Limb Pain Research Articles

Comparison of gait analysis before and after unilateral total knee arthroplasty for knee osteoarthritis

BackgroundGait ability can be objectively assessed using gait analysis. Three-dimensional gait analysis, the most commonly used analytical method, has limitations, such as a prolonged examination, high system costs, and inconsistently reported gait symmetry in patients with knee osteoarthritis (OA). Therefore, we aimed to evaluate the gait symmetry and changes before and after unilateral total knee arthroplasty (TKA) using the Walkway analyzer, a sheet-type gait analyzer.MethodsThe healthy group included 38 participants from the Locomotor Frailty and Sarcopenia Registry study with lower limb pain or Kellgren–Lawrence classification grade 3 or 4 OA. The OA group included 34 participants from the registry study who underwent unilateral TKA. The walking speed, step length, step width, cadence, stride time, stance time, swing phase time, double-limb support phase time, stride, step length, and step width were analyzed per side using the Walkway gait analyzer.ResultsNo significant differences between the right and left sides were observed in the healthy group. In the OA group, the time indices and stance phase (p = 0.011) and the double-limb support phase time (p = 0.039) were longer on the contralateral side and the swing phase was longer on the affected side (p = 0.004) pre-operatively. However, these differences disappeared post-operatively. There were no significant differences in the spatial indices. Thus, this study revealed that patients undergoing unilateral TKA had an asymmetric gait pre-operatively, with a time index compensating for the painful side, and an improved symmetric gait post-operatively.ConclusionsThe Walkway analyzer employs a simple test that requires only walking; hence, it is expected to be used for objective evaluation in actual clinical practice.

Spinal Cord Stimulation for Intractable Chronic Limb Ischemia: A Narrative Review.

Critical limb ischemia (CLI) is the most severe form of peripheral arterial disease, significantly impacting quality of life, morbidity and mortality. Common complications include severe limb pain, walking difficulties, ulcerations and limb amputations. For cases of CLI where surgical or endovascular reconstruction is not possible or fails, spinal cord stimulation (SCS) may be a treatment option. Currently, SCS is primarily prescribed as a symptomatic treatment for painful symptoms. It is used to treat intractable pain arising from various disorders, such as neuropathic pain secondary to persistent spinal pain syndrome (PSPS) and painful diabetic neuropathy. Data regarding the effect of SCS in treating CLI are varied, with the mechanism of action of vasodilatation in the peripheral microcirculatory system not yet fully understood. This review focuses on the surgical technique, new modalities of SCS, the mechanisms of action of SCS in vascular diseases and the parameters for selecting CLI patients, along with the clinical outcomes and complications. SCS is a safe and effective surgical option in selected patients with CLI, where surgical or endovascular revascularization is not feasible.

Overactivation of NF-kB pathway can induce apoptosis by down-regulating glycolysis in human degenerative nucleus pulposus cells

Intervertebral disc herniation, a prevalent condition in spinal surgery that frequently results in low back pain and lower limb dysfunction, significantly impacting patients' quality of life. Several factors, including spine biomechanics, biology, nutrition, injury, and abnormal inflammatory responses, have been associated with the development of intervertebral disc herniation. Among these factors, abnormal inflammatory responses have received considerable attention as a crucial mediator of both clinical symptoms and disease progression during the intervertebral disc herniation process. However, the underlying mechanisms of inflammation-induced intervertebral disc herniation remain inadequately explored. The NF-κB (Nuclear Factor-κB) pathway plays a central role in regulating the expression of proinflammatory cytokines. Research on intervertebral disc herniation has suggested that NF-κB can activate the NLRP3 inflammasome, thereby exacerbating intervertebral disc degeneration. Targeting the NF-κB pathway has shown promise in alleviating disc degeneration and associated pain. Previous research indicated that the upregulation of the NF-κB pathway, achieved through the inhibition of A20 (zinc finger protein A20), accelerated intervertebral disc herniation. In the present study, we observed that increased activation of NF-κB pathway activation suppressed the glycolysis process in nucleus pulposus cells (NPCs), leading to NPC apoptosis. Conversely, inhibition of the NF-κB pathway overactivated promoted the restoration of glycolysis and reversed NPC apoptosis, especially when treated with Lipopolysaccharide (LPS).

