Dry Needling Can Be An Alternative Treatment for Hemifacial Spasm

Back Ground: Hemifacial spasm is one of movement disorder case that commonly found in daily clinical practice. Epidemiological data are very limited, the average prevalence is 11 per 100,000 population, 14.5 per 100,000 in women and 7.4 per 100,000 in men. In Germany, the estimated prevalence is 8000 to 9000 peoples.1 The incidence of women is more than that of men with a ratio of 2:1. Based on Yaltho and Jankovic study in 2011, out of 215 patients, the ratio of men to women was 1:1.8.2 One study in Indonesia also reported that most of the subjects were female (64.7%).3 Treatment with botulinum toxin injections is preferred to microvascular decompression surgery therapy, but this injection is only effective in a few months and quite expensive. This study is the first study to assess the effectiveness of dry needling on clinical improvement of hemifacial spasm compared to standard therapy of botulinum toxin injection.Methods: The study design was quasi experimental. Total of 24 subjects were divided into two groups. The first group underwent dry needling intervention while the other had botulinum injection. Clinical severity before and after treatment in both groups was assessed using Jankovic and HFS7 scores.Results: In dry needling group there were significant differences between Jankovic and HFS7 score at baseline and at week 1, 2, 3 and 4. While in botox group significant differences were also Jankovic and HFS7 score at baseline and at weeks 2 and 4. There were also a significant difference of Jankovic and HFS7 score when we compared dry needling group to botulinum toxin group.Conclusion: Dry needling can be an alternative treatment for hemifacial spasm, although clinical improvements based on Jankovic and HFS7 scores in dry needling group were not as effective as those with botulinum toxin injections

HEADACHE PROFILE OF BRAIN TUMOR PATIENTS IN MOHAMMAD HOESIN HOSPITAL PALEMBANG

Background: Headache is one of the most common complaint in population while a serious causative of underlying disease is very rare. Although headaches are rarely the result of a brain tumor, brain tumors are frequently associated with headaches. The challenges to the physician are to determine the specific feature of headache related to brain tumor.Methods: This is cross sectional study involved primary and metastatic brain tumor patient admitted in neurology ward of Mohammad Hoesin hospital from April 2018 to June 2019. The inclusion criteria including age > 18 years old and there was symptom of headache based on anamnesis. All were interviewed about their personal details (age, gender). The characteristic of headache was obtained based on questionnaire designed in our department. Various neurological symptoms related to the tumor were also recorded. Information of the tumor was obtained from the patient’s chart (histopathology of the tumor) and from characteristic of neuroradiological finding (magnetic resonance imaging or computed tomography). Headache and tumor characteristics were compared between primary and metastatic tumor by contrasting frequencies. We also analysed the correlation between tumor characteristics (location, hidrocephalus, vasogenic edema and tumor type) with headache intensity.Results: A total of 95 of 199 patients (48%) with headache symptom were studied in this series. Most patients were complained of chronic headache. Headache was mostly throbbing in both primary and metastatic brain tumors.  Progressively headache was dominant in this study and more than half patients report the quality of headache as moderate at the onset. In 35,8% patients, headache was the patient’s first complaint.  Headache as the isolated symptom of brain tumor was found in only 3,2% and only 28,4% of patients ful?lled the three ‘classic criteria’ of the brain tumor headache. A great localizing value of the headache was found in 63 cases of 95 patients. Of the 61 patients with single tumor and unilateral side, the unilateral headache was on 48 cases (78,8%). Of the 26 patients with strictly bilateral headache, 10 cases (38,5%) had bilateral sided tumors. Conclusion: The incidence of brain tumor headache in this study is similar to previous reports although the classic brain tumor headache features was found in a small portion of the patients.

