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[PMID]:29252737
[Au] Autor:Lee WY; Hwang DS; Kang C; Zheng L
[Ad] Endereço:Department of Orthopaedic Surgery, Chungnam National University School of Medicine, Daejeon, South Korea.
[Ti] Título:Entrapment Neuropathy of the Sciatic Nerve Caused by a Paralabral Cyst: Three Cases Treated Arthroscopically: A Case Report.
[So] Source:JBJS Case Connect;6(4):e82, 2016 Oct-Dec.
[Is] ISSN:2160-3251
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:CASE: Three patients with sciatica were referred to our outpatient clinic between 2007 and 2012. Magnetic resonance imaging (MRI) of the hip showed compression of the sciatic nerve by a perineural cyst arising from a paralabral cyst. All 3 patients underwent arthroscopic decompression. Upon follow-up, the mean visual analog scale scores for pain had improved from 7.3 to 0.3. MRI showed no evidence of recurrence of the cyst in any of the patients. CONCLUSION: Arthroscopic treatment for entrapment neuropathy of the sciatic nerve caused by a paralabral cyst was effective for improving symptoms; at the final follow-up, none of the patients had experienced recurrence of the cyst.
[Mh] Termos MeSH primário: Cistos/complicações
Síndromes de Compressão Nervosa/etiologia
Ciática/etiologia
[Mh] Termos MeSH secundário: Adulto
Artroscopia
Feminino
Seres Humanos
Masculino
Meia-Idade
Síndromes de Compressão Nervosa/cirurgia
Ciática/cirurgia
[Pt] Tipo de publicação:CASE REPORTS; JOURNAL ARTICLE
[Em] Mês de entrada:1802
[Cu] Atualização por classe:180216
[Lr] Data última revisão:
180216
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:171219
[St] Status:MEDLINE
[do] DOI:10.2106/JBJS.CC.16.00064


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[PMID]:29390461
[Au] Autor:Xiang A; Xu M; Liang Y; Wei J; Liu S
[Ad] Endereço:Shanghai University of Traditional Chinese Medicine, Shanghai, China.
[Ti] Título:Immediate relief of herniated lumbar disc-related sciatica by ankle acupuncture: A study protocol for a randomized controlled clinical trial.
[So] Source:Medicine (Baltimore);96(51):e9191, 2017 Dec.
[Is] ISSN:1536-5964
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: Around 90% of sciatica cases are due to a herniated intervertebral disc in the lumbar region. Ankle acupuncture (AA) has been reported to be effective in the treatment of acute nonspecific low back pain. This study aims to evaluate the efficacy of a single session of ankle acupuncture for disc-related sciatica. METHOD: This will be a double-blinded, randomized controlled clinical trial. Patients diagnosed with disc-related sciatica will be randomly divided into 3 parallel groups. The treatment group (n = 30) will receive ankle acupuncture. The 2 control groups will either undergo traditional needle manipulation (n = 30) or sham acupuncture (n = 30) at the same point as the treatment group. The primary outcome will be pain intensity on a visual analog scale (VAS). The secondary outcomes will be paresthesia intensity on a VAS and the Abbreviated Acceptability Rating Profile (AAPR). The success of blinding will be evaluated, and the needle-induced sensation and adverse events will be recorded. All outcomes will be evaluated before, during, and after the treatment. DISCUSSION: This study will determine the immediate effect and specificity of ankle acupuncture for the treatment of disc-related sciatica. We anticipate that ankle acupuncture might be more effective than traditional needle manipulation or sham acupuncture. TRIAL REGISTRATION: ChiCTR-IPR-15007127 (http://www.chictr.org.cn/showprojen.aspx?proj=11989).
[Mh] Termos MeSH primário: Terapia por Acupuntura/métodos
Articulação do Tornozelo
Deslocamento do Disco Intervertebral/complicações
Medição da Dor
Ciática/terapia
[Mh] Termos MeSH secundário: Adulto
Análise de Variância
China
Método Duplo-Cego
Feminino
Seguimentos
Seres Humanos
Deslocamento do Disco Intervertebral/diagnóstico
Dor Lombar/diagnóstico
Dor Lombar/etiologia
Masculino
Meia-Idade
Valores de Referência
Ciática/etiologia
Ciática/fisiopatologia
Índice de Gravidade de Doença
Resultado do Tratamento
[Pt] Tipo de publicação:COMPARATIVE STUDY; JOURNAL ARTICLE; RANDOMIZED CONTROLLED TRIAL
[Em] Mês de entrada:1802
[Cu] Atualização por classe:180214
[Lr] Data última revisão:
180214
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:180203
[St] Status:MEDLINE
[do] DOI:10.1097/MD.0000000000009191