Analysis of amputations occurring in the earthquakes centered in Kahramanmaraş: Adıyaman experience.

Amputations are a common surgical procedure resulting from trauma during earthquakes, leading to severe disability. This study aims to investigate surgical outcomes specific to amputations that occurred in Adıyaman after the Kahramanmaraş earthquakes. This descriptive study included amputees who presented to Adıyaman University Training and Research Hospital. Between March 6, 2024 and March 29, 2024, amputees were contacted by phone and asked the questions in the form. Data analyzed included demographic information, number and level of amputated extremities, phantom limb pain, stump infection, extrication time, time to initiation of rehabilitation, number of revision, and whether a prosthesis was fitted. The study reached 75 amputees. The mean age was 37.9 ± 19.2, and the most frequently amputated age group was adults. Stump infection was observed in 40 amputees (53.3%), phantom limb pain in 47 (62.6%),and revision in 29 (38.7%). The median extrication time was 36h and initiation of rehabilitation time was 45 days. It was noted that 35 amputees (62.5%) used prostheses. A statistically significant relationship was found between fasciotomy and stump infection (p = .000). Infection was detected in 65% of those who underwent fasciotomy. Earthquake-related amputations most frequently affected the adult age group and primarily involved lower extremity amputations, such as transfemoral and transtibial amputations. Phantom limb pain, need for revision, and infection are common in earthquake-induced amputations. Delayed fasciotomy increases the risk of stump infection. The data obtained in this study will help plan local health services to coordinate amputation care in disasters.

Prevalence and factors associated with psychological morbidity, phantom limb Pain in lower limb amputees

BackgroundLower limb amputation can lead to psychological problems.There is a lack of data to evaluate the psychological problems and associated factors in lower limb amputees. AimPrevalence and factors associated with psychological disorder and phantom limb pain in lower limb amputees MethodsIt was a cross-sectional study with a consecutive sampling technique. Patients were assessed on the Hospital Anxiety and Depression Scale (HADS) for the presence of depression and anxiety disorder. DSM-5 diagnostic criteria for substance use disorder were used, andphantom limb pain was diagnosed as defined by Pare. Results103 patients were included in the present study with a mean age of37.7 ± 14.5 yrs. The majorityof patients were males (87.4 %), married (69.9 %), on paid employment (95.1 %), and were of middle socioeconomic status (83.5 %). Most of the patients presented with roadside accident injuries (83.5 %)and had below-knee amputation (58.3 %). As per DSM-5, 38.8 % had a substance use disorder, out of which 35.9 % and 24.3 % had alcohol and tobacco use disorders, respectively. On HADS, 48.5 % had a presence of depressive disorder, and 30.1 % had anxiety disorder. The majority of patients (97.1 %) had phantom limb pain. Those from rural areas reported significantly more frequency of anxiety (x2-5.501; p-0.019) and depressive disorder (x2-7.009; p-0.008). Lower incomehad a significant positive association with depression (r-0.228; p-0.021) and phantom limb pain (U-22.500; p-0.008). ConclusionThe prevalence of psychiatric morbidity in lower-limb amputeeswas very high. The most common psychological morbidity was depression,followed by anxiety disorder and substance use disorders.Our findings reflect that we would benefit by including mental health professionals asintegral members of the multidisciplinary team to do an early psychological assessment and intervention, which would help prevent psychological illnesses and improve quality of life.

Effects of Sling-Suspension-Based Active Shoulder Joint Exercise on Shoulder Joint Subluxation, Pain, Muscle Strength, and Upper Limb Function in Patients with Subacute Stroke.

