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Cohen SP, Doshi TL, Munjupong COLS, Qian C, Chalermkitpanit P, Pannangpetch P, Noragrai K, Wang EJ, Williams KA, Christo PJ, Euasobhon P, Ross J, Sivanesan E, Ukritchon S, Tontisirin N. Multicenter, randomized, controlled comparative-effectiveness study comparing virtual reality to sedation and standard local anesthetic for pain and anxiety during epidural steroid injections. THE LANCET REGIONAL HEALTH. SOUTHEAST ASIA 2024; 27:100437. [PMID: 39036653 PMCID: PMC11259926 DOI: 10.1016/j.lansea.2024.100437] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/17/2023] [Revised: 05/13/2024] [Accepted: 06/05/2024] [Indexed: 07/23/2024]
Abstract
Background The use of sedation during interventional procedures has continued to rise resulting in increased costs, complications and reduced validity during diagnostic injections, prompting a search for alternatives. Virtual reality (VR) has been shown to reduce pain and anxiety during painful procedures, but no studies have compared it to a control and active comparator for a pain-alleviating procedure. The main objective of this study was to determine whether VR reduces procedure-related pain and other outcomes for epidural steroid injections (ESI). Methods A randomized controlled trial was conducted in 146 patients undergoing an ESI at 6 hospitals in Thailand and the United States. Patients were allocated to receive immersive VR with local anesthetic, sedation with midazolam and fentanyl plus local anesthetic, or local anesthetic alone. The primary outcome was procedure-related pain recorded on a 0-10 scale. Other immediate-term outcome measures were pain from a standardized subcutaneous skin wheal, procedure-related anxiety, ability to communicate, satisfaction, and time to discharge. Intermediate-term outcome measures at 4 weeks included back and leg pain scores, function, and success defined as a ≥2-point decrease in average leg pain coupled with a score ≥5/7 on a Patient Global Impression of Change scale. Findings Procedure-related pain scores with both VR (mean 3.7 (SD 2.5)) and sedation (mean 3.2 (SD 3.0)) were lower compared to control (mean 5.2 (SD 3.1); mean differences -1.5 (-2.7, -0.4) and -2.1 (-3.3, -0.9), respectively), but VR and sedation scores did not significantly differ (mean difference 0.5 (-0.6, 1.7)). Among secondary outcomes, communication was decreased in the sedation group (mean 3.7 (SD 0.9)) compared to the VR group (mean 4.1 (SD 0.5); mean difference 0.4 (0.1, 0.6)), but neither VR nor sedation was different than control. The trends favoring sedation and VR over control for procedure-related anxiety and satisfaction were not statistically significant. Post-procedural recovery time was longer for the sedation group compared to both VR and control groups. There were no meaningful intermediate-term differences between groups except that medication reduction was lowest in the control group. Interpretation VR provides comparable benefit to sedation for procedure-related pain, anxiety and satisfaction, but with fewer side effects, superior communication and a shorter recovery period. Funding Funded in part by grants from MIRROR, Uniformed Services University of the Health Sciences, U.S. Dept. of Defense, grant # HU00011920011. Equipment was provided by Harvard MedTech, Las Vegas, NV.
