Neuropathic Signs Research Articles

The Effect of a Stretch and Strength-Based Yoga Exercise Program on Patients with Neuropathic Pain due to Lumbar Disc Herniation.

Randomized controlled trial. To investigate the effect of a stretch and strengthbased yoga exercise program on neuropathic pain due to LDH. LDH with neuropathic pain influences treatment outcomes negatively. Most yoga poses include the parameters of spinal training and help reduce pain and disability in patients with low back injuries. We hypothesized that yoga positively affects both LDH and neuropathic pain by increasing mobilization, core muscle strength, and spinal and hamstring flexibility. In total, 48 patients with neuropathic pain due to LDH were randomly assigned to a control group and a yoga group. All patients underwent a patient education program. In addition, the selected yoga exercise was taught and performed to the yoga group for one hour twice weekly for 12 weeks. Neuropathic pain (Douleur Neuropathique 4 for diagnosis; Leeds Assessment of Neuropathic Symptoms and Signs for severity), low back pain (the short-form of McGill Pain Questionnaire), disability (Oswestry Disability Index), and function (modified Schober and passive knee extension test) were measured blind before and at the one-, three-, and six-month follow-ups. The patient global assessment was applied at the six-month followup. The intention-to-treat analysis was performed in this study. The intention-to-treat analysis showed a statistically significant difference in neuropathic pain, patient global assess ment, low back pain, disability, and function in favor of the yoga group at post-treatment. The between-group effect sizes were moderate at six-months follow-up. It was determined that the selected stretch and strength-based yoga exercise could be a promising treatment option for neuropathic pain due to LDH. 2.

Different genes may be involved in distal and local sensitization: A genome-wide gene-based association study and meta-analysis.

BackgroundNeuropathic pain symptoms and signs of increased pain sensitization in osteoarthritis (OA) patients may explain persistent pain after total joint replacement (TJR). Therefore, identifying genetic markers associated with pain sensitization and neuropathic‐like pain phenotypes could be clinically important in identifying targets for early intervention.MethodsWe performed a genome‐wide gene‐based association study (GWGAS) using pressure pain detection thresholds (PPTs) from distal pain‐free sites (anterior tibia), a measure of distal sensitization, and from proximal pain‐affected sites (lateral joint line), a measure of local sensitization, in 320 knee OA participants from the Knee Pain and related health in the Community (KPIC) cohort. We next performed gene‐based fixed‐effects meta‐analysis of PPTs and a neuropathic‐like pain phenotype using genome‐wide association study (GWAS) data from KPIC and from an independent cohort of 613 post‐TJR participants, respectively.ResultsThe most significant genes associated with distal and local sensitization were OR5B3 and BRDT, respectively. We also found previously identified neuropathic pain‐associated genes—KCNA1, MTOR, ADORA1 and SCN3B—associated with PPT at the anterior tibia and an inflammatory pain gene—PTAFR—associated with PPT at the lateral joint line. Meta‐analysis results of anterior tibia and neuropathic‐like pain phenotypes revealed genes associated with bone morphogenesis, neuro‐inflammation, obesity, type 2 diabetes, cardiovascular disease and cognitive function.ConclusionsOverall, our results suggest that different biological processes might be involved in distal and local sensitization, and common genetic mechanisms might be implicated in distal sensitization and neuropathic‐like pain. Future studies are needed to replicate these findings.SignificanceTo the best of our knowledge, this is the first GWAS for pain sensitization and the first gene‐based meta‐analysis of pain sensitization and neuropathic‐like pain. Higher pain sensitization and neuropathic pain symptoms are associated with persistent pain after surgery hence, identifying genetic biomarkers and molecular pathways associated with these traits is clinically relevant.

