Role of shortwave and microwave diathermy in peripheral neuropathy

An overview of the non-procedural treatment options for peripheral neuropathic pain

Peripheral neuropathic pain is common in patients with peripheral nerve injury and can significantly impact both their function and quality of life. There is a wide variety of non-interventional treatment approaches, including pharmacologic therapy, physical/occupational therapy, modalities (therapeutic, mechanical, thermal, etc.), psychology, and lifestyle modification. First line pharmacologic therapy for peripheral neuropathic pain includes gabapentinoids, tricyclic antidepressants, and serotonin-norepinephrine reuptake inhibitors. Other classes of medications, such as topical treatments, opioids, and cannabinoids, have more limited usefulness in treatment but remain part of a treatment regimen. Physical and occupational therapy, psychological interventions, and lifestyle medicine are important adjuncts in the treatment and prevention of future peripheral neuropathic pain. The strength of the evidence supporting each intervention varies, with that for pharmacologic intervention being the strongest. A combination of these options tailored to the individual needs of the patient likely will result in the best treatment outcome for peripheral neuropathic pain.

The effectiveness of biophysical agents in the treatment of carpal tunnel syndrome- an umbrella review

BACKGROUND

Our objective was to summarize, synthesize, and integrate the evidence evaluating the effectiveness of biophysical agents compared to other conservative treatments, for the management of carpal tunnel syndrome (CTS).

METHODS

This was an overview of systematic reviews (SRs). We searched several online databases and obtained SRs relating to managing CTS using biophysical agents. Two independent researchers screened and appraised the quality of the SRs using the A MeaSurement Tool to Assess systematic Reviews-2 appraisal tool. We extracted information related to study characteristics as well as the effectiveness of biophysical agents for CTS, the effect sizes, and between-group significances. We categorized the information based on the type of biophysical agent. We also performed a citation mapping and calculated the corrected covered area index.

RESULTS

We found 17 SRs addressing 12 different biophysical agents. The quality of the SRs was mainly critically low (n = 16) or low (n = 1). The evidence was inconclusive for the effectiveness of Low-level Laser therapy and favorable for the short-term efficacy of non-thermal ultrasound in improving symptom severity, function, pain, global rating of improvement, satisfaction with treatment, and other electrophysiological measures compared to manual therapy or placebo. Evidence was inconclusive for Extracorporeal Shockwave therapy, and favorable for the short-term effectiveness of Shortwave and Microwave Diathermy on pain and hand function. The corrected covered area index was lower than 35% indicating a low overlap of the SRs.

CONCLUSIONS

The findings were based on low-quality primary studies, with an unclear or high risk of bias, small sample sizes, and short follow-ups. Therefore, no recommendations can be made for the long-term effectiveness of any biophysical agents. High-quality evidence is needed to support evidence-based recommendations on the use of biophysical agents in the management of CTS.

PROSPERO REGISTRATION NUMBER

CRD42022319002, registered on 17/04/2022.

The Effects of Microwave Diathermy on Pain and Function in Chronic Low Back Pain Patients

The Article Abstract is not available.

Sol-gel dip-coated TiO2 nanofilms reduce heat production in titanium alloy implants produced by microwave diathermy

Objective: To verify that the TiO₂ nanofilm dip-coated by sol-gel can reduce titanium alloy implants (TAI)'s heat production after microwave diathermy (MD).Methods: The effect of 40 W and 60 W MD on the titanium alloy substrate coated with TiO₂ nanofilm (Experimental Group) and the titanium alloy substrate without film (Control Group) were analyzed in vitro and in vivo. Changes in the skeletal muscle around the implant were evaluated in ex vivo by histology.Results: After 20 min of MD, in vitro the temperature rise of the titanium substrate was less in the Experimental Group than in the Control Group (40 W: 1.4 °C vs. 2.6 °C, p < .01, 60 W: 2.5 °C vs. 3.7 °C, p < .01) and in vivo, the temperature rise of the muscle tissue adjacent to TAI was lower in the Experimental Group than in the Control Group (40 W: 3.29 °C vs. 4.8 °C, p < .01, 60 W: 4.16 °C vs. 6.52 °C, p < .01). Skeletal muscle thermal injury can be found in the Control Group but not in the Experimental Group.Conclusion: Sol-gel dip-coated TiO₂ nanofilm can reduce the heat production of TAIs under single 40～60 W and continuous 40 W MD and protect the muscle tissue adjacent to the implants against thermal injury caused by irradiation.

