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多模式疼痛管理理念对神经根型颈椎病患者力量的增强作用——一项非随机、无对照的临床试验

Increase in Strength After Multimodal Pain Management Concept in Patients with Cervical Radiculopathy-A Non-Randomized, Uncontrolled Clinical Trial.

作者信息

Zirkl Gerd, Schaumburger Jens, Gehentges Matthias, Kaiser Moritz

机构信息

Dr. Kaiser & Kolleginnen MVZ GmbH, Puricellistraße 34, 93049 Regensburg, Germany.

Department of Orthopedic Surgery, Regensburg University, Medical Center, 93077 Bad Abbach, Germany.

出版信息

Medicina (Kaunas). 2024 Nov 28;60(12):1961. doi: 10.3390/medicina60121961.

Abstract

: Although multimodal pain therapy (MPT) is widely used in pain management for chronic cervical radiculopathy, its effect on increasing muscle strength in patients with cervical radiculopathy is not well documented. This study aimed to evaluate the impact of a structured multimodal pain management program on muscle strength in these patients, using objective strength measurements as indicators of therapeutic success. : This non-randomized, uncontrolled, prospective clinical study initially included 35 patients, but 10 were excluded due to incomplete data, resulting in a final sample of 25 patients (14 women and 11 men, aged 42 to 84 years) with cervical radiculopathy who underwent a multimodal pain management program at a specialized orthopedic clinic. Muscle strength was measured at admission and discharge using a hand-held dynamometer. Pain levels were assessed with the Numeric Rating Scale. An uncontrolled study design was chosen for ethical reasons, as it was deemed inappropriate to form a control group that would be deprived of necessary anti-inflammatory or analgesic medications. : Significant improvements were observed in overall muscle strength, with an 11% increase from 114.78 kg to 127.41 kg ( = 0.003). The strongest increase in strength was observed in the proximal cervical muscle groups, with a notable 22.9% ( < 0.001)improvement in the muscles involved in cervical inclination. However, no significant strength gains were detected in the peripheral muscle groups of the upper arm. Pain scores on the NRS decreased by 54.2% ( < 0.001). : This study demonstrates that a multimodal pain management approach leads to significant improvements in muscle strength and pain reduction in patients with cervical radiculopathy. The increase in cervical muscle strength is closely associated with pain relief and improved functional outcomes, highlighting the value of conservative pain management strategies for these patients.

摘要

尽管多模式疼痛疗法(MPT)在慢性神经根型颈椎病的疼痛管理中被广泛应用,但其对神经根型颈椎病患者肌肉力量增强的效果尚无充分文献记载。本研究旨在评估结构化多模式疼痛管理方案对这些患者肌肉力量的影响,采用客观的力量测量作为治疗成功的指标。

这项非随机、无对照的前瞻性临床研究最初纳入了35例患者,但因数据不完整排除了10例,最终样本为25例神经根型颈椎病患者(14名女性和11名男性,年龄42至84岁),他们在一家专业骨科诊所接受了多模式疼痛管理方案。入院和出院时使用手持测力计测量肌肉力量。使用数字评分量表评估疼痛程度。出于伦理原因选择了无对照研究设计,因为认为组建一个被剥夺必要抗炎或止痛药物的对照组是不合适的。

观察到整体肌肉力量有显著改善(P=0.003),从114.78千克增加到127.41千克,增幅为11%。近端颈部肌肉群力量增加最为明显,参与颈部倾斜的肌肉有显著的22.9%(P<0.001)的改善。然而,上臂外周肌肉群未检测到显著的力量增加。数字评分量表上的疼痛评分下降了54.2%(P<0.001)。

本研究表明,多模式疼痛管理方法可使神经根型颈椎病患者的肌肉力量显著改善,疼痛减轻。颈部肌肉力量的增加与疼痛缓解和功能改善密切相关,突出了这些患者保守疼痛管理策略的价值。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/e061/11676987/a66f4d716687/medicina-60-01961-g001.jpg

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