Articles: back-pain.
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A myriad of studies have argued that tactile sensibility is underpinned exclusively by large myelinated mechanoreceptors. However, the functional significance of their slow-conducting counterparts, termed C-low threshold mechanoreceptors (C-LTMRs), remains largely unexplored. We recently showed the emergence of brush- and vibration-evoked allodynia in human hairy and glabrous skin during background muscle pain. The allodynia persisted following the preferential blockade of myelinated fibres but was abolished by the preferential blockade of cutaneous C fibres, thereby suggesting a pathway involving hairy skin C-LTMRs and their functional counterparts in glabrous skin in this phenomenon. In the present study, we tested the effects of preferential A- and C-fibre conduction blocks and pharmacological blockade of T-type calcium channel Cav3.2 (expressed selectively on small-fibre LTMRs) on monofilament detection thresholds in healthy participants by compression, low-dose intradermal anaesthesia (xylocaine 0.25 %) and selective T-channel antagonist, TTA-A2. ⋯ These observations suggest that C-LTMRs need not be regarded as a redundant tactile system, but appear to complement normal large-myelinated-fibre tactile function. Convergent findings in glabrous and hairy skin lend support for an underlying system of innocuous mechanoreception with Cav3.2-expressing unmyelinated fibres.
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Background and purpose - The effect of postoperative intra-articular bolus injections after total hip arthroplasty (THA) remains unclear. We tested the hypothesis that intra-articular bolus injections administered every 6 hours after surgery during the first 24 hours would significantly improve analgesia after THA. Patients and methods - 80 patients undergoing THA received high-volume local infiltration analgesia (LIA; 200 mg ropivacaine and 30 mg ketorolac) followed by 4 intra-articular injections with either ropivacaine (100 mg) and ketorolac (15 mg) (the treatment group) or saline (the control group). ⋯ Time to readiness for hospital discharge was longer in the treatment group. Other secondary outcomes were similar between groups. Interpretation - Postoperative intra-articular bolus injections of ropivacaine and ketorolac cannot be recommended as analgesic method after THA.
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Degenerative lumbar scoliosis (DLS) is a spinal deformity that typically develops in adults over 50 years old. Although its etiology is unclear, asymmetric degeneration of the spine is the main cause. Individuals with DLS may experience no symptoms of the deformity, mild symptoms, or severe disability. Most patients with DLS receive conservative treatment, while a small number of patients receive surgery for severe DLS with back pain and/or progressive neurological symptoms. A variety of surgical procedures have emerged. However, a systemic comparison of these surgical procedures is currently unavailable. This study reviews the main outcomes and complications of surgical treatments. ⋯ Despite a high rate of complications, this review demonstrates that surgery is an effective and reasonable treatment intervention for severe DLS and ultimately improves spine function and deformity. This review also suggests that large scale, high quality studies with long term follow-up are needed to provide more reliable evidence for future evaluation.
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A nonlinear finite element study of a lumbar spine with different "patterns" of multilevel intervertebral disc degeneration. ⋯ N/A.