Microwaves, a potential treatment for bacteria: A review

Bacteria have brought great harm to the public, especially after the emergence of multidrug-resistant bacteria. This has rendered traditional antibiotic therapy ineffective. In recent years, hyperthermia has offered new treatments to remove bacteria. Microwaves (MW) are a component of the electromagnetic spectrum and can rapidly heat materials. Taking advantage of this characteristic of MW, related studies have shown that both thermal and non-thermal effects of MW can inactivate various bacteria. Even though the understanding of MW in the field of bacteria is not sufficient for widespread use at present, MW has performed well in dealing with microorganisms and controlling infection. This review will focus on the application of MW in bacteria and discuss the advantages, prospects and challenges of using MW in the bacterial field.

Infrared Thermography as a Non-Invasive Tool in Musculoskeletal Disease Rehabilitation—The Control Variables in Applicability—A Systematic Review

In recent years, the usefulness of infrared thermography (IRT) as a valuable supplementary imaging method in medical diagnostics, as well as for assessing the effects of the treatment of musculoskeletal injuries, has been increasingly confirmed. At the same time, great importance is attached to the standards of thermographic research, the fulfillment of which determines the correct methodology and interpretation of the results. This article discusses the medical applications of infrared thermography in musculoskeletal system diseases, with particular emphasis on its usefulness in assessing the therapeutic effects of physical treatments used in rehabilitation. The literature from the last decade that is available in the Medline and Web of Science databases has been reviewed. Among the physiotherapeutic methods used, the following were selected that directly affect the musculoskeletal system: cryotherapy, laser therapy, electrotherapy, diathermy, and massage. The article summarizes all the guidelines and recommendations for IR imaging in medicine and rehabilitation.

Effect of concentrated growth factor on lower lip hypoesthesia after osseous genioplasty: a prospective, split-mouth, double-blind randomized controlled trial

Lower lip hypoesthesia is the most common complication following osseous genioplasty. Concentrated growth factor (CGF) has recently been shown to improve neural regeneration. The aim of this study was to evaluate the effect of concentrated growth factor on neurosensory recovery after osseous genioplasty. Patients who underwent osseous genioplasty between June 2017 and February 2020 were enrolled. CGF was applied to the mental nerve on one side. The treatment side was randomized, and the other side was considered as the control. Lower lip hypoesthesia was assessed preoperatively and postoperatively (1 week, 1, 3, 6, and 9 months) using the two-point discrimination test and a 10-point visual analogue scale (self-reported paresthesia). The assessor was blinded. Twenty-six female patients completed the study. At 1 and 3 months, both the mean two-point discrimination value and mean visual analogue scale score were significantly lower in the CGF group than in the control group (P < 0.001). At 3 months, the percentage of patients with lower lip hypoesthesia in the CGF group was significantly lower than that in the control group (P < 0.001). Both groups showed resolution of lower lip hypoesthesia at 6 months. Concentrated growth factor may accelerate the recovery of long-standing sensory nerve impairment following mental osteotomy.

Trigeminal Traumatic Neuroma: a Comprehensive Review of the Literature Based On a Rare Case

PURPOSE OF REVIEW

Traumatic neuromas in general, and trigeminal traumatic neuromas in particular, are relatively rare entities originating from a damage to a corresponding nerve or its branches. This manuscript is a comprehensive review of the literature on trigeminal traumatic neuromas based on an interesting and challenging case of bilateral intraoral lesions.

RECENT FINDINGS

The diagnosis for this patient was bilateral trigeminal traumatic neuromas. It is possible that these patients have a genetic predisposition to the development of these lesions. It is a neuropathic pain condition and may mimic dental and other trigeminal pain entities. Topical treatment with lidocaine gel, utilizing a custom-made neurosensory stent, rendered the patient significant and sustained pain relief. Trigeminal traumatic neuromas present a diagnostic challenge even to a seasoned clinician, due to the complex clinical features that may mimic other entities. Topical medications such as local anesthetics may be a good viable alternative to systemic medications to manage the pain associated with the condition. Early identification of the lesion and the associated pain helps in the succinct management of symptomatic trigeminal traumatic neuromas.