Background and Objectives: We investigated the effects of sling-suspension-based active shoulder joint exercise training on shoulder joint subluxation, pain, muscle strength, and upper extremity function in patients with subacute stroke. Materials and Methods: Twenty-eight patients with subacute stroke were randomly assigned to either the sling-suspension-based active shoulder joint exercise (SASE) group (n = 14) or the motorized upper extremity exercise (MUEE) group (n = 14). The SASE group actively performed shoulder joint flexion, extension, abduction, adduction, external and internal rotation, and horizontal abduction and adduction using a sling suspension system, whereas the MUEE group underwent an exercise program using a motorized upper extremity exercise machine. All participants underwent a 4-week intervention with 30 min of exercise once a day for 5 days a week. Additionally, both groups received general physical therapy and functional electrical stimulation for 30 min twice a day for 5 days a week. Shoulder joint subluxation was measured by radiographic examination before and after training, and pain was evaluated in the splenius, upper trapezius, and infraspinatus muscles using pressure parameters. In addition, a manual muscle tester was used to assess the muscle strength of the shoulder joint flexors, extensors, abductors, adductors, and external and internal rotators, and the Fugl-Mayer Assessment (FMA) and Manual Functional Test (MFT) were used to evaluate upper extremity function. Results: A significant group-time interaction was observed for pain, with F-values of F(1, 26) = 7.470, p < 0.011 for the splenius and F(1, 26) = 9.623, p < 0.005 for the upper trapezius. A significant time-group interaction was observed for the muscle strength of the shoulder, with F-values of F(1, 26) = 13.211, p < 0.001; F(1, 26) = 4.974, p = 0.035 and F(1, 26) = 9.674, p = 0.004 for flexors, abductors, and external rotators, respectively. A significant time-group interaction was observed in the FMA, with F-values of F(1, 26) = 13.243, p < 0.001. When comparing the interaction effects between time and group for MFT scores, a significant difference was observed, with F-values of F(1, 26) = 32.386, p < 0.001. Conclusions: This study confirmed that sling-suspension-based active shoulder joint exercises are effective in improving shoulder joint subluxation, pain, muscle strength, and upper extremity function in patients with subacute stroke.

Alteration of bone microarchitecture in hereditary distal RTA patients with SLC4A1 gene mutation: assessed by HR-pQCT.

Hereditary distal renal tubular acidosis caused by SLC4A1 gene mutation (SLC4A1-dRTA) is a rare hereditary form of renal tubular acidosis. Rickets or osteomalacia is a common complication of SLC4A1-dRTA, and seriously affects patients' daily life. However, studies on the bone microstructure in SLC4A1-dRTA are limited. This work aimed to evaluate the bone microstructure of SLC4A1-dRTA patients, compared to age- and sex-matched healthy controls and X-linked hypophosphatemic rickets (XLH) patients. This was a retrospective study on eleven SLC4A1-dRTA patients. Clinical manifestations, biochemical and radiographical examinations were characterized. Bone microstructure was examined in seven SLC4A1-dRTA patients, seven healthy controls and twenty-one XLH patients using high-resolution peripheral quantitative computed tomography (HR-pQCT). Skeletal symptoms, including fracture, bone pain, and lower limb deformity, were presented in 72.7% of SLC4A1-dRTA patients. Short stature was presented in 63.6% of the patients. SLC4A1-dRTA patients had significantly lower volumetric BMD in the distal tibia, and more severe deteriorated trabecular bone in the distal radius and tibia than healthy controls. SLC4A1-dRTA patients had significantly more severe deteriorated trabecular bone in the distal radius and distal tibia compared to XLH patients. With long-term alkaline therapy, SLC4A1-dRTA patients had alleviation in bone pain, increase in height. Skeletal lesions were common clinical manifestations in SLC4A1-dRTA patients. Compared with XLH, another common type of rickets, SLC4A1-dRTA patients had more severe trabecular bone microstructure damage, further supporting the necessity of early diagnosis and timely treatment of the disease.

