This paper discusses the selection of abdominal area kidney and meridian acupoints120 patients suffering from lower lumbar pain using the fingers to press the acupoints. Althoughthe types of ailments, mildness or seve...This paper discusses the selection of abdominal area kidney and meridian acupoints120 patients suffering from lower lumbar pain using the fingers to press the acupoints. Althoughthe types of ailments, mildness or severity of the patients’ conditions f and duration of illness var-ied, in all cases satisfactory treatment results were achieved. The average effective rate was 97.5%. The average rate of cure (complete recovery rate) was 73.3%. Patients who had sufferedfrom symptoms for a period of less than one year and patients afflicted with mild or moderate con-ditions enjoyed the most outstanding treatment results. The advantages of this treatment method or technique are as follows: 1. This method ortechnique brings the distinctive dynamics of traditional Chinese medicine theory and meridian the-ory into full play. 2. This method of treatment uses neither acupuncture needles nor moxibus-tion. It merely utilizes the fingers to press certain acupoints. It is simple, convenient and easy toimplement.It is展开更多
Background Lumbar pedicle screw fixation and fusion are major procedures for treating discogenic low back pain （DLBP）. However, due to its advantages of preserving the segmental motion and biomechanical simulation, ...Background Lumbar pedicle screw fixation and fusion are major procedures for treating discogenic low back pain （DLBP）. However, due to its advantages of preserving the segmental motion and biomechanical simulation, artificial total lumbar disc replacement （TDR） is increasingly popular. Methods From 2007 to 2010, 68 DLBP patients were enrolled. TDR were performed on 34 patients and the other 34 controls underwent the traditional fixation procedure. Qualitative and quantitative evaluations were followed including the changes in range of motion （ROM） and interpedicle height （IPH） at the posterior intervertebral body of operated level, in 6 and 12 months, and 3 years, postoperatively. Results Qualitative results showed satisfying improvement in the two groups after 6 and 12 months, respectively, and the inter-group differences were significant （P 〉0.05）. The results of ROM and IPH have shown significant differences between the TDR and spinal fusion groups （P 〈0.05）. Conclusion With similar clinical improvements as the traditional spinal fusion method, TDR offered significantly better ROM and intervertebral foramen hei.qht.展开更多
AIM: To investigate the diagnostic validity and therapeutic value of lumbar facet joint interventions in managing chronic low back pain.METHODS: The review process applied systematic evidence-based assessment methodol...AIM: To investigate the diagnostic validity and therapeutic value of lumbar facet joint interventions in managing chronic low back pain.METHODS: The review process applied systematic evidence-based assessment methodology of controlled trials of diagnostic validity and randomized controlled trials of therapeutic efficacy. Inclusion criteria encompassed all facet joint interventions performed in a controlled fashion. The pain relief of greater than 50% was the outcome measure for diagnostic accuracy assessment of the controlled studies with ability to perform previously painful movements, whereas, for randomized controlled therapeutic efficacy studies, the primary outcome was significant pain relief and the secondary outcome was a positive change in functional status. For the inclusion of the diagnostic controlled studies, all studies must have utilized either placebo controlled facet joint blocks or comparative local anesthetic blocks. In assessing therapeutic interventions, short-term and long-term reliefs were defined as either up to 6 mo or greater than 6 mo of relief. The literature search was extensive utilizing various types of electronic search media including Pub Med from 1966 onwards, Cochrane library, National Guideline Clearinghouse, clinicaltrials.gov, along with other sources includingprevious systematic reviews, non-indexed journals, and abstracts until March 2015. Each manuscript included in the assessment was assessed for methodologic quality or risk of bias assessment utilizing the Quality Appraisal of Reliability Studies checklist for diagnostic interventions, and Cochrane review criteria and the Interventional Pain Management Techniques- Quality Appraisal of Reliability and Risk of Bias Assessment tool for therapeutic interventions. Evidence based on the review of the systematic assessment of controlled studies was graded utilizing a modified schema of qualitative evidence with best evidence synthesis, variable from level Ⅰ to level Ⅴ.RESULTS: Across all databases, 16 high quality diagnostic accuracy studies were identified. In addition, multiple studies assessed the influence of multiple factors on diagnostic validity. In contrast to diagnostic validity studies, therapeutic efficacy trials were limited to a total of 14 randomized controlled trials, assessing the efficacy of intraarticular injections, facet or