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Zhang X, Guan M, Yi W, Li X, Ding X, He Y, Han W, Wang Z, Tang Q, Liao B, Shen J, Han X, Bai D. Smart Response Biomaterials for Pain Management. Adv Healthc Mater 2024:e2401555. [PMID: 39039990 DOI: 10.1002/adhm.202401555] [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: 04/27/2024] [Revised: 07/12/2024] [Indexed: 07/24/2024]
Abstract
The intricate nature of pain classification and mechanism constantly affects the recovery of diseases and the well-being of patients. Key medical challenges persist in devising effective pain management strategies. Therefore, a comprehensive review of relevant methods and research advancements in pain management is conducted. This overview covers the main categorization of pain and its developmental mechanism, followed by a review of pertinent research and techniques for managing pain. These techniques include commonly prescribed medications, invasive procedures, and noninvasive physical therapy methods used in rehabilitation medicine. Additionally, for the first time, a systematic summary of the utilization of responsive biomaterials in pain management is provided, encompassing their response to physical stimuli such as ultrasound, magnetic fields, electric fields, light, and temperature, as well as changes in the physiological environment like reactive oxygen species (ROS) and pH. Even though the application of responsive biomaterials in pain management remains limited and at a fundamental level, recent years have seen the examination and debate of relevant research findings. These profound discussions aim to provide trends and directions for future research in pain management.
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Affiliation(s)
- Xinyu Zhang
- Department of Rehabilitation Medicine, First Affiliated Hospital of Chongqing Medical University, Chongqing, 400010, P. R. China
| | - Mengtong Guan
- Department of Rehabilitation Medicine, First Affiliated Hospital of Chongqing Medical University, Chongqing, 400010, P. R. China
| | - Weiwei Yi
- Department of Rehabilitation Medicine, First Affiliated Hospital of Chongqing Medical University, Chongqing, 400010, P. R. China
| | - Xinhe Li
- Department of Rehabilitation Medicine, First Affiliated Hospital of Chongqing Medical University, Chongqing, 400010, P. R. China
| | - Xiaoqian Ding
- Department of Rehabilitation Medicine, First Affiliated Hospital of Chongqing Medical University, Chongqing, 400010, P. R. China
| | - Yi He
- Department of Rehabilitation Medicine, First Affiliated Hospital of Chongqing Medical University, Chongqing, 400010, P. R. China
| | - Wang Han
- Department of Rehabilitation Medicine, First Affiliated Hospital of Chongqing Medical University, Chongqing, 400010, P. R. China
| | - Zijie Wang
- Department of Rehabilitation Medicine, First Affiliated Hospital of Chongqing Medical University, Chongqing, 400010, P. R. China
| | - Qiuyu Tang
- Department of Rehabilitation Medicine, First Affiliated Hospital of Chongqing Medical University, Chongqing, 400010, P. R. China
| | - Bo Liao
- Department of Rehabilitation Medicine, First Affiliated Hospital of Chongqing Medical University, Chongqing, 400010, P. R. China
| | - Jieliang Shen
- Department of Rehabilitation Medicine, Bishan Hospital of Chongqing Medical University, Bishan Hospital of Chongqing, Chongqing, 402760, P. R. China
| | - Xiaoyu Han
- Department of Rehabilitation Medicine, First Affiliated Hospital of Chongqing Medical University, Chongqing, 400010, P. R. China
- State Key Laboratory of Ultrasound in Medicine and Engineering, Chongqing Medical University, Chongqing, 400016, China
| | - Dingqun Bai
- Department of Rehabilitation Medicine, First Affiliated Hospital of Chongqing Medical University, Chongqing, 400010, P. R. China
- State Key Laboratory of Ultrasound in Medicine and Engineering, Chongqing Medical University, Chongqing, 400016, China
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Chen Y, Nelson AM, Cohen SP. Chronic pain for rheumatological disorders: Pathophysiology, therapeutics and evidence. Joint Bone Spine 2024; 91:105750. [PMID: 38857874 DOI: 10.1016/j.jbspin.2024.105750] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2024] [Revised: 05/20/2024] [Accepted: 05/22/2024] [Indexed: 06/12/2024]
Abstract
Pain is the leading reason people seek orthopedic and rheumatological care. By definition, most pain can be classified as nociceptive, or pain resulting from non-neural tissue injury or potential injury, with between 15% and 50% of individuals suffering from concomitant neuropathic pain or the newest category of pain, nociplastic pain, defined as "pain arising from altered nociception despite no clear evidence of actual or threatened tissue damage, or of a disease or lesion affecting the somatosensory system." Pain classification is important because it affects treatment decisions at all levels of care. Although several instruments can assist with classifying treatment, physician designation is the reference standard. The appropriate treatment of pain should ideally involve multidisciplinary care including physical therapy, psychotherapy and integrative therapies when appropriate, and pharmacotherapy with non-steroidal anti-inflammatory drugs for acute, mechanical pain, membrane stabilizers for neuropathic and nociplastic pain, and serotonin-norepinephrine reuptake inhibitors and tricyclic antidepressants for all types of pain. For nonsurgical interventions, there is evidence to support a small effect for epidural steroid injections for an intermediate-term duration, and conflicting evidence for radiofrequency ablation to provide at least 6months of benefit for facet joint pain, knee osteoarthritis, and sacroiliac joint pain. Since pain and disability represent the top reason for elective surgery, it should be reserved for patients who fail conservative interventions. Risk factors for procedural failure are the same as risk factors for conservative treatment failure and include greater disease burden, psychopathology, opioid use, central sensitization and multiple comorbid pain conditions, poorly controlled preoperative and postoperative pain, and secondary gain.
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Affiliation(s)
- Yian Chen
- Department of Anesthesiology and Pain Medicine, University of Washington, Seattle, WA, USA
| | - Ariana M Nelson
- Department of Anesthesiology and Perioperative Care, University of California-Irvine, Orange, CA, USA
| | - Steven P Cohen
- Departments of Anesthesiology, Physical Medicine & Rehabilitation, Neurology, Psychiatry and Neurosurgery, Northwestern University Feinberg School of Medicine, Chicago, IL, USA; Departments of Anesthesiology & Critical Care Medicine, Neurology, Physical Medicine & Rehabilitation and Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, Baltimore, MD, USA; Departments of Physical Medicine & Rehabilitation and Anesthesiology, Walter Reed National Military Medical Center, Uniformed Services, University of the Health Sciences, Bethesda, MD,USA.
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Zhang X, Gao W, Zhou J, Dai H, Xiang X, Xu J. Low-intensity pulsed ultrasound in the treatment of masticatory myositis and temporomandibular joint synovitis: A clinical trial. JOURNAL OF STOMATOLOGY, ORAL AND MAXILLOFACIAL SURGERY 2024; 125:101632. [PMID: 37703917 DOI: 10.1016/j.jormas.2023.101632] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Revised: 09/06/2023] [Accepted: 09/10/2023] [Indexed: 09/15/2023]
Abstract
BACKGROUND Low-intensity pulsed ultrasound (LIPUS) is a non-invasive physical stimulation application for the therapy of articular cartilage injury. This study aimed to explore the therapeutic effects of low-intensity pulsed ultrasound in treating masticatory myositis and synovitis in temporomandibular joint disorders and to establish an evaluation system to evaluate the clinical efficacy. METHODS TMD patients who met the inclusion criteria in the temporomandibular joint clinic of the affiliated Stomatological Hospital of Chongqing Medical University from April 3, 2021, to December 2021 were selected. Before the start and after 7 days of LIPUS treatment, the Fricton temporomandibular joint disorder index, Visual Analog Scale (VAS), and Pressure Difference of Precision Manometer (PD) were measured. A paired t-test was used to compare the values of the Fricton index, VAS, and PD before and after treatment in each group. One-way ANOVA analysis of variance was used to compare the differences between groups. RESULTS After one week of LIPUS treatment, the PI, DI and CMI of the Fricton index in the masticatory myositis (PI: P < 0.001; CMI: P < 0.001; DI: P = 0.2641, ns) and the synovitis group (DI: P < 0.001; CMI: P < 0.001, PI: P = 0.9729, ns) significantly decreased. The VAS of the masticatory myositis group and the synovitis group were significantly reduced (P < 0.001). The PD between the affected and healthy sides of the masticatory myositis group and the synovitis group was significantly reduced (P < 0.001), and the reduction was more evident in the M group. CONCLUSIONS LIPUS is effective in pain relief in patients with masticatory myositis and joint synovitis, meanwhile, masticatory myositis was more sensitive to LIPUS. A new comprehensive clinical efficacy evaluation system which includes PV, FI, and VAS was created to better 2 diagnose masticatory myositis and joint synovitis.