Study of Diabetic Peripheral Neuropathy in Adults of Telangana

Background: Diabetic peripheral neuropathy (DPN) predisposes to foot ulceration and gangrene. It has been reported thatprevalence of DPN is lower in Indians relative to Caucasians. Studies among recent onset patients with type 2 diabetesmellitus (Type2-M) are very few. We studied the prevalence and risk factors of DPN in patients with newly diagnosedType2DM.Methods: We prospectively studied 80 consecutive patients over age 30 with a duration of diabetes ≤1 year. Every patientunderwent a clinical and biochemical evaluation and was screened for DPN using TCSS scale (Toronto clinical scoringsystem) and Leeds Assessment of Neuropathic Symptoms and Signs (LANSS) pain scale.Results: The cases had a mean age of 60.28 years and duration of symptoms of DM is <1year prior to presentation. Theoverall prevalence of DPN was 12.5%. The prevalence of DPN showed an increasing trend with FBS (trend chi-square=3.517, P = 0.0304). A logistic regression analysis showed that DPN was independently associated with Fasting Blood Sugar(P = 0.0304), Body mass index (P= 0.0389), HbA1c (P = 0.0451), family history (P= 0.0426) and physical activity (P= 0.0219)but not with age, sex and education.Conclusions: Our study showed high prevalence of PN in recently diagnosed patients with Type2DM, which wasindependently associated with age and duration of symptoms of diabetes prior to the diagnosis. FBS, HbA1c, BMI, werefound to be risk factors for prevalence of Diabetic Neuropathy.

Neuropathic pain in athletes: basics of diagnosis and monitoring of a hidden threat.

The aim was to increase awareness about neuropathic pain in athletes and the available diagnostic criteria and explore the relevance to athletes and sports. In the report of its consensus meeting of 2016, the International Olympic Committee (IOC) noted the critical need to raise the awareness about pain and its management amongst sports physicians. The adequate management of pain requires recognition of its type and pathophysiological mechanisms. This is paramount in applying the multi-modal management of pain as a symptom or approach it as a disease. In athletes, the assessment of pain in general, and of neuropathic pain in particular, is more complex due to the impact of physiological, psychological and motivational factors and specific pathophysiological mechanisms on the pain threshold and tolerance. Neuropathic pain is not uncommon to encounter in athletes although not always recognised. Examples of neuropathic pain as a disease include complex regional pain syndrome (CRPS), peripheral neuropathy and spinal cord injuries. The recognition and diagnosis of neuropathic pain could be facilitated by the application of screening tools such as DN4 (Douleur Neuropathique 4) and LANSS (Leeds Assessment of Neuropathic Symptoms and Signs). Sports injuries may lead to neuropathic pain through different pathologies and mechanisms. Thus, neuropathic pain could be a real threat to athletes’ career if not promptly recognised and treated. We therefore believe that early recognition and expert management are mandatory for the best outcome.

Comparison of treatment outcomes in chronic coccygodynia patients treated with ganglion impar blockade versus caudal epidural steroid injection: a prospective randomized comparison study.

BackgroundCoccygodynia is one of the chronic, refractory painful musculoskeletal disorders. Interventional procedures are applied to patients unresponsive to initial treatment in coccygodynia. This study aims to compare the treatment outcomes of ganglion impar block (GIB) and caudal epidural steroid injection (CESI) in patients with chronic coccygodynia.MethodsThis study was a prospective randomized comparison study conducted between June 2019 and January 2021. Patients diagnosed with chronic coccygodynia were randomly divided into two groups the GIB group and the CESI group. The severity of pain, presence of neuropathic pain, and quality of life were evaluated using the Numeric Rating Scale, Leeds Assessment of the Neuropathic Symptoms and Signs Scale, and Short Form-12 Health Survey (SF-12), respectively.ResultsA total of 34 patients in each group were included in the final analyses. While there was a significant decrease in pain intensity in both groups in the 3-month follow-up, this decrease was more significant in the GIB group at the 3rd week. There was a significant improvement in the SF-12 physical score and the number of patients with neuropathic pain in both groups in the 3rd week, but this improvement was not observed in the 3rd month.ConclusionsAlthough GIB may provide more pain relief in short term, both GIB and CESI are useful treatment methods in coccygodynia unresponsive to more conservative treatments.

