Konservatives Schmerzmanagement beim Karpaltunnelsyndrom - die aktuelle wissenschaftliche Datenlage

Fragestellung: Ziel dieser Literaturrecherche war es, eine Übersicht über die aktuelle wissenschaftliche Datenlage des konservativen Schmerzmanagements beim Karpaltunnelsyndrom (KTS) zu geben. Methode: Es wurde eine EDV-unterstützte Literatursuche (Publikationszeitrahmen bis Ende März 2011) unter Verwendung üblich verwendeter Literaturdatenbanken (Pubmed, Embase) durchgeführt. Die Ergebnisse der Suche wurden in Form einer traditionellen Literaturübersicht dargestellt. Ergebnisse: Beim primären Management des Schmerzes beim milden bis moderaten KTS können kurzfristig bis mittelfristig wirksame konservative Therapiemaßnahmen wie z.B. Schienenbehandlung, Infiltrationen, Ultraschalltherapie, Iontophorese gut verwendet werden. An weiteren Therapiemöglichkeiten sind ergonomische Keyboards, Magnetfeldtherapie und lokale Spezialmassagen im Handbereich zu nennen. Die Kombination verschiedener konservativer Therapiemöglichkeiten kann die Wirksamkeit des Schmerzmanagements beim milden bis moderaten KTS verbessern. Beim sog. sekundären Management nach einer KTS-Operation kann die sinnvolle postoperative Rehabilitation in einer Krankengymnastik und einem Funktionstraining der Hand, in einer konsequenten Narbenbehandlung mittels Ultraschall- und Lasertherapie, Narbenmassage sowie einer Behandlung postoperativer lokaler Schwellungen mittels Lymphdrainagen und CO2-Bädern. bestehen. Der postoperative Schmerz der Hand kann mit medikamentöser Schmerztherapie und physikalischen Therapiemaßnahmen behandelt werden. Diskussion der Ergebnisse: Beim milden bis moderaten KTS können verschiedene konservative Therapiemöglichkeiten zur kurz bis mittelfristige Schmerzlinderung appliziert werden. Durch die hohe Prävalenz des Karpaltunnelsyndroms und der limitierten Datenlage hinsichtlich Langzeiteffekte von konservativen Therapieoptionen des KTS sind gute klinische Studien zwecks Verbesserung des „Langzeit-Managements“ von Schmerz infolge von KTS notwendig.The aim of this review was to investigate the effects of non-operative treatment options for carpal tunnel syndrome (CTS). Treatment options of CTS include 1) (only) conservative treatments and 2) postoperative rehabilitation. Meta-analyses and original articles concerning this topic were included in this review. CTS can be diagnosed by history taking, physical examination, and electrophysiological testing. Treatment options of CTS are 1) surgical treatment and 2) conservative treatment options like splinting, steroid injection, ultrasound therapy, and iontophoresis. After surgery, rehabilitation aims can be achieved by using different active and passive modalities. These are physiotherapy and occupational therapy (to accerlerate recovery after surgery), ultrasound therapy and Laser-therapy (treatment of scars), lymphatic drainage and Co2-baths (treatment of postoperative oedema and swelling). After surgery pain can be treated using pharmacological and physical-medical modalities. Using of “state of the art options” in diagnosis and therapy is a very important step to optimize the treatment of patients with CTS. Due to lack of knowledge about this topic, further randomised controlled high quality clinical studies researching the conservative treatment options of CTS would be necessary.vorgelegt von: Mohammad Yahya KeilaniMedizinische Universität Wien, Masterarb., 201

Sleep quality in subjects suffering from chronic pain

Background Sleeping problems are very common in patients with chronic pain. The aim of the study was to investigate the association between different dimensions of chronic pain and sleep quality in chronic pain patients. Methods In this cross-sectional interview-based questionnaire study, patients from 3 different pain treatment centers in Vienna aged 1865 years, with pain lasting 3 months or longer were asked to participate. The association between the short-form McGill pain questionnaire (SF-MPQ) and sleep quality (sleep onset latency, interrupted sleep due to pain, sleep duration and recovering effect of sleep) was assessed. Results In this study 121 patients (male 32, female 89, mean age 49 9 years) could be analyzed. Of the patients 38.8% needed more than 30min for falling asleep, 63.6% reported sleep fragmentation, 30.6% slept less than 5h and 60.3% reported no recovering effect of sleep. The strongest associations between pain characteristics and sleep quality were found for pain intensity and affective pain aspects. Logistic regression analyses revealed that one point more in the total score of SF-MPQ increased the odds of needing more than 30min for falling asleep, waking up more than 3 times due to pain, sleeping less than 5h, and perceiving the sleep as non-recovering, by 6%. Adjusting for physical and psychological quality of life lowered the odds ratios and the association was no longer significant. Conclusion The results underline the importance of paying attention to sleep quality in patients with chronic pain. The results also indicate that psychological factors might mediate the association between pain and sleep quality.(VLID)357361