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Affiliation(s)
- Xiaoqing Zhang
- Stomatological Hospital of Chongqing Medical University, No. 426 Songshi North Road, Chongqing, China; Chongqing Key Laboratory for Oral Diseases and Biomedical Sciences, Chongqing, China; Chongqing Municipal Key Laboratory of Oral Biomedical Engineering of Higher Education, Chongqing, China
| | - Wentong Gao
- Stomatological Hospital of Chongqing Medical University, No. 426 Songshi North Road, Chongqing, China; Chongqing Key Laboratory for Oral Diseases and Biomedical Sciences, Chongqing, China; Chongqing Municipal Key Laboratory of Oral Biomedical Engineering of Higher Education, Chongqing, China
| | - Jianping Zhou
- Stomatological Hospital of Chongqing Medical University, No. 426 Songshi North Road, Chongqing, China; Chongqing Key Laboratory for Oral Diseases and Biomedical Sciences, Chongqing, China; Chongqing Municipal Key Laboratory of Oral Biomedical Engineering of Higher Education, Chongqing, China
| | - Hongwei Dai
- Stomatological Hospital of Chongqing Medical University, No. 426 Songshi North Road, Chongqing, China; Chongqing Key Laboratory for Oral Diseases and Biomedical Sciences, Chongqing, China; Chongqing Municipal Key Laboratory of Oral Biomedical Engineering of Higher Education, Chongqing, China
| | - Xuerong Xiang
- Stomatological Hospital of Chongqing Medical University, No. 426 Songshi North Road, Chongqing, China; Chongqing Key Laboratory for Oral Diseases and Biomedical Sciences, Chongqing, China; Chongqing Municipal Key Laboratory of Oral Biomedical Engineering of Higher Education, Chongqing, China.
| | - Jie Xu
- Stomatological Hospital of Chongqing Medical University, No. 426 Songshi North Road, Chongqing, China; Chongqing Key Laboratory for Oral Diseases and Biomedical Sciences, Chongqing, China; Chongqing Municipal Key Laboratory of Oral Biomedical Engineering of Higher Education, Chongqing, China.
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Wei D, Yue J, Meng J, Gao J, Yang L, Niu X, Wang Z. Preliminary study of the effect of low-intensity focused ultrasound on postpartum uterine involution and breast pain in puerperal women: a randomised controlled trial. Sci Rep 2024; 14:658. [PMID: 38182657 PMCID: PMC10770318 DOI: 10.1038/s41598-024-51328-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Accepted: 01/03/2024] [Indexed: 01/07/2024] Open
Abstract
To evaluate the safety and efficacy of low-intensity focused ultrasound (LIFU) therapy in facilitating fundus descent and relieving postpartum breast pain compared with sham treatment. A multicentre, randomised, sham-controlled, blinded trial was conducted. A cohort of 176 eligible participants, who had normal prenatal check-ups and met the inclusion and exclusion criteria, were recruited from three medical centres and subsequently randomized into either the LIFU or sham group. All participants received three treatment sessions, wherein LIFU signal was applied to the uterus and breast sites using coupling gel, with the absence of ultrasound signal output in the sham group. Fundal height measurement and breast pain score were performed after each treatment. The primary outcome, uterine involution, was presented by measuring the fundal height of the uterus. The visual analogue scale (VAS) score, as a secondary outcome, was used to assess breast pain and determine the correlation between breast pain and fundal height as the outcome simultaneously. All participants were randomly assigned to either the LIFU group (n = 88) or sham group (n = 88), with seven individuals not completing the treatment. Overall, a statistically significant difference was noted in the rate and index of fundus descent after each treatment. The rate and index of fundus descent showed greater significance following the second treatment (rate: 1.5 (1.0, 2.0) cm/d; index: 0.15 (0.1, 0.18), P < 0.001) and third treatment (rate: 1.67 (1.33, 2.0) cm/d; index: 0.26 (0.23, 0.3), P < 0.001) in the LIFU group. VAS scores, which were based on the continuous variables for the baseline, first, second, and third treatments in the LIFU group (2.0 (2.0, 3.0), 1.0 (0.0, 2.0), 0.0 (0.0, 1.0), and 0.0 (0.0, 0.0) points, respectively), and the sham group (2.0 (2.0, 2.0), 2.0 (1.0, 2.0), 2.0 (1.0, 3.0), and 3.0 (1.0, 3.0) points, respectively), showed a statistically significant difference between the two groups. Meanwhile, the discrepancies in VAS score classification variables between the two groups were statistically significant. After the third treatment, a notable correlation was observed between the VAS score decrease and fundus descent rate; the more the VAS score decreased, the faster was the fundal decline rate in the LIFU group. LIFU therapy is safe and effective, contributing to the acceleration of uterine involution and the relief of postpartum breast pain.Trial ID The study has registered in the Chinese Clinical Trial Registry (ChiCTR2100049586) at 05/08/2021.
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Affiliation(s)
- Dongmei Wei
- Department of Gynecology and Obstetrics, West China Second Hospital, Sichuan University, Chengdu, 610041, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, China
| | - Jun Yue
- Department of Gynecology and Obstetrics, Sichuan Provincial People's Hospital, Chengdu, China
| | - Jian Meng
- Department of Gynecology and Obstetrics, West China Second Hospital, Sichuan University, Chengdu, 610041, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, China
| | - Jing Gao
- Department of Medicine, LIFU Research Institute, Chengdu, China
| | - Lei Yang
- Department of Medicine, LIFU Research Institute, Chengdu, China
| | - Xiaoyu Niu
- Department of Gynecology and Obstetrics, West China Second Hospital, Sichuan University, Chengdu, 610041, China.
- Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, China.
| | - Zhijian Wang
- Department of Gynecology and Obstetrics, Southern Hospital, Southern Medical University, Guangzhou, China.
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Vinikoor T, Dzidotor GK, Le TT, Liu Y, Kan HM, Barui S, Chorsi MT, Curry EJ, Reinhardt E, Wang H, Singh P, Merriman MA, D'Orio E, Park J, Xiao S, Chapman JH, Lin F, Truong CS, Prasadh S, Chuba L, Killoh S, Lee SW, Wu Q, Chidambaram RM, Lo KWH, Laurencin CT, Nguyen TD. Injectable and biodegradable piezoelectric hydrogel for osteoarthritis treatment. Nat Commun 2023; 14:6257. [PMID: 37802985 PMCID: PMC10558537 DOI: 10.1038/s41467-023-41594-y] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Accepted: 09/11/2023] [Indexed: 10/08/2023] Open
Abstract
Osteoarthritis affects millions of people worldwide but current treatments using analgesics or anti-inflammatory drugs only alleviate symptoms of this disease. Here, we present an injectable, biodegradable piezoelectric hydrogel, made of short electrospun poly-L-lactic acid nanofibers embedded inside a collagen matrix, which can be injected into the joints and self-produce localized electrical cues under ultrasound activation to drive cartilage healing. In vitro, data shows that the piezoelectric hydrogel with ultrasound can enhance cell migration and induce stem cells to secrete TGF-β1, which promotes chondrogenesis. In vivo, the rabbits with osteochondral critical-size defects receiving the ultrasound-activated piezoelectric hydrogel show increased subchondral bone formation, improved hyaline-cartilage structure, and good mechanical properties, close to healthy native cartilage. This piezoelectric hydrogel is not only useful for cartilage healing but also potentially applicable to other tissue regeneration, offering a significant impact on the field of regenerative tissue engineering.