zygapophysial joint nerve blocks, and radiofrequency neurotomy of the innervation of the facet joints. The evidence for the diagnostic validity of lumbar facet joint nerve blocks with at least 75% pain relief with ability to perform previously painful movements was level Ⅰ, based on a range of level Ⅰ to Ⅴ derived from a best evidence synthesis. For therapeutic interventions, the evidence was variable from level Ⅱ to Ⅲ, with level Ⅱ evidence for lumbar facet joint nerve blocks and radiofrequency neurotomy for long-term improvement(greater than 6 mo), and level Ⅲ evidence for lumbosacral zygapophysial joint injections for short-term improvement only.CONCLUSION: This review provides significant evidence for the diagnostic validity of facet joint nerve blocks, and moderate evidence for therapeutic radiofrequency neurotomy and therapeutic facet joint nerve blocks in managing chronic low back pain.展开更多
The lack of truly robust analgesics for chronic pain is owed,in part,to the lack of an animal model that reflects the clinical pain state and of a mechanismbased,objective neurological indicator of pain.The present st...The lack of truly robust analgesics for chronic pain is owed,in part,to the lack of an animal model that reflects the clinical pain state and of a mechanismbased,objective neurological indicator of pain.The present study examined stimulus-evo ked brain activation with functional magnetic resonance imaging in male and female cynomolgus macaques following unilateral L7 spinal nerve ligation and the effects of clinical analgesics pregabalin,duloxetine,and morphine on brain activation in these macaques.A modified straight leg raise test was used to assess pain severity in awake animals and to evo ke regional brain activation in anesthetized animals.The potential effects of clinical analgesics on both awake pain behavior and regional brain activation were examined.Following spinal nerve ligation,both male and female macaques showed significantly decreased ipsilateral straight leg raise thresholds,suggesting the presence of radicula rlike pain.Morphine treatment increased straight leg raise thresholds in both males and females whereas duloxetine and pregabalin did not.In male macaques,the ipsilateral straight leg raise activated contralateral insular and somatosensory cortex(Ins/SII),and thalamus.In female macaques,the ipsilateral leg raise activated cingulate cortex and contralateral insular and somatosensory cortex.Straight leg raises of the contralateral,unligated leg did not evoke brain activation.Morphine reduced activation in all brain regions in both male and female macaques.In males,neither pregabalin nor duloxetine decreased brain activation compared with vehicle treatment.In females,however,pregabalin and duloxetine decreased the activation of cingulate cortex compared with vehicle treatment.The current findings suggest a diffe rential activation of brain areas depending on sex following a peripheral nerve injury.Diffe rential brain activation observed in this study could underlie qualitative sexual dimorphism in clinical chronic pain perception and responses to analgesics.Future pain management approaches for neuropathic pain will need to consider potential sex differences in pain mechanism and treatment efficacy.展开更多
<b>Background and Aims:</b> Low back pain (LBP) is considered one of the most common health conditions in the world right now, and it affects many individuals throughout different stages of their lives. Ch...<b>Background and Aims:</b> Low back pain (LBP) is considered one of the most common health conditions in the world right now, and it affects many individuals throughout different stages of their lives. Chronic LBP (CLBP) was estimated to be between 5% and 10%, defined as LBP that lasts for 12 weeks. The most common causes of CLBP with radiculopathy are lumbar disc prolapse (LDP) and degenerative facet osteoarthropathy (DFO);the aim of this study is to investigate the efficacy of ultrasound (US) guided, fluoroscopy (FL) guided, Caudal Epidural Steroid Injection (CESI), lumbar epidural steroid injections (LESI), and blinding lumbosacral steroid injections (LSPSI) in patients with CLBP with radiculopathy. <b>Patients and Methods:</b> This is a randomized prospective study that was conducted at the department of rheumatology at Al Azhar University Hospital in Egypt between November 2020 and August 2021. A total of 100 patients with refractory CLBP with radiculopathy were enrolled in the study. Consequently, they were divided into 2 groups: the first consisted of fifty patients with CLBP and radiculopathy caused by LDP, as determined by lumbosacral magnetic resonance imaging (MRI), and the second group consisted of fifty patients with refractory low back pain and radiculopathy caused by DFO, as determined by lumbosacral plain x-rays and lumbosacral MRI. The following procedures were performed: US-guided CESI, FL-guided CESI, FL-guided LESI, US-guided LESI, and blinding LSPSI. <b>Results:</b> In the LDP group, there is a statistically significant difference between considered spinal nerve roots as regards Visual Analogue Scale (VAS) (at 2 months). Likewise, a statistically