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Affiliation(s)
- Steven P. Cohen
- Departments of Anesthesiology, Neurology, Physical Medicine & Rehabilitation, Psychiatry and Neurological Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
- Departments of Physical Medicine & Rehabilitation, Neurology, and Psychiatry & Behavioral Sciences, Johns Hopkins School of Medicine, Baltimore, MD
- Departments of Anesthesiology and Physical Medicine and Rehabilitation, Walter Reed National Military Medical Center, Uniformed Services University of the Health Sciences, Bethesda, MD
| | - Tina L. Doshi
- Departments of Anesthesiology & Critical Care Medicine and Neurosurgery, Johns Hopkins School of Medicine, Baltimore, MD, USA
- U.S. Food and Drug Administration, Silver Spring, MD, USA
| | - COL Sithapan Munjupong
- Department of Anesthesiology, Phramongkutklao Royal Thai Army Hospital and College of Medicine, Bangkok, Thailand
| | - CeCe Qian
- Department of Anesthesiology, NYU Langone Medical Center, NYU Grossman School of Medicine, New York, NY, USA
| | - Pornpan Chalermkitpanit
- Pain Management Research Unit, Department of Anesthesiology, Faculty of Medicine, King Chulalongkorn Memorial Hospital, Chulalongkorn University, Bangkok
| | - Patt Pannangpetch
- Pain Management Research Unit, Department of Anesthesiology, Faculty of Medicine, King Chulalongkorn Memorial Hospital, Chulalongkorn University, Bangkok
| | - Kamolporn Noragrai
- Department of Anesthesiology, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok
| | - Eric J. Wang
- Department of Anesthesiology, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Kayode A. Williams
- Department of Anesthesiology, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Paul J. Christo
- Department of Anesthesiology, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Pramote Euasobhon
- Department of Anesthesiology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok
| | - Jason Ross
- Department of Anesthesiology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Eellan Sivanesan
- Department of Anesthesiology, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Supak Ukritchon
- Office of Research and Development, Phramongkutklao Hospital and Phramongkutklao College of Medicine, Bangkok, Thailand
| | - Nuj Tontisirin
- Department of Anesthesiology, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok
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Kvasnitskyi MV. MANIFESTATIONS AND TREATMENT OF LOWER BACK PAIN SYNDROME IN WARTIME. WIADOMOSCI LEKARSKIE (WARSAW, POLAND : 1960) 2023; 76:1185-1190. [PMID: 37364071 DOI: 10.36740/wlek202305208] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/28/2023]
Abstract
OBJECTIVE The aim: To improve treatment of patients with lower back pain through identification of pathogenetic factors in its formation. PATIENTS AND METHODS Materials and methods: The early results of treatment of 84 patients with lower back pain (main group) were analysed. Patients of the main group were divided into two subgroups: one group involved patients with mental disorders, the other - patients not suffering from such disorders (the Spielberger-Hanin Anxiety Test used). The patients of the main group with mental disorders (49 patients) were administered with epidural steroid injections and antidepressants. The patients with no mental disorders (35 patients) were administered with epidural steroid injections only. The control group involved 36 patients with lower back pain who did not undergo any psychological testing and were administered with epidural steroid injections only. The Visual Analog Scale (VAS) and the Oswestry Disability Index questionnaire were used to assess pain syndrome. The assessment was carried out twice: in the pre-operative period and in three months after the treatment. RESULTS Results: A significant difference in the early treatment results between the main and control groups was established according to both the Visual Analog Scale and the Oswestry Disability Index in favour of the main group patients, who were differentiated by pathogenetic factors of the pain syndrome formation. CONCLUSION Conclusions: Lower back pain syndrome necessitates clarification of its components in order to develop pathogenically based treatment.
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Affiliation(s)
- Mykola V Kvasnitskyi
- STATE INSTITUTION OF SCIENCE «RESEARCH AND PRACTICAL CENTER OF PREVENTIVE AND CLINICAL MEDICINE» STATE ADMINISTRATIVE DEPARTMENT, KYIV, UKRAINE
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Cohen SP, Doshi TL, Kurihara C, Reece D, Dolomisiewicz E, Phillips CR, Dawson T, Jamison D, Young R, Pasquina PF. Multicenter study evaluating factors associated with treatment outcome for low back pain injections. Reg Anesth Pain Med 2021; 47:89-99. [PMID: 34880117 DOI: 10.1136/rapm-2021-103247] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2021] [Accepted: 11/10/2021] [Indexed: 01/03/2023]
Abstract
