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Toledano-Macías E, Martínez-Pascual MA, Cecilia-Matilla A, Bermejo-Martínez M, Pérez-González A, Jara RC, Sacristán S, Hernández-Bule ML. Radiofrequency Currents Modulate Inflammatory Processes in Keratinocytes. Int J Mol Sci 2024; 25:10663. [PMID: 39408993 PMCID: PMC11476504 DOI: 10.3390/ijms251910663] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2024] [Revised: 09/30/2024] [Accepted: 10/01/2024] [Indexed: 10/20/2024] Open
Abstract
Keratinocytes play an essential role in the inflammatory phase of wound regeneration. In addition to migrating and proliferating for tissue regeneration, they produce a large amount of cytokines that modulate the inflammatory process. Previous studies have shown that subthermal treatment with radiofrequency (RF) currents used in capacitive resistive electric transfer (CRET) therapy promotes the proliferation of HaCat keratinocytes and modulates their cytokine production. Although physical therapies have been shown to have anti-inflammatory effects in a variety of experimental models and in patients, knowledge of the biological basis of these effects is still limited. The aim of this study was to investigate the effect of CRET on keratinocyte proliferation, cytokine production (IL-8, MCP-1, RANTES, IL-6, IL-11), TNF-α secretion, and the expression of MMP9, MMP1, NF-κB, ERK1/2, and EGFR. Human keratinocytes (HaCat) were treated with an intermittent 448 kHz electric current (CRET signal) in subthermal conditions and for different periods of time. Cell proliferation was analyzed by XTT assay, cytokine and TNF-α production by ELISA, NF-κB expression and activation by immunofluorescence, and MMP9, MMP1, ERK1/2, and EGF receptor expression and activation by immunoblot. Compared to a control, CRET increases keratinocyte proliferation, increases the transient release of MCP-1, TNF-α, and IL-6 while decreasing IL-8. In addition, it modifies the expression of MMPs and activates EGFR, NF-κB, and ERK1/2 proteins. Our results indicate that CRET reasonably modifies cytokine production through the EGF receptor and the ERK1/2/NF-κB pathway, ultimately modulating the inflammatory response of human keratinocytes.
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Affiliation(s)
- Elena Toledano-Macías
- Photobiology and Bioelectromagnetic Lab, Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), Hospital Ramón y Cajal, Crta. Colmenar Viejo, km. 9.100, 28034 Madrid, Spain; (E.T.-M.); (M.A.M.-P.); (R.C.J.)
| | - María Antonia Martínez-Pascual
- Photobiology and Bioelectromagnetic Lab, Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), Hospital Ramón y Cajal, Crta. Colmenar Viejo, km. 9.100, 28034 Madrid, Spain; (E.T.-M.); (M.A.M.-P.); (R.C.J.)
| | - Almudena Cecilia-Matilla
- Angiology and Vascular Surgery Service, Hospital Ramón y Cajal, Crta. Colmenar Viejo, km. 9.100, 28034 Madrid, Spain; (A.C.-M.); (M.B.-M.)
| | - Mariano Bermejo-Martínez
- Angiology and Vascular Surgery Service, Hospital Ramón y Cajal, Crta. Colmenar Viejo, km. 9.100, 28034 Madrid, Spain; (A.C.-M.); (M.B.-M.)
| | - Alfonso Pérez-González
- Dermatology Service, Hospital Ramón y Cajal, Crta. Colmenar Viejo, km. 9.100, 28034 Madrid, Spain;
| | - Rosa Cristina Jara
- Photobiology and Bioelectromagnetic Lab, Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), Hospital Ramón y Cajal, Crta. Colmenar Viejo, km. 9.100, 28034 Madrid, Spain; (E.T.-M.); (M.A.M.-P.); (R.C.J.)
| | - Silvia Sacristán
- Aptamer Group, Histology Lab, Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), Hospital Ramón y Cajal, Crta. Colmenar Viejo, km. 9.100, 28034 Madrid, Spain;
| | - María Luisa Hernández-Bule
- Photobiology and Bioelectromagnetic Lab, Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), Hospital Ramón y Cajal, Crta. Colmenar Viejo, km. 9.100, 28034 Madrid, Spain; (E.T.-M.); (M.A.M.-P.); (R.C.J.)
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2
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Viva MG, Sveva V, Ruggiero M, Fai A, Savina A, Perrone R, Donati D, Tedeschi R, Monticone M, Farì G, Bernetti A. Efficacy and Accuracy of Ultrasound Guided Injections in the Treatment of Cervical Facet Joint Syndrome: A Systematic Review. J Clin Med 2024; 13:5290. [PMID: 39274505 PMCID: PMC11396720 DOI: 10.3390/jcm13175290] [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: 07/12/2024] [Revised: 08/23/2024] [Accepted: 09/04/2024] [Indexed: 09/16/2024] Open
Abstract
Background/Objectives: Cervical facet joint syndrome (CFJS) is a frequent cause of neck pain and motor disability. Among the available therapies for CFJS, ultrasound (US)-guided injections are becoming more and more widespread, but the evidence about their accuracy and effectiveness is still debated in the scientific literature. The aim of this systematic review is to assess efficacy, accuracy and feasibility of US-guided cervical facet injections for the related chronic neck pain treatment. Methods: This review was conducted following the preferred reporting items for systematic reviews and meta-analysis 2020 (PRISMA) statement guidelines. The scientific articles were identified through the PubMed, Google Scholar and Cochrane Library databases. Qualitative assessment of the selected studies was carried out using the modified Oxford quality scoring system. Nine studies with a total of 958 patients were included in this review. The risk of bias was assessed using the Cochrane Collaboration tool. The protocol was registered at PROSPERO 2024 (n°CRD42024512214). Results: The results of this review suggest that the US-guided cervical facet injection for CFJS treatment is an effective technique in terms of accuracy (using the lateral technique it ranges from 92% to 98%), and efficiency (it grants pain relief with a decrease in the procedure time and fewer needle passes in comparison with the X-ray-guided technique, which also involves radiation exposure). Conclusions: US-guided injections are a safe and effective method to treat this musculoskeletal disease, granting a high functional recovery and long-lasting pain relief, net of the used drugs. However, these procedures are strictly operator-dependent and require important training to acquire good expertise.
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Affiliation(s)
- Mattia Giuseppe Viva
- Department of Anatomical and Histological Sciences, Legal Medicine and Orthopedics, Sapienza University, 00189 Rome, Italy
| | - Valerio Sveva
- Department of Anatomical and Histological Sciences, Legal Medicine and Orthopedics, Sapienza University, 00189 Rome, Italy
| | - Marco Ruggiero
- Physical and Rehabilitation Medicine 2, IRCCS Istituto Ortopedico Rizzoli, 40136 Bologna, Italy
| | - Annatonia Fai
- Department of Translational Biomedicine and Neuroscience (DiBraiN), Aldo Moro University, 70121 Bari, Italy
| | - Alessio Savina
- Department of Anatomical and Histological Sciences, Legal Medicine and Orthopedics, Sapienza University, 00189 Rome, Italy
| | - Riccardo Perrone
- Unit of Physical Medicine and Rehabilitation, Sant'Andrea Hospital, "Sapienza" University of Rome, 00189 Rome, Italy
| | - Danilo Donati
- Clinical and Experimental Medicine PhD Program, University of Modena and Reggio Emilia, 41125 Modena, Italy
| | - Roberto Tedeschi
- Department of Biomedical and Neuromotor Sciences, Alma Mater Studiorum University, 40126 Bologna, Italy
| | - Marco Monticone
- Department of Surgical Sciences, University of Cagliari, 09124 Cagliari, Italy
| | - Giacomo Farì
- Department of Experimental Medicine (Di.Me.S.), University of Salento, 73100 Lecce, Italy
| | - Andrea Bernetti
- Department of Experimental Medicine (Di.Me.S.), University of Salento, 73100 Lecce, Italy
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3
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Farì G, Mariconda C, Dell'Anna L, Quarta F, Donati D, Sconza C, Ricci V, Varrassi G, Coco V, Manelli A, Spadini E, Giglio MT, Bernetti A. How to Evaluate the Efficacy of Manipulations in Spine Disorders-A Comprehensive Review of New and Traditional Outcome Measures. Clin Pract 2024; 14:1478-1495. [PMID: 39194923 DOI: 10.3390/clinpract14040119] [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: 06/06/2024] [Revised: 07/23/2024] [Accepted: 07/25/2024] [Indexed: 08/29/2024] Open
Abstract
Spine pain (SP) is the most common musculoskeletal disorder that causes transitional forms of motor disability. Considering its affordability and safety, manipulative therapy (MT) stands as one of the primary therapeutic approaches for SP and the related dysfunctional consequences. However, it is still difficult to assess and quantify the results of this treatment since there is a lack of objective evaluation tools in the available scientific literature. Thus, the purpose of this comprehensive review is to summarize the main outcomes used to evaluate the effectiveness of spine manipulations, focusing on their strengths and weaknesses. An extensive review of the PubMed, Cochrane, and Embase databases was performed to identify the literature of the last ten years regarding MT and the related assessment tools. A total of 12 studies met the inclusion criteria. The analyzed literature indicates that a wide range of outcome measures have been used to assess the effectiveness of spine MT. Pain is the main aspect to be investigated but it remains difficult to elucidate since it is strongly linked to various dimensions such as self-perception and psychological aspects. Therefore, it seems necessary to include new tools for evaluating the effects of spine MT, with the aim of exploiting new technologies and taking into consideration the SP biomechanical and biopsychosocial aspects.
