The Clinical journal of pain
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A 55-year-old woman presented with numbness and pain in both lower extremities. The pain was of sudden onset and of 4 months' duration. A nerve conduction study demonstrated a bilateral sensorimotor peripheral neuropathy with axonal and demyelinating features of a mild degree. Initial treatment with oral thiamine and topiramate had little efficacy and caused unacceptable side effects. A switch to 1500 mg bid levetiracetam plus nortriptyline resulted in a 60% improvement in pain symptoms. A 75-year-old man presented with numbness in both feet of 5 years' duration. The sensation of numbness had progressed to persistent pain, resulting in sleep disruption. The patient's use of oral thiamine did not lead to pain relief, but the addition of 500 mg levetiracetam once in the evening led to a complete resolution of his pain and to sleep improvement. A 67-year-old obese male was referred from a podiatrist with progressive dysfunction in both lower extremities that developed over a 1-year period. Walking more than a few steps resulted in sharp, shooting pain that at night disrupted sleep. A nerve conduction study demonstrated a severe bilateral sensorimotor peripheral neuropathy with axonal and demyelinating features. Treatment with 1000 mg levetiracetam bid resulted in complete absence of pain. ⋯ In these 3 case studies, levetiracetam was demonstrated to be an effective therapy in the treatment of neuropathic pain. It has the benefits of a low incidence of adverse events and an improvement in patients' sleep.
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To describe the attitudes and beliefs of physiotherapy students to chronic low back pain (LBP) and to investigate whether these attitudes change following exposure to a teaching module on chronic back pain. Also, to investigate the effect of current or previous LBP on student attitudes and beliefs. ⋯ These results suggest that the attitudes and beliefs of third year physiotherapy students not exposed to teaching are similar to those of community providers. There is no difference between students with and without a history of LBP.
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Randomized Controlled Trial Clinical Trial
A randomized controlled trial of radiofrequency denervation of the ramus communicans nerve for chronic discogenic low back pain.
The objective of this study was to determine the efficacy of percutaneous radiofrequency (RF) thermocoagulation of the ramus communicans nerve in patients suffering from chronic discogenic low back pain. ⋯ In patients with chronic discogenic low back pain, percutaneous RF denervation of the ramus communicans nerve should be considered as a treatment option.
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Review Comparative Study
Manual therapies for pain control: chiropractic and massage.
To evaluate the effectiveness of chiropractic and massage therapy for the reduction of any type of pain. ⋯ The notion that chiropractic or massage are effective interventions for pain control has not been demonstrated convincingly through rigorous clinical trials.
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The factor structure, reliability and validity of the Health Care Providers' Pain and Impairment Relationship Scale (HC-PAIRS) were determined in the current study. Furthermore, the ability of the HC-PAIRS to serve as a predictor for work and activity recommendations of paramedical health care providers was examined. ⋯ The HC-PAIRS appears to be a reliable and valid measure of health care providers' attitudes and beliefs about the relationship between pain and impairment. The role of health care providers' attitudes in the treatment of low back pain is discussed.