BACKGROUND There has been a worldwide surge in interventional procedures for low back pain (LBP), with studies yielding mixed results. These data support the need for identifying outcome predictors based on unique characteristics in a pragmatic setting. METHODS We prospectively evaluated the association between over two dozen demographic, clinical and technical factors on treatment outcomes for three procedures: epidural steroid injections (ESIs) for sciatica, and sacroiliac joint (SIJ) injections and facet interventions for axial LBP. The primary outcome was change in patient-reported average pain intensity on a numerical rating scale (average NRS-PI) using linear regression. For SIJ injections and facet radiofrequency ablation, this was average LBP score at 1 and 3 months postprocedure, respectively. For ESI, it was average leg pain 1- month postinjection. Secondary outcomes included a binary indicator of treatment response (success). RESULTS 346 patients were enrolled at seven hospitals. All groups experienced a decrease in average NRS-PI (p<0.0001; mean 1.8±2.6). There were no differences in change in average NRS-PI among procedural groups (p=0.50). Lower baseline pain score (adjusted coefficient -0.32, 95% CI -0.48 to -0.16, p<0.0001), depressive symptomatology (adjusted coefficient 0.076, 95% CI 0.039 to 0.113, p<0.0001) and obesity (adjusted coefficient 0.62, 95% CI 0.038 to 1.21, p=0.037) were associated with smaller pain reductions. For procedural outcome, depression (adjusted OR 0.94, 95% CI 0.91, 0.97, p<0.0001) and poorer baseline function (adjusted OR 0.59, 95% CI 0.36, 0.96, p=0.034) were associated with failure. Smoking, sleep dysfunction and non-organic signs were associated with negative outcomes in univariate but not multivariate analyses. CONCLUSIONS Identifying treatment responders is a critical endeavor for the viability of procedures in LBP. Patients with greater disease burden, depression and obesity are more likely to fail interventions. Steps to address these should be considered before or concurrent with procedures as considerations dictate. TRIAL REGISTRATION NUMBER NCT02329951.
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Affiliation(s)
- Steven P Cohen
- Department of Anesthesiology, Johns Hopkins School of Medicine, Baltimore, Maryland, USA .,Departments of Physical Medicine & Rehabilitation and Anesthesiology, Walter Reed National Military Medical Center, Bethesda, Maryland, USA
| | - Tina L Doshi
- Department of Anesthesiology, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | - Connie Kurihara
- Department of Physical Medicine & Rehabilitation, Walter Reed National Military Medical Center, Bethesda, Maryland, USA
| | - David Reece
- Department of Physical Medicine & Rehabilitation, Walter Reed National Military Medical Center, Bethesda, Maryland, USA
| | - Edward Dolomisiewicz
- Department of Physical Medicine & Rehabilitation, Walter Reed National Military Medical Center, Bethesda, Maryland, USA
| | | | - Timothy Dawson
- Department of Anesthesiology, VA Puget Sound Health Care System Seattle Division, Seattle, Washington, USA
| | - David Jamison
- Department of Anesthesiology, Walter Reed National Military Medical Center, Bethesda, Maryland, USA
| | - Ryan Young
- Department of Surgery, Landstuhl Regional Medical Center, Landstuhl Kirchberg, Rheinland-Pfalz, Germany
| | - Paul F Pasquina
- Department of Physical Medicine & Rehabilitation, Walter Reed National Military Medical Center, Bethesda, Maryland, USA
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Inal FY, Gul K, Yilmaz Camgoz Y, Daskaya H, Kocoglu H. Validation of the Turkish version of the Pain Sensitivity Questionnaire in patients with chronic pain. J Int Med Res 2021; 49:3000605211060158. [PMID: 34855531 PMCID: PMC8646826 DOI: 10.1177/03000605211060158] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Objective The Pain Sensitivity Questionnaire (PSQ) is a clinically beneficial instrument that has been proven to be correlated with various experimental pain sensitivity assessments in healthy people and in patients with chronic pain. In this study, we aimed to translate the PSQ into Turkish (PSQ-T) and validate it for the measurement of pain sensitivity among Turkish people. Methods Seventy-three patients with chronic back pain who were planning to undergo an interventional procedure completed the Brief Pain Inventory-Short Form (BPI-SF), Beck Depression Inventory (BDI), Beck Anxiety Inventory, Pain Catastrophizing Scale, and PSQ prior to their procedure. Subcutaneous infiltration of lidocaine was used as a standardized experimental pain stimulus. Pain was evaluated using a visual analog scale (VAS 1: infiltration in the hand, and VAS 2: infiltration in the procedure area) Results Scores on the PSQ-T were significantly correlated with those on the BPI-SF. A significant positive relationship was observed between VAS 1 and VAS 2 values and the PSQ-T score, BPI pain score, and BPI interference score. Conclusions The PSQ-T can be used as a valid and reliable tool for the assessment of pain sensitivity in the Turkish population.
