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All Journal SURABAYA PHYSICAL MEDICINE AND REHABILITATION JOURNAL Journal of Pain, Vertigo and Headache
Pringga, Gutama Arya
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Chemical Engineering, Chemistry & Bioengineering Health Professions Medicine & Pharmacology Neuroscience

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SEVERE POSTURE AND GAIT DISTURBANCE IN LUMBAR SPINAL STENOSIS: A CASE REPORT Lestari, Dwi Indriani; Anggraini, Vivid Prety; Pringga, Gutama Arya; Kurniawan, Shahdevi Nandar; Misnasari, Putri Priela
Journal of Pain, Headache and Vertigo Vol. 5 No. 1 (2024): March
Publisher : PERDOSSI (Perhimpunan Dokter Spesialis Saraf Indonesia Cabang Malang) - Indonesian Neurological Association Branch of Malang cooperated with Neurology Residency Program, Faculty of Medicine Brawijaya University, Malang, Indonesia

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.21776/ub.jphv.2024.005.01.4

Abstract

One of the causes of low back pain is lumbar spinal stenosis (LSS). LSS is defined as a disorder resulting from degenerative processes leading to narrowing of the spinal canal. The nature of pain in LSS—the neurogenic claudication—was aggravated by upright or extended trunk positions, such as during walking, descending stairs, or simply standing. Patient self-adjustments in response to pain can induce further muscle disturbance and worsen the condition. A 56-year-old male suffering from poor posture with antalgic and Trendelenburg gait. The MRI showed multiple spinal canal stenosis with compression of the L4-S1 nerve roots affected the gait and worsened posture. Physical medicine rehabilitation (PMR) program—including the use of ultrasound diathermy for severe muscle spasm followed by muscle stretching, Transcutaneous Electrical Stimulation (TENS) for pain relief, Neuromuscular Electrical Stimulation (NMES) for muscle strength improvement and several therapeutic exercises—has proven beneficial in reducing patient’s symptoms thus correcting the posture and gait. At this point spinal canal narrowing is not only causing pain with neurological deficit but may lead to posture and gait disturbance that increasing the patient's disability. The use of physical modalities combined with exercise has been shown to benefit patients similarly to surgery but without invasive approach.
PERINEURAL INJECTION THERAPY AS INTERVENTIONAL PAIN MANAGEMENT IN POST HERPETIC NEURALGIA : A CASE REPORT Pringga, Gutama Arya; R, Rahmad; Pudji, Rosalyna; Kurniawan, Shahdevi Nandar; Suratmono, Mia Fajarningtyas
Journal of Pain, Headache and Vertigo Vol. 5 No. 1 (2024): March
Publisher : PERDOSSI (Perhimpunan Dokter Spesialis Saraf Indonesia Cabang Malang) - Indonesian Neurological Association Branch of Malang cooperated with Neurology Residency Program, Faculty of Medicine Brawijaya University, Malang, Indonesia

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.21776/ub.jphv.2024.005.01.5

Abstract

Introduction: Post Herpetic Neuralgia is a neurological complication of herpes zoster resulting in neuropathic pain syndrome that worsens as a direct result of peripheral nerve damage that occurs during an attack of herpes zoster. It manifests as significant dermatomal pain or abnormal sensations and impacting various aspects of quality of life. Physically, patients may experience fatigue, anorexia, weight loss, insomnia, reduced mobility, and physical inactivity. Psychologically, it can lead to depression, anxiety, emotional burden, difficulty in concentration, and fear. Perineural Injection Therapy (PIT), developed by John Lyftogt, offers a treatment option for chronic neuropathic pain. Case Report: A 65-year-old male, currently unemployed for the past two years and previously worked as a tire repairman, came to the Husada Asih Clinic, with sharp, not radiating, and continuous left facial pain (VAS 9-10). He received treatment comprising Transcutaneous Electrical Nerve Stimulation (TENS) and Low Laser Light Therapy (LLLT) on the left face, combined with PIT injections using 5% dextrose at the left side of the face, targeting dermatomes left N V.1, V.2, V.3, and C3 , with repetition after three weeks. After the third injection, the pain at his left head was reduced (VAS 6). Pain at his left jaw and left neck reduced and became intermittently (VAS 5). Barthel Index : 20/20 (Independent). Discussion: The immediate clinical improvement in PIT administration is attributed to the sensorineural effects of dextrose. Clinically, pain decreases immediately or within 1-2 days after therapy. In this case, three series PIT resulted in significant pain relief, reduced burning sensation, improved left muscle motor function, full mouth opening, eased in eating and speaking, and the ability to resume social activities and work. Conclusion: Perineural injection therapy (PIT), previously developed by John Lyftogt, involves a series of subcutaneous injections using 5% dextrose in sterile water (D5W) near the affected nerve. This regenerative therapy offers pain control for PHN patients by targeting skin nerves as potential pain generators. PIT proves to be a valuable rehabilitation tool for managing PHN.
When a Massage Gone Wrong: Unveiling a Case of Post-Massage Brachial Plexopathy Anggi Gilang, Yudiansyah; Noor, Syeda Tazkia; Lestari, Dwi Indriani; Pringga, Gutama Arya
Surabaya Physical Medicine and Rehabilitation Journal Vol. 7 No. 1 (2025): SPMRJ, FEBRUARY 2025
Publisher : Faculty of Medicine, Universitas Airlangga