significant difference was found between blinding LSPSI and US-Guided LESI with respect to VAS (baseline) and VAS (2 months) (P-value = 0.018 and 0.003, respectively). Statistically significant differences were reported in VAS (2 months) for both FL-guided LESI and FL-guided CESI groups. Considering the VAS of studied spinal nerve roots in the DFO group, there is a statistically significant difference between the examined spinal nerve roots with respect to Oswestry Disability Index (ODI) (2 months). Similarly, there is a statistically significant difference in VAS (2 months) between US-guided LESI and para-spinal roots and FL-guided LESI and para-spinal roots (P-value = 0.038 and 0.021, respectively). Additionally, there is a statistically significant difference between the US-guided CESI, FL-guided CESI, FL-guided LESI, and spinal nerve roots with respect to ODI (at 2 months). (P-value = 0.033, 0.025 and 0.005, respectively). <b>Conclusion:</b> US is excellent in guiding CESI and LESI and should be the preferred alternative when FL is not provided, with a similar treatment outcome compared to FL-CESI and LESI.展开更多
Objective To evaluate and compare the immunopathological changes of lumbar disc herniation and discogenic pain.Methods Seventy-one lumbar disc nucleuses were collected intra-operation,and they were divided into four g...Objective To evaluate and compare the immunopathological changes of lumbar disc herniation and discogenic pain.Methods Seventy-one lumbar disc nucleuses were collected intra-operation,and they were divided into four groups.Group A:30 cases展开更多
Balanced acupuncture, a single-acupoint balance therapy, regulates the balance of the cerebral center, and is characterized by exerting quick effects and a short treatment course. A total of 20 low-back and leg pain p...Balanced acupuncture, a single-acupoint balance therapy, regulates the balance of the cerebral center, and is characterized by exerting quick effects and a short treatment course. A total of 20 low-back and leg pain patients with lumbar disc herniation were treated with balanced acupuncture or body acupuncture. Central mechanisms of vaded acupunctures were compared using resting-state functional MRI. Patients from both groups received functional MRI before and after acupuncture. Functional connectivity in brain regions that were strongly associated with the bilatera amygdala was analyzed utilizing AFNI software. Visual analogue scale scores were greater in the balanced acupuncture group compared with the body acupuncture group. Function of the endogenous pain regulation network was enhanced in patients in the balanced acupuncture group, but was not changed in the body acupuncture group. This result indicates that the analgesic effects of body acupuncture do not work through the central nervous system. These data suggest that balanced acupuncture exerts analgesic effects on low-back and leg pain patients with lumbar disc herniation by regulating the function of the endogenous pain regulation network.展开更多
文摘This paper discusses the selection of abdominal area kidney and meridian acupoints120 patients suffering from lower lumbar pain using the fingers to press the acupoints. Althoughthe types of ailments, mildness or severity of the patients’ conditions f and duration of illness var-ied, in all cases satisfactory treatment results were achieved. The average effective rate was 97.5%. The average rate of cure (complete recovery rate) was 73.3%. Patients who had sufferedfrom symptoms for a period of less than one year and patients afflicted with mild or moderate con-ditions enjoyed the most outstanding treatment results. The advantages of this treatment method or technique are as follows: 1. This method ortechnique brings the distinctive dynamics of traditional Chinese medicine theory and meridian the-ory into full play. 2. This method of treatment uses neither acupuncture needles nor moxibus-tion. It merely utilizes the fingers to press certain acupoints. It is simple, convenient and easy toimplement.It is
文摘Background Lumbar pedicle screw fixation and fusion are major procedures for treating discogenic low back pain （DLBP）. However, due to its advantages of preserving the segmental motion and biomechanical simulation, artificial total lumbar disc replacement （TDR） is increasingly popular. Methods From 2007 to 2010, 68 DLBP patients were enrolled. TDR were performed on 34 patients and the other 34 controls underwent the traditional fixation procedure. Qualitative and quantitative evaluations were followed including the changes in range of motion （ROM） and interpedicle height （IPH） at the posterior intervertebral body of operated level, in 6 and 12 months, and 3 years, postoperatively. Results Qualitative results showed satisfying improvement in the two groups after 6 and 12 months, respectively, and the inter-group differences were significant （P 〉0.05）. The results of ROM and IPH have shown significant differences between the TDR and spinal fusion groups （P 〈0.05）. Conclusion With similar clinical improvements as the traditional spinal fusion method, TDR offered significantly better ROM and intervertebral foramen hei.qht.
