- Email: [email protected]
Transforaminal selective nerve root steroid injection in the radicular pain
Posters
•
Chronic Pain Management I
65
193. Transforaminal selective nerve root steroid injection in the radicular pain
210. Specific electric acupuncture for the management of the central poststroke pain
Girgin N, Sahin S Uludag University Medical Faculty, Department of Anesthesiology and ICU, Division of Algology, Bursa, Turkey
Young Choi D Research Group of Pain and Neuroscience in Vision2000 Project, East-West Medical Research Institute, Kyung Hee University, Seoul, Korea
Background: The initial treatments for radicular pain are; bed rest, NSAIDs, and physical therapy. Epidural steroid injection is widely used through intralaminar, caudal or foraminal ways for radicular pain that does not respond to the conservative treatment.1
Purpose: In order to study the effectiveness of East-West pain treatment on central poststroke pain (CPSP), we evaluated its effect on alleviation of pain and rehabilitation of CPSP patients who were treated with west pain treatment and electric acupuncture for four weeks.
Aim: To evaluate the effectiveness and reliability of transforaminal nerve root injections in our pain clinic with 3 month intervals periodically. Material and method: In 19 patients who did not respond to medical treatment and have had radicular pain and/or back pain resulting from discal protrusion/hernia or failed back surgery (10 patients) and whose MRI results were consistent to the clinical symptoms. The procedure was done at the level of pathology in the prone position with transforaminal approach under fluoroscopy. After the confirmation of the correct localisation of the needle with contrast medium, periradicular local anesthetic and steroid injection was applied. The VAS values in 24 hours, 1 month and 3 months were recorded and compared with the values before the procedure. A 50% decrease was accepted as success. Results: 7 of 19 patients are male. The mean age was 51.4 ⫾ 13.0. 90% of the patients at the first day, 80% of them at the first month, and 70% of them at the third month were successfully treated. 1 patient has severe pain during the injection and 2 patients had transient paresthesia during the procedure. Conclusions: Transforaminal nerve root injection under fluoroscopy was found to be effective and reliable for radicular pain. We believe that this method should be considered as an alternative to other treatments.
Level
n
C5-C6 L4-L5 L5-S1 L4-L5⫹L5-S1
1 5 9 4
Reference 1. Pfirrmann CWA. Selective nerve root blocks for the treatment of sciatica: Evaluation of injection site and effectiveness—A study with patients and cadavers. Radiology. 2001;221:704-711.
Methods: In total, seventy patients diagnosed by their pain characteristics of central pain from stroke were enrolled and randomized into western treatment group (Group W) and East-Western combined treatment group (Group EW) in this study. The group W (n ⫽ 35) was treated with sympathetic nerve block, gabapentin, amitriptyline and the group EW (n ⫽ 35) was treated with electric acupuncture at the acupoint of LI11, LI4, ST36, LR 3, UE 79 and LE269 combined with those of group W for four weeks, respectively. Pain intensity through the visual analogue scale (VAS), and improvements of mobility and rehabilitation through the modified Barthel index (MBI) and Rankin scale (RS), respectively, before and after pain treatment were assessed. Results: VAS pain scores were significantly improved in both group W and Group EW before and after pain treatment (p ⬍ 0.05). In accordance with improvement of pain scores, RS and MBI scores were significantly improved in both groups before and after treatment (p ⬍ 0.05). VAS pain scores in group EW were not different from those of group W before pain treatment (8.02 ⫾ 1.74 and 7.62 ⫾ 1.53, respectively, p ⬎ 0.05). VAS pain scores of group EW after pain treatment were improved compared to those of controls, but no significant difference was found (4.54 ⫾ 2.46, 5.27 ⫾ 2.25, respectively, p ⬎ 0.05). MBI scores in treated group were not different from those of control before and after treatment (p ⬎ 0.05). RS scores of treated group before pain treatment were not different from those of controls (2.84 ⫾ 0.93 and 2.77 ⫾ 0.75, respectively, p ⬎ 0.05). MBI and RS scores of treated group after treatment were improved compared to those of control and significant improvements were observed (p ⬍ 0.05). Conclusions: The active pain treatment for CPSP might be contributed to improvement of rehabilitation as well as alleviation of pain of CPSP patients. It was suggested that the West pain treatment in combination with East pain treatment might be more useful modality to improve the rehabilitation of CPSP patients.