Prescribing Exercise to Cancer Patients Suffering from Increased Bone Fracture Risk Due to Metastatic Bone Disease or Multiple Myeloma in Austria—An Inter- and Multidisciplinary Evaluation Measure

Introduction: In the current absence of specific functional fracture risk assessment technology, the planning of physical exercise interventions for cancer patients suffering from increased bone fracture risk remains a serious clinical challenge. Until a reliable, solely technical solution is available for the clinician, fracture risk assessment remains an inter- and multidisciplinary decision to be made by various medical experts. The aim of this short paper is depicting how this challenge should be approached in the clinical reality according to Austrian experts in cancer rehabilitation, presenting the best-practice model in Austria. Following referral from the specialist responsible for the primary cancer treatment (oncologist, surgeon, etc.), the physiatrist takes on the role of rehabilitation case manager for each individual patient. Fracture risk assessment is then undertaken by specialists in radiology, orthopedics, oncology, and radiation therapy, with the result that the affected bone regions are classified as being at highly/slightly/not increased fracture risk. Following internal clearance, exercise planning is undertaken by a specialist in exercise therapy together with the physiatrist based on the individual’s fracture risk assessment. In the case in which the patient shows exercise limitations due to additional musculoskeletal impairments, adjuvant physical modalities such as physiotherapy should be prescribed to increase exercisability. Conclusion: Exercise prescription for cancer patients suffering from increased fracture risk is an inter- and multidisciplinary team decision for each individual patient

Immunohistochemical expression of substance P in breast cancer and its association with prognostic parameters and Ki-67 index.

BackgroundThe neuropeptide substance P is a potential biomarker and therapeutic target in cancer. The main objectives of this study were to investigate the expression level of substance P in different breast cancer molecular subtypes and identify its association with clinicopathological parameters of patients and with Ki-67 index.MethodsA retrospective analysis was performed for a total of 164 paraffin-embedded breast cancer tissue samples [42 Her2/neu-enriched, 40 luminal A, 42 luminal B (triple-positive) and 40 triple negative subtypes]. The tissue microarray slides containing specimens were used to determine the expression of substance p and Ki-67 by immunohistochemical staining.ResultsThe mean age of the cohort was 51.35 years. Twenty two percent of cases had low substance P expression levels (TS ≤ 5), while 78% had high expression levels (TS > 5). A significant association was found between SP expression level and breast cancer molecular subtype (p = 0.002), TNM stage (p = 0.034), pN stage (p = 0.013), axillary lymph node metastasis (p = 0.004), ER and PR statuses (pConclusionSP is overexpressed in most of the analyzed tissues and has a negative prognostic value in the breast cancer patients. Besides substance P is a potential therapeutic target in breast cancer

Wiener Medizinische Wochenschrift / Whole body vibration therapy on a treatment bed as additional means to treat postprostatectomy urinary incontinence

An innovative form of whole body vibration therapy on a treatment bed (Evocell®) to fight against the disabling and isolating symptom of postoperative incontinence in a prostate cancer patient is presented. A supervised program with outpatient active pelvic floor training and a novel form of synchronous high-intensity whole body vibration therapy using the Evocell® device was performed in a patient with postprostatectomy stress urinary incontinence. The patient had previously failed regular pelvic floor exercise. During the intervention, namely a whole body vibration treatment in a lying position on a treatment bed, the patient performed active and passive pelvic floor exercises under professional guidance. Over a period of 6 weeks after starting treatment, the patient regained continence (usage of 1 safety pad). Furthermore, his ability to work increased (return to work) and his ability to attend social activities improved.(VLID)353193

Effect of ischemic preconditioning in skeletal muscle measured by functional magnetic resonance imaging and spectroscopy: a randomized crossover trial