Correlations of spinopelvic parameters with quality of life of patients with adult degenerative scoliosis after posterior correction.

This study aimed to investigate the correlations of spinopelvic parameters with the quality of life of patients with adult degenerative scoliosis (ADS) after posterior correction, and their relationships with efficacy Patients and methods: Ninety patients (40 females, 50 males; mean age: 62.4±3.3 years; range, 47 to 73 years) with adult spinal deformity treated from March 2016 to May 2020 were retrospectively enrolled. The Scoliosis Research Society (SRS)-22 questionnaire was filled in by the patients, and the Oswestry disability index (ODI) and Visual Analog Scale (VAS) for back and lower limb pain were assessed. All the patients underwent posterior correction. Spearman's analysis was conducted for the correlations of the spinopelvic sagittal parameters with quality of life. The risk factors for efficacy were identified using the multivariate logistic regression model to construct a nomogram model for efficacy and risk prediction. After the operation, significant reductions were detected in the sagittal vertical axis (SVA), pelvic tilt (PT), T1 pelvic angle (TPA), pelvic incidence minus lumbar lordosis (PI-LL), and the ODI score (p<0.05). The SVA and LL were significantly negatively correlated with all subitems on the SRS-22 questionnaire but positively correlated with VAS scores for back pain (p<0.05). Thoracic kyphosis was significantly positively correlated with self-image and mental status on the SRS-22 questionnaire (p<0.05), while TPA was negatively correlated with pain and self-image (p<0.05). The PI-LL was significantly negatively correlated with pain (p<0.05). The SVA, LL, PT, and PI-LL were independent predictors of improvement in ODI after operation for ADS. The postoperative changes in spinopelvic parameters affected the clinical outcomes in patients with ADS.

Nursing Care for Mrs. W with Dyspepsia Diagnosis

Dyspepsia is a clinical condition that can cause limb pain, such as flatulence, fullness, nausea, and vomiting. Dyspepsia is one of the non-communicable diseases and not only occurs in Indonesia but also in other parts of the world. This study aims to provide an overview of the implementation of Nursing Care in patients with dyspepsia diagnoses in the Old Jimbaran Room, Sumber Kasih Hospital, Cirebon City. The method used is a case study approach. The subject in this case study was one patient with a medical diagnosis of dyspepsia in the inpatient room. The results of the study showed that the management of nursing care in patients with a medical diagnosis of dyspepsia in fulfilling basic needs with dyspeptic nursing problems carried out the intervention of deep breath relaxation techniques with a frequency of 15 times with a time of approximately 10--15 minutes, the intervention was carried out when the patient felt pain, the results of the patient's pain level were reduced from pain scale 6 (moderate) to pain scale 3 (mild). From the results of nursing care that has been made and interventions that have been carried out, it can be concluded that deep breath relaxation techniques are effective in reducing the pain scale from 6 (moderate) to a pain scale of 3 (mild). These non-pharmacological techniques can be used as a companion to pharmacological therapy.

Necrotizing fasciitis or acute limb ischemia? Similarities and the diagnostic tactics

The symptoms of necrotizing fasciitis (NF) and acute limb ischemia (ALI) are almost identical. We present a case of a 48-year-old male, who reported to the emergency room complaining of sudden severe pain in the right limb. The complaint was accompanied by blackish, water-filled lumps, and numbness. On examination, his femoral pulse was palpable but the pulse was weak in the common femoral artery (CFA), superficial femoral artery (SFA) and popliteal artery (POP A). No pulse was palpable in the posterior tibial artery (PTA), anterior tibial artery (ATA), and dorsalis pedis artery (DPA). SpO2 couldn’t be detected in first to fourth toes; it was 97% in the fifth toe. The laboratory investigations showed increased serum creatinine, so CT angiography could not be performed. Duplex Ultrasonography (DUS) was performed and showed triphasic morphology at the vascular level, while gas was seen in the subcutaneous tissues. Due to similar clinical appearances, it is difficult to differentiate the diagnosis of NF and ALI, while the treatments for both are very different. CT angiography, DUS examination and laboratory tests may be the first option to differentiate between the two conditions. Keyword: Necrotizing Fasciitis, Acute Limb Ischemia, Citation: Ardiana M, Putra TS, Sufiyah IM. Necrotizing fasciitis or acute limb ischemia: similarities and the diagnostic tactics. Anaesth. pain intensive care 2024;28(5):960−963; DOI: 10.35975/apic.v28i5.2237 Received: ; Reviewed: ; Accepted:

