Prospective medium-term results of multimodal pain management in patients with lumbar radiculopathy

Benditz, Achim; Madl, M.; Loher, Martin; Grifka, Joachim; Boluki, D.; Linhardt, O.

doi:10.1038/srep28187

Cited by 21 publications

(35 citation statements)

References 27 publications

(29 reference statements)

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“…In this study, the period of the first clinically relevant success with regard to pain reduction of more than NRS 2 was 4.4 days for neck pain and 4.1 days for arm pain. Because of the combination of several types of conservative treatment and 2 injections per day, patients receive different conservative treatments over a very short period of time, which leads to quick pain relief and thus − in combination with psychological lessons – tries to avoid chronification 32 .…”

Section: Discussionmentioning

confidence: 99%

“…Risk factors that can lead to chronic pain must be eliminated. All methods serve to interrupt the vicious circle of “pain−stress−malposition−pain” 32 . While reducing pain through injections, patients may take part in activating treatments as mentioned above.…”

Section: Discussionmentioning

confidence: 99%

“…This multimodal pain management concept has already been published several times by the author for low back pain 32 and has now been adapted for patients with cervical radiculopathy.…”

Section: Methodsmentioning

confidence: 99%

“…2 ). The other applications have already been described by the author 18 , 32 : ‘Physiotherapy and sports therapy as part of inpatient MPM includes group exercises and aqua training; accompanying measures consist of electrotherapy for muscle relaxation and thermotherapy. In addition, patients are instructed in progressive muscle relaxation according to Jacobsen and take part in coordination training 45 .…”

Section: Methodsmentioning

confidence: 99%

“…In the case of low back pain, injection therapy is often accompanied by multimodal treatment such as physical therapy and psychological counselling to avoid pain chronification 32 . MPM has been shown to be a very beneficial treatment option for avoiding surgery and reducing pain in patients with radicular nerve root compression 33 – 35 .…”

Section: Introductionmentioning

confidence: 99%

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Effectiveness of a multimodal pain management concept for patients with cervical radiculopathy with focus on cervical epidural injections

Benditz

Brunner

Zeman

et al. 2017

Sci Rep

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Cervical radiculopathy has become an increasing problem worldwide. Conservative treatment options have been recommended in many reviews on cervical radiculopathy, ranging from different types of physiotherapy to waiting for remission by natural history. No multimodal pain management concept (MPM) on an inpatient basis has been evaluated. This study aimed at showing the positive short-term effects of an inpatient multimodal pain management concept with focus on cervical translaminar epidural steroid injection for patients with cervical radiculopathy. 54 patients who had undergone inpatient MPM for 10 days were evaluated before and after 10-days treatment. The NRS (0-10) value for arm pain could be reduced from 6.0 (IQR 5.7-6.8) to 2.25 (IQR 2.0-3.1) and from 5.9 (IQR 4.8-6.0) to 2.0 (IQR 1.7-2.6) for neck pain. Neck pain was reduced by 57.4% and arm pain by 62.5%. 2 days after epidural steroid injection, pain was reduced by 40.1% in the neck and by 43.4% in the arms. MPM seems to be an efficient short-term approach to treating cervical radiculopathy. Cervical translaminar epidural steroid injection is an important part of this concept. In the absence of a clear indication for surgery, MPM represents a treatment option.The incidence of neck pain in clinical studies ranges between 10.4% and 71.5%, and the annual prevalence is estimated to vary between 30% and 50% 1-6 . 2009; Hoy 2010] The average annual age-adjusted incidence rates per 100,000 population for cervical radiculopathy are 83.2 and age-specific 202.9 in the age group 50-54 years 7 . Cervical radiculopathy has become an increasing problem over the last years. E.g. in Germany, the number of patients with cervical radiculopathy and inpatient treatment doubled from 2005 to 2015 8 .The degenerative changes mainly affect the lower levels of the cervical spine, in particular C5/C6 as well as C6/ C7 and rare C7/Th1 or C4/C5. In our clinical experience, radiologically elevated findings in native and sectional image diagnosis (CT, MRI) correlate only partially with clinical findings. Cervical radiculopathy is resulting from nerve root dysfunction, which may be caused by several reasons, most commonly by disc herniation and spinal foraminal stenosis 9 . In addition, there may be other reasons for upper extremity pain than radiculopathy. Muscles, ligaments or cervical facet joints may be responsible for pain in the neck or in the upper extremities 1,3,10,11 . 'Clinically, it is characterized by arm pain, in some cases paraesthesia and eventually reduced muscle strength, altered sensation and impairment of deep tendon reflexes' 12, 13 .The age group with the highest risk of developing cervical radiculopathy in the USA and European countries is that of people aged between 35 and 49 years 14 .Most authors have viewed pain episodes over a person's lifetime as common relapses. Women and residents of high-income countries or urban areas have a higher risk of developing cervical radiculopathy 14 .Furthermore, neck pain has a significant impact on socioeconomic factors and...

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

“…This multimodal pain management concept has already been published several times by the author for low back pain 32 and has now been adapted for patients with cervical radiculopathy.…”

Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%