Relief Of Low Back Pain Research Articles

Application of knowledge-attitude-practice theory in low back pain prevention of Operating Room nurses

Objective To explore the application of theory in low back pain prevention of operating room nurses. Methods From May 2014 to May 2015, 189 operating room nurses in 6 third-level grade-A hospitals were surveyed by self-designed questionnaire about their knowledge, attitude and practice on low back pain. Intervention measures were made according to investigation results. The 189 nurses were randomly divided into control group (n=95) and intervention group (n=94). Nurses in the control group were not intervened, while nurses in the intervention group were intervened by knowledge-attitude-practice on low back pain. After the 8-week intervention, nurses in the two groups were surveyed again. Visual analog scale (VAS) of nurses from the two groups about low back pain was compared before the intervention, after the 4 weeks and 8-week intervention. Results Before the intervention, scores of knowledge, attitude and practice of nurses in the two groups were both lower than 48 points. Knowledge-attitude-practice scores and VAS scores were statistically meaningless (P>0.05). After the 8-week intervention, scores of low back pain prevention knowledge (69.5±16.3), attitude (64.8±15.3) and practice (66.3±16.2) of nurses in the intervention group were all higher than that in the control group (t=-6.720, -4.759, -5.176; P<0.05). 4 weeks and 8 weeks after the intervention, VAS scores of low back pain of nurses in the intervention group were (3.7±0.8) and (2.7±0.8), both lower than that in the control group (t=3.433, 4.217; P<0.05). Conclusions High incidence of low back pain in operating room nurses is related to their low protection knowledge, attitude and practice. Intervention of can effectively promote relief and prevention of low back pain of nurses. Key words: Knowledge-attitude-practice; Low back pain; Operating Room nurses; Visual analog scale

Evaluation of Spinal Instability after Single Level Fenestration Discectomy: A Prospective Study

Introduction: Failed back surgery syndrome (FBSS) represents a clinical condition of patients that undergo one or more surgical procedures for lumbosacral disease and still present unsatisfactory long-term relief of symptoms, with persistent or recurrent low back pain. One of the sources of failed back surgery syndrome is segmental instability of the lumbar spine. There is very limited evidence in the literature regarding the incidence of spinal instability following fenestration and discectomy. Materials and Methods: This study was conducted on 50 patients who were between 17 and 52 years and who had undergone fenestration discectomy for a single-level lumbar intervertebral disc prolapse. Results: Results were evaluated using Prolo economic and functional outcome scoring which showed good outcome in 41 (82%) patients and moderate outcome in 9 (18%) patients after fenestration. Clinical instability as per criteria was noted in 9 (18%) patients post operatively while radiological instability was noted in 1(2%) patient . All 9 (100%) patients with clinical instability showed a moderate outcome. 13(26%) patients showed a decrease in the disc height more than 30% as compared with there preoperative images before lumbar fenestration. Patients with radiological sign of instability showed a good outcome. Conclusion: Standard fenestration discectomy does not destabilize the spine. Further studies are required to truly evaluate the development and progression of segmental instability in patients treated for lumbar disc herniation using different surgical methods.

124 Low-Back Pain Relief With a New 32-Contact Surgical Lead and Neural Targeting Algorithm

124 Low-Back Pain Relief With a New 32-Contact Surgical Lead and Neural Targeting Algorithm

Efficacy and tolerability of muscle relaxants for low back pain: Systematic review and meta-analysis.

Muscle relaxants are commonly prescribed for low back pain (LBP); however, there is limited evidence of their clinical efficacy and tolerability. This review evaluated the efficacy and tolerability of muscle relaxants in people with LBP. We searched online databases including Medline, EMBASE, CENTRAL and PsycINFO (inception to end October 2015) and performed citation tracking for eligible randomized controlled trials (RCTs). Two authors independently extracted data and assessed risk of bias of randomized controlled trials of muscle relaxants. Pain outcomes were converted to a common 0-100 scale. Data were pooled using a random effects model with strength of evidence assessed using GRADE. Fifteen trials (3362 participants) were evaluated in this review. A total of five trials (496 participants) provide high quality evidence that muscle relaxants provide clinically significant pain relief in the short term for acute LBP; MD -21.3, [-29.0, -13.5]. There was no information on long-term outcomes. The median adverse event rate in clinical trials for muscle relaxants was similar to placebo 14.1% IQR (7.0-28.7%) and 16.0% (4.1-31.2%); p=0.5, respectively. There is no evidence for the efficacy of benzodiazepines in LBP. For people with acute LBP, muscle relaxants provide clinically significant short-term pain relief. For chronic LBP, the efficacy of muscle relaxants is largely unknown. There was no eligible RCT evidence to support the efficacy of benzodiazepines in LBP. Prolonged use of these medicines in LBP cannot be guided by trial evidence. WHAT DOES THIS REVIEW ADD?: Muscle relaxants provide clinically significant pain relief for acute low back pain. Caution must be taken with the interpretation of the findings as the evidence comes from specific muscle relaxant medicines.

