Funda Levendoglu

Gabapentin Is a First Line Drug for the Treatment of Neuropathic Pain in Spinal Cord Injury

Study Design. Prospective, randomized, double blind, placebo-controlled, crossover clinical trial. Objectives. To determine the efficacy of gabapentin in the treatment of neuropathic pain related to spinal cord injury. Summary of Background Data. Neuropathic pain is initiated or caused by a primary lesion or dysfunction in the nervous system. Neuropathic pain associated with spinal cord injury is quite refractory, and current treatments are not effective. Gabapentin, an anticonvulsant, has become the first choice in the treatment of neuropathic pain. The place of gabapentin in the treatment of spinal cord injury-related neuropathic pain was questioned in only a few recent reports; however, they are retrospectively designed, nonstandardized, and uncontrolled studies, or involve a very small series of patients using less than optimum doses. Methods. A total of 18-week study period included a 4-week medication/placebo titration period. This was followed by a 4-week stable dosing period when the patients continued to receive maximum tolerated doses, a 2-week washout period, then a crossover of 4 weeks of medication/placebo titration, and another 4 weeks of stable dosing period. Twenty paraplegic patients (female/male: 7/13) with complete spinal cord injury at the thoracic and lumbar level, aged between 20 and 65 years, with neuropathic pain for more than 6 months were recruited for the study. Results. All patients completed the study. Gabapentin reduced the intensity as well as the frequency of pain, relieved all neuropathic pain descriptors except the itchy, sensitive, dull, and cold types, and improved the quality of life (P < 0.05). Conclusions. Gabapentin can be added to the list of first-line medications for the treatment of chronic neuropathic pain in spinal cord injury patients. It is a promising new agent and offers advantages over currently available treatments.

Physical disability, psychological status, and health-related quality of life in older hemodialysis patients and age-matched controls

We aimed at comparing the elderly adults and normal subjects with regard to their disability, psychological status, and quality of life (QOL). One hundred and twenty‐five dialysis patients and 61 controls were recruited in the study. Depression and anxiety symptoms of the patients were evaluated with the Psychological Symptom Screening List (SCL 90‐R). For evaluating the disability, the Rivermead mobility index (RMI) was utilized. For evaluating the QOL, we used the short form‐36 (SF‐36) scale. The Rivermead mobility index of the patients (9.6±3.4) was found. When compared with controls, dialysis patients had higher levels of disability (p=0.0001). Depression and anxiety symptom scores of these patients were also significantly higher than that of the controls (p<0.05). There was a correlation between the disability and depression symptom scores (r: 0.171, p=0.037). Both physical and mental capacity scores of the dialysis patients were lower than those of the controls (p<0.05 and p<0.05) QOL scores for elderly hemodialysis patients were found to be lower. Their disability was higher, making them dependable on others during their daily lives. Specific exercise programs should be developed for these patients. Even the smallest effort in this regard will result in improvements in physical functioning while bringing them significant benefits.

Ventricular function abnormalities in active rheumatoid arthritis: a Doppler echocardiographic study.

ObjectiveThe aim of the present study was to evaluate cardiac involvement in patients with active rheumatoid arthritis (RA).MethodsForty patients with active RA participated. All were submitted to standard Doppler echocardiography and myocardial performance index (MPI) grading.ResultsThere were left and right ventricular diastolic function abnormalities in RA patients. Left ventricular MPI was also significantly higher than in controls (P<0.05). A relationship was found between left ventricular early diastolic (E)/atrial (A) flow velocities (E/A ratio), isovolumic relaxation time (IRT), and disease duration (r=−0.47 and P=0.002, r=0.618 and P=0.000, respectively).ConclusionDiastolic function was impaired in both ventricles in patients with active RA. There was a direct relationship between some of the parameters of left ventricular diastolic function and disease duration as well. These findings suggest a subclinical myocardial involvement in RA patients.

