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Zhang B, Guo M, Dong T, Yang H, Zhang Q, Yang Q, Zhou X, Mao C, Zhang M. Disrupted Resting-State Functional Connectivity and Effective Connectivity of the Nucleus Accumbens in Chronic Low Back Pain: A Cross-Sectional Study. J Pain Res 2024; 17:2133-2146. [PMID: 38915479 PMCID: PMC11194467 DOI: 10.2147/jpr.s455239] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2024] [Accepted: 05/28/2024] [Indexed: 06/26/2024] Open
Abstract
Purpose Chronic low back pain (cLBP) is a recurring and intractable disease that is often accompanied by emotional and cognitive disorders such as depression and anxiety. The nucleus accumbens (NAc) plays an important role in mediating emotional and cognitive processes and analgesia. This study investigated the resting-state functional connectivity (rsFC) and effective connectivity (EC) of NAc and its subregions in cLBP. Methods Thirty-four cLBP patients and 34 age- and sex-matched healthy controls (HC) underwent resting-state functional magnetic resonance imaging (rs-fMRI). Seed-based rsFC and Dynamic Causal Modelling (DCM) were used to examine the alteration of the rsFC and EC of the NAc. Results Our results showed that the cLBP group had increased rsFC of the bilateral NAc-left superior frontal cortex (SFC), orbital frontal cortex (OFC), left angular gyrus, the left NAc-bilateral middle temporal gyrus, as well as decreased rsFC of left NAc-left supramarginal gyrus, right precentral gyrus, left cerebellum, brainstem (medulla oblongata), and right insula pathways compared with the HC; the results of the subregions were largely consistent with the whole NAc. In addition, the rsFC of the left NAc-left SFC was negatively correlated with Hamilton's Depression Scale (HAMD) scores (r = -0.402, p = 0.018), and the rsFC of left NAc-OFC was positively correlated with present pain intensity scores (r = 0.406, p = 0.017) in the cLBP group. DCM showed that the cLBP group showed significantly increased EC from the left cerebellum to the right NAc (p = 0.012) as compared with HC. Conclusion Overall, our findings demonstrate aberrant rsFC and EC between NAc and regions that are associated with emotional regulation and cognitive processing in individuals with cLBP, underscoring the pivotal roles of emotion and cognition in cLBP.
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Affiliation(s)
- Bo Zhang
- Department of Medical Imaging, The First Affiliated Hospital of Xi’an Jiaotong University, Xi’an, 710061, People’s Republic of China
- Department of Medical Imaging, The Second Affiliated Hospital of Xi’an Jiaotong University, Xi’an, 710004, People’s Republic of China
| | - Minmin Guo
- Department of Medical Imaging, The Second Affiliated Hospital of Xi’an Jiaotong University, Xi’an, 710004, People’s Republic of China
| | - Ting Dong
- Department of Medical Imaging, The Second Affiliated Hospital of Xi’an Jiaotong University, Xi’an, 710004, People’s Republic of China
| | - Huajuan Yang
- Department of Medical Imaging, The Second Affiliated Hospital of Xi’an Jiaotong University, Xi’an, 710004, People’s Republic of China
| | - Qiujuan Zhang
- Department of Medical Imaging, The Second Affiliated Hospital of Xi’an Jiaotong University, Xi’an, 710004, People’s Republic of China
| | - Quanxin Yang
- Department of Medical Imaging, The Second Affiliated Hospital of Xi’an Jiaotong University, Xi’an, 710004, People’s Republic of China
| | - Xiaoqian Zhou
- Department of Medical Imaging, The Second Affiliated Hospital of Xi’an Jiaotong University, Xi’an, 710004, People’s Republic of China
| | - Cuiping Mao
- Department of Medical Imaging, The Second Affiliated Hospital of Xi’an Jiaotong University, Xi’an, 710004, People’s Republic of China
| | - Ming Zhang
- Department of Medical Imaging, The First Affiliated Hospital of Xi’an Jiaotong University, Xi’an, 710061, People’s Republic of China
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Tang X, Li Q, Huang G, Chen Z, Huang Y, Pei X, Zhao S, Liu Z, Guo T, Liang F. Immediate Efficacy of Contralateral Acupuncture on SI3 Combined with Active Exercise for Acute Lumbar Sprains: Protocol for a Randomized Controlled Trial. J Pain Res 2024; 17:2099-2110. [PMID: 38887384 PMCID: PMC11182037 DOI: 10.2147/jpr.s475839] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2024] [Accepted: 06/10/2024] [Indexed: 06/20/2024] Open
Abstract
