reintegration, and empowerment of these subjects.