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Affiliation(s)
- Giacomo Farì
- National Council of the Manual Medicine Section, Italian Society of Physical and Rehabilitation Medicine (SIMFER), 00198 Rome, Italy
- Department of Experimental Medicine (Di.Me.S), University of Salento, 73100 Lecce, Italy
| | - Carlo Mariconda
- National Council of the Manual Medicine Section, Italian Society of Physical and Rehabilitation Medicine (SIMFER), 00198 Rome, Italy
- Department of Rehabilitation Sciences, Humanitas Gradenigo Hospital, 10153 Turin, Italy
| | - Laura Dell'Anna
- Department of Translational Biomedicine and Neuroscience (DiBraiN), Aldo Moro University, 70121 Bari, Italy
| | - Francesco Quarta
- Department of Biological and Environmental Science and Technologies (Di.S.Te.B.A.), University of Salento, 73100 Lecce, Italy
| | - Danilo Donati
- Clinical and Experimental Medicine, University of Modena and Reggio Emilia, 41121 Modena, Italy
| | | | - Vincenzo Ricci
- Physical and Rehabilitation Medicine Unit, Luigi Sacco University Hospital, 20157 Milano, Italy
| | | | - Valeria Coco
- National Council of the Manual Medicine Section, Italian Society of Physical and Rehabilitation Medicine (SIMFER), 00198 Rome, Italy
| | - Alessandro Manelli
- National Council of the Manual Medicine Section, Italian Society of Physical and Rehabilitation Medicine (SIMFER), 00198 Rome, Italy
| | - Ennio Spadini
- National Council of the Manual Medicine Section, Italian Society of Physical and Rehabilitation Medicine (SIMFER), 00198 Rome, Italy
| | - Maria Teresa Giglio
- Anaesthesia and Intensive Care Unit, Policlinico Hospital, 70124 Bari, Italy
| | - Andrea Bernetti
- Department of Experimental Medicine (Di.Me.S), University of Salento, 73100 Lecce, Italy
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4
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Obana KK, Trofa DP, Ahmad CS, Levine WN, Popkin CA. Surfer's neurapraxia - an uncommon surfing injury of the saphenous nerve. PHYSICIAN SPORTSMED 2024:1-5. [PMID: 38975984 DOI: 10.1080/00913847.2024.2375961] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2024] [Accepted: 07/01/2024] [Indexed: 07/09/2024]
Abstract
Surfer's neurapraxia is a rare surfing injury of the saphenous nerve secondary to persistent compression of the saphenous nerve along the medial thigh by the surfboard when paddling prone and while sitting upright on the board waiting for a wave. Symptoms may be nonspecific and consist of pain in the medial thigh with or without radiation along the saphenous nerve distribution (medial leg, medial ankle, medial arch of the foot). The saphenous nerve tension test can be utilized to reproduce the symptoms of surfer's neurapraxia. Treatment consists of conservative management while refractory cases may benefit from injection with local anesthetic. The authors propose the Obana Plan (WATER) for prevention of surfer's neurapraxia, consisting of Wetsuits, Abduction, Timing, Exercise, and Rest. Overall, surfer's neurapraxia is a benign condition that can be prevented and managed conservatively.
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Affiliation(s)
- Kyle K Obana
- Department of Orthopaedic Surgery, New York-Presbyterian, Columbia University Irving Medical Center, New York, NY, USA
| | - David P Trofa
- Department of Orthopaedic Surgery, New York-Presbyterian, Columbia University Irving Medical Center, New York, NY, USA
| | - Christopher S Ahmad
- Department of Orthopaedic Surgery, New York-Presbyterian, Columbia University Irving Medical Center, New York, NY, USA
| | - William N Levine
- Department of Orthopaedic Surgery, New York-Presbyterian, Columbia University Irving Medical Center, New York, NY, USA
| | - Charles A Popkin
- Department of Orthopaedic Surgery, New York-Presbyterian, Columbia University Irving Medical Center, New York, NY, USA
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5
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Liang CL, Yen CY, Wang HK, Tsai YD, Chye CL, Wang KW. Intramuscular Pulsed Radiofrequency Upregulates BNDF-TrKB Expression in the Spinal Cord in Rats as an Alternative Treatment for Complicated Pain. Int J Mol Sci 2024; 25:7199. [PMID: 39000303 PMCID: PMC11240886 DOI: 10.3390/ijms25137199] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2024] [Revised: 06/15/2024] [Accepted: 06/20/2024] [Indexed: 07/16/2024] Open
Abstract
Two cases of complicated pain exist: posterior screw fixation and myofascial pain. Intramuscular pulsed radiofrequency (PRF) may be an alternative treatment for such patients. This is a two-stage animal study. In the first stage, two muscle groups and two nerve groups were subdivided into a high-temperature group with PRF at 58 °C and a regular temperature with PRF at 42 °C in rats. In the second stage, two nerve injury groups were subdivided into nerve injury with PRF 42 °C on the sciatic nerve and muscle. Blood and spinal cord samples were collected. In the first stage, the immunohistochemical analysis showed that PRF upregulated brain-derived neurotrophic factor (BDNF) in the spinal cord in both groups of rats. In the second stage, the immunohistochemical analysis showed significant BDNF and tropomyosin receptor kinase B (TrkB) expression within the spinal cord after PRF in muscles and nerves after nerve injury. The blood biomarkers showed a significant increase in BDNF levels. PRF in the muscle in rats could upregulate BDNF-TrkB in the spinal cord, similar to PRF on the sciatica nerve for pain relief in rats. PRF could be considered clinically for patients with complicated pain and this study also demonstrated the role of BDNF in pain modulation. The optimal temperature for PRF was 42 °C.
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Affiliation(s)
- Cheng-Loong Liang
- Department of Neurosurgery, E-Da Hospital, I-Shou University, Kaohsiung City 82445, Taiwan; (C.-L.L.); (H.-K.W.); (Y.-D.T.); (C.-L.C.)
| | - Cheng-Yo Yen
- Department of Orthopedic, E-Da Hospital, I-Shou University, Kaohsiung City 82445, Taiwan;
| | - Hao-Kuang Wang
- Department of Neurosurgery, E-Da Hospital, I-Shou University, Kaohsiung City 82445, Taiwan; (C.-L.L.); (H.-K.W.); (Y.-D.T.); (C.-L.C.)
| | - Yu-Duan Tsai
- Department of Neurosurgery, E-Da Hospital, I-Shou University, Kaohsiung City 82445, Taiwan; (C.-L.L.); (H.-K.W.); (Y.-D.T.); (C.-L.C.)
| | - Cien-Leong Chye
- Department of Neurosurgery, E-Da Hospital, I-Shou University, Kaohsiung City 82445, Taiwan; (C.-L.L.); (H.-K.W.); (Y.-D.T.); (C.-L.C.)