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[PMID]:28745066
[Au] Autor:Guo JR; Jin XJ; Shen HC; Wang H; Zhou X; Liu XQ; Zhu NN
[Ad] Endereço:1 Gongli Hospital, the Second Military Medical University, Shanghai, People's Republic of China.
[Ti] Título:A Comparison of the Efficacy and Tolerability of the Treatments for Sciatica: A Network Meta-Analysis.
[So] Source:Ann Pharmacother;51(12):1041-1052, 2017 Dec.
[Is] ISSN:1542-6270
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: There remains a lack of a systematic summary of the efficacy and safety of various medicines for sciatica, and discrepancies among these exist. OBJECTIVE: The aim of this study is to comprehensively assess the efficacy of and tolerance to several medical options for the treatment of sciatica. METHODS: We performed a network meta-analysis and illustrated the results by the mean difference or odds ratio. The surface under the cumulative ranking curve (SUCRA) was used for indicating the preferable treatments. All data analyses and graphs were achieved via R 3.3.2 and Stata 13.0. RESULTS: The subcutaneous anti-tumor necrosis factor-α (anti-TNF-α) was superior to the epidural steroid + anesthetic in reducing lumbar pain in both acute + chronic sciatica patients and acute sciatica patients. The epidural steroid demonstrated a better ability regarding the Oswestry disability score (ODI) compared to the subcutaneous anti-TNF-α. In addition, for total pain relief, the use of nonsteroidal antiinflammatory drugs was inferior to the epidural steroid + anesthetic. The epidural anesthetic and epidural steroid + anesthetic both demonstrated superiority over the epidural steroid and intramuscular steroid. The intravenous anti-TNF-α ranked first in leg pain relief, while the subcutaneous anti-TNF-α ranked first in lumbar pain relief, and the epidural steroid ranked first in the ODI on the basis of SUCRA. In addition, their safety outcome (withdrawal) rankings were all medium to high. CONCLUSIONS: Intravenous and subcutaneous anti-TNF-α were identified as the optimal treatments for both acute + chronic sciatica patients and acute sciatica patients. In addition, the epidural steroid was also recommended as a good intervention due to its superiority in reducing ODI.
[Mh] Termos MeSH primário: Anti-Inflamatórios não Esteroides/uso terapêutico
Ciática/tratamento farmacológico
Esteroides/uso terapêutico
Fator de Necrose Tumoral alfa/antagonistas & inibidores
[Mh] Termos MeSH secundário: Seres Humanos
Injeções Epidurais
Dor Lombar/tratamento farmacológico
Metanálise em Rede
Razão de Chances
Manejo da Dor
Resultado do Tratamento
[Pt] Tipo de publicação:COMPARATIVE STUDY; JOURNAL ARTICLE; META-ANALYSIS
[Nm] Nome de substância:
0 (Anti-Inflammatory Agents, Non-Steroidal); 0 (Steroids); 0 (Tumor Necrosis Factor-alpha)
[Em] Mês de entrada:1801
[Cu] Atualização por classe:180129
[Lr] Data última revisão:
180129
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170727
[St] Status:MEDLINE
[do] DOI:10.1177/1060028017722008


