Journal of Back and Musculoskeletal Rehabilitation - Volume 13, issue 1
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Journal of Back and Musculoskeletal Rehabilitation is a journal whose main focus is to present relevant information about the interdisciplinary approach to musculoskeletal rehabilitation for clinicians who treat patients with back and musculoskeletal pain complaints. It will provide readers with both 1) a general fund of knowledge on the assessment and management of specific problems and 2) new information considered to be state-of-the-art in the field. The intended audience is multidisciplinary as well as multi-specialty.
In each issue clinicians can find information which they can use in their patient setting the very next day. Manuscripts are provided from a range of health care providers including those in physical medicine, orthopedic surgery, rheumatology, neurosurgery, physical therapy, radiology, osteopathy, chiropractic and nursing on topics ranging from chronic pain to sports medicine. Diagnostic decision trees and treatment algorithms are encouraged in each manuscript. Controversial topics are discussed in commentaries and rebuttals. Associated areas such as medical-legal, worker's compensation and practice guidelines are included.
The journal publishes original research papers, review articles, programme descriptions and cast studies. Letters to the editors, commentaries, and editorials are also welcomed. Manuscripts are peer reviewed. Constructive critiques are given to each author. Suggestions for thematic issues and proposed manuscripts are welcomed.
Abstract: Cervical dystonia is the most common form of focal dystonia in adults. It is characterized by involuntary contraction of neck muscles, causing abnormal posture and movements of the head. Pain is present in about 75% patients. Botulinum toxin injection into the dystonic neck muscles is considered the treatment of choice for patients with cervical dystonia. Botulinum toxin binds presynaptically to cholinergic nerve terminals causing decreased release of acetyl choline and reduction in muscle tone. It is important to precisely identify the sites of pain and the muscles responsible for the abnormal posture to have better success. The incidence of complications…can be reduced by the proper choice of dose for specific muscles. In this article, the authors review the clinical features, course, and pathophysiology of cervical dystonia. Also reviewed are the chemistry, pharmacology, mechanism of action of botulinum toxin along with practical aspects of its use and complications associated with its use in the treatment of cervical dystonia.
Abstract: Vertebral compression fractures, a common cause of pain, disability, diminished quality of life, and loss of self esteem, occur most often in elderly women with osteoporosis. Treatment has traditionally been medical (analgesics, bed rest, external bracing) with surgery reserved for those with spinal instability or nerve compression. Percutaneous vertebroplasty, an image-guided method of percutaneous bone augmentation, has provided an alternative therapy that offers rapid pain relief and return to routine activity. The current review describes the historical development of percutaneous vertebroplasty, patient selection criteria, and various technical aspects of the procedure.
Abstract: Objective: To determine if the chronic pain and sleep disturbances experienced by patients with fibromyalgia can be improved by sleeping on a magnetic mattress pad. Design: A double-blind randomized controlled trial. Setting: Patients’ homes and the private practice office of the principal investigator. Patients: Thirty-five female subjects diagnosed with fibromyalgia syndrome were recruited. Thirty met inclusion/exclusion criteria and entered the study. Twenty-five completed it. One was lost to follow-up. Three were withdrawn for protocol violations and one because of an intercurrent hospitalization. Intervention: Sleeping on an experimental (magnetized at a magnet surface…field strength of 1100 ± 50 Gauss and delivering 200–600 Gauss to the skin surface or a sham (non-magnetized) mattress pad over a 16 week period. Main Outcome Measures: Visual Analog Scales (VAS) for global wellbeing, pain, sleep, fatigue and tiredness on awakening; Total Myalgic Score; Pain Distribution Drawings; and a modified Fibromyalgia Impact Questionnaire. Results: Subjects sleeping on the experimental mattress pad experienced a significant decrease in pain (p < .05 ), fatigue (p < .006 ), total myalgic score (p < .03 ), and pain distribution drawing (p < .02 ). Additionally, these subjects showed significant improvement in reported sleep (p < .01 ) and physical functioning as evidenced from the modified Fibromyalgia Impact Questionnaire (p < .04 ). Subjects sleeping on the sham mattress pad experienced no significant change in these same outcome measures. Subjects in both the control and experimental groups showed improvement in tiredness on wakening, demonstrating a placebo effect in this parameter. Neither group showed any effect on global wellbeing. Conclusions: Sleeping on a magnetic mattress pad, with a magnet surface field strength of 1100 ± 50 Gauss, delivering 200–600 Gauss at the skin surface provides statistically significant and clinically relevant pain relief and sleep improvement in subjects with fibromyalgia. No adverse reactions were noted during the 16-week trial period.
Abstract: Program evaluation standards require pain centers to assess medication use as one of an array of outcome criteria. The Medication Quantification Scale (MQS) has been introduced as a continuous method for quantifying medication use in chronic nonmalignant pain patients that overcomes methodological concerns inherent in previous pain medication measures. The reliability and sensitivity to program effects of the MQS was demonstrated by the original authors. The present study reexamined the reliability and sensitivity, and provided evidence for the validity of the MQS in an effort to determine whether use of the MQS can be generalized to other pain centers. Interrater…reliability between two nurses on 40 pretreatment and 40 6-month follow-up MQS scores were .958 (p < .0001 ) and .968 (p < .0001 ) respectively. Six month follow-up MQS scores were significantly lower than pretreatment MQS scores (t = 5.40 , p < .0001 ) for 106 chronic nonmalignant pain patients treated at a multidisciplinary pain center. Convergent and divergent validity of the MQS were demonstrated by higher correlations between the MQS and conceptually similar rather than dissimilar outcome measures. The reliability, sensitivity, and validity of the MQS was demonstrated suggesting it can be generalized for program evaluation purposes to other pain centers.
Keywords: pain medication, pain outcome, program evaluation, chronic nonmalignant pain