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Affiliation(s)
- Tra Vinikoor
- Department of Biomedical Engineering, University of Connecticut, Storrs, CT, 06269, USA
- The Cato T. Laurencin Institute for Regenerative Engineering, University of Connecticut Health, Farmington, CT, 06030, USA
| | - Godwin K Dzidotor
- The Cato T. Laurencin Institute for Regenerative Engineering, University of Connecticut Health, Farmington, CT, 06030, USA
- Department of Chemical & Biomolecular Engineering, University of Connecticut, Storrs, CT, 06269, USA
| | - Thinh T Le
- Department of Mechanical Engineering, University of Connecticut, Storrs, CT, 06269, USA
| | - Yang Liu
- Center of Digital Dentistry/Department of Prosthodontics/Central Laboratory, Peking University School and Hospital of Stomatology & National Center for Stomatology & National Clinical Research Center for Oral Diseases & National Engineering Research Center of Oral Biomaterials and Digital Medical Devices & Beijing Key Laboratory of Digital Stomatology & NHC Research Center of Engineering and Technology for Computerized Dentistry & NMPA Key Laboratory for Dental Materials, Beijing, 100081, PR China
| | - Ho-Man Kan
- The Cato T. Laurencin Institute for Regenerative Engineering, University of Connecticut Health, Farmington, CT, 06030, USA
| | - Srimanta Barui
- The Cato T. Laurencin Institute for Regenerative Engineering, University of Connecticut Health, Farmington, CT, 06030, USA
| | - Meysam T Chorsi
- Department of Mechanical Engineering, University of Connecticut, Storrs, CT, 06269, USA
| | - Eli J Curry
- Eli Lilly and Company, 450 Kendall Street, Cambridge, MA, 02142, USA
- Department of Biomedical Engineering, University of Connecticut, Storrs, CT, 06269, USA
| | - Emily Reinhardt
- Department of Pathobiology and Veterinary Science, University of Connecticut, 61 North Eagleville Road, Unit 3089, Storrs, CT, 06269, USA
| | - Hanzhang Wang
- Pathology and Laboratory Medicine, University of Connecticut Health Center, 63 Farmington Avenue, Farmington, CT, 06030, USA
| | - Parbeen Singh
- Department of Mechanical Engineering, University of Connecticut, Storrs, CT, 06269, USA
| | - Marc A Merriman
- The Cato T. Laurencin Institute for Regenerative Engineering, University of Connecticut Health, Farmington, CT, 06030, USA
- Department of Chemical & Biomolecular Engineering, University of Connecticut, Storrs, CT, 06269, USA
| | - Ethan D'Orio
- Department of Advanced Manufacturing for Energy Systems Engineering, University of Connecticut, Storrs, CT, 06269, USA
| | - Jinyoung Park
- Department of Biomedical Engineering, University of Connecticut, Storrs, CT, 06269, USA
| | - Shuyang Xiao
- Department of Materials Science and Engineering & Institute of Materials Science, University of Connecticut, 25 King Hill Road, Unit 3136, Storrs, CT, 06269-3136, USA
| | - James H Chapman
- The Cato T. Laurencin Institute for Regenerative Engineering, University of Connecticut Health, Farmington, CT, 06030, USA
| | - Feng Lin
- Department of Mechanical Engineering, University of Connecticut, Storrs, CT, 06269, USA
| | - Cao-Sang Truong
- Department of Biomedical Engineering, University of Connecticut, Storrs, CT, 06269, USA
| | - Somasundaram Prasadh
- Center for Clean Energy Engineering, University of Connecticut, Storrs, CT, 06269, USA
| | - Lisa Chuba
- Center for Comparative Medicine, University of Connecticut Health Center, Farmington, CT, USA
| | - Shaelyn Killoh
- Center for Comparative Medicine, University of Connecticut Health Center, Farmington, CT, USA
| | - Seok-Woo Lee
- Department of Materials Science and Engineering & Institute of Materials Science, University of Connecticut, 25 King Hill Road, Unit 3136, Storrs, CT, 06269-3136, USA
- Institute of Materials Science, University of Connecticut, Storrs, CT, 06269, USA
| | - Qian Wu
- Pathology and Laboratory Medicine, University of Connecticut Health Center, 63 Farmington Avenue, Farmington, CT, 06030, USA
| | - Ramaswamy M Chidambaram
- Center for Comparative Medicine, University of Connecticut Health Center, Farmington, CT, USA
| | - Kevin W H Lo
- The Cato T. Laurencin Institute for Regenerative Engineering, University of Connecticut Health, Farmington, CT, 06030, USA
- Institute of Materials Science, University of Connecticut, Storrs, CT, 06269, USA
- Department of Medicine, University of Connecticut Health Center, Farmington, CT, 06030, USA
| | - Cato T Laurencin
- Department of Biomedical Engineering, University of Connecticut, Storrs, CT, 06269, USA
- The Cato T. Laurencin Institute for Regenerative Engineering, University of Connecticut Health, Farmington, CT, 06030, USA
- Department of Chemical & Biomolecular Engineering, University of Connecticut, Storrs, CT, 06269, USA
- Department of Materials Science and Engineering & Institute of Materials Science, University of Connecticut, 25 King Hill Road, Unit 3136, Storrs, CT, 06269-3136, USA
- Institute of Materials Science, University of Connecticut, Storrs, CT, 06269, USA
- Department of Orthopaedic Surgery University of Connecticut Health, Farmington, CT, 06030, USA
| | - Thanh D Nguyen
- Department of Biomedical Engineering, University of Connecticut, Storrs, CT, 06269, USA.
- Department of Mechanical Engineering, University of Connecticut, Storrs, CT, 06269, USA.
- Institute of Materials Science, University of Connecticut, Storrs, CT, 06269, USA.
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Das R, Le TT, Schiff B, Chorsi MT, Park J, Lam P, Kemerley A, Supran AM, Eshed A, Luu N, Menon NG, Schmidt TA, Wang H, Wu Q, Thirunavukkarasu M, Maulik N, Nguyen TD. Biodegradable piezoelectric skin-wound scaffold. Biomaterials 2023; 301:122270. [PMID: 37591188 PMCID: PMC10528909 DOI: 10.1016/j.biomaterials.2023.122270] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2022] [Revised: 04/12/2023] [Accepted: 08/06/2023] [Indexed: 08/19/2023]
Abstract
Electrical stimulation (ES) induces wound healing and skin regeneration. Combining ES with the tissue-engineering approach, which relies on biomaterials to construct a replacement tissue graft, could offer a self-stimulated scaffold to heal skin-wounds without using potentially toxic growth factors and exogenous cells. Unfortunately, current ES technologies are either ineffective (external stimulations) or unsafe (implanted electrical devices using toxic batteries). Hence, we propose a novel wound-healing strategy that integrates ES with tissue engineering techniques by utilizing a biodegradable self-charged piezoelectric PLLA (Poly (l-lactic acid)) nanofiber matrix. This unique, safe, and stable piezoelectric scaffold can be activated by an external ultrasound (US) to produce well-controlled surface-charges with different polarities, thus serving multiple functions to suppress bacterial growth (negative surface charge) and promote skin regeneration (positive surface charge) at the same time. We demonstrate that the scaffold activated by low intensity/low frequency US can facilitate the proliferation of fibroblast/epithelial cells, enhance expression of genes (collagen I, III, and fibronectin) typical for the wound healing process, and suppress the growth of S. aureus and P. aeruginosa bacteria in vitro simultaneously. This approach induces rapid skin regeneration in a critical-sized skin wound mouse model in vivo. The piezoelectric PLLA skin scaffold thus assumes the role of a multi-tasking, biodegradable, battery-free electrical stimulator which is important for skin-wound healing and bacterial infection prevention simultaneuosly.
