Impaired neck motor function and pronounced pain-related fear in helicopter pilots with neck pain - a clinical approach.

There is recognition that neck pain is a significant clinical problem in military aviation. In the present trial, the objectives were to explore neck motor function and pain-related fear in pilots with differing progression of neck pain. Seventy-two military helicopter pilots were enrolled: 20 had acute ongoing neck pain, 27 had subacute pain, and 25 were pain-free controls. Neck-flexor electromyography activity (root-mean-square) during staged active craniocervical flexion, median power frequency during sustained neck-flexor contraction, cervical range of motion, rating of perceived exertion after sustained flexor contraction, and rated fear-avoidance beliefs about physical activity were estimated. Main effects emerged for flexor activity, fear-avoidance and range of motion, but not for median frequency variables or perceived exertion. Post hoc testing showed that, compared to controls, both pain groups had greater flexor activity at higher stages of craniocervical flexion while the acute group had higher fear-avoidance and less range of motion in axial rotation and flexion-extension, all P<0.01. Discriminant regression revealed a sensitivity/specificity of 87%/71% (neck-pain/controls), with the flexor activity superior. The results indicate that altered neuromotor synergies are present at different progressions of pain. The tracing of such aberrant activity and fear-avoidance beliefs is suggested in future screening and neck intervention research.     

Spatial distribution of erector spinae activity is related to task-specific pain-related fear during a repetitive object lifting task

Fear-avoidance beliefs, particularly the fear of lifting with a flexed spine, are associated with reduced spinal motion during object lifting. Low back pain patients thereby also showed potentially clinically relevant changes in the spatial distribution of back muscle activity, but it remains unknown whether such associations are also present in pain-free individuals. This cross-sectional observational study investigated the relationship between fear-avoidance beliefs and the spatial distribution of lumbar paraspinal muscle activity in pain-free individuals during a repetitive lifting task. Thirty participants completed two pain-related fear questionnaires and performed 25 repetitions of lifting a 5 kg-box from a lower to an upper shelf and back, while multi-channel electromyographic signals were recorded bilaterally from the lumbar erector spinae muscles. Changes in spatial distribution were defined as the differences in vertical position of the weighted centroids of muscle activity (centroid shift) between the first and last few repetitions. Linear regression analyses were performed to examine the relationships between centroid shift and fear-avoidance belief scores. Fear of lifting an object with a flexed spine was negatively associated with erector spinae activity centroid shift (R² adj. = 0.1832; p = 0.045), which might be an expression of behavioral alterations to prevent the back from possible harm.     

O型臂引导下经皮椎间孔镜治疗腰椎间盘突出症

目的:总结O型臂引导下经皮椎间孔镜治疗腰椎间盘突出症术后疗效。方法:回顾性分析77例采用侧入路椎间孔镜技术治疗腰椎间盘突出症患者的临床资料,采用视觉模拟评分法(visual analogue score,VAS)及Oswestry功能障碍指数(Oswestry disability index,ODI)评估术后疼痛、功能改善等。结果:患者术前VAS7.5±1.2,ODI(%)62.7±16.0,术后6个月VAS1.6±1.9,ODI(%)32.1±24.3,治疗效果明显,且无严重并发症,少数短期并发症可恢复。结论:O型臂引导下经皮椎间孔镜是治疗腰椎间盘突出症安全、有效的微创手术方式。     

术前量化训练方法对腰椎间盘突出患者术后锻炼依从性及康复效果的影响

目的：探讨术前量化训练方法对腰椎间盘突出患者术后锻炼依从性及康复效果的影响。方法：将84 例腰椎间盘突出患者随 机分为观察组及对照组各42 例,对照组围手术期间实施常规性护理,观察组围手术期间实施术前量化训练,对比分析两组患者 负性情绪、术后锻炼依从性及康复情况。结果：观察组干预后汉密尔顿焦虑量表（HAMA）评分、汉密尔顿抑郁量表（HAMD）评分 低于对照组（P<0.05）。观察组术后锻炼依从率、满意率高于对照组（P<0.05）,而并发症发生率低于对照组(P<0.05)。观察组术后疼 痛评分低于对照组（P<0.05）,观察组术后下床活动时间及平均住院时间短于对照组（P<0.05）。结论：对腰椎间盘突出患者术前进 行适应手术训练可有效改善患者负性情绪,提高患者术后锻炼依从性,有利于患者术后康复,提高患者康复效果。     

