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Xinjian Kang,1,2 Man Qian,3 Mingli Liu,2 Haiwei Xu,4 Baoshan Xu4 1Department of Orthopedics, Traditional Chinese Medicine Hospital of Qinhuangdao, Qinhuangdao, Hebei, People’s Republic of China; 2Tianjin Medical University, Graduate School, Tianjin, People’s Republic of China; 3Department of Refractive Surgery, Qinhuangdao Aier Ophthalmic Hospital, Qinhuangdao, Hebei, People’s Republic of China; 4Department of Minimally Invasive Spine Surgery, Tianjin Hospital, Tianjin, People’s Republic of ChinaCorrespondence: Baoshan Xu, Department of Minimally Invasive Spine Surgery, Tianjin Hospital, No. 406 Jiefangnan Road, Hexi District, Tianjin, People’s Republic of China, Tel +86 13502028198, Fax +86- 22 -28241184, Email baoshanxu99@tmu.edu.cnPurpose: To explore the predictive factors of neck pain (NP) in patients with cervical degenerative disease by retrospectively analyzing their occupational and demographic characteristics and to provide a valuable reference for preventing and treating chronic NP.Patients and Methods: We retrospectively reviewed the occupational and demographic data of patients with cervical degenerative disease who had undergone anterior cervical surgery between June 2021 and December 2022 at our center. The patients were divided into NP and no-NP groups based on whether they had chronic NP before surgery. Relevant occupational and demographic data from all patients were statistically analyzed, and all variables were made categorical. Forward stepwise logistic regression models were constructed for preoperative chronic neck pain to explore the possible risk factors associated with chronic neck pain.Results: The differences in smoking, being an office worker, BMI, and disease types between NP and no-NP groups were statistically significant. In contrast, there were no statistically significant in age, sex, academic level, duration, and degeneration grade between the two groups. Moreover, further logistic regression analysis indicated that smoking, being an office worker, having an abnormal BMI, and cervical spondylotic radiculopathy (CSR) were related to chronic neck pain.Conclusion: The present study indicated that smoking, being an office worker, having an abnormal BMI, and CSR were predisposing risk factors for NP associated with cervical degenerative disease. Although intervertebral disc degeneration is the pathology basis of NP, the degeneration grade was not related to the occurrence of NP in our current study. Therefore, quitting smoking, avoiding sedentariness, and maintaining a normal BMI may prevent NP to some extent.Keywords: discogenic pain, radiating pain, musculoskeletal disorder, intervertebral disc degeneration

Background: The most prevalent disorder affecting the spinal cord is lumbar radiculopathy. The incidence of this condition is estimated between 3% and 5% of the population and it impacts both male and female equally. The goal of this present study is to compare the effectiveness of dry needling to interferential therapy [IFT] in terms of reducing pain and increasing the lumbar range of motion in patients with lumbar radiculopathy. Purpose: To determine the effect of dry needling on patients with lumbar radiculopathy in reducing pain and increasing lumbar ROM compared to interferential therapy. Materials and Methods: 30 subjects participated and pre assessment and post assessment was taken using Numerical Pain Rating Scale [NPRS] and the Modified-Modified Schober Test [MMST]. For both groups, the intervention period lasted for 2 weeks and the entire study procedure was carried out from November 2022 to April 2023. Result: This study showed an extremely satisfied statistical significance difference between post-test values of both groups (p<0.0001). However, the experimental group showed substantially greater statistical significance than the control group in terms of the decrease in pain levels and the increase in lumber ROM. Conclusion: The study concluded that intervention provided to the experimental group was more effective than intervention provided to the control group. [ABSTRACT FROM AUTHOR]

Study Design This study was designed as a randomized controlled trial. Purpose The present study aimed to determine the impact of neural mobilization by tensioner’s technique (NMTT) on the centralization of symptoms and pain in patients with cervicobrachial pain syndrome (CBPS). Overview of Literature CBPS is a disabling condition of the neck that is characterized by pain and paresthesia in the upper quarter. Several techniques have successfully provided immediate and long-term relief in CBPS; however, few studies have evaluated the effect of these techniques on the centralization of symptoms. Methods Thirty patients aged 18–45 years with a complaint of pain in the neck that had persisted for 2–12 weeks radiating to the arm and fulfilling Elvey’s criteria were randomly selected and divided into two groups. Group A received NMTT plus conventional treatment (hot pack and postural advice with cervical lateral glide), and group B received only conventional treatment 3 times a week for 2 weeks. The outcome measures were Wernicke’s scale score for the centralization of symptoms and Visual Analog Scale score for pain intensity. Within- and between-group comparisons were made before initiating treatment and at the end of the 3rd and 6th sessions. Within group analyses for the centralization values were performed using Friedmann test, and between-group analyses were performed using Mann-Whitney test. A 2×3 mixed model of the analysis of variance was used for analyzing the pain levels. Results There was a significant difference (p

Urge incontinence, often linked to prolapsed intervertebral disc (PIVD) due to nerve compression, involves sudden, involuntary urine leakage. Management includes behavioral therapy, bladder training, and pelvic floor muscle training (PFMT) to strengthen pelvic muscles and regulate voiding, effectively reducing symptoms and improving quality of life. A 40-year-old female patient presented with chief complaints of lower back pain radiating down the right lower limb below the knee, accompanied by a right-sided listing. Based on the McKenzie classification, she was diagnosed with McKenzie derangement VI, characterized by unilateral/asymmetrical pain across the L4-L5 region, radiating pain below the knee, and the presence of deformity, specifically trunk deviation away from the painful side that is the right side. Additionally, she reported experiencing urge urinary incontinence. Following surgery, she experienced significant reductions in pain and urinary incontinence, improved posture, and an enhanced quality of life. Surgical decompression and spinal fixation effectively alleviated neural compression and instability at the L4-L5 and L5-S1 levels. At the same time, the phased physiotherapy approach facilitated recovery through pain management, neuromuscular re-education, and functional restoration. Preoperative assessments such as the modified Schober's test, visual analogue scale (VAS), Revised Oswestry Disability Index (RODI), sciatica bothersome index, revised urinary incontinence scale (RUIS), and Michigan incontinence symptom index (MISI) were essential in guiding the rehabilitation process and measuring progress. The integration of these multidisciplinary interventions underscores the importance of a comprehensive treatment plan in achieving positive outcomes for PIVD, despite the potential for complications such as chronic pain and disability., Competing Interests: Human subjects: Consent was obtained or waived by all participants in this study. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, Kaur et al.)