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Affiliation(s)
- Ritopa Das
- Department of Biomedical Engineering, University of Connecticut, Storrs, CT, 06269, USA
| | - Thinh T Le
- Department of Mechanical Engineering, University of Connecticut, Storrs, CT, 06269, USA
| | - Benjamin Schiff
- Department of Physiology and Neurobiology, University of Connecticut, Storrs, CT, 06269, USA
| | - Meysam T Chorsi
- Department of Biomedical Engineering, University of Connecticut, Storrs, CT, 06269, USA; Department of Mechanical Engineering, University of Connecticut, Storrs, CT, 06269, USA
| | - Jinyoung Park
- Department of Biomedical Engineering, University of Connecticut, Storrs, CT, 06269, USA
| | - Priscilla Lam
- Molecular Cardiology and Angiogenesis Laboratory, Department of Surgery, University of Connecticut Health School of Medicine, Farmington, 06030, CT, USA
| | - Andrew Kemerley
- Molecular Cardiology and Angiogenesis Laboratory, Department of Surgery, University of Connecticut Health School of Medicine, Farmington, 06030, CT, USA
| | - Ajayan Mannoor Supran
- Molecular Cardiology and Angiogenesis Laboratory, Department of Surgery, University of Connecticut Health School of Medicine, Farmington, 06030, CT, USA
| | - Amit Eshed
- Department of Biomedical Engineering, Boston University, Boston, MA, 02215, USA
| | - Ngoc Luu
- Department of Biomedical Engineering, New York University, New York, NY, 10012, USA
| | - Nikhil G Menon
- Department of Biomedical Engineering, University of Connecticut Health Center, Farmington, 06030, CT, USA
| | - Tannin A Schmidt
- Department of Biomedical Engineering, University of Connecticut Health Center, Farmington, 06030, CT, USA; Institute of Materials Science, University of Connecticut, Storrs, CT, 06269, USA
| | - Hanzhang Wang
- Pathology and Laboratory Medicine, University of Connecticut Health Center, 263 Farmington Avenue, Farmington, CT, 06030, USA
| | - Qian Wu
- Pathology and Laboratory Medicine, University of Connecticut Health Center, 263 Farmington Avenue, Farmington, CT, 06030, USA
| | - Mahesh Thirunavukkarasu
- Molecular Cardiology and Angiogenesis Laboratory, Department of Surgery, University of Connecticut Health School of Medicine, Farmington, 06030, CT, USA
| | - Nilanjana Maulik
- Molecular Cardiology and Angiogenesis Laboratory, Department of Surgery, University of Connecticut Health School of Medicine, Farmington, 06030, CT, USA
| | - Thanh D Nguyen
- Department of Biomedical Engineering, University of Connecticut, Storrs, CT, 06269, USA; Department of Mechanical Engineering, University of Connecticut, Storrs, CT, 06269, USA; Institute of Materials Science, University of Connecticut, Storrs, CT, 06269, USA.
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7
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Shi Y, Wu W. Multimodal non-invasive non-pharmacological therapies for chronic pain: mechanisms and progress. BMC Med 2023; 21:372. [PMID: 37775758 PMCID: PMC10542257 DOI: 10.1186/s12916-023-03076-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Accepted: 09/11/2023] [Indexed: 10/01/2023] Open
Abstract
BACKGROUND Chronic pain conditions impose significant burdens worldwide. Pharmacological treatments like opioids have limitations. Non-invasive non-pharmacological therapies (NINPT) encompass diverse interventions including physical, psychological, complementary and alternative approaches, and other innovative techniques that provide analgesic options for chronic pain without medications. MAIN BODY This review elucidates the mechanisms of major NINPT modalities and synthesizes evidence for their clinical potential across chronic pain populations. NINPT leverages peripheral, spinal, and supraspinal mechanisms to restore normal pain processing and limit central sensitization. However, heterogeneity in treatment protocols and individual responses warrants optimization through precision medicine approaches. CONCLUSION Future adoption of NINPT requires addressing limitations in standardization and accessibility as well as synergistic combination with emerging therapies. Overall, this review highlights the promise of NINPT as a valuable complementary option ready for integration into contemporary pain medicine paradigms to improve patient care and outcomes.
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Affiliation(s)
- Yu Shi
- Department of Rehabilitation, Zhujiang Hospital, Southern Medical University, Guangzhou, 510282, China
| | - Wen Wu
- Department of Rehabilitation, Zhujiang Hospital, Southern Medical University, Guangzhou, 510282, China.
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Feng Y, Zhang Q, Li H, Qi Q, Tong Z, Rong D, Zhou Z. Design and characteristic analysis of flexible CNT film patch for potential application in ultrasonic therapy. NANOTECHNOLOGY 2023; 34:195502. [PMID: 36753751 DOI: 10.1088/1361-6528/acba1f] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Accepted: 02/07/2023] [Indexed: 06/18/2023]
Abstract
Ultrasonic therapy has drawn increasing attention due to its noninvasiveness, great sensitivity and strong penetration capabilities. However, most of traditional rigid ultrasonic probes cannot achieve a solid interfacial contact with irregular nonplanar surfaces, which leads to unstable therapeutic effects and limitations of widespread use in practical applications. In this paper, a new flexible ultrasonic patch based on carbon nanotube (CNT) films is designed and fabricated to achieve a potential application in ultrasonic therapy. This patch is composed of a CNT film, a thermal protective layer and a heat sinking layer, and has the advantages of simple structure, soft, ultrathin and completely conforming to the treatment area. Theoretical and experimental studies are performed to investigate the acoustic and temperature fields before and after deformation. Effects of key design parameters of the patch on acoustic performances and temperature distributions are revealed. Numerical results indicate that the CNT film patch can produce ultrasounds over a wide frequency range and temperatures under the threshold of burn injury whether it is bent or not. Furthermore, it is also noted that the sound waves emitted from the bending patch are focused at the center of the bending patch, which demonstrates that the target treatment area can be controlled.
