المؤلفون: Stéphane Varin, Grégoire Cormier, Lucie Planche, Benoit Le Goff, Guillaume Coiffier, Jean-David Albert, Christelle Darrieutort-Laffite, Yves Maugars

المصدر: Annals of the Rheumatic Diseases. 78:837-843

مصطلحات موضوعية: Adult, Male, Visual analogue scale, medicine.medical_treatment, Immunology, Equivalence Trials as Topic, Punctures, Methylprednisolone, General Biochemistry, Genetics and Molecular Biology, Injections, Intra-Articular, Rotator Cuff, 03 medical and health sciences, 0302 clinical medicine, Double-Blind Method, Rheumatology, Tendinitis, Shoulder Pain, Humans, Immunology and Allergy, Medicine, Therapeutic Irrigation, Glucocorticoids, Saline, Ultrasonography, Interventional, Pain Measurement, 030203 arthritis & rheumatology, Pain, Postoperative, 030222 orthopedics, Dry needling, business.industry, Calcinosis, Calcific tendinitis, Middle Aged, medicine.disease, Acute Pain, Treatment Outcome, Anesthesia, Tendinopathy, Female, Saline Solution, Subacromial bursa, business, Follow-Up Studies, medicine.drug, Calcification

الوصف: ObjectiveSteroid injections are common after an ultrasound-guided puncture and lavage (UGPL) of calcific tendonitis of the rotator cuff. However, steroids may prevent calcification resorption and negatively affect tendon healing. Our study was designed to determine whether saline solution was non-inferior to steroids in the prevention of acute pain reactions in the week following UGPL.MethodsThis was a randomised, double-blinded, controlled non-inferiority trial with 12-month follow-up. We included 132 patients (66 in each group) with symptomatic calcification measuring more than 5 mm. Patients received 1 mL of saline or steroid (methylprednisolone 40 mg) in the subacromial bursa at the end of UGPL. Primary outcome was the maximal pain during the week following the procedure with a prespecified non-inferiority margin of 10 mm (0–100 visual analogue scale). Secondary outcomes included pain at rest and during activity, function (disabilities of the arm, shoulder and hand score) and radiological evolution of the calcification over the 12-month follow-up.ResultsThe estimated mean difference in the first week’s maximal pain between these two groups was 11.76 (95% CI 3.78 to 19.75). Steroids significantly improved VAS pain at rest and during activities, as well as function at 7 days and 6 weeks. They did not change the rate of calcification resorption, which occurred in 83% and 74% of patients at 12 months in the saline and steroid groups.ConclusionNon-inferiority of saline when compared with steroids could not be established. However, steroid injection improved pain in the 6 weeks following the procedure, and function in the 3 months after, with no significant effect on calcification resorption.Trial registration numberNTC02403856.

الوصول الحر: https://explore.openaire.eu/search/publication?articleId=doi_dedup___::dcece3babe2a404951bc62970e939b9fTest
https://doi.org/10.1136/annrheumdis-2018-214971Test

المؤلفون: Philippe Montigny, Grégoire Cormier, Benoit Le Goff, Céline Cozic, Gilles Tanguy, Christelle Volteau, Yves Maugars, Stéphane Varin, Joëlle Glémarec, Christelle Darrieutort Laffite

المصدر: Joint Bone Spine. 85:359-363

مصطلحات موضوعية: Adult, Male, medicine.medical_specialty, Lidocaine, Visual analogue scale, medicine.drug_class, medicine.medical_treatment, Injections, Intralesional, Cortivazol, Placebo, Risk Assessment, Severity of Illness Index, Statistics, Nonparametric, 03 medical and health sciences, 0302 clinical medicine, Double-Blind Method, Rheumatology, Reference Values, 030202 anesthesiology, medicine, Humans, Prospective Studies, Anesthetics, Local, Glucocorticoids, Saline, Aged, Pain Measurement, Lumbar Vertebrae, Local anesthetic, business.industry, Lumbosacral Region, Middle Aged, Prognosis, Low back pain, Surgery, Treatment Outcome, Anesthesia, Drug Therapy, Combination, Female, medicine.symptom, Tomography, X-Ray Computed, business, Low Back Pain, 030217 neurology & neurosurgery, Lumbosacral joint, medicine.drug

الوصف: Objective The primary objective of this study was to compare the efficacy of local injection of a local anesthetic with a glucocorticoid versus a local anesthetic with saline to treat low back pain due to lumbosacral transitional vertebras (LSTV) with a pseudoarticulation. Methods A randomized placebo-controlled double-blind study was conducted in patients with unilateral low back pain ascribed clinically to LSTV. Patients were randomized to lidocaine plus saline (LS group) or lidocaine plus cortivazol (LC group) injected locally under computed tomography guidance. The primary outcome measure was the 24-hour mean visual analog scale (VAS) score for low back pain 4 weeks after the injection. Results Of 16 randomized patients, 15 were included in the analysis, 8 in the LS group and 7 in the LC group. The mean VAS pain score at week 4 was not significantly different between the two groups. In the two groups pooled, the mean VAS pain score decreased significantly from baseline to week 4, from 5.52 ± 0.99 to 3.86 ± 2.55 (P ≤ 0.05). The difference remained significant at week 12. Significant improvements occurred in the EIFEL disability index and items of the Dallas Pain Questionnaire. No adverse events were recorded. Conclusion In patients with chronic low back pain consistent with a symptomatic LSTV type II or IV in the Castellvi classification, a local injection of lidocaine with or without cortivazol may provide sustained improvements in pain and function. The underlying mechanism is unclear.