| | - Kuo-Wei Wang
- Department of Neurosurgery, E-Da Cancer Hospital, I-Shou University, Kaohsiung City 824005, Taiwan
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Scala L, Giglioni G, Bertazzoni L, Bonetti F. The Efficacy of the Smartphone App for the Self-Management of Low Back Pain: A Systematic Review and Assessment of Their Quality through the Mobile Application Rating Scale (MARS) in Italy. Life (Basel) 2024; 14:760. [PMID: 38929744 PMCID: PMC11204566 DOI: 10.3390/life14060760] [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: 04/16/2024] [Revised: 06/03/2024] [Accepted: 06/08/2024] [Indexed: 06/28/2024] Open
Abstract
Smartphone apps for self-management are valuable tools to help manage low back pain (LBP) patients. The purposes of this systematic review were to (a) summarize the available studies on the efficacy of smartphone apps for self-management of LBP and (b) identify free applications available in Italy that offer strategies for LBP self-management and provide a qualitative assessment using the Mobile Application Rating Scale (MARS). According to the Prisma Checklist, six bibliographic databases were searched with the keywords 'low back pain', 'mobile application', 'smartphone', and 'telemedicine'. In total, 852 records were screened, and 16 were included in the systematic review. Of the six RCTs included, four reported a statistically significant decrease in pain in favor of the app group, and two RCTs did not. Only in a non-RCT was there an increase in the disability score. In the application research conducted on mobile stores, we identified and rated 25 applications through MARS. The overall scores ranged from 1.93 to 3.92 for the IOS app and 1.73 to 4.25 for the Play Store app. The findings suggest that few apps meet satisfying quality, content, and functionality criteria for LBP self-management.
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Affiliation(s)
- Luca Scala
- Department of Clinical Sciences and Translational Medicine, University of Rome Tor Vergata, 00133 Rome, Italy; (G.G.); (F.B.)
- Physioup—Physiotherapy Practice, 00142 Rome, Italy
| | - Gloria Giglioni
- Department of Clinical Sciences and Translational Medicine, University of Rome Tor Vergata, 00133 Rome, Italy; (G.G.); (F.B.)
- Asl Roma 3, Department of Rehabilitation, 00122 Rome, Italy
| | - Luca Bertazzoni
- Pain in Motion Research Group (PAIN), Vrije Universiteit, 1050 Brussels, Belgium;
- Painlab Studio Osteopatico, 20145 Milan, Italy
| | - Francesca Bonetti
- Department of Clinical Sciences and Translational Medicine, University of Rome Tor Vergata, 00133 Rome, Italy; (G.G.); (F.B.)
- Physioup—Physiotherapy Practice, 00142 Rome, Italy
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Longo UG, Marino M, Candela V, Greco A, Piergentili I, Arias C, de Sire A, D’Hooghe P. Anxiety, Depression, and Quality of Sleep Vary in Their Correlation to Postoperative Outcomes of Rotator Cuff Repair: A Prospective Study. J Clin Med 2024; 13:3340. [PMID: 38893051 PMCID: PMC11173232 DOI: 10.3390/jcm13113340] [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: 02/24/2024] [Revised: 05/23/2024] [Accepted: 06/03/2024] [Indexed: 06/21/2024] Open
Abstract
Background/Objectives: Recent studies imply that psychological factors and sleep quality play a role in the outcomes of surgical procedures, including in orthopedic surgery. The aim of the present study is to evaluate possible correlations between preoperative depression, anxiety, and quality of sleep and functional 6-month postoperative scores in patients having undergone rotator cuff repair (RCR). Methods: All patients included in the study performed the Hospital Anxiety and Depression Scale (HADS) and Pittsburgh Sleep Quality Index (PSQI) questionnaires preoperatively and 36-item Short-Form Health Survey (SF-36), Oxford Shoulder Score (OSS), Shoulder Pain and Disability Index (SPADI), and PSQI questionnaires at the six-month postoperative follow-up. A total of 47 patients were included in the analysis. Results: Statistically significant differences between preoperative anxious and not-anxious groups were found in the postoperative SF-36 Physical Component Summary (PCS) and Mental Component Summary (MCS) scores and PSQI score. The correlation of the preoperative depression score to postoperative outcome measures revealed a strong positive correlation between the preoperative HADS-D score and the 6-month PCS, MCS, and OSS scores. The correlation of preoperative sleep quality to postoperative outcome measures revealed a strong positive correlation between the preoperative PSQI score and 6-month MCS score. Conclusions: Anxious patients had worse postoperative RCR outcomes. Depression may be influenced by factors related to RC pathology; however, there were no statistically significant correlations. Sleep quality generally improves postoperatively, and no significant association was found between bad preoperative sleepers and worse outcomes.
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Affiliation(s)
- Umile Giuseppe Longo
- Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 200, 00128 Rome, Italy; (M.M.); (V.C.); (A.G.)
- Research Unit of Orthopaedic and Trauma Surgery, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, 21, 00128 Rome, Italy
| | - Martina Marino
- Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 200, 00128 Rome, Italy; (M.M.); (V.C.); (A.G.)
- Research Unit of Orthopaedic and Trauma Surgery, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, 21, 00128 Rome, Italy
| | - Vincenzo Candela
- Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 200, 00128 Rome, Italy; (M.M.); (V.C.); (A.G.)
- Research Unit of Orthopaedic and Trauma Surgery, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, 21, 00128 Rome, Italy
| | - Alessandra Greco
- Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 200, 00128 Rome, Italy; (M.M.); (V.C.); (A.G.)
- Research Unit of Orthopaedic and Trauma Surgery, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, 21, 00128 Rome, Italy
| | - Ilaria Piergentili
- CNR-IASI, Laboratorio di Biomatematica, Consiglio Nazionale delle Ricerche, Istituto di Analisi dei Sistemi ed Informatica, 00128 Rome, Italy;
| | - Claudia Arias
- Hospital Nacional Edgardo Rebagliati Martins, Lima 15072, Peru;
| | - Alessandro de Sire
- Physical Medicine and Rehabilitation Unit, Department of Medical and Surgical Sciences, University of Catanzaro “Magna Graecia”, 88100 Catanzaro, Italy;
- Research Center on Musculoskeletal Health, MusculoSkeletalHealth@UMG, University of Catanzaro “Magna Graecia”, 88100 Catanzaro, Italy
| | - Pieter D’Hooghe
- Aspetar Orthopedic and Sports Medicine Hospital, Aspire Zone, 1, Sportscity Street, Doha P.O. Box 29222, Qatar;
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8
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Khateri S, Nejad FB, Kazemi F, Alaei B, Azami M, Moradkhani A, Majidi L, Moradi Y. The effect of dextrose prolotherapy on patients diagnosed with knee osteoarthritis: A comprehensive systematic review and meta-analysis of interventional studies. Health Sci Rep 2024; 7:e2145. [PMID: 38915358 PMCID: PMC11194473 DOI: 10.1002/hsr2.2145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2023] [Revised: 03/28/2024] [Accepted: 05/07/2024] [Indexed: 06/26/2024] Open
Abstract
Background and Aims The primary objective of this systematic review and meta-analysis was to assess the impact of dextrose prolotherapy on individuals diagnosed with knee osteoarthritis (KOA). Methods To conduct a thorough investigation, a variety of leading international databases were checked, including PubMed (Medline), Scopus, Web of Sciences, EMBASE (Elsevier), ClinicalTrials.gov, and the Cochrane Library. The search covered a period from January 2000 to the end of June 2023, which facilitated the collection of relevant studies. Results The findings of the study revealed that when the studies utilizing the Western Ontario McMaster Universities Index tool (WOMAC) were combined, patients with KOA who received prolotherapy experienced an improvement in function compared with those who received other treatments (SMD: 0.20; 95% Confidence Interval [1]: -0.11, 0.51; p value SMD = 0.221; I 2: 78.49%; p heterogeneity < 0.001). Additionally, there was a decrease in mean pain and stiffness among patients who received prolotherapy compared with those who received other treatments or a placebo [(SMD: -0.95; 95% CI: -1.14, -0.76; p value SMD < 0.001; I 2: 59.35%; p heterogeneity = 0.070) and (SMD: -0.21; 95% CI: -0.32, -0.10; p value SMD < 0.001; I 2: 88.11%; p heterogeneity < 0.001)]. Furthermore, based on the Visual Analog Scale (VAS) score, there was a reduction of 0.81 units out of 10 in mean pain for patients with KOA who received prolotherapy (SMD: -0.81; 95% CI: -5.63, 4.10; p value SMD = 0.693; I 2: 48.54%; p heterogeneity = 0.08). Conclusion Drawing from the data analysis performed in this meta-analysis, it is apparent that dextrose prolotherapy exhibits promising effectiveness in reducing joint pain and stiffness, as well as improving functional performance in individuals suffering from KOA. Furthermore, it is recommended that forthcoming studies incorporate follow-up periods to guide decisions concerning the duration of prolotherapy's effects.
