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Title: A Case Series: To Study The Outcome Of 20 Patients Of Chronic Pain Managed By Neuromodulation With Or Without Newer Approach Of Myofascial Intervention(Ultrasonography Guided Dry Needling)
e-poster Number: INSIM82
Category: Pain
Author Name: Pradeep Marotirao Chavan
Institute: Topiwala National Medical College and BYL NAIR hospital
Co-Author Name: Dr Pradeep Chavan, Dr Varsha S Suryavanshi, Dr Lipika Swain, Dr Bhaskar Patil
Abstract :
Aim: To study the outcome of chronic pain management by neruromodulation with or without USGDN(for muscles) To present novel perspective of myofascial pathology as a cause of pain I ntroduction: Chronic pains routinely managed with various neural interventions, mostly provide transient improvement even remissions are possible(medications, blocks, Radiofrequency) and physiotherapy. Methods:20 Patients,1(RA)Rheumatoid Arthritis,3 Backache (mild disc bulge/Normal MRI),2Trapezitis,1Post Amputation,1Lower limb CRPS(complex regional pain syndrome),1 post tooth extraction,1 varicose veins,3Trigeminal Neuralgia,6 skull base osteomyelitis(SBO),1 Frozen shoulder. All patients received long term painkillers. Started with oral pregabalin 75mg od, myospaz bd Results: After 7days of medications,2 patients(RA and post tooth extraction) pain improved vas 0-1/10.Tapered medications and stopped in a month. 18 patients pain persisted 2TGN patients received mandibular nerve block, had transient relief for 7days. Started USGDN twice week in18 patients, found muscle tightness with LTR(local twitch reflex) on USG. All were responded with 4-8 sessions Vas 0-1/10 with disabilities improved (LL CRPS, frozen shoulder, backache)measured with LEFS(Lower extremity functional scale),DASH score(Disabilities of Arm, shoulder, hands)
Disscussion:2 patients had complete pain relief with oral neuromodulators, remaining 18 improved with addition of USGDN. Motor neuropathy (neuromyopathy) leads to generation of myofascial trigger points (MTrPs taut bands) gives rise myofascial pain syndromes (MPS).Insertion of 32G solid needle in MTrPs produces local twitch reflex(LTR) in muscles with corresponding relaxation.
In combination with neural interventions, USGDN produced sustained pain relief and disabilities improvement.
Conclusion: considering neuromyopathy as cause of pain, USGDN with Neuromodulation has been proved to be successful in early pain and disability
