Radicular pain is a very common disease among the population that can be addressed with different therapeutic approaches. Particularly, the administration of epidural medication is widely used especially in cases that do not respond to drug therapy and systemic therapies rehabilitation. The affected population is generally older adult and elderly advanced and often has comorbidities that do not permit the use of steroids, which are the drug of choice in radicular pain. Among the therapies developed in recent years in the treatment of sciatica, Ozone seems a viable alternative. The goal of the study is to compare the administration of steroids versus ozone in two groups of people with radicular pain and to evaluate the effectiveness and side effects. The group of those who did not show contraindications was treated with peridural infiltration of Triamcinolone and Ropivacaine, while the second group was subjected to infiltration of Ozone and Ropivacaine. At enrollment, for each patient was prepared a data sheet in which were specified personal and clinical data of the patient, with particular attention to the characteristics of the pain, irradiation and the average intensity on a numerical rating scale from 0 to 10 of the symptoms (tingling, pins, painful cold, dull, burning, electric shock, itching) and the associated signs (numbness on touch and bite, mechanical, static, dynamic, thermal allodynia,), the drugs taken in the last week (FANS, oppioids) and adjuvants employed in the last 24 hours (steroids, anticonvulsants, antidepressants, etc.). All patients included in our study before enrollment were subjected to a preliminary clinical evaluation, and also made standard radiography of the spine later completed with the study using computed tomography (CT) and / or Magnetic Resonance Imaging (MRI). They were then subjected to five therapy sessions at a distance of a week each other. The level of insertion of the needle was chosen based on the results of the neurological examination and correspondence between the clinical and radiological results. Each of the participants has been subjected to three test sessions to evaluate the effectiveness of the treatment according to Brief Pain Inventory, Oswestry Disability Index, SF-12 survey. The results showed a greater benefit to 4 weeks for patients receiving triamcinolone but a benefit equal to 3 months for the 2 groups of subjects. Patients treated with ozone have shown a lower incidence of side effects.
Il dolore radicolare è una patologia molto diffusa tra la popolazione che prevede diversi approcci terapeutici. Tra questi la somministrazione peridurale di farmaci è molto utilizzata soprattutto nei casi che non rispondono alle terapie farmacologiche sistemiche ed alle terapie riabilitative. La popolazione interessata è generalmente di età adulta avanzata ed anziana e presenta spesso delle comorbilità che non permettono l’utilizzo di steroidi, che rappresentano il farmaco di elezione nel dolore radicolare. Tra le terapie sviluppatesi negli ultimi anni nel trattamento delle lombosciatalgie l’Ozono sembrerebbe una valida alternativa. L’obiettivo dello studio è quello di confrontare la somministrazione di steroidi versus quella di ozono in due gruppi di persone affette da dolore radicolare e di valutarne l’efficacia e gli effetti collaterali. Il gruppo di coloro che non presentavano controindicazioni è stato trattato con infiltrazione di Triamcinolone e Ropivacaina per via peridurale, mentre il secondo gruppo è stato sottoposto ad infiltrazione di Ozono e Ropivacaina. Al momento dell’arruolamento, per ciascun paziente è stata preparata una scheda di raccolta dati dove venivano specificati i dati anagrafici e clinici del paziente: con particolare attenzione alle caratteristiche del dolore, l’irradiazione e l’intensità media su una scala di valutazione numerica da 0 a 10 dei sintomi (formicolio, spilli, freddo doloroso, sordo, bruciore, scarica elettrica, prurito) e i segni (ipoestesia al tatto e alla puntura, allodinia meccanica, statica, dinamica,termica) associati, i farmaci assunti nell’ultima settimana (fans, oppiacei) e gli adiuvanti assunti nelle ultime 24 ore (steroidi, anticonvulsivanti, antidepressivi, altro) Tutti i pazienti inseriti nel nostro studio prima dell’arruolamento sono stati sottoposti ad una valutazione clinica preliminare, hanno inoltre effettuato indagini radiografiche standard del rachide successivamente completate con studio mediante Tomografia Computerizzata (TC) e/o Risonaza Magnetica (RM). Sono stati quindi sottoposti a 5 sedute terapeutiche a distanza di una settimana l’una dall’altra. Il livello per la sede d’infiltrazione è stato scelto sulla base dei risultati dell’esame neurologico e della corrispondenza tra i risultati clinici e radiologici. Ciascuno dei partecipanti è stato sottoposto a tre sessioni di test per valutare l’efficacia del trattamento secondo indagine Brief Pain Inventory, Oswestry Disability Index, SF-12. I risultati hanno evidenziato un maggior beneficio a 4 settimane per i pazienti trattati con Triamcinolone ma un uguale beneficio a 3 mesi per i 2 gruppi di soggetti. I pazienti trattati con ozono hanno evidenziato una minore incidenza di effetti collaterali.
UTILIZZO DELLA VIA PERIDURALE NEL DOLORE RADICOLARE: EFFICACIA ED EFFETTI COLLATERALI NEL CONFRONTO TRA DUE PRINCIPI ATTIVI
ROSSETTI, CARLOTTA
2014/2015
Abstract
Radicular pain is a very common disease among the population that can be addressed with different therapeutic approaches. Particularly, the administration of epidural medication is widely used especially in cases that do not respond to drug therapy and systemic therapies rehabilitation. The affected population is generally older adult and elderly advanced and often has comorbidities that do not permit the use of steroids, which are the drug of choice in radicular pain. Among the therapies developed in recent years in the treatment of sciatica, Ozone seems a viable alternative. The goal of the study is to compare the administration of steroids versus ozone in two groups of people with radicular pain and to evaluate the effectiveness and side effects. The group of those who did not show contraindications was treated with peridural infiltration of Triamcinolone and Ropivacaine, while the second group was subjected to infiltration of Ozone and Ropivacaine. At enrollment, for each patient was prepared a data sheet in which were specified personal and clinical data of the patient, with particular attention to the characteristics of the pain, irradiation and the average intensity on a numerical rating scale from 0 to 10 of the symptoms (tingling, pins, painful cold, dull, burning, electric shock, itching) and the associated signs (numbness on touch and bite, mechanical, static, dynamic, thermal allodynia,), the drugs taken in the last week (FANS, oppioids) and adjuvants employed in the last 24 hours (steroids, anticonvulsants, antidepressants, etc.). All patients included in our study before enrollment were subjected to a preliminary clinical evaluation, and also made standard radiography of the spine later completed with the study using computed tomography (CT) and / or Magnetic Resonance Imaging (MRI). They were then subjected to five therapy sessions at a distance of a week each other. The level of insertion of the needle was chosen based on the results of the neurological examination and correspondence between the clinical and radiological results. Each of the participants has been subjected to three test sessions to evaluate the effectiveness of the treatment according to Brief Pain Inventory, Oswestry Disability Index, SF-12 survey. The results showed a greater benefit to 4 weeks for patients receiving triamcinolone but a benefit equal to 3 months for the 2 groups of subjects. Patients treated with ozone have shown a lower incidence of side effects.È consentito all'utente scaricare e condividere i documenti disponibili a testo pieno in UNITESI UNIPV nel rispetto della licenza Creative Commons del tipo CC BY NC ND.
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https://hdl.handle.net/20.500.14239/22592