Decrease In Pain Level Research Articles

Pronator quadratus repair after volar plating of distal radius fractures or not? Results of a prospective randomized trial.

BackgroundThe purpose of the present study was to investigate the influence of the pronator quadratus (PQ) muscle repair following volar plate fixation of distal radius fractures with special regards to the forearm pronation strength. During the early recovery period of 3 months, an improvement of pronation strength and functional scorings was hypothesized for the PQ repair when compared to no repair.MethodsThe inclusion criteria were (1) men or women between 18 and 80 years, (2) isolated, closed fractures of the distal radius, (3) A2 to B2 types of fracture according to the AO fracture classification system, (4) primary volar locking plate osteosynthesis. Patients were randomized to group A = PQ repair and group B = no repair. Follow-up examinations after 6 and 12 weeks included bilateral isometric pronation strength measurement, range of motion, the QuickDASH and the Mayo-Wrist-Score, and a visual analog scale (VAS).Results60 patients (n = 31 in group A and n = 29 in group B) with an average age of 54 years (range 22–77 years) returned for both follow-up visits. The pronation strength measurements showed no significant differences between groups (PQ repair vs. no repair) neither at 6 weeks nor at 12 weeks. Additionally, no statistical significant differences were noted for ROM, QuickDASH-Score or Mayo-Wrist-Score. The VAS scoring revealed a significant decreased pain level after PQ repair at 6 weeks postoperatively (p = 0.017).ConclusionAn improved pronation strength after PQ repair in the early rehabilitation period could not be confirmed. However, the PQ repair might reduce pain in the early postoperative period.Trial registration number: NCT02595229 (ClinicalTrials.gov, registered 02 November 2015)

Reductions in physical pain predict lower risk of relapse following alcohol treatment

ObjectivePhysical pain is considered a potential predictor of relapse in alcohol-dependent individuals after treatment. The aim of this study was to evaluate whether reductions in pain level during the follow-up period after treatment were associated with lower relapse risk. MethodA sample of 366 participants was recruited from alcohol treatment centers in Warsaw, Poland. At baseline, information was obtained about pain level, demographics, childhood abuse, impulsivity, depressive symptoms, severity of alcohol and sleep problems. After finishing the alcohol treatment program, patients were followed for 12 months and alcohol drinking (relapse) as well as pain severity were evaluated. ResultsIn the followed-up group, 29.5% of patients confirmed that they drank any alcohol during past 4 weeks. Comparing follow-up to baseline pain, 48.6% of subjects reported an increased severity of pain, 28.8% reported the same level of pain, 22.6% reported decreased level of pain. There was a significant association between the decrease in level of pain and the lower risk of relapse. Other factors associated with relapse during 4 weeks prior to the follow-up were baseline severity of depressive symptoms, low baseline social support and number of drinking days during 4 weeks prior to entering treatment. In multivariate analysis, a decrease in pain level was associated with a lower likelihood of relapse (OR=0.159; 95%CI:0.04–0.62; p=0.008) even when controlled for other factors associated with relapse. ConclusionsDecreases in pain level following treatment for alcohol dependence are associated with, and may contribute to, a lower risk of alcohol relapse.

Low-Dose Docetaxel Combined with Dexamethasone Is Feasible for Patients with Castration-Resistant Prostate Cancer

Aim: Docetaxel-based chemotherapy against castration-resistant prostate cancer (CRPC) has recently been shown to be effective and tolerable. The objective of this study was to retrospectively evaluate the efficacy and toxicity of low-dose docetaxel in combination with dexamethasone. Methods: Thirty-seven CRPC patients were administered a treatment regimen consisting of 50 mg/m² docetaxel once every 3-4 weeks and 1 mg dexamethasone daily at our institution, between November 2004 and April 2014. Results: Twenty-four patients (65%) had a decrease in serum prostate-specific antigen (PSA) >50%. The median overall survival (OS) and PSA progression-free survival were 26.2 and 10.0 months, respectively. Ten of 12 patients (83%) taking analgesic agents reduced their intake because of decreased pain levels. Grade 3 febrile neutropenia occurred in 2 patients (5%). Nonhematological toxicities were less frequent but sometimes severe. Treatment-related death occurred in 2 octogenarian patients, 1 due to gastric bleeding and the other due to infective endocarditis. Conclusion: Low-dose docetaxel in combination with dexamethasone is feasible in Japanese CRPC patients. Hematological toxicity is less than that seen with standard docetaxel therapy, but it is necessary to monitor patients for severe nonhematological toxicities, particularly very elderly patients.