P.087 RETRACTION - Low back pain relief with a new 32-contact surgical lead and neural targeting algorithm

Background: Advances in surgical leads have been thought to potentially enable improved low-back pain relief using SCS. A recently introduced 32-contact surgical lead, which couples multiple independent current control and anatomically-based neural targeting stimulation algorithms, allows for patient-specific programming optimization. We present a real world study of this surgical lead. Methods: A multi-center, consecutive, observational study of a new 32-contact surgical lead was carried out, using the Precision Spectra SCS System (Boston Scientific) in 100 subjects out to 12 months post-implant. We examined procedural information, programming parameters, and clinical outcomes including pain reduction (NRS), activities of daily living, and change in pain medications. Results: Surgical lead placement distribution was between T7 and L2, with most at top of T9 (26%). A mean reduction of 5.1 points (SD 2.15, p&lt;0.001) from 7.8 (baseline) to 2.6 in overall pain was observed. A subset of subjects reporting low-back pain only exhibited a mean decrease of 6.0 points (SD 2.12, p&lt;0.001) from 8.3 (baseline) to 2.2. Of these, 83.1% of subjects showed ≥50% back pain reduction. Increases in activities of daily living and reduction in pain medication usage were also observed in majority of subjects. Conclusions: Subjects implanted with a 32-contact surgical lead using a neural targeting algorithm demonstrated significant low-back pain reduction.

The effect of total hip arthroplasty on sagittal spinal-pelvic-leg alignment and low back pain in patients with severe hip osteoarthritis.

Sagittal spinopelvic malalignment has been reported in spinal disorders such as low back pain (LBP), and restoration of normal alignment is targeted when treating these disorders. Abnormal sagittal spinal-pelvic-leg alignment has been reported in patients with severe hip osteoarthritis (OA), who have a high prevalence of associated LBP. This prospective longitudinal study aimed to investigate changes in sagittal spinal-pelvic-leg alignment after total hip arthroplasty (THA) in patients with severe hip OA, and whether these changes contribute to LBP relief. Patients undergoing primary THA due to severe unilateral hip OA were recruited. Physical examination and X-ray films were taken to rule out any spinal disorder. Sagittal alignment of pelvis, hip, and spine was analyzed on lateral radiographs taken before (baseline) and 1year after (follow-up) THA. Functional instruments were completed by patients including: visual analog scale (VAS) for LBP, Roland-Morris Disability Questionnaire (RMDQ), and Harris Hip Score (HHS). Comparisons were carried out at baseline and follow-up, and between patients with and without LBP. The recruited 69 patients showed significantly reduced hip flexion and improved global spinal balance at follow-up compared with baseline. LBP was reported by 39 patients (56.5%) before surgery; at follow-up, 17 reported complete resolution, while 22 reported significant relief. Significant decreases in VAS and RMDQ scores in lumbar spine and increase in hip HHS were observed. THA in patients with severe hip OA could help correct abnormal sagittal spinal-pelvic-leg alignment and relieve comorbid LBP. Improvements in hip flexion and global spinal balance might be involved in the mechanism of LBP relief.

Effects of intracutaneous injections of sterile water in patients with acute low back pain: a randomized, controlled, clinical trial.

