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Guan H, Wu Y, Wang X, Liu B, Yan T, Abedi-Firouzjah R. Ultrasound therapy for pain reduction in musculoskeletal disorders: a systematic review and meta-analysis. Ther Adv Chronic Dis 2024; 15:20406223241267217. [PMID: 39170758 PMCID: PMC11337181 DOI: 10.1177/20406223241267217] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2023] [Accepted: 06/20/2024] [Indexed: 08/23/2024] Open
Abstract
Background Ultrasound therapy is a non-invasive technique used to address a variety of health issues. Objectives This systematic review and meta-analysis aim to assess the effectiveness of ultrasound therapy in alleviating pain associated with musculoskeletal diseases. Design This study was conducted following PRISMA guidelines, with relevant articles identified through comprehensive searches in electronic databases. Data sources and methods We conducted searches across multiple databases, including Scopus, PubMed, MEDLINE, ProQuest, Science Direct, CINAHL, AIM, and ELDIS. Two independent reviewers screened the titles and abstracts of the retrieved articles. We included randomized controlled trials (RCTs) and observational cohort studies published between 2010 and 2023 that evaluated ultrasound therapy for knee and shoulder skeletal disorders. The selected data were analyzed qualitatively and synthesized, with the risk of bias assessed using the RoB2 tool. Results Initially, 117 articles were reviewed using the search strategy, and 10 trials that met the inclusion criteria were identified. In seven of these studies, the primary musculoskeletal disorder was osteoarthritis, while three studies focused on shoulder pain and impingement. Most studies indicated that ultrasound therapy significantly reduced pain. The meta-analysis showed that ultrasound therapy was significantly more effective than other interventions for knee disorders (I 2 = 51%, Z = 2.65, p = 0.008). However, for shoulder disorders, both ultrasound and other intervention methods were found to be ineffective (I 2 = 93%, Z = 0.73, p = 0.46). Conclusion The current evidence supports the effectiveness of ultrasound therapy in reducing pain and aiding rehabilitation for knee conditions. However, there are mixed results regarding its efficacy for shoulder conditions, highlighting the need for further research in this area.
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Affiliation(s)
- Haiying Guan
- Department of Spine Surgery, Xi’an Hospital of Traditional Chinese Medicine, Xi’an, China
| | - Yilun Wu
- Department of Ultrasound, Honghui Hospital, Xi’an Jiaotong University, Xi’an, China
| | - Xiangyang Wang
- Department of Spine Surgery, Xi’an Hospital of Traditional Chinese Medicine, Xi’an, China
| | - Bo Liu
- Department of Spine Surgery, Xi’an Hospital of Traditional Chinese Medicine, Xi’an, China
| | - Ting Yan
- Department of Ultrasound, Honghui Hospital, Xi’an Jiaotong University, Xi’an 710000, China
| | - Razzagh Abedi-Firouzjah
- Department of Medical Physics, Radiobiology and Radiation Protection, School of Medicine, Babol University of Medical Sciences, Babol, Iran
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Ozen S, Guzel S, Senlikci HB, Cosar SNS, Selcuk ES. Efficacy of ultrasound versus short wave diathermy in the treatment of chronic low back pain in patients with lumbar disk herniation: a prospective randomized control study. BMC Sports Sci Med Rehabil 2023; 15:157. [PMID: 37986090 PMCID: PMC10658980 DOI: 10.1186/s13102-023-00769-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Accepted: 11/09/2023] [Indexed: 11/22/2023]
Abstract
BACKGROUND Lumbar disk herniation (LDH) is a cause of chronic low back pain (CLBP) treated using physical therapy (PT), including exercise and physical modalities such as ultrasound (US) and short wave diathermy (SWD). Despite the use of US and SWD, there is inconclusive evidence on their efficacy. The aim of this study was to investigate the efficacy of US and SWD in the treatment of CLBP in patients with LDH. METHODS A prospective randomized control clinical study. Individuals with radicular CLBP and LDH on magnetic resonance imaging, presenting to the Physical and Rehabilitation Medicine Department were randomized into 3 treatment groups. All participants received 10 sessions of hotpack, transcutaneous nerve stimulation (TENS) and therapeutic exercises. In addition, Group 1 received 10 sessions of therapeutic US (1 MHz, 1.5W/cm2, 10 min), Group 2 SWD (27.12 MHz, wavelength 11.06 m, induction technique, 20 min) to the lower back. Group 3 (control group) received hotpack, TENS and therapeutic exercises alone. Visual analogue scale (VAS) for LBP, Modified Oswestry Disability Index (MODI) and Short Form 36 (SF-36) were evaluated pre and post treatment and at one and three months follow up. RESULTS In all groups, VAS for LBP and MODI improved with treatment and at the one and three month follow up (p < 0.001). In Groups 1 and 2, MODI scores continued to reduce at 1 and 3 months (p < 0.001 and p = 0.012 respectively). SF-36 physical, social function and pain parameters reduced in all groups (p < 0.05). Role limitation due to physical and emotional problems, emotional well-being, vitality and mental health improved in Groups 1 and 2 (p < 0.05). CONCLUSIONS Deep heating agents can be used as part of the physical therapy for CLBP in those with LDH with positive mid-term effects. TRIAL REGISTRATION NCT03835182, 02/04/2019.
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Affiliation(s)
- Selin Ozen
- Faculty of Medicine, Department of Physical Medicine and Rehabilitation, Baskent University, Ankara, Turkey.
| | - Sukran Guzel
- Ankara Etlik City Hospital, Physical Medicine and Rehabilitation Hospital, Ankara, Turkey
| | - Huma Boluk Senlikci
- Ankara City Hospital, Physical Medicine and Rehabilitation Hospital, Ankara, Turkey
| | - Sacide Nur Saracgil Cosar
- Faculty of Medicine, Department of Physical Medicine and Rehabilitation, Baskent University, Ankara, Turkey
| | - Ebru Selin Selcuk
- Department of Physical Medicine and Rehabilitation, Dr.Abdurrahman Yurtaslan Ankara Oncology Education and Research Hospital, Ankara, Turkey
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Hong JY, Song KS, Cho JH, Lee JH, Kim NH. An Updated Overview of Low Back Pain Management. Asian Spine J 2022; 16:968-982. [PMID: 34963043 PMCID: PMC9827206 DOI: 10.31616/asj.2021.0371] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Accepted: 12/12/2021] [Indexed: 01/11/2023] Open
Abstract
We aimed to determine the recommendation level for the treatment of acute and chronic low back pain (LBP). A systematic review (SR) of the literature was performed and all English-language articles that discuss acute and chronic LBP, including MEDLINE and the Cochrane Database of Systematic Reviews, were searched. Of the 873 searched literature reports, 259 articles, including 131 clinical trials, 115 SRs, nine meta-analyses, and four clinical guidelines were analyzed. In these articles, high-quality randomized controlled trials, SRs, and used well-written clinical guidelines were reviewed. The results indicated multiple acute and chronic LBP treatment methods in the literature, and these reports when reviewed included general behavior, pharmacological therapy, psychological therapy, specific exercise, active rehabilitation and educational interventions, manual therapy, physical modalities, and invasive procedures. The Trial conclusions and SRs were classified into four categories of A, B, C, and D. If there were not enough high-quality articles, it was designated as "I" (insufficient). This review and summary of guidelines may be beneficial for physicians to better understand and make recommendations in primary care.
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Affiliation(s)
- Jae-Young Hong
- Department of Orthopedics, Korea University Ansan Hospital, Ansan,
Korea
| | - Kwang-Sup Song
- Department of Orthopaedic Surgery, Chung-Ang University College of Medicine, Seoul,
Korea
| | - Jae Hwan Cho
- Department of Orthopedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul,
Korea
| | - Jae Hyup Lee
- Department of Orthopedic Surgery, SMG-SNU Boramae Medical Center, Seoul,
Korea
| | - Nack Hwan Kim
- Department of Physical Medicine and Rehabilitation, Korea University Ansan Hospital, Ansan,
Korea
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A Comparison of the Effect of a 4.4-MHz Radiofrequency Deep Heating Therapy and Ultrasound on Low Back Pain: A Randomized, Double-Blind, Multicenter Trial. J Clin Med 2022; 11:jcm11175011. [PMID: 36078940 PMCID: PMC9457341 DOI: 10.3390/jcm11175011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2022] [Revised: 08/22/2022] [Accepted: 08/24/2022] [Indexed: 11/17/2022] Open
Abstract
Despite the increasing interest in RF (Radiofrequency) therapy, little is known about its effectiveness for low back pain (LBP). The aim of this study was to investigate the effectiveness of 4.4-MHz RF diathermy compared to ultrasound (US) in patients with LBP. One-hundred-and-eighteen patients with LBP were randomized with RF (n = 62) or US (n = 56). Investigator and subjects were blinded to the treatment group. Either RF (4.4 MHz, 45 W/cm2) or US (1 MHz, 2 W/cm2) was applied for 10 to 15 min, 3 times per week for 4 weeks. The primary outcome was the Oswestry Disability Index (ODI, %). Secondary outcomes were numeric rating scale (NRS), Biering−Sorensen test, up-and-go test, successful pain relief, and successful functional improvement. Clinical outcomes were evaluated prior to intervention (baseline), and at 4 and 12 weeks after treatment. There were no significant differences between the groups regarding baseline demographic and clinical characteristics. Both groups observed a significant improvement of ODI (%), NRS, Biering−Sorensen test, and up-and-go test at 4 and 12 weeks after treatment (p < 0.05); however, no significant differences were found between groups. The RF group showed a higher proportion of successful pain relief at 12 weeks after treatment than the US group (p = 0.048). The RF diathermy showed favorable results in pain reduction, improvement of function, mobility, and back muscle endurance. Compared with US, RF diathermy obtained slightly better perception of patients in pain relief at 12 weeks after treatment. The results from this study indicated that 4.4-MHz RF diathermy can effectively be used as a conservative treatment option for patients with LBP.