The effects of ilioinguinal nerve block on acute and chronic neuropathic pain in patients following inguinal hernia repair with spinal anesthesia: A prospective cohort study

Background/Aim: Post-surgical pain is a major factor affecting the quality of life of patients. This study aims to investigate the effectiveness of ilioinguinal block on acute and chronic neuropathic pain after inguinal hernia surgery with spinal anesthesia. Methods: This prospective cohort study included sixty ASA I-III patients aged 18-65 years, who underwent a unilateral inguinal hernia operation. The patients were divided into two groups: Those who received spinal block only (Group 1, n=30), and those who received spinal and ultrasound-guided ilioinguinal nerve block (Group 2, n=30). The perioperative and postoperative complications, Visual Analogue Scale (VAS) scores on rest and Leeds Assessment of Neuropathic Symptoms and Signs (LANSS) scores at the postoperative 2nd, 6th, 12th, and 24th hours, and in the 3rd and 6th months were noted. Results: No significant difference was observed in the time of first analgesic administration among the groups, but tramadol use significantly reduced in Group 2 (P=0.019). Time until mobilization and discharge was significantly shorter among the Group 2 patients (P

Effect of Ketamine Instillation on Acute and Chronic Post Mastectomy Pain, a Dose Finding Clinical Study

Background: Uncontrolled acute postoperative pain is considered a risk factor for the development of chronic pain afterward. Objectives: To explore the most effective dose of ketamine instillation (1 of 3 doses: 1, 2, or 3 mg/kg) for acute and chronic post mastectomy pain (PMP). Methods: Ninety female patients with cancer breast, aged (18 - 60 yrs), weighted (50 - 90 kg), scheduled for modified radical mastectomy, randomly allocated into 3 groups to receive ketamine instillation after surgical homeostasis before wound closure (1 of 3 doses; 1, 2, or 3 mg/kg as A, B or C groups respectively) patients were followed up for 48 h for acute pain (total morphine consumption, the first request of analgesia and visual analog scale at rest and movement (VASR/M), chronic pain by Leeds assessment of neuropathic signs and symptoms (LANSS) for six-months, hemodynamics, and side effects. Results: Median total dose of morphine consumption was 8 mg (5 - 10) versus 6 mg (6 - 7) in A and B groups respectively in the first 48 h postoperatively. Lowest VASR/M was recorded in C then B and lastly A group (P = 0.037). No patients in the C group requested analgesia versus thirty (100%) and nine (30%) patients in the A and B groups respectively with the first request of analgesia was 12 h (5 - 36) in the A group versus 30 h (12 - 36) in the B group respectively (P Conclusion: Ketamine instillation effectively controlled acute post mastectomy pain (PMP) in a dose-dependent manner and reduced the incidence and severity of chronic pain in patients who undergoing a modified radical mastectomy.

The Effect of Structured Exercise Compared with Education on Neuropathic Signs and Symptoms in People at Risk of Neuropathic Diabetic Foot Ulcers: A Randomized Clinical Trial.

Background and Objectives: Lifestyle interventions such as exercise prescription and education may play a role in the management of peripheral neuropathy in people with diabetes. The aim of this study was to determine the effect of undertaking an exercise program in comparison with an education program on the signs and symptoms of peripheral neuropathy in people with diabetes at risk of neuropathic foot ulceration. Materials and Methods: Twenty-four adult participants with diabetes and peripheral neuropathy were enrolled in this parallel-group, assessor blinded, randomised clinical trial. Participants were randomly allocated to one of two 8-week lifestyle interventions, exercise or education. The primary outcome measures were the two-part Michigan Neuropathy Screening Instrument (MNSI) and vibratory perception threshold (VPT). Secondary outcome measures included aerobic fitness, balance and lower limb muscular endurance. Results: Participants in both lifestyle interventions significantly improved over time for MNSI clinical signs (MD: −1.04, 95% CI: −1.68 to −0.40), MNSI symptoms (MD: −1.11, 95% CI: −1.89 to −0.33) and VPT (MD: −4.22, 95% CI: −8.04 to −0.40). Although the interaction effects did not reach significance, changes in values from pre to post intervention favoured exercise in comparison to control for MNSI clinical signs (MD −0.42, 95% CI −1.72 to 0.90), MNSI clinical symptoms (MD −0.38, 95% CI −1.96 to 1.2) and VPT (MD −4.22, 95% CI −12.09 to 3.65). Conclusions: Eight weeks of exercise training or lifestyle education can improve neuropathic signs and symptoms in people with diabetes and peripheral neuropathy. These findings support a role for lifestyle interventions in the management of peripheral neuropathy.

Evaluation of the relationship between stiffness and thickness of the sciatic nerve and clinical outcomes after total hip arthroplasty: A prospective casecontrolled study.