A Placebo-Controlled, Multicenter, Randomized, Double-Blind, Flexible-Dose, Two-Way Crossover Study to Evaluate the Efficacy and Safety of Sildenafil in Men With Traumatic Spinal Cord Injury and Erectile Dysfunction

Abstract Background/objective: To show the efficacy, safety, and tolerability of sildenafil in men with erectile dysfunction (ED) associated with complete or incomplete spinal cord injury (SCI) and to assess its effects onquality of life (Qol) using the Life-Satisfaction Check List. Methods: This was a placebo-controlled, multicenter, randomized, double-blind, flexible-dose, 2-way crossover study with a 2-week washout period between each phase. Patients with ED attributable to SCI(Sexual Health Inventory-Male score ≤21) received 50 to 100 mg sildenafil (n = 24) or placebo (n = 26). Results: Compared with placebo, sildenafil produced higher levels of successful sexual stimulation,intercourse success, satisfaction with sexual life and sexual relationship, erectile function, overall sexual satisfaction, and an improved Erectile Dysfunction Inventory of Treatment Satisfaction score, with no clinically relevant effects onvital signs. Sildenafil seemed more effective in patients with incomplete SCI than in those with complete SCI, producing significant improvements, compared with placebo, in a number of measures only in patients with incomplete SCI. All patients who expressed a preference selected sildenafil over placebo, although the drug had no effect on patient Qol. Sildenafil was well tolerated, with a profile comparable to that of placebo. Conclusions: Compared with placebo, treatment with oral sildenafil safelyand effectively improved erectile function in patients with ED attributable to SCI, especially in those with incomplete injury, and was theagent of choice in those who expressed a preference.

Vertebral artery loop formation: A frequent cause of cervicobrachial pain

Study Design. Patients with cervicobrachial pain were examined in detail with special attention to vertebral artery loop formation. Objectives. To determine the incidence, short-time natural course and response to a conservative approach to vertebral artery loop formation in a group of patients with cervicobrachial pain. Summary of the Background Data. Vertebral artery loop formation is reported to be a rare cause of cervicobrachial neuralgia, discovered incidentally during the search for its cause. It can be congenital or acquired, occurring equally in both sexes. Surgical decompression has been the preferred method in the majority of reported cases, with favorable results. Methods. One hundred seventy-three patients with cervicobrachial pain were examined in a period of 7 months using physical examination, radiography, and magnetic resonance imaging with or without angiography. Results. Thirteen patients with a mean age of 43.9 ± 13.5 years were diagnosed with vertebral artery loop formation. The most common level was C6–C7. Four patients presented with loop formation at two levels. None of the patients had symptoms attributable to intervertebral disc pathology. The complaints were in accordance with the level of the vascular pathology. Complete relief or decrease in pain was observed in all patients with the conservative approach. Conclusions. In patients with cervicobrachialgic symptoms and without established discopathy, during the examination of sagittal magnetic resonance images, vertebral artery loop formation should be kept in mind, and in suspected cases, the vertebral artery should be visualized using three-dimensional time of flight magnetic resonance angiography. Vertebral artery-nerve root relation should also be demonstrated using the multiplanar reformatting method from time of flight images. A conservative course of treatment has a favorable outcome.

The association between bone mineral density, quality of life, quality of sleep and fatigue

Objectives:: This study was undertaken to examine quality of life (QoL), the quality of sleep and fatigue level in postmenopausal women with osteoporosis (OP) but without fractures, to assess the associations between these parameters and to compare the results with those for subjects who have osteopenia or normal bone mineral density (BMD). Methods:: In this study, 113 postmenopausal osteoporosis (PMO) subjects without fractures, 172 subjects with osteopenia and 102 subjects with normal BMD were included. The severity of pain, QoL, quality of sleep and fatigue were assessed using the visual analogue scale (VAS), the QoL Questionnaire of the European Foundation for Osteoporosis (QUALEFFO-41), the Pittsburgh Sleep Quality Index (PSQI) and the Checklist of Individual Strength (CIS) questionnaire. Results:: No statistically significant differences between the three groups were found in terms of VAS and QUALEFFO-41 total scores (p > 0.05). On the other hand, PSQI and CIS total scores were significantly different in the PMO and osteopenia groups (P = 0.015 and 0.007, respectively) compared to the group with normal BMD. Conclusions:: During the follow-up and treatment of women with PMO or osteopenia, QoL, quality of sleep and fatigue should be assessed and incorporated into treatment decisions, even in the absence of fractures.

Efficacy of Pulsed Radiofrequency Therapy to Dorsal Root Ganglion Adding to TENS and Exercise for Persistent Pain after Total Knee Arthroplasty.