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Chronic Pain in Musculoskeletal Diseases: Do You Know Your Enemy? J Clin Med 2022; 11:jcm11092609. [PMID: 35566735 PMCID: PMC9101840 DOI: 10.3390/jcm11092609] [Citation(s) in RCA: 22] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Revised: 05/02/2022] [Accepted: 05/03/2022] [Indexed: 02/06/2023] Open
Abstract
Musculoskeletal pain is a condition that characterises several diseases and represents a constantly growing issue with enormous socio-economic burdens, highlighting the importance of developing treatment algorithms appropriate to the patient’s needs and effective management strategies. Indeed, the algic condition must be assessed and treated independently of the underlying pathological process since it has an extremely negative impact on the emotional and psychic aspects of the individual, leading to isolation and depression. A full understanding of the pathophysiological mechanisms involved in nociceptive stimulation and central sensitization is an important step in improving approaches to musculoskeletal pain. In this context, the bidirectional relationship between immune cells and neurons involved in nociception could represent a key point in the understanding of these mechanisms. Therefore, we provide an updated overview of the magnitude of the musculoskeletal pain problem, in terms of prevalence and costs, and summarise the role of the most important molecular players involved in the development and maintenance of pain. Finally, based on the pathophysiological mechanisms, we propose a model, called the “musculoskeletal pain cycle”, which could be a useful tool to counteract resignation to the algic condition and provide a starting point for developing a treatment algorithm for the patient with musculoskeletal pain.
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Effectiveness and safety of extracorporeal shock wave treatment for low back pain:a systematic review and meta-analysis of RCTs. INT J OSTEOPATH MED 2022. [DOI: 10.1016/j.ijosm.2022.03.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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Bomberg H, Lorenzana D, Schlickeiser J, Dünki A, Farshad M, Eichenberger U. [Noninvasive Treatments for Acute and Chronic Back Pain]. PRAXIS 2022; 111:797-813. [PMID: 36285410 DOI: 10.1024/1661-8157/a003858] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
Noninvasive Treatments for Acute and Chronic Back Pain Abstract. The therapy of back pain - especially the medication with opioids - can be challenging for the treating physician. Specific back pain can often be diagnosed by imaging and successfully treated by surgery or medication. In contrast, nonspecific back pain can be worsened by inappropriate imaging, questionable surgical indications and uncontrolled drug use. For the therapy of nonspecific back pain, maintaining daily activity and exercise therapy is central. Opioids are effective drugs for short-term use. However, long-term use often leads to opioid-induced hyperalgesia and hormonal dysfunction with decreased quality of life and libido. Furthermore, opioids can lead to abuse and addiction. After an ineffective treatment with non-opioids, opioids may be given for a limited time period (if possible shorter than four weeks) according to international guidelines.
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Affiliation(s)
- Hagen Bomberg
- Abteilung für Anästhesiologie, Intensivmedizin und Schmerztherapie, Universitätsklinik Balgrist, Zürich, Schweiz
- Diese Autoren haben gleichermassen zu dieser Arbeit beigetragen und teilen sich die Erstautorschaft
| | - David Lorenzana
- Abteilung für Anästhesiologie, Intensivmedizin und Schmerztherapie, Universitätsklinik Balgrist, Zürich, Schweiz
- Diese Autoren haben gleichermassen zu dieser Arbeit beigetragen und teilen sich die Erstautorschaft
| | - Jannis Schlickeiser
- Abteilung für Anästhesiologie, Intensivmedizin und Schmerztherapie, Universitätsklinik Balgrist, Zürich, Schweiz
| | - Alexandro Dünki
- Abteilung für Anästhesiologie, Intensivmedizin und Schmerztherapie, Universitätsklinik Balgrist, Zürich, Schweiz
| | | | - Urs Eichenberger
- Abteilung für Anästhesiologie, Intensivmedizin und Schmerztherapie, Universitätsklinik Balgrist, Zürich, Schweiz
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Effectiveness of Radial Extracorporeal Shockwave Therapy in Patients with Acute Low Back Pain-Randomized Controlled Trial. J Clin Med 2021; 10:jcm10235569. [PMID: 34884271 PMCID: PMC8658438 DOI: 10.3390/jcm10235569] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2021] [Revised: 11/24/2021] [Accepted: 11/26/2021] [Indexed: 11/17/2022] Open
Abstract
The aim of this study was to investigate the effect of radial extracorporeal shockwave therapy (rESWT) primarily on acute lumbar back pain (aLBP), and secondarily on physical function and quality of life. This randomized, placebo-controlled, single-blinded trial with 12-week follow-up (FU) randomized 63 patients with aLBP 1:1 into two groups receiving either rESWT (intervention) or sham rESWT (placebo) with a manipulated shockwave head not delivering any shockwaves. Both, rESWT and sham procedure were carried out eight times for four weeks. Both groups received additional analgesics and physiotherapy twice a week. Primary patient-reported outcome measure (PROM) was the visual analogue scale for aLBP (VAS-LBP). Secondary PROMs included the Oswestry disability index (ODI), Roland and Morris Disability Questionnaire (RDQ), EuroQol EQ-5D-3L, and the Beck Depression Index (BDI-II). Primary endpoint was a between-arm comparison of mean changes in VAS-LBP from baseline to final FU. At randomization, there were no differences between the two groups in relation to age and PROMs. Both groups showed significant improvement in all PROMs at final FU. VAS-LBP declined by 60.7% (p < 0.001) in the intervention and by 86.4% (p < 0.001) in the sham group. The intervention group showed significantly less pain relief after 4 and 12 weeks. The EQ-5D submodality pain showed significantly inferior results for the intervention (1.5 (0.58)) compared to the sham group (1.1 (0.33)) (p < 0.014) after eight weeks. No significant intergroup differences were observed for RDQ, ODI or BDI-II. Additional rESWT alongside conventional guideline therapy in aLBP does not have any significant effects on pain intensity, physical function, or quality of life. To the best of our knowledge, this is the first study with a high level of evidence reporting the efficacy of rESWT in aLBP treatment and will be a future basis for decision-making.
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Yue L, Sun MS, Chen H, Mu GZ, Sun HL. Extracorporeal Shockwave Therapy for Treating Chronic Low Back Pain: A Systematic Review and Meta-analysis of Randomized Controlled Trials. BIOMED RESEARCH INTERNATIONAL 2021; 2021:5937250. [PMID: 34840977 PMCID: PMC8617566 DOI: 10.1155/2021/5937250] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Accepted: 10/19/2021] [Indexed: 12/28/2022]
Abstract
OBJECTIVE To assess the effectiveness and safety of extracorporeal shockwave therapy (ESWT) for the treatment of chronic low back pain (CLBP). METHODS This was a systematic review and meta-analysis of randomized controlled trials (RCTs) designed in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-analysis statement standard. We identified relevant studies by searching multiple electronic databases, trial registries, and websites up to April 30, 2021, and examining reference lists. We selected RCTs that compared ESWT, in unimodal or multimodal therapeutic approaches, with sham ESWT or other active therapies. Two investigators independently extracted data and assessed the risk of bias and quality of the evidence. The main outcomes were pain intensity and disability status, examined as standardized mean differences (SMD) with 95% confidence intervals (CI). The risk of bias was assessed by using Cochrane Back and Neck (CBN) Group risk of bias tool and Jadad score, and GRADE was applied to determine the confidence in effect estimates. Heterogeneity was explored using sensitivity analysis and meta-regression. RESULTS Ten RCTs, including a total of 455 young to middle-aged individuals (29.2-55.8 years), were identified. Compared with control, the ESWT group showed lower pain intensity at month 1 (SMD = -0.81, 95% CI -1.21 to -0.42), as well as lower disability score at month 1 (SMD = -1.45, 95% CI -2.68 to -0.22) and at month 3 (SMD = -0.69, 95% CI -1.08 to -0.31). No serious shockwave-related adverse events were reported. CONCLUSION The use of ESWT in CLBP patients results in significant and quantifiable reductions in pain and disability in the short term. However, further well-conducted RCTs are necessary for building high-quality evidence and promoting the application of ESWT in clinical practice.