The aim of this study was to conduct a sonographic assessment of sciatic nerve thickness and stiffness following total hip arthroplasty (THA) and to determine the relationship between sonographic characteristics of the sciatic nerve and clinical outcomes. This prospective study included patients undergoing primary cementless THA due to hip osteoarthritis between January 2018 and January 2019 in a tertiary-level hospital. The thickness, strain elastography, strain ratio (SR), and shear wave elastography (SWE) of the sciatic nerve were measured. The clinical outcome measures included leg lengthening (LL), leg length discrepancy (LLD), Oxford Hip Score (OHS), Visual Analog Scale (VAS) at rest, VAS during activity, and the Leeds Neuropathic Symptoms and Signs Evaluation (LANSS) scale. The data of the patient group were assessed preoperatively and at 3, 6, and 12 months postoperatively. The sciatic thickness and SR values of the operated side were significantly lower than those of the non-operated side (P < 0.05 for all). The sciatic SWE was significantly greater on the operated side compared with the non-operated side (P < 0.001 for all). Sciatic nerve thickness and SR were negatively correlated, and sciatic nerve SWE was positively correlated with OHS, VAS at rest, VAS during activity, and LANSS values. Sciatic nerve thickness and SR values were significantly lower, and SWE was significantly higher in the group with a change in LL > 20 mm. Clinical scores decreased during the following period in mild and moderate lengthening group (< 20 mm). In the severe lengthening group (≥ 20 mm), the clinical score increased over time. The VAS activity score was higher in the mild and moderate LL group (< 20 mm) than the VAS rest score (P < 0.001). However, the VAS rest score was significantly higher in the severe LL group (≥ 20 mm) than the VAS activity score (P < 0.001). The results of this study have shown a significant relationship between thickness and stiffness of the sciatic nerve and LL after THA. The ultrasound parameters were significantly associated with functional outcomes. Level IV, Therapeutic Study.

Potential association between serum 25-hydroxy vitamin D levels and symptomatic neuropathic pain in rheumatoid arthritis patients

Aim of the workTo study the effect of vitamin D levels on clinical and laboratory characteristics of rheumatoid arthritis (RA), and to evaluate a possible relationship with neuropathic pain (NP). Patients and methodsSixty RA patients with neuropathic pain symptoms and 60 healthy controls were included. All patients were assessed by Leeds assessment of neuropathic symptoms and signs (LANSS) to confirm the presence of NP, modified health assessment questionnaire (MHAQ), disease activity score (DAS-28) and visual analogue scale (VAS). Anti-cyclic citrullinated peptide (anti-CCP), glycolysated hemoglobin (HbA1C) and 25-hydroxy vitamin D levels were assessed. Nerve conduction velocity study (NCVS) was performed in those with confirmed NP. ResultsMean age of patients was 42.4 ± 10.9 years, disease duration 5.3 ± 4.2 years and 91.7% were females. RA patients showed significant lower vitamin D levels than controls (23.5 ± 14.03 ng/ml vs 37.8 ± 13.8 ng/ml; p < 0.001). There was a significant difference between RA patients with NP (n = 30; 18.3 ± 5.5 ng/ml), and patients without (n = 30; 28.8 ± 17.7 ng/ml) regarding 25-hydroxyvitamin D (p = 0.003), LANSS, VAS, MHAQ (all p < 0.001), DAS-28 and TJC (p = 0.04). Carpal tunnel syndrome (CTS) was found in 46.7%; 42.3% of the females and 75% of males, mononeuritis multiplex (MM) in 23.3%; 25% males and 23.1% females. Patients, with deficient vitamin D had either CTS or MM (85.7% each). RA patients with NP had significant delayed latency and reduction of conduction velocity of motor and sensory branches of median, ulnar and tibial nerves. ConclusionVitamin D deficiency could be a plausible cause for neuropathic pain in RA patients.