Clinical Practice Guideline: The Treatment of Peripheral Nerve Injuries.

Nerve lesions often heal incompletely, leading to lifelong functional impairment and high costs for the health care system. The updated German clinical practice guideline is intended to promote the early recognition of nerve lesions and the timely initiation of proper treatment for optimal restoration of function. The recommendations are based on an assessment of all the evidence revealed by a systematic search of the literature, as well as on the expertise of the multiprofessional guideline group. Only a few publications contain high-quality evidence. This version of the guideline contains a more detailed discussion of war injuries, iatrogenic injuries, MR neurography, and specific treatments than the previous version. As for the different methods of nerve replacement, a comparison of autologous transplantation versus the use of conduits and tubes revealed no significant difference between these two methods on the mBMRC scale, and minimal superiority of autologous transplantation with respect to two-point discrimination. As for the use of nerve transfers when nerve reconstruction is not feasible or unlikely to succeed, nerve transfer yielded slightly better results than proximal reconstruction for elbow flexion, but the difference did not reach statistical significance (mBMRC ≥ 3: RR 1.16, 95% confidence interval [1.02; 1.32]). The treatment of neuromas with targeted muscle reinnervation was superior to the classic approach in decreasing both stump pain (MD 2.0 +/- 2.8) and phantom limb pain (MD 3.4 +/- 4.03). The delayed or improper treatment of peripheral nerve lesions can lead to severe impairment. Timely diagnosis, the use of appropriate treatments in conformity with the guidelines, and interdisciplinary collaboration among specialists are all essential for optimizing the outcome.

‘I presumed the pain would eventually get better by itself’; challenges with access to rehabilitation for upper limb dysfunction after breast cancer treatment - Descriptive and qualitative findings from a cross-sectional survey

PurposeSixty percent of breast cancer patients develop persistent upper limb pain and dysfunction, but only limited knowledge exists about how these symptoms relate to rehabilitation access. MethodsA postal survey was sent to patients treated at a London University Teaching Hospital (2018–2020). Data were collected on pain (Pain Detect), shoulder function (Disability of Shoulder Arm and Hand (DASH)), quality-of-life (QoL) (EQ-5D-5L), and clinical characteristics, including treatment and access to rehabilitation. The free-text section invited patients’ comments on upper limb symptoms and management strategies, which were analysed thematically. Quantitative data were analysed descriptively, and the medians were examined with Mann-Whitley U-Tests or Kruskal-Wallis Test. ResultsOf 511 patients surveyed, 162 (32 %) questionnaires were returned and analysed. Respondents’ mean age was 62 years (SD 11.3). The majority had Sentinel Node Biopsy 71 % (116/162) and mastectomy 61 % (99/162). 73 % (119/162) reported pain. Mean (SD) Pain Detect and DASH Score were respectively 11.07 (7) and 21.7 (21.5), with 51 % recording significant shoulder dysfunction, and only 28 % reporting access to rehabilitation. Individuals with neuropathic pain had significantly higher median (range) DASH score 60.8 (35.8, 75.0) p = 0.000. Median DASH score for sedentary individuals was significantly higher 22.9 (7.9, 31.8) p = 0.0009.Free-text analysis revealed persistent, progressive symptoms, mixed attitudes towards exercise and variations in access to rehabilitation and support. ConclusionTwo years following surgery many patients reported significant upper limb symptoms which adversely impact on QoL. However, approximately two thirds did not access potentially beneficial rehabilitation treatments. There is a need to improve pathways of care.

