No abstract

Background Neuropathic pain (NP) is one of the most frequent spinal cord injury (SCI) complications. Pain, quality of life, and functionality are associated and can lead to pain catastrophization. Pharmacological management of patients with NP secondary to SCI is widely known and there is increasing evidence in the area. Nevertheless, nonpharmacological management is not fully elucidated since its efficacy is inconclusive. Objective We hypothesize that (1) hydrotherapy is effective in reducing NP secondary to SCI. Additionally, our secondary hypotheses are that (2) hydrotherapy decreases the catastrophization of NP, and that (3) hydrotherapy improves life quality and minimizes the degree of disability, when compared to physical therapy. Methods A sample of approximately 20 participants will be randomly assigned to either the intervention (hydrotherapy) or control group (standard physical therapy). Both interventions will be administered twice a week over a 9-week period (18 sessions in total). Primary outcomes are changes in neuropathic pain perception and pain catastrophization. Secondary outcomes are changes in disability and quality of life scores. They will be assessed at baseline and follow-up at 4 weeks after discharge. Validated Spanish language scales that will be used are the following: Numerical Pain Rating Scale, Pain Catastrophization, Health-related Quality of life, and the World Health Organization’s Disability Assessment Schedule 2.0. Generalized mixed linear models will be used for comparing baseline and postintervention means of each group and their differences, together with 95% CIs and P values. A P value of less than .05 will be considered significant. Results Recruitment began in April 2019, and we recruited the last participants by December 2019, with 10 individuals assigned to hydrotherapy and 8 to physical therapy (control). Results from this study will be disseminated via scientific publication, in ClinicalTrials.gov, and in national and international conferences in the latter half of 2022. Conclusions This trial will explore the effects of hydrotherapy on neuropathic pain, together with functionality and quality of life, in patients with SCI. Furthermore, this study aims to evaluate these therapeutic modalities, including perception variables, and mental processes, which may affect the clinical condition and rehabilitation outcomes in these patients. Hydrotherapy is likely to be a safe, efficient, and cost-effective alternative to the current standard of care for NP secondary to SCI, with comparable results between the two. Trial Registration ClinicalTrials.gov NCT04164810; https://clinicaltrials.gov/ct2/show/NCT04164810 International Registered Report Identifier (IRRID) DERR1-10.2196/37255

Introducción. La ataxia espinocerebelosa es un grupo de desórdenes genéticos que consisten en una degeneración progresiva que afecta principalmente al cerebelo, el tronco encefálico y la médula espinal, y se asocia de forma variable con otros síntomas neurológicos. Presentación del caso. Mujer de 60 años sin antecedentes médicos relevantes, quien consultó al servicio de fisiatría por cuadro clínico de dos años de evolución consistente en alteración progresiva en la marcha, pérdida de fuerza en miembros inferiores, temblor en miembros superiores,  disfagia y fatiga. Al examen físico se encontró disartria leve, disdiadococinesia, dismetría, sacadas hipométricas bilaterales y marcha atáxica. Se realizó resonancia magnética nuclear (RMN) del cerebro que mostró atrofia cerebelosa, y electromiografía y neuroconducciones que confirmó polirradiculoneuropatía axonal. Las pruebas genéticas moleculares evidenciaron expansión de una de una repetición de pentanucleotidos ATTCT, lo que confirmó el diagnóstico de ataxia cerebelosa tipo 10 (SCA10). Se inició manejo multidisciplinario donde fisiatría inició plan de rehabilitación neurológica, manejo del dolor con neuromodulador y prescripción de dispositivo de asistencia para la movilidad tipo caminador. La paciente mejoró su independencia en actividades de la vida diaria: el índice de Barthel pasó de 45 puntos a 75 tras 12 semanas en rehabilitación neurológica. Conclusión. La SCA10 se consideró inicialmente como una ataxia cerebelosa pura asociada a convulsiones; sin embargo, en los últimos años la identificación de nuevas familias con este desorden ha revelado fenotipos más diversos, incluyendo polineuropatía, signos piramidales y deterioro cognitivo y neuropsiquiátrico. Se describe aquí un caso de SCA10 de inicio tardío (más de 50 años de edad) que podría ser el primero esporádico reportado en Colombia.

Introduction: Myofascial pain syndrome is an acute and chronic painful musculoskeletal condition that involves muscle and surrounding connective tissue. Trigger point injection is a common treatment for this condition providing long-term relief. The procedure is generally safe; however some side effects have been reported including pain, nerve injury, bleeding, infection, and pneumothorax. Objective: To report a case of a patient with myofascial pain syndrome successfully treated by Ultra Sound-guided infiltration of a myofascial trigger point in the rhomboid major muscle. Case description: A 39-year-old presented with cervical and dorsal pain of 4 months of evolution. She had physical and occupational therapy, with partial improvement of cervical pain but persistence of dorsal pain. No abnormal finding was noted on the neurological examination. On palpation, the patient had a myofascial trigger point in the left rhomboid major muscle. Given the persistence of the myofascial trigger point after physical therapy, it was considered the patient might benefit from Ultra Sound-guided infiltration. No adverse events were reported. At the end of the procedure, the patient reported a 70% reduction in pain. The patient returned for a follow-up visit one month after the procedure, reporting pain relief of 80%. Conclusions: The use of an Ultra Sound-guided technique for trigger point injection decreases the risk of iatrogenic complications. The blind method may result in poor localization of the point. Further studies are required to develop Ultra Sound based criteria to determine its clinical use.