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[PMID]:29023556
[Au] Autor:Korse NS; Kruit MC; Peul WC; Vleggeert-Lankamp CLA
[Ad] Endereço:Department of Neurosurgery, Leiden University Medical Centre, Leiden, the Netherlands.
[Ti] Título:Lumbar spinal canal MRI diameter is smaller in herniated disc cauda equina syndrome patients.
[So] Source:PLoS One;12(10):e0186148, 2017.
[Is] ISSN:1932-6203
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:INTRODUCTION: Correlation between magnetic resonance imaging (MRI) and clinical features in cauda equina syndrome (CES) is unknown; nor is known whether there are differences in MRI spinal canal size between lumbar herniated disc patients with CES versus lumbar herniated discs patients without CES, operated for sciatica. The aims of this study are 1) evaluating the association of MRI features with clinical presentation and outcome of CES and 2) comparing lumbar spinal canal diameters of lumbar herniated disc patients with CES versus lumbar herniated disc patients without CES, operated because of sciatica. METHODS: MRIs of CES patients were assessed for the following features: level of disc lesion, type (uni- or bilateral) and severity of caudal compression. Pre- and postoperative clinical features (micturition dysfunction, defecation dysfunction, altered sensation of the saddle area) were retrieved from the medical files. In addition, anteroposterior (AP) lumbar spinal canal diameters of CES patients were measured at MRI. AP diameters of lumbar herniated disc patients without CES, operated for sciatica, were measured for comparison. RESULTS: 48 CES patients were included. At MRI, bilateral compression was seen in 82%; complete caudal compression in 29%. MRI features were not associated with clinical presentation nor outcome. AP diameter was measured for 26 CES patients and for 31 lumbar herniated disc patients without CES, operated for sciatica. Comparison displayed a significant smaller AP diameter of the lumbar spinal canal in CES patients (largest p = 0.002). Compared to average diameters in literature, diameters of CES patients were significantly more often below average than that of the sciatica patients (largest p = 0.021). CONCLUSION: This is the first study demonstrating differences in lumbar spinal canal size between lumbar herniated disc patients with CES and lumbar herniated disc patients without CES, operated for sciatica. This finding might imply that lumbar herniated disc patients with a relative small lumbar spinal canal might need to be approached differently in managing complaints of herniated disc. Since the number of studied patients is relatively small, further research should be conducted before clinical consequences are considered.
[Mh] Termos MeSH primário: Deslocamento do Disco Intervertebral/diagnóstico por imagem
Imagem por Ressonância Magnética/métodos
Polirradiculopatia/diagnóstico por imagem
Ciática/cirurgia
Canal Vertebral/patologia
[Mh] Termos MeSH secundário: Adulto
Descompressão Cirúrgica
Discotomia
Feminino
Seres Humanos
Deslocamento do Disco Intervertebral/complicações
Deslocamento do Disco Intervertebral/patologia
Deslocamento do Disco Intervertebral/cirurgia
Masculino
Meia-Idade
Polirradiculopatia/etiologia
Polirradiculopatia/patologia
Polirradiculopatia/cirurgia
Complicações Pós-Operatórias/classificação
Canal Vertebral/diagnóstico por imagem
Resultado do Tratamento
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1710
[Cu] Atualização por classe:171024
[Lr] Data última revisão:
171024
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:171013
[St] Status:MEDLINE
[do] DOI:10.1371/journal.pone.0186148


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[PMID]:28679342
[Au] Autor:van den Akker-van Marle ME; Brouwer PA; Brand R; Koes B; van den Hout WB; van Buchem MA; Peul WC
[Ad] Endereço:1 Leiden University Medical Center, Leiden, Netherlands.
[Ti] Título:Percutaneous laser disc decompression versus microdiscectomy for sciatica: Cost utility analysis alongside a randomized controlled trial.
[So] Source:Interv Neuroradiol;23(5):538-545, 2017 Oct.
[Is] ISSN:2385-2011
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:Background Percutaneous laser disc decompression (PLDD) for patients with lumbar disc herniation is believed to be cheaper than surgery. However, cost-effectiveness has never been studied. Materials and Methods A cost utility analysis was performed alongside a randomized controlled trial comparing PLDD and conventional surgery. Patients reported their quality of life using the EuroQol five dimensions questionnaire (EQ-5D), 36-item short form health survey (SF-36 and derived SF-6D) and a visual analogue scale (VAS). Using cost diaries patients reported health care use, non-health care use and hours of absenteeism from work. The 1-year societal costs were compared with 1-year quality adjusted life years (QALYs) based on the United States (US) EQ-5D. Sensitivity analyses were carried out on the use of different utility measures (Netherland (NL) EQ-5D, SF-6D, or VAS) and on the perspective (societal or healthcare). Results On the US EQ-5D, conventional surgery provided a non-significant gain in QALYs of 0.033 (95% confidence interval (CI) -0.026 to 0.093) in the first year. PLDD resulted in significantly lower healthcare costs (difference €1771, 95% CI €303 to €3238) and non-significantly lower societal costs (difference €2379, 95% CI -€2860 to €7618). For low values of the willingness to pay for a QALY, the probability of being cost-effective is in favor of PLDD. For higher values of the willingness to pay, between €30,000 and €70,000, conventional microdiscectomy becomes favorable. Conclusions From a healthcare perspective PLDD, followed by surgery when needed, results in significantly lower 1-year costs than conventional surgery. From a societal perspective PLDD appears to be an economically neutral innovation.
[Mh] Termos MeSH primário: Descompressão Cirúrgica/métodos
Discotomia
Deslocamento do Disco Intervertebral/complicações
Deslocamento do Disco Intervertebral/cirurgia
Terapia a Laser/métodos
Ciática/etiologia
Ciática/prevenção & controle
[Mh] Termos MeSH secundário: Adolescente
Adulto
Idoso
Análise Custo-Benefício
Descompressão Cirúrgica/economia
Discotomia/economia
Feminino
Seres Humanos
Terapia a Laser/economia
Masculino
Meia-Idade
Medição da Dor
Qualidade de Vida
Inquéritos e Questionários
Resultado do Tratamento
[Pt] Tipo de publicação:COMPARATIVE STUDY; JOURNAL ARTICLE; RANDOMIZED CONTROLLED TRIAL
[Em] Mês de entrada:1711
[Cu] Atualização por classe:171108
[Lr] Data última revisão:
171108
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170707
[St] Status:MEDLINE
[do] DOI:10.1177/1591019917710297


