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Clinical Neuroscience

JANUARY 30, 2021

Evaluation of the effectiveness of transforaminal epidural steroid injection in far lateral lumbar disc herniations

EVRAN Sevket, KATAR Salim

Far lateral lumbar disc herniations (FLDH) consist approximately 0.7-12% of all lumbar disc herniations. Compared to the more common central and paramedian lumbar disc herniations, they cause more severe and persistent radicular pain due to direct compression of the nerve root and dorsal root ganglion. In patients who do not respond to conservative treatments such as medical treatment and physical therapy, and have not developed neurological deficits, it is difficult to decide on surgical treatment because of the nerve root damage and spinal instability risk due to disruption of facet joint integrity. In this study, we aimed to evaluate the effect of transforaminal epidural steroid injection (TFESI) on the improvement of both pain control and functional capacity in patients with FLDH. A total of 37 patients who had radicular pain caused by far lateral disc herniation which is visible in their lumbar magnetic resonance imaging (MRI) scan, had no neurological deficit and did not respond to conservative treatment, were included the study. TFESI was applied to patients by preganglionic approach. Pre-treatment Visual Analogue Scale (VAS) and Oswestry Disability Index (ODI) scores of the patients were compared with the 3rd week, 3rd month and 6th month scores after the procedure. The mean initial VAS score was 8.63 ± 0.55, while it was 3.84 ± 1.66, 5.09 ± 0.85, 4.56 ± 1.66 at the 3rd week, 3rd month and 6th month controls, respectively. This decrease in the VAS score was found statistically significant (p = 0.001). ODI score with baseline mean value of 52.38 ± 6.84 was found to be 18.56 ± 4.95 at the 3rd week, 37.41 ± 14.1 at the 3rd month and 34.88 ± 14.33 at the 6th month. This downtrend of pa­tient’s ODI scores was found statistically significant (p = 0.001). This study has demonstrated that TFESI is an effective method for gaining increased functional capacity and pain control in the treatment of patients who are not suitable for surgical treatment with radicular complaints due to far lateral lumbar disc hernia.

Journal of Nursing Theory and Practice

FEBRUARY 28, 2020

[Physical Dimensions of Quality of Life on Dialysis and Renal Transplant Patients]


[End stage renal failure is a disease with a serious impact on the everyday life of patients. The aim of this study is to measure and compare the quality of life of patients on hemodialysis and following renal transplant in Szeged, based primarily on physical dimensions and to compare the results with similar national and international data. Throughout the research the authors used the Kidney Disease Qualitiy of Life Questionnary- Short Form-36, the Illness Intrusiveness Rating Scale, and their own questionnary. They involved 111 patients into their study from September 2018 to May 2019. The results show that among the dimensions regarding physical health the pain subscale in the renal transplant cohort reached the highest scores: 76±26 (average±SD) vs. 55±33 in the dialysis cohort. (p<0,001). The result of physical role functioning subscale was the lowest, reaching 69±25 points vs. 50±30 in the dialysis cohort. (p<0001). Analyzing the correlation of quality of life and illness intrusiveness, they found that the higher the quality of life result, the lower is the illness intrusiveness result (r=-0,478). Due to the results of the present study, it can be stated, that the quality of life in the dialysis cohort is lower in Szeged. These results may contribute to a holistic view of care of our patients. ]

Journal of Nursing Theory and Practice

APRIL 30, 2020

[The Effectiveness of Pain Control in Cancer]

BÖGYÖS Dorina Viola, KIRÁLY Edit

[Introduction: Cancer diseases pose a serious public health issue nowadays, as they are among the leading causes of death. As today it is possible to live with this disease for a long time, the quality of life, which is greatly affected by pain, becomes a very important factor. Objective: The purpose of the research is to investigate and explore potential existing problems in the field of cancer pain relief in Hungary and to propose solutions to these problems. In our questionnaire survey, we asked patients suffering from tumors who were in pain and living their lives at home. The research was an anonymous cross-sectional study using descriptive and comparative statistical methods. The average age of respondents was 55 and most of them were women. Answers showed that primary tumors appear mostly in breasts (n=25) or the lungs (n=13). Metastasis developed by almost 30% of the patients. 42% of the respondents experienced severe pain (VAS ≥7 point), which they estimated to last for 1-2 (n=40) or rather 4-5 hours daily (n=30). Almost two third of the respondents were using products containing NSAID (n=64). The number of mild (n=18) versus strong painkiller (n=15) users were almost equal. There was a significant difference between groups of patients experiencing “mild-medium” (p=0,01) versus “mild-strong” pains (p=0,004) due to the usage of medication containing stronger opioids. From this revealed that individuals with greater pain used potent analgetics. More than half of the patients use some sort of sleep or relax aid as a supplement to their medication. Patients with metastasis (n=28) use strong (n=7) as well as mild analgesics (n=10) in greater numbers than those without metastasis. The results reveal that in Hungary, relatively few patients with cancer diseases use strong opioid-containing drugs despite of the fact that their pains are severe. Therefore, a nearly precise estimate of pain levels would be important. Fear of side effects is often unjustified and cannot limit the choice of appropriate therapy. ]