EFEKTIVITAS MAGNESIUM ORAL TERHADAP INTENSITAS NYERI DAN STATUS FUNGSIONAL PADA NYERI PUNGGUNG BAWAH KRONIS

Nyeri punggung bawah kronis merupakan salah satu masalah kesehatan yang utama. Pada setiap tahap penatalaksanaan, terapi adjuvant seperti antidepresan atau antikonvulsan mungkin bermanfaat untuk mengurangi nyeri, namun modalitas perawatan ini gagal pada banyak pasien. Ketika obat-obatan ini gagal memberikan efek analgesia yang memuaskan, obat lain seperti antagonis reseptor N-metil-D-aspartat (NMDA) dapat memberikan pilihan yang tepat. Magnesium berperan dalam sensitisasi sentral dan peningkatan reaksi terhadap rangsangan perifer. Studi ini untuk mengetahui efektivitas magnesium oral terhadap intensitas nyeri dan status fungsional pasien nyeri punggung bawah kronis di klinik rawat jalan RSUP Dr. Mohammad Hoesin Palembang. Penelitian ini merupakan studi eksperimental randomized control trial (RCT) dengan metode Add On yang dilakukan dengan cara double blind di RSUP Dr. Mohammad Hoesin Palembang periode Januari 2021- Maret 2021. Terdapat 28 subjek penelitian dengan usia terbanyak 30-60 tahun (71,4%) mayoritas berjenis kelamin perempuan (57,1%), tingkat pendidikan paling banyak yaitu SLTA (32,1%), mayoritas status pekerjaan sebagai ibu rumah tangga (46,4%), dengan IMT overweight (25%), lamanya nyeri 3 bulan-1tahun (50%), paling banyak mendapatkan terapi standar gabapentin dosis 300 mg (53,6%), amitriptilin 12,5 mg (57,1%), dan natrium diklofenak 50 mg (100%). Pada analisis bivariat ditemukan bahwa penambahan magnesium pada terapi standar terbukti lebih efektif untuk mengurangi intensitas nyeri (p 0,011) dan meningkatkan status fungsional (p 0,007) Magnesium oral efektif untuk menurunkan intensitas nyeri ringan-sedang dan meningkatkan status fungsional pada pasien nyeri punggung bawah kronis di RSUP Dr. Mohammad Hoesin Palemban

PAIN CHARACTERISTICS OF CENTRAL NERVOUS SYSTEM TUMOR IN MOHAMMAD HOESIN GENERAL HOSPITAL

Pain is one of the cardinal symptom in tumor patient, especially in Central Nervous System (CNS) tumor. It often impacts patient’s quality of life. The incidence and characteristic of pain have rarely been reported in Palembang, Indonesia. This observational study was planned to investigate the clinical presentation and epidemiology of CNS tumor firstly diagnosed in ward throughout July to December 2018. 99 patients recently diagnosed with CNS tumor were enrolled. From 99 patients, we found 34 patients with tumor associated pain. We further evaluated the information of pain linked with brain tumors via questionnaire and medical record. Of all 34 subjects, the age ranged from 43 to 79 years old with female : male ratio 3:1. Pain was present 100% in spinal tumor and 54% in brain tumor. Clinical characteristics of pain found in brain tumor were typically in ipsilateral lesion (92%), pulsating (76%), moderate intensity (60%), recurrent (84%), not radiating (80%), with frequency of 3-4 times in a week (48%). On the other hand, pain in spinal tumor was generally felt on the site of the lesion (100%), radiating (77.8%), electrical type of pain (44.4%), high intensity (77.8), and constant (88.9%). From this study we conclude that tumor locations can show some different pain characteristics. Therefore careful pain assessment is compulsory to have better understanding and more appropriate management

CORRELATION BETWEEN CHRONIC PAIN WITH DEPRESSION AND ANXIETY DISORDERS IN PATIENTS AT RSUP DR MOHAMMAD HOESIN PALEMBANG

The International Association for the Study of Pain defines pain as an unpleasant sensory and emotional experience related to the actual or potential damage to a tissue. Recent research reports 30% - 60% of the incidence of pain in depression and anxiety. Both of these conditions affect the quality and function of life of patients with chronic pain. This study was observational analytic research with a cross-sectional study. The subject of this study was the patien with chronic pain treated at Dr. Moh. Hoesin Palembang. Determination of pain level was assessed by Numeric Pain Rating Scale (NPRS) and Functional Pain Scale (FPS). Determination of depression is valued by Beck Depression Inventory II (BDI II) and determination of anxiety with the Beck Anxiety Inventory (BAI). Statistical analysis using a correlation test, is a method to find relationships between variables with a confidence level of 95%, significant if p <0.05. In this study there were 78 patients with chronic pain where the correlation between NPRS scores and depression disorders with a correlation of 35.3% and a p-value of 0.002 showed significant. The correlation between NPRS scores and anxiety disorders with a correlation was 43.5% with and p-value 0,000 which showed a significant correlation. Correlation between FPS score and depression disorders was 33.1% and p-value of 0.003 which showed a significant correlation. Correlation between FPS score and anxiety disorders was 20.8% with a p-value of 0.068 showed not significant correlation. There was a significant correlation between chronic pain with depression and anxiety disorders

