Conservative Pain Management Research Articles

Surgical Management of Central Pain in Persons with Spinal Cord Injury: The Dorsal Root Entry Zone (DREZ) Procedure

When conservative management of central pain in spinal cord injury (SCI) has failed to provide adequate relief, ablative surgery may be beneficial in carefully selected cases. Cordotomy and other procedures have been advocated in the past but are no longer in widespread use due to concerns about efficacy and morbidity. The standard dorsal root entry zone (DREZ) procedure is currently the primary focus of neurosurgical management of central pain, but its effectiveness is limited to at-level pain. Recently, the advent of neurophysiologically directed lesioning has been shown to improve the success rate of the DREZ technique and has expanded the indications to include below-level central pain.

Conservative Management of Patellofemoral Pain

Conservative Management of Patellofemoral Pain

Factors predicting radical treatment after in-hospital conservative management of disk-related sciatica

Objective. To determine predictive factors for radical treatment (nucleolysis or surgery) after in-hospital conservative management of low back pain with sciatica (LBPS). Patients and methods. A standardized form was used to collect data on 134 patients admitted for conservative treatment of LBPS. Subsequent radical procedures were recorded 11 to 24 months after discharge. Results. Forty-seven patients required radical treatment after discharge. Significant risk factors for radical treatment in the univariate analysis were taller stature, use of a lumbar support, more preadmission epidural injections, a positive straight leg-raising test, and a disk herniation diameter of at least 50% of the spinal canal diameter. Protective factors were onset within the month preceding admission and normal range of motion of the lumbar spine. In the multivariate analysis, symptom duration longer than one month, use of a lumbar support prior to admission, and a positive straight leg-raising test were associated with radical treatment. A positive straight leg-raising test was the only significant clinical risk factor in the subset of patients investigated by computed tomography (CT). When CT findings were added to the model, only size of the herniation was significant. Conclusion. Sixty-five percent of patients admitted for conservative treatment of LBPS do not receive radical treatment during a mean follow-up of 18 months. Several factors are associated with the likelihood of radical treatment.

A critical appraisal of review articles on the effectiveness of conservative treatment for neck pain.

A criteria-based appraisal of review articles on neck pain. To assess the methodologic quality, conclusions, and extent of concordance among reviews on the conservative treatment of neck disorders. During the past decades there has been an increasing interest in summarizing and analyzing the available evidence on the effectiveness of conservative management of neck pain. Considering the growing number and quality of reviews, consumers may question which reviews to read and believe. Computerized bibliographic databases were searched without language restriction. The reviews assessed had been published before January 1998, included neck pain and evaluated conservative therapies, and reported at least one controlled clinical trial. Identification, selection, and quality assessment were performed independently by two investigators. Of the 108 identified articles, 25 review articles were selected, of which 12 were systematic reviews. The reviews differed in their reporting of study population, interventions, and outcomes. Statistical pooling was performed in two high-quality systematic reviews, whereas in other reviews, the investigators explicitly decided not to pool data. The results of the current study show that the concordance among reviews varied. Regarding manipulation and traction, there is inconclusive evidence among reviews. Concordance regarding the effectiveness of other conservative interventions was absent. Many of the reviews displayed major methodologic flaws. Consumers should consider reports of reviews both carefully and critically, given the wide variety of review methodology, descriptive information, and final conclusions. There is a paucity of evidence from primary studies on neck pain. Therefore, more research is needed to allow systematic reviews to formulate stronger conclusions.

The Change of Cervical Epidural Pressure according to Infused Normal Saline in Epiduroscopy

Background: Normal saline is used to dilate the epidural space to provide a focal length for the lens and to wash the epidural adhesive neural tissue in an epiduroscopy. Saline infusion into the epidural space during an epiduroscopy might affect pressure-volume compliance of the CSF which has a high compliance; therefore, it might cause neurological sequelaes. The purpose of this study was to investigate the change of cervical epidural pressure according to the volume of infused saline during epiduroscopy. Methods: Twenty-one patients who complained of low back pain with radiculopathy that did not respond to conservative pain management and underwent an epiduroscopy were included in this study. The epidural catheter was placed between the 5th and 6th cervical epidural space under fluoroscopic guidance and cervical epidural pressure was monitored. Next, an epiduroscopy via caudal route was performed and cervical epidural pressure was measured after each 10 ml of infused saline. We also checked neurological sequelaes that might be resulted from increased epidural pressure. Results: All patients except two showed no difference in basal cervical epidural pressure. One patient who had failed back surgery syndrome complained of a headache and dizziness when the cervical epidural pressure was rapidly increased from -90 mmHg to 5 mmHg following an infusion of 27 ml of saline. One patient who had a herniated disc showed posterior nuchal pain and stiffness following an infusion of 48 ml of saline despite a stable cervical epidural pressure (range: 0-3 mmHg) during the procedure. There were no residual neurological sequelaes in this study. Conclusions: There are variable patterns in cervical epidural pressure according to the volume of infused saline. Close monitoring of intracranial pressure is therefore neccessary during an epiduroscopy. (Korean J Anesthesiol 2001; 40: 483∼488) ꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏ

