Articles: treatment.
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To determine the effectiveness of low-energy extracorporeal shock wave therapy (ESWT) in the treatment of previously untreated lateral epicondylitis. ⋯ Low-dose ESWT did not have a clinically important effect in reducing pain, improving quality of life, or increasing pain-free grip strength in middle-aged patients with previously untreated unilateral or bilateral lateral epicondylitis.
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Many patients enrolled in chronic pain centers suffer from failed back surgery syndrome (FBSS). However, there has been a paucity of research concerning how these patients differ from other chronic pain patients, and how to most effectively address their complex problems within an interdisciplinary chronic pain treatment environment. The current study represents the first large-scale examination of these issues, with two major aims: (1) to elucidate the differences between FBSS patients and other chronic lumbar pain patients; and (2) to clarify the role of injections in interdisciplinary treatment, particularly with FBSS patients. ⋯ However, Non-FBSS patients were associated with greater reductions in self-reported pain and disability than FBSS patients. On the other hand, FBSS patients were significantly more improved on physical therapy measures, including Activities of Daily Living, Strength, and Fear of Exercise. Statistical comparisons of Injection (INJ) and No-Injection (No-INJ) groups yielded few significant findings.
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Low back pain (LBP) is a major physical and socioeconomic entity. A significant percentage of LBP is attributable to internal disc disruption. The management of internal disc disruption has traditionally been limited to either conservative treatment or spinal fusion. ⋯ PNT represents a new less invasive technique for the treatment of discogenic pain, but limited research is available to determine long-term clinical efficacy. IDET and PNT are potentially beneficial treatments for internal disc disruption in carefully selected patients as an alternative to spinal fusion. More basic science and clinical research with long-term follow-up evaluation is necessary.
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Intracerebral haemorrhage (ICH) is much less common than ischaemic stroke (15% versus 85% in most Western studies), but is associated with a significantly worse prognosis. ICH is much more common in Asian populations, probably reflecting higher rates of small vessel disease, hypertension and genetic factors. Overall, ICH mortality rates approach 50% and there has been little effective treatment to date, except for the overall benefit from stroke unit care. ⋯ Medical therapies to reduce brain edema and intracranial pressure, including glycerol and mannitol, are not of proven value. It is accepted that corticosteroids should not be used in ICH and may worsen outcomes. The management of acute hypertension is controversial and guidelines are based on little direct evidence.
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Therapeutic hypothermia is a potentially dangerous treatment with a very narrow therapeutic index. It is of proven benefit in certain conditions, including post ventricular fibrillation cardiac arrest and intermediate severity neonatal asphyxia. ⋯ While it is clear that hypothermia decreases intracranial pressure, a major phase III trial demonstrated no improvement in neurological outcomes with hypothermia, in an unselected group of patient with severe head injury. More focused phase III trials are underway but until the results are known this treatment should not be offered to patients outside the context of a clinical trial.