Purpose Acute lumbar sprain (ALS) is a common clinical disease characterized by persistent intolerable low back pain and limitation of movement, and quick pain relief and restoration of mobility in a short time are the main needs of patients when they visit the clinic. This study aims to evaluate the immediate efficacy of contralateral acupuncture (CAT) on SI3 combined with active exercise in treating ALS. Methods and Analysis This study is a randomized controlled trial which will recruit 118 eligible participants aged 18 to 55 years with ALS at the Second Affiliated Hospital of Yunnan University of Chinese Medicine between March 2024 and December 2026. Participants will be randomly assigned to the acupuncture group or the sham-acupuncture group in a 1:1 ratio. The acupuncture group will receive a 10-minute acupuncture treatment combined with active exercise, while the sham-acupuncture group will receive a 10-minute sham acupuncture treatment combined with active exercise. Randomization will use a computer-generated sequence with allocation concealed in opaque envelopes. The primary outcome will be the pain visual analogue scale (VAS) scores after 10 minutes of treatment. Secondary outcomes will include the pain VAS scores at other time points (2, 4, 6, and 8 minutes post-treatment), the lumbar range of motion (ROM) scores at various time points, blinded assessment, the treatment effect expectancy scale, and the rescue analgesia rate. The analysis will follow the intention-to-treat principle. The primary outcome will be analyzed using ANCOVA, and secondary outcomes with repeated measures ANOVA. The rescue analgesia rate will be assessed using either the χ2 test or Fisher's exact test. Discussion This study is the first randomized controlled trial to assess the immediate efficacy of CAT in combination with active exercise for ALS. This study will provide a simple, rapid, and effective treatment for the clinical management of ALS.
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Affiliation(s)
- Xin Tang
- School of Second Clinical Medicine/The Second Affiliated Hospital, Yunnan University of Chinese Medicine, Kunming, People’s Republic of China
| | - Qifu Li
- School of Second Clinical Medicine/The Second Affiliated Hospital, Yunnan University of Chinese Medicine, Kunming, People’s Republic of China
| | - Gaoyangzi Huang
- School of Second Clinical Medicine/The Second Affiliated Hospital, Yunnan University of Chinese Medicine, Kunming, People’s Republic of China
| | - Ziwen Chen
- College of Acupuncture and Tuina, Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, People’s Republic of China
| | - Ya Huang
- School of Second Clinical Medicine/The Second Affiliated Hospital, Yunnan University of Chinese Medicine, Kunming, People’s Republic of China
| | - Xianmei Pei
- School of Second Clinical Medicine/The Second Affiliated Hospital, Yunnan University of Chinese Medicine, Kunming, People’s Republic of China
| | - Siwen Zhao
- School of Second Clinical Medicine/The Second Affiliated Hospital, Yunnan University of Chinese Medicine, Kunming, People’s Republic of China
| | - Zili Liu
- School of Second Clinical Medicine/The Second Affiliated Hospital, Yunnan University of Chinese Medicine, Kunming, People’s Republic of China
| | - Taipin Guo
- School of Second Clinical Medicine/The Second Affiliated Hospital, Yunnan University of Chinese Medicine, Kunming, People’s Republic of China
| | - Fanrong Liang
- College of Acupuncture and Tuina, Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, People’s Republic of China
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Scaturro D, Migliorino D, Lauricella L, Quartararo F, Calabrese N, Tomasello S, Vecchio M, Letizia Mauro G. Extracorporeal ShockWave Treatment vs. mesotherapy in the treatment of myofascial syndromes: a clinical trial. Front Med (Lausanne) 2024; 11:1388922. [PMID: 38841584 PMCID: PMC11152160 DOI: 10.3389/fmed.2024.1388922] [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: 02/20/2024] [Accepted: 04/23/2024] [Indexed: 06/07/2024] Open
Abstract