Changes in brain activation patterns after physiotherapy program: A preliminary randomized controlled trial study after Postural Reconstruction® and stretching programs

Postural Reconstruction® is a physiotherapy method that has been developed over the last two decades. Its main therapeutic objectives are to decrease pain levels, normalize joint alignment and posture and improve movement and function. The goal of this study was to substantiate the neuromuscular mechanism of action of Postural Reconstruction® by evidencing pre- vs. post-intervention changes in brain activation patterns during sustained ankle dorsiflexion. It concerns a single-centre, prospective, randomized, controlled, parallel-group trial. Sixteen healthy subjects (8 males and 8 females; age range: 20–23) were randomized into two groups: an interventional Postural Reconstruction® group (n=8) and a control stretching group (n=8). Both groups performed 10 weekly sessions. The Postural Reconstruction® sessions involved five manoeuvres and the stretching sessions involved five different exercises. Brain activation patterns were measured via single-photon emission computed tomography. Each subject received two 1480 MBq doses (3 months apart). We performed a voxel-wise statistical analysis (using Statistical Parametric Mapping software) to detect changes in brain activation within each group. ResultsWe observed statistically significant pre- vs. post-intervention changes in brain activation patterns in the Postural Reconstruction® group (a neuromuscular approach), but also in the stretching group (viewed as a mechanical approach). There were no significant intergroup differences in the pre- or post-intervention brain activation patterns. ConclusionsOur results suggest that the two different physiotherapy programmes have a neuromuscular mechanism of action and evidenced changes in brain activation patterns in young, healthy adults (i.e. free of CNS lesions) during the performance of ankle movements.

Local Anesthetics delivered through Pleural Drainages improve Pain and Lung Function after Cardiac Surgery.

Pleural tubes after coronary artery bypass graft (CABG) surgery usually cause pain resulting interalia in an impact of postoperative breathing. Therefore, the influence of intrapleural lidocaine application through special double-lumen chest tubes with respect to pain relief and lung function was investigated and compared with placebo. In this study, 40 patients who underwent CABG got intrapleural injection either with 2% lidocaine (n = 20) or placebo (0.9% saline solution) (n = 20) on the first 2 days after surgery. Pain was measured by pain intensity numeric rating scale (NRS) (0 = no pain; 10 = the most intense pain) and lung function by portable spirometer. On the first postoperative day (POD1), mean pain reduction was NRS 1.9 for the lidocaine group with an improvement of the forced expiratory volume in 1 second (FEV1) of 0.51 L. Similar results were shown on the second postoperative day (POD2) with a decreased pain level of mean NRS 1.65 and an FEV1 improvement of 0.26 L. In comparison, results of the placebo group showed no significant pain reduction, neither on the POD1 (NRS 0.35; p = 0.429) nor on the POD2 (NRS 0.55; p = 0.159). Also, there was no significant influence of FEV1 after placebo on the POD1 (FEV1 = 0.048 L; p = 0.70) or on the POD2 (FEV1 = 0.0135 L; p = 0.925). Intrapleural application of lidocaine is a safe and feasible method to reduce drainage-related pain and improving lung function after CABG.