Introduction: Disseminated herpes zoster is defined as at least 20 skin lesions in multiple dermatomes. In particular, it has been reported mainly in patients with immunological defects. To our knowledge, there is no reported case of disseminated zoster in a non-immunocompromised patient with leg radiating pain and weakness. Case presentation: A 74-year-old man visited our hospital with left leg radiating pain and left hip pain. He had no underlying disease other than hypertension. Neurologic examination revealed radiating pain on the L4 dermatome of the left leg. The muscle power was grade 3 for the hip flexor and knee extensor, and grade 4 for the ankle dorsiflexor and big toe dorsiflexor of the left leg. There were no sensory changes or skin lesions on his left leg. Herniation of the nucleus pulposus of the lumbar spine was suspected and lumbar magnetic resonance imaging (MRI) was performed. However, no pathologic lesions were seen on lumbar MRI. On the third day of hospitalization, erythematous patches and vesicles were observed on the head, face, ear, neck, trunk, back, and both lower extremities. Herpes zoster infection was confirmed by polymerase chain reaction analysis. Treatment was performed with 250 mg of intravenous acyclovir every 8 hours for 6 days and 62.5 mg of intravenous methylprednisolone for 4 days. On the 13th day of hospitalization, the skin lesions and left leg radiating pain and weakness improved. Conclusion: We report the first case of disseminated herpes zoster involving the whole body in a non-immunocompromised patient complaining of left leg radiating pain and weakness. After treatment, both the patient's radiating pain and weakness improved. [ABSTRACT FROM AUTHOR]

Abstract Background It has been suggested that radiating pain during spinal or epidural needle insertion and catheter placement can be an indicator of needle-related nerve injury. In this study, using a historical cohort, we investigated what factors could be associated with postoperative persistent paresthesia. In addition, we focused on radiating pain during epidural needle insertion and catheterization. Methods This was a retrospective review of an institutional registry containing 21,606 anesthesia cases. We conducted multivariate logistic analysis in 2736 patients, who underwent epidural anesthesia, using the incidence of postoperative persistent paresthesia as a dependent variable and other covariates, including items of the anesthesia registry and the postoperative questionnaire, as independent variables in order to investigate the factors that were significantly associated with the risk of persistent paresthesia. Results One hundred and seventy-six patients (6.44%) were found to have persistent paresthesia. Multivariate analysis revealed that surgical site at the extremities (odds ratio (OR), 12.5; 95% confidence interval (CI), 2.77–56.4; the reference was set at abdominal surgery), duration of general anesthesia (per 10 min) (OR, 1.02; 95% CI, 1.01–1.03), postoperative headache (OR, 1.78; 95% CI, 1.04–2.95), and days taken to visit the consultation clinic (OR, 1.03; 95% CI, 1.01–1.06) were independently associated with persistent paresthesia. Radiating pain was not significantly associated with persistent paresthesia (OR, 1.56; 95% CI, 0.69–3.54). Conclusion Radiating pain during epidural procedure was not statistically significantly associated with persistent paresthesia, which may imply that this radiating pain worked as a warning of nerve injury.

Jia Chen,1,2 Hai-Jian Ni,1,2 Fei Xue,3 Yun-Shan Fan,1,2 Xi-Fan Li,4 Xian-Zhen Chen,3 Shi-Sheng He1,2 1Department of Orthopaedics, Shanghai Tenth People’s Hospital, Tongji University School of Medicine, Shanghai, 200072, People’s Republic of China; 2Spinal Pain Research Institute, Tongji University School of Medicine, Shanghai, 200072, People’s Republic of China; 3Department of Neurosurgery, Shanghai Tenth People’s Hospital, Tongji University School of Medicine, Shanghai, 200072, People’s Republic of China; 4Department of Radiology, Shanghai Tenth People’s Hospital, Tongji University School of Medicine, Shanghai, 200072, People’s Republic of ChinaCorrespondence: Shi-Sheng HeSpinal Pain Research Institute, Tongji University School of Medicine, 301 Yanchang Middle Road, Jing’an District, Shanghai, 200072, People’s Republic of ChinaEmail tjhss7418@tongji.edu.cnXian-Zhen ChenDepartment of Neurosurgery, Shanghai Tenth People’s Hospital, Tongji University School of Medicine, 301 Yanchang Middle Road, Jing’an District, Shanghai, 200072, People’s Republic of ChinaEmail chenxianzheny@126.comBackground: Intradural disc herniation (IDH) is a rare type of disc degeneration that infrequently affects the upper lumbar spine. Pre- and intraoperative diagnosis and surgical management of IDH are challenging. The present case study provides insight into these aspects of upper lumbar IDH and discusses possible mechanisms.Case Description: A 63-year-old female with a history of chronic lower back and leg pain presented with an acute lumbar sprain that had occurred 1 month prior. The pain progressed and spread to the front of the left thigh, which affected her ability to lift her leg when ascending/descending stairs. Sagittal gadolinium-enhanced magnetic resonance imaging (MRI) revealed a disc protruding into the ventral dural sac showing a hawk-beak sign, and the posterior edge of the disc annulus and local posterior longitudinal ligament was broken. Total L2 laminectomy was performed, and the dorsal side of the dural sac was exposed and incised to enable exploration of the ventral side of the dura. We found two free fragments protruding into the inner wall of the dura through the left ventral dura mater defect. After carefully and completely removing the mass, we repaired the defect and performed internal fixation. Postoperative pathologic analysis confirmed that the mass was nucleus pulposus tissue from the degenerated disc. The patient’s pain significantly improved after surgery, and she was able to walk normally at the 1-month follow-up.Conclusion: Upper lumbar IDH is an extremely rare type of disc degeneration. An enhanced MRI scan can provide diagnostic evidence, but the final diagnosis requires surgical exploration of the path of herniation and pathologic examination of the mass lesion.Keywords: lower back pain, radiating pain, upper lumbar, intradural disc herniation, case report

Abstract Background Only low-quality evidence is currently available to support the effectiveness of different traction modalities in the treatment of lumbar radiculopathy (LR). Yet, traction is still very commonly used in clinical practice. Some authors have suggested that the subgroup of patients presenting signs and symptoms of nerve root compression and unresponsive to movements centralizing symptoms may benefit from lumbar traction. The aim of this study is to conduct a systematic review of randomized controlled trials (RCTs) on the effects of vertical traction (VT) on pain and activity limitation in patients affected by LR. Methods We searched the Cochrane Controlled Trials Register, PubMed, CINAHL, Scopus, ISI Web of Science and PEDro from their inception to March 31, 2019 to retrieve RCTs on adults with LR using VT to reduce pain and activity limitation. We considered only trials reporting complete data on outcomes. Two reviewers selected the studies, extracted the results, and performed the quality assessment using the Risk of Bias and GRADE tools. Results Three studies met the inclusion criteria. Meta-analysis was not possible due to the heterogeneity of the included studies. We found very low quality evidence for a large effect of VT added to bed rest when compared to bed rest alone (g = − 1.01; 95% CI = -2.00 to − 0.02). Similarly, VT added to medication may have a large effect on pain relief when compared to medication alone (g = − 1.13; 95% CI = -1.72 to − 0.54, low quality evidence). Effects of VT added to physical therapy on pain relief were very small when compared to physical therapy without VT (g = − 0.14; 95% CI = -1.03 to 0.76, low quality evidence). All reported effects concerned short-term effect up to 3 months post-intervention. Conclusions With respect to short-term effects, VT may have a positive effect on pain relief if added to medication or bed rest. Long-term effects of VT are currently unknown. Future higher quality research is very likely to have an important impact on our confidence in the estimate of effect and may change these conclusions.