Diaphyseal Tibia and Fibula Malunion Treated with Open Osteotomy and Internal Fixation: A Case Report

Diaphyseal fractures of the tibia and fibula often occur due to traffic accidents. Bone fractures can heal well with proper treatment. However, many cases that are neglected lead to complications such as malunion, particularly in developing countries. Malunion occurs when a fractured bone heals with the fragments in improper positions. Malunion in bone fractures can lead to complications such as decreased bone or limb function, deformities, pain, non-union, avascular necrosis, and limb shortening. This case study reports on a 29-year-old woman with malunion in the tibia and fibula due to a neglected bone fracture for eight months. Symptoms include pain, deformities, and limb shortening. The management involved open osteotomy and ORIF (open reduction with internal fixation), demonstrating that ORIF and osteotomy are successful surgical techniques for correcting malunion in this case. The goals of surgical treatment for malunion are to restore function, reduce discomfort, and correct visually apparent abnormalities.

Robotic-Enhanced Prosthetic Liners for Vibration Therapy: Reducing Phantom Limb Pain in Transfemoral Amputees.

Phantom limb pain, a common challenge for amputees, lacks effective treatment options. Vibration therapy is a promising non-pharmacologic intervention for reducing pain intensity, but its efficacy in alleviating phantom limb pain requires further investigation. This study focused on developing prosthesis liners with integrated vibration motors to administer vibration therapy for phantom limb pain. The prototypes developed for this study addressed previous issues with wiring the electronic components. Two transfemoral amputees participated in a four-week at-home trial, during which they used the vibration liner and rated their initial and final pain intensity on a numeric rating scale each time they had phantom pain. Semi-structured interviews were conducted to gather feedback following the at-home trial. Both participants described relaxing and soothing sensations in their residual limb and phantom limb while using vibration therapy. One participant reported a relaxation of his phantom limb sensations, while both participants noted a decrease in the intensity of their phantom limb pain. Participants said the vibration liners were comfortable but suggested that the vibration could be stronger and that aligning the contacts could be easier. The results of this study highlight the potential effectiveness of using vibration therapy to reduce the intensity of phantom limb pain and suggest a vibration liner may be a feasible mode of administering the therapy. Future research should address optimizing the performance of the vibration liners to maximize their therapeutic benefits.

Low molecular weight 35 kDa hyaluronan fragment HA35 in the treatment of bone metastasis pain: A case report.

Late-stage cancer patients often experience severe pain due to bone metastasis, caused by structural damage and cancer-induced inflammation. Hyaluronan, known to alleviate pain by blocking the TRVP1 calcium channel, faces limitations due to its high molecular weight. However, 35 kDa low molecular weight hyaluronan fragment (HA35) have shown promise in relieving various pains, including cancer-related pain. Nonetheless, evidence regarding their efficacy in bone metastasis pain remains scarce. A 52-year-old female with a rectal malignant tumor and multiple secondary tumors in the sacrum and lungs, accompanied by bone metastasis pain. Despite undergoing radiotherapy, her pain relief was unsatisfactory. Before treatment with HA35, her numerical rating scale score was 10, severely affecting her sleep, appetite, and daily activities. The patient was diagnosed with rectal malignant tumor with multiple metastases, presenting symptoms such as sacral metastasis pain, anal pain, lower limb pain, and anterior abdominal pain. Sacral metastasis pain and lower limb pain indicated a clear diagnosis of bone metastasis pain. Treatment involved subcutaneous injection into the deep fat tissue layer of the abdomen. A subcutaneous injection of 100 mg/5 mL of HA35 was administered once into the deep fat tissue of the abdomen, with subsequent injections repeated every 3 days. Following 1 injection, the patient's pain score decreased to 6 points within 20 minutes, providing 40% pain relief. After 40 minutes, the score further dropped to 4 points, with 60% pain relief. After 50 injections, pain was consistently controlled at around 3 points. Subcutaneous injection of HA35 into the abdominal fat tissue effectively alleviates pain in cancer and bone metastasis patients resistant to conventional treatments. Additionally, it helps alleviate anxiety and fatigue, and improves diet and sleep, thereby offering crucial palliative care for advanced cancer patients.

