RESUMEN
OBJECTIVES: The objective of this historical cohort study was to determine the claimant and prescriber factors associated with receiving opioids at first postinjury dispense compared with non-steroidal anti-inflammatory drugs (NSAIDs) and skeletal muscle relaxants (SMRs) in a sample of workers' compensation claimants with low back pain (LBP) claims between 1998 and 2009 in British Columbia, Canada. METHODS: Administrative workers' compensation, prescription and healthcare data were linked. The association between claimant factors (sociodemographics, occupation, diagnosis, comorbidities, pre-injury prescriptions and healthcare) and prescriber factors (sex, birth year, specialty) with drug class(es) at first dispense (opioids vs NSAIDs/SMRs) was examined with multilevel multinomial logistic regression. RESULTS: Increasing days supplied with opioids in the previous year was associated with increased odds of receiving opioids only (1-14 days OR 1.62, 95% CI 1.51 to 1.75; ≥15 days OR 5.12, 95% CI 4.65 to 5.64) and opioids with NSAIDs/SMRs (1-14 days OR 1.49, 95% CI 1.39 to 1.60; ≥15 days OR 2.82, 95% CI 2.56 to 3.12). Other significant claimant factors included: pre-injury dispenses for NSAIDs, SMRs, antidepressants, anticonvulsants and sedative-hypnotics/anxiolytics; International Statistical Classification of Diseases and Related Health Problems, 9th Revision diagnosis; various pre-existing comorbidities; prior physician visits and hospitalisations; and year of injury, age, sex, health authority and occupation. Prescribers accounted for 25%-36% of the variability in the drug class(es) received, but prescriber sex, specialty and birth year did not explain observed between-prescriber variation. CONCLUSIONS: During this period in the opioid crisis, early postinjury dispensing was multifactorial, with several claimant factors associated with receiving opioids at first prescription. Prescriber variation in drug class choice appears particularly important, but was not explained by basic prescriber characteristics.
Asunto(s)
Analgésicos Opioides/uso terapéutico , Antiinflamatorios no Esteroideos/uso terapéutico , Dolor de la Región Lumbar/tratamiento farmacológico , Fármacos Neuromusculares/uso terapéutico , Pautas de la Práctica en Medicina/estadística & datos numéricos , Adulto , Traumatismos de la Espalda/tratamiento farmacológico , Colombia Británica , Estudios de Cohortes , Comorbilidad , Prescripciones de Medicamentos/estadística & datos numéricos , Femenino , Humanos , Masculino , Persona de Mediana Edad , Traumatismos Ocupacionales/tratamiento farmacológico , Indemnización para TrabajadoresRESUMEN
OBJECTIVES: To examine and compare whether dispensing of prescription opioids, non-steroidal anti-inflammatory drugs (NSAIDs) and skeletal muscle relaxants (SMRs) within 8 weeks after a work-related low back pain (LBP) injury is associated with work disability. METHODS: A historical cohort study of 55 571 workers' compensation claimants with LBP claims in British Columbia from 1998 to 2009 was conducted using linked compensation, dispensing and healthcare data. Four exposures were constructed to estimate the effect on receipt of benefits and days on benefits 1 year after injury: drug class(es) dispensed, days' supply, strength of opioids dispensed and average daily morphine-equivalent dose. RESULTS: Compared with claimants receiving NSAIDs and/or SMRs, the incidence rate ratio (IRR) of days on benefits was 1.09 (95% CI 1.04 to 1.14) for claimants dispensed opioids only and 1.26 (95% CI 1.22 to 1.30) for claimants dispensed opioids with NSAIDs and/or SMRs. Compared with weak opioids only, the IRR for claimants dispensed strong opioids only or strong and weak opioids combined was 1.21 (95% CI 1.12 to 1.30) and 1.29 (95% CI 1.20 to 1.39), respectively. The incident rate of days on benefits associated with each 7-day increase in days supplied of opioids, NSAIDs and SMRs was 10%, 4% and 3%, respectively. Similar results were seen for receipt of benefits, though effect sizes were larger. CONCLUSIONS: Findings suggest provision of early opioids leads to prolonged work disability compared with NSAIDs and SMRs, though longer supplies of all drug classes are also associated with work disability. Residual confounding likely partially explains the findings. Research is needed that accounts for prescriber, system and workplace factors.