An inhibin B and estrogen-secreting adrenocortical carcinoma leading to selective FSH suppression

OBJECTIVE: Hormone-secreting adrenocortical tumors are frequently associated with endocrine syndromes. We describe a 30-year-old man who had abdominal pain, a nodule in the right breast and loss of libido. Abdominal magnetic resonance imaging revealed a very large tumor in the right adrenal gland. METHODS: Hormonal profile disclosed increased levels of estradiol and slightly low testosterone levels. The basal and stimulated LH levels were normal, whereas basal and stimulated FSH levels were totally suppressed. Cortisol and adrenal androgen levels were normal. The unusual finding of selective FSH suppression suggested secretion of inhibin B by the adrenocortical tumor. A very high level of serum inhibin B (405 pg/ml) was demonstrated by ELISA assay. Right adrenalectomy and nephrectomy were performed and the tumor was classified as a malignant tumor (Weiss score: 7.0) and unilateral mastectomy disclosed a lipoma. RESULTS: One week after surgery, a GnRH-stimulation test disclosed normal basal and stimulated FSH levels and low levels of inhibin B and estradiol. Immunohistochemical analysis with anti-B-inhibin antibody revealed intense staining in the adrenocortical tumor cells. One month after surgery, an abdominal magnetic resonance imaging revealed a local recurrence of the tumor and a second surgery was performed with partial resection of the tumor and the patient died 1 year after the first surgery. CONCLUSION: We herein report the first inhibin B and estradiol-secreting adrenocortical carcinoma. The unusual selective inhibition of FSH secretion should be considered a valuable hormonal finding for the diagnosis of inhibin B-secreting adrenocortical tumors.     

不同手术方式对腰椎间盘突出症治疗的效果比较分析

目的:探讨应用微创技术治疗腰椎间盘突出症的疗效.方法:对我院脊柱骨科自2005年l1月～2010年10月收治的128例腰椎间盘突出症患者应用不同手术方式进行治疗,其中应用APLD( automated percutaneous lumbar discectomy)治疗单纯腰椎间盘突出症48例;应用MED(microendoscopic discectomy)治疗复杂型腰椎间盘突出症42例;应用传统后路椎板开窗技术治疗单纯腰椎间盘突出症38例;比较各组手术时间、术中出血、术后住院时间、疗效及并发症.术后均随访8个月～3年,观察复发情况.结果:三组不同手术方式手术时间及优良率比较差异无统计学意义(P＞0.05),APLD及MED组术中出血量及术后住院时间与传统手术组比较,差异有显著性(P＜0.05);术后随访疼痛全部缓解,无复发.结论:在严格掌握适应症的基础上,采用微创技术和采用传统手术治疗腰椎间盘突出症疗效相当,但微创技术创伤小、术中出血量少,术后住院日短,恢复快,优于传统手术.     

Are Pain-Related Fears Mediators for Reducing Disability and Pain in Patients with Complex Regional Pain Syndrome Type 1? An Explorative Analysis on Pain Exposure Physical Therapy

Objective

To investigate whether pain-related fears are mediators for reducing disability and pain in patients with Complex Regional Pain Syndrome type 1 when treating with Pain Exposure Physical Therapy.

Design

An explorative secondary analysis of a randomised controlled trial.

Participants

Fifty-six patients with Complex Regional Pain Syndrome type 1.

Interventions

The experimental group received Pain Exposure Physical Therapy in a maximum of five treatment sessions; the control group received conventional treatment following the Dutch multidisciplinary guideline.

Outcome measures

Levels of disability, pain, and pain-related fears (fear-avoidance beliefs, pain catastrophizing, and kinesiophobia) were measured at baseline and after 3, 6, and 9 months follow-up.