A comparison of water-based and land-based core stability exercises in patients with lumbar disc herniation: a pilot study

Purpose: To determine and compare the effects of core stability exercise programs performed in two different environments in lumbar disc herniation (LDH) patients. Method: Thirty-one patients who were diagnosed with LDH and were experiencing pain or functional disability for at least 3 months were randomly divided into two groups as land-based exercises or water specific therapy. Also, 15 age–sex-matched healthy individuals were recruited as healthy controls. Both groups underwent an 8-week (3 times/week) core stabilization exercise program. Primary outcomes were pain, trunk muscle static endurance and perceived disability level. The secondary outcome was health-related quality of life. Results: Level of static endurance of trunk muscles was found to be lower in the patients compared to the controls at baseline (p < 0.05). Both treatment groups showed significant improvements in all outcomes (p < 0.05) after 8-week intervention. When two treatment groups were compared, no differences were found in the amount of change after the intervention (p > 0.05). After the treatment, static endurance of trunk muscles of the LDH patients became similar to controls (p > 0.05). Conclusion: According to these results, core stabilization exercise training performed on land or in water both could be beneficial in LDH patients and there is no difference between the environments.Implications for RehabilitationAn 8-week core stabilization program performed in water or on land decrease pain level and improve functional status in LDH patients.Both programs seem beneficial to increase health-related quality of life and static endurance of trunk muscles.Core stability exercises could be performed in water as well, no differences were found between methods due to environment.

Steal syndrome following an arteriovenous fistula – case report and treatment option

The paper presents the case of a 48 year-old diabetic patient that underwent hemodialysis for a long period of time and presented to our hospital with digital hypoperfusion symptoms following an arteriovenous fistula between the humeral artery and the basilic vein. The anamnesis of the patient reveals prior circulatory problems and in the case of a previous fistula the patient required the amputation of the distal phalanx of the left index finger. The arterial theft syndrome was dealt with in this case by using a simple method based on techniques of flow diminution through the vein, assessing the calibration by means of clinical criteria such as capillary flow, presence of thrill and decrease in pain levels. A 1 year follow-up showed the fistula was still viable and the symptoms diminished to a level that no longer interfered with the lifestyle of the patient.

Is Scheduled Intravenous Acetaminophen Effective in the Pain Management Protocol of Geriatric Hip Fractures?

Background:Hip fractures have significant effects on the geriatric population and the health care system. Prior studies have demonstrated both the safety of intravenous (IV) acetaminophen and its efficacy in decreasing perioperative narcotic consumption. The purpose of this study is to evaluate the effect of scheduled IV acetaminophen for perioperative pain control on length of hospital stay, pain level, narcotic use, rate of missed physical therapy (PT) sessions, adverse effects, and discharge disposition in geriatric patients with hip fractures.Methods:A retrospective review was performed of all patients 65 years and older admitted to a level I trauma center, who received operative treatment for a hip fracture over a 2-year period. Demographic data, in-hospital variables, and outcome measures were analyzed. Three hundred thirty-six consecutive fractures in 332 patients met inclusion criteria. These patients were divided into 2 cohorts. Group 1 (169 fractures) consisted of patients treated before the initiation of a standardized IV acetaminophen perioperative pain control protocol, and group 2 (167 fractures) consisted of those treated after the protocol was initiated.Results:Group 2 had a statistically significant shorter mean length of hospital stay (4.4 vs 3.8 days), lower mean pain score (4.2 vs 2.8), lower mean narcotic usage (41.3 vs 28.3 mg), lower rate of PT sessions missed (21.8% vs 10.4%), and higher likelihood of discharge home (7% vs 19%; P ≤ .001). Use of IV acetaminophen was also consistently and independently predictive of the same variables (P < .01).Conclusion:The utilization of scheduled IV acetaminophen as part of a standardized pain management protocol for geriatric hip fractures resulted in shortened length of hospital stay, decreased pain levels and narcotic use, fewer missed PT sessions, and higher rate of discharge to home.Level of Evidence:Therapeutic level III.

Patient-reported outcomes in a large community-based pain medicine practice: evaluation for use in phenotype modeling.

