Agents physiques antalgiques

Microwave diathermy for treating nonspecific chronic neck pain: a randomized controlled trial

BACKGROUND CONTEXT

Although the use of deep heat therapy is widespread, there is scant literature available on its effectiveness in treating back or neck pain.

PURPOSE

The purpose of this study was to determine the efficacy of microwave diathermy to treat nonspecific chronic neck pain.

DESIGN

The study was designed as a double-blind, randomized controlled trial.

PATIENT SAMPLE

The patient sample consisted of 149 patients with nonspecific chronic neck pain in a hospital of the Andalusian Public Health Care System, Spain

OUTCOME MEASURES

The study outcome measures are as follows: at baseline, pain intensity (using a visual analogue scale), disability (Neck Disability Index), and health-related quality of life (36-item short form health survey [SF-36]); at 3 weeks, baseline measures and patients' perceived overall outcome and satisfaction with the treatment; and at 6 months, 3-week measures, therapeutic co-interventions, and adherence to exercises.

METHODS

Patients were allocated randomly to three groups. The first group received continuous microwave diathermy, the second group was administered pulsed microwaves, and the third group (the control group) received unplugged microwaves. All three groups received the same general treatment: range of motion, isometric exercises, and transcutaneous electrical nerve stimulation.

RESULTS

The three groups had reduced pain and disability, and improvement was seen in some dimensions of the SF-36. However, there were no differences found in any of the parameters measured among the three therapeutic groups.

CONCLUSIONS

Microwave diathermy does not provide additional benefit to a treatment regimen of chronic neck pain that already involves other treatment approaches.

[Physiological assessment of a gaseous cryotherapy device: thermal effects and changes in cardiovascular autonomic control]

PURPOSE

The aim of the study was to assess thermal effects and cardiovascular autonomic control with application of a gaseous cryotherapy device to the hand.

MATERIAL AND METHODS

Before, during and after cooling of the left hand, we continuously evaluated cutaneous temperature of the right and left hands, as well as heart rate (HR) and arterial blood pressure (BP) and their neurovegetatif control (HR and BP variability) in 8 healthy subjects. Comparison of cooling caused by projection of CO(2) microcrystals (2 min) under high pressure (75 bar) and low temperature (-78 degrees C) to that with application of a latex ice pack (15 min). Assessment of whether cooling triggered any changes in cardiovascular autonomic control, especially as compared with responses by the hand cold-pressure test (2 min).

RESULTS

CO(2) projection in the left hand induced a steep decrease (-26 degrees C) in temperature followed by a rapid increase and a cutaneous vasoconstriction of the right hand, with significant increases in BP and cardiac parasympathetic activity. Cardiovascular responses were similar to those with application of the hand cold-pressure test. Application of an ice pack decreased cutaneous temperature to a lesser extent (-19 degrees C) and more slowly, without changing BP or indices of HR and BP variability.

CONCLUSION

CO(2) projection caused "thermal shock" and triggered a systemic cutaneous vasoconstriction response, with activation of indices of both ortho- and parasympathetic activity, as with the hand cold-pressure test. Vascular responses during ice pack cooling appeared solely localised to the cooled area, without any significant change in autonomic cardiovascular control.

[A comparative study of fibromyalgia treatment: ultrasonography and physiotherapy versus sertraline treatment]

OBJECTIVE

To compare the efficacy of sertraline versus physical therapy (ultrasonography and physical therapy) in fibromyalgia.

DESIGN

A 6-month comparative, prospective, randomised study of 70 female patients, aged 42 to 52, with fibromyalgia according to the criteria of the American College of Rheumatology. One group (N=36) underwent 6-month treatment with sertraline, 50 mg/24 h. The other group (N=34) received 15 sessions of 1 W/cm2 ultrasonography on the cervical trigger points plus physical therapy. Variables analyzed on a visual 10-point scale were pain and morning stiffness and sleep disorders by use of the sleep questionnaire of the Medical Outcome Study (MOS). Measurements were taken at the beginning of the study and at 3-month and 6-month follow-up.

RESULTS

Pain significantly diminished in the sertraline group during the entire study (visual numeric scale: 7.2+/-1.1 initially, 5.3+/-?? at 3 months and 3+/-0.7 at 6 months, P<0.05). Morning stiffness and sleep disorder scores were positive only for the sertraline group during the entire 6 months (P<0.05). Results from the MOS questionnaire showed improvement only for the sertraline group. Of the Sertraline group, 83% evaluated the treatment as good or very good, as compared with only 6% of the ultrasonography group. No patient withdrew from the study.

CONCLUSION

Patients treated with sertraline had a better outcome in terms of pain, morning stiffness and sleep disorders, than the group treated with ultrasonography and physical therapy.