Results

The experimental group had a significantly larger decrease in disability of 7.77 points (95% CI 1.09 to 14.45) and in pain of 1.83 points (95% CI 0.44 to 3.23) over nine months than the control group. The potential mediators pain-related fears decreased significantly in both groups, but there were no significant differences between groups, which indicated that there was no mediation.

Conclusion

The reduction of pain-related fears was comparable in both groups. We found no indication that pain-related fears mediate the larger reduction of disability and pain in patients with Complex Regional Pain Syndrome type 1 treated with Pain Exposure Physical Therapy compared to conventional treatment.

Trial registration

International Clinical Trials Registry NCT00817128     

THE ERECT LATERAL LUMBAR ROENTGENOGRAM IN THE EVALUATION OF “LOW BACK” PAIN

A study was made of the potential value of the erect lateral flexion lumbar roentgenogram in a series of 50 adults, some with symptoms of low back pain and some without such symptoms. The film was made in addition to the standard antero-posterior, lateral and sometimes oblique views taken in the recumbent position.In 11 of 37 patients with low back pain, some narrowing of lumbar discs was visible in both horizontal and erect lateral films, the degree being not significantly different between the two positions. In one patient, localized anterior narrowing of a lumbar disc, which was not visible in the recumbent lateral film, was observed. This finding was confirmed at a subsequent examination.In one of 13 patients without lumbar area symptoms, slight anterior narrowing of a lumbar disc could be seen in the erect lateral film but not in the horizontal. The reason for this is not known; it may be physiologic in this particular patient.The value of the routine erect lateral flexion lumbar roentgenogram was not confirmed by this preliminary study.     

Indirect Acquisition of Pain-Related Fear: An Experimental Study of Observational Learning Using Coloured Cold Metal Bars

Background

Previous research has demonstrated that pain-related fear can be acquired through observation of another’s pain behaviour during an encounter with a painful stimulus. The results of two experimental studies were presented, each with a different pain stimulus, of which the aim was to investigate the effect of observational learning on pain expectancies, avoidance behaviour, and physiological responding. Additionally, the study investigated whether certain individuals are at heightened risk to develop pain-related fear through observation. Finally, changes in pain-related fear and pain intensity after exposure to the feared stimulus were examined.

Methods

During observational acquisition, healthy female participants watched a video showing coloured cold metal bars being placed against the neck of several models. In a differential fear conditioning paradigm, one colour was paired with painful facial expressions, and another colour was paired with neutral facial expressions of the video models. During exposure, both metal bars with equal temperatures (-25° or +8° Celsius) were placed repeatedly against participants’ own neck.

Results

Results showed that pain-related beliefs can be acquired by observing pain in others, but do not necessarily cause behavioural changes. Additionally, dispositional empathy might play a role in the acquisition of these beliefs. Furthermore, skin conductance responses were higher when exposed to the pain-associated bar, but only in one of two experiments. Differential pain-related beliefs rapidly disappeared after first-hand exposure to the stimuli.

Conclusions

This study enhances our understanding of pain-related fear acquisition and subsequent exposure to the feared stimulus, providing leads for pain prevention and management strategies.     

Increase of nerve growth factor levels in the human herniated intervertebral disc: can annular rupture trigger discogenic back pain?

Introduction

Nerve growth factor (NGF) has an important role in the generation of discogenic pain. We hypothesized that annular rupture is a trigger for discogenic pain through the action of NGF. In this study, the protein levels of NGF in discs from patients with disc herniation were examined and compared with those from discs of patients with other lumbar degenerative disc diseases.

Methods

Patients (n = 55) with lumbar degenerative disc disease treated by surgery were included. Nucleus pulposus tissue (or herniated disc tissue) was surgically removed and homogenized; protein levels were quantified using an enzyme-linked immunosorbent assay (ELISA) for NGF. Levels of NGF in the discs were compared between 1) patients with herniated discs (herniated group) and those with other lumbar degenerative disc diseases (non-herniated group), and 2) low-grade and high-grade degenerated discs. Patient’s symptoms were assessed using a visual analog scale (VAS) and the Oswestry disability index (ODI); the influence of NGF levels on pre- and post-operative symptoms was examined.