Numerous scientific papers have compared different treatment options in the management of myofascial pain syndrome. This study evaluated the efficacy of Extracorporeal ShockWave Treatment (ESWT) and mesotherapy in patients with Myofascial Pain Syndrome (MPS) in terms of improvement in pain, functional capacity, and quality of life. A case-control study was conducted on 54 patients, who were randomized into 2 groups: group A, consisting of 27 patients, who were treated with 5 sessions of focal ESWT on a weekly basis; and group B, consisting of 27 patients, who underwent 5 sessions of mesotherapy with Thiocolchicoside fl 4 mg/2 mL and Mepivacaine fl 10 mg/1 mL on a weekly basis. Patients were evaluated at enrollment (T0), after 5 weeks, at the end of rehabilitation treatment (T1), and at a follow- up 30 days after the end of treatment (T2), by administering rating scales (Numeric Rating Scale (NRS) - Pressure Pain Threshold (PPT) - Short Form-36 (SF-36)). The results showed that focal ESWT and Mesoterapy are two valid and effective treatment options in reducing algic symptoms and improving short- and long-term quality of life. However, the use of ESWTs, despite being mildly painful but tolerated, has been shown to be superior to mesotherapy in terms of pain reduction and increased functional capacity.
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Affiliation(s)
- Dalila Scaturro
- Department of Medicine of Precision in the Medical, Surgical and Critical Care Areas, University of Palermo, Palermo, Italy
| | - Domenico Migliorino
- Section of Pharmacology, Department of Biomedical and Biotechnological Sciences, University of Catania, Catania, Italy
| | - Lorenza Lauricella
- Department of Medicine of Precision in the Medical, Surgical and Critical Care Areas, University of Palermo, Palermo, Italy
| | - Francesco Quartararo
- Section of Pharmacology, Department of Biomedical and Biotechnological Sciences, University of Catania, Catania, Italy
| | - Noemi Calabrese
- Section of Pharmacology, Department of Biomedical and Biotechnological Sciences, University of Catania, Catania, Italy
| | - Sofia Tomasello
- Department of Neuroscience, Biomedicine and Movement of the University of Verona, Verona, Italy
| | - Michele Vecchio
- Section of Pharmacology, Department of Biomedical and Biotechnological Sciences, University of Catania, Catania, Italy
| | - Giulia Letizia Mauro
- Department of Medicine of Precision in the Medical, Surgical and Critical Care Areas, University of Palermo, Palermo, Italy
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Xia JC, Huang YC, Wu K, Pang J, Shi Y. Efficacy of Electroacupuncture Combined with Chinese Herbal Medicine on Pain Intensity for Chronic Sciatica Secondary to Lumbar Disc Herniation: Study Protocol for a Randomised Controlled Trial. J Pain Res 2024; 17:1381-1391. [PMID: 38618296 PMCID: PMC11012699 DOI: 10.2147/jpr.s448631] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2023] [Accepted: 03/09/2024] [Indexed: 04/16/2024] Open
Abstract
Purpose Chinese herbal medicine and electroacupuncture (EA) have been used to control pain for many decades in China. We aim to explore the efficacy of intervening patients whose discogenic sciatica symptoms lasting longer than 3 months with these conservative treatments. Patients and Methods This is a single-center, parallel-group, patient-unblinded Randomized Controlled Trial (RCT) with blinded outcome assessment and statistician. One hundred and twenty-four patients will be assigned randomly into 2 groups including conservative treatment group (Shenxie Zhitong capsule combined with EA treatment) and Nonsteroidal Anti-inflammatory Drugs (Nonsteroidal Anti-inflammatory Drugs, NSAIDs) control group (Celecoxib) in a 1:1 ratio. The trial involves a 4-week treatment along with follow-up for 6 months. The primary outcome is the leg pain intensity measured by the visual analogue scale (VAS) at 6 months after randomization. Secondary outcomes include leg pain intensity at other time points, back pain intensity, leg pain and back pain frequency, functional status, quality of life, return to work status and satisfaction of patients. Adverse events will also be recorded. Strengths and Limitations of This Study Through this study, we want to observe the efficacy of electroacupuncture combined with Chinese herbal medicine on pain intensity for chronic sciatica secondary to Lumbar Disc Herniation. If the final results are favorable, it is expected to be a safe, economical, and effective treatment for patients. The study design has the following limitations: the setup of control group was less than perfect; patients and doctors could not be blinded in this trial; we skipped the feasibility study. We have tried our best to minimize adverse impacts. Trial Registration ChiCTR2300070884 (Chinese Clinical Trial Registry, http://www.chictr.org.cn, registered on 25th April 2023).