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Affiliation(s)
- Ferda Yilmaz Inal
- Department of Anaesthesiology and Reanimation, Faculty of Medicine, Istanbul Medeniyet University, Istanbul 34000, Turkey
| | - Kursat Gul
- Department of Anaesthesiology and Reanimation, Faculty of Medicine, Bezmialem Vakif University, Istanbul 34000, Turkey
| | - Yadigar Yilmaz Camgoz
- Clinic of Anaesthesiology and Reanimation, Sultan Abdülhamid Han Training and Research Hospital, Istanbul 34000, Turkey
| | - Hayrettin Daskaya
- Department of Anaesthesiology and Reanimation, Faculty of Medicine, Bezmialem Vakif University, Istanbul 34000, Turkey
| | - Hasan Kocoglu
- Department of Anaesthesiology and Reanimation, Faculty of Medicine, Istanbul Medeniyet University, Istanbul 34000, Turkey
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Wei JJ, Chotai S, Sivaganesan A, Archer KR, Schneider BJ, Yang AJ, Devin CJ. Effect of pre-injection opioid use on post-injection patient-reported outcomes following epidural steroid injections for radicular pain. Spine J 2018; 18:788-796. [PMID: 28962907 DOI: 10.1016/j.spinee.2017.09.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2017] [Revised: 08/16/2017] [Accepted: 09/20/2017] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT Chronic opioid therapy is associated with worse patient-reported outcomes (PROs) following spine surgery. However, little literature exists on the relationship between opioid use and PROs following epidural steroid injections for radicular pain. PURPOSE We evaluated the association between pre-injection opioid use and PROs following spine epidural steroid injection. STUDY DESIGN This study is a retrospective analysis of a prospective longitudinal registry database. PATIENT SAMPLE A total of 392 patients within our database who were undergoing epidural steroid injections (ESIs) at our institution for degenerative structural spine diagnoses and met our inclusion criteria were included in this study. OUTCOME MEASURES Patient-reported outcomes for disability (Oswestry Disability Index/Neck Disability Index [ODI/NDI)]), quality of life (EuroQol-5D [EQ-5D]), and pain (Numerical Rating Scale scores for back pain, neck pain, leg pain, and arm pain [NRS-BP/NP/LP/AP]) were assessed at baseline and at 3 and 12 months post-injection. METHODS Multivariable proportional odds logistic regression models were created to examine the relationship between pre-injection opioid use and post-injection PROs. A logistic regression with Bayesian Markov chain Monte Carlo parameter estimation was used to investigate a possible cutoff value of pre-injection opioid use above which the effectiveness of ESI (as measured by minimum clinically important difference [MCID] for ODI/NDI) decreases. RESULTS A total of 276 patients with complete 12-month follow-up following ESI were analyzed. The mean pre-injection daily morphine equivalent amount (MEA) was 14.7 mg (95% confidence interval [CI] 12.4 mg-19.1 mg) for the cohort. Pre-injection opioid use was associated with slightly higher odds of worse disability (odds ratio [OR] 1.03, p=.03) and leg/arm pain (OR 1.01, p=.04) scores at 3 months post-injection only. No significant association between pre-injection opioid use and MCID for ODI/NDI was found, although a cutoff of 55.5 mg/day might serve as a significant threshold. CONCLUSION Increased pre-injection opioid use does not impact long-term outcomes after ESIs for degenerative spine diseases. A pre-injection MEA around 50 mg/day may represent a threshold above which the 3-month effectiveness of ESI for back- and neck-related disability decreases. Epidural steroid injection is an effective treatment modality for pain in patients using opioids, and can be part of a multimodal strategy for opioid independence.