Asunto(s)
Traumatismos de la Espalda/tratamiento farmacológico , Prescripciones de Medicamentos/estadística & datos numéricos , Traumatismos Ocupacionales/tratamiento farmacológico , Indemnización para Trabajadores , Adulto , Analgésicos Opioides/uso terapéutico , Antiinflamatorios no Esteroideos/uso terapéutico , Traumatismos de la Espalda/complicaciones , Colombia Británica , Estudios de Cohortes , Femenino , Humanos , Dolor de la Región Lumbar/tratamiento farmacológico , Masculino , Persona de Mediana Edad , Fármacos Neuromusculares/uso terapéutico , Traumatismos Ocupacionales/complicaciones , Factores de TiempoRESUMEN
INTRODUCTION: Neoadjuvant chemotherapy prior to lumpectomy or mastectomy for breast cancer challenges wound healing. Suberoylanilide hydroxamic acid (SAHA), a histone deacetylase inhibitor, has been shown to work synergistically with paclitaxel in vitro and in preclinical studies. In addition, our laboratory has demonstrated that SAHA treatment decreases paclitaxel-associated stem cell toxicity, modulates inflammatory response, and promotes wound healing in injured fibroblast cells. Our goal was to determine if combined SAHA and paclitaxel treatment would improve wound healing in an in vivo full-thickness murine model, without altering antitumor effect. METHODS: Thirty-two nude athymic mice received intraperitoneal injections of paclitaxel (20 mg/kg), SAHA (25 mg/kg), paclitaxel + SAHA (20 mg/kg + 25 mg/kg), or no treatment for 2 weeks prior to surgery. Under general anesthesia, 8-mm full-thickness dorsal wounds were created in all animals, and a silicone splint was attached to minimize wound contraction. The wounds were measured twice a week with a surgical caliper until healing was complete. To evaluate the in vivo effect of drug treatment, 16 athymic nude mice with MDA-MB-231 xenografts received the treatments described previously, following which tumor volumes were compared between groups. RESULTS: Average wound healing time was prolonged in mice treated with paclitaxel (20 ± 1.9 days), and combination SAHA + paclitaxel therapy improved average wound healing time (17.0 ± 1.8 days). In the xenograft model, the antitumor effect of SAHA and paclitaxel (average tumor volume 43.9 ± 34.1 mm) was greater than paclitaxel alone (105.8 ± 73.8 mm). CONCLUSIONS: The addition of SAHA to taxane chemotherapy improves the therapeutic effect on triple-negative breast cancer while decreasing the detrimental effect of paclitaxel on wound healing. This may have substantial implications on improving outcomes in breast reconstruction following chemotherapy.
Asunto(s)
Traumatismos de la Espalda/tratamiento farmacológico , Inhibidores de Histona Desacetilasas/farmacología , Paclitaxel/farmacología , Vorinostat/farmacología , Cicatrización de Heridas/efectos de los fármacos , Animales , Modelos Animales de Enfermedad , Ratones , Ratones DesnudosRESUMEN
OBJECTIVE: Compare prescription dispensing before and after a work-related low back injury. METHODS: Descriptive analyses were used to describe opioid, nonsteroidal anti-inflammatory drug (NSAID), and skeletal muscle relaxant (SMR) dispensing 1 year pre- and post-injury among 97,124 workers in British Columbia with new workers' compensation low back claims from 1998 to 2009. RESULTS: Before injury, 19.7%, 21.2%, and 6.3% were dispensed opioids, NSAIDs, and SMRs, respectively, increasing to 39.0%, 50.2%, and 28.4% after. Median time to first post-injury prescription was less than a week. Dispensing was stable pre-injury, followed by a sharp increase within 8 weeks post-injury. Dispensing dropped thereafter, but remained elevated nearly a year post-injury, an increase attributable to less than 2% of claimants. CONCLUSION: These drug classes are commonly dispensed, particularly shortly after injury and dispensing is of short duration for most, though a small subgroup receives prolonged courses.