BackgroundAn academic, community medicine partnership was established to build a phenotype-to-outcome model targeting chronic pain. This model will be used to drive clinical decision support for pain medicine in the community setting. The first step in this effort is an examination of the electronic health records (EHR) from clinics that treat chronic pain. The biopsychosocial components provided by both patients and care providers must be of sufficient scope to populate the spectrum of patient types, treatment modalities, and possible outcomes.MethodsThe patient health records from a large Midwest pain medicine practice (Michigan Pain Consultants, PC) contains physician notes, administrative codes, and patient-reported outcomes (PRO) on over 30,000 patients during the study period spanning 2010 to mid-2014. The PRO consists of a regularly administered Pain Health Assessment (PHA), a biopsychosocial, demographic, and symptomology questionnaire containing 163 items, which is completed approximately every six months with a compliance rate of over 95 %. The biopsychosocial items (74 items with Likert scales of 0–10) were examined by exploratory factor analysis and descriptive statistics to determine the number of independent constructs available for phenotypes and outcomes. Pain outcomes were examined both in the aggregate and the mean of longitudinal changes in each patient.ResultsExploratory factor analysis of the intake PHA revealed 15 orthogonal factors representing pain levels; physical, social, and emotional functions; the effects of pain on these functions; vitality and health; and measures of outcomes and satisfaction. Seven items were independent of the factors, offering unique information. As an exemplar of outcomes from the follow-up PHAs, patients reported approximately 60 % relief in their pain. When examined in the aggregate, patients showed both a decrease in pain levels and an increase in coping skills with an increased number of visits. When examined individually, 80-85 % of patients presenting with the highest pain levels reported improvement by approximately two points on an 11-point pain scale.ConclusionsWe conclude that the data available in a community practice can be a rich source of biopsychosocial information relevant to the phenotypes of chronic pain. It is anticipated that phenotype linkages to best treatments and outcomes can be constructed from this set of records.

Specimen extraction from the defunctioning ileostomy site or Pfannenstiel incision during total laparoscopic low anterior resection for rectal cancer.

Laparoscopic low anterior resection is commonly performed, but there is controversy about the optimal specimen extraction site. The purpose of the study was to evaluate the outcomes of two different specimen extraction sites. In this prospective study of total laparoscopic low anterior resection for rectal cancer, we compared the outcomes of specimen extraction from a right lower quadrant trocar site that is also used for a defunctioning ileostomy (21 patients) or a Pfannenstiel incision (25 patients). The median visual analog pain score on postoperative Days 1 and 3 and meperidine requirement were significantly higher in the Pfannenstiel than in the ileostomy site group. Time to resumption of oral diet and hospital stay were significantly shorter in the ileostomy site than in the Pfannenstiel group. All four parastomal hernias were observed in the ileostomy site group. Use of the stoma site for specimen extraction in total laparoscopic low anterior resection for rectal cancer may minimize abdominal wall incisions, decrease postoperative recovery time, decrease pain level and analgesic requirement, and improve cosmesis. Although this procedure may increase the incidence of parastomal hernia, hernia repair may be performed during ileostomy takedown surgery, and the temporary stoma site (which also is the right lower quadrant trocar entry site) may be suggested as a proper specimen extraction site.

Primary results using the mini TightRope for revision surgery for painful proximalisation of the first metacarpal after trapezectomy for CMC-1-osteoarthritis