•
Chronic Pain Management I
65
193. Transforaminal selective nerve root steroid injection in the radicular pain
210. Specific electric acupuncture for the management of the central poststroke pain
Girgin N, Sahin S Uludag University Medical Faculty, Department of Anesthesiology and ICU, Division of Algology, Bursa, Turkey
Young Choi D Research Group of Pain and Neuroscience in Vision2000 Project, East-West Medical Research Institute, Kyung Hee University, Seoul, Korea
Background: The initial treatments for radicular pain are; bed rest, NSAIDs, and physical therapy. Epidural steroid injection is widely used through intralaminar, caudal or foraminal ways for radicular pain that does not respond to the conservative treatment.1
Purpose: In order to study the effectiveness of East-West pain treatment on central poststroke pain (CPSP), we evaluated its effect on alleviation of pain and rehabilitation of CPSP patients who were treated with west pain treatment and electric acupuncture for four weeks.
Aim: To evaluate the effectiveness and reliability of transforaminal nerve root injections in our pain clinic with 3 month intervals periodically. Material and method: In 19 patients who did not respond to medical treatment and have had radicular pain and/or back pain resulting from discal protrusion/hernia or failed back surgery (10 patients) and whose MRI results were consistent to the clinical symptoms. The procedure was done at the level of pathology in the prone position with transforaminal approach under fluoroscopy. After the confirmation of the correct localisation of the needle with contrast medium, periradicular local anesthetic and steroid injection was applied. The VAS values in 24 hours, 1 month and 3 months were recorded and compared with the values before the procedure. A 50% decrease was accepted as success. Results: 7 of 19 patients are male. The mean age was 51.4 ⫾ 13.0. 90% of the patients at the first day, 80% of them at the first month, and 70% of them at the third month were successfully treated. 1 patient has severe pain during the injection and 2 patients had transient paresthesia during the procedure. Conclusions: Transforaminal nerve root injection under fluoroscopy was found to be effective and reliable for radicular pain. We believe that this method should be considered as an alternative to other treatments.
Level
n
C5-C6 L4-L5 L5-S1 L4-L5⫹L5-S1
1 5 9 4
Reference 1. Pfirrmann CWA. Selective nerve root blocks for the treatment of sciatica: Evaluation of injection site and effectiveness—A study with patients and cadavers. Radiology. 2001;221:704-711.
Methods: In total, seventy patients diagnosed by their pain characteristics of central pain from stroke were enrolled and randomized into western treatment group (Group W) and East-Western combined treatment group (Group EW) in this study. The group W (n ⫽ 35) was treated with sympathetic nerve block, gabapentin, amitriptyline and the group EW (n ⫽ 35) was treated with electric acupuncture at the acupoint of LI11, LI4, ST36, LR 3, UE 79 and LE269 combined with those of group W for four weeks, respectively. Pain intensity through the visual analogue scale (VAS), and improvements of mobility and rehabilitation through the modified Barthel index (MBI) and Rankin scale (RS), respectively, before and after pain treatment were assessed. Results: VAS pain scores were significantly improved in both group W and Group EW before and after pain treatment (p ⬍ 0.05). In accordance with improvement of pain scores, RS and MBI scores were significantly improved in both groups before and after treatment (p ⬍ 0.05). VAS pain scores in group EW were not different from those of group W before pain treatment (8.02 ⫾ 1.74 and 7.62 ⫾ 1.53, respectively, p ⬎ 0.05). VAS pain scores of group EW after pain treatment were improved compared to those of controls, but no significant difference was found (4.54 ⫾ 2.46, 5.27 ⫾ 2.25, respectively, p ⬎ 0.05). MBI scores in treated group were not different from those of control before and after treatment (p ⬎ 0.05). RS scores of treated group before pain treatment were not different from those of controls (2.84 ⫾ 0.93 and 2.77 ⫾ 0.75, respectively, p ⬎ 0.05). MBI and RS scores of treated group after treatment were improved compared to those of control and significant improvements were observed (p ⬍ 0.05). Conclusions: The active pain treatment for CPSP might be contributed to improvement of rehabilitation as well as alleviation of pain of CPSP patients. It was suggested that the West pain treatment in combination with East pain treatment might be more useful modality to improve the rehabilitation of CPSP patients.