Asunto(s)
Traumatismos de la Espalda/tratamiento farmacológico , Prescripciones de Medicamentos/estadística & datos numéricos , Dolor de la Región Lumbar/tratamiento farmacológico , Traumatismos Ocupacionales/tratamiento farmacológico , Indemnización para Trabajadores , Adolescente , Adulto , Analgésicos Opioides/uso terapéutico , Antiinflamatorios no Esteroideos/uso terapéutico , Traumatismos de la Espalda/complicaciones , Colombia Británica , Femenino , Humanos , Dolor de la Región Lumbar/etiología , Masculino , Persona de Mediana Edad , Fármacos Neuromusculares/uso terapéutico , Traumatismos Ocupacionales/complicaciones , Factores de Tiempo , Adulto JovenAsunto(s)
Analgésicos Opioides/administración & dosificación , Dolor de Espalda/tratamiento farmacológico , Control de Medicamentos y Narcóticos/legislación & jurisprudencia , Trastornos Relacionados con Opioides , Analgésicos Opioides/efectos adversos , Traumatismos de la Espalda/complicaciones , Traumatismos de la Espalda/tratamiento farmacológico , Brotes de Enfermedades , Femenino , Humanos , Persona de Mediana Edad , Trastornos Relacionados con Opioides/epidemiología , Trastornos Relacionados con Opioides/etiología , Trastornos Relacionados con Opioides/prevención & control , Trastornos Relacionados con Opioides/terapia , Rol del Médico , Estados Unidos/epidemiologíaAsunto(s)
Analgésicos Opioides/uso terapéutico , Trastornos Relacionados con Opioides/prevención & control , Guías de Práctica Clínica como Asunto , Adolescente , Traumatismos de la Espalda/tratamiento farmacológico , Centers for Disease Control and Prevention, U.S. , Sobredosis de Droga , Dependencia de Heroína , Humanos , Masculino , Trastornos Relacionados con Opioides/terapia , Pautas de la Práctica en Medicina , Mal Uso de Medicamentos de Venta con Receta , Estados Unidos , Adulto JovenRESUMEN
The number of prescription opioid overdose deaths has increased dramatically in recent years and many prescribers are unsure how to balance treatment of pain with secondary prevention. Guidelines recommend low-severity injury patients not receive opioids early in the course of their care, but evidence supporting this guideline is limited. Data from 123â 096 workers' compensation claims with back and shoulder injuries were analysed to evaluate this guideline. Back and shoulder injury claimants with early opioid use (≤1â month after injury) had 33% lower (95% CI 24% to 41% lower) odds and 29% higher (95% CI 6% to 58% higher) odds, respectively, of long-term opioid use (>3â months) than claimants with late opioid use, after adjusting for key covariates. Stratified analyses indicate that early opioid use does not appear to increase the risk of long-term use except in cases where no diagnosis or only the diagnosis of unspecified shoulder pain is given prior to prescription.
Asunto(s)
Analgésicos Opioides/uso terapéutico , Traumatismos de la Espalda/tratamiento farmacológico , Dolor Musculoesquelético/tratamiento farmacológico , Enfermedades Profesionales/tratamiento farmacológico , Trastornos Relacionados con Opioides/epidemiología , Pautas de la Práctica en Medicina/estadística & datos numéricos , Lesiones del Hombro/tratamiento farmacológico , Adulto , Analgésicos Opioides/efectos adversos , Evaluación de la Discapacidad , Prescripciones de Medicamentos , Femenino , Humanos , Masculino , Enfermedades Profesionales/economía , Trastornos Relacionados con Opioides/economía , Trastornos Relacionados con Opioides/prevención & control , Guías de Práctica Clínica como Asunto , Estudios Retrospectivos , Factores de Tiempo , Estados Unidos/epidemiología , Indemnización para Trabajadores/estadística & datos numéricosRESUMEN
BACKGROUND: The purpose of this study was to develop novel sandwich-structured nanofibrous membranes to provide sustained-release delivery of vancomycin, gentamicin, and lidocaine for repair of infected wounds. METHODS: To prepare the biodegradable membranes, poly(D, L)-lactide-co-glycolide (PLGA), collagen, and various pharmaceuticals, including vancomycin, gentamicin, and lidocaine, were first dissolved in 1,1,1,3,3,3-hexafluoro-2-propanol. They were electrospun into sandwich-structured membranes with PLGA/collagen as the surface layers and PLGA/drugs as the core. An elution method and a high-pressure liquid chromatography assay were used to characterize in vivo and in vitro drug release from the membranes. In addition, repair of infected wounds in rats was studied. Histological examination of epithelialization and granulation at the wound site was also performed. RESULTS: The biodegradable nanofibrous membranes released large amounts of vancomycin and gentamicin (well above the minimum inhibition concentration) and lidocaine in vivo for more than 3 weeks. A bacterial inhibition test was carried out to determine the relative activity of the antibiotics released. The bioactivity ranged from 40% to 100%. The nanofibrous membranes were functionally active in treating infected wounds, and were very effective as accelerators in early-stage wound healing. CONCLUSION: Using the electrospinning technique, we will be able to manufacture biodegradable, biomimetic, nanofibrous, extracellular membranes for long-term delivery of various drugs.