The aim of the current study was to review the significance of the TightRope to suspend the first metacarpal in the case of a revision for patients with painful proximalisation after trapezectomy. After an average of 25.5 months (13-60) from initial operative treatment for rhizarthrosis, revision surgery was performed on 6 female patients with a mean age of 56 years, using a Mini TightRope. Before and after revision-surgery the pain level was measured, using the visual analogue scale (1-10) as was the level of strength in the fingertips. The overall result was documented according to the evaluation scale according to Buck-Gramcko. Directly after surgery as well as at the last follow-up exam, the degree of proximalisation of the first metacarpal was radiologically measured. The follow-up period was 13.7 months on average (4-31 months). After revision surgery a decrease in pain level was detected, but no patient was completely pain-free. According to the visual analogue scale the pain level after surgery compared to preoperatively was: at rest at an average of 2.5 (1-4), preoperatively 3.3 (2-4); with mild load 3.5 (2-5), preoperatively 4.8 (4-6); and with high load 4.8 (3-7), preoperatively 7 (6-8). The level of strength in the fingertips was postoperatively measured at below 60% in 2 patients (preoperatively 5 patients), once between 60 and 79% (preoperatively 1 patient) and 3 times between 80 and 99%. With an average preoperative score of 11.7 (6-16) points according to Buck-Gramcko, an increase of 20.3 points could be achieved by performing the revision operation. This resulted in a score of 32 (14-44) out of 56 points. The measured distance between the distal scaphoid pole and the centre of the base of the first metacarpal was postoperatively at an average of 8.3 mm (5.6-11.4 mm). The final follow-up shows an average distance of 3.3 mm (2.8-4.3 mm). This is consistent with an average proximalisation of 5 mm. The Mini TightRope had to be removed three times. An additional operation had to be performed twice. The use of the Mini TightRope for a suspension of the first metacarpal, in cases of a painful proximalisation after trapezectomy is a procedure that can cause an improvement for a certain percentage of patients. But a further proximalisation cannot be prevented by the use of the Mini TightRope.

Single- or multiple-session viscosupplementation protocols for temporomandibular joint degenerative disorders: a randomized clinical trial.

The aim of the study was to compare the effectiveness of two single-session protocols, either adopting high- (protocol A) or medium-molecular weight hyaluronic acid (protocol B), with the reference five-session protocol of temporomandibular joint (TMJ) lavage plus viscosupplementation (protocol C) in the management of chronic TMJ degenerative disorders. A randomized clinical trial (RCT) with ten participants per treatment group was designed, with multiple observation points, ending at 6months after treatment. Pain levels on a 10-point VAS scale were selected as the primary outcome variable to rate treatment effectiveness, along with a number of secondary outcome parameters. Findings showed that Group C patients had the highest decrease in pain levels. Nonparametric permutation analyses revealed that the global effect of treatment was significantly different between the three protocols (P=0·024). Pairwise comparisons showed that the differences of treatment effect between the two single-session interventions were negligible (global P-value=0·93). On the contrary, the five-session protocol was significantly superior to both single-session protocols (global P-values ranging from 0·003 to 0·012). In conclusion, in a population of age-, sex-, and psychosocial aspects-matched study groups, the standard of reference five-session protocol proved to be superior at 6months as far as the decrease in pain levels was concerned, whilst there were no differences between the two single-session interventions. The absence of differences in treatment effect as for some other secondary clinical outcome variables may suggest that there is further space for future investigations attempting to reduce the number of multiple interventions for TMJ viscosupplementation.

Self‐reported pain perception of patients after mucosal graft harvesting in the palatal area

To evaluate the patient-reported pain perception after palatal graft harvesting during a 4 weeks healing period Ninety patients, scheduled for different periodontal and peri-implant plastic surgeries requiring palatal mucosal graft harvesting, were consecutively recruited. Mucosal thickness was measured at the donor sites with an ultrasonic device prior to the surgeries. Graft thickness, length, and width were assessed after harvesting, and the wound areas were calculated. Based on a Visual Analogue Scale (VAS), the patients were asked to report their perceived pain after the intervention and 1, 3, 7, 14, 21 and 28 days thereafter. Pain was most pronounced on the first postoperative day and decreased within the course of time. Graft thickness directly correlated with the amount of pain perceived while increased palatal mucosal thickness before and after graft harvesting decreased pain levels. The denuded wound surface area, however, did not influence the perceived pain level. The wound depth at the donor site (graft thickness) was positively correlated with the patient's perception for pain. The wound surface area, however, did not influence the perceived pain level.