الوصول الحر: https://explore.openaire.eu/search/publication?articleId=doi_dedup___::a9bfad3bd3d962e0479cdcb9f6bd8f59Test
https://doi.org/10.1016/j.jbspin.2017.05.003Test

المؤلفون: Benoit Le Goff, Jean-Marie Berthelot, Noura Biha, Yves Maugars, Christelle Darrieutort-Laffite

المصدر: Pain Reports
PAIN Reports, Vol 4, Iss 3, p e739 (2019)

مصطلحات موضوعية: Osteoporosis, Tendinopathies, 02 engineering and technology, Osteoarthritis, Daily, 01 natural sciences, lcsh:RD78.3-87.3, Tendinitis, Fibromyalgia, 0103 physical sciences, 0202 electrical engineering, electronic engineering, information engineering, Back pain, Medicine, 010306 general physics, Back, business.industry, Arthritis, Spondylarthrosis, medicine.disease, Anesthesiology and Pain Medicine, Duration, lcsh:Anesthesiology, Rheumatoid arthritis, Anesthesia, Musculoskeletal, PainDetect, 020201 artificial intelligence & image processing, medicine.symptom, Neuropathic, business, Radiculopathies, Research Paper

الوصف: Objectives:. We aimed to compare painDETECT scores in outpatients seen in a rheumatology department over a 1-month period and search for correlations between painDETECT scores and the estimated duration of daily pain and time elapsed since the onset of current pain. Patients and Methods:. A total of 529 of 738 outpatients agreed to complete a set of questionnaires, including painDETECT. Results:. The mean painDETECT score was 14.14 ± 7.59, and 31% of the patients had painDETECT scores of >18. Fibromyalgia ranked first (21.2 ± 6.0), followed by osteoarthritis of the lower limbs (17.8 ± 8.2), back pain and radiculopathies (16.1 ± 6.8), osteoarthritis of the upper limbs (15.7 ± 8.1), spondylarthrosis (15.1 ± 7.2), entrapment neuropathies (14.1 ± 2.4), rheumatoid arthritis (13.8 ± 7.1), miscellaneous conditions (13.8 ± 8.2), tendinitis (13.4 ± 7.9), connectivitis (11.5 ± 6.7), and osteoporosis (8.5 ± 6.9). The duration of daily pain was much longer in patients with painDETECT scores of >18 (12.41 ± 8.45 vs 6.53 ± 7.45 hours) (t = 0.0000), but very similar painDETECT scores were observed for patients suffering from pain for less than 1 week (13.7 ± 8.2; 38% > 18), for 1 month (14.5 ± 8.2; 25% > 18), several months (12.7 ± 7.3; 23% > 18), 1 year (13.8 ± 7.7; 29% > 18), or several years (14.7 ± 7.4; 33% > 18). Conclusion:. PainDETECT scores differed little depending on the musculoskeletal condition, strongly correlated with the duration of daily pain, and appeared to be as high in patients with recent pain as in those suffering for years.

الوصول الحر: https://explore.openaire.eu/search/publication?articleId=doi_dedup___::26400756998df32727fc18cf0b18d300Test
http://europepmc.org/articles/PMC6749904Test

المؤلفون: Benoit Le Goff, Lucie Planche, Christelle Darrieutort-Laffite, Géraldine Bart, Yves Maugars, Joëlle Glémarec

المصدر: Joint Bone Spine. 82:356-361

مصطلحات موضوعية: Anesthesia, Epidural, Male, medicine.medical_specialty, Hydrocortisone, Visual analogue scale, medicine.medical_treatment, Anti-Inflammatory Agents, Injections, Epidural, Spinal Puncture, Palpation, law.invention, Sciatica, Lumbar, Rheumatology, Randomized controlled trial, law, medicine, Clinical endpoint, Humans, Single-Blind Method, Prospective Studies, Pain Measurement, Ultrasonography, Lumbar Vertebrae, medicine.diagnostic_test, Epidural steroid injection, business.industry, Lumbosacral Region, Middle Aged, Epidural space, Surgery, Treatment Outcome, medicine.anatomical_structure, Anesthesia, Feasibility Studies, Female, medicine.symptom, business, Low Back Pain