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Affiliation(s)
- Yanxia Feng
- State Key Laboratory of Structure Analysis of Industrial Equipment, Department of Engineering Mechanics, International Research Center for Computational Mechanics, Dalian University of Technology, Dalian 116024, People's Republic of China
| | - Qilin Zhang
- State Key Laboratory of Structure Analysis of Industrial Equipment, Department of Engineering Mechanics, International Research Center for Computational Mechanics, Dalian University of Technology, Dalian 116024, People's Republic of China
| | - Houyang Li
- CAEP Software Center for High Performance Numerical Simulation, Chengdu, 610203, People's Republic of China
| | - Qianshou Qi
- State Key Laboratory of Structure Analysis of Industrial Equipment, Department of Engineering Mechanics, International Research Center for Computational Mechanics, Dalian University of Technology, Dalian 116024, People's Republic of China
| | - Zhenzhen Tong
- College of Locomotive and Rolling Stock Engineering, Dalian Jiaotong University, Dalian, 116028, People's Republic of China
| | - Dalun Rong
- School of Aeronautics and Astronautics, Sun Yat-Sen University, Guangzhou 510275, People's Republic of China
| | - Zhenhuan Zhou
- State Key Laboratory of Structure Analysis of Industrial Equipment, Department of Engineering Mechanics, International Research Center for Computational Mechanics, Dalian University of Technology, Dalian 116024, People's Republic of China
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9
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Čota S, Delimar V, Žagar I, Kovač Durmiš K, Kristić Cvitanović N, Žura N, Perić P, Laktašić Žerjavić N. Efficacy of therapeutic ultrasound in the treatment of chronic calcific shoulder tendinitis: a randomized trial. Eur J Phys Rehabil Med 2023; 59:75-84. [PMID: 36723056 PMCID: PMC10035437 DOI: 10.23736/s1973-9087.22.07715-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
BACKGROUND Calcific shoulder tendinitis (CST) is characterized by hydroxyapatite crystals deposition in the rotator cuff tendons. Therapeutic exercises have been the mainstay of CST treatment, and evidence for therapeutic ultrasound (T-US) utilization and efficacy is lacking. AIM This study aimed to determine whether 4500 J T-US combined with therapeutic exercises is superior to therapeutic exercises alone regarding calcification size reduction and symptom improvement in chronic symptomatic CST. DESIGN This is a double-blind, placebo-controlled study. SETTING This study was conducted at a University Department for Rheumatic Diseases and Rehabilitation of a University Hospital. POPULATION Patients with chronic CST were analyzed. METHODS After eligibility allocation, 46 patients with sonographically confirmed CST were divided into two groups (56 shoulders, 26 per group). Both groups performed the same therapeutic exercises for half an hour under physiotherapist supervision. In the treatment group T-US (4500 J, 10 minutes per session at a frequency of 1 MHz and an intensity of 1.5 W/cm2), and in the placebo group, sham T-US was applied for 4 weeks. Patients were assessed for: calcification size, shoulder pain, global health (GH), shoulder mobility (ROM), handgrip strength, Health Assessment Questionnaire Disability Index (HAQ-DI), Shoulder Pain and Disability Index (SPADI), and overall rehabilitation satisfaction. RESULTS All assessed variables improved in both groups. A significantly greater reduction in calcification size was recorded in the treatment group compared to placebo: -10.92% (IQR 4.61% to 19.38%) versus -5.04% (2.30% to 7.22%), P=0.008. There was a significantly greater decrease in HAQ-DI, reduction of VAS GH, and an increase in hand grip strength in the treatment group, while no significant differences were observed for other parameters between the groups. CONCLUSIONS Our results showed that adding the 4500 J T-US to therapeutic exercises in chronic symptomatic CST therapy resulted in greater calcification size reduction immediately following the treatment, as well as hand grip strength, HAQ-DI, and VAS GH improvement. CLINICAL REHABILITATION IMPACT 4500 J T-US combined with therapeutic exercises is more effective in reducing calcification size than therapeutic exercises alone in the treatment of chronic symptomatic CST.
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Affiliation(s)
- Stjepan Čota
- Department of Pediatric Orthopedics, Children's Hospital of Zagreb, Zagreb, Croatia
| | - Valentina Delimar
- Special Hospital for Medical Rehabilitation of Krapinske Toplice, Krapinske Toplice, Croatia
| | - Iva Žagar
- University Department for Rheumatic Diseases and Rehabilitation, University Hospital Centre of Zagreb, Zagreb, Croatia
- School of Medicine, University of Zagreb, Zagreb, Croatia
| | - Kristina Kovač Durmiš
- University Department for Rheumatic Diseases and Rehabilitation, University Hospital Centre of Zagreb, Zagreb, Croatia
- School of Medicine, University of Zagreb, Zagreb, Croatia
| | | | - Nikolino Žura
- University Department for Rheumatic Diseases and Rehabilitation, University Hospital Centre of Zagreb, Zagreb, Croatia
| | - Porin Perić
- University Department for Rheumatic Diseases and Rehabilitation, University Hospital Centre of Zagreb, Zagreb, Croatia
- School of Medicine, University of Zagreb, Zagreb, Croatia
| | - Nadica Laktašić Žerjavić
- University Department for Rheumatic Diseases and Rehabilitation, University Hospital Centre of Zagreb, Zagreb, Croatia -
- School of Medicine, University of Zagreb, Zagreb, Croatia
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10
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Moussadikine I, Nguyễn MV, Nich C, Arrigoni PP, Quinette Y, Crenn V. MRI Bone Abnormality of the Knee following Ultrasound Therapy: Case Report and Short Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:14202. [PMID: 36361081 PMCID: PMC9654887 DOI: 10.3390/ijerph192114202] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Revised: 10/27/2022] [Accepted: 10/28/2022] [Indexed: 06/16/2023]
Abstract
Ultrasound (US) therapy in sports and medical pathologies is widely used by many physiotherapists and sports medicine clinicians; however, data regarding their potential side effects remain rare. We report a case of a 21-year-old woman with iliotibial band (ITB) syndrome treated with a physiotherapy session combined with US therapy. She had twenty 7 min US sessions on the knee, for 3 months (US at 1 Mhz with an intensity between 1 and 2 W/cm2). Due to persistence of the ITB syndrome's symptomatology after the 3 months of physiotherapy sessions, an MRI (magnetic resonance imaging) was carried out and revealed osteonecrosis-like bone abnormalities on the external femoral condyle, the external tibial plateau, and the proximal fibula. In view of these lesions, the ultrasonic therapy was stopped, and a repeat MRI demonstrated the progressive disappearance of these imaging abnormalities one year after the last US (ultrasound) treatment. In light of this case, we propose here a short review of reported osseous "osteonecrosis" abnormalities associated with US therapies.
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Affiliation(s)
- Ismaël Moussadikine
- Orthopedic and Traumatology Unit, Nantes University Hospital, 1 Place Alexis Ricordeau, 44000 Nantes, France
| | - Mỹ-Vân Nguyễn
- Orthopedic and Traumatology Unit, Nantes University Hospital, 1 Place Alexis Ricordeau, 44000 Nantes, France
| | - Christophe Nich
- Orthopedic and Traumatology Unit, Nantes University Hospital, 1 Place Alexis Ricordeau, 44000 Nantes, France
- INSERM, UMRS 1229, Regenerative Medicine and Skeleton (RMeS), Nantes Université, ONIRIS, 44042 Nantes, France
| | - Pierre-Paul Arrigoni
- Radiology Department, Nantes University Hospital, 1 Place Alexis Ricordeau, 44000 Nantes, France
| | - Yonis Quinette
- Orthopedic and Traumatology Unit, Nantes University Hospital, 1 Place Alexis Ricordeau, 44000 Nantes, France
| | - Vincent Crenn
- Orthopedic and Traumatology Unit, Nantes University Hospital, 1 Place Alexis Ricordeau, 44000 Nantes, France
- CRCI2NA (Centre de Recherche en Cancérologie et Immunologie Nantes-Angers), INSERM UMR 1307, CNRS UMR 6075-Team 9 CHILD (Chromatin and Transcriptional Deregulation in Pediatric Bone Sarcoma), Nantes Université, 1 rue Gaston Veil, 44035 Nantes, France
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11
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Parkinson SD, Zanotto GM, Maldonado MD, King MR, Haussler KK. The Effect of Capacitive-Resistive Electrical Therapy on Neck Pain and Dysfunction in Horses. J Equine Vet Sci 2022; 117:104091. [PMID: 35908601 DOI: 10.1016/j.jevs.2022.104091] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2022] [Revised: 07/25/2022] [Accepted: 07/26/2022] [Indexed: 11/27/2022]
Abstract
Neck pain and stiffness are increasingly recognized in horses and often treated using multimodal pharmaceutical and rehabilitation approaches. In humans, deep tissue heating is reported to reduce neck pain and increase flexibility. The objective of this project was to determine the effects of capacitive-resistive electrical therapy on neck pain and stiffness in horses. A blinded, randomized, controlled clinical trial with 10 horses assigned to active and 10 horses assigned to sham treatment groups. Neck pain, stiffness, and muscle hypertonicity were assessed by manual palpation. Forelimb postural stability was evaluated using a portable media device with built-in inertial sensing components. All outcome parameters were recorded once weekly for four weeks. Using manufacturer recommendations, the treatment group received active capacitive-resistive electrical therapy to the lower cervical region (C4-C7), twice weekly for a total of six treatments, while the control group received a sham (inactive) treatment. Data was analyzed using a mixed model that was fit separately for each response variable. There were no significant differences noted over time or between groups for any outcome parameter evaluated. While neck pain and stiffness decreased by week three in both groups, the improvement was not significant. Limitations include the lack of a definitive pathoanatomic diagnosis of cervical pathology and in vivo temperature measurements. Capacitive-resistive electrical therapy was ineffective in reducing neck pain and dysfunction using the recommended treatment protocols. No short-term adverse effects were noted. Specific clinical applications and effective treatment parameters need further evaluation.