Evaluation of Knowledge and Attitudes About The Traditional and Complementary Medicine Practices of the Patients with Neuropatic Pain Who Applied to the Physıcal Medicine and Rehabilitation Clinic

Objective: To evaluate the frequency of traditional and complementary medicine (TCM) use, the variety of applications, the sociodemographic and clinical characteristics of patients with neuropathic pain, and their knowledge and attitudes about TCM practices.Material and Methods: A total of 250 patients with neuropathic pain were included in this, cross-sectional study. The patients were divided into two groups: medication only (group 1, n=119) and medication with TCM practices (group 2, n=131). Questionnaires were completed by the patients in face-to-face interviews by a blinded physician.Results: The mean age of the patients in group 2 (50.68±16.39) was found to be higher than in group 1 (p=0.043). In terms of chronic diseases, hypertension, cardiovascular diseases, and other diseases were found to be more common in group 2 than in group 1 (p&amp;lt;0.05). The number of patients with duration of neuropathic pain more than 5 years, the Leeds Assessment of Neuropathic Symptoms and Signs (LANSS) pain scale and the Neuropathic Pain 4 (DN4) scale scores were found to be higher in group 2 than in group 1 (p&amp;lt;0.05). At least one TCM is known by %78.6 of group 2 and 61.3% of group 1 (p=0.003). The three most commonly used TCM practice in group 2 were wet cupping/cupping therapy (24%), leeches (22.8%), and acupuncture (11.6%).Conclusion: It was determined that the mean age of patients who used medication with TCM practices together for the treatment of neuropathic pain was higher, neuropathic pain severity was higher, and neuropathic pain duration was longer than patients who used medication only for the treatment of neuropathic pain.

Efficacy of moxibustion in diabetes peripheral neuropathy.

Background:Diabetic peripheral neuropathy (DPN) is one of the most common complications of diabetes mellitus. The main clinical manifestations of DPN include pain, numbness, paraesthesia, and weakness of the lower limbs which often leads to diabetic foot ulceration, eventually resulting in amputation. Based on Traditional Chinese Medicine theory, moxibustion has a great effect on treating and preventing DPN. However, randomized clinical trials done to evaluate the efficacy of this treatment are still lacking. Hence, this study is carried out to evaluate the effectiveness and safety of moxibustion therapy on diabetic peripheral neuropathy.Methods:This study will be a pilot, interventional, randomized, 2-armed, parallel, singled-masked, controlled trial. A total of 40 diabetes mellitus patients with peripheral neuropathy will be recruited and assigned randomly into 2 groups (moxibustion group and waiting group) at a 1:1 ratio. This trial consists of an 8-week intervention period and a 4-week follow-up period. During the intervention period, the moxibustion group will take 3 moxibustion sessions per week, whereas no intervention will be done on the waiting group to act as the control group. The outcome will be assessed by an outcome assessor who is unaware of the group assignment. The primary outcome will be pain assessment measured with algometry, Leeds Assessment of Neuropathic Symptoms and Signs pain scale, visual analogue scale, and neuropathy pain scale. The secondary outcome will be an evaluation of functional performance capacity with 6 minutes walking test, evaluation of the Foot and Ankle Ability Measure, and serum HbA1c and albumin levels.Discussion:We hope that this trial will provide valuable insights on the efficacy of moxibustion in the management of diabetic peripheral neuropathy.Trial registration:ClinicalTrials.gov Registry No.: NCT04894461 (URL: https://clinicaltrials.gov/ct2/show/NCT04894461?term=NCT04894461&draw=2&rank=1) Registered on May 20, 2021.

An overlooked nerve in neuropathies associated with intragluteal injections: the posterior femoral cutaneous nerve

ABSTRACT Objective The aim of this study was to investigate the frequency of posterior femoral cutaneous nerve (PFCN) lesions in patients referred to the electrophysiology laboratory with an initial diagnosis of sciatic nerve lesion following injection, and to create awareness that PFCN lesions can occur following intramuscular injections administered to the gluteal region. Methods Fifty-seven patients who were referred to the electrophysiology laboratory because of injection neuropathy were identified from the hospital records. In addition to the routine electrophysiological examination, PFCN sensory conduction study was performed according to the technique of Dumitru and Nelson. The scores of the Hospital Anxiety and Depression Scale (HADS) and the Leeds Assessment of Neuropathic Symptoms and Signs Pain Scale were recorded for all participants. Results Of the 21 participants who agreed to participate in the study, 2 patients were diagnosed with PFCN lesions, one of them had isolated complete PFCN lesion, and another had it accompanied by sciatic nerve lesion. Patients with PFCN lesions had a lower body mass index and a higher HADS score than patients with sciatic nerve lesions (p = 0.01, p = 0.04, respectively) Conclusions As correct diagnosis is the priority starting point for successful treatment, clinicians should plan examinations taking into consideration the fact that PFCN lesions can occur following gluteal region injection.