Efeito do método Pilates na flexibilidade, qualidade de vida e nível de dor em idosos

Objetivo: Avaliar a influência do método Pilates na flexibilidade, nível de dor e qualidade de vida em idosos. Métodos: Participaram do estudo 31 idosas (65,84±3,64 anos) que foram dividas em dois grupos: grupo controle (n=17) e grupo Pilates (n=14). O Grupo Pilates realizou treinamento com o método Pilates, enquanto o controle recebeu palestras. A avaliação foi composta por testes específicos de dor (Escala Visual Analógica), flexibilidade (Sentar e Alcançar, Ângulo Poplíteo) e qualidade de vida (SF-36), ao término das oito semanas foi realizada a reavaliação. Resultados: O Grupo Pilates apresentou melhora da flexibilidade no teste Sentar e Alcançar (p=0,033), Ângulo Poplíteo direito (p=0,015) e esquerdo (p=0,0027), diminuição do nível de dor (p=0,0187) e manutenção da qualidade de vida. O grupo controle não apresentou diferença significativa. Conclusão: O método Pilates pode contribuir na redução da dor, aumento da flexibilidade e manutenção da qualidade de vida em idosas.&#x0D; Registro Brasileiro de Ensaios Clínicos: RBR-9mndx8

Nonoperative Korean Medicine Combination Therapy for Lumbar Spinal Stenosis: A Retrospective Case-Series Study.

This is a retrospective case series exploring the therapeutic benefits and harm of nonoperative Korean medicine combination therapy for lumbar spinal stenosis (LSS). The medical records of a total of 33 LSS patients, who were treated as inpatients at Mokhuri Neck and Back Hospital, Republic of Korea, from November 2010 to January 2012, were reviewed first and telephone survey on these patients was conducted after one year. Body acupuncture, pharmacoacupuncture, Chuna, and oral administration of herbal medicines were offered to all patients. A Visual analogue scale (VAS) of pain and the walking duration without pain were used to assess the patients during the approximately 1-month treatment period. The average VAS score of pain and the walking duration improved significantly; the VAS score decreased from 9 (SD, 1.15) to 2.75 (2.22) (p < 0.01), and the walking duration increased from 5.5 (6.66) to 16.75 (13.00) minutes (p < 0.01). No adverse event was reported during the treatment. In addition, the decreased pain level and improved function continued for over one year. Although we did not find definitive evidence, the study results suggest that KM combination therapy may be beneficial for decreasing pain and improving function in LSS patients and may produce comparatively few adverse events.

La prise en charge des lésions du TFCC chez les adolescents par arthroscopie et mini voie d’abord

Purpose Post-traumatic injury of the triangular fibrocartilagineus complex (TFCC) can result in debilitating wrist problems. Although diagnosis and treatment of these lesions is well described for the adult population, hardly any data exists for this type of injury in young adolescents. Methods Between 2011 and 2014 seven patients between 10 and 14 years of age have consulted our department for posttraumatic ulnar-sided wrist pain. Previous trauma included distal radial fractures with a concomitant fracture of the ulnar styloid, multiple micro-traumas of the wrist and an overuse injury. Clinical evaluation showed tenderness over the TFCC complex, pain on movement and in most cases instability of the distal radio-ulnar joint (DRUJ) with episodes of sub/dislocation in two patients. Pre-operative arthro-MRIs were conducted confirming the pathology in only 3 cases. Therefore, all patients underwent diagnostic arthroscopy of the wrist followed by surgical treatment according to the discovered lesion. The mean age at the time of surgery was 12.9 years. Results Arthroscopy of the wrist confirmed a TFCC lesion in all patients. In 5 cases the injury was classified as Palmer type 1B, once as a combined type 1A/1B and once as type 1A. All 6 patients with a type 1B injury underwent arthroscopically assisted mini-open reconstruction of the TFCC. Treatment of the type 1A injury consisted of arthroscopic shaving of the central lesion. Postoperative clinical examination revealed stable wrists with a normal range of motion in all cases. Patients reported a decrease in pain-level during daily activities or were entirely pain-free. Conclusion TFCC lesions in the adolescent population are difficult to evaluate on an arthro-MRI and results are often inconclusive. Diagnostic arthroscopy is thus the preferred method of diagnosis for this type of injury. The arthroscopic assisted mini-open TFCC reconstruction is a reliable technique to achieve DRUJ stability and good clinical outcomes.

