1,720,968 research outputs found
La Sindrome Miofasciale come fattore di attivazione della sintomatologia dolorosa della Fibromialgia
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A randomized, controlled study comparing a lidocaine patch, aplacebo patch, and anesthetic injection for treatment of trigger points in patients with myofascial pain syndrome: evaluation of pain and somatic pain thresholds
No full textBackground: Myofascial pain syndrome (MPS), a regional pain condition caused by trigger points in muscle or muscle fascia, produces muscle pain, tenderness, and disability. The gold standard of treatment for MPS—infiltration of trigger points with anesthetic—may provoke discomfort to the patients and require medical intervention. Objectives: This study was designed to compare the
effects of a topical lidocaine patch, a placebo patch, and injection of anesthetic (infiltration) for the symptoms of MPS in terms of pain, disability, and local tissue hypersensitivity, and to determine the acceptability of the lidocaine patch to the patients. Methods: Patients were randomly allocated to receive 1 of 3 treatments: a lidocaine patch applied to the trigger point for 4 days (replacement every 12 hours; total daily dose, 350 mg), a placebo patch applied to the trigger point for 4 days (replacement every 12 hours), or infiltration of the trigger point with two 1-mL injections of 0.5% bupivacaine hydrochloride given 2 days apart. Treatment with the patches was doubleblinded, whereas treatment with infiltration was single-blinded. The number of pain attacks, pain intensity at rest and on movement, and pain-related interference with daily activity, work activity, mood, and quality of life were recorded before, during, and after treatment using a visual analog scale (VAS). Pressure and electrical pain thresholds of the skin, subcutis, and muscle in the trigger point, target area, and a pain-free area were evaluated before starting therapy (day 1) and on days 5 and 9. A VAS was used to measure discomfort from therapy, and a diary was given to each patient to record requests for additional treatment (if needed) and adverse effects. Results: Sixty white patients (46 women and 14 men) 19 to 76 years of age were studied. Mean (SD) age was 46.88 (15.37) years, and mean (SD) weight was 69.58 (13.94) kg. Twenty patients were assigned to each treatment group. Subjective symptoms did not change with placebo, but decreased significantly with the lidocaine patch and infiltration (both, P < 0.001) relative to baseline. Pain thresholds did not vary with the placebo patch, but increased significantly with the lidocaine patch and infiltration (all, P < 0.001); effects at muscle trigger points and target areas were greater with infiltration. Discomfort from therapy was greater with infiltration than with the lidocaine patch. Only patients in the placebo group requested additional treatment (P < 0.001). No adverse events occurred in any group. Conclusion: Lidocaine patches were effective in, and highly acceptable to, these patients with MPS and high tissue hypersensitivity
Teaching neuroimages: a dangerous complication of spontaneous intracranial hypotension
No full textA 43-year-old man presented with a nontraumatic orthostatic headache, spatial disorientation, and visual hallucinations ("colored flames"). General and neurologic examination were normal. Turbo spin echo T2-weighted MRI showed bilateral subdural fluid collection and venous sinus engorgement (figure, A), suggesting spontaneous intracranial hypotension (SIH). Two subdural hematomas were also found, the biggest (2.5 cm) with mass effect in the left hemisphere (figure, B). Spine MRI identified a small radicular cyst emerging from the left T1-T2 foramen as the putative cause of CSF leakage (figure, C and D). The patient underwent drainage of the largest hematoma with benefit. Though initially planned, epidural blood patch and surgical treatment of the radicular cyst were not performed because clinical and radiologic findings improved with hematoma drainage, bed rest, and hydration. At a 3-month follow-up, MRI documented complete resolution of the subdural collection and dimensional stability of the radicular cyst. SIH is often considered benign and treated conservatively,(1)but it can rarely manifest with serious complications requiring rapid surgical evaluation.(2)
Effects of topical diclofenac plus heparin (dhep+h plaster) on somatic pain sensitivity in healthy subjects with a latent algogenic condition of the lower limb
No full textOBJECTIVE: To evaluate whether a diclofenac epolamine + heparin topical (plaster)
is more effective than diclofenac plaster alone in reducing deep somatic
hyperalgesia in subjects without spontaneous pain and whether the effect is
linked to or independent of the anti-edematous action of heparin.
DESIGN: Prospective, double-blind, randomized and controlled, four-arm parallel
design trial.
SUBJECTS: One hundred and four patients (84 women, 20 men, mean age
42.2 ± 13.3 years), with deep somatic hyperalgesia in one thigh, randomly
assigned to one of 4 groups of 26 each.
INTERVENTION: Each group underwent one of the following plaster treatments on one
thigh: diclofenac+heparin; diclofenac; heparin; placebo, for 7 days, renewing the
plaster every 24 hours.
OUTCOME MEASURES: Before treatment (day 1), at day 4 and day 8, assessment of (a)
pressure and electrical pain thresholds of vastus lateralis and overlying
subcutis and skin; and (b) structure/thickness of subcutis and muscle with
ultrasounds at the same level.
RESULTS: During treatment, in placebo and heparin, no significant threshold
changes, except subcutis thresholds which increased slightly (P < 0.02); in
diclofenac and diclofenac+heparin, significant increase in all thresholds (0.0001
< P < 0.04). Electrical muscle pain thresholds increased significantly more in
diclofenac+heparin than in diclofenac, heparin, and placebo (0.0001 < P < 0.04).
In all groups: no edema and thickness changes at ultrasounds in muscle and
subcutis.
CONCLUSIONS: Topical diclofenac+heparin is significantly more effective than
diclofenac alone in reducing muscle hyperalgesia in subjects without spontaneous
pain, independently of the anti-edematous action of heparin. The results provide
a rationale for the use of diclofenac+heparin also in algogenic conditions
without evident signs of injury/edema/hematoma
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