&NA; The majority of patients achieve substantial pain relief and improved function after total knee arthroplasty (TKA), but a proportion continues to experience life‐disturbing persistent postsurgical pain (PPSP) in the months and years after surgery. This study aimed to assess the efficacy of transcutaneous electrical nerve stimulation (TENS), exercise, and pulsed radiofrequency (PRF) treatment on pain severity, neuropathic pain, knee flexion range of motion (ROM), functional status, and patient satisfaction in patients with PPSP after TKA. This is a retrospective study of prospectively collected data. Patients who were identified retrospectively from hospital charts were divided into two groups: group 1 (n = 17) received TENS and exercise treatment and group 2 (n = 22) received TENS, exercise, and PRF application to the dorsal root ganglion (DRG). The following procedure‐related parameters were collected from the special registry form: visual analog scale (VAS), Douleur Neuropathique 4 (DN4) questionnaire, knee flexion ROM, the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), and patient satisfaction scale scores. The mean follow‐up was 253.8 ± 109 days. When the two groups were compared, a significant difference of at least 50% improvement in the VAS (activity) and a significant reduction in the DN4 scores following the last control examination were found in group 2. There was a significant reduction in total WOMAC scores in group 1 compared with group 2 for the four study periods. Higher scores for the patient satisfaction scale were found in group 1 compared with group 2 following the last control examination. Adding PRF to TENS and exercise therapy is useful in reducing the degree of pain and the neuropathic component of PPSP in patients with PPSP.

Complex Regional Pain Syndrome in a Patient with Muscular Dystrophy

Dear Editor We describe an adolescent patient with Becker muscular dystrophy (BMD) who exhibited complex regional pain syndrome type I (CRPS I) in both lower extremities that developed after instrumentation for scoliosis, together with bilateral achilloplasty. This patient was successfully treated with physical and massage therapy after a lumber epidural block via a caudally inserted epidural catheter. A 16-year old, 55 kg, 160 cm with the diagnosis of BMD was admitted to the orthopedic clinic with 90 degrees of thoracolumbar scoliosis and a disturbed body balance. He had not been able to walk for 6 years, and he underwent posterior instrumentation and fusion with lumbosacral fixation, together with bilateral achilloplasty, followed by bilateral below-knee casts for 3 weeks. After cast removal, the pharmacological therapies that were attempted included the analgesic tenoxicam (1 × 20 mg) and the co-analgesics amitriptyline (1 × 10 mg) and pregabalin (2 × 75 mg). Physical therapy was not attempted because of the patients severe pain. At the second postoperative appointment, throracolumbosacral radiographies and computed tomography images were taken to rule out any hardware failure or malposition of pedicle screws, and serological tests were also repeated to rule out any infection secondary to the operation as he had complaints of pain of his both lower extremities that began during the postoperative period. He was admitted …

Transient Sensory Recovery in Stroke Patients After Pulsed Radiofrequency Electrical Stimulation on Dorsal Root Ganglia: A Case Series

Introduction: The integrity of the somatosensory system is important for motor recovery and neuroplasticity after strokes. Peripheral stimulation or central stimulation in patients with central nervous system lesions can be an effective modality in improving function and in facilitating neuroplasticity. Case Report: We present 2 hemiplegic cases with sensory motor deficit and the result of the pulsed radiofrequency (PRF) electrical stimulation to the dorsal root ganglia. After PRF electrical stimulation, significant improvement was achieved in the examination of patients with superficial and deep sensation. However, during the follow-up visits were observed that the effect of PRF electrical stimulation disappeared. Conclusions: We believe that these preliminary results could be used in the development of future prospective cohort studies and randomized controlled trials that focus on the effect of PRF electrical stimulation on dorsal root ganglia to treat sensory deficits in poststroke patients.

Pulsed radiofrequency applied to the dorsal root ganglia for treatment of post-stroke complex regional pain syndrome: A case series

STUDY OBJECTIVE Complex regional pain syndrome is a painful and disabling syndrome where the patient presents with neuropathic pain, edema, or vasomotor or pseudomotor abnormalities that are often refractory to treatment. Complex regional pain syndrome type 1 may occurs in stroke patients. Radiofrequency is a therapeutic modality that has been used for years for diseases associated with neuropathic pain. DESIGN Case series report. SETTING Selcuk University Hospital. PATIENTS A 69-year-old woman and a 48-year-old women who suffered post-stroke complex regional pain syndrome type 1. INTERVENTIONS Pulsed radiofrequency current application to the cervical dorsal root ganglia. MEASUREMENTS Pain reduction. MAIN RESULTS The patients had complete resolution of their symptoms, which was maintained at 10 and 5 months of follow-up. CONCLUSIONS These cases illustrates that pulsed radiofrequency applied to cervical dorsal root ganglia might play a significant role in multi-modal approach of complex regional pain syndrome type 1 management after stroke. Further randomized, controlled studies are needed to support this argument.