Open microsurgical tumor excavation and vertebroplasty for metastatic destruction of the second cervical vertebra—outcome in seven cases

Background contextMetastatic osteolytic involvement of the second cervical vertebra (C2) is rare, but usually very painful. Percutaneous vertebroplasty has shown to be effective regarding pain control, but carries the risk of cement leakage. PurposeTo describe an alternative microsurgical procedure suitable for patients suffering from C2 osteolysis who are considered to be high risk with respect to cement leakage. Study designA technical report. Patient sampleIt included seven patients. Outcome measuresThey include the assessment of clinical safety regarding approach- and procedure-related morbidity and radiologic safety regarding extravertebral cement leakage and the assessment of clinical efficacy by monitoring the pain activity using the visual analog scale (VAS). Materials and methodsSeven patients (five men, two women; mean age 70 years) presented with an acute onset of excruciating neck pain (VAS>6) due to osteolytic destruction of the axis vertebra. There was no neurologic deficit and no compression of the spinal cord preoperatively requiring surgical decompression or stabilization in any of the cases. An open treatment strategy via an anterolateral microsurgical approach was performed. Under biplanar fluoroscopic control, the soft tumor tissue was resected out of the vertebral body through a drilled entry in the anterior wall. After the excavation procedure, the resection cavity was filled with minimal pressure with polymethylmethacrylate bone cement. ResultsAll patients suffered from severe spontaneous neck pain (mean VAS 8.1, range 6–9), with head motion-dependent pain exacerbation despite high dose of opiates and fixation of the head with a brace.Mean duration of the operative procedure was 51 minutes. Histologic analysis revealed a diagnosis of cancer metastasis in all cases. On average, 1.9 mL cement was placed within the vertebral body, and no cement leakage was observed in postoperative computed tomography and X-ray controls. All patients experienced immediate pain relief at Day 1 after the procedure (mean VAS 4.0, range 2–6), and a further decrease of pain levels was observed at Week 6 after the completion of radiation therapy (mean VAS 2.0, range 0–5). ConclusionsIn cases of metastatic C2 destruction, tumor excavation via an anterolateral approach and subsequent filling of the resection cavity with bone cement offers a safe and effective alternative to percutaneous approaches.

Trunk and lower extremity segment kinematics and their relationship to pain following movement instruction during a single-leg squat in females with dynamic knee valgus and patellofemoral pain.

To understand how instructing females with patellofemoral pain to correct dynamic knee valgus affects pelvis, femur, tibia and trunk segment kinematics. To determine if pain reduction in the corrected condition was associated with improved segment kinematics. Cross-sectional. A 3D-motion capture system was used to collect multi-joint kinematics on 20 females with dynamic knee valgus and patellofemoral pain during a single-leg squat in two conditions: usual movement pattern, and corrected dynamic knee valgus. During each condition pain was assessed using a visual analog scale. Pelvis, femur, tibia and trunk kinematics in the frontal and transverse planes were compared between conditions using a paired T-test. Pearson correlation coefficients were generated between visual analog scale score and the kinematic variables in the corrected condition. In the corrected condition subjects had increased lateral flexion of the pelvis toward the weight-bearing limb (p<0.001), decreased femoral adduction (p=0.001) and internal rotation (p=0.01). A trend toward decreased tibial internal rotation (p=0.057) and increased trunk lateral flexion toward the weight-bearing limb (p=0.055) was also found. Lower pain levels were associated with less femoral internal rotation (p=0.04) and greater trunk lateral flexion toward the weight-bearing limb (p=0.055). Decreased hip adduction after instruction was comprised of motion at both the pelvis and femur. Decreased pain levels were associated with lower extremity segment kinematics moving in the direction opposite to dynamic knee valgus. These results increase our understanding of correction strategies used by females with patellofemoral pain and provide insight for rehabilitation.