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Affiliation(s)
- Jing-Chun Xia
- Shi’s Center of Orthopedics and Traumatology, Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai, People’s Republic of China
- Institute of Traumatology & Orthopedics, Shanghai Academy of Traditional Chinese Medicine, Shanghai, People’s Republic of China
| | - Yu-Cheng Huang
- Shi’s Center of Orthopedics and Traumatology, Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai, People’s Republic of China
- Institute of Traumatology & Orthopedics, Shanghai Academy of Traditional Chinese Medicine, Shanghai, People’s Republic of China
| | - Ke Wu
- Shi’s Center of Orthopedics and Traumatology, Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai, People’s Republic of China
- Institute of Traumatology & Orthopedics, Shanghai Academy of Traditional Chinese Medicine, Shanghai, People’s Republic of China
| | - Jian Pang
- Shi’s Center of Orthopedics and Traumatology, Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai, People’s Republic of China
- Institute of Traumatology & Orthopedics, Shanghai Academy of Traditional Chinese Medicine, Shanghai, People’s Republic of China
| | - Ying Shi
- Shi’s Center of Orthopedics and Traumatology, Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai, People’s Republic of China
- Institute of Traumatology & Orthopedics, Shanghai Academy of Traditional Chinese Medicine, Shanghai, People’s Republic of China
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Junior PRQ, Siéssere S, de Mello EC, Rodrigues S, Regalo I, Gonçalves LMN, Arnoni VW, Palinkas M, Regalo S. Effect of dry needling and instrumental myofascial release on masticatory, facial, and cervical muscles of patients with temporomandibular disorders of muscular origin. J Clin Exp Dent 2023; 15:e366-e375. [PMID: 37214753 PMCID: PMC10198697 DOI: 10.4317/jced.60312] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2023] [Accepted: 03/22/2023] [Indexed: 05/24/2023] Open
Abstract
Background To evaluate the effectiveness of dry needling (DN) and instrumental myofascial release (IMR) therapies in the cervico-cranio-mandibular system through pain, bite force, and distribution of occlusal contacts in patients with muscular temporomandibular disorders. Material and Methods Thirty patients were divided into treatment groups: DN (n=15) and IMR (n=15). Therapeutic efficacy regarding pain perception and tolerance of masticatory, facial, and cervical muscles, bite force, and distribution of occlusal contacts were analyzed in this observational longitudinal clinical study pre/post-intervention and pre/post one month of therapeutic intervention. The data were tabulated and statistically analyzed (repeated measures and Bonferroni post-hoc test, p<0.05). Results There was a statistically significant difference in pain between the groups in the comparison of pre- and post-intervention with effect on time versus intervention in the head and neck. Pain perception and tolerance showed a statistical effect of time on the temporal, suboccipital, sternocleidomastoid, mental (right and left), right masseter, and left trapezius muscles. There was a statistically significant effect of the intervention on the mentalis, supraorbital, and infraorbital (right and left) muscles. There was a statistically significant effect of the interaction on the upper masseter (right and left), anterior temporal (left), suboccipital, sternocleidomastoid, and mentalis (left) muscles. There was an increase in post-intervention molar bite force in the groups, with a statistical effect on time versus intervention in the right and left regions. Contact of occlusal forces at the maxilla/mandible interface showed a difference between the mean times on teeth 26-36 after versus 1 month after the intervention. Conclusions The two therapeutic techniques are viable for the treatment of muscular temporomandibular disorders; however, IMR proved to be more effective immediately after the intervention and after one month. Key words:Temporomandibular disorders, pain, masticatory muscles, facial muscles, cervical muscles, dry needling, instrumental myofascial release.