Intracutaneous sterile water injection (ISWI) is used for relief of low back pain during labor, acute attacks of urolithiasis, chronic neck and shoulder pain following whiplash injuries, and chronic myofascial pain syndrome. We conducted a randomized, double-blinded, placebo-controlled trial to evaluate the effect of ISWI for relief of acute low back pain (aLBP). A total of 68 patients (41 females and 27 males) between 18 and 55 years old experiencing aLBP with moderate to severe pain (scores ≥5 on an 11-point visual analogue scale [VAS]) were recruited and randomly assigned to receive either ISWIs (n=34) or intracutaneous isotonic saline injections (placebo treatment; n=34). The primary outcome was improvement in pain intensity using the VAS at 10, 45, and 90 min and 1 day after treatment. The secondary outcome was functional improvement, which was assessed using the Patient-Specific Functional Scale (PSFS) 1 day after treatment. The mean VAS score was significantly lower in the ISWI group than in the control group at 10, 45, and 90 min, and 1 day after injection (P<0.05, t-test). The mean increment in PSFS score of the ISWI group was 2.9±2.2 1 day after treatment, while that in the control group was 0.9±2.2. Our study showed that ISWI was effective for relieving pain and improving function in aLBP patients at short-term follow-up. ISWI might be an alternative treatment for aLBP patients, especially in areas where medications are not available, as well as in specific patients (e.g., those who are pregnant or have asthma), who are unable to receive medications or other forms of analgesia because of side effects.

Overview: the role of Propionibacterium acnes in nonpyogenic intervertebral discs

Propionibacterium acnes (P. acnes), an important opportunistic anaerobic Gram-positive bacterium, causes bone and joint infections, discitis and spondylodiscitis. Accumulated evidence suggested that this microbe can colonise inside intervertebral discs without causing symptoms of discitis. Epidemiological investigation shows that the prevalence ranges from 13% to 44%. Furthermore, colonisation by P. acnes inside nonpyogenic intervertebral discs is thought to be one pathogen causing sciatica, Modic changes and nonspecific low back pain. Specially, patients can attain significant relief of low back pain, amelioration of Modic changes and alleviation of sciatica after antibiotic therapy, indicating the role of P. acnes in these pathological changes. However, until now, there were hypotheses only to explain problems such as how P. acnes access intervertebral discs and what the exact pathological mechanism it employs during its latent infection period. In addition, research regarding diagnostic procedures and treatment strategies were also rare. Overall, the prevalence and possible pathological role that P. acnes plays inside nonpyogenic intervertebral discs is summarised in this paper.

Large, well-designed trials are needed to test the effectiveness of herbal medicines for the symptomatic relief of low back pain

Large, well-designed trials are needed to test the effectiveness of herbal medicines for the symptomatic relief of low back pain

Single intradiscal injection of the interleukin-6 receptor antibody tocilizumab provides short-term relief of discogenic low back pain; prospective comparative cohort study

BackgroundInflammatory cytokines, such as interleukin-6 and tumor necrosis factor-α, are gaining attention as important etiologic factors associated with discogenic low back pain. We conducted a prospective cohort study to evaluate the efficacy and safety of intradiscal injection of the interleukin-6 receptor antibody tocilizumab in patients with discogenic low back pain. MethodsThirty-two consecutive patients were intradiscally injected with 2 mL of 0.5% bupivacaine (control group). Another 31 consecutive patients were intradiscally injected with 40 mg tocilizumab and 1–2 mL of 0.5% bupivacaine (tocilizumab group) at the same time. Prior to treatment, the vertebral origin of low back pain was confirmed in all patients based on pain provocation during discography and pain relief with 1 mL of 1% xylocaine. Numeric rating scale and Oswestry disability index scores were used to evaluate pain level before and after treatment between the 2 groups. The association between pain relief with tocilizumab and intervertebral disc degeneration grade was also determined. ResultsAt the end of the study (8 weeks after treatment), 30 patients in each group were evaluable. In the tocilizumab group, numeric rating scale and Oswestry disability index scores improved significantly at 2 and 4 weeks after treatment, respectively. Intervertebral disc degeneration was not associated with improvement of numeric rating scale score in the tocilizumab group. Local infection (i.e., discitis) was observed in 1 patient in the tocilizumab group. ConclusionsThe results demonstrate the clinical relevance of interleukin-6 in discogenic low back pain. Intradiscal tocilizumab injection was shown to exert a short-term analgesic effect in patients with discogenic low back pain. Further research is required to determine the long-term effects of intradiscal tocilizumab therapy in patients with discogenic low back pain.