Asunto(s)
Vendajes , Preparaciones de Acción Retardada/farmacología , Membranas Artificiales , Nanofibras/química , Cicatrización de Heridas/efectos de los fármacos , Análisis de Varianza , Animales , Traumatismos de la Espalda/tratamiento farmacológico , Traumatismos de la Espalda/patología , Preparaciones de Acción Retardada/química , Preparaciones de Acción Retardada/farmacocinética , Técnicas Electroquímicas , Gentamicinas/química , Gentamicinas/farmacocinética , Gentamicinas/farmacología , Histocitoquímica , Lidocaína/química , Lidocaína/farmacocinética , Lidocaína/farmacología , Ratas , Ratas Sprague-Dawley , Vancomicina/química , Vancomicina/farmacocinética , Vancomicina/farmacología , Cicatrización de Heridas/fisiologíaAsunto(s)
Analgésicos Opioides , Traumatismos de la Espalda , Dolor de Espalda/tratamiento farmacológico , Auxiliares de Urgencia/normas , Detección de Abuso de Sustancias/métodos , Accidentes de Trabajo , Analgésicos Opioides/sangre , Analgésicos Opioides/uso terapéutico , Analgésicos Opioides/orina , Traumatismos de la Espalda/complicaciones , Traumatismos de la Espalda/tratamiento farmacológico , Traumatismos de la Espalda/etiología , Traumatismos de la Espalda/prevención & control , Dolor de Espalda/etiología , Humanos , MasculinoRESUMEN
OBJECTIVES: The objectives for presenting these medico-legal forensic case reports are the following: 1) detail three cases where chronic opioid analgesic therapy (COAT) was alleged to cause iatrogenic addiction and/or re-addiction; 2) detail the plaintiff's and defendant's medical experts' opinions on these allegations; and 3) through analyzing these cases, develop some recommendations for future prevention of such allegations during COAT. METHODS: Case Reports. RESULTS: Medico-legal issues surrounding the allegation of iatrogenic addiction were identified in each case. CONCLUSIONS: Before starting COAT, physicians should obtain and document patient informed consent for the risk of addiction/re-addiction with COAT treatment. Patients with a history of addictions pre-COAT should be placed on adherence monitoring immediately on beginning COAT.
Asunto(s)
Analgésicos Opioides/efectos adversos , Enfermedad Iatrogénica , Mala Praxis/legislación & jurisprudencia , Trastornos Relacionados con Opioides/psicología , Dolor/tratamiento farmacológico , Dolor/psicología , Adulto , Traumatismos de la Espalda/complicaciones , Traumatismos de la Espalda/tratamiento farmacológico , Traumatismos de la Espalda/psicología , Testimonio de Experto , Femenino , Medicina Legal , Humanos , Hidrocodona/efectos adversos , Consentimiento Informado , Dolor de la Región Lumbar/complicaciones , Dolor de la Región Lumbar/tratamiento farmacológico , Dolor de la Región Lumbar/psicología , Masculino , Persona de Mediana Edad , Morfina/efectos adversos , Dolor/complicaciones , Cooperación del Paciente , Examen Físico , Dolor de Hombro/complicaciones , Dolor de Hombro/tratamiento farmacológico , Dolor de Hombro/psicología , Terminología como AsuntoAsunto(s)
Analgésicos Opioides/uso terapéutico , Traumatismos de la Espalda/tratamiento farmacológico , Traumatismos de la Espalda/epidemiología , Personas con Discapacidad/estadística & datos numéricos , Evaluación de la Discapacidad , Humanos , Dolor de la Región Lumbar/tratamiento farmacológico , Dolor de la Región Lumbar/epidemiología , Enfermedades Profesionales/tratamiento farmacológico , Enfermedades Profesionales/epidemiología , Factores de RiesgoRESUMEN
STUDY DESIGN: Prospective, population-based cohort study. OBJECTIVE: To examine whether prescription of opioids within 6 weeks of low back injury is associated with work disability at 1 year. SUMMARY OF BACKGROUND DATA: Factors related to early medical treatment have been little investigated as possible risk factors for development of long-term work disability among workers with back injuries. We have previously shown that about 1 of 3 of workers receive an opioid prescription early after a low back injury, and a recent study suggested that such prescriptions may increase risk for subsequent disability. METHODS: We analyzed detailed data reflecting paid bills for opioids prescribed within 6 weeks of the first medical visit for a back injury among 1843 workers with lost work-time claims. Additional baseline measures included an injury severity rating from medical records, and