Introduction: Teachers are more susceptible to neck and shoulder pain due to their daily tasks and regular employment, making it the most prevalent occupational health issue contributing to morbidity and absence among teachers globally. Neck and/or shoulder pain in working population such as in teachers is increasing day by day. Incidence of shoulder pain is 73.4% and neck pain is 68.9%. Aim: To find out the prevalence of neck and shoulder pain among the teaching professionals. Materials and Methods: A cross-sectional study was conducted in the Department of Physiotherapy, CSHS, Chitkara University, Punjab, India. Atotal of 207 educators teaching in colleges and universities completed a questionnaire. Sampling method used was convenient sampling method. The data collection was done using a questionnaire which was circulated through Google form. Results: Out of 207 subjects, 125 teaching professionals were found to have neck and shoulder pain. Among them, 57.1% females and 42.9% males of which, 48.3% reported neck pain, 21.3% radiating pain and 38.4% describe it as dull aching, whereas 39.6% reported shoulder pain. The screen usage per day: 79.7% reported >3 hours, 10.6% with 3 hours, 4.8% with 2 hours, and 4.8% with 0-1 hours. Conclusion: The incidence of neck pain and shoulder pain was found to be quite high among teaching professionals. They need to be administered regular postural advices so as to maximise their outputs. [ABSTRACT FROM AUTHOR]

BACKGROUND: Patients with lumbar disc herniation (LDH) may experience low back pain (LBP) and radiating pain (RP). Currently, there is no substantial clinical benefit (SCB) of assessing both LBP and RP due to LDH. OBJECTIVE: To determine enhanced SCB values by simultaneously assessing LBP and RP. METHODS: We retrospectively evaluated hospitalized LDH patients with concomitant LBP and RP between June 1, 2012, and May 31, 2013, and determined the numeric rating scale (NRS) and Oswestry Disability Index (ODI) scores at admission and discharge. Furthermore, the area under the receiver operating characteristic curve (AUC) was computed to assess diagnostic accuracy. RESULTS: SCB as per NRS for both LBP and RP was - 2.50 in the 186 enrolled patients (AUC: 0.699 and 0.704, respectively). SCB as per ODI was - 18.78 (AUC: 0.771). SCB for the mean of the two NRS scores for LBP and RP was - 2.75 (AUC: 0.757). SCB for NRS score with a larger change in LBP and RP was - 3.50 (AUC: 0.767). CONCLUSIONS: SCB may be determined by comprehensively considering LBP and RP and choosing the mean NRS or NRS score with a large change. [ABSTRACT FROM AUTHOR]

Study Design: This study was designed as a randomized controlled trial. Purpose: The present study aimed to determine the impact of neural mobilization by tensioner's technique (NMTT) on the centralization of symptoms and pain in patients with cervicobrachial pain syndrome (CBPS). Overview of Literature: CBPS is a disabling condition of the neck that is characterized by pain and paresthesia in the upper quarter. Several techniques have successfully provided immediate and long-term relief in CBPS; however, few studies have evaluated the effect of these techniques on the centralization of symptoms. Methods: Thirty patients aged 18-45 years with a complaint of pain in the neck that had persisted for 2-12 weeks radiating to the arm and fulfilling Elvey's criteria were randomly selected and divided into two groups. Group A received NMTT plus conventional treatment (hot pack and postural advice with cervical lateral glide), and group B received only conventional treatment 3 times a week for 2 weeks. The outcome measures were Wernicke's scale score for the centralization of symptoms and Visual Analog Scale score for pain intensity. Within- and between-group comparisons were made before initiating treatment and at the end of the 3rd and 6th sessions. Within group analyses for the centralization values were performed using Friedmann test, and between-group analyses were performed using Mann-Whitney test. A 2×3 mixed model of the analysis of variance was used for analyzing the pain levels. Results: There was a significant difference (p <0.05) within and between the groups for both the measures at the end of the 3rd and 6th sessions. Thus, NMTT may be beneficial in decreasing the peripheralization of symptoms and pain intensity in patients with CBPS. Conclusions: NMTT can be used as an alternative and effective treatment option for patients with CBPS. [ABSTRACT FROM AUTHOR]

Background: Only low-quality evidence is currently available to support the effectiveness of different traction modalities in the treatment of lumbar radiculopathy (LR). Yet, traction is still very commonly used in clinical practice. Some authors have suggested that the subgroup of patients presenting signs and symptoms of nerve root compression and unresponsive to movements centralizing symptoms may benefit from lumbar traction. The aim of this study is to conduct a systematic review of randomized controlled trials (RCTs) on the effects of vertical traction (VT) on pain and activity limitation in patients affected by LR. Methods: We searched the Cochrane Controlled Trials Register, PubMed, CINAHL, Scopus, ISI Web of Science and PEDro from their inception to March 31, 2019 to retrieve RCTs on adults with LR using VT to reduce pain and activity limitation. We considered only trials reporting complete data on outcomes. Two reviewers selected the studies, extracted the results, and performed the quality assessment using the Risk of Bias and GRADE tools. Results: Three studies met the inclusion criteria. Meta-analysis was not possible due to the heterogeneity of the included studies. We found very low quality evidence for a large effect of VT added to bed rest when compared to bed rest alone (g = − 1.01; 95% CI = -2.00 to − 0.02). Similarly, VT added to medication may have a large effect on pain relief when compared to medication alone (g = − 1.13; 95% CI = -1.72 to − 0.54, low quality evidence). Effects of VT added to physical therapy on pain relief were very small when compared to physical therapy without VT (g = − 0.14; 95% CI = -1.03 to 0.76, low quality evidence). All reported effects concerned short-term effect up to 3 months post-intervention. Conclusions: With respect to short-term effects, VT may have a positive effect on pain relief if added to medication or bed rest. Long-term effects of VT are currently unknown. Future higher quality research is very likely to have an important impact on our confidence in the estimate of effect and may change these conclusions. [ABSTRACT FROM AUTHOR]