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[PMID]:28644835
[Au] Autor:Fischer MA; McKinlay JB; Katz JN; Gerstenberger E; Trachtenberg F; Marceau LD; Welch LC
[Ad] Endereço:Division of Pharmacoepidemiology and Pharmacoeconomics, Brigham & Women's Hospital, Harvard Medical School, Boston, Massachusetts, United States of America.
[Ti] Título:Physician assessments of drug seeking behavior: A mixed methods study.
[So] Source:PLoS One;12(6):e0178690, 2017.
[Is] ISSN:1932-6203
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: Pain complaints are common, but clinicians are increasingly concerned about overuse of opioid pain medications. This may lead patients with actual pain to be stigmatized as "drug-seeking," or attempting to obtain medications they do not require medically. We assessed whether patient requests for specific opioid pain medication would lead physicians to classify them as drug-seeking and change management decisions. METHODS AND FINDINGS: Mixed-methods analysis of interviews with 192 office-based primary care physicians after viewing video vignettes depicting patients presenting with back pain. For each presentation physicians were randomly assigned to see either an active request for a specific medication or a more general request for help with pain. The main outcome was assignment by the physician of "drug-seeking" as a potential diagnosis among patients presenting with back pain. Additional outcomes included other actions the physician would take and whether the physician would prescribe the medication requested. A potential diagnosis of drug-seeking behavior was included by 21% of physicians seeing a specific request for oxycodone vs. 3% for a general request for help with back pain(p<0.001). In multivariable models an active request was most strongly associated with a physician-assigned diagnosis of drug-seeking behavior(OR 8.10; 95% CI 2.11-31.15;p = 0.002); other major patient and physician characteristics, including gender and race, did not have strong associations with drug-seeking diagnosis. Physicians described short courses of opioid medications as a strategy for managing patients with pain while avoiding opioid overuse. CONCLUSIONS: When patients make a specific request for opioid pain medication, physicians are far more likely to suspect that they are drug-seeking. Physician suspicion of drug-seeking behavior did not vary by patient characteristics, including gender and race. The strategies used to assess patients further varied widely. These findings indicate a need for the development of better clinical tools to support the evaluation and management of patients presenting with pain.
[Mh] Termos MeSH primário: Tomada de Decisão Clínica
Comportamento de Procura de Droga
Médicos de Atenção Primária
[Mh] Termos MeSH secundário: Analgésicos Opioides/uso terapêutico
Feminino
Seres Humanos
Masculino
Meia-Idade
Análise Multivariada
Narração
Oxicodona/uso terapêutico
Dor/tratamento farmacológico
Dor/fisiopatologia
Manejo da Dor/métodos
Médicos de Atenção Primária/psicologia
Padrões de Prática Médica
Pesquisa Qualitativa
Distribuição Aleatória
Ciática/tratamento farmacológico
Ciática/fisiopatologia
Gravação em Vídeo
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Nm] Nome de substância:
0 (Analgesics, Opioid); CD35PMG570 (Oxycodone)
[Em] Mês de entrada:1709
[Cu] Atualização por classe:170920
[Lr] Data última revisão:
170920
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170624
[St] Status:MEDLINE
[do] DOI:10.1371/journal.pone.0178690