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Affiliation(s)
- Lei Yue
- Department of Orthopaedics, Peking University First Hospital, Beijing 100034, China
| | - Ming-shuai Sun
- Department of General Surgery, Peking University First Hospital, Beijing 100034, China
| | - Hao Chen
- Department of Rehabilitation, Peking University First Hospital, Beijing 100034, China
| | - Guan-zhang Mu
- Department of Orthopaedics, Peking University First Hospital, Beijing 100034, China
| | - Hao-lin Sun
- Department of Orthopaedics, Peking University First Hospital, Beijing 100034, China
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Aiyer R, Noori SA, Chang KV, Jung B, Rasheed A, Bansal N, Ottestad E, Gulati A. Therapeutic Ultrasound for Chronic Pain Management in Joints: A Systematic Review. PAIN MEDICINE 2021; 21:1437-1448. [PMID: 31095336 DOI: 10.1093/pm/pnz102] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
BACKGROUND Treatments for joint pain and dysfunction focus on restoration of joint motion, improvement in pain and a return to the previous level of the patient's daily activity. Therapeutic ultrasound is a noninvasive modality widely utilized in the management of musculoskeletal disorders. The objective of this systematic review was to evaluate the effectiveness of therapeutic ultrasound in the management of patients with knee, shoulder and hip pain. METHODS Using PRISMA guidelines, a search of the PubMed, CENTRAL (The Cochrane Library), Web of Science and Scopus databases was performed to retrieve randomized controlled trials (RCTs) that evaluated therapeutic ultrasound (continuous and pulsed) in patients with chronic knee, shoulder and hip pain. RESULTS The search strategy identified 8 trials for knee, 7 trials for shoulder and 0 trials for hip that met the criteria for inclusion. All 8 trials showed improvement in knee pain, and of these studies 3 showed statistical significance improvement for therapeutic ultrasound versus the comparator. For shoulder pain, all 7 trials showed reduction in pain, but should be noted that 4 of studies demonstrated that therapeutic ultrasound is inferior to the comparator modality. CONCLUSION Therapeutic ultrasound is frequently used in the treatment of knee, shoulder and hip pain and is often combined with other physiotherapeutic modalities. The literature on knee arthritis is most robust, with some evidence supporting therapeutic ultrasound, though the delivery method of ultrasound (pulsed vs continuous) is controversial. As a monotherapy, ultrasound treatment may not have a significant impact on functional improvement but can be a reasonable adjunct to consider with other common modalities. In all three pain syndromes, especially for hip pain, further trials are needed to define the true effect of low-intensity ultrasound therapy knee, shoulder and hip pain. No conclusive recommendations may be made for optimal settings or session duration.
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Affiliation(s)
- Rohit Aiyer
- Department of Anesthesiology, New York-Presbyterian Hospital/Weill Cornell Medicine, New York, New York
| | - Selaiman A Noori
- Department of Pain Management, Anesthesiology Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Ke-Vin Chang
- Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital, Bei-Hu Branch, Taipei City, Taiwan
| | - Boyoun Jung
- Department of Anesthesiology, New York-Presbyterian Hospital/Weill Cornell Medicine, New York, New York
| | - Abdullah Rasheed
- Department of Anesthesiology, New York-Presbyterian Hospital/Weill Cornell Medicine, New York, New York
| | - Nitin Bansal
- Department of Anesthesiology, New York-Presbyterian Hospital/Weill Cornell Medicine, New York, New York
| | - Einar Ottestad
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Palo Alto, California
| | - Amitabh Gulati
- Department of Anesthesia and Critical Care, Memorial Sloan Kettering Cancer Center, New York, New York, USA
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Fleischmann M, McLaughlin P, Hayes A, Vaughan B. The clinical management of neck pain of novice and experienced Australian osteopaths: A secondary analysis of a nationally representative sample. J Bodyw Mov Ther 2021; 25:87-93. [PMID: 33714517 DOI: 10.1016/j.jbmt.2020.11.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2020] [Revised: 10/05/2020] [Accepted: 11/04/2020] [Indexed: 10/23/2022]
Abstract
INTRODUCTION Neck pain is one of the most common musculoskeletal disorders worldwide. Osteopaths are primary contact health professionals who predominantly manage musculoskeletal complaints. How Australian osteopaths manage neck pain is beginning to emerge in the literature and there may be differences based on clinical experience. This work presents a secondary data analysis of the Australian osteopathy practice-based research network and aims to examine the clinical management characteristics of experienced and novice osteopaths who often treat neck pain. METHODOLOGY Secondary analysis of a cross-sectional survey of osteopaths registered with the Osteopathy Research and Innovation Network (ORION), an Australian practice-based research network. Demographic, practice and treatment characteristics of osteopaths who 'often' treat neck pain. Data was split into two groups: novice practitioners (up to nine years in clinical practice), and experienced practitioners (10 years or more in clinical practice), and clinical management was compared. RESULTS Most (98%) of the 971 osteopaths reported that they treat neck pain often. Of those that treat neck pain often, 58% reported being male. The mean number of patient care hours per week was 28.1 ± 12.1 and the mean number of patient visits per week was 36.7 ± 18.7. There was a statistically significant difference between novice and experienced groups for discussing occupation (p < 0.01; d = 0.26) and stress (p = 0.045; d = 0.13) during their consultations, with a low to medium and low effect size, respectively. CONCLUSION This work demonstrates differences in the management strategies of experienced and novice Australian osteopaths that includes utilisation of a multidisciplinary approach to patient management. The results support the conclusion that there are differences in the clinical management strategies employed by experienced versus novice Australian osteopaths.
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Affiliation(s)
- Michael Fleischmann
- Institute for Health & Sport (IHeS), Victoria University, Melbourne, Australia.
| | - Patrick McLaughlin
- Institute for Health & Sport (IHeS), Victoria University, Melbourne, Australia
| | - Alan Hayes
- Institute for Health & Sport (IHeS), Victoria University, Melbourne, Australia; Australian Institute for Musculoskeletal Science (AIMSS), Department of Medicine - Western Health, Melbourne Medical School, The University of Melbourne, Melbourne, Australia
| | - Brett Vaughan
- Department of Medical Education, The University of Melbourne, Melbourne, Australia; School of Health & Human Sciences, Southern Cross University, Lismore, Australia
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Sung WS, Park JR, Park K, Youn I, Yeum HW, Kim S, Choi J, Cho Y, Hong Y, Park Y, Kim EJ, Nam D. The effectiveness and safety of electroacupuncture for nonspecific chronic low back pain: A protocol for systematic review and/or meta-analysis. Medicine (Baltimore) 2021; 100:e24281. [PMID: 33530216 PMCID: PMC7850747 DOI: 10.1097/md.0000000000024281] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Accepted: 12/21/2020] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND Low back pain (LBP) is a common symptom that affects almost 80% of the global population. LBP manifests as diverse pathologies and has different causes. The focus of this paper is nonspecific chronic low back pain (NSCLBP) wherein the pain lasts for more than 12 weeks, and for which there is no definite cause. Although there are various treatment options for NSCLBP, including medication and exercise, each option has its own limitations. Although electroacupuncture (EA) has been known to have useful analgesic effects on chronic LBP, there is no systematic review (SR) on EA in the literature. Therefore, this study aims to systematically review and validate the effectiveness and safety of EA for NSCLBP. METHODS We will search for randomized controlled trials on the use of EA for NSCLBP in multiple electronic databases, manual searches, and contacting authors. We will screen and select studies according to the predefined criteria and extract the data needed for this SR. The primary outcome will be the pain index (Visual Analog Scale and Numeric Rating Scale), and the secondary outcomes will be the functional status (Roland-Morris Disability Questionnaire), patient-centered outcomes, and adverse events. We will perform a meta-analysis using Review Manager software (Version 5.3; Copenhagen; The Nordic Cochrane Center, The Cochrane Collaboration, 2014) and assess the risk of bias using Cochrane Collaboration "risk of bias" tools and the quality of evidence using the Grades of Recommendation, Assessment, Development and Evaluation. RESULTS Our SR will investigate the effectiveness and safety of EA on NSCLBP. CONCLUSION Our SR will support the published clinical evidence of the usage of EA for NSCLBP to assess the effectiveness and safety of EA. TRIAL REGISTRATION NUMBER INPLASY; INPLASY2020120039.
