Miofasciālo palaidējpunktu infiltrācijas injekciju efektivitātes noteikšana, pielietojot anestētisku līdzekli pie hroniskam muguras lejas daļas sāpēm
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Date
2021
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Rīgas Stradiņa universitāte
Rīga Stradiņš University
Rīga Stradiņš University
Abstract
Mūsdienu mācības un darbs saistīts ar ilgām stundām pie datora, darbu fiksētā pozā un neadekvātu lielu slodzi muguras muskulatūrai. Tas var novest pie miofasciālo trigera punktu (MTrP) veidošanās un hroniskām muguras lejasdaļas sāpēm (MLS). Cilvēkiem ir nepieciešamība pēc efektīvas, ātras un ilgstošas atsāpināšanas. Pētījuma mērķis bija izpētīt kāds ir MTrP infiltrācijas injekciju ar anestētisko līdzekli efekts un noturīgums dažāda vecuma un dzimuma pacientiem ar hroniskām MLS, salīdzinot ar bezinjekciju kontroles grupu. Tā sasniegšanai viena speciālista praksē pacientiem ar piekrišanu tika veiktas injekcijas MTrP. Tās veica pacientiem ar hroniskām MLS pēc Travellas un Simonsa aprakstītās, un Fišera uzlabotās metodes ar anestētiskajiem līdzekļiem lidokaīnu un bupivakaīnu.
Tika ievākti pacientu demogrāfiskie dati un reģistrētas pacienta atbildes uz Īsās sāpju aptaujas (BPI) un Osvestrija nespējas indeksa (ODI) anketām pirms injekcijas. Pēc injekcijas vēlreiz dati tika reģistrēti 2., 7., 28. un 90. dienā. Tie tika salīdzināti savā starpā un ar kontroles grupas pacientiem, kuriem injekcija netika veikta.
Pētījumā piedalījās 100 pacienti vecumā no 19 līdz 78 gadiem, kuru vecuma mediāna bija 55 gadi (Q1;Q3 42,25 un 63,00), 59 bija vīrieši un 41 sieviete. Demogrāfiskie dati un sākotnējie ODI, un sāpju lieluma rādītāji bija statistiski nozīmīgi atšķirīgi abām grupām. Pētījuma grupai sāpju intensitāte un ODI no sākotnējā lieluma visvairāk samazinājās 2.dienā, mediānu starpība 19,00 punkti (p<0,001), ar tendenci vēlāk tuvināties pirms injekcijas pozīcijai. Kontroles grupai pētījuma laikā nebija statistiski nozīmīgas izmaiņas ODI un sāpju skalas rādītājos nevienā vecuma grupā. Starp pētījuma un kontroles grupu visos apsekojuma etapos ODI un sāpju skalas rezultāti bija savstarpēji statistiski nozīmīgi atšķirīgi (p<0,016). Abās pacientu grupās atšķirības ODI rādītājos un sāpju skalas rādītājos starp dzimumiem nebija statistiski nozīmīgi atšķirīgas (p>0,051). Statistiski nozīmīgi lielāki ODI un sāpju skalas rādītāji bija cilvēkiem virs 50 gadu vecuma visos apsekojuma etapos pētījuma grupā (p<0,005) Līdz ar to secināju, ka miofasciālo palaidējpunktu infiltrācijas injekcijas ar anestētisku līdzekli pie hroniskām muguras lejas daļas sāpēm lielākais efekts ir 2.dienā pēc injekcijas un tas uz sāpju intensitāti un funkcionālām spējām saglabājas vismaz 3 mēnešus ilgi. Infiltrācijas ietekme uz funkcionālo nespēju un sāpju intensitāti pacientiem atkarībā no dzimuma neatšķiras. Pacientiem vecuma grupā virs 50 gadiem ar lielāku funkcionālo spēju ierobežojumu un sāpju intensitāti pēc MTrP injekcijas tie joprojām saglabāsies lielāki, salīdzinoši ar jaunākiem cilvēkiem.