Background : Sciatica, a pain radiating along the sciatic nerve, can cause significant suffering and functional limitations. Understanding individual populations' knowledge and attitudes about sciatica pain is crucial for designing targeted interventions and enhancing healthcare delivery, especially in Saudi Arabia. This study aimed to evaluate the knowledge and attitude toward sciatica pain and treatment methods among the population of Al-Qassim in Saudi Arabia. Methods and materials:This online cross-sectional study was conducted in the Al-Qassim region, Saudi Arabia, using a self-administered questionnaire. The data was analyzed using SPSS software, with numeric data presented as mean ± SD and categorical variables as frequencies and percentages. Correlation analyses included the Chi-squared test and one-way ANOVA. Results : The study received 398 responses, from mostly female (n=305, 76.6%) and Saudi adults aged under 30 (n=248, 62.3%). Most participants sought treatment for sciatica pain from a specialist doctor (n=28, 56.0%) or a general doctor (n=10, 20.0%). Physical therapy was the most common self-treatment method (n=11, 32.4%), followed by painkillers and muscle relaxants (n=10, 29.4%). Knowledge and attitude toward sciatica were generally low (mean score: 3.54 ± 2.61 out of 9), with only 70 (17.6%) showing good knowledge. Most respondents recognized practices like spinal imaging, surgery as a last resort, and exercise/sitting habits as impacting sciatica outcomes. Traditional therapies like massage, cupping, acupuncture, and cautery were considered beneficial. Educational level significantly impacted knowledge scores, with higher mean scores among postgraduate education holders and bachelor's degree holders (mean scores: 4.06 ± 2.48 and 3.98 ± 2.53, respectively). Age, gender, occupation, nationality, and region showed no significant differences in mean knowledge scores. Attitude scores were similar across sociodemographic spectra, with younger respondents having slightly more positive attitudes.  Conclusion : The study showed poor knowledge, influenced by education levels, and neutral attitudes about sciatica among residents of Al-Qassim. Therefore, educational programs and engagement of healthcare stakeholders are recommended to raise awareness and improve knowledge and attitudes., Competing Interests: Human subjects: Consent was obtained or waived by all participants in this study. The Buraydah Central Hospital Institutional Review Board issued approval Ref: H-04-Q-001. Animal subjects: All authors have confirmed that this study did not involve animal subjects or tissue. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, Alruwaysan et al.)

In Guillain-Barré syndrome, the body's immune system attacks part of the peripheral nervous system. We present a case series of four cases with different variants. Three cases have been diagnosed with nerve conduction studies, one case with positive lumbar puncture test with albumino-cytological dissociation. Each patient was treated with Intravenous Immunoglobulin (IVIG) and improved clinically. This series is being delivered in order to clinically inform individuals on the early diagnosis of GBS and its management. In Guillain-Barré syndrome, the body's immune system attacks part of the peripheral nervous system. We present a case series of four cases with different variants. Three cases have been diagnosed with nerve conduction studies, one case with positive lumbar puncture test with albumino-cytological dissociation. Each patient was treated with Intravenous Immunoglobulin (IVIG) and improved clinically. This series is being delivered in order to clinically inform individuals on the early diagnosis of GBS and its management. [ABSTRACT FROM AUTHOR]

Background: It has been suggested that radiating pain during spinal or epidural needle insertion and catheter placement can be an indicator of needle-related nerve injury. In this study, using a historical cohort, we investigated what factors could be associated with postoperative persistent paresthesia. In addition, we focused on radiating pain during epidural needle insertion and catheterization. Methods: This was a retrospective review of an institutional registry containing 21,606 anesthesia cases. We conducted multivariate logistic analysis in 2736 patients, who underwent epidural anesthesia, using the incidence of postoperative persistent paresthesia as a dependent variable and other covariates, including items of the anesthesia registry and the postoperative questionnaire, as independent variables in order to investigate the factors that were significantly associated with the risk of persistent paresthesia. Results: One hundred and seventy-six patients (6.44%) were found to have persistent paresthesia. Multivariate analysis revealed that surgical site at the extremities (odds ratio (OR), 12.5; 95% confidence interval (CI), 2.77–56.4; the reference was set at abdominal surgery), duration of general anesthesia (per 10 min) (OR, 1.02; 95% CI, 1.01–1.03), postoperative headache (OR, 1.78; 95% CI, 1.04–2.95), and days taken to visit the consultation clinic (OR, 1.03; 95% CI, 1.01–1.06) were independently associated with persistent paresthesia. Radiating pain was not significantly associated with persistent paresthesia (OR, 1.56; 95% CI, 0.69–3.54). Conclusion: Radiating pain during epidural procedure was not statistically significantly associated with persistent paresthesia, which may imply that this radiating pain worked as a warning of nerve injury. [ABSTRACT FROM AUTHOR]

Proprioceptive neuromuscular facilitation (PNF) stretching of the hamstrings improves flexibility but requires assistance from a clinician or partner. The original intent of our work was to assess the efficacy of self-assisted PNF hamstring stretching using a commercially available device. The authors observed improved flexibility in the stretched leg and, to a lesser extent, in the contralateral leg. While this was at first simply interesting, the finding became clinically relevant in the subsequent application in the care of a patient with low-back pain with radiating pain. This report provides study data and describes the translation of study findings into the care of a patient in a clinical setting. [ABSTRACT FROM AUTHOR]

Objective Lumbar radiculopathy (LR) is a pain syndrome caused by compression/irritation of the lumbar nerve root(s). Traction is a well-known and commonly used conservative treatment for LR, although its effectiveness is disputed. The purpose of this systematic review and meta-analysis of randomized controlled trials was to evaluate the effects of different types of traction added to or compared with conservative treatments on pain and disability. Methods Data were obtained from CENTRAL, PUBMED, CINAHL, Scopus, ISI Web of Science, and PEDro from their inception to April 2020. All randomized controlled trials on adults with LR, using mechanical traction, and without any restriction regarding publication time or language were considered. Two reviewers selected the studies, evaluated the quality assessment, and extracted the results. Meta-analysis used a random-effects model. Eight studies met the inclusion criteria, and 5 were meta-analyzed. Results Meta-analyses of results from low-quality studies indicated that supine mechanical traction added to physical therapist treatments had significant effects on pain (g = −0.58 [95% confidence interval = −0.87 to −0.29]) and disability (g = −0.78 [95% confidence interval = −1.45 to −0.11]). Analyses of results from high-quality studies of prone mechanical traction added to physical therapist intervention for pain and disability were not significant. These results were also evident at short-term follow-up (up to 3 months after intervention). Conclusion The literature suggests that, for pain and disability in LR, there is short-term effectiveness of supine mechanical traction when added to physical therapist intervention. Impact This systematic review may be relevant for clinical practice due to its external validity because the treatments and the outcome measures are very similar to those commonly used in a clinical context. [ABSTRACT FROM AUTHOR]

Objective: The purpose of this study was to investigate the methodology, interpretation, and perceived value of Spurling's test toward diagnosis/classification and treatment. Methods: An anonymous web-based survey was made available to physical therapist members of the Academy of Orthopaedic Physical Therapy of the American Physical Therapy Association. Based on video demonstrations of technique and symptom distribution, questions included preferred method, criteria for test interpretation, and perceived value of Spurling's test and other examination findings toward clinical decision-making. Professional profile data were also collected. Results: Among the 452 participants completing the survey, no method of testing was preferred by more than 37%, with ipsilateral lateral flexion, rotation, and extension with compression being most frequently preferred followed by ipsilateral lateral flexion with compression at 32%. Proximal provocation of symptoms only without distal symptoms was interpreted as a positive test by 67%. Participants rated Spurling's test of moderate to low value toward diagnosis/classification and treatment. Discussion: Inconsistency with methodology and interpretation of Spurling's test is suggested to be pervasive in physical therapist practice. While an optimal test methodology has yet to be identified, result interpretation does have a basis for clarification toward diagnosis/classification and reduction of unwanted variance in practice. [ABSTRACT FROM AUTHOR]