Homogeneous spinal-shortening axial decompression procedure for tethered cord syndrome

Surgical detethering is a traditional treatment for symptomatic tethered cord syndrome. However, such complications as cerebrospinal fluid leakage and neurologic deterioration are common. Homogeneous spinal-shortening axial decompression (HSAD) is a modified procedure of monosegmental spinal-shortening osteotomy and it is a novel surgical alternative of reducing neural tension indirectly. The objective was to evaluate the surgical outcomes of HSAD for tethered cord syndrome. The surgical outcomes were examined for 15 consecutive patients with tethered cord syndrome undergoing HSAD from April 2010 to July 2014. Improvements of neurological symptoms including urinary dysfunction, lower-extremity motor and sensory disturbances and/or gait abnormalities, low-back and/or lower-extremity pain, bowel incontinence and sexual dysfunction were evaluated. Their average follow-up period was 21.5 months. The length of spinal column shortening was 17.2 ± 2.9 mm. Urinary dysfunction (n = 9) was the most common residual deficit. All 9 patients with urological symptoms reported improvements, although deficits persisted at the last follow-up. All patients with lower-extremity motor dysfunction improved and 4 (50.0%) noted complete resolution of preoperative lower-extremity sensory symptoms. All patients reported immediate low-back or lower-extremity pain relief after HSAD. One patient reported improved sexual functioning and regained complete erectile capabilities. Two patients (11%) experienced less satisfactory symptomatic or functional benefit from HSAD. However, the main objective of surgery was to prevent further worsening of neurological status. Complete bone union at osteotomy site was noted in all cases at the last follow-up. As a novel surgical option for tethered cord syndrome, HSAD may avoid such complications as cerebrospinal fluid leakage or neurologic deterioration commonly encountered during traditional detethering surgery. All patients gain satisfactory functional outcomes without complications compared to their preoperative symptoms.

One decade follow up after nucleoplasty in the management of degenerative disc disease causing low back pain and radiculopathy.

Objectives:Nucleoplasty is a minimally invasive procedure that is developed to treat patients with symptomatic, but contained disc herniations or bulging discs. The purpose of this study was to evaluate a decade follow-up of coblation nucleoplasty treatment for protruded lumbar intervertebral disc.Methods:In this retrospective study there a total 50 patients who underwent intradiscal coblation therapy for symptomatic, but contained lumbar degenerative disc disease were included. Relief of low back pain, leg pain and numbness after the operation were assessed by visual analog pain scale (VAS). Function of lower limb and daily living of patients were evaluated by the Oswestry disability index (ODI) and subjective global rating of overall satisfaction were recorded and analyzed.Results:There were 27 male and 23 female with followup mean follow up of 115 months (range 105–130 months) with a mean age was 52 years (range 26–74 years). Analgesic consumption was reduced or stopped in 90% of these cases after 1 year. At 24 months follow up VAS was four points and ODI was 7.2. In three patients, we repeated the cool ablation after 36 months, at L3–4 level in two cases. Ten patients continue to be asymptomatic after 114 months of intervention. There were no complications with the procedure including nerve root injury, discitis or allergic reactions.Conclusions:Nucleoplasty may provide intermittent relief in contained disc herniation without significant complications and minimal morbidity. In accordance with the literature the evidence for intradiscal coablation therapy is moderate in managing chronic discogenic low back pain; nucleoplasty appears to be safe and effective.

Low magnitude of tensile stress represses the inflammatory response at intervertebral disc in rats

ObjectiveThis study aims to determine if the involvement of tensile stress affects the expressions of inflammatory cytokines interleukin-17(IL-17), interleukin-1β (IL-1β), and inducible nitric oxide synthase (iNOS) at intervertebral discs in vivo.Material and methodSixty-four female Sprague–Dawley rats were randomly divided into four groups: sham, tail-suspended (TS), tail-suspended with needle puncture (TSNP), and single-needle puncture (SNP) groups. A tail-suspension device provides low magnitude of tensile stress (2.45 Newton (N)), and aseptic needle puncture on the tail disc induces inflammatory response. After 4 weeks, the treated discs were harvested for histologic analysis, quantitative real-time reverse transcription-polymerase chain reaction (RT-qPCR), and enzyme-linked immunosorbent assay (ELISA).ResultPathological examination demonstrated that compared to the sham group, the morphologies of nucleus pulposus (NP) and anulus fibrosus (AF) in TS, SNP, and TSNP groups displayed degenerative changes in varying degrees. Results from RT-qPCR showed that IL-17 and iNOS mRNA expression levels were significantly higher in both TSNP and SNP groups than those in the sham groups. Expression of IL-17 and iNOS are not significantly different between the sham and TS groups (P > 0.05). Compared with the SNP group, the mRNA expression of IL-17 and iNOS in the TSNP groups were markedly decreased (P < 0.05). The regulation of IL-1β and IL-17 detected by ELISA was coincident with the qRT-PCR results.ConclusionThe results from this study suggested that relatively low magnitude tensile stress might play an essential role in the anti-inflammatory process and the relief of low-back pain (LBP).