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Affiliation(s)
- Won-Suk Sung
- Department of Acupuncture & Moxibustion, Dongguk University Bundang Oriental Hospital, Seongnam-si, Gyeonggi-do
| | - Jeong Ryul Park
- Department of Clinical Korean Medicine, Graduate School, Kyung Hee University
| | - Kyungbok Park
- Department of Clinical Korean Medicine, Graduate School, Kyung Hee University
| | - Inae Youn
- Department of Clinical Korean Medicine, Graduate School, Kyung Hee University
| | - Hye Won Yeum
- Department of Clinical Korean Medicine, Graduate School, Kyung Hee University
| | - Sungyoon Kim
- Department of Clinical Korean Medicine, Graduate School, Kyung Hee University
| | - Jieun Choi
- Singil Kyunghee Korean Medical Clinic, Seoul
| | - Yeeun Cho
- Kyunghee Taerim Korean Medical Clinic, Incheon
| | - Yejin Hong
- Department of Clinical Korean Medicine, Graduate School, Kyung Hee University
| | - Yeoncheol Park
- Department of Acupuncture & Moxibustion, Kyung Hee University Hospital at Gangdong
| | - Eun-Jung Kim
- Department of Acupuncture & Moxibustion, Dongguk University Bundang Oriental Hospital, Seongnam-si, Gyeonggi-do
| | - Dongwoo Nam
- Department of Acupuncture & Moxibustion, College of Korean Medicine, Kyung Hee University, Seoul, Republic of Korea
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Baumgart SBE, Baumbach-Kraft A, Lorenz J. Effect of Psycho-Regulatory Massage Therapy on Pain and Depression in Women with Chronic and/or Somatoform Back Pain: A Randomized Controlled Trial. Brain Sci 2020; 10:E721. [PMID: 33053728 PMCID: PMC7601155 DOI: 10.3390/brainsci10100721] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2020] [Revised: 09/29/2020] [Accepted: 09/30/2020] [Indexed: 02/03/2023] Open
Abstract
Chronic unspecific back pain (cBP) is often associated with depressive symptoms, negative body perception, and abnormal interoception. Given the general failure of surgery in cBP, treatment guidelines focus on conservative therapies. Neurophysiological evidence indicates that C-tactile fibers associated with the oxytonergic system can be activated by slow superficial stroking of the skin in the back, shoulder, neck, and dorsal limb areas. We hypothesize that, through recruitment of C-tactile fibers, psycho-regulatory massage therapy (PRMT) can reduce pain in patients with cBP. In our study, 66 patients were randomized to PRMT or CMT (classical massage therapy) over a 12-week period and tested by questionnaires regarding pain (HSAL= Hamburger Schmerz Adjektiv Liste; Hamburg Pain adjective list), depression (BDI-II = Beck depression inventory), and disability (ODI = Oswestry Disability Index). In all outcome measures, patients receiving PRMT improved significantly more than did those receiving CMT. The mean values of the HSAL sensory subscale decreased by -51.5% in the PRMT group compared to -6.7% in the CMT group. Depressive symptoms were reduced by -55.69% (PRMT) and -3.1% (CMT), respectively. The results suggest that the superiority of PRMT over CMT may rely on its ability to activate the C-tactile fibers of superficial skin layers, recruiting the oxytonergic system.
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Affiliation(s)
- Sabine B.-E. Baumgart
- Faculty of Medicine, Institute for Health and Nursing Sciences, Martin Luther University Halle-Wittenberg, 06108 Halle, Germany
| | | | - Juergen Lorenz
- Department of Biomedical Engineering, Faculty of Life Science, University of Applied Sciences, 21033-Hamburg, Germany;
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Chien A, Yang CC, Chang SC, Jan YM, Yang CH, Hsieh YL. Ultrasound Acupuncture for Oxaliplatin-induced Peripheral Neuropathy in Patients With Colorectal Cancer: A Pilot Study. PM R 2020; 13:55-65. [PMID: 32168417 DOI: 10.1002/pmrj.12361] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2019] [Revised: 02/21/2020] [Accepted: 03/03/2020] [Indexed: 12/19/2022]
Abstract
BACKGROUND Oxaliplatin is frequently used in the treatment of metastatic colorectal cancer. However, peripheral neuropathy is a severe adverse effect of oxaliplatin that may persist and impact quality of life. OBJECTIVE To assess the potential effects of ultrasound acupuncture for the alleviation of symptoms related to oxaliplatin-induced peripheral neuropathy (OIPN) among patients with metastatic colorectal cancer. DESIGN Prospective cohort pilot study. SETTING Education and research hospital. PARTICIPANTS Patients with a diagnosis of stage II-IV colorectal cancer undergoing oxaliplatin-based treatment regimens who experienced OIPN symptoms (n = 17). INTERVENTIONS Pulsed therapeutic ultrasound (1 MHz) at bilateral acupuncture points of PC6, PC7, BL60, and KI1 was administered for 5 minutes per point daily for 12 days. MAIN OUTCOME MEASUREMENTS Pain Quality Assessment Scale (PQAS), Chemotherapy-induced Neurotoxicity Questionnaire (CINQ), quantitative touch-detection threshold, cold-trigger pain withdrawal latency, and quality of life (EORTC QLQ-C30) were measured at baseline (day 0), pre-intervention (day 12, post wash-out period), post-intervention (day 24), and final follow-up (day 54). A P value of less than .05 was considered statistically significant. RESULTS Scores of PQAS and CINQ significantly improved after ultrasound acupuncture at post-intervention and follow-up compared to both baseline and pre-intervention. Similar trends were also observed for the quantitative sensory testing, where touch-detection threshold significantly decreased and cold-trigger pain withdrawal latency significantly increased after ultrasound acupuncture. Patients also showed an improvement on quality of life outcomes as measured by QLQ-C30 post-intervention and at follow-up. CONCLUSIONS Ultrasound acupuncture could be an effective intervention for OIPN symptoms for patients with colorectal cancer. However, larger and randomized clinical trials with placebo controls are needed to confirm such effects.
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Affiliation(s)
- Andy Chien
- Department of Physical Therapy, Graduate Institute of Rehabilitation Science, China Medical University, Taichung, Taiwan
| | | | - Sheng-Chi Chang
- Department of Colorectal Surgery, China Medical University Hospital, Taichung, Taiwan
| | - Yi-Min Jan
- Center for General Education, China Medical University, Taichung, Taiwan
| | - Ching-Hsiang Yang
- Department of Physical Therapy, Graduate Institute of Rehabilitation Science, China Medical University, Taichung, Taiwan
| | - Yueh-Ling Hsieh
- Department of Physical Therapy, Graduate Institute of Rehabilitation Science, China Medical University, Taichung, Taiwan
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Rubira APFDA, Rubira MC, Rubira LDA, Comachio J, Magalhães MO, Marques AP. Comparison of the effects of low-level laser and pulsed and continuous ultrasound on pain and physical disability in chronic non-specific low back pain: a randomized controlled clinical trial. Adv Rheumatol 2019; 59:57. [PMID: 31847915 DOI: 10.1186/s42358-019-0099-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2019] [Accepted: 11/18/2019] [Indexed: 01/01/2023] Open
Abstract
OBJECTIVE To compare the short-term effects of pulsed laser and pulsed and continuous ultrasound on pain and functional disability in women with chronic non-specific low back pain. METHODS The sample was composed of 100 volunteers randomly allocated into four groups: The Pulsed Laser Group (n = 26) was treated with 3 J/cm2; the Pulsed Ultrasound Group (n = 24; 3 MHz) was treated with 1 W/cm2; the Continuous Ultrasound Group (n = 26; 1 MHz) was treated with 1 W/cm2; and a Control Group (n = 24), where the patients were still waiting for treatment. Before and after 10 sessions of treatment, the intensity of pain was assessed using the visual analogue scale (VAS), the quality of pain was evaluated using the McGill pain questionnaire and functional disability was investigated using the Roland-Morris questionnaire. RESULTS The three treated groups exhibited a decrease in pain (p < 0.001); the Pulsed Laser Group showed the greater relative gain (91.2%), Meanwhile, the Control Group exhibited a worsening of - 5.8%. The three treated groups demonstrated improvement in the quality of pain (McGill) in the total, sensory and affective dimensions (p < 0.005; p < 0.002; p < 0.013, respectively). All treated groups showed a decrease in functional disability (p < 0.001), but the Pulsed Ultrasound Group showed the highest relative gain (83.3%). CONCLUSIONS The three modalities have significant effects to decreasing low back pain and improving functional disability in women with non-specific chronic low back pain, but the pulsed low-level laser had the best results on pain while the pulsed ultrasound had the best results on improve the functional disability. TRIAL REGISTRATION ClinicalTrials.gov: NCT02150096.
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Affiliation(s)
- Ana Paula Fernandes De Angelis Rubira
- Physical Therapy, Speech and Occupational Therapy Department, School of Medicine, University of Sao Paulo, Cipotânea, n 51, Cidade Universitária, Sao Paulo, Brazil
| | | | | | - Josielli Comachio
- Physical Therapy, Speech and Occupational Therapy Department, School of Medicine, University of Sao Paulo, Cipotânea, n 51, Cidade Universitária, Sao Paulo, Brazil.
| | - Maurício Oliveira Magalhães
- Physical Therapy, Speech and Occupational Therapy Department, School of Medicine, University of Sao Paulo, Cipotânea, n 51, Cidade Universitária, Sao Paulo, Brazil
| | - Amélia Pasqual Marques
- Physical Therapy, Speech and Occupational Therapy Department, School of Medicine, University of Sao Paulo, Cipotânea, n 51, Cidade Universitária, Sao Paulo, Brazil
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Gérvas J, Oliver LL, Pérez-Fernandez M. Family and Community Medicine and its role in preventing health overuse (preventive, diagnostic, therapeutic and rehabilitative). CIENCIA & SAUDE COLETIVA 2019; 25:1233-1240. [PMID: 32267426 DOI: 10.1590/1413-81232020254.30082019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2019] [Accepted: 10/23/2019] [Indexed: 11/22/2022] Open
Abstract
In Medicine, it is critical "to offer 100% of what is needed and avoid 100% of what is not needed." Unfortunately, this primary issue is challenging, and generally, more than required is offered, and everything that is unnecessary is not avoided. This is a nonsystematic review with a teaching objective that reviews the general issue in primary care and suggests ways to avoid overuse and shortcomings concerning preventive, diagnostic, therapeutic, and rehabilitative interventions. Knowing not to do is science and art that is hardly taught and practiced less. The overuse that harm are an almost daily part of clinical practice in prevention, diagnosis, treatment, and rehabilitation. It is essential to promote "the art and science of not doing".