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Affiliation(s)
- Sorour Khateri
- Department of Physical Medicine and Rehabilitation, Faculty of MedicineHamadan University of Medical SciencesHamedanIran
| | | | - Farnoush Kazemi
- Student Research CommitteeKurdistan University of Medical SciencesSanandajIran
| | - Behnaz Alaei
- Department of Physical Medicine and Rehabilitation, Faculty of MedicineHamadan University of Medical SciencesHamedanIran
| | - Mobin Azami
- Student Research CommitteeKurdistan University of Medical SciencesSanandajIran
| | - Asra Moradkhani
- Student Research CommitteeKurdistan University of Medical SciencesSanandajIran
| | - Lobat Majidi
- Department of Physical Medicine and Rehabilitation, Faculty of MedicineHamadan University of Medical SciencesHamedanIran
| | - Yousef Moradi
- Social Determinants of Health Research Center, Research Institute for Health DevelopmentKurdistan University of Medical SciencesSanandajIran
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Albornoz-Cabello M, Ibáñez-Vera AJ, Barrios-Quinta CJ, Espejo-Antúnez L, Lara-Palomo IC, de los Ángeles Cardero-Durán M. Non-Invasive Radiofrequency Diathermy Neuromodulation Added to Supervised Therapeutic Exercise in Patellofemoral Pain Syndrome: A Single Blind Randomized Controlled Trial with Six Months of Follow-Up. Biomedicines 2024; 12:850. [PMID: 38672204 PMCID: PMC11048228 DOI: 10.3390/biomedicines12040850] [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: 03/02/2024] [Revised: 03/25/2024] [Accepted: 04/09/2024] [Indexed: 04/28/2024] Open
Abstract
The evidence-based treatment of patellofemoral pain (PFP) suggests that therapeutic exercise (TE) focused on improving muscle strength and motor control be the main conservative treatment. Recent research determined that the success of the TE approach gets improved in the short term by the addition of neuromodulation via radiofrequency diathermy (RFD). As there is no follow up data, the objective of this research is to assess the long-term effects of adding RFD to TE for the pain, function and quality of life of PFP patients. To this aim, a single-blind randomized controlled trial was conducted on 86 participants diagnosed of PFP. Participants who met the selection criteria were randomized and allocated into either a TE group or an RFD + TE group. TE consisted of a 20 min daily supervised exercise protocol for knee and hip muscle strengthening, while RFD consisted of the application of neuromodulation using a radiofrequency on the knee across 10 sessions. Sociodemographic data, knee pain and lower limb function outcomes were collected. The RFD + TE group obtained greater improvements in knee pain (p < 0.001) than the TE group. Knee function showed statistically significant improvements in Kujala (p < 0.05) and LEFS (p < 0.001) in the RFD + TE group in the short and long term. In conclusion, the addition of RFD to TE increases the beneficial effects of TE alone on PFP, effects that remain six months after treatment.
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Affiliation(s)
| | | | | | - Luis Espejo-Antúnez
- Department of Medical-Surgical Therapy, Universidad de Extremadura, 06006 Badajoz, Spain; (L.E.-A.)
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Mohammadi N, Sedlak CA. Physiatry for Treating Hip, Knee, and Back Pain. Orthop Nurs 2024; 43:23-31. [PMID: 38266261 DOI: 10.1097/nor.0000000000000999] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2024] Open
Abstract
Physical Medicine and Rehabilitation (PM&R) is a rapidly expanding field. Physicians who practice PM&R are known as physiatrists and provide care primarily for patients who have disabilities or physical impairments affecting the musculoskeletal system, brain, and spinal cord. Physiatrists may work in an inpatient or outpatient setting, with outpatient physiatrists being an invaluable resource in treating patients experiencing pain. It is worthwhile to refer patients experiencing hip, knee, or back pain to a PM&R specialist because of their skill in making specific and accurate diagnoses, as well as providing a wide range of modalities to treat pain and augment function such as management of pain medications, osteopathic manipulative therapy, trigger point injections, intra-articular steroid injections, orthobiologic therapy, and interventional spinal procedures. Emphasis is on the use of the least invasive modality before employing more invasive treatments. The need for physiatrists to help individuals maximize function and enhance quality of life is increasing with the aging population, expanding workforce of older adults, and a growing population of people with a disability, especially since the COVID-19 pandemic.
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Affiliation(s)
- Neema Mohammadi
- Neema Mohammadi, DO, Chief Resident Physician, Physical Medicine and Rehabilitation, University Hospitals, Cleveland, OH
- Carol A. Sedlak, PhD, RN, FAAN, Professor Emeritus, College of Nursing, Kent State University, Kent, OH
| | - Carol A Sedlak
- Neema Mohammadi, DO, Chief Resident Physician, Physical Medicine and Rehabilitation, University Hospitals, Cleveland, OH
- Carol A. Sedlak, PhD, RN, FAAN, Professor Emeritus, College of Nursing, Kent State University, Kent, OH
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Jiang X, Sun W, Chen Q, Xu Q, Chen G, Bi H. Effects of breathing exercises on chronic low back pain: A systematic review and meta-analysis of randomized controlled trials. J Back Musculoskelet Rehabil 2024; 37:13-23. [PMID: 37718775 DOI: 10.3233/bmr-230054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/19/2023]
Abstract
BACKGROUND A range of studies concerning the effects of breathing exercises on chronic low back pain (CLBP) have been proven inconclusive. OBJECTIVE The study aimed to evaluate the effectiveness of breathing exercises for the treatment of CLBP. METHODS We considered randomized controlled trials in English or Chinese that used breathing exercises for the treatment of CLBP. An electronic search was performed in the MEDLINE, EMBASE, Web of Science, Cochrane Library, CNKI, Wan Fang, and CBM databases for articles published up to November 2022. Two reviewers independently screened the articles, assessed the risk of bias using the Cochrane risk of bias tool, and extracted the data. The outcomes included pain, lumbar function and pulmonary function post-intervention. RESULTS A total of thirteen studies (n= 677) satisfied the inclusion criteria. The meta-analysis results demonstrated a significant effect of breathing exercises on the Visual Analog Scale (VAS) score (SMD =-0.84, 95% CI: -1.24 to -0.45, P< 0.0001), the Oswestry Disability Index (ODI) score (SMD =-0.74, 95% CI: -0.95 to -0.54, P< 0.00001), Forced Vital Capacity (FVC) score (MD = 0.24, 95% CI: 0.10 to 0.37, P= 0.0006), Forced Expiratory Volume in 1 second /Forced Vital Capacity (FEV1/FVC) (MD = 1.90, 95% CI: 0.73 to 3.07, P= 0.001), although there was no significant difference between the breathing exercises and control interventions for Forced Expiratory Volume in the first second (FEV1) score (MD = 0.22, 95% CI = [0.00, 0.43], P= 0.05), and Maximal Voluntary Ventilation (MVV) score (MD = 8.22, 95% CI = [-4.02, 20.45], P= 0.19). CONCLUSION Breathing exercises can reduce pain, assist people with lumbar disabilities, and improve pulmonary function, and could be considered as a potential alternative treatment for CLBP.
