Carboxytherapy in the practice of an occupational pathologist: experience of use in cervical dorsopathy in workers of harmful professions

The task of ensuring the working capacity of the country’s industrial potential is to preserve the health of employees of enterprises with harmful working conditions. High rates of general morbidity and disability of the working population due to vertebrogenic diseases of the spine, the genesis of which is associated with organ overstrain, microtraumatization and vibration exposure, make the problem of treatment, prevention and rehabilitation of this pathology a priority in occupational medicine. In the present study, the expediency of using carboxytherapy in the treatment of cervical dorsopathies in 2 groups of patients working in harmful professions has been studied, in one of which, along with basic drug treatment, physiotherapy exercises and massage, injections of purified carbon dioxide into paravertebral points are included in the complex of therapy. At the end of the course of treatment in the group of patients receiving carboxytherapy, a more significant improvement in clinical and electrophysiological parameters was achieved: a decrease in the intensity of pain syndrome according to a visual analogue scale by 73.3 %, myofascial syndrome by 33.3 %, expansion of the range of motion by 40 %; according to stimulation electroneuromyography and rheovasography — improvement of nerve impulse conduction along the peripheral nerves of the upper extremities and the roots of the C6–8 — Th1 spinal nerves by 35 %, the hemodynamics of peripheral blood vessels of the upper extremities by 45 %. The extensive physiological properties of carbon dioxide, the availability and safety of the method, the absence of negative consequences, the effectiveness shown in the study allows us to recommend the use of carboxytherapy in occupational pathological practice in the treatment of vertebrogenic reflex syndromes in workers in hazardous occupations.

Myofascial pain syndrome: risk factors, diagnosis and local therapy

One of the main reasons for seeking medical help is myofascial syndrome (MFS), which is manifested by local inflammation with elements of degenerative changes in the affected tissue, pain and muscle spasm due to dysfunctional disorders in the nociceptive system and a decrease in the quality of life. This review discusses etiopathogenesis in detail, taking into account the factors predisposing to the development of MFS, which are divided into anatomical, ergonomic, medical and psychosocial, and also provides diagnostic criteria for pain MFS, including 5 large and 3 small criteria necessary for diagnosis. The second part of the review examines the indications, efficacy, safety, and benefits of topical forms of nonsteroidal anti-inflammatory drugs (NSAIDs), which have a moderate effect on pain, but have a much better safety profile due to reduced systemic absorption. The use of topical drugs allows you to create an effective concentration of the drug directly in the lesion and avoid undesirable systemic effects. Experts strongly recommend prescribing primarily topical, rather than oral, NSAIDs to patients aged 65 years and older who have concomitant cardiovascular and renal pathology, as well as diseases of the gastrointestinal tract. In more detail, the review examines topical forms of diclofenac, which differ in the maximum degree of transdermal penetration compared to other NSAIDs and the effect of slow release of the active substance into the surrounding tissues.

Efficacy of the dry needling of myofascial syndrome in the trapezius muscle: A systematic review

Objective: To analyze the efficacy of the dry needling technique in the treatment of trigger points of the trapezius muscle. Material & Methods: A systematic search was carried out in the databases: PubMed, Scopus and Web of Science with the terms neck pain, trapezius, dry needling and acupuncture therapy. The results were analyzed following two inclusion criteria: studies published after 2014, and studies that aimed to evaluate the effects of dry needling on trapezius muscle. Seventeen articles were obtained, which were evaluated according to their methodological quality with the JADAD Scale and analyzed according to: study objective, experimental design, sample, intervention applied, variables analyzed, instruments used to quantify the results and results obtained. Results: Thirteen articles were selected in which, practically all, show that dry needling decreases pain intensity, improves range of motion, increases the painful threshold to pressure and eliminates, in most cases, trigger points. Conclusions: The dry needling has effects on cervical pain and disability, generated by myofascial dysfunction, have been identified. This technique did not show significant improvements compared to other techniques analyzed, but it did prove to be a treatment as valid as other more conventional ones. Keywords: Dry needling; Trigger point; Cervical pain; Trapezius; Rehabilitation

Osteopathic support of sportsmen during the annual training process

Introduction. Modern sports places high demands on the functional systems of the body at all stages of the training and competitive processes. High loads create signifi cant background for the occurrence of musculoskeletal diseases, among which the myofascial syndrome (MFS) holds the leading position. MFS negatively affects the functional readiness of the sportsman′s body and is a risk factor for injuries of the musculoskeletal system. In this regard, timely treatment of MFS is important. It creates the conditions for the improvement of sports achievements, for health maintenance and sports longevity. Treatment of patients with MFS should include methods that normalize trophism and muscle tone. Given the problem of doping, the use of non-drug methods, including osteopathy, is preferable. The goal of research — to develop a system of monitoring and osteopathic correction of myofascial disorders (MFD) and to introduce it into the practice of medical and biological support for sportsmen of different categories and levels during the annual training process.Materials and methods. 93 sportsmen (45 women and 48 men), mean age 22,1±1,1 years, representing diffe rent sports were examined. The essence of the proposed system is regular clinical and electroneurophysiological monitoring of the body condition and preventive correction of myofascial disorders in order to exclude their infl uence on the success of sports activities.Results. It was established that the proposed system of monitoring and osteopathic correction led to a signifi cant reduction in clinical and electroneurophysiological manifestations both in local and in extensive forms of myofascial disorders, which allowed to maintain the optimal functional readiness of sportsmen throughout the entire annual training cycle.Conclusion. The system of monitoring and correction of MFS with the use of osteopathic treatment can be one of the elements of medical and biological support for sportsmen during the annual training process.