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Affiliation(s)
- Juan Gérvas
- Equipo CESCA. Pradillo 68.28002 Madrid España.
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Abdulla FA, Alsaadi S, Sadat-Ali M, Alkhamis F, Alkawaja H, Lo S. Effects of pulsed low-frequency magnetic field therapy on pain intensity in patients with musculoskeletal chronic low back pain: study protocol for a randomised double-blind placebo-controlled trial. BMJ Open 2019; 9:e024650. [PMID: 31182440 PMCID: PMC6561444 DOI: 10.1136/bmjopen-2018-024650] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2018] [Revised: 03/22/2019] [Accepted: 05/15/2019] [Indexed: 12/19/2022] Open
Abstract
INTRODUCTION The aim of the present study is to investigate the effectiveness of pulsed low-frequency magnetic field (PLFMF) on the management of chronic low back pain (CLBP). METHODS AND ANALYSIS A randomised double-blinded controlled clinical trial will be conducted, involving 200 patients with CLBP. Participants will be randomised in a 1:1 ratio to receive either active PLFMF (experimental arm) or sham treatment (control arm) using a permuted-block design which will be stratified according to three subtypes of musculoskeletal CLBP (nociceptive, peripheral neuropathic or central sanitisation). The intervention consists of three sessions/week for 6 weeks. The primary outcome is the percentage change in Numerical Rating Scale (NRS) pain at week 24 after treatment completion with respect to the baseline. Secondary outcomes include percentage NRS pain during treatment and early after treatment completion, short form 36 quality of life, Roland and Morris Disability Questionnaire; Depression Anxiety Stress Scale 21, Patient Specific Functional Scale, Global perceived effect of condition change, Pittsburgh Sleep Quality Index and Modified Fatigue Impact Scale. Measures will be taken at baseline, 3 and 6 weeks during the intervention and 6, 12 and 24 weeks after completing the intervention. Adverse events between arms will be evaluated. Data will be analysed on an intention-to-treat basis. ETHICS AND DISSEMINATION The study is funded by Imam Abdulrahman Bin Faisal University (IAU). It has been approved by the institutional review board of IAU (IRB- 2017-03-129). The study will be conducted at King Fahd Hospital of the University and will be monitored by the Hospital monitoring office for research and research ethics. The trial is scheduled to begin in September 2018. Results obtained will be presented in international conferences and will be published in peer-reviewed journals. TRIAL REGISTRATION NUMBER ACTRN12618000921280, prospectively.
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Affiliation(s)
- Fuad A Abdulla
- Department of Physical Therapy, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Saad Alsaadi
- Department of Physical Therapy, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Mir Sadat-Ali
- Department of Orthopedic Surgery, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Fahd Alkhamis
- Department of Neurology, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Hani Alkawaja
- Department of Physical Therapy, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Serigne Lo
- Institute of Research and Medical Consultation, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
- Melanoma Institute Australia, North Sydney, New South Wales, Australia
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Lewis R, Gómez Álvarez CB, Rayman M, Lanham-New S, Woolf A, Mobasheri A. Strategies for optimising musculoskeletal health in the 21 st century. BMC Musculoskelet Disord 2019; 20:164. [PMID: 30971232 PMCID: PMC6458786 DOI: 10.1186/s12891-019-2510-7] [Citation(s) in RCA: 81] [Impact Index Per Article: 16.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2018] [Accepted: 03/17/2019] [Indexed: 12/19/2022] Open
Abstract
We live in a world with an ever-increasing ageing population. Studying healthy ageing and reducing the socioeconomic impact of age-related diseases is a key research priority for the industrialised and developing countries, along with a better mechanistic understanding of the physiology and pathophysiology of ageing that occurs in a number of age-related musculoskeletal disorders. Arthritis and musculoskeletal disorders constitute a major cause of disability and morbidity globally and result in enormous costs for our health and social-care systems.By gaining a better understanding of healthy musculoskeletal ageing and the risk factors associated with premature ageing and senescence, we can provide better care and develop new and better-targeted therapies for common musculoskeletal disorders. This review is the outcome of a two-day multidisciplinary, international workshop sponsored by the Institute of Advanced Studies entitled "Musculoskeletal Health in the 21st Century" and held at the University of Surrey from 30th June-1st July 2015.The aim of this narrative review is to summarise current knowledge of musculoskeletal health, ageing and disease and highlight strategies for prevention and reducing the impact of common musculoskeletal diseases.
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Affiliation(s)
- Rebecca Lewis
- School of Veterinary Medicine, Faculty of Health and Medical Sciences, University of Surrey, Guildford, UK
| | - Constanza B. Gómez Álvarez
- School of Veterinary Medicine, Faculty of Health and Medical Sciences, University of Surrey, Guildford, UK
| | - Margaret Rayman
- School of Biosciences and Medicine, Faculty of Health and Medical Sciences, University of Surrey, Guildford, UK
| | - Susan Lanham-New
- School of Biosciences and Medicine, Faculty of Health and Medical Sciences, University of Surrey, Guildford, UK
| | - Anthony Woolf
- Department of Rheumatology, Royal Cornwall Hospital, Truro, UK
| | - Ali Mobasheri
- School of Veterinary Medicine, Faculty of Health and Medical Sciences, University of Surrey, Guildford, UK
- Centre for Sport, Exercise and Osteoarthritis Research Versus Arthritis, Queen’s Medical Centre, Nottingham, UK
- Department of Regenerative Medicine, State Research Institute Centre for Innovative Medicine, Vilnius, Lithuania
- The D-BOARD FP7 Consortium, http://www.d-board.eu
- The APPROACH IMI Consortium, https://www.approachproject.eu
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Effects of physical therapy agents on pain, disability, quality of life, and lumbar paravertebral muscle stiffness via elastography in patients with chronic low back pain. Turk J Phys Med Rehabil 2019; 65:30-39. [PMID: 31453542 DOI: 10.5606/tftrd.2019.2373] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2017] [Accepted: 01/25/2018] [Indexed: 01/16/2023] Open
Abstract
Objectives This study aims to evaluate early effects of combined hot pack (HP) and transcutaneous electrical nerve stimulation (TENS) treatment and therapeutic ultrasound (US) on pain, quality of life, disability, and the multifidus muscle stiffness. Patients and methods Between December 2016 and March 2017, a total of 69 patients (36 females, 33 males; mean age 48.9±10.9; range, 27 to 73 years) were included in this randomized-controlled study. The patients were divided into three groups as HT + TENS (Group H+T, n=23), HP + TENS + US (Group H+T+U, n=23), and controls (control group, n=23). All patients filled out the Numeric Rating Scale (NRS), Oswestry Disability Index (ODI), and Short Form-36 (SF-36) questionnaire at baseline and at the end of treatment. The left multifidus muscle strain ratio at fourth lumbar spinal level was obtained from the upper, middle, and lower parts of the muscle along the longitudinal axis on the first and last days of treatment. Results There was a significant improvement in the NRS, ODI, and SF-36 physical function, physical role function, pain, and general health perceptions in the H+T and H+T+U groups, compared to the control group (p<0.05). However, there was no significant difference between the H+T and H+T+U groups. The H+T+U group showed an improvement in the SF-36 social role function and emotional role function. There was no significant difference in the multifidus muscle strain ratios among the groups. Conclusion Our study results suggest that H+T treatment has a beneficial effect on pain, disability, and certain subscales of the quality of life. However, US seems not to have an additional benefit.
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Zati A, Cavazzuti L, Colori BCM, Benedetti MG. Deep heating therapy via MF radiowaves versus superficial heating therapy in the treatment of nonspecific chronic low back pain: A double blind randomized trial. J Back Musculoskelet Rehabil 2019; 31:963-971. [PMID: 30103299 DOI: 10.3233/bmr-170944] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND Nonspecific Chronic Low Back Pain (CLBP) is a condition difficult to treat due to multiple etiopathogenesis and there is wide consensus on the multidisciplinary approach. In physiotherapy, the Medium Frequencies (MF) diathermy has recently been introduced but without enough evidence of effectiveness. OBJECTIVE To explore the effects of a deep heating therapy (DHT) produced by a MF diathermy for the treatment of CLBP compared with a superficial heating therapy (SHT). The study was a double blind randomized trial. METHODS Forty-nine patients affected by CLBP were randomly subdivided in 2 groups and treated with either DHT (450 KHz) or SHT via electric resistance applying the same instrument on the lumbar spine. NRS (Numerical Rating Scale) for pain and ODI (Oswestry Disability Index) for disability were used as outcome measures. The follow up was: T1, 15 days (end of the therapy); T2, 30 days; T3, 45 days after T0. RESULTS Both therapies were effective in reducing pain throughout the follow up with greater improvement in DHT group at T1. DHT resulted to have a higher efficacy with respect to SHT in reducing disability (ODI) throughout all follow ups. CONCLUSION This study provides evidence of the positive effects of MF radio waves diathermy in the treatment of CLBP.