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Affiliation(s)
- Johnny J Wei
- Department of Orthopedic Surgery, Vanderbilt University, School of Medicine Medical Center East, South Tower, Suite 4200, Nashville, TN 37232-8774, USA
| | - Silky Chotai
- Department of Orthopedic Surgery, Vanderbilt University, School of Medicine Medical Center East, South Tower, Suite 4200, Nashville, TN 37232-8774, USA; Department of Neurological Surgery, Vanderbilt University Medical Center, 1161 21st Ave. So. T4224 Medical Center North, Nashville, TN 37232-2380, USA
| | - Ahilan Sivaganesan
- Department of Neurological Surgery, Vanderbilt University Medical Center, 1161 21st Ave. So. T4224 Medical Center North, Nashville, TN 37232-2380, USA
| | - Kristin R Archer
- Department of Orthopedic Surgery, Vanderbilt University, School of Medicine Medical Center East, South Tower, Suite 4200, Nashville, TN 37232-8774, USA; Department of Physical Medicine and Rehabilitation, Vanderbilt Stallworth Rehabilitation Hospital 2201 Children's Way, Suite 1318, Nashville, TN 37212, USA
| | - Byron J Schneider
- Department of Physical Medicine and Rehabilitation, Vanderbilt Stallworth Rehabilitation Hospital 2201 Children's Way, Suite 1318, Nashville, TN 37212, USA
| | - Aaron J Yang
- Department of Physical Medicine and Rehabilitation, Vanderbilt Stallworth Rehabilitation Hospital 2201 Children's Way, Suite 1318, Nashville, TN 37212, USA
| | - Clinton J Devin
- Department of Orthopedic Surgery, Vanderbilt University, School of Medicine Medical Center East, South Tower, Suite 4200, Nashville, TN 37232-8774, USA; Department of Neurological Surgery, Vanderbilt University Medical Center, 1161 21st Ave. So. T4224 Medical Center North, Nashville, TN 37232-2380, USA.
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Comparison of Two Lidocaine Administration Techniques on Perceived Pain From Bedside Procedures: A Randomized Clinical Trial. Chest 2018; 154:773-780. [PMID: 29698720 DOI: 10.1016/j.chest.2018.04.018] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2017] [Revised: 03/19/2018] [Accepted: 04/02/2018] [Indexed: 01/30/2023] Open
Abstract
BACKGROUND Lidocaine is used to alleviate procedural pain but paradoxically increases pain during injection. Pain perception can be modulated by non-noxious stimuli such as temperature or touch according to the gate control theory of pain. We postulated that lidocaine dripped onto the skin prior to injection would cool or add the sensation of touch at the skin surface to reduce pain perception from the procedure. METHODS A randomized clinical trial of patients referred to the procedure service from February 2011 through March 2015 was conducted. All patients received 1% subcutaneous lidocaine injection. Patients randomized to the intervention group had approximately 1 to 2 ml of lidocaine squirted onto the skin surface prior to subcutaneous lidocaine injection. Patients were blinded to the details of the intervention and were surveyed by a blinded investigator to document the primary outcome (severity of pain from the procedure) using a visual analog scale. RESULTS A total of 481 patients provided consent and were randomized to treatment. There was a significant improvement in the primary outcome of procedural pain (control, 16.6 ± 24.8 mm vs 12.2 ± 19.4 mm; P = .03) with the intervention group as assessed by using the visual analog scale score. Pain scores were primarily improved for peripherally inserted central catheters (control, 18.8 ± 25.6 mm vs 12.2 ± 18.2 mm; P = .02) upon subgroup analysis. CONCLUSIONS Bedside procedures are exceedingly common. Data regarding the severity of procedural pain and strategies to mitigate it are important for the informed consent process and patient satisfaction. Overall, pain reported from common bedside procedures is low, but pain can be further reduced with the addition of lidocaine onto the skin surface to modulate pain perception. TRIAL REGISTRY ClinicalTrials.gov; No.: NCT01330134; URL: www.clinicaltrials.gov.