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.20473/spmrj.v7i1.56484

Abstract

The brachial plexopathy associated with massage therapy is rarely reported. This case report describes an uncommon case of brachial plexopathy that developed after a session of massage therapy and revealed past published reports of peripheral nerve injury following massage therapy. A 54-year-old Javanese woman developed sudden unilateral paralysis of her left shoulder girdle after a session of massage therapy. The massage session was stopped due to pain. She could not move her left shoulder immediately after 5 minutes of massage. There was hypoesthesia from shoulder to forearm, and there was decreased MMT of the left deltoid muscle. She regularly participated in a twice-weekly rehabilitation program targeting the left shoulder. It included NMES, laser therapy, PROM, strengthening exercises, and a home exercise program. A diagnosis of acute brachial plexopathy was suspected due to her recent history and the results of several examinations. She had a gradual recovery of strength, resolution of limitations of ROM, and sensory function in her shoulder. Rehabilitation programs have a major role in helping the patient do her functional activities. This case report presents as a reminder to massage therapists or physical therapists that massage therapy of the neck and shoulder should be carefully performed to avoid any injury. Further studies will help improve the safety procedures and effectiveness of massage therapy in the future.
Prolotherapy as a Novel Adjunct in Post-Stroke Pain Management: A Pilot Study at RSUD Dr. Saiful Anwar Malang Lestari, Dwi Indriani; Rahmad; Pringga, Gutama Arya; Pambayun, Sheilla Elfira San; Musthafa, Ferdian; Puspitasari, Yuan Laura; Ichsan; Noor, Syeda Tazkia; Zulfikar, Dilloniar Bahny; Ariani, Maydah
Surabaya Physical Medicine and Rehabilitation Journal Vol. 7 No. 2 (2025): SPMRJ, AUGUST 2025
Publisher : Faculty of Medicine, Universitas Airlangga

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.20473/spmrj.v7i2.65514

Abstract

Background: Post-stroke pain (PSP) and musculoskeletal complications significantly hinder recovery and quality of life in stroke survivors. Prolotherapy, a regenerative injection therapy, has shown promise in managing musculoskeletal disorders but remains underexplored for PSP. Aim(s): This study evaluates the effectiveness of prolotherapy in reducing pain, improving range of motion (ROM), and enhancing functional outcomes in PSP patients. Material and methods: This pilot study employed a pre-experimental design with pretest and posttest measurements. Conducted at RSUD Dr. Saiful Anwar Malang, the study included three stroke patients experiencing chronic musculoskeletal pain. Prolotherapy injections containing hypertonic dextrose were administered at regular intervals. Primary outcomes included pain (Numerical Rating Scale), ROM, and spasticity (Modified Ashworth Scale). Secondary outcomes were assessed using the Barthel Index, Short Form-36, and Fugl-Meyer Assessment. Statistical analyses were descriptive, with paired t-tests applied to outcome changes. Result: Significant improvements in pain levels (mean NRS reduction from 5.67±1.5 to 3.0±2.0) and ROM, particularly in shoulder flexion and wrist extension, were observed. Spasticity showed minor improvements in some muscle groups. Functional outcomes, including Barthel Index and SF-36 scores, demonstrated positive trends, with two participants improving from severe dependency to moderate independence. Conclusions: Prolotherapy shows promise as an adjunctive intervention for PSP, offering potential benefits in pain reduction and functional recovery. As the first study of its kind at RSUD Dr. Saiful Anwar Malang, it lays the groundwork for future large-scale research to validate these findings and refine clinical applications. Keywords: Stroke, Prolotherapy, Pain, Rehabilitation, post-stroke pain, functional performance
Co-Authors Anggi Gilang, Yudiansyah Anggraini, Vivid Prety Ariani, Maydah Ichsan Lestari, Dwi Indriani Misnasari, Putri Priela Musthafa, Ferdian Noor, Syeda Tazkia Pambayun, Sheilla Elfira San Pudji, Rosalyna Puspitasari, Yuan Laura R, Rahmad Rahmad Shahdevi Nandar Kurniawan, Shahdevi Nandar Suratmono, Mia Fajarningtyas Zulfikar, Dilloniar Bahny