Questionnaires can reflect the severity of electrophysiological findings In diabetic patients

Objective: The aim of this study was to determine whether a relationship exists between pain questionnaires, diabetic peripheral neuropathy, and the severity of electrophysiological findings. Methods: Patients with diabetes mellitus (DM) whose clinical signs and symptoms were found to be consistent with diabetic neuropathy were included in the present study in Ankara City Hospital Neurology Department between June 2020-January 2021. It was designed as a prospective cross-sectional study. Demographic characteristics, type and duration of DM, the onset of neuropathic complaints, systemic diseases, and DM treatments were noted. Blood tests were performed on all patients. Participants were administered the Douleur Neuropathique 4 Questions (DN4), Leeds Assessment of Neuropathic Symptoms and Signs (LANSS), and Numerical Rating Scale (NRS) questionnaires and an electrophysiological examination. Results: The study included 108 patients. A statistically significant correlation was found between the severity of electrophysiological findings and the age of patients, duration of diabetes, and treatment modality. Additionally, a statistically significant correlation was found between the severity of electrophysiological findings and blood urea nitrogen (BUN) levels and monocyte and platelet counts. According to the NRS, a significant relation was found between BUN values and the severity of pain experienced. The LANSS predicted the severity of electrophysiological findings at a significantly higher accuracy than other questionnaires. Conclusion: Questionnaires can detect diabetic neuropathy, which is mostly asymptomatic, before the onset of DM complications. The LANSS questionnaire reflects the electrophysiological findings severity.

The occurrence of neuropathic pain following surgery of brainstem cavernous malformations.

This study aimed to assess the occurrence and significance of postoperative neuropathic pain (NP) in patients with surgically treated brainstem cavernous malformations (BSCMs). Seventy-four BSCM patients surgically treated between 2003 and 2019 were reviewed for the occurrence of postoperative NP and related treatment. The relevance of BSCM location, preoperative characteristics, influence on functional outcome, postoperative health-related quality of life (HRQOL) and life satisfaction was evaluated. Six out of 74 patients (8%) suffered from NP. The Leeds Assessment of Neuropathic Symptoms and Signs scores ranged from 12 to 16 (mean 14.28±1.6). Visual analog scale pain was 5.2±2.0. NP had no effect on preoperative characteristics or functional outcome. Bodily pain (HRQOL) and vocational time (life satisfaction) were significantly decreased in NP compared to non-NP patients. Specific BSCM location (regarding brainstem nuclei involved in pain processing) and other preoperative patient- and BSCM-related parameters were not associated with the occurrence of postoperative NP. Three out of six patients were currently under NP-specific treatment. The proportion of patients suffering from postoperative NP (8%) was substantially higher compared to previously published studies. The pain affected the HRQOL of patients, most of whom were insufficiently treated and not satisfied with treatment results. Our findings may help to raise awareness for postoperative NP in BSCM, which is essential to improve diagnosis and initiation of proper treatment, as well as preoperative informed consent of patients.

Mechanism of Chronic Pain of Symptomatic Hip Osteoarthritis by Association of its Distribution, Nociceptive, Neuropathic, Nociplastic, or Mixed-pain Screening, and the Prevalence of Lumbar Spinal Stenosis: A Cross-sectional Study.

The pain of hip osteoarthritis (OA) is generally recognized as nociceptive in origin because of the local pathology. However, some patients with OA experience a neuropathic pain component as an essential part of some nociplastic pain subtype. Here, we sought to examine the mechanism of chronic pain of symptomatic hip OA by the association of its distribution, complex pain mechanism screening, and the prevalence of lumbar spinal stenosis. We conducted a prospective cross-sectional study of 100 hips in 100 patients with symptomatic hip OA in a chronic state. We examined all baseline clinical characteristics including clinical and functional score, location of pain and numbness, and pain score (PainDETECT questionnaire and the Leeds Assessment of Neuropathic Symptoms and Signs), and magnetic resonance imaging of the hip and lumbar spine. The PainDETECT questionnaire and Leeds Assessment of Neuropathic Symptoms and Signs revealed that 23% of the patients had a neuropathic pain component. There were 24 variations of the pain pattern. By contrast, the pain localized around the hip joint was only 15%. Pain distal to the thigh and any numbness was significantly more frequent in the group with neuropathic pain (P<0.001). Lumbar spinal stenosis grade was not significantly different between patients with nociceptive pain and those with neuropathic pain. Pain score was significantly correlated with the pain in clinical and functional scores. Among patients with symptomatic hip OA, the distribution of pain was various, and about 23% of patients had neuropathic, nociplastic, or mixed pain as a possibility for somatosensory system disturbances.

