Róbert Rapčan1,2,3, Ladislav Kočan4, Viktor Witkovsky5, Juraj Mláka6, Martin Griger1, Miroslav Burianek2, Simona Rapčanová2, Anthony Hammond7, Ľubomír Poliak1, Róbert Tirpák8, Jana Šimonová9, František Sabol8, Janka Vašková10. 1. Europainclinics, Kominárska 21/5, 831 04, Bratislava, Slovakia. 2. Europainclinics, Starochodovská 1750, 149 00, Prague 4, Czech Republic. 3. Europainclinics, Štefánikova 1599/82, 085 01, Bardejov, Slovakia. 4. Clinic of Anaesthesiology and Intensive Care Medicine, East Slovak Institute of Cardiovascular Disease, Ondavská 8, 040 11, Košice, Slovakia. 5. Institute of Measurement Science, Slovak Academy of Sciences, Dúbravská cesta 9, 841 04, Bratislava, Slovakia. 6. Poliklinika Terasa, Europainclinics, Toryská 1, 040 11, Košice, Slovakia. 7. Kent Institute of Medicine and Surgery, Newnham Court Way, ME14 5FT, Bearsted, Kent, UK. 8. Department of Cardiac Surgery, East Slovak Institute of Cardiovascular Disease, Ondavská 8, 040 11, Košice, Slovakia. 9. 1st Clinic of Anaesthesiology and Intensive Care Medicine, Louis Pasteur University Hospital, SNP 1, 040 11, Košice, Slovakia. 10. Department of Medical and Clinical Biochemistry, Faculty of Medicine, Pavol Jozef Šafárik University, Trieda SNP 1, 040 66, Košice, Slovakia. janka.vaskova@upjs.sk.
Abstract
BACKGROUND:Epiduroscopy is a well-established diagnostic and to certain level therapeutic tool in complex situations, where conventional methods such as magnetic resonance imaging (MRI) lack power or resolution to detect pathological changes. Such a situation is primarily failed back surgery syndrome (FBSS) but also radicular pain without surgery. The aim of this study was to determine the effectiveness of epiduroscopic treatment in patients with FBSS. METHODS: A total of 79 patients with FBSS were randomized into 2 groups. The first group underwent epiduroscopy and received mechanical lysis of adhesions only, the second group received also medication into the epidural space (methylprednisolone and hyaluronidase). Patients were subsequently followed for 12 months, with evaluation also after 6 months post-epiduroscopy. Patients were checked in terms of mobility, self-care, usual activities, pain/discomfort and anxiety/depression as defined in the 5‑dimensional EQ-5D-5L questionnaire and to asses suitability of this questionnaire in chronic pain states. Data were collected using EQ-5D-5L questionnaire and also quality of life (QoL) questionnaire. RESULTS: In the terms of ability to walk (dimension mobility) and also ability to do housework, study or leisure activities (dimension usual activity) patients improved in both groups after 6 and 12 months after epiduroscopy. In pain dimension there was improvement mainly after 6 months which correlated also with self-care dimension and quality of life self-assessment. Results in anxiety/depression dimension were mixed. CONCLUSION:Epiduroscopy appears to be a beneficial procedure for both patient groups, especially after 6 months, with some benefit remaining after 12 months. The EQ-5D-5L questionnaire seems to be a suitable and comprehensive way to assess patient health in chronic pain states.
RCT Entities:
BACKGROUND: Epiduroscopy is a well-established diagnostic and to certain level therapeutic tool in complex situations, where conventional methods such as magnetic resonance imaging (MRI) lack power or resolution to detect pathological changes. Such a situation is primarily failed back surgery syndrome (FBSS) but also radicular pain without surgery. The aim of this study was to determine the effectiveness of epiduroscopic treatment in patients with FBSS. METHODS: A total of 79 patients with FBSS were randomized into 2 groups. The first group underwent epiduroscopy and received mechanical lysis of adhesions only, the second group received also medication into the epidural space (methylprednisolone and hyaluronidase). Patients were subsequently followed for 12 months, with evaluation also after 6 months post-epiduroscopy. Patients were checked in terms of mobility, self-care, usual activities, pain/discomfort and anxiety/depression as defined in the 5‑dimensional EQ-5D-5L questionnaire and to asses suitability of this questionnaire in chronic pain states. Data were collected using EQ-5D-5L questionnaire and also quality of life (QoL) questionnaire. RESULTS: In the terms of ability to walk (dimension mobility) and also ability to do housework, study or leisure activities (dimension usual activity) patients improved in both groups after 6 and 12 months after epiduroscopy. In pain dimension there was improvement mainly after 6 months which correlated also with self-care dimension and quality of life self-assessment. Results in anxiety/depression dimension were mixed. CONCLUSION: Epiduroscopy appears to be a beneficial procedure for both patient groups, especially after 6 months, with some benefit remaining after 12 months. The EQ-5D-5L questionnaire seems to be a suitable and comprehensive way to assess patient health in chronic pain states.
Entities:
Keywords:
Back pain; EQ-5D-5L questionnaire; Epiduroscopy; Failed back surgery syndrome; Hyaluronidase
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