Electroacupuncture for Temporomandibular Disorders: A Systematic Review of Randomized Controlled Trials

Although electroacupuncture (EA) is an effective treatment for pain relief, there has been no systematic review of EA treatment for temporomandibular disorder TMD. This systematic review aimed to evaluate the efficacy and safety of EA in TMD management. We searched 14 databases until April 2021 for randomized controlled trials (RCTs) evaluating the effects of EA on TMDs. Eleven RCTs with 667 patients that used three acupuncture points (ST6, ST7, and LI4) were included. Two RCTs reported significant effects of EA plus microwave treatment compared with EA treatment alone on the total effectiveness rate (TER) for TMD. Further, two studies reported that compared with ultrashort wave alone, EA plus ultrashort wave had a significant effect on the TER for TMD and visual analog scale. All RCTs did not report adverse events. Our findings demonstrated the positive potential of EA in TMD management. However, there was weak evidence regarding EA use for TMD management given the poor quality and small sample sizes of the included studies. In the future, well-designed RCTs are required. It is necessary to investigate clinical trials and systematic reviews to compare the effectiveness and safety of EA and acupuncture for TMD.

Effect of Neurodynamics Nerve Flossing on Femoral Neuropathy in Haemophilic Patients: A randomized controlled study

OBJECTIVE

Heamophilia is considered a disorder in both children and adolescents which may affect their quality of life seriously than their normal peers; this study investigated the impact of the Neurodynamics Nerve Flossing Technique (NFT) on femoral neuropathy in patients with haemophilia.

METHOD

Thirty haemophilic children with Femoral Neuropathy were randomly allocated into two equivalent groups; the study group which received Neurodynamics NFT of the femoral nerve and conventional therapy program, and the control group which received only the conventional therapy program, three sessions/week for 12 weeks. Femoral nerve motor conduction velocity (MCV) and level of pain sensation according to the Visual Analogue Scale (VAS), were assessed pre and post interventions.

RESULTS

post-treatment comparison between both groups revealed that there was a significant increase in femoral nerve MCV and reduction of pain sensation of the study group compared to the control group (p<0.05).

CONCLUSION

Neurodynamics Nerve flossing had a clear effect in the treatment of femoral neuropathy in children with haemophilia.

Efficacy of shortwave diathermy in ulnar nerve entrapment at the elbow: a double-blind randomized controlled clinical trial

OBJECTIVE

To investigate the efficacy of shortwave diathermy in treatment of ulnar nerve entrapment at the elbow.

DESIGN

The study was a double blind, randomized controlled clinical trial.

SETTING, PARTICIPANTS

A total of 76 adult patients diagnosed with ulnar nerve entrapment at the elbow clinically and electrophysiologically, were randomly assigned into two groups. Patients were evaluated at baseline, after completing treatment and 1 and 3 months after treatment. Physical examination, quick-DASH (disabilities of arm, shoulder, hand) and SF-36 (short form) questionnaires for daily life activities, dynamometer for grip strength, and visual analog scale for pain were used.

INTERVENTION

A total of 10 sessions of shortwave diathermy were applied to patients in treatment group as five sessions/week, 2 weeks. Control group was given placebo shortwave diathermy. Both groups were given elbow splints and informed to avoid symptom provoking activities.

MAIN OUTCOME MEASURES

Visual analog scale, grip strength, SF-36, and quick-DASH results.

RESULTS

Out of 76 patients, 61 of them completed the study where n = 31 for treatment group and n = 30 for control group. Mean age was 46.18 ± 13.45 years. There were 32 (52.5%) women and 29 (47.5%) men. The p values between groups 3 months after intervention for visual analog scale, quick-DASH, SF-36 questionnaire, and dynamometer were 0.669, 0.277, 0.604, and 0.126, respectively (p > 0.05).

CONCLUSION

Application of shortwave diathermy to patients with ulnar nerve neuropathy at the elbow was not associated with any difference in outcome.