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Affiliation(s)
| | - Selma Siéssere
- DDS, PhD, Professor. Department of Basic and Oral Biology, Ribeirão Preto School of Dentistry and National Institute and Technology - Translational Medicine (INCT.TM), University of São Paulo, Brazil
| | - Edneia-Corrêa de Mello
- DDS. Department of Basic and Oral Biology, Ribeirão Preto School of Dentistry, University of São Paulo, Brazil
| | - Sergio Rodrigues
- DDS. Department of Basic and Oral Biology, Ribeirão Preto School of Dentistry, University of São Paulo, Brazil
| | - Isabela Regalo
- DDS. Department of Basic and Oral Biology, Ribeirão Preto School of Dentistry, University of São Paulo, Brazil
| | - Ligia-Maria-Napolitano Gonçalves
- DDS, PhD, Professor. Department of Basic and Oral Biology, Ribeirão Preto School of Dentistry and National Institute and Technology - Translational Medicine (INCT.TM), University of São Paulo, Brazil
| | - Veridiana-Wanshi Arnoni
- DDS. Department of Basic and Oral Biology, Ribeirão Preto School of Dentistry, University of São Paulo, Brazil
| | - Marcelo Palinkas
- DDS, PhD, Professor. Department of Basic and Oral Biology, Ribeirão Preto School of Dentistry and National Institute and Technology - Translational Medicine (INCT.TM), University of São Paulo, Brazil
| | - Simone Regalo
- DDS, PhD, Professor. Department of Basic and Oral Biology, Ribeirão Preto School of Dentistry and National Institute and Technology - Translational Medicine (INCT.TM), University of São Paulo, Brazil
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Naka A, Kotz C, Gutmann E, Pramhas S, Schukro RPJ, Ristl R, Schuhfried O, Crevenna R, Sator S. Effect of Regular Electrotherapy on Spinal Flexibility and Pain Sensitivity in Patients with Chronic Non-Specific Neck Pain and Low Back Pain: A Randomized Controlled Double-Blinded Pilot Trial. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:medicina59050823. [PMID: 37241055 DOI: 10.3390/medicina59050823] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Revised: 04/03/2023] [Accepted: 04/21/2023] [Indexed: 05/28/2023]
Abstract
Background and Objectives: Chronic neck pain and low back pain are common conditions in high-income countries leading to social and medical problems such as invalidity and decreased quality of life. The aim of this study was to investigate the effect of supra-threshold electrotherapy on pain level, subjective feeling of disability, and spinal mobility in patients with chronic pain in the spinal cord. Materials and Methods: 11 men and 24 women with a mean age of 49 years were randomly divided into three groups: group 1, "therapy": supra-threshold electrotherapy was applied on the whole back after electrical calibration; group 2, "control": electrical calibration without successive electrotherapy; group 3, "control of control": no stimulation. Sessions were performed once a week and six times in total, each lasting 30 min. The numeric pain rating scale (NRS), cervical and lumbar range of motion (ROM), as well as disability in daily live were investigated before and after the sessions using questionnaires (Neck Disability Index, Roland Morris Questionnaire, Short-form Mc Gill Pain Questionnaire (SF-MPQ)). Results: Spinal mobility improved significantly in the lumbar anteflexion (baseline mean, 20.34 ± SD 1.46; post session mean, 21.43 ± SD 1.95; p = 0.003) and retroflexion (baseline mean, 13.68 ± SD 1.46; post session mean, 12.05 ± SD 1.37; p = 0.006) in the group receiving electrotherapy. Pain levels measured by the NRS and disability-questionnaire scores did not differ significantly before and after treatment in any of the groups. Conclusions: Our data indicate that regular supra-threshold electrotherapy for six times has a positive effect on lumbar flexibility in chronic neck pain and low back pain patients, whereas pain sensation or subjective feeling of disability remained unchanged.