Association Between Spinopelvic Parameters and Clinical Outcomes of Patients Treated With Transforaminal Platelet-Rich Plasma Injections for Lumbar Disc Prolapse.

Introduction Lumbar disc prolapse mainly occurs in the regions involving the L4-L5 and L5-S1 vertebrae. In this context, the significance of spinopelvic parameters becomes notably prominent. Non-invasive management of lumbar disc prolapse encompasses medicinal therapy, physical therapy, exercise, and epidural injections. Because of its autologous blood origin, platelet-rich plasma (PRP) therapy has minimal risks associated with immunogenic reactions and side consequences. We evaluated the extent of pain reduction and improvement of functional outcomes in patients having discogenic low back pain with modified spinopelvic parameters before and after undergoing transforaminal autologous PRP injection interventions. Methodology An observational study was conducted between September 2022 and August 2023 on 100 patients with low back pain for six months.The study populationcomprised patients whodid not respond to conservative treatment; they were recruited from the orthopaedicward of the emergency medicine department and outpatient department at the RLJalappa Hospital and Research Centre affiliated with Sri Devaraj Urs Medical College in Kolar, India. Every patient received a thorough evaluation that comprised an extensive medical history, a clinical examination, and imaging of the lumbosacral spine from both the front and side views. After obtaining the patient's consent and confirming their readiness for surgery, a PRPinjection was administered. The injection technique followed the standardized protocol and was performed by an experienced spine surgeon in collaboration with orthopaedic residents. Pain evaluations utilizing the Visual Analog Scale (VAS) and assessment of functional outcomes using the Oswestry Disability Index (ODI) scale were conducted before and after PRPinjections at the one- and six-month follow-ups. Results The average age of the study participants was 41.82 ± 5.0 years, with 55% of them being male. A total of 39% of study samples exhibited an increased angle in spinopelvic parameters. The independent t-test revealed a statistically significant difference in the mean score of back pain, limb pain, and ODI score between patients with increased and decreased angles of spinopelvic parameters before and after injection (p=0.0001). The severity of back pain, leg pain, and functional disability was significantly reduced in patients with increased angles of spinopelvic parameters following PRP injections at the one-month follow-up (p=0.0001). However, at the six-month follow-up, patients encountered recurring symptoms and worsening back pain, leg pain, and functional disability compared to the one-month follow-up. Conversely, the severity of back pain, leg pain, and functional disability has been markedly reduced in the patients with lower spinopelvic parameter angles following PRP injections at one month (p=0.0001) and six months (p=0.0001) compared to pre-injections. Conclusion During the long-term follow-up, subjects with elevated spinopelvic parameter angles reported a lower level of improvement in functional outcome, leg pain, and back pain. The impact of spinopelvic parameterson back pain severity and functional disability is substantial, significantly affecting the functional outcome of patients with lumbar disc prolapse.