Efficacy of epidural injections in the treatment of lumbar central spinal stenosis: a systematic review.

Context:Lumbar central spinal stenosis is common and often results in chronic persistent pain and disability, which can lead to multiple interventions. After the failure of conservative treatment, either surgical or nonsurgical modalities such as epidural injections are contemplated in the management of lumbar spinal stenosis.Evidence Acquisition:Recent randomized trials, systematic reviews and guidelines have reached varying conclusions about the efficacy of epidural injections in the management of central lumbar spinal stenosis. The aim of this systematic review was to determine the efficacy of all three anatomical epidural injection approaches (caudal, interlaminar, and transforaminal) in the treatment of lumbar central spinal stenosis. A systematic review was performed on randomized trials published from 1966 to July 2014 of all types of epidural injections used in the management of lumbar central spinal stenosis. Methodological quality assessment and grading of the evidence was performed.Results:The evidence in managing lumbar spinal stenosis is Level II for long-term improvement for caudal and lumbar interlaminar epidural injections. For transforaminal epidural injections, the evidence is Level III for short-term improvement only. The interlaminar approach appears to be superior to the caudal approach and the caudal approach appears to be superior to the transforaminal one.Conclusions:The available evidence suggests that epidural injections with local anesthetic alone or with local anesthetic with steroids offer short- and long-term relief of low back and lower extremity pain for patients with lumbar central spinal stenosis. However, the evidence is Level II for the long-term efficacy of caudal and interlaminar epidural injections, whereas it is Level III for short-term improvement only with transforaminal epidural injections.

High-frequency - Spinal Cord Stimulation.

Our clinical experience with high - frequency SCS for FBSS in patients with predominant low back pain is presented. After a trial period, 100 % (21 out of 21) of patients with FBSS with predominant low back pain reported a significant improvement in visual analog scale (VAS) pain score and underwent permanent implantation of the high - frequency SCS system. SCS trials lasted 7-14 days (median 9 days). SCS leads were mostly positioned at the T8-10 or T8-12 vertebral levels . We used both single and dual lead placement. VAS, patient satisfaction, patient performance status, opioid consumption and complication rate were assessed for the period of 12 months. The mean VAS score before implantation (8.7) compared to VAS 12 months after implantation (4.0) was significantly lower (CI95[3.9-5.4], p < 0.001). There was a significant improvement in performance status when comparing PS before implantation (3.0) and 12 months after implantation (1.8) (CI95[0.9-1.6], p < 0.001). The mean patient satisfaction scores (PSS) did not differ throughout the whole one year follow-up period. Our group of 21 patients with implanted high - frequency SCS systems reported significant low back pain and leg pain relief within the period of 12 months as well as significant improvement in their performance status. We had a special subgroup of 5 patients with regular change of frequencies between high frequency and conventional frequency (with paresthesia) also with significant leg and low back pain relief (Tab. 2, Fig. 1, Ref. 8). Text in PDF www.elis.sk.

Effect of transforaminal epidural block for relief of chronic low back pain with radiculopathy of multiple etiologies

