OBJECTIVETo search for an effective therapy for the nerve root pain caused by prolapse of lumbar intervertebral disc.

METHODSOne hundred and ninety-two cases were randomly divided into a Huaisanzhen group of 96 cases, a drug control group of 48 cases and an acupuncture control group of 48 cases. The Huaisanzhen group were treated by Huaisanzhen therapy, the drug control group by intramuscular injection of aspirin-DL-lysine and the acupuncture control group by routine acupuncture.

RESULTSThe time inducing analgesic effect was shorter, the effect-lasting time was longer, and the analgesic effect and the comprehensive therapeutic effect were better in the treatment group as compared with the two control groups with very significant differences (P < 0.01).

CONCLUSIONHuaisanzhen therapy has a better analgesic effect on the nerve root pain due to prolapse of lumbar intervertebral disc.

Analgesics ; Humans ; Intervertebral Disc ; Intervertebral Disc Displacement ; therapy ; Pain ; drug therapy ; Prolapse

To evaluate the clinical efficacy and safety of Shentong Zhuyu Decoction in the treatment of lumbar disc herniation, in order to provide evidence for its clinical application. PubMed, Cochrane Library, EMbase, CNKI, WanFang, VIP, CBM and Clinical Trials.gov databases were sysmatically retrieved. Two researchers independently searched, screened and extracted data. Randomized controlled trials in line with the inclusion criteria were included in the study. The article quality was assessed with the bias risk tool in the Cochrane Handbook. Meta-analysis was performed using RevMan 5.3. A total of 604 articles were obtained from the retrieval, and 824 patients in 9 studies were finally selected through screening. The course of treatment was about 1 month, and all of the studies were completed in China. Meta-analysis showed that the efficacy of Shentong Zhuyu Decoction in the treatment of lumbar disc herniation was better than that of the control group(RR=1.19, 95%CI[1.12, 1.26], P<0.000 01), including the comparison with Yaotongning Capsules(RR=1.10, 95%CI[1.02, 1.19], P=0.01) and diclofenac sodium tablets(RR=1.26, 95%CI[1.11, 1.44], P=0.000 4). In VAS pain score, Shentong Zhuyu Decoction had also obvious advantages(MD=-3.70, 95%CI[-6.31,-1.09], P=0.005). In addition, the number of adverse events in the Shentong Zhuyu Decoction group was lower than that in the control group. Shentong Zhuyu Decoction can effectively alleviate discomfort symptoms of patients with LDH. It has an obvious clinical efficacy and less adverse reactions. However, restricted by the quality of the included literatures, prospective, multi-center, large-sample-size randomized controlled trials are still needed to further improve the clinical evidence of the effect of Shentong Zhuyu Decoction in the treatment of LDH.
China ; Drugs, Chinese Herbal/therapeutic use* ; Humans ; Intervertebral Disc Displacement/drug therapy* ; Randomized Controlled Trials as Topic

OBJECTIVETo evaluate the combination of drop in canales sacralis with acupotomy dissolution in the treatment of lumbocrural pain caused by slipped discs.

METHODSOne hundred and thirty-nine patients with lumbocrural pain caused by slipped discs were randomly divided into 3 groups: cases in Group A were treated by the drop in canales sacralis, in Group B by acupotomy dissolution and in Group C by the combination of canales sacralis drop with acupotomy dissolution. MacNab score and VAS score were assayed before treatment and 1 week, 3 and 6 months after treatment.

RESULTThe effective rates in Groups A, B and C at 1 week, 3 and 6 months after treatment were 71.4%, 75.5%, 79.6%; 75.0%, 79.6%, 81.8% and 89.1%, 91.3%, 93.5%, respectively (P < 0.01). The pain intensity in Group C was reduced more markedly at different time points after treatment than that in Group A and Group B (P < 0.01).

CONCLUSIONThe combination of canales sacralis drop with acupotomy dissolution is superior to each method used alone in treatment of lumbocrural pain caused by slipped discs in the short-and long-term.

Acupuncture Therapy ; Female ; Humans ; Instillation, Drug ; Intervertebral Disc Displacement ; complications ; therapy ; Low Back Pain ; drug therapy ; etiology ; therapy ; Lumbar Vertebrae ; Male ; Treatment Outcome

BACKGROUNDVisceral pain is a common cause for seeking medical attention. Afferent fibers innervating viscera project to the central nervous system via sympathetic nerves. The lumbar sympathetic nerve trunk lies in front of the lumbar spine. Thus, it is possible for patients to suffer visceral pain originating from sympathetic nerve irritation induced by anterior herniation of the lumbar disc. This study aimed to evaluate lumbar discogenic visceral pain and its treatment.