Masks of Chronic Prostatitis: Overactive bladder and Myofascial Syndrome. Case study

Prostatitis is a chronic disease that does not respond well to therapy. It is prone to frequent relapses and does not have a clear and unambiguous clinical picture, which can lead to diagnostic failure. A case of overactive bladder and myofascial syndrome described. The clinical picture was interpreted as «chronic prostatitis» erroneously. Differentiated analysis of the International Prostate Symptom Score (IPSS) and NIH-CPSI (National Institute of Health Chronic Prostatitis Symptom Index) questionnaires, as well as palpation of trigger points made it possible to establish the correct diagnosis. The following drugs were prescribed: Trospium chloride (Spasmex® ) 15 mg twice a day, Baclоfen (Baclophenum) 10 mg daily, Combilipen (B vitamins multicomplex) intramuscularly, Nimesulide (Nimesulide) orally, and locally low-intensity laser therapy. The patient noted a marked improvement after 14 days: the pain intensity decreased from 8 points to 1, urination urgency was not noted, nocturia stopped. The quality of life (QoL) accordingly improved to 1 point on the IPSS scale. The total score for domains III and IV decreased from 11 to 3 according to the NIH-CPSI symptom scale of chronic prostatitis. The pronounced positive dynamics of the patient’s state of health has confirmed the accuracy of the diagnosis and treatment.

Back Pain in Pregnant Women: Its Origins, Peculiarities of Pathogenesis and Biomechanics

The problem of the back pain in pregnant women is one of the most important in modern medicine. 65–90 % of pregnant women complain of the back pain. The women may have the back pain from the early stages of pregnancy, or it may occur with the growth of the fetus.The causes of the pain during pregnancy are late reproductive age, high body mass index, physical strain, pain during previous pregnancies. Vertebrogenic and pelvic pain in pregnant women can first appear at the beginning of the gestational period. According to various authors, the frequency of such pain is 30–35 %. As a rule, painful neurologic manifestations begin in the third trimester, on average at the 18 th –22 nd week of pregnancy. About a half of women with early manifestation of lumbosacral pain during the pregnancy keep suffering from pain for a year after giving birth. In 20 % of cases, symptomatic pain is felt for 3 years after the delivery. The primary factors causing the pain syndrome is the shift in the centre of gravity due to enlargement of the pregnant uterus of the postural balance. The localization of the pain depending on the peculiarities of the posture can be different. In most of cases the lower back, thoracolumbar passage, sacrum, with the occasional radiation to buttock or pelvic joint, are affected. One of the most common pain syndromes in gynecology is the myofascial syndrome characterized by hyper tonus of the muscles and fasciae and ligaments of the pelvic minor.

Coexistence of musculoskeletal disorders in the upper body of labor origin

The coexistence of musculoskeletal disorders is common in work activities around the world, however, information on the subject is insufficient both in Latin America and in Colombia despite its impact at the economic and social level. The objective of this research was to determine the coexistence of musculoskeletal disorders of work origin in the upper body in the working population that attends a Service Provider Institution (IPS). An observational, descriptive, quantitative, and cross-sectional design study was conducted between the first of March in 2017 and the first of March in 2018. Four semiological tests were applied for physiotherapists to seek the coexistence of carpal tunnel syndrome, lateral epicondylitis, rotator cuff syndrome, and cervical myofascial syndrome. Among the results, it was found that 92.6% (n=138) of the patients had two or more pathologies, 59.73% (n=89) had the rotator cuff and the myofascial syndrome, 52.35% (n=78) had epicondylitis and myofascial syndrome, and 37.58% (n=56) had carpal tunnel syndrome and lateral epicondylitis. This study highlights the high coexistence of musculoskeletal disorders in the upper body, especially in the female gender.

Therapeutic use of botulinum toxin in pain treatment

Botulinum toxin is one of the most potent molecule known to mankind. A neurotoxin, with high affinity for cholinergic synapse, is effectively capable of inhibiting the release of acetylcholine. On the other hand, botulinum toxin is therapeutically used for several musculoskeletal disorders. Although most of the therapeutic effect of botulinum toxin is due to temporary skeletal muscle relaxation (mainly due to inhibition of the acetylcholine release), other effects on the nervous system are also investigated. One of the therapeutically investigated areas of the botulinum neurotoxin (BoNT) is the treatment of pain. At present, it is used for several chronic pain diseases, such as myofascial syndrome, headaches, arthritis, and neuropathic pain. Although the effect of botulinum toxin in pain is mainly due to its effect on cholinergic transmission in the somatic and autonomic nervous systems, research suggests that botulinum toxin can also provide benefits related to effects on cholinergic control of cholinergic nociceptive and antinociceptive systems. Furthermore, evidence suggests that botulinum toxin can also affect central nervous system (CNS). In summary, botulinum toxin holds great potential for pain treatments. It may be also useful for the pain treatments where other methods are ineffective with no side effect(s). Further studies will establish the exact analgesic mechanisms, efficacy, and complication of botulinum toxin in chronic pain disorders, and to some extent acute pain disorders.