Introduction: Low back pain is one of the most common causes of chronic pain syndrome. Epidural steroids are being used for relieving mechanical causes of back pain, accompanied by signs of nerve root irritation with good results. Transforaminal epidural block at a particular level is a convenient route for steroid injection. Methods: The study was carried out on patients attending our pain clinic complaining of low back pain with radiculopathy where conservative therapy failed. Patients were divided into three groups (20 in each, allocated by random number table), 1 st one having collapsed vertebra, 2 nd one having disc protrusion following degenerative changes, 3 rd one having Grade I spondylolisthesis in lumbosacral region. Each of them received transforaminal epidural block at one level (L1/L2) with a dose of 40 mg of depot methyl prednisolone, diluted with 1 ml of 0.25% isobaric bupivacaine (to make a volume of 2 ml for each level on both sides). Initial pain response (at 1 h) was assessed by visual analogue scale (VAS). Long-term pain and disability were assessed (at 1 st , 3 rd and 6 th months) by using VAS score and oswestry disability index (ODI) score. Results: Significant improvement in VAS and ODI score were observed in cases of collapsed vertebra and disc protrusion due to degenerative changes but in the cases of Grade I spondylolisthesis no such improvement was observed. Conclusion: Transforaminal epidural block causes significant relief of symptoms where compression of nerve roots at a particular level causing radiculopathy as in collapsed vertebra or disc protrusion, but not in spondylolisthesis.

Results of Lumbar Endoscopic Adhesiolysis Using a Radiofrequency Catheter in Patients with Postoperative Fibrosis and Persistent or Recurrent Symptoms After Discectomy.

To evaluate the results of lumbar epiduroscopic adhesiolysis using mechanical methods and a radiofrequency catheter followed by epidural steroid and local anesthetic administration in patients with postoperative fibrosis and persistent or recurrent symptoms. Prospective study. Patients with persistent or recurrent low back and/or lower limb pain after lumbar spine surgery, in whom no relevant findings were present on MR images besides epidural scar tissue, were submitted to epiduroscopic adhesiolysis. Patient-reported outcomes including pain and disability were assessed in predefined time intervals and compared to baseline. Twenty-four patients were enrolled. It was possible to elicit the patient's usual pain by probing the epidural scar tissue in all patients. Statistically significant improvement in low back and lower limb pain was observed in all assessment periods up to 12 months. A pain relief over 50% was achieved in 71% of the patients at 1 month, 63% at 3 and 6 months, and 38% at 12 months. Disability scores significantly improved for around 6 months. Mean patient satisfaction rates were 80% at 1 month, 75% at 3 months, 70% at 6 months, and 67% 1 year after intervention. Only 1 transient postprocedural complication was detected. Endoscopic adhesiolysis is a potentially useful treatment for the relief of chronic intractable low back and lower limb pain in patients with previous lumbar spine surgery and epidural fibrosis. The use of larger volumes of saline during endoscopy and the employment of radiofrequency for the lysis of epidural adhesions are safe procedures, which may provide an additional benefit to the intervention.

Effectiveness of Chinese massage therapy (Tui Na) for chronic low back pain: study protocol for a randomized controlled trial.

BackgroundLow back pain is a common, disabling musculoskeletal disorder in both developing and developed countries. Although often recommended, the potential efficacy of massage therapy in general, and Chinese massage (tuina) in particular, for relief of chronic low back pain (CLBP) has not been fully established due to inadequate sample sizes, low methodological quality, and subclinical dosing regimens of trials to date. Thus, the purpose of this randomized controlled trial (RCT) is to evaluate the comparative effectiveness of tuina massage therapy versus conventional analgesics for CLBP.Methods/DesignThe present study is a single center, two-arm, open-label RCT. A total of 150 eligible CLBP patients will be randomly assigned to either a tuina treatment group or a conventional drug control group in a 1:1 ratio. Patients in the tuina group receive a 20 minutes, 4-step treatment protocol which includes both structural and relaxation massage, administered in 20 sessions over a period of 4 weeks. Patients in the conventional drug control group are instructed to take a specific daily dose of ibuprofen. The primary outcome measure is the change from baseline back pain and function, measured by Roland-Morris Disability Questionnaire, at two months. Secondary outcome measures include the visual analogue scale, Japanese orthopedic association score (JOAS), and McGill pain questionnaire.DiscussionThe design and methodological rigor of this trial will allow for collection of valuable data to evaluate the efficacy of a specific tuina protocol for treating CLBP. This trial will therefore contribute to providing a solid foundation for clinical treatment of CLBP, as well as future research in massage therapy.Trial registrationThis trial was registered with ClinicalTrials.gov of the National Institute of Health on 22 October 2013 (http://NCT01973010).