Management of Separation Pain After Single-Dose Methotrexate Therapy for Ectopic Pregnancy

In Brief Objective To evaluate the conservative management of pain after systemic methotrexate therapy for ectopic pregnancy; identify prognostic factors for success; and compare hCG resolution time for patients with and without pain. Methods A retrospective review of patients with ectopic pregnancy requiring evaluation for pain after receiving single-dose methotrexate therapy is performed. Results of hematocrits, ultrasound findings, hCG levels, time for hCG levels to reach less than 15 mIU/mL, and outcome were noted. Results Fifty-three patients with 64 episodes of pain were identified. Seven hospitalized patients required surgery during admission. Two previously hospitalized and one outpatient also ultimately underwent surgery. For hospitalized patients, there were no statistical differences between patients who did or did not undergo surgery during admission for any variable studied, including the presence of free peritoneal blood or rebound tenderness. However, comparison of hospitalized and nonhospitalized patients showed those with rebound tenderness were more likely to be admitted. Hospitalized patients not requiring surgery had shorter resolution time than nonhospitalized patients. For hospitalized and nonhospitalized patients, the median time from treatment to presentation for pain was 8 days. Conclusion The occurrence of pain following methotrexate therapy for ectopic pregnancy should not be the sole indication for surgical intervention. The majority of stable patients with pain after methotrexate therapy, even with rebound or free peritoneal fluid, can be treated successfully without surgery, either in hospital with close observation for severe pain or as outpatients for patients with less severe pain. After administration of systemic methotrexate for treatment of ectopic pregnancy, stable patients with separation pain frequently can be managed successfully without surgery.

Management of separation pain after single-dose methotrexate therapy for ectopic pregnancy

Objective: To evaluate the conservative management of pain after systemic methotrexate therapy for ectopic pregnancy; identify prognostic factors for success; and compare hCG resolution time for patients with and without pain. Methods: A retrospective review of patients with ectopic pregnancy requiring evaluation for pain after receiving single-dose methotrexate therapy is performed. Results of hematocrits, ultrasound findings, hCG levels, time for hCG levels to reach less than 15 mIU/mL, and outcome were noted. Results: Fifty-three patients with 64 episodes of pain were identified. Seven hospitalized patients required surgery during admission. Two previously hospitalized and one outpatient also ultimately underwent surgery. For hospitalized patients, there were no statistical differences between patients who did or did not undergo surgery during admission for any variable studied, including the presence of free peritoneal blood or rebound tenderness. However, comparison of hospitalized and nonhospitalized patients showed those with rebound tenderness were more likely to be admitted. Hospitalized patients not requiring surgery had shorter resolution time than nonhospitalized patients. For hospitalized and nonhospitalized patients, the median time from treatment to presentation for pain was 8 days. Conclusion: The occurrence of pain following methotrexate therapy for ectopic pregnancy should not be the sole indication for surgical intervention. The majority of stable patients with pain after methotrexate therapy, even with rebound or free peritoneal fluid, can be treated successfully without surgery, either in hospital with close observation for severe pain or as outpatients for patients with less severe pain.

Conservative management of mechanical neck pain: systematic overview and meta-analysis

To review the efficacy of conservative management of mechanical neck disorders. Published and unpublished reports were identified through computerised and manual searches of bibliographical databases, reference lists from primary articles, and letters to authors, agencies, foundations, and content experts. Selection criteria were applied to blinded articles, and selected articles were scored for methodological quality. Effect sizes were calculated from raw pain scores and combined by using meta-analytic techniques when appropriate. Twenty four randomised clinical trials met the selection criteria and were categorised by type of intervention: nine used manual treatments; 12 physical medicine methods; four drug treatment; and three education of patients (four trials investigated more than one form of intervention). The intervention strategies were summarised separately. Pooling of studies was considered only within each category. Five of the nine trials that used manual treatment in combination with other treatments were combined. One to four weeks after treatment the pooled effect size was -0.6 (95% confidence interval -0.9 to -0.4), equivalent to an improvement of 16 (6.9 to 23.1) points on a 100 point scale. Sensitivity analyses on study quality, chronicity, and data imputation did not alter this estimate. For other interventions, studies could not be combined to arrive at pooled estimates of effect. There is little information available from clinical trials to support many of the treatments for mechanical neck pain. In general, conservative interventions have not been studied in enough detail to assess efficacy or effectiveness adequately.

Conservative management of patellofemoral pain

38 knees of 27 patients with patellofemoral pain were treated by a home exercise program. There were 22 females and 5 males whose ages averaged 28 years (range, 16-45 years). The duration of symptoms varied between one month and ten years (av. 2 years). Follow-up was 6 to 36 months, average 18 months. No exercises had been done to nine knees. The efficiency of the exercise program was 10% to 90%, average 41% for the remaining 29 knees. At the last follow-up there was an average 12 point increase (from 74 to 86) modified Lysholm scores. 27 knees (71 %) had better modified Lysholm scores. Tegner activity levels increased from average 3.3 (2-7) to average 3.8 (2-9). Only two patients (four knees) accepted operation. These results led us to conclude that a tnal of conservative treatment should be done pnor to any surgical procedure including arthroscopy. The success rate might be even higher with a supervised physiotherapy program.