Efficacy of Lidocaine and Ketamine Combination on Reduction of Pain Intensity, Improvement of Functional State and Central Desensitization of Chronic Low Back Pain

Abstract Background: Chronic low back pain (LBP) prevalence is approximately 20% of world population. Central and peripheral sensitization are considered as the main mechanism of pain chronification. This study hypothesize that lidocaine and ketamine combination reduces pain intensity, improves functional state and central desensitization of chronic low back pain. It is&nbsp; by modulating central sensitization in sub-anesthetic dose, prolonging inactivation of Na-channel, blocking NMDA-receptor and preventing secondary hyperalgesia. Aim of study: To evaluate the efficacy of lidocaine and ketamine combination on the intensity of pain, functional state and central desensitization of chronic low back pain. Methods:. This double blind randomized control trial study was carried out in Mohammad Hoesin General Hospital, Palembang, Indonesia from May 2018 to January 2019. A total of 20 patients with low back pain that last for more than 3 months, aged &gt;18 years old, of either sex who were willing to be enrolled in this study, were randomly allocated into one of the two groups of 10 each. The treatment group (n=10) received standardized therapy (analgesic and physiotherapy) + intravenous ketamine 0.5 mg/kg + lidocaine 2 mg/kg and the control group (n=10) received standardized therapy + 100 ml Nacl 0.9%. Pain intensity, functional state, and central desensitization were measured before the treatment, day 7 after treatment, and a month after treatment using Numeric Pain Rating Scale (NPRS), Functional Pain Scale (FPS), and Central Sensitization Inventory (CSI). Results: The administration of ketamine 0.5 mg/kg + lidocaine 2 mg/kg resulted in NPRS and CSI changes was effective since the 7th day post intervention (p-value=0.021 and p-value=0.001) while on FPS changes, it was effective since the 30th day post intervention (p-value=0.000) Conclusion: From the result, it could be concluded that the administration of ketamine and lidocaine is effective on decreasing pain intensity and central desensitization in chronic LBP

Efektivitas Dry-Needling Terhadap Spatisitas, Range of Motion, dan Intensitas Nyeri Pasien Paska Stroke di Rumah Sakit Umum Pusat Dr. Mohammad Hoesin Palembang

Spastisitas merupakan kelainan motorik yang ditandai dengan peningkatan kecepatan refleks regang otot dan peningkatan hentakan tendon sebagai sindrom upper motor neuron (UMN). Prevalensi spastisitas adalah 43% pada 6 bulan setelah serangan pertama stroke dan 38% pada 1 tahun setelah stroke. Spastisitas dapat menurunkan kualitas hidup, sehingga diperlukan terapi untuk memperbaikinya. Tujuan penelitian ini adalah untuk mengetahui efektivitas dry needling (DN) terhadap spastisitas, Range of Motion (ROM), status fungsional dan intensitas nyeri pada pasien paska stroke di RSUP dr. Moh. Hoesin Palembang. Penelitian ini adalah uji klinik randomized control trial (RCT) add on, double blind. Terdapat 20 subyek yang secara random terbagi ke dalam kelompok kontrol dan kelompok perlakuan. Kedua kelompok menjalani terapi standar rehabilitasi medik dan kelompok perlakuan diberikan terapi DN sebanyak 4 sesi, 1 kali perminggu. Evaluasi dilakukan dengan menilai Modified Modified Asworth Scale (MMAS), ROM, Upper Extremity Functional Index (UEFI) dan Numeric Rating Scale (NRS) penderita. Hasil penelitian ini menunjukkan adanya perbaikan MMAS, ROM, UEFI, dan NRS pada kelompok perlakuan selama evaluasi paska intervensi setiap minggu hingga minggu ke-4 dan bertahan hingga minggu ke-8 (4 minggu paska intervensi). Perbedaan yang signifikan didapatkan antar kelompok sejak minggu ke-2 hingga minggu ke-8 dengan p<0,05 pada MMAS fleksor siku, sedangkan MMAS fleksor pergelangan tangan berbeda signifikan pada minggu ke-3 (p=0,021). Perbedaan signifikan pada minggu ke-8 juga didapatkan pada nilai ROM (p=0,029 untuk fleksor siku dan p=0,036 untuk fleksor pergelangan tangan), UEFI (p=0,036), dan NRS (p=0,037). Sehingga, dapat disimpulkan bahwa DN terbukti efektif memperbaiki spastisitas, ROM, status fungsional dan intensitas nyeri dibandingkan dengan sham needling