DOĞUM EYLEMİNDE BEL AĞRISININ HAFİFLETİLMESİNDE İNTRADERMAL STERİL SU ENJEKSİYONU

OZET Dogum agrisi; bilinen ve tanimlanan en siddetli agri kaynaklarindan biridir ve algilanmasi bireyden bireye farklilik gosterir. Intrapartum bakimin en buyuk amaci kadinlarin dogumda yasadigi agriyi en iyi sekilde yonetmektir. Tum dogumlarin yaklasik %15-74’unde kadinlar bel bolgesinde ciddi agri yasamaktadir. Bel agrisinin etiyolojisinde fetal oksiput posterior pozisyon, kadinlarin bireysel lumbopelvik ozellikleri ve uterustan kaynaklanan nedenler yer almaktadir. Intradermal steril su bloklari enjeksiyonu dogumda bel agrisini ve belli olcude de abdominal agriyi azaltmaktadir. Intradermal su enjeksiyonu 0.05-0.1 ml steril suyun sakrum cevresinde dort ayri noktaya enjeksiyonu ile dort su kabarciginin olusturulmasi esasina dayanir. Agrinin azalmasinda Kapi Kontrol Teorisinin ve Lokal Endorfin salgisinin etkili oldugu dusunulmektedir. Bes randomize calismada intadermal steril su bloklari uygulamasi ile transkutanoz elektriksel sinir stimulasyonu, annenin hareketi ve pozisyonu, masaj, banyo gibi alternatif nonfarmakolojik metotlarin dogumda bel bolgesindeki agriya etkisi karsilastirilmistir. Calismalarin hepsinde intradermal steril su blogu uygulamasinin diger yontemlere gore bel agrisini onemli derecede azalttigi bulunmustur. Sonuc olarak intradermal steril su enjeksiyonu fetus ve anne uzerinde herhangi bir yan etki olusturmadigi sonucuna ulasildigindan dogumda yasanan bel agrisini azaltmada kullanilabilir. Anahtar Kelimeler: Intradermal steril su enjeksiyonu; dogum; bel agrisi. ABSTRACT Intradermal Sterile Water Injections for The Relief of Low Back Pain in Labour Pain of labor known and identified sources of pain is one of the most severe and perception varies from individual to individual. The aim of intrapartum care of women at birth, the largest in the best way to manage her pain. Estimates of the experience of low back pain in labor range between 15 and 74 percent of womens at all labors. Possible etiologies of low back pain include a fetal occiput posterior position, the woman's lumbopelvic characteristics, and referred pain from the uterus. Intradermal sterile water blocks injections, decrease back pain during labor, and, to a certain extent, the abdominal pain of labor. Intradermal water injections in four different points around the sacrum injection of 0.05-0.1 ml of sterile water and four are based on the creation of the water bubble. At reduction of pain are thought to be effective of The Gate Control Theory and the local secretion of Endorphins. Five randomized trials compared the effect of intradermal sterile water blocks or an alternative nonpharmacological method such as transcutaneous electrical nevre stimulation, maternal movement and positioning, massage, bath for low back pain in labor. All five studies found that intradermal sterile water blocks significantly decreased severe low back pain. In summary, intradermal sterile water injections may significantly reduce the perception of severe low back pain in labor without side-effects on the fetus or mother. Keywords: Intradermal sterile water injections; labor; back pain.

Effects of Acupressure on Menstrual Distress and Low Back Pain in Dysmenorrheic Young Adult Women: An Experimental Study

The purpose of this study was to examine the effects of acupressure on menstrual distress and low back pain (LBP) in dysmenorrheic young adult women. In all, 129 female students, who had been experiencing dysmenorrhea with LBP during menstruation and who scored more than 4 points on the visual analog scale for pain, were randomly assigned to an experimental group and a control group. The experimental group (n = 65) received acupressure massage three times a week for 30 minutes on the sanyinjiao (SP6), ciliao (BL32), and taichong (Liver 3) acupoints. The control group (n = 64) received only a manual of menstrual health education without acupressure intervention. Data were collected at five time points: at baseline, 30 minutes, and 4, 8, and 12 months after the intervention. During the 12-month follow-up, the experimental group had significantly lower menstrual distress and LBP scores than the control group. Among 65 participants in the experimental group, 53 (82%) reported a moderate to high levels of menstrual distress, 51 (78%) reported moderate to high levels of LBP relief, and 49 (75%) reported moderate to high levels of satisfaction with acupressure. Our findings may serve as a reference for health care professionals and young women to improve self-care during menstruation and help further understand the therapeutic effects of acupressure on menstrual distress and LBP.