METHODSTwelve consecutive patients with a median age of 56.4 years were enrolled for investigation between June 2012 and December 2012. These patients suffered from long-term abdominal pain unresponsive to current treatment options. Apart from obvious anterior herniation of the lumbar discs and high signal intensity anterior to the herniated disc on magnetic resonance imaging, no significant pathology was noted on gastroscopy, vascular ultrasound, or abdominal computed tomography (CT). To prove that their visceral pain originated from the anteriorly protruding disc, we evaluated whether pain was relieved by sympathetic block at the level of the anteriorly protruding disc. If the block was effective, CT-guided continuous lumbar sympathetic nerve block was finally performed.

RESULTSAll patients were positive for pain relief by sympathetic block. Furthermore, the average Visual Analog Scale of visceral pain significantly improved after treatment in all patients (P < 0.05). Up to 11/12 patients had satisfactory pain relief at 1 week after discharge, 8/12 at 4 weeks, 7/12 at 8 weeks, 6/12 at 12 weeks, and 5/12 at 24 weeks.

CONCLUSIONSIt is important to consider the possibility of discogenic visceral pain secondary to anterior herniation of the lumbar disc when forming a differential diagnosis for seemingly idiopathic abdominal pain. Continuous lumbar sympathetic nerve block is an effective and safe therapy for patients with discogenic visceral pain.

Adult ; Aged ; Female ; Humans ; Intervertebral Disc ; drug effects ; pathology ; physiopathology ; Intervertebral Disc Displacement ; complications ; physiopathology ; Low Back Pain ; drug therapy ; Lumbar Vertebrae ; drug effects ; pathology ; physiopathology ; Lumbosacral Region ; Male ; Middle Aged ; Prospective Studies ; Visceral Pain ; drug therapy ; Young Adult

OBJECTIVETo investigate the therapeutic effects of acupuncture combined with nerve block for treatment of lumbar disc herniation.

METHODSNinety cases of lumbar disc herniation were randomly divided into three groups: acupuncture combined with nerve block group, acupuncture group and nerve block group, 30 cases in each group. The acupuncture combined with nerve block group was treated with acupuncture combined with nerve block therapy, L2-L5 Jiaji (EX-B 2), Zhibian (BL 54), Huantiao (GB 30), Yanglingquan (GB 34) etc. were selected for acupuncture, affected nerve root, sciatic nerve or common peroneal nerve were selected for nerve block with anti-inflammation-analgesic injection; the acupuncture group was treated with acupuncture only; the nerve block group was treated with nerve block only. After 4 weeks of treatment, the visual analogue scale (VAS), Oswestry lumbar dysfunction index (ODI) and modified MacNab standard were compared to evaluate the therapeutic effects of three groups.

RESULTSThe VAS and ODI in all groups were significantly decreased after one week, two weeks and four weeks of treatment (all P<0.01); after one week of treatment, the scores of VAS and ODI in nerve block group and acupuncture combined with nerve block group were significantly lower than those of acupuncture group (P<0.05); after two weeks and four weeks of treatment, the scores of VAS and ODI in acupuncture combined with nerve block group were significantly lower than those of acupuncture group and nerve block group (P<0.05). The effective rate and excellent and good rate of the acupuncture combined with nerve block group were significantly higher than those of acupuncture group and nerve block group (both P<0.01).

CONCLUSIONThe nerve block therapy and acupuncture are effective methods for treatment of lumbar disc herniation, while it has a better effect when these two treatments are combined used.

Acupuncture Therapy ; Adult ; Analgesics ; administration & dosage ; Anti-Inflammatory Agents ; administration & dosage ; Female ; Humans ; Injections ; Intervertebral Disc Displacement ; drug therapy ; therapy ; Male ; Middle Aged ; Nerve Block ; Treatment Outcome

Lumbar disk herniation (LDH) is a common orthopaedic disorder. Many clinical and basic science researches have been conducted recently on using Chinese medicinal herbs to treat LDH. Literature review reveals that the common basic formulas include Duhuo Jisheng decoction (DHJST), Buyang Huanwu decoction (HYBWT), Shentong Zhuyu decoction (STZYT), Taohong Siwu decoction (THSWT), Yanghe decoction (YHT) and Tongdu Huoxue decoction (TDHXT). A basic formula can be modified by adding more herbs or removing some herbs from the formula according to clinical symptoms and traditional Chinese medicine (TCM) syndrome differentiation. Literatures show that herbal treatment have better clinical effects, the medicinal herbs make low-back pain, sciatica and low limb numbness disappeared or alleviated; and restore normal low limb sensation, muscle strength and daily activity. These formulas have also been used to treat LDH postoperative remaining pain, postoperative discitis, postoperative recurrent LDH, and to prevent epidural scar formation and dura mata adhesion. Herbs in these formulas include 5 categories of drugs classified by TCM. They are blood circulation promoting herbs for relieving pain; liver and kidney nourishing and tendons and bones strengthening herbs; blood circulation promoting herbs for unblocking collaterals; pathogenic wind and dampness expelling herbs; and qi invigorating herbs. These herbs have actions of analgesia, anti-inflammation, immunomodulation, phagocytosis of macrophages enhancement, blood circulation improvement, nerve protection, collagen synthesis enhancement. Future research needs to focus on the effects of herbs on four aspects: to enhance collagen synthesis in the disks and inhibit disk degeneration; to promote the resorption of herniated nucleus pulposus and epidural hemorrhage; to prevent nerve cell apoptosis and promote nerve cell regeneration, and to inhibit nociception in the nerve system.
Diagnosis, Differential ; Drug Combinations ; Drugs, Chinese Herbal ; isolation & purification ; therapeutic use ; Humans ; Intervertebral Disc Displacement ; drug therapy ; Lumbar Vertebrae ; Medicine, Chinese Traditional ; Phytotherapy ; Plants, Medicinal ; chemistry