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Affiliation(s)
- Samantha D Parkinson
- Department of Clinical Sciences, College of Veterinary Medicine and Biomedical Sciences, Colorado State University, Fort Collins, CO; Present address: Samantha Parkinson, Department of Veterinary Preventive Medicine, The Ohio State University, Columbus, OH
| | - Gustavo M Zanotto
- Department of Clinical Sciences, College of Veterinary Medicine and Biomedical Sciences, Colorado State University, Fort Collins, CO
| | - Mikaela D Maldonado
- Department of Clinical Sciences, College of Veterinary Medicine and Biomedical Sciences, Colorado State University, Fort Collins, CO
| | - Melissa R King
- Department of Clinical Sciences, College of Veterinary Medicine and Biomedical Sciences, Colorado State University, Fort Collins, CO
| | - K K Haussler
- Department of Clinical Sciences, College of Veterinary Medicine and Biomedical Sciences, Colorado State University, Fort Collins, CO.
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12
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Bedside Point-of-Care Ultrasonography in Anesthesiology and Pain Management: A New Trend in Iran: A Narrative Review. Neuromodulation 2022. [DOI: 10.5812/ipmn-123157] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
: Since the emergence of ultrasonography, many specialists, including anesthesiologists, have become interested in its practices. Technological innovations in portable ultrasonography devices and their quality enable anesthesiologists to use ultrasonography in various medical conditions and improve their diagnostic and therapeutic interventions. This article clarifies the significance of point-of-care ultra-sonography (POCUS) and highlights the challenges ahead. POCUS can help regional anesthesiologists and pain physicians in vascular access, airway management, focused cardiac ultra-sound (FoCUS), lung ultrasound, gastric ultrasound, focus assessment with sonography in trauma (FAST), regional and neuraxial nerve blocks, and acute and chronic pain management. However, similar to any new clinical method, there are challenges to POCUS, especially in developing countries like Iran. These challenges include the need for more budget allocation for medical equipment and portable devices, developing a comprehensive local curriculum and transparent framework to train residents and postgraduates, creating and/or revising university policies, clinical coordination with healthcare networks, and collaboration with healthcare providers. This article expresses the importance and effectiveness of point-of-care sonography performed by anesthesiologists and pain specialists in Iran and highlights the challenges ahead.
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13
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A systematic review and meta-analysis of the effect of phonophoresis on patients with knee osteoarthritis. Sci Rep 2022; 12:12877. [PMID: 35896559 PMCID: PMC9329477 DOI: 10.1038/s41598-022-16084-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2021] [Accepted: 07/04/2022] [Indexed: 11/08/2022] Open
Abstract
This systematic review and meta-analysis investigated the effect of phonophoresis when various gel types were used. Medline (using PubMed), EMBASE, and Cochrane Central Register of Controlled Trials (CENTRAL) were used to search for relevant studies from the date of their inception to June 28, 2021. We included studies that were randomized controlled trials (RCTs), included patients with a diagnosis of knee osteoarthritis, included treatment with either phonophoresis or therapeutic ultrasound with placebo gel, and reported clinical and functional outcomes. Continuous variables are expressed as standardized mean differences (SMDs) with 95% confidence intervals (CIs). Statistical analysis was performed using RevMan 5.3 software. We initially retrieved 2176 studies and finally analyzed nine RCTs including 423 patients. The intervention group significantly outperformed the control group in pain scores with NSAID gel (SMD = - 0.53, 95% CI [- 1.02, - 0.05], I2 = 73%) and in the Western Ontario and McMaster Universities Arthritis Index (WOMAC) function score with corticosteroid gel (SMD = - 0.96, 95% CI [- 1.47, - 0.44], I2 = 20%). Phonophoresis alleviated pain and improved functional performance. Because of some limitations of this study, additional high-quality, large-scale RCTs are required to confirm the benefits.
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14
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Effect of Ultrasonic Penetration with Volatile Oil of Olibanum and Chuanxiong Rhizoma on Acute Knee Synovitis Induced by Sports Training: An Open-Label Randomized Controlled Study. Pain Res Manag 2022; 2022:6806565. [PMID: 35265234 PMCID: PMC8901337 DOI: 10.1155/2022/6806565] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Revised: 12/16/2021] [Accepted: 01/28/2022] [Indexed: 01/15/2023]
Abstract
Background Knee synovitis is a common sports injury. We proposed the use of UTVOR, which is a combination of the use of volatile oil of Olibanum (VOO) and volatile oil of Chuanxiong Rhizoma (VOCR) and conventional ultrasound (US) therapy, to treat knee synovitis. Design, Setting, Participants, and Interventions. Participants were randomly assigned into a control group (conventional US therapy group) and a test group (UTVOR group). The control group received conventional US therapy with a coupling agent as the medium. The test group received a revised US therapy with VOO and VOCR as media. Both groups were treated once per day for three consecutive days. Main Outcome Measures. The subjects' Visual Analogue Scale (VAS) pain score, Lysholm knee score, knee swelling degree, circumference, and range of motion of the knee joint were evaluated before the first treatment and 24 h after the third treatment. The VAS pain score was considered the primary outcome, while the three other measurements were regarded as the secondary outcomes. An adverse event was reported subjectively and recorded. Results A total of 116 participants were included in the analysis (test group: n = 64; control group: n = 52). The evaluation results showed that the VAS pain scores of the male and female participants in both groups decreased after treatment (P < 0.001), but only the difference among the male sub-group had significant between-group difference (P < 0.001). After treatment, the Lysholm scores in both groups increased significantly (all P < 0.001), the range of motion and the circumference of the injured knee decreased significantly (P < 0.001), while no between-group difference was observed in general or in the gender sub-groups (all P > 0.025). No side effect or complication was reported during the treatment. Conclusion UTVOR had a superior analgesic effect to conventional US therapy in the male population, but its effects on alleviating joint function, swelling, and range of motion were comparable to that of conventional US therapy. Our study found that UTVOR can be an effective method to reduce pain and treat knee synovitis, and it is subjectively safe. Trial registration. This study was registered under the Chinese Clinical Trial Registry (Trial Registration Number: ChiCTR2000035671).
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15
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Chen FR, Manzi JE, Mehta N, Gulati A, Jones M. A Review of Laser Therapy and Low-Intensity Ultrasound for Chronic Pain States. Curr Pain Headache Rep 2022; 26:57-63. [PMID: 35133560 DOI: 10.1007/s11916-022-01003-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/09/2021] [Indexed: 11/28/2022]
Abstract
PURPOSE OF REVIEW Chronic pain management therapies have expanded quickly over the past decade. In particular, the use of laser therapy and ultrasound in the management of chronic pain has risen in recent years. Understanding the uses of these types of therapies can better equip chronic pain specialists for managing complicated chronic pain syndromes. The purpose of this review was to summarize the current literature regarding laser radiation and ultrasound therapy used for managing chronic pain syndromes. RECENT FINDINGS In summary, there is stronger evidence supporting the usage of laser therapy for managing chronic pain states compared to low-intensity ultrasound therapies. As a monotherapy, laser therapy has proven to be beneficial in managing chronic pain in patients with a variety of pain syndromes. On the other hand, LIUS has less clear benefits as a monotherapy with an uncertain, optimal delivery method established. Both laser therapy and low-intensity ultrasound have proven beneficial in managing various pain syndromes and can be effective interventions, in particular, when utilized in combination therapy.