Patients with radicular low back pain (radicular LBP, sciatica) frequently describe their pain as "shooting" or "radiating." The dictionary meaning of these words implies rapid movement, and indeed, many sufferers report feeling pain moving rapidly from the lower back or buttock into the leg. But, others do not. Moreover, the sensation of movement is paradoxical; it is neither predicted nor accounted for by current ideas about the pathophysiology of radicular LBP. We have used a structured questionnaire to evaluate the sensory qualities associated with "shooting" and "radiating" in 155 patients, 98 with radicular LBP and 57 with trigeminal neuralgia, a second chronic pain condition in which shooting/radiating are experienced. Results indicated a spectrum of different sensations in different people. Although many sciatica patients reported rapid downward movement of their pain, even more reported downward expansion of the area of pain, some reported upward movement, and for some, there was no spatial dynamic at all. The velocity of movement or expansion was also variable. By cross-referencing sensations experienced in the sciatica and trigeminal neuralgia cohorts with known signal processing modes in the somatosensory system, we propose testable hypotheses concerning the pathophysiology of the various vectorial sensations reported, their direction and velocity, and the structures in which they are generated. Systematic evaluation of qualitative features of "shooting" and "radiating" pain at the time of diagnosis can shed light on the pain mechanism in the individual patient and perhaps contribute to a better therapeutic outcomes. [ABSTRACT FROM AUTHOR]

Introduction: Cervical radiculopathy is one of those disabling conditions which results in central and peripheral pain and thus affects the quality of life. Transcutaneous Electrical Nerve Stimulation (TENS) and exercises produce analgesic effect but their long-term effect has not been available to date. Transcranial Direct Current stimulation (tDCS) is known to produce promising effects on central pain by targeting cortical activity., Purpose: To determine the combined effect of tDCS and TENS with exercises on pain and quality of life in patients with cervical radiculopathy., Method: Forty four patients (male: female = 26:18) of the age group 18-50 years were recruited and randomly allocated into the experimental group and control group. The experimental group received active anodal tDCS for 20 min with an intensity of 2 mA, while the control group received sham anodal tDCS. TENS over the pain distribution area for 20 min with 5 Hz intensity and 80-150 ms pulse duration followed by neck-specific exercises were given in both groups. This protocol was given 5 days a week for 4 weeks. Pre and post-assessments were obtained through outcome measures that the Numeric Pain Rating Scale and Neck Disability Index for the measurement of pain, functional disability, and quality of life., Result: Paired t-test/Wilcoxon-Signed Rank test, and Index and Mann-Whitney U test were used to compare the demographic variables within and across the groups, respectively for Neck Disability for Numeric Pain Rating Scale, keeping the P -value < 0.05 as significant. One-way repeated-measures analysis of variance (ANOVA) was applied to determine the between-subject factor differences. Post hoc tests with Bonferroni correction for repeated analyses were performed. Results depicted a significant effect for NDI ( P  = 0.001 for both groups) and NPRS ( P  = 0.003 for the experimental group and 0.007 for the control group). Significant Interaction effect (time*group) was observed for NDI (F = 42, 5382.77) and NPRS (F = 42, 1844.57) with a P -value of 0.001 for both outcome measures. Clinical significance was observed for both outcome measures having a mean difference in 50.21 and 4.57 for NDI and NPRS, respectively compared with the established MCID of 13.2 and 2.2 scores for respective outcome measures., Conclusion: It was concluded that active tDCS along with TENS and exercise intervention was effective on pain, disability, and quality of life in patients with cervical radiculopathy.

Background: The pattern of linear graph schematized by visual analogue scale (VAS) score displaying pain worsening between 2 days and 2 weeks after selective nerve root block (SNRB) is called rebound pain.Purpose: The purpose of this study was to determine if sodium hyaluronate and carboxymethyl cellulose solution (HA-CMC sol) injection could reduce the occurrence of rebound pain at 3 days to 2 weeks after SNRB in patients with radiculopathy compared with injection with corticosteroids and local anesthetics alone.Study Design/setting: Double blinded randomized controlled clinical trial.Patient Sample: A total of 44 patients (23 of 24 patients in the Guardix group and 21 of 24 patients in the control group) who finished the follow-up session were subjects of this study.Outcome Measurement: Patients were asked to write down their average VAS pain scores daily for 12 weeks. Functional outcomes were assessed by Oswestry Disability Index, Roland Morris Disability Questionnaire , and Short Form-36.Method: A cocktail of corticosteroids, 1% lidocaine, 0.5% Bupivacaine, and 1 mL of normal saline was used for the control group whereas a cocktail of corticosteroids, 1% lidocaine, 0.5% Bupivacaine, and 1 mL of HA-CMC solution was used for the G group. Study participants were randomized into one of two treatment regimens. They were followed up for 3 months.Results: VAS score at 2 weeks after the procedure was 4.19±1.32 in the control group, which was significantly (p<.05) higher than that (2.43±1.24) in the G group. VAS score at 6 weeks after the procedure was 4.00±1.23 in the control group and 3.22±1.45 in the G group, showing no significant (p=.077) difference between the two groups. There were no significant differences in functional outcomes at 6 or 12 weeks after the procedure.Conclusions: Compared with conventional cocktail used for SNRB, addition of HA-CMC sol showed effective control of rebound pain at 3 days to 2 weeks after the procedure. [ABSTRACT FROM AUTHOR]

Pathology of the lumbar spine and hip joint can commonly coexist in the elderly. Anterior and lateral leg pain as symptoms of hip osteoarthritis and spinal stenosis can closely resemble each other, with only subtle differences in both history and physical examinations. It is not easy to identify the origin of this kind of hip pain. The possibility of hip osteoarthritis should not be underestimated, as this could lead to an incorrect diagnosis and inappropriate spinal surgery. We report the case of a 54-year-old female with chronic right anterior and lateral leg pain who did not respond to repeated spinal blocks based on lumbar MRI, but in whom hip osteoarthritis was considered since severe atrophy of the ipsilateral psoas muscle was identified. We suggest that severe psoas muscle atrophy can be a clinical clue to identify hip osteoarthritis and is related to lower extremity pain, even if there is a coexisting lumbar spine pathology.