Lege Artis Medicinae

SEPTEMBER 30, 2020

[The pain-trigger role of cytokines in the nervous system – the direct analgesic effect of anti-cytokine therapy ]


[Nociceptive, neuropathic and central me­chanisms are involved in the perception, transmission and processing of chronic pain and shaping of cerebral pain image. Alar­mins – molecules alarming defence and signing the presence of pathogens and tissue damage - trigger a series of pathogenic events resulting in inflammatory pain stimuli. Proinflammatory cytokines play a determining role in the pain perception at the level of the nervous system. Continuous inflammatory stimuli while sensitizing the periferic and central neurons activate the pain-related cerebral areas and develop the complex pain image, the pain matrix. Ce­reb­ral functional connections are operating in networks and can be visualized by functional MRI. Cytokines activate the neurons directly or indirectly by other neuromediators. Cytokine receptors are expressed on no­ciceptors and even on higher-level neurons and on various non-neural cells, such as microglia and astrocytes. The most ubiquitous cytokines are the Tumour Necrosis Factor and Interleukin 6 in the nervous sys­tem. The signaling pathways are the Nuclear Factor κB and the Janus-kinase enzyme system. The proinflammatory cytokines and the Janus-kinase are therefore primary therapeutic targets. Anti-cytokine biologicals and small molecular kinase inhibitors decrease the pain and improve functional activity in rheumatoid arthritis. Decrease of pain was more pronounced than expected only from the decrease of the clinical biomarkers of inflammation. The early and ra­pid painkiller effect of targeted biological and chemical-biological response modifiers is attributed to their direct analgesic effect on the brain.]

Clinical Neuroscience

MAY 30, 2020

Autonomic nervous system may be affected after carpal tunnel syndrome surgery: A possible mechanism for persistence of symptoms after surgery

ONDER Burcu, KELES Yavuz Betul

After carpal tunnel surgery, some patients report complaints such as edema, pain, and numbness. Purpose – The aim of this study was to evaluate autonomic nervous system function in patients with a history of carpal tunnel surgery using sympathetic skin response (SSR). Thirty three patients (55 ±10 years old) with a history of unilateral operation for carpal tunnel syndrome were included in the study. The SSR test was performed for both hands. Both upper extremities median and ulnar nerve conduction results were recorded. A reduced amplitude (p=0.006) and delayed latency (p<0.0001) were detected in the SSR test on the operated side compared to contralateral side. There was no correlation between SSR and carpal tunnel syndrome severity. Although complex regional pain syndrome does not develop in patients after carpal tunnel surgery, some of the complaints may be caused by effects on the autonomic nervous system.

Clinical Neuroscience

MARCH 30, 2020

Evaluation of anxiety, depression and marital relationships in patients with migraine


Aim - The aim of this study was to evaluate the frequency and characteristics of attacks in patients with migraine, to determine the effects of anxiety or depressive symptoms, and to evaluate the marital relationships of patients with migraine. Method - Thirty patients who were admitted to the neurology outpatient clinic of our hospital between July 2018 and October 2018 and were diagnosed with migraine according to the 2013 International Headache Society (IHS) diagnostic criteria were included in this cross-sectional study. Age, sex, headache frequency and severity, depressive traits, marital satisfaction and anxiety status were examined. We used the Beck Depression Inventory (BDI), State-Trait Anxiety Inventory (STAI), Maudsley Marital Questionnaire (MMQ) and Visual Analogue Scale (VAS) for measuring relevant parameters. Results - The mean severity of migraine pain according to VAS scale was 6.93 ± 1.41 and the mean number of migraine attacks was 4.50 ± 4.24. The mean BDI score of the patients was 12.66 ± 8.98, the mean MMQ-M score was 19.80 ± 12.52, the mean MMQ-S score was 13.20 ± 9.53, the mean STAI-state score was 39.93 ± 10.87 and the mean STAI-trait score was 45.73 ± 8.96. No significant correlation was found between age, number of migraine attacks, migraine duration, migraine headache intensity, and BDI, STAI and MMQ scores (p>0.05). But there was a positive correlation between MMQ-S and scores obtained from the BDI and STAI-state scales (p<0.05). Conclusion - In this study more than half of the migraine patients had mild, moderate or severe depression. A positive correlation was found between sexual dissatisfaction and scale scores of depression and anxiety.

