- Email: [email protected]
Sacral nerve stimulation for the treatment of chronic low back, pelvic girdle and leg pain – A prospective study
e14
Abstracts / Journal of Science and Medicine in Sport 20S (2017) e2–e31
31
32
Exercise regimens and physical activity after lumbar discectomy: Facilitators and barriers
Sacral nerve stimulation for the treatment of chronic low back, pelvic girdle and leg pain – A prospective study
T. Oosterhuis 1,∗ , M.J. Westerman 1 , A. Suman 2 , R.C. Ostelo 3 , M.W. van Tulder 1 1
Department of Health Sciences, VU University Amsterdam, The Netherlands 2 Department of Public and Occupational Health, VU University Medical Center, The Netherlands 3 Department of Epidemiology and Biostatistics, VU University Medical Center, The Netherlands Introduction: Patients who underwent lumbar discectomy are commonly referred for rehabilitation after discharge from the hospital. Performing home exercises and increasing physical activity, which are part of the rehabilitation program, are expected to influence its effectiveness. However, non-adherence to exercise regimens and to advice regarding physical activity is a known problem. Methods: A qualitative study using a phenomenological framework, semi-structured individual interviews, thematic analysis, and member checks to increase validity. We selected participants from different age groups and both genders, with diverse scores on three preoperative measures: expectations regarding rehabilitation, pain and disability. Twelve people who received rehabilitation after lumbar discectomy were interviewed. Interview duration usually ranged from 35 to 40 min with four interviews lasting for 50–80 min. Results: Surgery was often experienced as a major event, in contrast to the neurosurgeons, who saw lumbar discectomy as a minor operation according to the respondents. The main barriers to adherence to exercise and advice were fear of pain aggravation and subsequent activity avoidance immediately post-surgery, and perceived poor practical skills to cope with treatment requirements. Key facilitators to adherence were expected recovery and treatment efficacy; a decrease in pain or other symptoms and expected preventative effect, which were contributed to performing exercises or increasing physical activity; perceived sufficient practical skills to perform home exercises and follow advice about increasing physical activity; a strong belief that exercises were needed for recovery, which enhanced skills to find solutions to any perceived time constraints. Finally, therapist involvement which was tailored to the participant’s needs, i.e., merely providing information and feedback for patients taking full responsibility for their own recovery, a more extensive therapist involvement offering a structured approach and supervision for patients with perceived limited practical skills, or a collaborative approach for those patients with sufficient practical skills, consisting of providing information and advice, inquiring about the patient’s experiences, providing feedback, being a motivator and enhancing practical skills if needed. Discussion: Factors influencing adherence to exercise regimens and advice to increase physical activity differed widely. Therefore, it is important to assess: practical skills to cope with treatment requirements, and recovery and treatment expectations. To our knowledge, this is the first study where respondents described three types of patient and therapist involvement. Assessment of preferred therapist involvement in the rehabilitation process in each individual patient is important to provide patient-centered rehabilitation and to enable the performance of home exercises and increase of physical activity after discectomy. http://dx.doi.org/10.1016/j.jsams.2016.12.035
B. Mitchell 1,∗ , P. Verrills 1 , D. Vivian 1 , A. Barnard 2 1 2
Metro Pain Group, Australia Monash Clinical Research, Australia
Introduction: Sacral nerve stimulation (SNS) has been used effectively in the management of the urinary and bowel symptoms associated with some chronic pelvic pain disorders in the last 15 years. We have also found it useful for treating pain from the belt line down. SNS is an effective treatment option when the thoracic epidural space is compromised through scar tissue or vertebral collapse. Of note, paraesthesia in an area is not necessarily required for pain relief. Purpose/aim: To present results of a case series of patients with intractable pelvic nerve pain treated with SNS. Materials and methods: Over a 3 year period we assessed 31 consecutive patients who had a successful trial and were subsequently implanted with octrode percutaneous leads within the major area of pain in their pelvis using sacral hiatus approach. Questionnaires, along with patients’ histories were used to assess pain, analgesic use, disability and patient satisfaction with the treatment. Patients were followed up at baseline, trial end, and at 3-, 6-, 12months following implant or as required as per standard of care. Study was IRB approved. Results: All patients with a permanent sacral implant reported significant reductions in mean pain compared with baseline values (Baseline vs. End of trial 3.7 ± 1.1; Follow ups: 4.0 ± 0.9, 3.9 ± 0.8, 4.3 ± 0.9 at 3, 6 and 12 months respectively; p = 0.05). Reductions in the Oswestry disability index and psychometric scales were observed. Over 80% of patients using analgesics were able to reduce their analgesic use, with no patients increasing their medication. Overall, 95% of patients reported some degree of improvement on the patient global impression of change scale, whilst 81% of patients were satisfied with their treatment outcome. Patient satisfaction highly correlated with increased pain relief (r = 0.756, p = 0.003). Three patients required repositioning of their leads due to migration. Upon ceasing use of vicryl sutures, no further migrations occurred. A fourth patient had a replacement of their implantable programmable generator (IPG) due to hardware failure. Conclusion(s): SNS can produce effective pain relief in the majority of carefully selected patients suffering from low back, buttock and leg pain, as well as chronic pelvic pain. SNS should be considered as an alternative to SCS, particularly where there is compromise of the thoracic epidural space, high risk of lead migration, the need for low power use or coexisting incontinence. http://dx.doi.org/10.1016/j.jsams.2016.12.036