Neuropathic pain in primary knee osteoarthritis patients: correlation with physical function, quality of life, disease severity, and serum beta nerve growth factor levels

BackgroundNeuropathic mechanisms are thought to play a role in knee osteoarthritis (KOA) pain. Neuropathic pain questionnaires can promote diagnosis of a neuropathic component. Thus, we aimed to assess the frequency of neuropathic pain in primary KOA patients (using clinical questionnaires) and to investigate its correlation with socio-demographic factors, physical function, quality of life, disease severity, and serum beta nerve growth factor (β-NGF) levels.ResultsSeventy primary KOA patients were included. Neuropathic pain was detected in 52.9% of patients based on Douleur Neuropathique en 4 Questions (DN4) questionnaire and in 38.6% of patients based on Leeds assessment neuropathic pain symptoms and signs questionnaire (LANSS). Serum β-NGF levels were significantly higher in KOA patients than controls (P<0.0001), and in KOA patients with neuropathic pain compared with patients with non-neuropathic pain. DN4 score was positively correlated with Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) pain, stiffness, and physical function, and it was also negatively correlated with Osteoarthritis knee hip quality of life questionnaire (OAKHQOL) pain scores (rs=0.459, P<0.001; rs= 0.258, P= 0.031; rs= 0.307, P= 0.010; rs = −0.337, P= 0.004, respectively), while LANSS scale was positively correlated with symptom duration, WOMAC stiffness, Lequesne pain, and Lequesne index (rs= 0.260, P= 0.020; rs= 0.343, P= 0.004; rs= 0.344, P= 0.004; rs= 0.322, P= 0.007) and negatively correlated with OAKHQOL physical, OAKHQOL mental health, OAKHQOL social support, and total OAKHQOL scores (rs= −0.258, P= 0.031;rs= −0.254, P= 0.034; rs= −0.283, P= 0.018; rs= −0.261, P= 0.029 respectively).ConclusionsNeuropathic pain symptoms are frequent in primary KOA patients. KOA patients with neuropathic pain have worse quality of life, extreme disability, and higher serum β-NGF levels. Nerve growth factor inhibitors could have a potential role for not only relieving pain in KOA patients but also improving functional disability and quality of life in these patients.

Is Shoulder Pain and Disability Index a Prognostic Factor for Neuropathic Shoulder Pain?

IntroductionSo far, investigations in patients with rotator cuff diseases have used pain measurement tools such as visual analog scale (VAS) for nociceptive pain as well as neuropathic pain (NeuP) specialized ones like Douleur Neuropathique 4 Question (DN4) and Pain Detect. The study’s goal was to look at the existence of NeuP in patients with chronic shoulder pain, as well as variables that may be predictive of its progression.MethodsThere were 112 outpatients in all. Current and previous pain intensity levels were documented with the numerical rating scale (NRS), the Shoulder Pain and Disability Index (SPADI) was used to assess pain and disability levels, and the S-LANSS (self-completed Leeds Assessment of Neuropathic Symptoms and Signs Pain Scale) was used to diagnose NeuP. The Pearson Chi-Square test was employed to check for any relationships between variables. The Mann-Whitney U test was also employed to check for between-group differences (with or without NeuP). To investigate factors that may be utilized as a prognostic for NeuP, logistic regression was performed, with those components (from the univariate analysis) that were statistically significant being included.ResultsAccording to the S-LANSS questionnaire for NeuP diagnosis, 21 patients had NeuP. According to S-LANSS, chi-square test findings revealed that NeuP is independent of sex, smoking, size, and location or rotator cuff tear. Univariate analysis with Mann-Whitney U test revealed statistically significant differences in SPADI and NRS scores between the two patient groups (p < 0.001). Α multivariate analysis using S-LANSS as the binary dependent variable and NRS currently, NRS average last month and SPADI total score as independent variables (with statistical significance) revealed that total SPADI score may be considered as an independent prognostic factor for NeuP (odds ratio = 1.189, p < 0.001).LimitationsDue to the limited number of patients who participated in the study, the findings were deemed insufficient in terms of statistical power. In particular, the power analysis of the study (type I error probability being [a] = .05) was less than 80% (for the total SPADI score), hence relatively small. As a result, there is a limited probability of a type I error.ConclusionsUsing S-LANSS, we discovered that 18.8% of patients with rotator cuff tears had NeuP. The SPADI scores (pain and disability) in the NeuP group were substantially greater than in the nociceptive pain group. As previous studies have suggested utilizing certain levels of the VAS for pain assessment and specialized questionnaires for NeuP evaluation, we recommend that SPADI be included as a tool for emphasizing the neuropathic features of shoulder pain.