الوصف: Ultrasound (US) is widely used in rheumatology to study and guide injection of peripheral joints. It can also provide useful information about the anatomy of the lumbar spine. Studies have shown that US examination of the spine was a useful tool to help perform epidural anaesthesia. The purpose of the study was to determine if the selection of the optimum puncture level by US may facilitate epidural steroid injection in case of presumed difficult puncture (BMI30 kg/m(2), age60 years or lumbar scoliosis).We performed a prospective randomized controlled study. Eighty patients were randomized in two groups: US group (n=40) which underwent a pre-procedure spinal US to determine the optimal lumbar level for injection or control group (n=40) for which the level of injection was determined by palpation. Primary endpoint was the pain during the procedure assessed using the Visual Analogue Scale (VAS).We found a positive correlation between depth of the epidural space and BMI (P0.001) and a negative correlation between size of the interspinous spaces and age (P0.01). Visibility of the epidural space was not altered by obesity or age. We observed a trend toward a reduction in pain intensity during the procedure in the US group compared to the control group with a mean difference at -0.94 [-1.90; 0.02] but the difference was not significant (P=0.054).US of the lumbar spine was feasible in patients with lumbar conditions even in obese and old ones and allowed the visualization of the epidural space. However, pre-procedure US examination did not reduce pain during the procedure.

الوصول الحر: https://explore.openaire.eu/search/publication?articleId=doi_dedup___::19e267d8a378100ff867b09137e81d59Test
https://doi.org/10.1016/j.jbspin.2015.02.001Test

المؤلفون: Grégoire Cormier, Guillaume Coiffier, B. Le Goff, Christelle Darrieutort-Laffite, Jean-David Albert, Stéphane Varin

المصدر: THURSDAY, 14 JUNE 2018.

مصطلحات موضوعية: Percutaneous, business.industry, Radiography, medicine.medical_treatment, Methylprednisolone acetate, Placebo, medicine.disease, medicine.anatomical_structure, Anesthesia, medicine, Rotator cuff, Subacromial bursa, business, Saline, Calcification

الوصف: Background Rotator cuff calcific tendinopathy is a common condition causing up to 20% of the painful shoulder. Ultrasound guided percutaneous lavage (UGPL) is indicated after failure of conservative treatments. Steroids injections in the subacromial bursa (SAB) are usually performed after the lavage to prevent the pain induced by the procedure. However, some suggested that this injection could prevent the inflammatory reaction leading to the disappearance of the calcific deposit. Moreover, its efficacy to prevent post-procedure pain has never been demonstrated. Objectives The goal of this study was to evaluate the effect of a steroid injection in the SAB after UGPL on the pain and the radiographic evolution of the calcification. Methods This was a multicentric prospective double blinded randomised controlled study. We included patients with shoulder pain for more than 3 months and a type A or B calcification >5 mm on X-Ray. Patients were treated with UGPL using a single needle technic. At the end of the procedure, they received a blind injection of either 2 mL of methylprednisolone acetate or 2 mL of serum saline. The primary outcome was the maximal VAS pain (0–100) the first week following UGPL. Secondary outcomes were the evolution of VAS pain at 7 days, 6 weeks and 3 months and the radiographic changes of the calcification at 3 months. Results We included 134 patients, mean age 49.8 (±9.7) years, 89 females (67.4%). Calcifications involved the supraspinatus, infraspinatus and subscapularis in 114 (85%), 14 (10%) and 6 patients (5%) respectively. Calcifications were type A and type B in 42,5% and 57,5% of the cases respectively and mean size of the calcification was 1,5 cm (±0,5). Backflow of calcific material was obtained in 107 patients (81.1%). Maximum pain during the first week following UGPL was 71.5 [CI95%:63.9–79.20] in the serum saline group versus 59.8 [CI95%:52.2–67.41] in the steroid group with a mean difference of 11.7 [CI95%:3.7–19.7]. More patients in the placebo group needed to take NSAID (12.1% versus 6.1%) and paracetamol (16.7% versus 9.1%) during the first week. VAS pain at rest and during activities decreased significantly more in the steroid group compared to the placebo: VAS pain during activity was 72.02 [62.98–81.06], 26.63 [17.60–35.67], 32.30 [23.11–41.49] and 43.27 [34.18–52.37] in the steroid group versus 72.46 [63.41–81.51], 48.22 [39.14–57.31], 51.44 [42.26–60.62] and 51.09 [41.95–60.24] in the placebo group at day 0, 7, 6 weeks and 3 months respectively (figure 1). At 3 months no difference was found in the radiographic evolution: 62.1% of the patients treated with steroid and 64.8% treated with serum saline had more than 50% of resorption of their calcification. Conclusions Our study shows that steroid injection in the SAB leads to a significant decrease of maximal pain the following week. This treatment also decreases significantly the pain during the 3 first months after UGPL. Importantly, we found no difference between the 2 groups in the radiographic evolution of the calcification at 3 months. Overall, steroids injections in the SAB can be recommended after UGPL. Disclosure of Interest None declared

الوصول الحر: https://explore.openaire.eu/search/publication?articleId=doi_________::219b20233bbfecc6e03a86fc3e2f7998Test
https://doi.org/10.1136/annrheumdis-2018-eular.7349Test