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Affiliation(s)
- Xiaoyu Jiang
- College of Rehabilitation Medicine, Shandong University of Traditional Chinese Medicine, Jinan, Shandong, China
| | - Wenyu Sun
- Department of Rehabilitation Medicine, Affiliated Hospital of Shandong University of Chinese Medicine, Jinan, Shandong, China
| | - Qiang Chen
- College of Rehabilitation Medicine, Shandong University of Traditional Chinese Medicine, Jinan, Shandong, China
| | - Qiling Xu
- College of Rehabilitation Medicine, Shandong University of Traditional Chinese Medicine, Jinan, Shandong, China
| | - Guoming Chen
- Department of Rehabilitation Medicine, Affiliated Hospital of Shandong University of Chinese Medicine, Jinan, Shandong, China
| | - Hongyan Bi
- Department of Rehabilitation Medicine, Affiliated Hospital of Shandong University of Chinese Medicine, Jinan, Shandong, China
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Suputtitada A, Chen JL, Wu CK, Peng YN, Yen TY, Chen CPC. Determining the Most Suitable Ultrasound-Guided Injection Technique in Treating Lumbar Facet Joint Syndrome. Biomedicines 2023; 11:3308. [PMID: 38137529 PMCID: PMC10741858 DOI: 10.3390/biomedicines11123308] [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: 10/31/2023] [Revised: 12/05/2023] [Accepted: 12/11/2023] [Indexed: 12/24/2023] Open
Abstract
(1) Background: Lower back pain is often caused by lumbar facet joint syndrome. This study investigated the effectiveness of three different injection methods under ultrasound guidance in treating elderly patients with lumbar facet joint syndrome. The difficulty in performing these injections was also evaluated; (2) Methods: A total of 60 elderly patients with facet joint syndrome as the cause of lower back pain were recruited and divided into 3 groups. Group 1 received medial branch block (MBB). Group 2 received intra-articular facet joint injections. Group 3 received injection into the multifidus muscle portion that covers the facet joint. Five percent dextrose water (D5W) was used as the injectant. The visual analog scale (VAS) was used to measure the degree of lower back pain; (3) Results: Before the injection treatments, the VAS score averaged about 7.5. After three consecutive injection treatments (two weeks interval), the VAS score decreased significantly to an average of about 1 in all 3 groups, representing mild to no pain. Between group analyses also did not reveal significant statistical differences, suggesting that these procedures are equally effective; (4) Conclusions: Ultrasound-guided injection of the multifidus muscle may be a feasible option in treating elderly patients with lower back pain caused by facet joint syndrome as it is easier to perform as compared to MBB and intra-articular facet joint injection.
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Affiliation(s)
- Areerat Suputtitada
- Department of Rehabilitation Medicine, Faculty of Medicine, Chulalongkorn University, King Chulalongkorn Memorial Hospital, Bangkok 10330, Thailand;
| | - Jean-Lon Chen
- Department of Physical Medicine & Rehabilitation, Chang Gung Memorial Hospital at Linkou, College of Medicine, Chang Gung University, Guishan District, Taoyuan City 33343, Taiwan; (J.-L.C.); (C.-K.W.); (Y.-N.P.); (T.-Y.Y.)
| | - Chih-Kuan Wu
- Department of Physical Medicine & Rehabilitation, Chang Gung Memorial Hospital at Linkou, College of Medicine, Chang Gung University, Guishan District, Taoyuan City 33343, Taiwan; (J.-L.C.); (C.-K.W.); (Y.-N.P.); (T.-Y.Y.)
| | - Yu-Ning Peng
- Department of Physical Medicine & Rehabilitation, Chang Gung Memorial Hospital at Linkou, College of Medicine, Chang Gung University, Guishan District, Taoyuan City 33343, Taiwan; (J.-L.C.); (C.-K.W.); (Y.-N.P.); (T.-Y.Y.)
| | - Tzu-Yun Yen
- Department of Physical Medicine & Rehabilitation, Chang Gung Memorial Hospital at Linkou, College of Medicine, Chang Gung University, Guishan District, Taoyuan City 33343, Taiwan; (J.-L.C.); (C.-K.W.); (Y.-N.P.); (T.-Y.Y.)
| | - Carl P. C. Chen
- Department of Physical Medicine & Rehabilitation, Chang Gung Memorial Hospital at Linkou, College of Medicine, Chang Gung University, Guishan District, Taoyuan City 33343, Taiwan; (J.-L.C.); (C.-K.W.); (Y.-N.P.); (T.-Y.Y.)
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13
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Vieira A, Coroa MC, Carrillo-Alfonso N, Correia FD. Treatment of Greater Trochanteric Pain Syndrome With Ultrasound-Guided Bipolar Pulsed Radiofrequency of the Trochanteric Branches of the Femoral Nerve: A Case Series of Nine Patients. Cureus 2023; 15:e50422. [PMID: 38222155 PMCID: PMC10784712 DOI: 10.7759/cureus.50422] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/12/2023] [Indexed: 01/16/2024] Open
Abstract
BACKGROUND Greater trochanteric pain syndrome (GTPS) is a prevalent cause of lateral hip pain that often leads to significant functional limitations. Conservative treatment options include physical therapy, pharmacological treatment, and more invasive techniques such as corticosteroid injections. However, despite the high success rates reported with corticosteroid injections, a significant number of patients have their symptoms persist or recur. OBJECTIVES In this case series, we present the outcomes of nine patients with GTPS who underwent ultrasound-guided bipolar pulsed radiofrequency targeting the trochanteric branches of the femoral nerve. We aim to discuss the effectiveness and safety of this approach. MATERIAL AND METHODS Eligible patients referred to our centre underwent ultrasound-guided bipolar pulsed radiofrequency aimed at the trochanteric branches of the femoral nerve. The procedure consisted of one cycle at 42°C for six minutes, followed by the injection of ropivacaine (0.2%, 3 mL) and dexamethasone (12 mg). The Brief Pain Inventory - Short Form (BPI-sf) and Lequesne Algofunctional Index (LAI) were used before the procedure and at the third and sixth months post-procedure. We monitored immediate and late complications, as well as adverse effects. RESULTS AND DISCUSSION Our results indicate a favourable outcome for most patients, with an average pain reduction of 76.51% according to their report of the BPI-sf. Additionally, eight out of nine patients experienced at least 50% relief. These findings align with a previous case series, which reported a similar average pain reduction. Before the procedure, most patients were classified as "extremely severe" in the LAI, with an average score of 18.17. Although there was only a slight reduction of 16.84% at the six-month follow-up, this suggests a potential improvement in their functional status. We did not observe any immediate complications or adverse effects after the procedure, nor were any reported at the subsequent follow-ups, which is consistent with existing literature. CONCLUSIONS Our study suggests that ultrasound-guided bipolar pulsed radiofrequency treatment is a promising minimally invasive technique for GPTS, especially for patients who do not respond to conservative treatments. Although our case series provides some evidence of effectiveness and safety, further controlled studies on a larger scale are necessary, particularly to compare this intervention with the use of corticosteroid injections alone.
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Affiliation(s)
- André Vieira
- Physical Medicine and Rehabilitation, Hospital Central do Funchal, Funchal, PRT
| | - Mariana C Coroa
- Anesthesiology, Centro Hospitalar de Vila Nova de Gaia e Espinho, Vila Nova de Gaia, PRT
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Iaconisi GN, Gallo N, Caforio L, Ricci V, Fiermonte G, Della Tommasa S, Bernetti A, Dolce V, Farì G, Capobianco L. Clinical and Biochemical Implications of Hyaluronic Acid in Musculoskeletal Rehabilitation: A Comprehensive Review. J Pers Med 2023; 13:1647. [PMID: 38138874 PMCID: PMC10744407 DOI: 10.3390/jpm13121647] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2023] [Revised: 11/20/2023] [Accepted: 11/23/2023] [Indexed: 12/24/2023] Open
Abstract
Hyaluronic acid (HA) naturally occurs as a biopolymer in the human body, primarily in connective tissues like joints and skin. Functioning as a vital element of synovial fluid, it lubricates joints, facilitating fluid movement and diminishing bone friction to protect articular well-being. Its distinctive attributes encompass notable viscosity and water retention capacities, ensuring flexibility and absorbing shock during motion. Furthermore, HA has gained significant attention for its potential benefits in various medical applications, including rehabilitation. Ongoing research explores its properties and functions, especially its biomedical applications in several clinical trials, with a focus on its role in improving rehabilitation outcomes. But the clinical and biochemical implications of HA in musculoskeletal rehabilitation have yet to be fully explored. This review thoroughly investigates the properties and functions of HA while highlighting its biomedical applications in different clinical trials, with a special emphasis on its role in rehabilitation. The presented findings provide evidence that HA, as a natural substance, enhances the outcomes of musculoskeletal rehabilitation through its exceptional mechanical and biochemical effects.