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[PMID]:28617571
[Au] Autor:Figueiredo EG; Teixeira MJ
[Ad] Endereço:University of São Paulo, São Paulo, Brazil ebgadelha@yahoo.com
[Ti] Título:Trial of Pregabalin for Acute and Chronic Sciatica
[So] Source:N Engl J Med;376(24):2396, 2017 06 15.
[Is] ISSN:1533-4406
[Cp] País de publicação:United States
[La] Idioma:eng
[Mh] Termos MeSH primário: Pregabalina
Ciática/tratamento farmacológico
[Mh] Termos MeSH secundário: Analgésicos/uso terapêutico
Seres Humanos
Medição da Dor
Resultado do Tratamento
Ácido gama-Aminobutírico/uso terapêutico
[Pt] Tipo de publicação:LETTER; COMMENT
[Nm] Nome de substância:
0 (Analgesics); 55JG375S6M (Pregabalin); 56-12-2 (gamma-Aminobutyric Acid)
[Em] Mês de entrada:1706
[Cu] Atualização por classe:170622
[Lr] Data última revisão:
170622
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:170616
[St] Status:MEDLINE
[do] DOI:10.1056/NEJMc1705241


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[PMID]:28617570
[Au] Autor:Kosugi K; Tagami K; Tanimoto T
[Ad] Endereço:Kawasaki Municipal Ida Hospital, Kawasaki, Japan kanabunapapa@gmail.com
[Ti] Título:Trial of Pregabalin for Acute and Chronic Sciatica.
[So] Source:N Engl J Med;376(24):2396, 2017 06 15.
[Is] ISSN:1533-4406
[Cp] País de publicação:United States
[La] Idioma:eng
[Mh] Termos MeSH primário: Pregabalina
Ciática/tratamento farmacológico
[Mh] Termos MeSH secundário: Analgésicos/uso terapêutico
Seres Humanos
Medição da Dor
Resultado do Tratamento
Ácido gama-Aminobutírico/uso terapêutico
[Pt] Tipo de publicação:LETTER; COMMENT
[Nm] Nome de substância:
0 (Analgesics); 55JG375S6M (Pregabalin); 56-12-2 (gamma-Aminobutyric Acid)
[Em] Mês de entrada:1706
[Cu] Atualização por classe:170622
[Lr] Data última revisão:
170622
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:170616
[St] Status:MEDLINE
[do] DOI:10.1056/NEJMc1705241


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[PMID]:28614682
[Au] Autor:Maher CG; Lin CWC; Mathieson S
[Ad] Endereço:George Institute for Global Health, Sydney, NSW, Australia
[Ti] Título:Trial of Pregabalin for Acute and Chronic Sciatica.
[So] Source:N Engl J Med;376(24):2396-7, 2017 06 15.
[Is] ISSN:1533-4406
[Cp] País de publicação:United States
[La] Idioma:eng
[Mh] Termos MeSH primário: Pregabalina
Ciática/tratamento farmacológico
[Mh] Termos MeSH secundário: Analgésicos/uso terapêutico
Seres Humanos
Medição da Dor
Resultado do Tratamento
Ácido gama-Aminobutírico/uso terapêutico
[Pt] Tipo de publicação:LETTER; COMMENT
[Nm] Nome de substância:
0 (Analgesics); 55JG375S6M (Pregabalin); 56-12-2 (gamma-Aminobutyric Acid)
[Em] Mês de entrada:1706
[Cu] Atualização por classe:170622
[Lr] Data última revisão:
170622
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:170615
[St] Status:MEDLINE
[do] DOI:10.1056/NEJMc1705241


  10 / 3710 MEDLINE  
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[PMID]:28566052
[Au] Autor:Akinyemi OA; Mabry LM; Dardenelle SI
[Ti] Título:Buttock Pain and Sciatica Caused by a Femoral Osteochondroma.
[So] Source:J Orthop Sports Phys Ther;47(6):442, 2017 Jun.
[Is] ISSN:1938-1344
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:A 26-year-old woman was referred to physical therapy with lower back pain extending into the right buttock. Palpation of the right buttock revealed a firm, immobile mass of considerable size, which the patient identified as her locus of symptoms. Due to the noted palpable mass, her pain, her inability to sit normally, and the longevity of symptoms, the physical therapist ordered radiographs, which identified multiple osteochondromas. J Orthop Sports Phys Ther 2017;47(6):442. doi:10.2519/jospt.2017.6877.
[Mh] Termos MeSH primário: Neoplasias Ósseas/diagnóstico por imagem
Nádegas/diagnóstico por imagem
Fêmur/diagnóstico por imagem
Osteocondroma/diagnóstico por imagem
[Mh] Termos MeSH secundário: Adulto
Feminino
Seres Humanos
Imagem por Ressonância Magnética
Dor Musculoesquelética/etiologia
Osteocondroma/diagnóstico
Ciática/diagnóstico
Ciática/etiologia
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1708
[Cu] Atualização por classe:170802
[Lr] Data última revisão:
170802
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170602
[St] Status:MEDLINE
[do] DOI:10.2519/jospt.2017.6877



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