文摘AIM: To investigate the diagnostic validity and therapeutic value of lumbar facet joint interventions in managing chronic low back pain.METHODS: The review process applied systematic evidence-based assessment methodology of controlled trials of diagnostic validity and randomized controlled trials of therapeutic efficacy. Inclusion criteria encompassed all facet joint interventions performed in a controlled fashion. The pain relief of greater than 50% was the outcome measure for diagnostic accuracy assessment of the controlled studies with ability to perform previously painful movements, whereas, for randomized controlled therapeutic efficacy studies, the primary outcome was significant pain relief and the secondary outcome was a positive change in functional status. For the inclusion of the diagnostic controlled studies, all studies must have utilized either placebo controlled facet joint blocks or comparative local anesthetic blocks. In assessing therapeutic interventions, short-term and long-term reliefs were defined as either up to 6 mo or greater than 6 mo of relief. The literature search was extensive utilizing various types of electronic search media including Pub Med from 1966 onwards, Cochrane library, National Guideline Clearinghouse, clinicaltrials.gov, along with other sources includingprevious systematic reviews, non-indexed journals, and abstracts until March 2015. Each manuscript included in the assessment was assessed for methodologic quality or risk of bias assessment utilizing the Quality Appraisal of Reliability Studies checklist for diagnostic interventions, and Cochrane review criteria and the Interventional Pain Management Techniques- Quality Appraisal of Reliability and Risk of Bias Assessment tool for therapeutic interventions. Evidence based on the review of the systematic assessment of controlled studies was graded utilizing a modified schema of qualitative evidence with best evidence synthesis, variable from level Ⅰ to level Ⅴ.RESULTS: Across all databases, 16 high quality diagnostic accuracy studies were identified. In addition, multiple studies assessed the influence of multiple factors on diagnostic validity. In contrast to diagnostic validity studies, therapeutic efficacy trials were limited to a total of 14 randomized controlled trials, assessing the efficacy of intraarticular injections, facet or zygapophysial joint nerve blocks, and radiofrequency neurotomy of the innervation of the facet joints. The evidence for the diagnostic validity of lumbar facet joint nerve blocks with at least 75% pain relief with ability to perform previously painful movements was level Ⅰ, based on a range of level Ⅰ to Ⅴ derived from a best evidence synthesis. For therapeutic interventions, the evidence was variable from level Ⅱ to Ⅲ, with level Ⅱ evidence for lumbar facet joint nerve blocks and radiofrequency neurotomy for long-term improvement(greater than 6 mo), and level Ⅲ evidence for lumbosacral zygapophysial joint injections for short-term improvement only.CONCLUSION: This review provides significant evidence for the diagnostic validity of facet joint nerve blocks, and moderate evidence for therapeutic radiofrequency neurotomy and therapeutic facet joint nerve blocks in managing chronic low back pain.
文摘The lack of truly robust analgesics for chronic pain is owed,in part,to the lack of an animal model that reflects the clinical pain state and of a mechanismbased,objective neurological indicator of pain.The present study examined stimulus-evo ked brain activation with functional magnetic resonance imaging in male and female cynomolgus macaques following unilateral L7 spinal nerve ligation and the effects of clinical analgesics pregabalin,duloxetine,and morphine on brain activation in these macaques.A modified straight leg raise test was used to assess pain severity in awake animals and to evo ke regional brain activation in anesthetized animals.The potential effects of clinical analgesics on both awake pain behavior and regional brain activation were examined.Following spinal nerve ligation,both male and female macaques showed significantly decreased ipsilateral straight leg raise thresholds,suggesting the presence of radicula rlike pain.Morphine treatment increased straight leg raise thresholds in both males and females whereas duloxetine and pregabalin did not.In male macaques,the ipsilateral straight leg raise activated contralateral insular and somatosensory cortex(Ins/SII),and thalamus.In female macaques,the ipsilateral leg raise activated cingulate cortex and contralateral insular and somatosensory cortex.Straight leg raises of the contralateral,unligated leg did not evoke brain activation.Morphine reduced activation in all brain regions in both male and female macaques.In males,neither pregabalin nor duloxetine decreased brain activation compared with vehicle treatment.In females,however,pregabalin and duloxetine decreased the activation of cingulate cortex compared with vehicle treatment.The current findings suggest a diffe rential activation of brain areas depending on sex following a peripheral nerve injury.Diffe rential brain activation observed in this study could underlie qualitative sexual dimorphism in clinical chronic pain perception and responses to analgesics.Future pain management approaches for neuropathic pain will need to consider potential sex differences in pain mechanism and treatment efficacy.