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Affiliation(s)
- Giorgia Natalia Iaconisi
- Department of Biological and Environmental Science and Technologies (Di.S.Te.B.A.), University of Salento, 73100 Lecce, Italy; (G.N.I.); (A.B.)
| | - Nunzia Gallo
- Department of Engineering for Innovation, University of Salento, 73100 Lecce, Italy;
| | - Laura Caforio
- Department of Basic Medical Sciences, Neurosciences and Sense Organs, Aldo Moro University, 70121 Bari, Italy;
| | - Vincenzo Ricci
- Physical and Rehabilitation Medicine Unit, Luigi Sacco University Hospital, ASST Fatebenefratelli-Sacco, 20157 Milan, Italy;
| | - Giuseppe Fiermonte
- Department of Biosciences, Biotechnologies and Biopharmaceutics, University of Bari, 70125 Bari, Italy;
| | - Simone Della Tommasa
- Department for Horses, Faculty of Veterinary Medicine, Leipzig University, 04109 Leipzig, Germany;
| | - Andrea Bernetti
- Department of Biological and Environmental Science and Technologies (Di.S.Te.B.A.), University of Salento, 73100 Lecce, Italy; (G.N.I.); (A.B.)
| | - Vincenza Dolce
- Department of Pharmacy, Health and Nutritional Sciences, University of Calabria, 87036 Arcavacata di Rende, Italy;
| | - Giacomo Farì
- Department of Translational Biomedicine and Neuroscience (DiBraiN), Aldo Moro University, 70121 Bari, Italy
| | - Loredana Capobianco
- Department of Biological and Environmental Science and Technologies (Di.S.Te.B.A.), University of Salento, 73100 Lecce, Italy; (G.N.I.); (A.B.)
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Huang Z, Liu S, Nie M, Yuan J, Lin X, Chu X, Shi Z. Treatment of Lumbar Degenerative Disease with a Novel Interlaminar Screw Elastic Spacer Technique: A Finite Element Analysis. Bioengineering (Basel) 2023; 10:1204. [PMID: 37892934 PMCID: PMC10604319 DOI: 10.3390/bioengineering10101204] [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: 09/02/2023] [Revised: 09/30/2023] [Accepted: 10/09/2023] [Indexed: 10/29/2023] Open
Abstract
A novel interlaminar elastic screw spacer technique was designed to maintain lumbar mobility in treating lumbar degenerative diseases. A validated finite element model of L4/5 was used to establish an ISES-1/2 model and an ISES-1/3 model based on different insertion points, a unilateral fixation model and a bilateral fixed model based on different fixation methods, and a Coflex-F model based on different implants. The elastic rods were used to fix screws. Under the same mechanical conditions, we compared the biomechanical characteristics to investigate the optimal entry point for ISES technology, demonstrate the effectiveness of unilateral fixation, and validate the feasibility of the ISES technique. Compared to ISES-1/3, the ISES-1/2 model had lower intradiscal pressure, facet cartilage stress, and posterior structural stress. Compared to the ISES-BF model, the ISES-UF model had lower intervertebral pressure, larger mobility, and smaller stress on the posterior structures. The ISES model had a similar intervertebral pressure and limitation of extension as the Coflex-F model. The ISES model retained greater mobility and reduced the stress on the facet cartilage and posterior structure compared with the Coflex-F model. Our study suggests that the ISES technique is a promising treatment of lumbar degenerative diseases, especially those with osteoporosis.
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Affiliation(s)
- Zebin Huang
- Department of Orthopedics, Changhai Hospital, Naval Medical University, Shanghai 200433, China; (Z.H.); (S.L.); (J.Y.); (X.L.)
| | - Shu Liu
- Department of Orthopedics, Changhai Hospital, Naval Medical University, Shanghai 200433, China; (Z.H.); (S.L.); (J.Y.); (X.L.)
| | - Maodan Nie
- School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai 200240, China;
| | - Jiabin Yuan
- Department of Orthopedics, Changhai Hospital, Naval Medical University, Shanghai 200433, China; (Z.H.); (S.L.); (J.Y.); (X.L.)
| | - Xumiao Lin
- Department of Orthopedics, Changhai Hospital, Naval Medical University, Shanghai 200433, China; (Z.H.); (S.L.); (J.Y.); (X.L.)
| | | | - Zhicai Shi
- Department of Orthopedics, Changhai Hospital, Naval Medical University, Shanghai 200433, China; (Z.H.); (S.L.); (J.Y.); (X.L.)
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Chalidis B, Papadopoulos P, Givissis P, Pitsilos C. Is Radiofrequency Ablation Superior to Intra-Articular Injections for the Treatment of Symptomatic Knee Osteoarthritis?-A Systematic Review. J Pers Med 2023; 13:1227. [PMID: 37623477 PMCID: PMC10455107 DOI: 10.3390/jpm13081227] [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: 06/20/2023] [Revised: 07/26/2023] [Accepted: 08/01/2023] [Indexed: 08/26/2023] Open
Abstract
The radiofrequency ablation (RFA) is considered a valid, minimally invasive treatment modality for the management of symptomatic knee osteoarthritis (OA). The aim of this study was to compare the outcomes of RFA with that of commonly used intra-articular injections for the persistent knee pain due to OA. Medline/Pubmed and Scopus databases were systematically searched up to April 2023 to identify studies comparing the effect of RFA and intra-articular injections (IAIs) on knee OA. Nine studies including 899 patients fulfilled the eligibility criteria and were included in the systematic review. The RFA procedure was related with improved knee pain relief compared to IAIs at 3-, 6- and 12-month follow-up (p < 0.001). Similarly, functional improvement was greater in RFA treatment than that observed after hyaluronic acid (HA), steroid or platelet-rich plasma (PRP) injections (Visual Analogue Scale p < 0.001, Numeric Rating Scale p = 0.019, Western Ontario and McMaster University Osteoarthritis Index p = 0.012). The overall procedural complication rate of RFA was 10.2% and was higher than steroid (p = 0.023) and PRP (p = 0.017) injections. However, no severe adverse events were reported. For patients with symptomatic knee OA, RFA seems to be more effective than IAIs in alleviating pain and improving joint function, despite the relatively higher incidence of non-serious adverse events. However, due to the limited number of studies and patients, this result should be interpreted with caution and not be generalized to the entire knee OA population.
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Affiliation(s)
- Byron Chalidis
- 1st Orthopaedic Department, Aristotle University of Thessaloniki, 57010 Thessaloniki, Greece;
| | - Pericles Papadopoulos
- 2nd Orthopaedic Department, Aristotle University of Thessaloniki, 54635 Thessaloniki, Greece; (P.P.); (C.P.)
| | - Panagiotis Givissis
- 1st Orthopaedic Department, Aristotle University of Thessaloniki, 57010 Thessaloniki, Greece;
| | - Charalampos Pitsilos
- 2nd Orthopaedic Department, Aristotle University of Thessaloniki, 54635 Thessaloniki, Greece; (P.P.); (C.P.)
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Reinhard J, Pulido LC, Schindler M, Schraag A, Greimel F, Grifka J, Benditz A. No Success without Effort: Follow-Up at Six Years after Implementing a Benchmarking and Feedback Concept for Postoperative Pain after Total Hip Arthroplasty. J Clin Med 2023; 12:4577. [PMID: 37510694 PMCID: PMC10380292 DOI: 10.3390/jcm12144577] [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: 05/24/2023] [Revised: 06/12/2023] [Accepted: 07/07/2023] [Indexed: 07/30/2023] Open
Abstract
BACKGROUND Total hip arthroplasty (THA) is still ranked among the operations with the highest postoperative pain scores. Uncontrolled postsurgical pain leads to prolongated hospital stays, causes more frequent adverse reactions and can induce chronical pain syndromes. In 2014, we implemented a standardized, multidisciplinary pain management concept with continuous benchmarking at our tertiary referral center by using the "Quality Improvement in Postoperative Pain Management" (QUIPS) program with excellent results over a period of two years. The initial study ended in 2016 and we aimed to evaluate if it was possible to obtain the excellent short-term results over a period of six years without any extra effort within the daily clinical routine. MATERIALS AND METHODS In a retrospective study design, we compared postoperative pain, side effects and functional outcome after primary THA for 2015 and 2021, using validated questionnaires from the QUIPS project. In contrast to the implementation of the pain management concept in 2014, the weekly meetings of the multidisciplinary health care team and special education for nurses were stopped in 2021. Data assessment was performed by an independent pain nurse who was not involved in pain management. RESULTS Altogether, 491 patients received primary THA in 2015 and 2021 at our tertiary referral center. Collected data revealed significantly worse maximum and activity-related pain (both p < 0.001) in combination with significantly higher opioid consumption in comparison to implementation in 2015. Though the patients reported to be less involved in pain management (p < 0.001), the worse pain scores were not reflected by patient satisfaction which remained high. While the participation rate in this benchmarking program dropped, we still fell behind in terms of maximum and activity-related pain in comparison to 24 clinics. CONCLUSION Significantly worse pain scores in combination with higher opioid usage and a lower hospital participation rate resemble a reduced awareness in postoperative pain management. The significantly lower patient participation in pain management is in line with the worse pain scores and indirectly highlights the need for special education in pain management. The fact patient satisfaction appeared to remain high and did not differ significantly from 2015, as well as the fact we still achieved an acceptable ranking in comparison to other clinics, highlight the value of the implemented multidisciplinary pain management concept.