Results

Mean levels of NGF in discs of patients were significantly higher in herniated discs (83.4 pg/mg total protein) than those in non-herniated discs (68.4 pg/mg).No significant differences in levels of NGF were found between low-grade and high-grade degenerated discs. Multivariate analysis, adjusted for age and sex, also showed significant correlation between the presence of disc herniation and NGF levels, though no significant correlation was found between disc degeneration and NGF levels. In both herniated and non-herniated groups, pre-operative symptoms were not related to NGF levels. In the herniated group, post-operative lower extremity pain and low back pain (LBP) in motion were greater in patients with low levels of NGF; no significant differences were found in the non-herniated group.

Conclusions

This study reports that NGF increased in herniated discs, and may play an important role in the generation of discogenic pain. Analysis of patient symptoms revealed that pre-operative NGF levels were related to post-operative residual lower extremity pain and LBP in motion. The results suggest that NGF in the disc is related to pain generation, however, the impact of NGF on generation of LBP varies in individual patients.

Electronic supplementary material

The online version of this article (doi:10.1186/ar4674) contains supplementary material, which is available to authorized users.     

Percutaneous radiofrequency lumbar rhizolysis (rhizotomy).

Low back pain may arise from degenerative changes in the posterior joints of the lumbar spine. These joints are innervated by a branch of the posterior primary ramus, which follows an anatomically constant course. Pain impulses from these joints can be interrupted by coagulating this nerve with a radiofrequency wave, the probe having been placed in the area of the nerve percutaneously. Percutaneous lumbar rhizolysis was carried out under local anesthesia on an outpatient basis in 82 patients, most of whom had multiple level rhizolysis. Rhizolysis was successful in 67% of patients with mechanical low back pain without evidence of disc herniation and nerve-root compression or psychogenic pain, who had not previously undergone an operation for relief of the pain.     

Short aggrecan gene repetitive alleles associated with lumbar degenerative disc disease in Turkish patients

We investigated a possible association between aggrecan gene polymorphism and lumbar degenerative disc disease in Turkish patients. One hundred 20-30-year-old patients with or without low back pain were selected for the study. Lumbar magnetic resonance imaging was performed on all patients. The patient group had low back pain clinically and degenerative disc disease radiographically. The control group included patients with and without low back pain: all were negative radiographically for degenerative disc disease. Genomic DNA was extracted from all participants. A PCR assay were used to evaluate variable number of tandem repeat polymorphism of aggrecan gene alleles to determine if there was any correlation with degenerative disc disease. Significant associations were found between short repeated alleles of the aggrecan gene and severe disc degeneration. A significant association was also found between short repeated alleles of the aggrecan gene and multilevel disc herniation as well as extrusion and sequestration types of disc herniation. In Turkish population, short repeated alleles of the aggrecan gene are associated with increased disc degeneration and disc herniation.     

腰腹肌运动联合超声波对非特异性下腰痛的治疗效果及机制

为了解腰腹肌运动联合超声波治疗的效果,本研究对腰腹肌运动联合超声波治疗非特异性下腰痛进行了探讨。研究显示,治疗4周后,腰腹肌运动+超声波治疗组的疼痛评分(0.73)显著低于超声波治疗组(1.22)(p<0.05)。腰腹肌运动+超声波治疗组的立位体前屈活动幅度(2.35 cm)显著低于超声波治疗组(6.23 cm)(p<0.05)。腰腹肌运动+超声波治疗组的屈伸肌总功和屈伸肌峰值力矩比显著高于超声波治疗组(p<0.05)。腰腹肌运动+超声波治疗组的Oswestry功能障碍指数问卷表(ODI)评分显著低于超声波治疗组(p<0.05)。治疗4周后,腰腹肌运动+超声波治疗组的血清超氧化物歧化酶(SOD)和过氧化氢酶(CAT)水平显著高于超声波治疗组,而丙二醛(MDA)水平显著低于超声波治疗组(p<0.05)。为了进一步考察运动联合超声波疗法对下腰痛的治疗机制,本研究建立了完全弗氏佐剂诱导的腰椎间盘退变大鼠模型。采用阿利新蓝染色检测大鼠椎间盘纤维环区和髓核区蛋白多糖的水平,并采用免疫组化染色检测蛋白聚糖和Ⅱ型胶原的表达,发现运动联合超声波治疗可明显提高大鼠蛋白多糖、Ⅱ型胶原和蛋白聚糖水平。本研究表明,与超声波治疗相比,腰腹肌运动联合超声波治疗可更大程度地降低非特异性下腰痛患者的疼痛,提高肌肉功能和腰椎功能,增强血清抗氧化能力,并减少氧化应激损伤。此外,该联合疗法可明显提高腰椎间盘退变大鼠椎间盘中的蛋白多糖、Ⅱ型胶原和蛋白聚糖水平。     