demographic, psychosocial, pain, function, smoking, and alcohol measures from a worker survey conducted 18 days (median) after receipt of the back injury claim. Computerized database records of work disability 1 year after claim submission were obtained for the primary outcome measure. RESULTS: Nearly 14% (254 of 1843) of the sample were receiving work disability compensation at 1 year. More than one-third of the workers (630 of 1843) received an opioid prescription within 6 weeks, and 50.7% of these (319 of 630) were received at the first medical visit. After adjustment for pain, function, injury severity, and other baseline covariates, receipt of opioids for more than 7 days (odds ratio = 2.2; 95% confidence interval, 1.5-3.1) and receipt of more than 1 opioid prescription were associated significantly with work disability at 1 year. CONCLUSION: Prescription of opioids for more than 7 days for workers with acute back injuries is a risk factor for long-term disability. Further research is needed to elucidate this association.
Asunto(s)
Analgésicos Opioides/uso terapéutico , Traumatismos de la Espalda/epidemiología , Evaluación de la Discapacidad , Personas con Discapacidad/estadística & datos numéricos , Dolor de la Región Lumbar/epidemiología , Enfermedades Profesionales/epidemiología , Adolescente , Adulto , Anciano , Traumatismos de la Espalda/tratamiento farmacológico , Traumatismos de la Espalda/fisiopatología , Estudios de Cohortes , Femenino , Humanos , Dolor de la Región Lumbar/tratamiento farmacológico , Masculino , Persona de Mediana Edad , Enfermedades Profesionales/tratamiento farmacológico , Enfermedades Profesionales/fisiopatología , Dimensión del Dolor , Estudios Prospectivos , Factores de Riesgo , Índice de Severidad de la Enfermedad , Washingtón/epidemiología , Indemnización para Trabajadores/estadística & datos numéricosRESUMEN
Pain is one of the most common symptoms reported to primary care providers and has significant implications for health care costs. The primary aim of this article is to describe and illustrate how to integrate the treatment of chronic pain in the primary care setting. First, we address the integration and coordination of care between mental health and primary care. We then present a typical case and discuss the patient's treatment, outcome, and prognosis. The article concludes with a discussion of issues that frequently arise when integrating psychological treatment for pain in primary care settings.
Asunto(s)
Traumatismos de la Espalda/psicología , Manejo del Dolor , Atención Primaria de Salud/métodos , Consumo de Bebidas Alcohólicas , Traumatismos de la Espalda/tratamiento farmacológico , Traumatismos de la Espalda/etiología , Dolor de Espalda/etiología , Dolor de Espalda/psicología , Dolor de Espalda/terapia , Enfermedad Crónica , Humanos , Masculino , Persona de Mediana Edad , Personal Militar , Sobrepeso , Dolor/psicología , Atención Primaria de Salud/organización & administración , Resultado del TratamientoRESUMEN
Reversible posterior leukoencephalopathy syndrome is a recently described disorder with typical radiologic findings in the posterior regions of the cerebral hemisphere and cerebellum. The symptoms include headache, nausea, vomiting, visual disturbances, focal neurologic deficits, and seizures. A 10-year-old male was hit on his back, resulting in backache. He was medicated with sodium diclofenate and mefenamic acid. The next day, he had edema and oliguria. By the third day, his blood pressure increased and he began to experience restlessness and worsening mental status. He then complained of headache and visual disturbances and had a seizure. A magnetic resonance imaging scan revealed abnormalities in the posterior regions of the cerebral hemisphere and cerebellum. The patient was treated with antiepileptics and calcium antagonists. His hypertension and seizures were well controlled. On the 22nd day, he was discharged without any neurologic or renal deficits. Reversible posterior leukoencephalopathy syndrome does not occur frequently in childhood, and this is the first case report of reversible posterior leukoencephalopathy syndrome related to nonsteroidal anti-inflammatory drugs. One should consider reversible posterior leukoencephalopathy syndrome as a side effect of nonsteroidal anti-inflammatory drug use in daily medical treatment.