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Affiliation(s)
- Jan Reinhard
- Department of Orthopedic Surgery, University Medical Center Regensburg, Asklepios Klinikum Bad Abbach, Kaiser-Karl-V.-Allee 3, 93077 Bad Abbach, Germany
| | - Loreto C Pulido
- Department of Orthopedic Surgery, University Medical Center Regensburg, Asklepios Klinikum Bad Abbach, Kaiser-Karl-V.-Allee 3, 93077 Bad Abbach, Germany
| | - Melanie Schindler
- Department of Orthopedic Surgery, University Medical Center Regensburg, Asklepios Klinikum Bad Abbach, Kaiser-Karl-V.-Allee 3, 93077 Bad Abbach, Germany
| | - Amadeus Schraag
- Department of Orthopedic Surgery, University Medical Center Regensburg, Asklepios Klinikum Bad Abbach, Kaiser-Karl-V.-Allee 3, 93077 Bad Abbach, Germany
| | - Felix Greimel
- Department of Orthopedic Surgery, University Medical Center Regensburg, Asklepios Klinikum Bad Abbach, Kaiser-Karl-V.-Allee 3, 93077 Bad Abbach, Germany
| | - Joachim Grifka
- Department of Orthopedic Surgery, University Medical Center Regensburg, Asklepios Klinikum Bad Abbach, Kaiser-Karl-V.-Allee 3, 93077 Bad Abbach, Germany
| | - Achim Benditz
- Department of Orthopedic Surgery, University Medical Center Regensburg, Asklepios Klinikum Bad Abbach, Kaiser-Karl-V.-Allee 3, 93077 Bad Abbach, Germany
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Jandura J, Vajda M, Kostysyn R, Vanasek J, Cermakova E, Zizka J, Ryska P. Previous Lumbar Spine Surgery Decreases the Therapeutic Efficacy of Dorsal Root Ganglion Pulsed Radiofrequency in Patients with Chronic Lumbosacral Radicular Pain. J Pers Med 2023; 13:1054. [PMID: 37511667 PMCID: PMC10381565 DOI: 10.3390/jpm13071054] [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: 05/29/2023] [Revised: 06/23/2023] [Accepted: 06/25/2023] [Indexed: 07/30/2023] Open
Abstract
Chronic lumbosacral radicular pain (CLRP) as a possible adverse consequence of lumbar spine surgery represents a serious medical challenge. Pulsed radiofrequency of dorsal root ganglion (PRF-DRG) treatment is known to be effective in alleviating CLRP. This retrospective study compares the efficacy of a single CT-guided PRF-DRG procedure in the treatment of unilateral CLRP between patients without (non-PSS) and with (PSS) previous lumbar spine surgery. Non-PSS and PSS groups included 30 and 20 patients, respectively. Outcomes (pain intensity and disability) were evaluated by means of the visual analog scale (VAS) and Oswestry disability index (ODI) immediately after the procedure (VAS), as well as three and six months after the procedure, respectively. Non-PSS group showed a significant (p ˂ 0.001) decrease of VAS (median) at all follow-up intervals (from 6 to 4; 4; 4.5 points, respectively). The PSS group showed a significant yet transient VAS (median) decrease (from 6 to 5 points) immediately after the procedure only (p < 0.001). The decrease of VAS was more pronounced in the non-PSS group after three and six months (p = 0.0054 and 0.011, respectively) in intergroup comparison. A relative decrease of VAS ≥ 50% during follow-up was achieved in 40%; 43.3%; 26.7% (non-PSS), and 25%; 5%; 0% (PSS) of patients. ODI (median) significantly decreased in the non-PSS group (from 21.5 to 18 points) at three and six months (p = 0.014 and 0.021, respectively). In conclusion, previous lumbar spine surgery decreases the therapeutic efficacy of PRF-DRG procedure in CLRP patients.
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Affiliation(s)
- Jiri Jandura
- Department of Diagnostic Radiology, University Hospital Hradec Kralove, Sokolska 581, 50005 Hradec Kralove, Czech Republic
- Department of Diagnostic Radiology, Faculty of Medicine in Hradec Kralove, Charles University, Simkova 870, 50003 Hradec Kralove, Czech Republic
| | - Milan Vajda
- Department of Diagnostic Radiology, University Hospital Hradec Kralove, Sokolska 581, 50005 Hradec Kralove, Czech Republic
- Department of Diagnostic Radiology, Faculty of Medicine in Hradec Kralove, Charles University, Simkova 870, 50003 Hradec Kralove, Czech Republic
| | - Roman Kostysyn
- Department of Diagnostic Radiology, Faculty of Medicine in Hradec Kralove, Charles University, Simkova 870, 50003 Hradec Kralove, Czech Republic
- Department of Neurosurgery, University Hospital Hradec Kralove, Sokolska 581, 50005 Hradec Kralove, Czech Republic
| | - Jiri Vanasek
- Department of Diagnostic Radiology, University Hospital Hradec Kralove, Sokolska 581, 50005 Hradec Kralove, Czech Republic
| | - Eva Cermakova
- Department of Medical Biophysics, Faculty of Medicine in Hradec Kralove, Charles University, Simkova 870, 50003 Hradec Kralove, Czech Republic
| | - Jan Zizka
- Department of Imaging and Functional Medicine, University of Umea Daniel Naezéns väg, 90737 Umea, Sweden
| | - Pavel Ryska
- Department of Diagnostic Radiology, University Hospital Hradec Kralove, Sokolska 581, 50005 Hradec Kralove, Czech Republic
- Department of Diagnostic Radiology, Faculty of Medicine in Hradec Kralove, Charles University, Simkova 870, 50003 Hradec Kralove, Czech Republic
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Hemp Seed Oil in Association with β-Caryophyllene, Myrcene and Ginger Extract as a Nutraceutical Integration in Knee Osteoarthritis: A Double-Blind Prospective Case-Control Study. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:medicina59020191. [PMID: 36837393 PMCID: PMC9960141 DOI: 10.3390/medicina59020191] [Citation(s) in RCA: 14] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Revised: 01/11/2023] [Accepted: 01/15/2023] [Indexed: 01/19/2023]
Abstract
Background and Objectives: Nutraceuticals are gaining more and more importance as a knee osteoarthritis (KOA) complementary treatment. Among nutraceuticals, hemp seed oil and terpenes are proving to be very useful as therapeutic support for many chronic diseases, but there are still few studies regarding their effectiveness for treating KOA, both in combination and separately. The aim of this study is thus to compare the effect of two dietary supplements, both containing hemp seed oil, but of which only one also contains terpenes, in relieving pain and improving joint function in patients suffering from KOA. Materials and Methods: Thirty-eight patients were recruited and divided into two groups. The control group underwent a 45 day treatment with a hemp seed oil-based dietary supplement, while the treatment group assumed a hemp seed oil and terpenes dietary supplement for the same period. Patients were evaluated at the enrollment (T0) and at the end of treatment (T1). Outcome measures were: Numeric Rating Scale (NRS), Oswestry Disability Index (ODI), Short-Form-12 (SF-12), Knee Injury Osteoarthritis Outcome Score (KOOS), and Oxford Knee Score (OKS). Results: All outcome measures improved at T1 in both groups, but NRS, KOOS and OKS had a greater significant improvement in the treatment group only. Conclusions: Hemp seed oil and terpenes resulted a more effective integrative treatment option in KOA, improving joint pain and function and representing a good complementary option for patients suffering from osteoarthritis.