Background Context: Percutaneous endoscopic lumbar discectomy (PELD) is one of minimally invasive techniques to treat patients with low back and radiating pain resulting from lumbosacral disc herniation (LDH).Purpose: The purpose of this study is to evaluate the clinical efficacy of PELD to treat patients with low back and radicular pain due to LDH and to investigate which clinical and radiological variables have the ability to predict clinical outcome after PELD.Study Design/setting: This is a retrospective study design carried out at a spine hospital.Patient Sample: The sample comprised 75 patients who had undergone PELD for treatment of low back and radiating leg pain resulting from LDH and who could be followed up for at least 12 months.Outcomes Measures: Clinical outcomes were assessed using numeric rating scale for back and radiating leg pain (NRS back and leg), Oswestry Disability Index (ODI), and modified MacNab criteria at 1 month (short-term follow-up) and at least 12 months (long-term follow-up) after PELD.Methods: The patients were divided into successful and unsuccessful outcome groups according to improvement of NRS back, NRS leg, and ODI (%) at long-term follow-up period. We compared the various clinical and radiological variables between the two groups to identify which variables could be the prognostic factors of clinical outcomes of PELD. This analysis was performed in terms of whole population, the subgroup of dominant back pain, and the subgroup of dominant leg pain, respectively.Results: Significant improvements were observed in NRS back, NRS leg, ODI (%), and modified MacNab criteria at short-term and long-term follow-up after PELD. Positive straight leg raising (SLR) was significantly related to successful outcome as to NRS leg and ODI (%), and longer pain duration also showed significant relationship with unsuccessful outcomes as to NRS leg in whole population. Positive SLR had significant relationship with successful NRS leg as well as successful ODI (%) in the subgroup of dominant leg pain.Conclusions: PELD was an effective treatment in patients with back and leg pain due to LDH. Positive SLR had the predictive ability to successful reduction of radiating leg pain and successful functional improvement. Longer pain duration was also related to unsuccessful reduction of radiating leg pain. [ABSTRACT FROM AUTHOR]

Background: Patients with lumbar disc herniation are treated with physiotherapy/medication and some with surgery. However, even after technically successful surgery some develop a failed back syndrome with persistent pain. Our aim was to evaluate the efficacy of epiduroscopy in patients who suffer chronic low back pain and/or radicular pain with or without surgery and the gender difference in outcome. Methods: A total of 88 patients were included with a mean age of 52 years (27-82), 54 women and 34 men. 66 of them were operated previously and 22 were non-operated. They all had persistent chronic back pain and radicular pain despite of medication and physical rehabilitation. Visual Analog Scale (VAS) for pain and Oswestry Disability Index (ODI) were evaluated preoperatively, after one month, six months and one-year after the epiduroscopy. Results: All patients, and also the subgroups (gender and operated/non-operated) improved significantly in pain (VAS) and disability (ODI) at one month. A significant improvement was also seen at one year. No differences were found between men and woman at the different follow-up times. A slight worsening in VAS and ODI was noticed over time except for the non-operated group. Conclusions: Epiduroscopy helps to improve the back and leg pain due to lumbar disc herniation in the early stage. At one year an improvement still exists, and the non-operated group seems to benefit most of the procedure. [ABSTRACT FROM AUTHOR]

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We have previously shown that nerve inflammation (neuritis) and transient vinblastine application lead to axonal mechanical sensitivity in nociceptors innervating deep structures. We also have shown that these treatments reduce axonal transport and have proposed that this leads to functional accumulation of mechanically sensitive channels in the affected part of the axons. Though informing the etiology of mechanically induced pain, axonal mechanical sensitivity does not address the common report of ongoing radiating pain during neuritis, which could be secondary to the provocation of axonal chemical sensitivity. We proposed that neuritis and vinblastine application would induce sensitivities to noxious chemicals and that the number of chemo-sensitive channels would be increased at the affected site. In adult female rats, nerves were either untreated or treated with complete Freund’s adjuvant (to induce neuritis) or vinblastine. After 3–7 days, dorsal root teased fiber recordings were taken from group IV neurons with axons within the sciatic nerve. Sciatic nerves were injected intraneurally with a combination of noxious inflammatory chemicals. Whereas no normal sciatic axons responded to this stimulus, 80% and 38% of axons responded in the neuritis and vinblastine groups, respectively. In separate experiments, sciatic nerves were partially ligated and treated with complete Freund’s adjuvant or vinblastine (with controls), and after 3–5 days were immunolabeled for the histamine H3 receptor. The results support that both neuritis and vinblastine treatment reduce transport of the histamine H3 receptor. The finding that nociceptor axons can develop ectopic chemical sensitivity is consistent with ongoing radiating pain due to nerve inflammation. NEW & NOTEWORTHY Many patients suffer ongoing pain with no local pathology or apparent nerve injury. We show that nerve inflammation and transient application of vinblastine induce sensitivity of group IV nociceptor axons to a mixture of endogenous inflammatory chemicals. We also show that the same conditions reduce the axonal transport of the histamine H3 receptor. The results provide a mechanism for ongoing nociception from focal nerve inflammation or pressure without overt nerve damage. [ABSTRACT FROM AUTHOR]

Introduction Selective nerve root block (SNRB) is a valuable diagnostic and therapeutic tool. In some cases, intra-nerve root puncture is difficult and time-consuming, and radiation exposure time for the surgeon may be prolonged. The aim of this study is to examine the contrast findings, fluoroscopic time, and outcomes of SNRB. Methods A total of 139 cases of SNRB were included in the study. We investigated radiating pain presence, duration of fluoroscopic time, contrast types for nerve roots, and SNRB outcomes. Contrast patterns of nerve roots were categorized into three types, which were: type 1: the presence of contrast along the nerve roots; type 2: the presence of contrast within the intravertebral foramen but not in the nerve root; and type 3: the absence of both nerve root and intravertebral foramen contrast. Results The mean fluoroscopic time was 12.8 ± 15.3 seconds for type 1, 11.1 ± 8.9 seconds for type 2, and 23.6 ± 18.8 seconds for type 3. Statistically significant differences were found between the three groups (p = 0.007), and subsequent multiple comparisons showed significant differences between type 1 and type 2 (p = 0.010) and between type 2 and type 3 (p = 0.015). The visual analog scale (VAS) score before and 30 minutes after SNRB demonstrated a significant improvement in all patients. The mean change in VAS before and after nerve root block was 49.6 ± 21.7 mm for type 1 cases, 49.8 ± 25.2 mm for type 2 cases, and 37.8 ± 23.6 mm for type 3 cases, with no statistically significant difference between the three groups (p = 0.090). The proportion of patients with subjective symptomatic improvement before and after SNRB was 91.3% in type 1 cases, 88.5% in type 2 cases, and 85.7% in type 3 cases, with no statistically significant difference between the three groups (p = 0.641). Conclusions The above findings indicate that type 3 is beneficial for both diagnostic and therapeutic purposes., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2023, Serikyaku et al.)