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Affiliation(s)
- Frank R Chen
- Department of Anesthesiology, Hospital of the University of Pennsylvania, 3400 Spruce Street, Philadelphia, PA, 19104, USA
| | - Joseph E Manzi
- Department of Interventional Pain Medicine, New-York Presbyterian Hospital, Weill Cornell Medical Center, 1300 York Ave, New York, NY, 10065, USA
| | - Neel Mehta
- Department of Interventional Pain Medicine, New-York Presbyterian Hospital, Weill Cornell Medical Center, 1300 York Ave, New York, NY, 10065, USA
| | - Amitabh Gulati
- Department of Chronic Pain Management, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY, 10065, USA
| | - Mark Jones
- Department of Interventional Pain Medicine, New-York Presbyterian Hospital, Weill Cornell Medical Center, 1300 York Ave, New York, NY, 10065, USA. .,Pain Medicine of the South, Knoxville, TN, 37934, USA.
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16
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Winkler SL, Urbisci AE, Best TM. Sustained acoustic medicine for the treatment of musculoskeletal injuries: a systematic review and meta-analysis. BMC Sports Sci Med Rehabil 2021; 13:159. [PMID: 34922606 PMCID: PMC8684070 DOI: 10.1186/s13102-021-00383-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Accepted: 11/18/2021] [Indexed: 11/10/2022]
Abstract
BACKGROUND Musculoskeletal injuries account for 10 million work-limited days per year and often lead to both acute and/or chronic pain, and increased chances of re-injury or permanent disability. Conservative treatment options include various modalities, nonsteroidal anti-inflammatory drugs, and physical rehabilitation programs. Sustained Acoustic Medicine is an emerging prescription home-use mechanotransductive device to stimulate cellular proliferation, increase microstreaming and cavitation in situ, and to increase tissue profusion and permeability. This research aims to summarize the clinical evidence on Sustained Acoustic Medicine and measurable outcomes in the literature. METHODS A systematic literature review was conducted using PubMed, EBSCOhost, Academic Search Complete, Google Scholar and ClinicalTrials.gov to identify studies evaluating the effects of Sustained Acoustic Medicine on the musculoskeletal system of humans. Articles identified were selected based on inclusion criteria and scored on the Downs and Black checklist. Study design, clinical outcomes and primary findings were extracted from included studies for synthesis and meta-analysis statistics. RESULTS A total of three hundred and seventy-two participants (372) were included in the thirteen clinical research studies reviewed including five (5) level I, four (4) level II and four (4) level IV studies. Sixty-seven (67) participants with neck and back myofascial pain and injury, one hundred and fifty-six (156) participants with moderate to severe knee pain and radiographically confirmed knee osteoarthritis (Kellgren-Lawrence grade II/III), and one hundred forty-nine (149) participants with generalized soft-tissue injury of the elbow, shoulder, back and ankle with limited function. Primary outcomes included daily change in pain intensity, change in Western Ontario McMaster Osteoarthritis Questionnaire, change in Global Rate of Change, and functional outcome measures including dynamometry, grip strength, range-of-motion, and diathermic heating (temperature measurement). CONCLUSION Sustained Acoustic Medicine treatment provides tissue heating and tissue recovery, improved patient function and reduction of pain. When patients failed to respond to physical therapy, Sustained Acoustic Medicine proved to be a useful adjunct to facilitate healing and return to work. As a non-invasive and non-narcotic treatment option with an excellent safety profile, Sustained Acoustic Medicine may be considered a good therapeutic option for practitioners.
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Affiliation(s)
| | | | - Thomas M Best
- UHealth Sports Medicine Institute, University of Miami, Coral Gables, FL, USA.
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17
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Gosch M, Pils K, Venkat S, Singler K. [Aspects of multimodal pain therapy in old age]. Z Gerontol Geriatr 2021; 54:823-832. [PMID: 34319451 DOI: 10.1007/s00391-021-01952-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Accepted: 06/21/2021] [Indexed: 11/29/2022]
Abstract
Chronic pain in older adults should be explained and treated on the basis of the biopsychosocial model. With its interdisciplinary and interprofessional approach, multimodal pain therapy is the method of choice. In old age freedom from pain is usually not the primary goal. It is more important to restore the quality of life of those affected and to maintain independence and autonomy with a versatile treatment offer. This article explains the basics of multimodal pain therapy and its special features in old age.
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Affiliation(s)
- M Gosch
- Medizinische Klinik 2, Schwerpunkt Geriatrie, Klinikum Nürnberg, Paracelsus Medizinische Privatuniversität Nürnberg, Prof. Ernst-Nathan-Str. 1, 90419, Nürnberg, Deutschland.
| | - K Pils
- Institut für Physikalische Medizin und Rehabilitation, Wiener Gesundheitsverbund - Klinik Favoriten, Kundratstr. 1, 1100, Wien, Österreich
| | - S Venkat
- Klinik für Psychosomatische Medizin und Psychotherapie, Schmerztagesklinik, Klinikum Nürnberg, Paracelsus Medizinische Privatuniversität Nürnberg, Prof. Ernst-Nathan-Str. 1, 90419, Nürnberg, Deutschland
| | - K Singler
- Medizinische Klinik 2, Schwerpunkt Geriatrie, Klinikum Nürnberg, Paracelsus Medizinische Privatuniversität Nürnberg, Prof. Ernst-Nathan-Str. 1, 90419, Nürnberg, Deutschland.,Institut für Biomedizin des Alterns, Friedrich-Alexander-Universität Erlangen-Nürnberg, Kobergerstr. 60, 90408, Nürnberg, Deutschland
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18
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Uddin SMZ, Komatsu DE, Motyka T, Petterson S. Low-Intensity Continuous Ultrasound Therapies—A Systematic Review of Current State-of-the-Art and Future Perspectives. J Clin Med 2021; 10:2698. [PMID: 34207333 PMCID: PMC8235587 DOI: 10.3390/jcm10122698] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Revised: 06/10/2021] [Accepted: 06/14/2021] [Indexed: 01/02/2023] Open
Abstract
Therapeutic ultrasound has been studied for over seven decades for different medical applications. The versatility of ultrasound applications are highly dependent on the frequency, intensity, duration, duty cycle, power, wavelength, and form. In this review article, we will focus on low-intensity continuous ultrasound (LICUS). LICUS has been well-studied for numerous clinical disorders, including tissue regeneration, pain management, neuromodulation, thrombosis, and cancer treatment. PubMed and Google Scholar databases were used to conduct a comprehensive review of all research studying the application of LICUS in pre-clinical and clinical studies. The review includes articles that specify intensity and duty cycle (continuous). Any studies that did not identify these parameters or used high-intensity and pulsed ultrasound were not included in the review. The literature review shows the vast implication of LICUS in many medical fields at the pre-clinical and clinical levels. Its applications depend on variables such as frequency, intensity, duration, and type of medical disorder. Overall, these studies show that LICUS has significant promise, but conflicting data remain regarding the parameters used, and further studies are required to fully realize the potential benefits of LICUS.