文摘<b>Background and Aims:</b> Low back pain (LBP) is considered one of the most common health conditions in the world right now, and it affects many individuals throughout different stages of their lives. Chronic LBP (CLBP) was estimated to be between 5% and 10%, defined as LBP that lasts for 12 weeks. The most common causes of CLBP with radiculopathy are lumbar disc prolapse (LDP) and degenerative facet osteoarthropathy (DFO);the aim of this study is to investigate the efficacy of ultrasound (US) guided, fluoroscopy (FL) guided, Caudal Epidural Steroid Injection (CESI), lumbar epidural steroid injections (LESI), and blinding lumbosacral steroid injections (LSPSI) in patients with CLBP with radiculopathy. <b>Patients and Methods:</b> This is a randomized prospective study that was conducted at the department of rheumatology at Al Azhar University Hospital in Egypt between November 2020 and August 2021. A total of 100 patients with refractory CLBP with radiculopathy were enrolled in the study. Consequently, they were divided into 2 groups: the first consisted of fifty patients with CLBP and radiculopathy caused by LDP, as determined by lumbosacral magnetic resonance imaging (MRI), and the second group consisted of fifty patients with refractory low back pain and radiculopathy caused by DFO, as determined by lumbosacral plain x-rays and lumbosacral MRI. The following procedures were performed: US-guided CESI, FL-guided CESI, FL-guided LESI, US-guided LESI, and blinding LSPSI. <b>Results:</b> In the LDP group, there is a statistically significant difference between considered spinal nerve roots as regards Visual Analogue Scale (VAS) (at 2 months). Likewise, a statistically significant difference was found between blinding LSPSI and US-Guided LESI with respect to VAS (baseline) and VAS (2 months) (P-value = 0.018 and 0.003, respectively). Statistically significant differences were reported in VAS (2 months) for both FL-guided LESI and FL-guided CESI groups. Considering the VAS of studied spinal nerve roots in the DFO group, there is a statistically significant difference between the examined spinal nerve roots with respect to Oswestry Disability Index (ODI) (2 months). Similarly, there is a statistically significant difference in VAS (2 months) between US-guided LESI and para-spinal roots and FL-guided LESI and para-spinal roots (P-value = 0.038 and 0.021, respectively). Additionally, there is a statistically significant difference between the US-guided CESI, FL-guided CESI, FL-guided LESI, and spinal nerve roots with respect to ODI (at 2 months). (P-value = 0.033, 0.025 and 0.005, respectively). <b>Conclusion:</b> US is excellent in guiding CESI and LESI and should be the preferred alternative when FL is not provided, with a similar treatment outcome compared to FL-CESI and LESI.
文摘Objective To evaluate and compare the immunopathological changes of lumbar disc herniation and discogenic pain.Methods Seventy-one lumbar disc nucleuses were collected intra-operation,and they were divided into four groups.Group A:30 cases
基金funded by the Scientific Research Innovation Program regarding Traditional Chinese Medicine of Guangzhou University of Chinese Medicine (Central mechanism of balanced acupuncture for lumbar disc herniationusing functional MRI), No. 09CX068
文摘Balanced acupuncture, a single-acupoint balance therapy, regulates the balance of the cerebral center, and is characterized by exerting quick effects and a short treatment course. A total of 20 low-back and leg pain patients with lumbar disc herniation were treated with balanced acupuncture or body acupuncture. Central mechanisms of vaded acupunctures were compared using resting-state functional MRI. Patients from both groups received functional MRI before and after acupuncture. Functional connectivity in brain regions that were strongly associated with the bilatera amygdala was analyzed utilizing AFNI software. Visual analogue scale scores were greater in the balanced acupuncture group compared with the body acupuncture group. Function of the endogenous pain regulation network was enhanced in patients in the balanced acupuncture group, but was not changed in the body acupuncture group. This result indicates that the analgesic effects of body acupuncture do not work through the central nervous system. These data suggest that balanced acupuncture exerts analgesic effects on low-back and leg pain patients with lumbar disc herniation by regulating the function of the endogenous pain regulation network.