Acupuncture Points ; Adult ; Aged ; Female ; Humans ; Injections ; Intervertebral Disc Displacement ; drug therapy ; Lumbar Vertebrae ; drug effects ; Male ; Middle Aged ; Ozone ; administration & dosage

OBJECTIVETo evaluate the effect of targeted percutaneous injection of medical ozone through the posterior approach via the spinal canal and dural sac under CT guidance for treatment of lumbar disc herniation.

METHODSIn 262 patients with lumbar disc herniation, medical ozone was injected percutaneously under CT guidance into the lumbar intervertebral disc by the posterior approach at paramedian 1-2 cm from the spinous process, targeting the affected lumbar discs, protruded nucleus pulposus and ipsilateral lateral recess. The concentration of ozone was 40-50 µg/ml in the disc/protruded nucleus pulposus and 30 µg/ml in the lateral recess (around the nerve root).

RESULTSThe treatment procedures were successfully completed in all the 262 patients. The average scores of JOA and VAS before treatment were 8.30∓1.4 and 8.73∓0.8, and changed significantly to 24.16∓3.2 (P=0.0158) and 2.41∓0.2 (P=0.0242) after treatment, respectively. According to the modified MacNab criteria, the therapeutic effect was excellent in 165 cases, fair in 64 cases, acceptable in 20 cases, and poor in 13 cases, with a total success rate of 87.4%. No patient showed serious complications after the treatment.

CONCLUSIONCompared with routine ozone therapy by the posterior-lateral approach, targeted percutaneous ozone injection into the intervertebral disc by the modified posterior approach is safe and yields better therapeutic effect for lumbar disc herniation.

Adult ; Aged ; Female ; Humans ; Injections, Intralesional ; methods ; Intervertebral Disc Displacement ; drug therapy ; Lumbar Vertebrae ; Male ; Middle Aged ; Ozone ; administration & dosage ; Spinal Canal ; Young Adult

Epidural Space ; Female ; Headache Disorders, Primary ; etiology ; Humans ; Intervertebral Disc Displacement ; drug therapy ; Middle Aged ; Oxygen ; administration & dosage ; Ozone ; administration & dosage ; Spinal Puncture ; adverse effects

OBJECTIVETo observe the outcome after sacral canal injection in patients with disc herniation associated with without sciatica.

METHODSFrom December 2010 to June 2011, 65 patients with acute low back pain without sciatica due to lumbar disc herniation or bulging confirmed by CT or MRI were randomly divided into sacral canal injection group (experimental group) and lumbar oblique wrench group (control group): the experimental group had 35 cases, including 30 males and 5 females, with an average age of (43.90 +/- 1.14) years old ranging from 33 to 56 years old. The control group had 30 cases, including 27 males and 3 females,with an average age of (44.00 +/- 1.19) years old ranging from 34 to 57 years old. The course of morbidity was 1 to 3 days. All patients received sacral canal injection or lumbar oblique wrench method. The visual analog scale (VAS) scores before and at 30 min after treatment were compared between two groups.

RESULTSThe symptom of acute low back pain were relieved obviously. The average VAS scores before and after treatment in experimental group were decreased from 6.63 +/- 0.97 to 3.06 +/- 1.51,in control group were from 6.67 +/- 0.96 to 3.93 +/- 1.20 respectively. These two methods could improve the VAS score,but the effect of sacral canal injection group was better than that of lumbar oblique wrench group, there was statistically differences (P < 0.05).

CONCLUSIONIt is effective that the methods of sacral canal injection and lumbar oblique wrench applied to patients with acute low back pain without sciatica due to lumbar disc herniation or bulging confirmed, the former has better effect.

Adult ; Female ; Humans ; Injections, Spinal ; Intervertebral Disc Displacement ; drug therapy ; Lidocaine ; administration & dosage ; Lumbar Vertebrae ; Male ; Middle Aged ; Prednisone ; administration & dosage ; Sacrococcygeal Region ; Visual Analog Scale