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Affiliation(s)
- Sardar M. Z. Uddin
- Department of Orthopaedics and Rehabilitation, Stony Brook University, Stony Brook, NY 11794, USA;
| | - David E. Komatsu
- Department of Orthopaedics and Rehabilitation, Stony Brook University, Stony Brook, NY 11794, USA;
| | - Thomas Motyka
- Department of Osteopathic Manipulative Medicine, Campbell University, Buies Creek, NC 27506, USA;
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Király M, Gömöri E, Kiss R, Nógrádi N, Nusser N, Hodosi K, Bender T. Effects of various types of ultrasound therapy in hip osteoarthritis - a double-blind, randomized, controlled, follow-up study. Physiother Theory Pract 2021; 38:1958-1968. [PMID: 33715574 DOI: 10.1080/09593985.2021.1895386] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Purpose: To compare the effects of various types of ultrasound therapy (UST) on pain, function, and quality of life in patients with hip osteoarthritis.Methods: Seventy-one patients receiving conventional physiotherapy (exercise, massage, and balneotherapy), were randomly allocated into four treatment groups: (1) continuous UST, (2) pulsed UST, (3) UST combined with transcutaneous electrical nerve stimulation (TENS), (4) placebo UST. We evaluated the hip pain (Visual Analog Scale), medication use, functional impairment (Western Ontario and McMaster Universities Arthritis Index; 6-minute walking test) and quality of life (SF-36) before, right after the treatments, and at 3 months follow-up.Results: Resting pain improved significantly in all treatment groups at the follow-up visit compared to baseline (p (group1-4) ≤0.002). The proportion of patients achieving Minimal Clinically Important Improvement (MCII) in function at month 3 was the highest in group 3 (73%). The 6-minute walking test significantly improved in each group during the follow-up period (p (group1-4) ≤ 0.025). Pain (p (group1-4) ≤ 0.014) and general health domains of the SF-36 showed the greatest improvement (p (group 2-4) ≤ 0.018).Conclusions: There was no difference among the effects of various types of UST on pain, function, and quality of life in the treatment of hip osteoarthritis. Additional ultrasound treatment is not likely to increase the effect of the conventional therapy on pain and function in hip osteoarthritis.
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Affiliation(s)
- Márta Király
- Rheumatology Department, Petz Aladár County Teaching Hospital, Győr, Hungary
| | - Edina Gömöri
- Rheumatology Department, Petz Aladár County Teaching Hospital, Győr, Hungary
| | - Rita Kiss
- Rheumatology Department, Petz Aladár County Teaching Hospital, Győr, Hungary
| | - Noémi Nógrádi
- Rheumatology Department, Petz Aladár County Teaching Hospital, Győr, Hungary
| | - Nóra Nusser
- Rehabilitation Department, Zsigmondy Vilmos Harkány Spa Hospital, Harkány, Hungary
| | - Katalin Hodosi
- Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - Tamás Bender
- Physiotherapy Department, Polyclinic of Hospitaller Brothers of St. John of God, Budapest, Budapest, Hungary
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Madzia A, Agrawal C, Jarit P, Petterson S, Plancher K, Ortiz R. Sustained Acoustic Medicine Combined with A Diclofenac Ultrasound Coupling Patch for the Rapid Symptomatic Relief of Knee Osteoarthritis: Multi-Site Clinical Efficacy Study. Open Orthop J 2020; 14:176-185. [PMID: 33408796 PMCID: PMC7784557 DOI: 10.2174/1874325002014010176] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Revised: 09/07/2020] [Accepted: 09/17/2020] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Sustained Acoustic Medicine (SAM) is an emerging, non-invasive, non-narcotic, home-use ultrasound therapy for the daily treatment of joint pain. The aim of this multi-site clinical study was to examine the efficacy of long-duration continuous ultrasound combined with a 1% diclofenac ultrasound gel patch in treating pain and improving function in patients with knee osteoarthritis. METHODS The Consolidated Standards of Reporting Trials (CONSORT) were followed. Thirty-two (32) patients (18-males, 14-females) 54 years of average age with moderate to severe knee pain and radiographically confirmed knee osteoarthritis (Kellgren-Lawrence (KL) grade II/III) were enrolled for treatment with the SAM device and diclofenac patch applied daily to the treated knee. SAM ultrasound (3 MHz, 0.132 W/cm2, 1.3 W) and 6 grams of 1% diclofenac were applied with a wearable device for 4 hours daily for 1 week, delivering 18,720 Joules of ultrasound energy per treatment. The primary outcome was the daily change in pain intensity using a numeric rating scale (NRS 0-10), which was assessed prior to intervention (baseline, day 1), before and after each daily treatment, and after 1 week of daily treatment (day 7). Rapid responders were classified as those patients exhibiting greater than a 1-point reduction in pain following the first treatment. Change in Western Ontario McMaster Osteoarthritis Questionnaire (WOMAC) score from baseline to day 7 was the secondary functional outcome measure. Additionally, a series of daily usability and user experience questions related to devising ease of use, functionality, safety, and effectiveness, were collected. Data were analyzed using t-tests and repeated measure ANOVAs. RESULTS The study had a 94% retention rate, and there were no adverse events or study-related complaints across 224 unique treatment sessions. Rapid responders included 75% of the study population. Patients exhibited a significant mean NRS pain reduction over the 7-day study of 2.06-points (50%) for all subjects (n=32, p<0.001) and 2.96-points (70%) for rapid responders (n=24, p<0.001). The WOMAC functional score significantly improved by 351 points for all subjects (n=32, p<0.001), and 510 points for rapid responders (n=24, p<0.001). Over 95% of patients found the device safe, effective and easy to use, and would continue treatment for their knee OA symptoms. CONCLUSION Sustained Acoustic Medicine combined with 1% topical diclofenac rapidly reduced pain and improved function in patients with moderate to severe osteoarthritis-related knee pain. The clinical findings suggest that this treatment approach may be used as a conservative, non-invasive treatment option for patients with knee osteoarthritis. Additional research is warranted on non-weight bearing joints of the musculoskeletal system as well as different topical drugs that could benefit from improved localized delivery.Clinical Trial Registry Number: (NCT04391842).
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Affiliation(s)
- Alex Madzia
- Department of Biomedical Engineering, University of Cincinnati, Cincinnati, OH 45219, USA
| | - Chirag Agrawal
- Department of Biomedical Engineering, University of Cincinnati, Cincinnati, OH 45219, USA
| | - Paddy Jarit
- Sport and Orthopaedic Physical Therapy, Fairfield, CT 06824, USA
| | | | - Kevin Plancher
- Albert Einstein College of Medicine, Bronx, NY, New York, USA
- Weill Cornell Medical College, New York, NY 13053, USA
- Plancher Orthopaedics & Sports Medicine, New York, NY 13053, USA
| | - Ralph Ortiz
- Medical Pain Consultants, Dryden, NY 13053, USA
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Papadopoulos ES, Mani R. The Role of Ultrasound Therapy in the Management of Musculoskeletal Soft Tissue Pain. INT J LOW EXTR WOUND 2020; 19:350-358. [DOI: 10.1177/1534734620948343] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Ultrasound is an invaluable physical modality widely used for diagnosis and therapy in humans and animals. It is noninvasive, atraumatic, and may be used repeatedly. As a therapeutic tool, ultrasound has been in use for some 6 decades. Therapeutic ultrasound (TUS) is used for the treatment of musculoskeletal disorders, including acute soft tissue injuries, overuse syndromes, as well as chronic orthopedic and rheumatologic conditions. The aim of this review was to investigate the clinical effectiveness of TUS in musculoskeletal acute and chronic pain, mainly through the control of inflammation and the promotion of soft tissue injury healing. Based on the evidence presented, TUS is clinically effective in some musculoskeletal soft tissue pain conditions, but due to conflicting results in some studies, no specific positive recommendations can be made, nor does it permit exclusion of TUS from clinical practice. In phonophoresis, TUS plays a significant role, without reported adverse effects. There is scope for improving the evidence base with better designed studies.
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Affiliation(s)
| | - Raj Mani
- Shanghai Jiao Tong University, Shanghai, China
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Gulati A, Ottestad E. Hearing the Call for Therapeutic Ultrasound. PAIN MEDICINE 2020; 21:1317-1318. [DOI: 10.1093/pm/pnaa156] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Affiliation(s)
- Amitabh Gulati
- Anesthesiology, Memorial Sloan Kettering Cancer Center, New York, New York
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