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Altan L, Kasapoğlu Aksoy M, Kösegil Öztürk E. Efficacy of diclofenac & thiocolchioside gel phonophoresis comparison with ultrasound therapy on acute low back pain; a prospective, double-blind, randomized clinical study. ULTRASONICS 2019; 91:201-205. [PMID: 30139568 DOI: 10.1016/j.ultras.2018.08.008] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/28/2017] [Revised: 06/29/2018] [Accepted: 08/12/2018] [Indexed: 06/08/2023]
Abstract
PURPOSE To investigate the effect of Phonophoresis (PP) with the combination of nonsteroidal anti-inflammatory drugs (NSAID's) and myorelaxant versus routine Ultrasound (US) treatment with non-therapeutic gel on the patients with acute low back pain (ABP). METHODS Sixty patients with ABP were randomly assigned into 2 groups. In Group 1 (n = 30) US was applied using diclofenac + Thiocolchicoside gel for 10 min and for a total of 10 sessions. In Group 2 (n = 30) the same US protocol was applied with the same setting and timing with Group 1 using US gel that does not contain any pharmaceutical ingredient. Evaluation parameters were Visual numeric scale (VNS), Oswestry Disability Index (ODI), and Shober test. RESULTS Comparison of the results obtained from the two groups before treatment and at second (W2) and sixth weeks (W6) posttreatment showed significant improvement in all parameters in both groups (p < 0.05). Comparison of the groups showed significantly superior improvement in Group 1 for ODI while there was no difference in other parameters at W2. At W6, there was significantly superior improvement in all parameters (p < 0.05) except for Shober test in Group1. CONCLUSION Our results showed that PP treatment is superior than conventional US therapy at short term in ABP patients.
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Affiliation(s)
- L Altan
- Uludağ University Medicine Faculty, Department of Physical Medicine and Rehabilitation, Turkey; University of Health Sciences Bursa Yüksek Ihtisas Training and Research Hospital, Department of Physical Medicine and Rehabilitation, Turkey
| | - M Kasapoğlu Aksoy
- University of Health Sciences Bursa Yüksek Ihtisas Training and Research Hospital, Department of Physical Medicine and Rehabilitation, Turkey.
| | - E Kösegil Öztürk
- University of Health Sciences Bursa Yüksek Ihtisas Training and Research Hospital, Department of Physical Medicine and Rehabilitation, Turkey
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Schneider R. Low-frequency vibrotherapy considerably improves the effectiveness of manual lymphatic drainage (MLD) in patients with lipedema: A two-armed, randomized, controlled pragmatic trial. Physiother Theory Pract 2018; 36:63-70. [DOI: 10.1080/09593985.2018.1479474] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
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Schneider R. Effectiveness of myofascial trigger point therapy in chronic back pain patients is considerably increased when combined with a new, integrated, low-frequency shock wave vibrotherapy (Cellconnect Impulse): A two-armed, measurement repeated, randomized, controlled pragmatic trial. J Back Musculoskelet Rehabil 2018; 31:57-64. [PMID: 28826166 DOI: 10.3233/bmr-169662] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND The prevalence of chronic back pain poses major challenges for all health care systems and patients worldwide. Myofascial trigger therapy (MT), although a very popular standard non-pharmaceutical form of treatment, only shows small to medium effectiveness. OBJECTIVE To test a new vibrotreatment (Cellconnect Impulse) transmitting low-frequency, vertical shock waves in a routine clinical practice. METHODS Eligible patients were adults seeking physiotherapeutic treatment. They were randomly allocated to either six treatments of MT or to six treatments of combined MT and vibrotreatment. Outcome parameters were pain intensity, pain days, pain duration, and quality of life. RESULTS The pain relieving effects of the combined treatment were very large (d= 1.6). It clearly outperformed MT and considerably improved patients' health related quality of life. CONCLUSIONS Combining MT with Cellconnect Impulse enhances the physiotherapeutic effectiveness of treating chronic back pain.
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Chenot JF, Greitemann B, Kladny B, Petzke F, Pfingsten M, Gabriele Schorr S. Non-Specific Low Back Pain. DEUTSCHES ARZTEBLATT INTERNATIONAL 2017; 114:883-890. [PMID: 29321099 PMCID: PMC5769319 DOI: 10.3238/arztebl.2017.0883] [Citation(s) in RCA: 78] [Impact Index Per Article: 11.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/28/2017] [Revised: 07/28/2017] [Accepted: 10/26/2017] [Indexed: 12/28/2022]
Abstract
BACKGROUND For many years, low back pain has been both the leading cause of days lost from work and the leading indication for medical rehabilitation. The goal of the German Disease Management Guideline (NDMG) on nonspecific low back pain is to improve the treatment of patients with this condition. METHODS The current update of the NDMG on non-specific low back pain is based on articles retrieved by a systematic search of the literature for systematic reviews. Its recommendations for diagnosis and treatment were developed by a collaborative effort of 29 scientific medical societies and organizations and approved in a formal consensus process. RESULTS If the history and physical examination do not arouse any suspicion of a dangerous underlying cause, no further diagnostic evaluation is indicated for the time being. Passive, reactive measures should be taken only in combination with activating measures, or not at all. When drugs are used for symptomatic treatment, patients should be treated with the most suitable drug in the lowest possible dose and for as short a time as possible. CONCLUSION A physician should be in charge of the overall care process. The patient should be kept well informed over the entire course of his or her illness and should be encouraged to adopt a healthful lifestyle, including regular physical exercise.
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Affiliation(s)
- Jean-François Chenot
- Section Family Medicine, Institute for Community Medicine, University Hospital of Greifswald
| | | | - Bernd Kladny
- Department of Orthopedics, Fachklinik Herzogenaurach
| | - Frank Petzke
- ain Clinic, Center for Anesthesiology, Emergency and Intensive Care Medicine, University Hospital Göttingen
| | - Michael Pfingsten
- ain Clinic, Center for Anesthesiology, Emergency and Intensive Care Medicine, University Hospital Göttingen
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van Dongen JM, Ketheswaran J, Tordrup D, Ostelo RWJG, Bertollini R, van Tulder MW. Health economic evidence gaps and methodological constraints in low back pain and neck pain: Results of the Research Agenda for Health Economic Evaluation (RAHEE) project. Best Pract Res Clin Rheumatol 2017; 30:981-993. [PMID: 29103555 DOI: 10.1016/j.berh.2017.09.001] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2017] [Revised: 08/18/2017] [Accepted: 08/20/2017] [Indexed: 10/18/2022]
Abstract
Despite the increased interest in economic evaluations, there are difficulties in applying the results of such studies in practice. Therefore, the "Research Agenda for Health Economic Evaluation" (RAHEE) project was initiated, which aimed to improve the use of health economic evidence in practice for the 10 highest burden conditions in the European Union (including low back pain [LBP] and neck pain [NP]). This was done by undertaking literature mapping and convening an Expert Panel meeting, during which the literature mapping results were discussed and evidence gaps and methodological constraints were identified. The current paper is a part of the RAHEE project and aimed to identify economic evidence gaps and methodological constraints in the LBP and NP literature, in particular. The literature mapping revealed that economic evidence was unavailable for various commonly used LBP and NP treatments (e.g., injections, traction, and discography). Even if economic evidence was available, many treatments were only evaluated in a single study or studies for the same intervention were highly heterogeneous in terms of their patient population, control condition, follow-up duration, setting, and/or economic perspective. Up until now, this has prevented economic evaluation results from being statistically pooled in the LBP and NP literature, and strong conclusions about the cost-effectiveness of LBP and NP treatments can therefore not be made. The Expert Panel identified the need for further high-quality economic evaluations, especially on surgery versus conservative care and competing treatment options for chronic LBP. Handling of uncertainty and reporting quality were considered the most important methodological challenges.