Effect of minimally invasive percutaneous plates versus interlocking intramedullary nailing in tibial shaft treatment for fractures in adults: A meta-analysis

OBJECTIVE:The aim of this article was to determine the effects of minimally invasive percutaneous plates versus interlocking intramedullary nailing in the treatment of tibial shaft fractures in adults.METHOD:Literature searches of the Cochrane Library, PubMed, EMBASE, the Chinese Biomedical Literature database, the CNKI database, Wanfang Data, and the Weipu Journal database were performed up to August 2013. Only randomized and quasi-randomized controlled clinical trials comparing the use of percutaneous plates and interlocking intramedullary nails for tibial shaft fractures were included. Data collection and extraction, quality assessment, and data analyses were performed according to the Cochrane standards.RESULTS:Eleven trials were included. Compared with interlocking intramedullary nailing, minimally invasive percutaneous plates shortened fracture healing time and resulted in lower rates of postoperative delayed union and pain. There was no significant difference between the two methods with regard to the rates of excellent and good Johner-Wruh scoring, the rate of reoperation, and other complications.CONCLUSIONS:Overall, insufficient evidence exists regarding the effects of minimally invasive percutaneous plates versus interlocking intramedullary nailing in the treatment of tibial shaft fractures in adults. Low-quality evidence suggests that minimally invasive percutaneous plates could shorten fracture healing time, decrease the rate of postoperative delayed union, and decrease pain levels compared with interlocking intramedullary nailing. There is no significant difference between the two groups in terms of functional recovery scores, reoperation, and other complications. Further research that includes high-quality randomized controlled, multicenter trials is required to compare the effects of minimally invasive percutaneous plates versus interlocking intramedullary nailing in the treatment of tibial shaft fractures in adults.

Efficacy of High Frequency [10 Hz] Repetitive Transcranial Magnetic Stimulation of the Primary Motor Cortex in Patients with Fibromyalgia Syndrome: A Randomized, Double Blind, Sham-Controlled Trial

Objectives: Repetitive transcranial magnetic stimulation [rTMS] of the cerebral cortex has been tested as a treatment tool for various neurological and psychiatric diseases and other painful disorders. Our objectives were to determine whether high-frequency rTMS applied to the primary motor cortex could decrease pain intensity and influence the quality of life in patients with fibromyalgia syndrome [FMS]. Design: Fifty two patients with FMS were randomized to real [n ¼ 27] or sham [n ¼ 25] treatment groups. Ten consecutive sessions of rTMS were given to each of the patients. All patients were evaluated with the Structured Clinical Interview from the Diagnostic and Statistical Manual of Mental Disorders before treatment. The level of pain and the mood status were assessed with a visual analog scale and the Montgomery Asberg Rating Scale, respectively. The Turkish version of the World Health Quality of Life-BREF instrument was used to evaluate the quality of life. Results: The decrease of pain scale scores was found to be significantly greater among the real rTMS group than among those in the sham group [p50.001]. Also the life quality physical subscale score improvement was significantly greater among those in the real rTMS therapy group than among those in the sham treatment group [p50.001]. A strong relationship was found betweeen the decrease of pain levels in the real rTMS treated patients and the life quality physical subscale score improvement [R 2 ¼ 0.419 and p50.001]. Conclusions: These findings suggest that high-frequency rTMS application to the primary motor cortex could have an analgesic effect. Therefore, rTMS may be an alternative therapeutic option in FMS.