Objective : The aim of this study is to investigate if Sweet Bee Venom therapy has the equal effect in comparison with Bee Venom Therapy on Low back pain with Radiation pain. Methods : Clinical studies were done 24 patients who were treated low back pain with radiation pain to Dept. of Acupuncture & Moxibusition, of Oriental Medicine Se-Myung University from April 1, 2007 to September 30, 2007. Subjects were randomly divided into two groups ; Bee Venom treated group(Group A, n=10), Sweet Bee Venom treatred group(Group B, n=14). In Bee Venom treated group(Group A), we treated patients with dry needle acupuncture and Bee Venom therapy. In Sweet Bee Venom treatred group(Group B), we treated patients with dry needle acupuncture and Sweet Bee Venom therapy. All process of treatment were performed by double blinding method. To estimate the efficacy of controlling pain. we checked Visual Analog Scale(VAS). For evaluating functional change of patients, Straight Leg Raising Test(S.L.R.T) was measured. Results :1. In controlling pain, Sweet Bee Venom treatred group(Group B) had similar ability in comparison with Bee Venom treated group(Group A). 2. In promoting function, Sweet Bee Venom treatred group(Group B) had similar ability in comparison with Bee Venom treated group(Group A). Conclusions : It may be equal effects as compared with using Bee Venom to treat low back pain with radiation pain using Sweet Bee Venom. We can try to treat other disease known to have effect with Bee Venom.

The aim of this study is to evaluate the effect of acupotomy for treating patients with a herniated intervertebral disc (HIVD). This case series includes five HIVD patients who were treated at the Department of Acupuncture and Moxibustion, Daejeon University Dunsan Korean Hospital, Daejeon, Korea, from January 2015 to April 2015. Acupotomy was performed three times over a 2-week period, along with Korean medical treatment. The outcomes were evaluated by using a numeric rating scale (NRS), physical examination, the Oswestry Low Back Pain Disability Index (ODI), the Short-Form 36-Item Health Survey (SF-36), and the Surgical Safety Checklist. The NRS and physical examination results, as well as the ODI scores, were improved in all cases. No significant differences were noted on the SF-36. No patients had any adverse effects. This study, with its findings of encouraging responses in reducing low back pain and radiating pain and in recovering the kinetic state of soft tissue, supports the potential use of acupotomy for the treatment of patients suffering from HIVD. [ABSTRACT FROM AUTHOR]

Background: Lumbar transforaminal epidural injection (TFEI) effectively decreases low back pain and radicular pain in herniated intervertebral disc (HIVD) and spinal stenosis (SS). The precise delivery of drugs to the target is important for pain control and minimizing complications., Objectives: We aimed to evaluate the efficacy and complications of the subpedicular (SP) and retrodiscal (RD) approaches by analysis of contrast spread patterns into the pathologic target on the basis of a newly established specific criterion. We also investigated whether the severity of patients' spinal disease influenced this pattern., Study Design: A prospective, randomized, observational study., Setting: Interventional pain management center at a university-affiliated hospital., Methods: Among patients who showed lumbar spinal stenosis or HIVD at the L4/5 level, participants were randomly assigned to undergo TFEI with the SP approach (SP group) or RD approach (RD group). Pain relief in terms of the visual analog scale (VAS) score and complications such as intravascular or intradiscal uptake were also analyzed. The contrast image was analyzed as the contrast media was injected, starting from 0.5 mL up to 3.0 mL. The spread patterns of contrast media were graded into 4 categories, which were newly defined in this study., Results: Both groups demonstrated a significant decrease in pain relief (P value < 0.01) at 2 and 4 weeks after the procedures, but no significant difference was found between the 2 groups. In the intergroup analysis between the RD and SP groups, with a 1.5-mL contrast media injection, more patients in the RD group (17.2%) showed a grade 3 spread than those in the SP group (8.2%). In the subgroup analysis, the RD group showed superior spread (more grade 3 and 4) with 1.5-, 2-, and 2.5-mL contrast media injections (P values = 0.02, 0.03, and 0.04) in severe central stenosis, and 1.5- and 2-mL contrast media injections (P values = 0.01, 0.02) in severe foraminal stenosis., Limitations: The follow-up period was only 4 weeks after TFESI, and higher contrast injection was used for procedures., Conclusions: The RD approach for TFEI showed a better contrast spreading pattern than the SP approach, especially in patients with severe central and foraminal spinal stenosis. The RD approach might be more beneficial for patients with severe central and foraminal spinal stenosis in the short-term follow-up.

Objective The aim of this study was to evaluate the significance of diagnostic markers obtained through epiduroscopy by evaluating the accuracy of outcome prediction after treatment of epidural pathology using epiduroscopy. Design A prospective observational study of 139 patients was performed. Patients with chronic low back and leg pain were included. Of the 150 patients who underwent epiduroscopy in the year 2008 at a US hospital, 139 were available for evaluation at 1 month. Study Outcome of treatment was predicted based on direct visual information (hyperemia, vascularity, and fibrosis) and mechanical information (pain to touch, contrast spread, and patency) obtained through epiduroscopy. Main Outcome Measures Outcome of treatment was measured at 1 month. Accuracy of prediction of outcome was calculated using contingency tables and odds ratios. Results A prediction of outcome was made in 114 of 139 patients (82%). This prediction was correct in 89 of these 114 patients (accuracy of 78%). The sensitivity and specificity of epiduroscopy with respect to the prediction of outcome were 75% and 82%, respectively. These results were statistically significant ( P < 0.01). In 25 of the 139 patients (18%), discrete epidural pathology was not observed. Nine of these 25 patients reported good relief after epiduroscopy. The sensitivity and specificity of epiduroscopy in the diagnosis of epidural pathology were 91% and 39%, respectively. These results were not statistically different ( P > 0.1). Conclusion Our results show that lumbosacral epiduroscopy predicts outcome of treatment accurately in the majority of patients. This suggests that information obtained through epiduroscopy may carry significant diagnostic and prognostic value. [ABSTRACT FROM AUTHOR]

Background: The precise localization of painful structures in the spine of patients with low back pain and/or pain radiating (LBP/RP) to the lower extremities is important for targeted therapeutic intervention. The aim of the study reported here was to determine and compare the spinal segment(s) where pain was elicited via endoscopic evaluation vs. the vertebral level from where the pain was thought to originate as determined by clinical evaluation and by MRI. Methods: Observational cohort study of 143 patients 19 to 88 years of age undergoing spinal canal endoscopy (epiduroscopy) in a combined academic and private practice setting January 2008 to December 2008. Patients were asked whether pain generated by pressure upon epidural structures with the tip of an endoscope was similar in character and distribution (concordant) to the pain for which patients sought treatment. Notes from clinical evaluation and MRI reports were reviewed, and segmental level determined to be the locus of pathology was tabulated. Results: One hundred twenty-five (87%) patients reported maximal reproducible pain at a specific level during epiduroscopy. The most common level was at L4 to L5 (87 patients). The least common level was L5 to S1 (2 patients). In only 40 patients did the level determined by clinical evaluation correlate with the level at which pain could be reproduced during epiduroscopy. MRI indicated a specific vertebral level that corresponded to the level at which pain could be reproduced during epiduroscopy in 28 of 143 (20%) patients. The results of the 3 diagnostic methods were significantly different ( P < 0.01). Conclusion: Results of this study indicate that epiduroscopy is more reliable than is either clinical evaluation or MRI for determining the vertebral level where clinically significant spinal pathology occurs in patients with LBP/RP. [ABSTRACT FROM AUTHOR]

The article investigates whether radiating spinal pain from the low back, mid back, and neck is related to future use of health-related benefits and their duration versus those with nonradiating spinal pain. Results reveal that the incidence of sickness benefit was greater for those with radiating spinal pain compared with those with nonradiating spinal pain. However, the duration of time off work was the same between those with and without radiating spinal pain.