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Affiliation(s)
- J M van Dongen
- Department of Health Sciences, Faculty of Science, Vrije Universiteit Amsterdam, MOVE Research Institute Amsterdam, The Netherlands; Department of Health Sciences, Faculty of Science, Vrije Universiteit Amsterdam, Amsterdam Public Health Research Institute, The Netherlands.
| | - J Ketheswaran
- World Health Organization Representation to the EU, Brussels, Belgium
| | - D Tordrup
- World Health Organization Representation to the EU, Brussels, Belgium; WHO Collaborating Centre for Pharmaceutical Policy and Regulation, Utrecht Institute for Pharmaceutical Sciences, Utrecht, The Netherlands
| | - R W J G Ostelo
- Department of Health Sciences, Faculty of Science, Vrije Universiteit Amsterdam, MOVE Research Institute Amsterdam, The Netherlands
| | - R Bertollini
- World Health Organization Representation to the EU, Brussels, Belgium
| | - M W van Tulder
- Department of Health Sciences, Faculty of Science, Vrije Universiteit Amsterdam, MOVE Research Institute Amsterdam, The Netherlands
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Telephysiotherapy: time to get online. J Physiother 2017; 63:193-195. [PMID: 28939309 DOI: 10.1016/j.jphys.2017.08.001] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2017] [Revised: 08/01/2017] [Accepted: 08/03/2017] [Indexed: 12/14/2022] Open
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Babatunde OO, Jordan JL, Van der Windt DA, Hill JC, Foster NE, Protheroe J. Effective treatment options for musculoskeletal pain in primary care: A systematic overview of current evidence. PLoS One 2017; 12:e0178621. [PMID: 28640822 PMCID: PMC5480856 DOI: 10.1371/journal.pone.0178621] [Citation(s) in RCA: 207] [Impact Index Per Article: 29.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2016] [Accepted: 05/16/2017] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND & AIMS Musculoskeletal pain, the most common cause of disability globally, is most frequently managed in primary care. People with musculoskeletal pain in different body regions share similar characteristics, prognosis, and may respond to similar treatments. This overview aims to summarise current best evidence on currently available treatment options for the five most common musculoskeletal pain presentations (back, neck, shoulder, knee and multi-site pain) in primary care. METHODS A systematic search was conducted. Initial searches identified clinical guidelines, clinical pathways and systematic reviews. Additional searches found recently published trials and those addressing gaps in the evidence base. Data on study populations, interventions, and outcomes of intervention on pain and function were extracted. Quality of systematic reviews was assessed using AMSTAR, and strength of evidence rated using a modified GRADE approach. RESULTS Moderate to strong evidence suggests that exercise therapy and psychosocial interventions are effective for relieving pain and improving function for musculoskeletal pain. NSAIDs and opioids reduce pain in the short-term, but the effect size is modest and the potential for adverse effects need careful consideration. Corticosteroid injections were found to be beneficial for short-term pain relief among patients with knee and shoulder pain. However, current evidence remains equivocal on optimal dose, intensity and frequency, or mode of application for most treatment options. CONCLUSION This review presents a comprehensive summary and critical assessment of current evidence for the treatment of pain presentations in primary care. The evidence synthesis of interventions for common musculoskeletal pain presentations shows moderate-strong evidence for exercise therapy and psychosocial interventions, with short-term benefits only from pharmacological treatments. Future research into optimal dose and application of the most promising treatments is needed.
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Affiliation(s)
- Opeyemi O. Babatunde
- Arthritis Research UK Primary Care Centre, Research Institute for Primary Care & Health Sciences, Keele University, Keele, United Kingdom
| | - Joanne L. Jordan
- Arthritis Research UK Primary Care Centre, Research Institute for Primary Care & Health Sciences, Keele University, Keele, United Kingdom
| | - Danielle A. Van der Windt
- Arthritis Research UK Primary Care Centre, Research Institute for Primary Care & Health Sciences, Keele University, Keele, United Kingdom
| | - Jonathan C. Hill
- Arthritis Research UK Primary Care Centre, Research Institute for Primary Care & Health Sciences, Keele University, Keele, United Kingdom
| | - Nadine E. Foster
- Arthritis Research UK Primary Care Centre, Research Institute for Primary Care & Health Sciences, Keele University, Keele, United Kingdom
| | - Joanne Protheroe
- Arthritis Research UK Primary Care Centre, Research Institute for Primary Care & Health Sciences, Keele University, Keele, United Kingdom
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Wellington J. Noninvasive and alternative management of chronic low back pain (efficacy and outcomes). Neuromodulation 2015; 17 Suppl 2:24-30. [PMID: 25395114 DOI: 10.1111/ner.12078] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2012] [Revised: 03/04/2013] [Accepted: 04/03/2013] [Indexed: 11/30/2022]
Abstract
OBJECTIVES The goal of this article is to provide a thorough literature review of available noninvasive and alternative treatment options for chronic low back pain. In particular, the efficacy of each therapy is evaluated and pertinent outcomes are described. MATERIALS AND METHODS A comprehensive search for available literature was done through PubMed and Cochrane data base for topics discussed in this paper. RESULTS Relevant current and past references were reviewed and presented to reflect the efficacy of each therapy and related outcomes. CONCLUSIONS There are a wide variety of noninvasive and alternative therapies for the treatment of chronic low back pain. Those with the strongest evidence in the literature for good efficacy and outcomes include exercise therapy with supervised physical therapy, multidisciplinary biopsychosocial rehabilitation, and acupuncture. Therapies with fair evidence or moderately supported by literature include yoga, back schools, thermal modalities, acupressure, and cognitive-behavioral therapy. Those therapies with poor evidence or little to no literature support include manipulation, transcutaneous electrical nerve stimulation, low-level laser therapy, reflexology, biofeedback, progressive relaxation, hypnosis, and aromatherapy. Providers delivering care for patients with chronic low back pain must carefully evaluate these available treatment options related to their efficacy or lack thereof as well as relevant outcomes.
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North RB, Shipley J, Wang H, Mekhail N. A review of economic factors related to the delivery of health care for chronic low back pain. Neuromodulation 2015; 17 Suppl 2:69-76. [PMID: 25395118 DOI: 10.1111/ner.12057] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2011] [Revised: 02/07/2013] [Accepted: 02/22/2013] [Indexed: 11/30/2022]
Abstract
INTRODUCTION AND METHODS We describe tools used to evaluate the economic impact of health care interventions, discuss the economic burden of chronic low back pain, and review evidence on the cost-effectiveness of treating failed back surgery syndrome with spinal cord stimulation, intrathecal drug delivery, acupuncture, epidural injections, disc prosthesis, lumbar fusion, and noninvasive therapies. We also mention the lack of cost studies for emerging therapies, such as vibrotherapy and peripheral nerve field stimulation. Topics include types of cost studies; the economic perspectives taken by such studies; direct and indirect costs; measures of success; definitions of cost-effectiveness, incremental cost-effectiveness, incremental cost-utility ratios, and quality-adjusted life years; the concept of maximum willingness to pay; and the use of cost-effectiveness models. CONCLUSION The fact that chronic low back pain arises from a variety of causes makes choosing appropriate treatment difficult. Determining the cost-effectiveness of various treatments for chronic low back pain depends on well-designed and well-executed randomized controlled trials with parallel economic evaluations. Researchers can use economic models to extrapolate costs and outcomes over the long term.
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Affiliation(s)
- Richard B North
- The Johns Hopkins University School of Medicine (ret.), Baltimore, MD, USA; The Neuromodulation Foundation, Inc., Baltimore, MD, USA
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Seco J, Kovacs FM, Urrútia G. Improving methodology when analyzing shockwave evidence: evidence holds the key. Spine J 2015; 15:1703. [PMID: 26087851 DOI: 10.1016/j.spinee.2015.05.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2015] [Accepted: 05/07/2015] [Indexed: 02/03/2023]
Affiliation(s)
- Jesús Seco
- Institute of Biomedicine (IBIOMED), University of León, Campus Universitario, 24071, León, Spain; University of the Basque Country, Spain; Spanish Back Pain Research Network
| | - Francisco M Kovacs
- Research Department, Kovacs Foundation, Paseo de Mallorca 36, 3°, 1(a). 07012, Palma de Mallorca, Spain; Spanish Back Pain Research Network
| | - Gerard Urrútia
- Iberoamerican Cochrane Center-Servei d'Epidemiologia Clínica i Salut Pública, Institut d'Investigació Biomèdica Sant Pau, Sant Antoni M. Claret 171, Barcelona, Catalonia 08041, Spain; CIBER Epidemiología y Salud Pública (CIBERESP), Spain
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Effectiveness of passive physical modalities for shoulder pain: systematic review by the Ontario protocol for traffic injury management collaboration. Phys Ther 2015; 95:306-18. [PMID: 25394425 DOI: 10.2522/ptj.20140361] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/09/2023]
Abstract
BACKGROUND Shoulder pain is a common musculoskeletal condition in the general population. Passive physical modalities are commonly used to treat shoulder pain. However, previous systematic reviews reported conflicting results. PURPOSE The aim of this study was to evaluate the effectiveness of passive physical modalities for the management of soft tissue injuries of the shoulder. DATA SOURCES MEDLINE, EMBASE, CINAHL, PsycINFO, and the Cochrane Central Register of Controlled Trials were searched from January 1, 1990, to April 18, 2013. STUDY SELECTION Randomized controlled trials (RCTs) and cohort and case-control studies were eligible. Random pairs of independent reviewers screened 1,470 of 1,760 retrieved articles after removing 290 duplicates. Twenty-two articles were eligible for critical appraisal. Eligible studies were critically appraised using the Scottish Intercollegiate Guidelines Network criteria. Of those, 11 studies had a low risk of bias. DATA EXTRACTION The lead author extracted data from low risk of bias studies and built evidence tables. A second reviewer independently checked the extracted data. DATA SYNTHESIS The findings of studies with a low risk of bias were synthesized according to principles of best evidence synthesis. Pretensioned tape, ultrasound, and interferential current were found to be noneffective for managing shoulder pain. However, diathermy and corticosteroid injections led to similar outcomes. Low-level laser therapy provided short-term pain reduction for subacromial impingement syndrome. Extracorporeal shock-wave therapy was not effective for subacromial impingement syndrome but provided benefits for persistent shoulder calcific tendinitis. LIMITATIONS Non-English studies were excluded. CONCLUSIONS Most passive physical modalities do not benefit patients with subacromial impingement syndrome. However, low-level laser therapy is more effective than placebo or ultrasound for subacromial impingement syndrome. Similarly, shock-wave therapy is more effective than sham therapy for persistent shoulder calcific tendinitis.