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Simopoulos T, Leffler D, Barnett S, Campbell D, Lian SJ, Gill JS. Prospective Assessment of Pain and Comfort in Chronic Pain Patients Undergoing Interventional Pain Management Procedures. PAIN MEDICINE 2018; 19:336-347. [PMID: 28431040 DOI: 10.1093/pm/pnx064] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Objective Interventional pain management procedures have an important role in the management of chronic pain. The present study seeks to identify the proportion of patients who experience severe pain during pain procedures either with or without sedation. There is then an attempt to identify any association of high pain levels with factors such as age, gender, ethnicity, preprocedure pain level, procedure type, tobacco use, and baseline pharmaceuticals taken for both pain and/or mood disorder management. Methods This is a prospective survey study evaluating patients' discomfort during interventional pain procedures in an outpatient academic facility. Patient discomfort was assessed by the PROcedural Sedation Assessment Survey (PROSAS) and modified for nonsedation cases. Results There were 155 patients in the survey, with 20 of these receiving nonspinal injections. Of the remaining 135 patients who underwent spinal injections, only 10 received conscious sedation. On average, 14.2% experienced severe pain during spinal injections, whereas 20% experienced severe pain with nonspinal injections. Though few patients received conscious sedation, most of these (60%) experienced high levels of pain. There was no correlation between level of procedural pain with age, gender, ethnicity, preprocedure pain level, procedure type, tobacco use, or medication type used. Conclusions The majority of patients who undergo nonsedated interventional pain management procedures do not experience severe pain. There is a small but appreciable group of subjects who seem to experience severe pain that cannot be correlated to any particular clinical characteristic in a standard patient evaluation. Even with standard conscious sedation, there is no clear best method to ensure patient comfort for this high-pain level group.
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Affiliation(s)
- Thomas Simopoulos
- Harvard Medical School, Beth Israel Deaconess Medical Center, Brookline, Massachusetts, USA
| | | | - Sheila Barnett
- Harvard Medical School, Beth Israel Deaconess Medical Center, Brookline, Massachusetts, USA
| | | | | | - Jatinder S Gill
- Harvard Medical School, Beth Israel Deaconess Medical Center, Brookline, Massachusetts, USA
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Kim SH, Ha KW, Kim YH, Seol PH, Kwak HJ, Park SW, Ryu BJ. Effect of Radial Extracorporeal Shock Wave Therapy on Hemiplegic Shoulder Pain Syndrome. Ann Rehabil Med 2016; 40:509-19. [PMID: 27446789 PMCID: PMC4951371 DOI: 10.5535/arm.2016.40.3.509] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2015] [Accepted: 10/20/2015] [Indexed: 01/18/2023] Open
Abstract
Objective To investigate the effect of radial extracorporeal shock wave therapy (rESWT) on hemiplegic shoulder pain (HSP) syndrome. Methods In this monocentric, randomized, patient-assessor blinded, placebo-controlled trial, patients with HSP were randomly divided into the rESWT (n=17) and control (n=17) groups. Treatment was administered four times a week for 2 weeks. The visual analogue scale (VAS) score and Constant-Murley score (CS) were assessed before and after treatment, and at 2 and 4 weeks. The Modified Ashworth Scale and Fugl-Meyer Assessment scores and range of motion of the shoulder were also assessed. Results VAS scores improved post-intervention and at the 2-week and 4-week follow-up in the intervention group (p<0.05). Respective differences in VAS scores between baseline and post-intervention in the intervention and control groups were –1.69±1.90 and –0.45±0.79, respectively (p<0.05), between baseline and 2-week follow-up in the intervention and control groups were –1.60±1.74 and –0.34±0.70, respectively (p<0.05), and between baseline and 4-week follow-up in the intervention and control groups were –1.61±1.73 and –0.33±0.71, respectively (p<0.05). Baseline CS improved from 19.12±11.02 to 20.88±10.37 post-intervention and to 20.41±10.82 at the 2-week follow-up only in the intervention group (p<0.05). Conclusion rESWT consisting of eight sessions could be one of the effective and safe modalities for pain management in people with HSP. Further studies are needed to generalize and support these results in patients with HSP and a variety conditions, and to understand the mechanism of rESWT for treating HSP.
