Tülay Erçalik

Cutaneous silent period in myofascial pain syndrome

Introduction: An increased response to painful stimuli without spontaneous pain suggests a role of central hyperexcitability of pain pathways in the pathogenesis of myofascial pain syndrome (MPS). In this study we aimed to test the hypothesis that spinal pain pathways are affected in MPS. We used cutaneous silent period (CSP) parameters to demonstrate the hyperexcitability of spinal pain pathways in MPS. Methods: Twenty‐nine patients diagnosed with MPS and 30 healthy volunteers were included in the study. The CSP recordings were performed in the right upper and left lower extremities. Results: In both upper and lower extremities, patients had prolonged CSP latencies (P = 0.034 and P = 0.049 respectively) and shortened CSP durations (P = 0.009 and P = 0.008, respectively). Discussion: Delayed and shortened CSP in MPS patients implies dysfunction in the inhibitory mechanism of the spinal/supraspinal pain pathways, suggesting central sensitization in the pathogenesis of MPS and supporting our research hypothesis. Muscle Nerve 57: E24–E28, 2018

The influence of coccygeal dynamic patterns on ganglion impar block treatment results in chronic coccygodynia

Objective Ganglion impar block (GIB) can be performed in patients with chronic coccygodynia who do not respond to conservative treatments. We investigated the effect of coccygeal dynamic patterns on the treatment outcome in patients with chronic coccygodynia treated with GIB. Materials and methods We retrospectively analyzed the data for patients diagnosed with chronic coccygodynia who underwent GIB only once by a transsacrococcygeal method under fluoroscopy guidance in our Pain Medicine Clinic. Patients were assessed with standard and dynamic coccyx radiographs and classified according to coccygeal mobility. Pain scores were assessed with a numerical rating scale (NRS) before and after the intervention (at 1 hour and 4, 12 and 24 weeks). A 50% or more reduction in the NRS score was accepted as significant pain relief. Results Of the 37 patients included in the study, 14 had normal coccyx (Group I) and 23 had immobile coccyx (Group II) based on the radiological evaluation. The NRS scores were significantly reduced in both groups on each follow-up visit but there was no significant difference between the two groups in terms of pre- and post-intervention NRS scores. Significant pain relief was achieved in 42.9% and 61.9% of patients in Group I and II at the last examination, respectively. Conclusion GIB administered by transsacrococcygeal method in patients with chronic coccygodynia is a safe and alternative treatment approach with reduced pain scores and low complication rates. In patients with chronic coccygodynia, having a normal or immobile coccyx does not appear to affect treatment outcomes.

Recovery of H-Reflex with Transforaminal Epidural Steroid Injection in S1 Radiculopathy

Transforaminal epidural steroid injection (TFESI) is a recognized nonsurgical management of radicular back pain through its effects on neural inflammation and edema [1]. Electrodiagnostic changes of the compressed nerve root such as Hoffmann reflex (H-reflex) are apparent within days following injury and persist throughout nerve compression [2], with sensitivity and specificity of 50% and 91%, respectively, making the detection of H-reflex abnormality an option to identify early radiculopathy [3]. Despite its prevalent diagnostic use, to our knowledge there is limited information in the current literature regarding changes of an abnormal H-reflex following treatment of radiculopathy. We have investigated the changes of the H-reflex profile following fluoroscopyguided epidural steroid injections in three patients with S1 radiculopathy secondary to disc herniation.

Poster 39 The Assessment of Pain and Quality of Life in Cancer Patients

Group 1, n1⁄4 236, patients who were ambulating less than 150 feet at admission to inpatient rehabilitation. Group 2, n1⁄455, patientswhowere ambulating over 150 feet at admission to inpatient rehabilitation. Interventions: Anticoagulation Therapy. Main Outcome Measures: VTE outcomes, discharge destination, and FIM gait gains. Results: A total of 295 patients admitted one year were identified through admission medical records met the inclusion criteria of this study and became subjects of this investigation. Group 1 (ambulation less than150 feet) mean age was 71.38 years (SD1⁄413.77) and sex distribution was 49% male / 51% female. Group 2 (ambulation greater than 150 feet) mean age was 69.4 years (SD1⁄414.2 years) and sex distribution was 53% male / 47% female. Group 1, 64% (151/236) were on anticoagulation VTE prophylactic treatment as compared to Group 2 at 44% (24/55) and differences between the two groups were significant (x1⁄49.04, P1⁄4.01). Incidence of VTE for Group 1 was 2.5% (6/236) and for Group 2 was 0% (differences between the two groups was nonsignificant, X1⁄41.479, P1⁄4.477). FIM gait gains for Group 11⁄4 2.28 (SD1⁄41.55) and Group 21⁄41.35 (SD1⁄4.77) and differences in FIM gait gains were significant (t1⁄46.401, P1⁄4.0001). Discharge destination for Group 1 to home1⁄452.1%, SNF1⁄435.5%, acute care1⁄412.4% and for Group 2 to home1⁄490.7%, SNF1⁄47.4%, acute care1⁄41.9% (3 x 2 x21⁄431.61, P1⁄4.0001). Conclusions: These results suggest that, as expected, patients with lower mobility scores were more likely to be anticoagulated. Anticoagulation does not appear to negatively impact FIM gait gains and may in fact be associated with greater gains in FIM gait scores. In spite of lower initial mobility, incidence of VTE and discharge destination were similar between the two groups. Level of Evidence: Level III

Clinical and Radiological Recovery of Osteitis Pubis: Spontaneous or Steroid-Induced?

On our physical examination, there was tenderness on pubis. After delivery, plain radiograph showed erosions all through both pubic rami, which were more prominent at the inferior part. Her numeric rating scale for pain was 7/10. Symphysis pubis injection with fluoroscopic guidance was performed with 40 mg methylprednisolone and 1 mL 0.5% bupivacaine. One hour after this injection, her numeric rating scale decreased to 3/10, which remained at the same level throughout the first three weeks. At seventh week, she was symptom free after a second injection with the same technique.