<p>Abstract</p> <p>Background</p> <p>Nuclear magnetic resonance (NMR) imaging and spectroscopy have been applied to assess skeletal muscle oxidative metabolism. Therefore, in-vivo NMR may enable the characterization of ischemia-reperfusion injury. The goal of this study was to evaluate whether NMR could detect the effects of ischemic preconditioning (IPC) in healthy subjects.</p> <p>Methods</p> <p>Twenty-three participants were included in two randomized crossover protocols in which the effects of IPC were measured by NMR and muscle force assessments. Leg ischemia was administered for 20 minutes with or without a subsequent impaired reperfusion for 5 minutes (stenosis model). IPC was administered 4 or 48 hours prior to ischemia. Changes in ³¹phosphate NMR spectroscopy and blood oxygen level-dependent (BOLD) signals were recorded. 3-Tesla NMR data were compared to those obtained for isometric muscular strength.</p> <p>Results</p> <p>The phosphocreatine (PCr) signal decreased robustly during ischemia and recovered rapidly during reperfusion. In contrast to PCr, the recovery of muscular strength was slow. During post-ischemic stenosis, PCr increased only slightly. The BOLD signal intensity decreased during ischemia, ischemic exercise and post-ischemic stenosis but increased during hyperemic reperfusion. IPC 4 hours prior to ischemia significantly increased the maximal PCr reperfusion signal and mitigated the peak BOLD signal during reperfusion.</p> <p>Conclusions</p> <p>Ischemic preconditioning positively influenced muscle metabolism during reperfusion; this resulted in an increase in PCr production and higher oxygen consumption, thereby mitigating the peak BOLD signal. In addition, an impairment of energy replenishment during the low-flow reperfusion was detected in this model. Thus, functional NMR is capable of characterizing changes in reperfusion and in therapeutic interventions in vivo.</p> <p>Trial Registration</p> <p>ClinicalTrials.gov: <a href="http://www.clinicaltrials.gov/ct2/show/NCT00883467">NCT00883467</a></p

Wiener klinische Wochenschrift / Functional outcome after recurrent patellar dislocation : Comparison of two surgical techniquesMedial patellofemoral ligament reconstruction (MPFL) vs. Elmslie Trillat procedure

Background There is no final consensus regarding the ideal surgical technique for the treatment of patellar dislocation. The aim of this retrospective pilot study was to describe muscle strength, body composition, self-reported physical performance, and pain in male patients after patellar dislocation treatment with two different surgical techniques: medial patellofemoral ligament (MPFL) reconstruction vs. the Elmslie-Trillat procedure. Methods Isokinetic testing of knee extensor muscles was performed using a Biodex System 3 pro dynamometer at an angular velocity of 60/s. Body composition was measured with bioelectrical impedance analysis (Nutribox). Self-reported physical performance and pain were assessed by the SF-36 subscales of physical functioning, role physical and bodily pain. The outcome variables of peak torque normalized to participants body mass (Nm/kg), lean body mass, phase angle, self-reported physical performance, and pain were compared between the study groups. Results Of the 12 included male patients, 6 had been treated with MPFL reconstruction (age: median = 33 years, range = 1838 years; BMI: median = 26 kg/m2, range = 2329) and 6 with the Elmslie-Trillat procedure (age: median = 26 years, range = 1932 years; BMI: median = 23 kg/m2, range = 1928). No statistically significant differences were found between the groups in any outcome parameter of muscle strength, body composition, self-reported physical performance, or pain. Conclusions The results of the present pilot study revealed that MPFL reconstruction shows equal results to the Elmslie-Trillat procedure, with respect to isokinetic knee muscle strength, body composition, self-reported physical performance and pain in male patients suffering from recurrent patellar dislocation.(VLID)509278

Evaluation of serum VIP and aCGRP during pulmonary exacerbation in cystic fibrosis: A longitudinal pilot study of patients undergoing antibiotic therapy.

BackgroundObjective monitoring of improvement during treatment of pulmonary exacerbation can be difficulty in children when pulmonary function testing cannot be obtained. Thus, the identification of predictive biomarkers to determine the efficacy of drug treatments is of high priority. The major aim of the current study was to investigate the serum levels of vasoactive intestinal peptide (VIP) and alpha calcitonin gene related peptide (aCGRP) of cystic fibrosis pediatric patients during pulmonary exacerbation and post-antibiotic therapy, and possible associations of their levels with different clinicopathological parameters.Methods21 patients with cystic fibrosis were recruited at onset of pulmonary exacerbation. Serum was collected at time of admission, three days post-antibiotic therapy, and two weeks post-antibiotic therapy (end of antibiotic therapy). Serum VIP and aCGRP levels were measured using ELISA.ResultsOverall least square means of serum aCGRP level but not VIP changed from time of exacerbation to completion of antibiotic therapy (p = 0.005). Serum VIP was significantly associated with the presence of diabetes mellitus (p = 0.026) and other comorbidities (p = 0.013), and with type of antibiotic therapy (p = 0.019). Serum aCGRP level was significantly associated with type of antibiotic therapy (p = 0.012) and positive Staphylococcus aureus microbiology test (p = 0.046).ConclusionThis study could only show significant changes in serum aCGRP levels following treatment of pulmonary exacerbations. Future studies with larger sample size are required to investigate the clinical importance of VIP and aCGRP in cystic fibrosis patients