Abstracts / Journal of Science and Medicine in Sport 20S (2017) e2–e31
31
32
Exercise regimens and physical activity after lumbar discectomy: Facilitators and barriers
Sacral nerve stimulation for the treatment of chronic low back, pelvic girdle and leg pain – A prospective study
T. Oosterhuis 1,∗ , M.J. Westerman 1 , A. Suman 2 , R.C. Ostelo 3 , M.W. van Tulder 1 1
Department of Health Sciences, VU University Amsterdam, The Netherlands 2 Department of Public and Occupational Health, VU University Medical Center, The Netherlands 3 Department of Epidemiology and Biostatistics, VU University Medical Center, The Netherlands Introduction: Patients who underwent lumbar discectomy are commonly referred for rehabilitation after discharge from the hospital. Performing home exercises and increasing physical activity, which are part of the rehabilitation program, are expected to influence its effectiveness. However, non-adherence to exercise regimens and to advice regarding physical activity is a known problem. Methods: A qualitative study using a phenomenological framework, semi-structured individual interviews, thematic analysis, and member checks to increase validity. We selected participants from different age groups and both genders, with diverse scores on three preoperative measures: expectations regarding rehabilitation, pain and disability. Twelve people who received rehabilitation after lumbar discectomy were interviewed. Interview duration usually ranged from 35 to 40 min with four interviews lasting for 50–80 min. Results: Surgery was often experienced as a major event, in contrast to the neurosurgeons, who saw lumbar discectomy as a minor operation according to the respondents. The main barriers to adherence to exercise and advice were fear of pain aggravation and subsequent activity avoidance immediately post-surgery, and perceived poor practical skills to cope with treatment requirements. Key facilitators to adherence were expected recovery and treatment efficacy; a decrease in pain or other symptoms and expected preventative effect, which were contributed to performing exercises or increasing physical activity; perceived sufficient practical skills to perform home exercises and follow advice about increasing physical activity; a strong belief that exercises were needed for recovery, which enhanced skills to find solutions to any perceived time constraints. Finally, therapist involvement which was tailored to the participant’s needs, i.e., merely providing information and feedback for patients taking full responsibility for their own recovery, a more extensive therapist involvement offering a structured approach and supervision for patients with perceived limited practical skills, or a collaborative approach for those patients with sufficient practical skills, consisting of providing information and advice, inquiring about the patient’s experiences, providing feedback, being a motivator and enhancing practical skills if needed. Discussion: Factors influencing adherence to exercise regimens and advice to increase physical activity differed widely. Therefore, it is important to assess: practical skills to cope with treatment requirements, and recovery and treatment expectations. To our knowledge, this is the first study where respondents described three types of patient and therapist involvement. Assessment of preferred therapist involvement in the rehabilitation process in each individual patient is important to provide patient-centered rehabilitation and to enable the performance of home exercises and increase of physical activity after discectomy. http://dx.doi.org/10.1016/j.jsams.2016.12.035
B. Mitchell 1,∗ , P. Verrills 1 , D. Vivian 1 , A. Barnard 2 1 2
Metro Pain Group, Australia Monash Clinical Research, Australia
Introduction: Sacral nerve stimulation (SNS) has been used effectively in the management of the urinary and bowel symptoms associated with some chronic pelvic pain disorders in the last 15 years. We have also found it useful for treating pain from the belt line down. SNS is an effective treatment option when the thoracic epidural space is compromised through scar tissue or vertebral collapse. Of note, paraesthesia in an area is not necessarily required for pain relief. Purpose/aim: To present results of a case series of patients with intractable pelvic nerve pain treated with SNS. Materials and methods: Over a 3 year period we assessed 31 consecutive patients who had a successful trial and were subsequently implanted with octrode percutaneous leads within the major area of pain in their pelvis using sacral hiatus approach. Questionnaires, along with patients’ histories were used to assess pain, analgesic use, disability and patient satisfaction with the treatment. Patients were followed up at baseline, trial end, and at 3-, 6-, 12months following implant or as required as per standard of care. Study was IRB approved. Results: All patients with a permanent sacral implant reported significant reductions in mean pain compared with baseline values (Baseline vs. End of trial 3.7 ± 1.1; Follow ups: 4.0 ± 0.9, 3.9 ± 0.8, 4.3 ± 0.9 at 3, 6 and 12 months respectively; p = 0.05). Reductions in the Oswestry disability index and psychometric scales were observed. Over 80% of patients using analgesics were able to reduce their analgesic use, with no patients increasing their medication. Overall, 95% of patients reported some degree of improvement on the patient global impression of change scale, whilst 81% of patients were satisfied with their treatment outcome. Patient satisfaction highly correlated with increased pain relief (r = 0.756, p = 0.003). Three patients required repositioning of their leads due to migration. Upon ceasing use of vicryl sutures, no further migrations occurred. A fourth patient had a replacement of their implantable programmable generator (IPG) due to hardware failure. Conclusion(s): SNS can produce effective pain relief in the majority of carefully selected patients suffering from low back, buttock and leg pain, as well as chronic pelvic pain. SNS should be considered as an alternative to SCS, particularly where there is compromise of the thoracic epidural space, high risk of lead migration, the need for low power use or coexisting incontinence. http://dx.doi.org/10.1016/j.jsams.2016.12.036