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Ruiz-Molinero C, Jimenez-Rejano JJ, Chillon-Martinez R, Suarez-Serrano C, Rebollo-Roldan J, Perez-Cabezas V. Efficacy of therapeutic ultrasound in pain and joint mobility in whiplash traumatic acute and subacute phases. ULTRASOUND IN MEDICINE & BIOLOGY 2014; 40:2089-2095. [PMID: 25023094 DOI: 10.1016/j.ultrasmedbio.2014.04.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/27/2013] [Revised: 03/31/2014] [Accepted: 04/26/2014] [Indexed: 06/03/2023]
Abstract
To determine if ultrasound (US) is effective in reducing pain and mobility limitation in the treatment of traumatic cervical sprain, we performed an experimental study. The sample comprised 54 diagnosed subjects with a mean age of 36.54 y (standard deviation = 12.245), assigned by simple random selection to an experimental group with ultrasound treatment and a control group with placebo ultrasound. Treatment consisted of 10 sessions of an ultrasound treatment protocol, followed by 15 sessions of a protocol identical for both groups without ultrasound. The variables assessed were pain and joint mobility. There was no significant difference (p > 0.05) between groups in the first 10 sessions of treatment. However, there was a statistically significant difference (p < 0.05) between groups on the pain variable, 20 days after completion of the US. High-active ultrasound treatment is more effective than placebo in reducing pain.
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Cheville AL, Basford JR. Role of rehabilitation medicine and physical agents in the treatment of cancer-associated pain. J Clin Oncol 2014; 32:1691-702. [PMID: 24799472 PMCID: PMC5569680 DOI: 10.1200/jco.2013.53.6680] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
PURPOSE To provide an overview of rehabilitation medicine- and physical modality-based approaches to cancer pain management, and to highlight the fact that these approaches are generally used in conjunction and that a majority are focused on minimizing pain during periods of mobility and the performance of activities of daily living. METHODS We performed a nonsystematic literature review and provide a description of the current standard of care. RESULTS Rehabilitative and physical modalities used to manage pain can be grouped into four categories: those that modulate nociception, stabilize or unload painful structures, influence physiological processes that indirectly influence nociception, or alleviate pain arising from the overloading of muscles and connective tissues that often occurs after surgery or with sarcopenia in late-stage cancer. Most modalities have been pragmatically refined over the years, and many have an evidence base, although few have been explicitly validated in the oncologic setting. With few exceptions, they are patient controlled and free of adverse effects. CONCLUSION Physical modalities and rehabilitation medicine offer a range of pain management approaches that may serve as beneficial adjuncts to the conventional systemic and interventional analgesic strategies used to control cancer-related pain. These approaches may be particularly beneficial to patients with movement-associated pain and those who are ambivalent regarding pharmacoanalgesia.
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Mathews K, Kronen PW, Lascelles D, Nolan A, Robertson S, Steagall PVM, Wright B, Yamashita K. Guidelines for Recognition, Assessment and Treatment of Pain. J Small Anim Pract 2014; 55:E10-68. [DOI: 10.1111/jsap.12200] [Citation(s) in RCA: 178] [Impact Index Per Article: 17.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Campillo-Artero C, Kovacs FM. The use of risk sharing tools for post adoption surveillance of a non pharmacological technology in routine practice: results after one year. BMC Health Serv Res 2013; 13:181. [PMID: 23688287 PMCID: PMC3664591 DOI: 10.1186/1472-6963-13-181] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2012] [Accepted: 05/13/2013] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND To report results obtained by combining risk sharing tools with post-adoption surveillance mechanisms in order to control quality of care and implement a value-based reimbursement scheme for Neuro-reflexotherapy (NRT), a non-pharmacological treatment proven effective for neck pain (NP), thoracic pain (TP) and low back pain (LBP). METHODS Pre-post prospective cohort study in routine clinical practice, carried out in primary care centers in the Spanish National Health Service in the Balearic Islands (Ib-Salut). Eight-hundred and seventy-one subacute and chronic NP, TP and LBP patients treated in Ib-Salut, who underwent NRT during 2011. A shared risk contract (SRC) was developed, where payments for NRT were linked to results on patients' clinical evolution, reduction in medication and proportion of patients undergoing spinal surgery. Main outcome measures were local pain (NP, TP or LBP), referred pain, LBP-related disability and NP-related disability, measured using previously validated instruments at referral and 3 months later, use of medication assessed at referral and discharge, and rates of spinal surgery prescription after undergoing NRT. RESULTS Median improvements at discharge corresponded to 57.1% of baseline value for local pain, 75.0% for referred pain, 53.8% for LBP-related disability and 45.0% for NP-related disability. Patients taking medication at discharge represented 29.0% of those taking it at referral. The proportion of patients in whom spinal surgery was prescribed after undergoing NRT was 0%. These results were consistent with those from previous randomised controlled trials (RCTs) and studies in routine practice, and complied with the standards set in the SRC. CONCLUSIONS It is feasible and effective to enhance post adoption surveillance methods with risk sharing tools to improve quality control and support value-based reimbursement decisions for NRT. The feasibility of generalising this approach to other settings and to other non-pharmacological treatments should be explored.
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Affiliation(s)
| | - Francisco M Kovacs
- Spanish Back Pain Research Network, Madrid, Spain
- Scientific Department, Fundación Kovacs, Palma de Mallorca, Spain
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Licciardone JC, Minotti DE, Gatchel RJ, Kearns CM, Singh KP. Osteopathic manual treatment and ultrasound therapy for chronic low back pain: a randomized controlled trial. Ann Fam Med 2013; 11:122-9. [PMID: 23508598 PMCID: PMC3601389 DOI: 10.1370/afm.1468] [Citation(s) in RCA: 105] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
PURPOSE We studied the efficacy of osteopathic manual treatment (OMT) and ultrasound therapy (UST) for chronic low back pain. METHODS A randomized, double-blind, sham-controlled, 2 × 2 factorial design was used to study OMT and UST for short-term relief of nonspecific chronic low back pain. The 455 patients were randomized to OMT (n = 230) or sham OMT (n = 225) main effects groups, and to UST (n = 233) or sham UST (n = 222) main effects groups. Six treatment sessions were provided over 8 weeks. Intention-to-treat analysis was performed to measure moderate and substantial improvements in low back pain at week 12 (30% or greater and 50% or greater pain reductions from baseline, respectively). Five secondary outcomes, safety, and treatment adherence were also assessed. RESULTS There was no statistical interaction between OMT and UST. Patients receiving OMT were more likely than patients receiving sham OMT to achieve moderate (response ratio [RR] = 1.38; 95% CI, 1.16-1.64; P <.001) and substantial (RR = 1.41, 95% CI, 1.13-1.76; P = .002) improvements in low back pain at week 12. These improvements met the Cochrane Back Review Group criterion for a medium effect size. Back-specific functioning, general health, work disability specific to low back pain, safety outcomes, and treatment adherence did not differ between patients receiving OMT and sham OMT. Nevertheless, patients in the OMT group were more likely to be very satisfied with their back care throughout the study (P <.001). Patients receiving OMT used prescription drugs for low back pain less frequently during the 12 weeks than did patients in the sham OMT group (use ratio = 0.66, 95% CI, 0.43-1.00; P = .048). Ultrasound therapy was not efficacious. CONCLUSIONS The OMT regimen met or exceeded the Cochrane Back Review Group criterion for a medium effect size in relieving chronic low back pain. It was safe, parsimonious, and well accepted by patients.
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Affiliation(s)
- John C Licciardone
- The Osteopathic Research Center, University of North Texas Health Science Center, Fort Worth, TX 76107, USA.
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Seco J, Kovacs FM, Urrútia G. Recommendations on ultrasound for low back pain: profit-driven or evidence-based? Spine J 2012; 12:360; author reply 360-1. [PMID: 22656314 DOI: 10.1016/j.spinee.2012.01.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2011] [Accepted: 01/22/2012] [Indexed: 02/03/2023]
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Affiliation(s)
- Greg N Kawchuk
- Department of Physical Therapy, Faculty of Rehabilitation Medicine, Spinal Function Laboratory, University of Alberta, 3-44 Corbett Hall, Edmonton, Alberta, Canada T6G 2G4.
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