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Affiliation(s)
- Sung Hwan Kim
- Department of Physical Medicine and Rehabilitation, Sahmyook Medical Center, Seoul, Korea
| | - Kang Wook Ha
- Department of Physical Medicine and Rehabilitation, Sahmyook Medical Center, Seoul, Korea
| | - Yun Hee Kim
- Department of Physical Medicine and Rehabilitation, Sahmyook Medical Center, Seoul, Korea
| | - Pyong-Hwa Seol
- Department of Physical Medicine and Rehabilitation, Sahmyook Medical Center, Seoul, Korea
| | - Ho-Jun Kwak
- Department of Physical Medicine and Rehabilitation, Sahmyook Medical Center, Seoul, Korea
| | - Seung-Wan Park
- Department of Physical Medicine and Rehabilitation, Sahmyook Medical Center, Seoul, Korea
| | - Byung-Ju Ryu
- Department of Physical Medicine and Rehabilitation, Sahmyook Medical Center, Seoul, Korea
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Bakshi R, Berri H, Kalpakjian C, Smuck M. The Effects of Local Anesthesia Administration on Pain Experience During Interventional Spine Procedures: A Prospective Controlled Trial. PAIN MEDICINE 2015; 17:488-493. [PMID: 26814251 DOI: 10.1093/pm/pnv015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/04/2015] [Revised: 08/19/2015] [Accepted: 09/06/2015] [Indexed: 11/12/2022]
Abstract
OBJECTIVE It has been postulated that local anesthetic administration may be the most painful part of interventional spine procedures. Despite this, there is a lack of evidence supporting the commonly used traditional technique of anesthetic delivery as part of these procedures. This study tested three hypotheses: 1) alternative method of local anesthesia injection is superior to the traditional method; 2) using the traditional method of injection is not superior to using no local anesthetic; and 3) treatment needle size, anesthetic injection technique, and sedation are associated with pain experienced during procedures. DESIGN Prospective, multicenter clinical trial of 127 participants who underwent elective bilateral symmetric interventional spine procedures in outpatient spine clinics. METHODS Primary outcomes were pain scores during and after procedures to examine the influence of anesthetic injection method and treatment needle gauge on pain experience using linear mixed model regression analysis. A post-hoc comparison of estimated marginal mean pain scores was completed on both anesthetic injection method and treatment needle gauge. CONCLUSIONS The alternative method was superior (P < 0.05) to the traditional method on post procedural pain scores. Injecting local anesthetic with the traditional or alternative method was not superior to using no local anesthetic. Treatment needle size, pain at one inch of treatment needle insertion, and baseline pain were all significantly (P < 0.05) associated with overall procedural pain. Further studies are needed optimize and justify local anesthetic injections for these procedures.
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Affiliation(s)
- Rishi Bakshi
- *Department of Physical Medicine and Rehabilitation, University of Michigan, Ann Arbor, Michigan
| | - Hassen Berri
- *Department of Physical Medicine and Rehabilitation, University of Michigan, Ann Arbor, Michigan;
| | - Claire Kalpakjian
- *Department of Physical Medicine and Rehabilitation, University of Michigan, Ann Arbor, Michigan
| | - Matthew Smuck
- Department of Physical Medicine and Rehabilitation, Stanford University, Redwood City, California, USA
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Abstract
Epidural steroid injections (ESIs) are the most widely utilized pain management procedure in the world, their use supported by more than 45 placebo-controlled studies and dozens of systematic reviews. Despite the extensive literature on the subject, there continues to be considerable controversy surrounding their safety and efficacy. The results of clinical trials and review articles are heavily influenced by specialty, with those done by interventional pain physicians more likely to yield positive findings. Overall, more than half of controlled studies have demonstrated positive findings, suggesting a modest effect size lasting less than 3 months in well-selected individuals. Transforaminal injections are more likely to yield positive results than interlaminar or caudal injections, and subgroup analyses indicate a slightly greater likelihood for a positive response for lumbar herniated disk, compared with spinal stenosis or axial spinal pain. Other factors that may increase the likelihood of a positive outcome in clinical trials include the use of a nonepidural (eg, intramuscular) control group, higher volumes in the treatment group, and the use of depo-steroid. Serious complications are rare following ESIs, provided proper precautions are taken. Although there are no clinical trials comparing different numbers of injections, guidelines suggest that the number of injections should be tailored to individual response, rather than a set series. Most subgroup analyses of controlled studies show no difference in surgical rates between ESI and control patients; however, randomized studies conducted by spine surgeons, in surgically amenable patients with standardized operative criteria, indicate that in some patients the strategic use of ESI may prevent surgery.
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