经皮椎间孔镜治疗腰椎间盘突出症临床疗效观察

目的:评估经皮椎间孔镜技术(percutaneous transforaminal endoscopic discectomy,PTED)治疗腰椎间盘突出症的临床疗效。方法:回顾性分析2009~2013年我院收治的明确诊断为腰椎间盘突出症且接受PTED治疗的194例患者的临床和随访资料,评价其Mac Nab疗效,比较手术前后患者的VAS疼痛评分、Lehmann腰椎功能评分及SF-36生存质量评分。结果:所有患者均至少随访至术后12月,患者术后当天及术后3月、12月的VAS评分、Lehmann腰椎功能评分、SF-36生存质量评分均较术前明显改善,差异均具有统计学意义(P0.05)。术后3月、12月,患者Macnab疗效的优良率分别为90.7%、92.3%。结论:采用PTED治疗腰椎间盘突出症的临床疗效较好,患者的疼痛明显缓解,腰椎功能和生活质量均明显改善,且安全方便。     

Ligamentum Flavum Hypertrophy in Asymptomatic and Chronic Low Back Pain Subjects

Purpose

To examine ligamentum flavum thickness using magnetic resonance (MR) images to evaluate its association with low back pain symptoms, age, gender, lumbar level, and disc characteristics.

Materials and Methods

Sixty-three individuals were part of this IRB-approved study: twenty-seven with chronic low back pain, and thirty-six as asymptomatic. All patients underwent MR imaging and computed tomography (CT) of the lumbar spine. The MR images at the mid-disc level were captured and enlarged 800% using a bilinear interpolation size conversion algorithm that allowed for enhanced image quality. Ligamentum flavum thickness was assessed using bilateral medial and lateral measurements. Disc height at each level was measured by the least-distance measurement method in three-dimensional models created by CT images taken of the same subject. Analysis of variance and t-tests were carried out to evaluate the relationship between ligamentum flavum thickness and patient variables.

Results

Ligamentum flavum thickness was found to significantly increase with older age, lower lumbar level, and chronic low back pain (p < 0.03). No difference in ligamentum flavum thickness was observed between right and left sided measurements, or between male and female subjects. Disc height and both ligamentum flavum thickness measurements showed low to moderate correlations that reached significance (p < 0.01). Additionally, a moderate and significant correlation between disc degeneration grade and ligamentum flavum thickness does exist (p <0.001).

Conclusion

By measuring ligamentum flavum thickness on MR images at two different sites and comparing degrees of disc degeneration, we found that ligamentum flavum thickness may be closely related to the pathogenesis of pain processes in the spine.     

The rate and magnitude of atmospheric pressure change that aggravate pain-related behavior of nerve injured rats

Complaints of patients with chronic pain may increase when the weather changes. The exact mechanism for weather change-induced pain has not been clarified. We have previously demonstrated that artificially lowering barometric pressure (LP) intensifies pain-related behaviors in rats with neuropathic pain [chronic constriction injury (CCI) and spinal nerve ligation (SNL)]. In the present study, we examined the rate and magnitude of LP that aggravates neuropathic pain. We measured pain-related behaviors [number of paw lifts to von Frey hair (VFH) stimulation] in awake rats after SNL or CCI surgery, and found that rates of decompression ≥5 hPa/h and ≥10 hPa/h and magnitudes of decompression ≥5 hPa and ≥10 hPa augmented pain-related behaviors in SNL and CCI rats, respectively. These results indicate that LP within the range of natural weather patterns augments neuropathic pain in rats, and that SNL rats are more sensitive to LP than CCI rats.     