The Effect of a Combined Scapula and Shoulder Exercise Program with Kinesio Tape on Pain, Shoulder Proprioception, and Upper Limb Function in Swimmers with Shoulder Impingement Syndrome

The Effect of a Combined Scapula and Shoulder Exercise Program with Kinesio Tape on Pain, Shoulder Proprioception, and Upper Limb Function in Swimmers with Shoulder Impingement Syndrome

Adaptions of mirror therapy for phantom limb pain with telescoping phenomenon

Adaptions of mirror therapy for phantom limb pain with telescoping phenomenon

A preliminary study exploring the effects of transcutaneous spinal cord stimulation on spinal excitability and phantom limb pain in people with a transtibial amputation

Objective. Phantom limb pain (PLP) is debilitating and affects over 70% of people with lower-limb amputation. Other neuropathic pain conditions correspond with increased spinal excitability, which can be measured using reflexes andF-waves. Spinal cord neuromodulation can be used to reduce neuropathic pain in a variety of conditions and may affect spinal excitability, but has not been extensively used for treating PLP. Here, we propose using a non-invasive neuromodulation method, transcutaneous spinal cord stimulation (tSCS), to reduce PLP and modulate spinal excitability after transtibial amputation.Approach. We recruited three participants, two males (5- and 9-years post-amputation, traumatic and alcohol-induced neuropathy) and one female (3 months post-amputation, diabetic neuropathy) for this 5 d study. We measured pain using the McGill Pain Questionnaire (MPQ), visual analog scale (VAS), and pain pressure threshold (PPT) test. We measured spinal reflex and motoneuron excitability using posterior root-muscle (PRM) reflexes andF-waves, respectively. We delivered tSCS for 30 min d-1for 5 d.Main Results. After 5 d of tSCS, MPQ scores decreased by clinically-meaningful amounts for all participants from 34.0 ± 7.0-18.3 ± 6.8; however, there were no clinically-significant decreases in VAS scores. Two participants had increased PPTs across the residual limb (Day 1: 5.4 ± 1.6 lbf; Day 5: 11.4 ± 1.0 lbf).F-waves had normal latencies but small amplitudes. PRM reflexes had high thresholds (59.5 ± 6.1μC) and low amplitudes, suggesting that in PLP, the spinal cord is hypoexcitable. After 5 d of tSCS, reflex thresholds decreased significantly (38.6 ± 12.2μC;p< 0.001).Significance. These preliminary results in this non-placebo-controlled study suggest that, overall, limb amputation and PLP may be associated with reduced spinal excitability and tSCS can increase spinal excitability and reduce PLP.

The Test-Retest Reliability of Pain Outcome Measures in People With Phantom Limb Pain.

To quantify the test-retest reliability of 3 patient-reported outcome measures of pain for people living with phantom limb pain (PLP) and assess the impact of test-retest errors on future research and clinical decisions. Thirty-nine participants (30 males), mean (SD) age: 55 (16), mean (SD) years postamputation: 6.8 (8.3), reported their PLP levels on a visual analogue scale (VAS) for pain intensity, the revised short-form McGill Pain Questionnaire (SF-MPQ-2), and a pain diary, on 2 occasions 7 to 14 days apart. Mean systematic change, within-subjects SD, limits of agreement (LOA), coefficient of variation, and the intraclass correlation coefficient (ICC) were quantified alongside their respective 95% confidence intervals (95% CIs). Systematic learning effects (mean changes) were not clinically relevant across the VAS, SF-MPQ-2, and pain diary. Within-subject SDs (95% CI) were 11.8 (9.6-15.3), 0.9 (0.7-1.2), and 8.6 (6.9-11.5), respectively. LOA (95% CI) were 32.6 (26.5-42.4), 2.5 (2-3.3), and 23.9 (19.2-31.8), respectively. ICCs (95% CI) were 0.8 (0.6-0.9), 0.8 (0.7-0.9), and 0.9 (0.8-0.9), respectively, but may have been inflated by sample heterogeneity. The test-retest errors allowed detection of clinically relevant effect sizes with feasible sample sizes in future studies, but individual errors were large. For people with PLP, a pain intensity VAS, the SF-MPQ-2, and a pain diary show an acceptable level of intersession reliability for use in future clinical trials with feasible sample sizes. Nevertheless, the random error observed for all 3 of the pain outcome measures suggests they should be interpreted with caution in case studies and when monitoring individuals' clinical status and progress.