The effect of popliteal sciatic nerve block with methylprednisolone in the management of postinjection sciatic neuropathy after clinical and electrophysiological examination.

Background/aim This study aimed to investigate the effects of popliteal sciatic nerve block (PSNB) in the treatment of postinjection sciatic neuropathy (PISN) resistant to conservative treatments.Materials and methods Patients diagnosed with PISN were included in the study. A damaged branch of the sciatic nerve was detected after neurological and electrophysiologic studies (EPSs). Visual analogue scale (VAS) was administered before, one hour after, and one month after the procedure. Also Leeds Assessment of Neuropathic Symptoms and Signs pain scale (LANSS) was administered before and one month after the procedure. The effects of EPSs findings and loss of muscle strength on the VAS and LANSS scores that measured after PSNB were evaluated.ResultsPSNB was performed in 17 patients (12 males and 5 females) with a diagnosis of PISN. Their mean age was 54.95 ± 12.55 years, and the mean duration of symptoms was 3.53 ± 1.28 months. The EPS findings revealed a lateral truncus injury in 5, a medial truncus injury in 3, and injury to both in 9 patients. The initial muscle power scale scores were grade 0 in 2, grade 2 in 1, grade 3 in 7, grade 4 in 5, and grade 5 in 2 patients. The initial VAS and LANSS scores were 7.53 ± 1.06 and 17.35 ± 3.12. The mean VAS scores at the first hour and one month after the procedure decreased to 2.53 ± 1.70 and 4.18 ± 1.74 while the mean LANSS score one month after the procedure was reduced to 7.88 ± 5.84. The effects of EPSs findings and loss of muscle strength were found significant (p = 0.001), but the duration of symptoms was not found significant (p = 0.36) on the VAS and LANSS scores that measured after PSNB.ConclusionThe outcome of this research proved the effectiveness of PSNB with methylprednisolone in the management of PISN, especially in patients whose pain was located below the knee. EPSs findings and loss of muscle strength indicated the severity of the nerve damage affect the success of PSNB in pain management, but the length of time that elapsed after the nerve injury did not.

Distal Symmetric Polyneuropathy Pain in Diabetes Mellitus

Objective: To evaluate neuropathic pain (NP), its intensity, and complications in people with type 2 diabetes mellitus (T2DM) in a city of eastern São Paulo. Method: Cross-sectional study conducted with 96 individuals with T2DM served by primary health units in São João da Boa Vista-SP. The following instruments were used to screen NP: Michigan Neuropathy Screening Instrument, Leeds Assessment of Neuropathic Symptoms and Signs, Douleur Neuropathique 4, and Brief Pain Inventory. The data were analyzed using descriptive and inferential statistics, with a 5 % significance level. Results: Of the 96 people with T2DM for longer than five years, 22.9 % had pain. NP was related to high levels of fasting blood glucose (mean = 214 ± 65.58 mg/dl; p = 0.0002), glycated hemoglobin (mean = 8.8 ± 0.11 %; p &lt; 0.001), absence of a balanced diet (p = 0.0066), obesity (p = 0.023), and high blood pressure (p &lt; 0.001). Conclusion: Higher values ​​of glycated hemoglobin rates increased three times the chance of NP. The screening and management of painful diabetic neuropathy is a challenge but adopting a screening protocol supports the secondary prevention of this manifestation.