Background
Lumbar radicular pain (LRP) results from inflammation and irritation of lumbar spinal nerves and the dorsal root ganglion (DRG).
Methods
Our study is a prospective, triple‐blind, randomized, activecontrol trial (CTRI/2016/02/006666) comparing transforaminal epidural local anesthetic (LA) injection and pulsed radiofrequency treatment of DRG in patients with chronic LRP. Patients with LRP after failed conservative management for >3 months received selective diagnostic nerve root block with 1 mL 2% lidocaine. Fifty patients showing positive responses were divided into groups of 25 each. The LA group received transforaminal epidural injection of 1 mL 0.5% bupivacaine. The lumbar pulsed radiofrequency (LPRF) group received transforaminal epidural injection of 1 mL 0.5% bupivacaine with 3 cycles of pulsed radiofrequency of the DRG for 180 seconds
Results
Both groups were compared by observing pain intensity on a 0‐ to 100‐point VAS and improvement in functional status by the Oswestry Disability Index (ODI version 2.0) at 2 weeks and 1, 2, 3, and 6 months. All baseline variables were comparable between the 2 groups. Statistically significant reduction in both outcomes was seen in the LPRF group compared to the LA group from 2 weeks to 6 months. One hundred percent of patients in the LPRF group had a ≥20‐ point decrease in VAS and significant percentage reduction in ODI at all time intervals up to 6 months, whereas it was seen in 80% and 28% of patients in the LA group at 3 and 6 months, respectively. No complications were seen in any patients
Conclusion
Pulsed radiofrequency of the DRG applied for longer duration results in long‐term pain relief and improvement in the functional quality of life in patients with chronic LRP.
Background andAims: Dry needling is a therapeutic technique in which thin monofilament needles are inserted into muscle eliciting a localized twitch response with the purpose of reducing pain associated with musculoskeletal disorder. These are often caused by the presence of Myofascial Trigger Points (MTrPs). Many RTCs comparing Dry needling with other treatments shows significant improvement in neck and shoulder pain, specifically in short and medium term. Performing DN under ultrasound guidance allows to identify MTrPs and to visualize local twitch response (LTR). Methods: A 31 years-old tattoo artist woman came to our observation complaining right neck and shoulder chronic pain. She referred a NRS pain score of 8 at rest raising 10 with movement, affecting her ability to work, McGill Pain Questionnaire=12(S6A3V1M2). She underwent several session of physiotherapy and taping and took NSAIDs as needed before our visit. We subjected her to 4 sessions of ultrasound guided dry needling: once every two weeks for two sessions and then once a month for the last two ones. We treated Upper trapezius, Sternocleidomastoid, Levator Scapulae, Semispinalis capitis, Splenius Capitis and Cervicis muscles. Results: We observed a marked reduction of local twitch response and NRS score, decreasing down to 0-1, McGill Pain Questionnaire=5 (S2A1V1M1). One year follow up confirmed absence of pain. The patient was able to return to daily and work activities without functional limitations caused by pain. Conclusions: Ultrasounds guided dry needling treatment could be a safe and effective technique in the management of chronic neck and shoulder pain, even in the medium and long term. ESRA8-0252 Ultrasounds guided Dry needling: an effective technique for a long term relief of neck and shoulder pain
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