Asunto(s)
Antiinflamatorios no Esteroideos/efectos adversos , Traumatismos de la Espalda/tratamiento farmacológico , Dolor de Espalda/tratamiento farmacológico , Diclofenaco/efectos adversos , Encefalopatía Hipertensiva/inducido químicamente , Ácido Mefenámico/administración & dosificación , Nefritis Intersticial/inducido químicamente , Lóbulo Occipital/efectos de los fármacos , Lóbulo Parietal/efectos de los fármacos , Heridas no Penetrantes/tratamiento farmacológico , Enfermedad Aguda , Antiinflamatorios no Esteroideos/administración & dosificación , Corteza Cerebral/efectos de los fármacos , Corteza Cerebral/patología , Niño , Diclofenaco/administración & dosificación , Quimioterapia Combinada , Estudios de Seguimiento , Humanos , Encefalopatía Hipertensiva/diagnóstico , Aumento de la Imagen , Procesamiento de Imagen Asistido por Computador , Imagen por Resonancia Magnética , Masculino , Ácido Mefenámico/efectos adversos , Nefritis Intersticial/diagnóstico , Lóbulo Occipital/patología , Lóbulo Parietal/patología , Remisión EspontáneaRESUMEN
STUDY DESIGN: A randomized single-blind clinical trial of facet injections plus exercise, versus exercise alone, in chronic disabling work-related lumbar spinal disorders (CDWRLSD), accompanied by pilot interrater reliability and facet syndrome prevalence studies. OBJECTIVES: To systematically investigate the use of facet injections as an adjunct to supervised lumbar stretching exercises in regaining lumbar range of motion (ROM) following prolonged deconditioning after work-related lumbar injuries. To assess interrater reliability of visual assessment of segmental rigidity (SR), and to evaluate the prevalence of facet syndrome in cases of lumbar SR. SUMMARY OF BACKGROUND DATA: Corticosteroid joint injections have often been used to reduce musculoskeletal inflammation to facilitate joint mobilization in the presence of degenerative arthritis. Lumbar segmental rigidity is a recently described entity usually associated with painful chronic spinal disorders and postoperative spine surgery. Previous work has shown that SR and lumbar ROM improves with a brief intervention consisting of facet injections followed by specific stretching exercises. No systematic study has investigated the potential benefits of a combination of facet injections and exercise over supervised exercises alone to treat lumbar SR. Similarly, no study has assessed the association between SR and the facet syndrome. METHODS: From a group of consecutive patients (n = 421) with CDWRLSD referred for tertiary rehabilitation between November 1999 and January 2001, 70 were noted to have SR on intake physical examination. The first part of this study assessed interrater reliability for detecting SR, and intrarater reliability for 3-segment true lumbar ROM measurements. Patients randomly assigned to participate in supervised stretching exercises with the addition of fluoroscopically guided bilateral facet injections at the involved levels (Group A, n = 36) also underwent facet syndrome prevalence assessment at the time of injection. They were compared to a randomly allocated comparison group (Group B, n = 34) undergoing exercises alone in a single-blind design. Physical therapists saw patients an average of twice per week, providing supervision of a progressive home stretching program. Inclinometric joint ROM was measured at the time of group allocation, and again 5 to 7 weeks later. Validated questionnaires of pain (intensity VAS) and disability (Million VAS) related to the CDWRLSD were provided before and after the interventions. RESULTS: Part 1 reliability and facet syndrome prevalence work revealed that interrater reliability for experienced examiners to detect rigid segments was excellent (Pearson's r = 0.97, P < 0.01). Intrarater 3-joint motion measurement reliability was also good for all sagittal/coronal ROM (Pearson's r = 0.95-0.99, P < 0.01). Only 5 of 29 subjects with SR met criteria for facet syndrome (17%), consistent with prior prevalence studies of unselected patients with low back pain. In Part 2, a large majority of patients in both groups improved from the initial to the post-treatment ROM measurements (the primary outcome criterion of the study). However, a higher proportion of Group A (injection) patients (87%-95%) showed ROM improvement, compared to Group B (exercise only) patients (64%-79%). Group A patients showed a significantly greater ROM improvement in all sagittal and coronal movements, both in absolute terms and percent of initial measurement. No significant differences in pain or disability self-report were found between groups, pre- or postintervention, but both groups showed significant improvement from pre- to postintervention in pain and disability assessments. CONCLUSIONS: The detection of SR and measurement of 3-segment true lumbar ROM by experienced examiners is highly reliable. Only 17% of CDWRLSD patients with lumbar SR met criteria for the facet syndrome, a rate approximately equal to that of unselected low back pain cohorts. This indicates that lumbar SR may be found whether or not pain of facet joint origin is present. In the randomized trial, facet injections significantly increased the percentage of patients with SR showing ROM improvement, as well as the degree of improvement in lumbar mobility after treatment. There is no evidence that facet injections increase the improvements in pain/disability report noted in both groups.