中药熏蒸联合推拿治疗腰椎间盘突出症的临床效果

目的：探讨中药熏蒸联合推拿治疗腰椎间盘突出症的临床效果。方法：选择2013 年12 月到2015 年1 月我院收治的112 例 腰椎间盘突出症患者为研究对象,根据治疗方法的不同分为研究组和对照组。对照组给予常规推拿治疗措施,研究组给予常规推 拿措施联合中药熏蒸治疗。比较两组患者的住院时间,下肢放射痛、麻木、腰痛的发生率及临床疗效。结果：研究组患者的住院时 间及下肢放射痛、麻木、腰痛的发生率均较对照组明显缩短或降低,其治疗总有效率为92.9%,显著高于对照组,均有统计学差异 (P＜0.05)。结论：中药熏蒸联合推拿方法治疗腰椎间盘突出症的临床效果优于单一推拿治疗措施,可有效改善患者的临床症状,缩 短疗程,提高治疗有效率,值得临床推广使用。     

显微内窥镜椎间盘切除术(MED)治疗腰椎间盘突出症的特点及易出现的并发症研究

摘要 目的：探讨与研究显微内窥镜椎间盘切除术(microendoscopic discectomy,MED)治疗腰椎间盘突出症的特点及易出现的并发症情况。方法：2017年1月到2020年2月选择在空军第九八六医院诊治的椎间盘突出症患者72例,根据治疗方法把患者分为MED组与对照组,各36例,MED组给予MED手术治疗,对照组给予开放手术治疗,记录两组术后并发症发生情况。结果：MED组术后6个月的优良率为97.2 %,显著高于对照组的77.8 %(P<0.05)。两组术后1个月、术后6个月的日本骨科协会(Japanese orthopaedic association,JOA)评分高于术前,MED组高于对照组(P<0.05)。两组术后1个月、术后6个月的视觉模拟评分法(visual analogue scale,VAS)评分低于术前,MED组低于对照组(P<0.05)。MED组术后6个月的髓核组织残留、神经根损伤、硬脊膜破裂、脑脊液漏等并发症发生率为5.6 %,显著低于对照组的33.3 %(P<0.05)。结论：MED治疗腰椎间盘突出症能改善患者的腰椎功能,缓解患者疼痛,提高总体治疗优良率,减少术后并发症的发生。     

保守疗法治疗腰椎间盘突出症的短期临床疗效分析

目的:分析保守疗法治疗腰椎间盘突出症的短期临床疗效。方法:选取2013年1月~2013年12月来我科就诊并采取保守疗法治疗的69例腰椎间盘突出症患者,对其临床资料进行回顾性分析。其中,37例采用了电针、推拿、中频、牵引和功能锻练等综合疗法(综合疗法治疗组),32例仅采用了药物治疗(单纯药物对照组),比较两组治疗前后的JOA评分及VAS疼痛评分,并比较其临床疗效。结果:治疗后,两组患者的腰椎功能JOA评分均较治疗前明显改善(P0.05),且综合保守治疗组的JOA评分明显高于单纯药物对照组(p0.05);两组患者的VAS疼痛评分均较治疗前明显降低(P0.05),且综合保守治疗组患者的VAS疼痛评分降低程度明显高于单纯药物对照组(P0.05)。单纯药物对照组的总有效率为71.87%,而综合保守治疗组的总有效率为91.89%,较单纯药物对照组显著升高(P0.05)。结论:与单纯药物治疗相比,采用综合保守疗法治疗腰间盘突出症的短期临床疗效更好,可更有效改善患者的腰椎功能并缓解其疼痛。