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Uysal B, Özkuk K, Şahin N, Ökmen BM, Sezer R, Ateş Z. Comparison of the effectiveness of high-intensity laser and ultrasound therapies in adhesive capsulitis: A randomized controlled study. J Back Musculoskelet Rehabil 2023; 36:227-236. [PMID: 35964170 DOI: 10.3233/bmr-220026] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [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 Adhesive capsulitis (AC) is a common musculoskeletal disease characterized with shoulder pain, limitation of range of motion (ROM) and disability. Although physical therapy is used in the treatment of AC, studies on its effectiveness are continuing. OBJECTIVE This study aimed to assess the effectiveness of ultrasound (US) and high-intensity laser therapy (HILT) in the treatment of AC. METHODS Sixty patients were randomized into two groups. Group I received US (15 sessions) and Group II received HILT (9 sessions) for 3 weeks. In addition, all patients received physical therapy program (hot pack, TENS and exercises). Assessments were made using VAS-pain, Shoulder Pain and Disability Index (SPADI), range of motion (ROM) at baseline and in post-treatment 3rd, 8th and 24th weeks. RESULTS There was no statistically significant difference between the groups in terms of all pre-treatment values. In intragroup assessment, statistically significant difference was identified in all the values of Groups 1 and 2 in all assessment periods compared with the pre-treatment values (p< 0.05). There was no significant difference between groups in all assessment periods. CONCLUSION According to results, US therapy and HILT were effective on the improvement of pain, ROM and functional conditions of patients in the treatment of AC.
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Affiliation(s)
- Bilal Uysal
- Department of Physical Medicine and Rehabilitation, Faculty of Medicine, Balikesir University, Balikesir, Turkey
| | - Kağan Özkuk
- Department of Medical Ecology and Hydroclimatology, Faculty of Medicine, Usak University, Usak, Turkey
| | - Nilay Şahin
- Department of Physical Medicine and Rehabilitation, Faculty of Medicine, Balikesir University, Balikesir, Turkey
| | - Burcu M Ökmen
- Department of Physical Medicine and Rehabilitation, Saglik Bilimleri University Bursa Yuksek Ihtisas Training and Research Hospital, Bursa, Turkey
| | - Refia Sezer
- Department of Physical Medicine and Rehabilitation, İzzet Baysal Physical Medicine and Rehabilitation Training and Research Hospital, Bolu, Turkey
| | - Zeynep Ateş
- Department of Physical Medicine and Rehabilitation, İzzet Baysal Physical Medicine and Rehabilitation Training and Research Hospital, Bolu, Turkey
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Ersoy S, Paker N, Kesiktaş FN, Bugdayci DS, Karakaya E, Çetin M. Comparison of transcutaneous electrical stimulation and suprascapular nerve blockage for the treatment of hemiplegic shoulder pain. J Back Musculoskelet Rehabil 2022; 36:731-738. [PMID: 36565102 DOI: 10.3233/bmr-220189] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
BACKGROUND Hemiplegic shoulder pain (HSP) is a common morbidity of stroke. Different treatment modalities can be used for optimizing the results and limiting the possible side effects. This research compares the effects of two therapies used to reduce the pain and improve the quality of life of the patients with HSP. OBJECTIVE This study aimed to compare the effects of transcutaneous electrical nerve stimulation (TENS) and suprascapular nerve blockage (SSNB) in patients with HSP. METHODS In this clinical research, 24 patients with HSP who participated in a conventional rehabilitation program were randomized into TENS or SSNB treatment groups. A 100 mm visual analogue scale was used to assess the severity of pain. Passive range of motion (ROM) of the shoulder was measured. The Modified Ashworth Scale (MAS) was used to evaluate spasticity of the upper extremities, and the Modified Barthel Scale was used to assess activities of daily living (ADL). Quality of life was measured using the Stroke-specific Quality of Life (SS-QoL) questionnaire. RESULTS The pain scores of the SSNB group decreased more significantly (p< 0.05) than in the TENS group. SS-QoL scores at the 3rd week in both groups were significantly higher than before treatment (p< 0.05). MAS scores and Barthel scores after treatment did not differ significantly between the groups. CONCLUSION TENS and SSNB were beneficial in relieving pain and increasing passive shoulder ROM and ADL in all patients. The alleviating of pain was faster in patients who underwent SSNB.
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Filip A, Veliceasa B, Puha B, Filip N, Cojocaru E, Pertea M, Carp CA, Huzum B, Alexa O, Rommens PM. Pain Intensity and Degree of Disability after Fragility Fractures of the Pelvis. MEDICINA (KAUNAS, LITHUANIA) 2022; 58:medicina58040477. [PMID: 35454313 PMCID: PMC9024514 DOI: 10.3390/medicina58040477] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/06/2022] [Revised: 03/22/2022] [Accepted: 03/23/2022] [Indexed: 12/03/2022]
Abstract
Background and objectives: Fragility fractures of the pelvis (FFP) are of increasing interest lately, being associated with a loss of mobility and affecting the quality of life. The aim of our study was to investigate the effect of FFP on disability and pain in patients, after one year since injury. Materials and Methods: In the study, we included 76 patients diagnosed with FFP, who were admitted to our trauma department between January 2016 and January 2019, and were above 65 years of age. The Von Korff pain intensity and disability scores were calculated in the hospital at 6 months and after 1 year. Results: Fifty-four patients were female (71%), with an average age of 75.9 ± 7.19 years. Twenty-two patients were male (29%) and had a mean age of 77.22 ± 7.33 years. We did not record significant differences regarding age between the men and women (p > 0.05). Significant improvements appeared between the baseline and the 6 month follow-up; the average pain intensity score at 6 months was 44.94 (SD 21.20) (p < 0.001), and the disability score was 54.30 (SD 21.62). The following average pain intensity and disability scores after 12 months were similar to the values at6 months: 44.48 (SD 21.74) for pain intensity and 52.36 (SD 24.53) for disability. The Von Korff pain score at 6 months and after 1 year depends on gender and on the initial Von Korff pain score (p = 0.02). The Von Korff disability score at 6 months depends on gender, the baseline pain score and the baseline disability score (p = 0.001). Conclusions: our patients reported long-lasting pain that had a severe effect on their daily routines, and they could not return to their normal status prior to injury.
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Affiliation(s)
- Alexandru Filip
- Department of Orthopedics and Traumatology, Surgical Science (II), Faculty of Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, 700020 Iasi, Romania; (A.F.); (B.P.); (C.A.C.); (B.H.); (O.A.)
| | - Bogdan Veliceasa
- Department of Orthopedics and Traumatology, Surgical Science (II), Faculty of Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, 700020 Iasi, Romania; (A.F.); (B.P.); (C.A.C.); (B.H.); (O.A.)
- Correspondence: (B.V.); (N.F.)
| | - Bogdan Puha
- Department of Orthopedics and Traumatology, Surgical Science (II), Faculty of Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, 700020 Iasi, Romania; (A.F.); (B.P.); (C.A.C.); (B.H.); (O.A.)
| | - Nina Filip
- Department of Morpho-Functional Sciences (II), Faculty of Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, 700020 Iasi, Romania
- Correspondence: (B.V.); (N.F.)
| | - Elena Cojocaru
- Department of Morpho-Functional Sciences (I), Faculty of Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, 700020 Iasi, Romania;
| | - Mihaela Pertea
- Department Plastic Surgery and Reconstructive, Surgical Sciences (I), Faculty of Medicine, Grigore T. Popa University of Medicine and Pharmacy, 700020 Iasi, Romania;
| | - Claudiu Adrian Carp
- Department of Orthopedics and Traumatology, Surgical Science (II), Faculty of Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, 700020 Iasi, Romania; (A.F.); (B.P.); (C.A.C.); (B.H.); (O.A.)
| | - Bogdan Huzum
- Department of Orthopedics and Traumatology, Surgical Science (II), Faculty of Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, 700020 Iasi, Romania; (A.F.); (B.P.); (C.A.C.); (B.H.); (O.A.)
| | - Ovidiu Alexa
- Department of Orthopedics and Traumatology, Surgical Science (II), Faculty of Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, 700020 Iasi, Romania; (A.F.); (B.P.); (C.A.C.); (B.H.); (O.A.)
| | - Pol Maria Rommens
- Department of Orthopedics and Traumatology, University Medical Center of Johannes Gutenberg-University Mainz, 55131 Mainz, Germany;
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