Asunto(s)
Corticoesteroides/uso terapéutico , Traumatismos de la Espalda/rehabilitación , Terapia por Ejercicio , Vértebras Lumbares , Enfermedades Profesionales/rehabilitación , Articulación Cigapofisaria/fisiopatología , Corticoesteroides/administración & dosificación , Adulto , Traumatismos de la Espalda/tratamiento farmacológico , Terapia Combinada , Preparaciones de Acción Retardada , Discitis/tratamiento farmacológico , Discitis/rehabilitación , Discitis/cirugía , Discectomía , Femenino , Fluoroscopía , Humanos , Inyecciones , Lidocaína/administración & dosificación , Lidocaína/uso terapéutico , Masculino , Persona de Mediana Edad , Variaciones Dependientes del Observador , Enfermedades Profesionales/tratamiento farmacológico , Dimensión del Dolor , Rango del Movimiento Articular , Recuperación de la Función , Método Simple Ciego , Síndrome , Resultado del TratamientoRESUMEN
Most skin lesions heal delay and even heal efficiently within 1-2 weeks, the healed tissue is neither aesthetically nor functionally perfect. Therefore, facilitating skin healing rate and controlling healed skin quality are major aims of drug treatment for a wound event. Bismuth subgallate (BS) and Borneol (BO) are the two components of Sulbogin, a new Vaseline-based wound healing ointment, one for treating skin wounds. Although BO has antibiotic function, while BS is widely used clinically, neither has been used specifically for wound healing. The experiment described here aimed to study the effect of BS and BO on the healing of skin wounds. This study also compared the effects of BS and BO with Flamazine cream, which is currently the most popular drug for wound healing in hospitals. Full-thickness wounds (3 cm x 3 cm x 0.2 cm) were created on the back of adult male Sprague-Dawley rats. BS, BO, BS+BO, and Flamazine were then evenly applied to cheesecloth and placed over the lesion areas. The drug patches were replaced every 2-3 days until the wound areas were completely covered by epidermis in any kinds of drug treatment. The combined BS and BO treatment had the best effect on healing by decreasing lesion area, while increasing granulation tissue formation, re-epithelialization, eating behavior and reconstitution of skin appendages. This investigation showed that BS and BO have a synergistic effect on the skin wound restoration.
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Canfanos/administración & dosificación , Ácido Gálico/análogos & derivados , Ácido Gálico/administración & dosificación , Pomadas/administración & dosificación , Compuestos Organometálicos/administración & dosificación , Piel/efectos de los fármacos , Piel/lesiones , Piel/patología , Cicatrización de Heridas/efectos de los fármacos , Heridas Penetrantes/tratamiento farmacológico , Heridas Penetrantes/patología , Administración Tópica , Antiinfecciosos Locales/uso terapéutico , Traumatismos de la Espalda/tratamiento farmacológico , Traumatismos de la Espalda/patología , Canfanos/química , Sinergismo Farmacológico , Ácido Gálico/química , Pomadas/química , Compuestos Organometálicos/química , Sulfadiazina de Plata/uso terapéutico , Resultado del TratamientoRESUMEN
To the present study were used males rats (Rattus Norvegicus, var. Albinus, Rodentia Mammalia) EPM-1 Wistar, which came from Biotério Central da UNIFESP-EPM. Each animal was submitted to two wound of circular shape, made with a ôpunchö, with superficial cuts of 2 cm diameter; located on medium line of dorsal region. In the present study, one wound was re-covered with the cellulose coat and the other serves as a control. This experimental form, makes it possible to us realize different studies such as macroscopic aspects of the wounds as well morphometric and morphological parameters analysis.