Can the use of physical modalities for pain control be rationalized by the research evidence?

Physical modalities, including cold and heat, are widely used in the conservative management of pain associated with musculoskeletal disorders. This review has critically appraised the literature supporting the use of these modalities in the treatment of musculoskeletal pain. It was concluded that, apart from a few exceptions and in a few types of disorders, existing evidence does not support the use of these modalities in long-term pain control. There was, however, evidence that several modalities, specifically cold and a form of deep heat (shortwave diathermy), do have short-lived analgesic effects and so may contribute to more painfree function in the short term. Further research is clearly warranted to define the short- and long-term therapeutic efficacy of physical modalities in the treatment of musculoskeletal pain to justify their continued use in clinical practice.

Indications for conservative management of acute scrotal pain in children: K.J. Hastie and C.A.C. Charlton. Br J Surg 77:309–311, (March), 1990

Indications for conservative management of acute scrotal pain in children: K.J. Hastie and C.A.C. Charlton. Br J Surg 77:309–311, (March), 1990

Conservative management of low back pain. An evaluation of current methods.

The overwhelming majority of patients with low back pain recover, most of them within 6 to 12 weeks. Those who do not, however, represent a major challenge to physicians, who need to choose from among the many therapies for low back pain that have been advocated but in many cases not proven. For those with chronic low back pain, a functional restoration program and a multidisciplinary pain management program may prove effective.

Conservative management of metatarsal and heel pain in the adult foot.

The Louisiana State University (LSU) Affiliated Hospitals foot clinic has had good success in the treatment of metatarsal and heel pain using the following five modalities. Muscle strengthening and muscle stretching of the intrinsic muscles and the muscles about the ankle joint, especially the gastrocnemius-soleus complex. Contrast baths in the acute condition to decrease the edema and inflammatory process. Nonsteroidal agents with the acute condition to decrease the inflammatory response. Shoe modifications. Orthotic devices. Orthotic devices seem to be the most useful in the treatment of both conditions. It has been found necessary to prescribe orthotics in almost all cases of chronic problems to institute permanent relief. Opposition remains to multiple steroid injections into either area, although there is no great objection to one or possibly two injections into a particular area to decrease the inflammatory process. It has been observed that a general worsening of the condition occurs from multiple injections. After repeated steroid injections one sets the stage for increased atrophy of the fat pad, which results in a more prominent bony surface and increased pain. Cases have been documented on many occasions showing indented areas over the heel or metatarsals or complete loss of the metatarsal fat pad of patients who have received multiple injections of steroids.

Achilles tendon lesions in sport.

Achilles tendon pain is a common cause of disability in sportsmen. The majority of cases are due to overuse injury often exacerbated or precipitated by specific and recognisable factors. A variety of pathologies is demonstrable in Achilles tendon pain which accounts for the considerable variation in the described natural history of the disease. The study of patients with Achilles tendon pain is almost impossible unless an accurate diagnosis is made first. The specific factors of the various conditions demonstrated as causes of Achilles tendon pain are set out and the value of different laboratory and other investigations indicated in the particular pathological conditions. Conservative management of Achilles tendon pain may be unrewarding except in acute crepitating peritendinitis. Various forms of conservative treatment are discussed and the literature reviewed. The role of surgery in management of chronic resistent Achilles tendon pain is discussed in detail with particular reference to the indications and the surgical procedures available. The postoperative management of patients following Achilles tendon surgery is discussed and the outcome indicated.

Conservative management of low back pain.

Diagnosis and treatment of low back pain may well have seen more progress in the past five years than in the previous 50. Specific diagnoses can be made by history and physical examination and can often be objectively documented by modern high-resolution computed tomographic scanning of the lumbar spine. A number of innovative conservative treatment modalities show great promise in decreasing the need for surgical intervention. Surgery is indicated only when appropriate conservative measures have failed. However, the greatest changes are yet to come. These will relate to prevention of low back pain through professional instruction of patients regarding activities, exercises, and life-style beneficial to the lumbar spine.

Conservative management of low back pain: a review of 700 cases.

Medical Journal of AustraliaVolume 1, Issue 6 p. 266-267 Original Article CONSERVATIVE MANAGEMENT OF LOW BACK PAIN: A REVIEW OF 700 CASES Leon L. Marshall F.R.A.C.S., Leon L. Marshall F.R.A.C.S. MelbourneSearch for more papers by this author Leon L. Marshall F.R.A.C.S., Leon L. Marshall F.R.A.C.S. MelbourneSearch for more papers by this author First published: 01 February 1967 https://doi.org/10.5694/j.1326-5377.1967.tb21198.xCitations: 1AboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinkedInRedditWechat No abstract is available for this article.Citing Literature Volume1, Issue6February 1967Pages 266-267 RelatedInformation

Conservative management of low back pain

Conservative management of low back pain