Modern studying and work involves long hours at the computer, work in a fixed position and an inadequate load for back muscles. This can lead to the formation of myofascial trigger points (MTrP) and chronic lower back pain (LBP). People need effective, fast and long-lasting pain relief. The aim of the study was to investigate the effect and persistence of MTrP infiltration with anesthetic injection in patients of different ages and genders with chronic LBP compared to the non-injection control group. To achieve this, MTrP injections were given to patients with the consent of one specialist. They were performed in patients with chronic LBP as described by Travell and Simons and Fisher's improved methode with the anesthetics lidocaine and bupivacaine. Patient demographics were collected and the patient's responses to the Brief Pain Inventory (BPI) and the Oswestry Disability Index (ODI) questionnaires before injection were recorded. Data were collected again on days 2, 7, 28, and 90 after injection. They were compared with each other and with non-injection control group. The study included 100 patients aged 19 to 78 years with a median age of 55 years (Q1; Q3 42.25 and 63.00), 59 men and 41 women. Demographics and baseline ODIs and pain magnitudes were statistically significantly different between the two groups. For the study group, pain intensity and ODI decreased the most from baseline on day 2, with a median difference of 19.00 points (p <0.001), with a tendency to approach pre-injection later. The control group had no statistically significant changes in ODI and pain scale in any age group during the study. The ODI and pain scale results were statistically significantly different between the study and control groups at all stages of the survey (p<0.016). There were no statistically significant differences by gender in ODI and pain scale between the two groups of patients (p>0.051). There was a statistically significant higher ODI and pain scale in people over 50 years of age at all stages of the study in the study group (p<0.005). Therefore, I concluded that the infiltration injections of myofascial trigger point with an anesthetic agent for chronic lower back pain has the greatest effect on the second day after the injection and it lasts for at least 3 months on the pain intensity and functional capacity. The effects of infiltration on functional disability and pain intensity do not differ between patients by gender. Patients over the age of 50 with greater functional disability and pain intensity after MTrP injection will remain higher compared to younger people.
Modern studying and work involves long hours at the computer, work in a fixed position and an inadequate load for back muscles. This can lead to the formation of myofascial trigger points (MTrP) and chronic lower back pain (LBP). People need effective, fast and long-lasting pain relief. The aim of the study was to investigate the effect and persistence of MTrP infiltration with anesthetic injection in patients of different ages and genders with chronic LBP compared to the non-injection control group. To achieve this, MTrP injections were given to patients with the consent of one specialist. They were performed in patients with chronic LBP as described by Travell and Simons and Fisher's improved methode with the anesthetics lidocaine and bupivacaine. Patient demographics were collected and the patient's responses to the Brief Pain Inventory (BPI) and the Oswestry Disability Index (ODI) questionnaires before injection were recorded. Data were collected again on days 2, 7, 28, and 90 after injection. They were compared with each other and with non-injection control group. The study included 100 patients aged 19 to 78 years with a median age of 55 years (Q1; Q3 42.25 and 63.00), 59 men and 41 women. Demographics and baseline ODIs and pain magnitudes were statistically significantly different between the two groups. For the study group, pain intensity and ODI decreased the most from baseline on day 2, with a median difference of 19.00 points (p <0.001), with a tendency to approach pre-injection later. The control group had no statistically significant changes in ODI and pain scale in any age group during the study. The ODI and pain scale results were statistically significantly different between the study and control groups at all stages of the survey (p<0.016). There were no statistically significant differences by gender in ODI and pain scale between the two groups of patients (p>0.051). There was a statistically significant higher ODI and pain scale in people over 50 years of age at all stages of the study in the study group (p<0.005). Therefore, I concluded that the infiltration injections of myofascial trigger point with an anesthetic agent for chronic lower back pain has the greatest effect on the second day after the injection and it lasts for at least 3 months on the pain intensity and functional capacity. The effects of infiltration on functional disability and pain intensity do not differ between patients by gender. Patients over the age of 50 with greater functional disability and pain intensity after MTrP injection will remain higher compared to younger people.
Description
Medicīna
Medicine
Veselības aprūpe
Health Care
Medicine
Veselības aprūpe
Health Care
Keywords
miofasciālie trigerpunkti, trigerpunktu injekcijas, hroniskas muguras lejasdaļas sāpes, myofascial trigger points, trigger point injections, chronic lower back pain