Objective: To assess treatment with the 5% lidocaine medicated plaster for peripheral neuropathic pain after disk herniation. Study design: Case series, single center, retrospective data. Patients and methods: Data of 23 patients treated for neuropathic pain with the lidocaine plaster for up to 24 months after a protrusion or prolapse of the cervical, thoracic, or lumbar vertebral disks were retrospectively analyzed. Changes in overall pain intensity, in intensity of different pain qualities and of allodynia and hyperalgesia were evaluated. Results: Patients (14 female/nine male, mean age 53.5 ± 10.4 years) presented with radiating pain into the abdomen, back, neck, shoulder, or legs and feet with a mean pain intensity of 8.3 ± 1.5 on the 11-point Likert scale. Mean treatment duration was 7.6 months; 52% of the patients received lidocaine plaster as monotherapy. At the end of the observation, mean overall pain intensity had been reduced to 3.1 ± 1.8. All other parameters also improved. The treatment was well tolerated. Conclusion: These results point to a safe and effective treatment approach with 5% lidocaine medicated plaster for localized neuropathic pain related to disk herniation. However, owing to the small sample size, further investigation in a larger-scale controlled trial is warranted. [ABSTRACT FROM AUTHOR]

Abstract: Little is known about the relationships of clinical findings in the low back with low back pain (LBP) in the normal working population. We studied whether physiotherapist’s findings in the low back were associated with local and radiating LBP among a cohort (n =902) of employees in the engineering industry. A systematic non-proportional sample was drawn in strata by age, gender, and occupational class. The non-proportionality aimed at increasing sample size in smaller strata. Physiotherapists performed the straight-leg raising test (SRL), and made assessments of the fingertip-to-floor distance and pain in palpation of the lumbar interspinous spaces. The variables on pain at the interspinous spaces and the SRL tests were entered in cluster analysis. Three clusters emerged: no, minor, and severe clinical findings. In logistic regression analysis at baseline, limited forward flexion and the clinical findings cluster variable were associated with local and, particularly, radiating LBP. Follow-ups of the occurrence of local and radiating LBP at 5, 10, and 28years from baseline were made. At the 5-year follow-up among subjects with no radiating LBP at baseline, the OR of radiating LBP for the clusters of minor and severe clinical findings compared to no findings were 2.7 (95% CI 1.4–5.1) and 3.8 (2.0–6.9), respectively, adjusted for age, gender, and occupational class. At the 10-year follow-up, the latter cluster predicted new reports of radiating LBP (1.9; 1.0–3.1) and of local LBP (4.1; 1.9–9.0, among subjects with no local LBP at baseline), similarly adjusted. No associations between limited forward flexion and new cases of LBP were observed. Thus, membership in clusters with different levels of findings in simple clinical measurements predicted new reports of radiating LBP, in particular, among employees. The generalizability of the results may be limited due to the characteristics of the sampling. [Copyright &y& Elsevier]

The purpose of this study was to investigate the existence of neck pain and arm pain among professional forest machine drivers and to find out if pain were related to their whole-body vibration (WBV) exposure. A self-administered questionnaire was sent to 529 forest machine drivers in northern Sweden and the response was 63%. Two pain groups were formed; 1) neck pain; 2) neck pain combined with arm pain. From WBV exposure data (recent measurements made according to ISO 2631-1, available information from reports) and from the self-administered questionnaire, 14 various WBV exposure/dose measures were calculated for each driver. The prevalence of neck pain reported both for the previous 12 months and for the previous 7 d was 34% and more than half of them reported neck pain combined with pain in one or both arms. Analysis showed no significant association between neck pain and high WBV exposure; however, cases with neck pain more often experienced shocks and jolts in the vehicle as uncomfortable. There was no significant association between the 14 WBV measures and type of neck pain (neck pain vs. neck pain combined with arm pain). It seems as if characteristics of WBV exposure can explain neither existence nor the type of neck pain amongst professional drivers of forest machines. The logging industry is important for several industrialised countries. Drivers of forest machines frequently report neuromusculoskeletal pain from the neck. The type of neck pain is important for the decision of treatment modality and may be associated with exposure characteristics at work. [ABSTRACT FROM AUTHOR]

Abstract: Immune-mediated nerve inflammation is involved in many painful states in humans, and causes axonal and behavioral changes in rats. While models of nerve inflammation have been characterized using electrophysiological and behavioral methods, the presence of immune cells has not been fully assessed. We inflamed rat sciatic nerves using complete Freund''s adjuvant and quantified the presence of ED-1 macrophages and TCR-αβ T-cells for up to 12 weeks. We report that these immune cells are prominent extraneurally up to 12 weeks following the induction of inflammation. This observation does not easily correlate with inflammation-induced axonal mechanical sensitivity, which peaks within 1 week and is resolved after 8 weeks. [Copyright &y& Elsevier]

The article presents a study on the effects of intramuscular oxygen therapy on patients suffering from acute back pain associated with lumbar herniation. It is conducted through multicenter randomized simulated therapy-controlled trial with the use of oxygen-ozone mixture. The tests were conducted to 60 patients suffering from acute low back pain (LBP) and were observed to assess such as the pain intensity. Findings show that the mixture seem to effectively and safely relieve pain.

Abstract: Low back pain (LBP) and neck pain (NP) are common among the adult population but relatively few reports exist on the associations between these. We examined cross-sectional and prospective relationships of LBP with NP in an employee cohort studied repeatedly over 28 years. Locally perceived pain was studied separately from pain with a radiating component. At baseline, adjusted for age, gender, and occupational class, the prevalence ratio (PR) of local NP for those with local LBP was 1.93 (95% CI 1.47–2.54), and for those with radiating LBP 2.16 (1.59–2.94), while the PR of radiating NP for those with local LBP was 1.51 (0.97–2.35) and for those with radiating LBP 3.24 (2.25–4.65). These associations remained stable at the 5-, 10-, and 28-year follow-ups. Both local and radiating LBP at baseline predicted new cases of radiating NP at the 5- and 10-year follow-ups, but not at the 28-year follow-up. In analyses stratified by gender, both the cross-sectional and prospective associations were more pronounced in men. In conclusion, the study showed a clear association of LBP with NP that persisted on a similar level irrespective of the aging of the cohort. Particularly, radiating LBP was associated with radiating NP. The prospective associations of LBP at baseline with new reports of radiating NP decreased as the length of follow-up increased. [Copyright &y& Elsevier]