Journal of Nursing Theory and Practice

AUGUST 30, 2019

[The effect of whole body electrostimulation for the pelvic floor muscles ]

ARANYNÉ Molnár Tímea, NAGY Edit, DOMJÁN Andrea, FEKETE Zoltán, SURÁNYI Andrea, BÓDIS József

[The aim of the study: Few studies research the effects of trunk stabilizer muscle strengthening on pelvic floor dysfunctions. We assessed a new core strengthening method on the pelvic floor muscles. Material and method: Female patient (70 years) with stressincontinence and low back pain received the Whole Body Electric Muscle Stimulation for 10 weeks (2x25 minutes/week). The EMG (for the conditioning ability of pelvic floor muscle such as maximal isometric contraction, dynamic endurance and relaxation values), urodynamic assessment, introitus and the transabdominal ultrasound were used before and after training. Results: The patient’s the stressincontinence, low back pain and the conditioning ability of pelvic floor muscles improved. The urodynamic and ultrasounds values showed improvement in functions of the bladder neck and deep abdominal muscle. Conclusion: This method would increase the trunk stabilization and pelvic floor muscle strength of the eldery age group, which might decrease the prevalence of urinary incontinence.]

Clinical Neuroscience

JANUARY 30, 2020

[The quality of life of the cluster headache patients during the active phase of the headache]


[Introduction - Cluster headache (CH), which affects 0.1% of the population, is one of the most painful human conditions: despite adequate treatment, the frequent and severe headaches cause a significant burden to the patients. According to a small number of previous studies, CH has a serious negative effect on the sufferers’ quality of life (QOL). In the current study, we set out to examine the quality of life of the CH patients attending our outpatient service between 2013 and 2016, using generic and headache-specific QOL instruments. Methods - A total of 42 CH patients (16 females and 26 males; mean age: 39.1±13.5 years) completed the SF-36 generic QOL questionnaire and the headache- specific CHQQ questionnaire (Comprehensive Headache- related Quality of life Questionnaire), during the active phase of their headache. Their data were compared to those of patients suffering from chronic tension type headache (CTH) and to data obtained from controls not suffering from significant forms of headache, using Kruskal-Wallis tests. Results - During the active phase of the CH, the patients’ generic QOL was significantly worse than that of normal controls in four of the 8 domains of the SF-36 instrument. Apart from a significantly worse result in the ‘Bodily pain’ SF-36 domain, there were no significant differences between the CH patients’ and the CTH patients’ results. All the dimensions and the total score of the headache-specific CHQQ instrument showed significantly worse QOL in the CH group than in the CTH group or in the control group. Conclusion - Cluster headache has a significant negative effect on the quality of life. The decrease of QOL experienced by the patients was better reflected by the headache-specific CHQQ instrument than by the generic SF-36 instrument. ]

Clinical Oncology

DECEMBER 10, 2018

[Medical use of marihuana especially in oncology]


[The medical use of marijuana has gained a considerable attention among wide range of cancer patients lately in Hungary. Consequently, oncologist sare facing questions related to cannabinoids more and more in their clinical practice. This article aims to clarify some basic concepts and to give a brief introduction on the current international and national legislation on their accessibility. Numerous publications have dealt with the application of marijuana in various indications. Among the tumour related indications, the concerned studies mainly refer to chemotherapy induced nausea and vomiting, chronic pain, sleep disorders, anorexia and cachexia. The article also to uches upon on knowledge connected to the causal treatment of malignant tumours, which are currently limited to glioblastoma. Information on the carcinogenic potential of cannabis and information on the popularity and attitudes of American oncologists can be found in this article. This paper gives a literature review in the above mentioned themes.]

Journal of Nursing Theory and Practice

JUNE 30, 2019

[Postoperative pain management today in Hungary - Part 2 ]

LOVASI Orsolya, LÁM Judit

[According to the literature, the practice of postoperative pain relief in Hungary is an area to be developed. Postoperative pain is a key issue for patients. Surveys show that more than 59% of patients are worried about postoperative pain. Their concerns are not baseless, as recent studies have consistently shown that pain has not been properly treated after surgery. It has also been shown that postoperative pain can lead to a deterioration in the quality of life of patients. The aim of our study was to assess the degree of postoperative pain in patients and their satisfaction with pain relief. We conducted interviews based on personal inquiries with a total of 168 patients, with the involvement of certain surgical departments of three Hungarian institutions. Based on our results, we found that patients report remarkable pain after surgery, so the practice of postoperative pain relief is in many cases unsatisfactory. Comparing the results and the international literature, postoperative analgesic practice can be considered as an area to be developed. ]