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Affiliation(s)
- Asami Naka
- Department of Special Anaesthesia and Pain Medicine, Vienna General Hospital, Medical University of Vienna, 1090 Vienna, Austria
| | - Clea Kotz
- Department of Special Anaesthesia and Pain Medicine, Vienna General Hospital, Medical University of Vienna, 1090 Vienna, Austria
| | - Edith Gutmann
- Department of Special Anaesthesia and Pain Medicine, Vienna General Hospital, Medical University of Vienna, 1090 Vienna, Austria
| | - Sibylle Pramhas
- Department of Special Anaesthesia and Pain Medicine, Vienna General Hospital, Medical University of Vienna, 1090 Vienna, Austria
| | - Regina Patricia Juliane Schukro
- Department of Special Anaesthesia and Pain Medicine, Vienna General Hospital, Medical University of Vienna, 1090 Vienna, Austria
| | - Robin Ristl
- Section for Medical Statistics, Center for Medical Data Science, Medical University of Vienna, 1090 Vienna, Austria
| | - Othmar Schuhfried
- Department of Physical Medicine, Rehabilitation and Occupational Medicine, Vienna General Hospital, Medical University of Vienna, 1090 Vienna, Austria
| | - Richard Crevenna
- Department of Physical Medicine, Rehabilitation and Occupational Medicine, Vienna General Hospital, Medical University of Vienna, 1090 Vienna, Austria
| | - Sabine Sator
- Department of Special Anaesthesia and Pain Medicine, Vienna General Hospital, Medical University of Vienna, 1090 Vienna, Austria
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Presence of Differences in the Radiofrequency Parameters Applied to Complex Pressure Ulcers: A Secondary Analysis. Medicina (B Aires) 2023; 59:medicina59030516. [PMID: 36984517 PMCID: PMC10059019 DOI: 10.3390/medicina59030516] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2023] [Revised: 02/21/2023] [Accepted: 03/02/2023] [Indexed: 03/09/2023] Open
Abstract
Background: Pressure ulcers are a public health problem given the impact that they have on morbidity, mortality and the quality of life and participation of patients who suffer from them. Therefore, the main objective of this study was to evaluate the presence of differences in the radiofrequency parameters applied to complex pressure ulcers throughout the sessions and between the right and left leg. As a secondary objective, the subjective perceptions of the effects of the treatment by both the patients and the practitioner were analyzed. Methods: We performed a secondary analysis of data from a prospective study involving 36 patients from the Hospital de Guadarrama in Madrid, Spain, who presented ulcers in the lower limbs. Ten treatment sessions of radiofrequency were administered with a frequency of one session/week, collecting the data referring to the variables in each of the sessions. The main outcome variables were the radiofrequency parameters automatically adjusted in each session and that referred to the frequency (Hz), maximum and average power (W), absorbed energy by the ulcer (J/cm2) and temperature (°C) reached by the tissues. On the other hand, the subjective perception of the results was evaluated using the Global Response Assessment (GRA), a Likert-type scale that scores the treatment results from 1 (significantly worse) to 5 (significantly better). Likewise, the satisfaction of both the patients and the professional were evaluated using a 10-point numerical scale. Results: The ANOVA test showed significant differences (p < 0.05) throughout the sessions except in patient satisfaction. The ANOVA test showed significant differences (p < 0.05) between both legs and over time in all parameters except for frequency. The presence of significant differences (p < 0.05) was observed over time between legs compared to the initial values in the absorbed energy and in temperature, with higher final values in the absorbed energy in the left leg compared to the right (26.31 ± 3.75 W vs. 17.36 ± 5.66 W) and a moderate effect on both (R2 = 0.471 and 0.492, respectively). The near absence of changes in the satisfaction of both the patients and the professional was observed, while the score in the GRA decreased continuously throughout the sessions. Conclusions: Radiofrequency parameters are indicative of an improved clinical response to ulcers. In addition, higher radiofrequency exposure increases healing capacity. However, the subjective perception of treatment outcomes worsened, which may be related to the chronic nature of the ulcers, leading to patients’ expectations not being met.
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Audoux CR, Estrada-Barranco C, Martínez-Pozas O, Gozalo-Pascual R, Montaño-Ocaña J, García-Jiménez D, Vicente de Frutos G, Cabezas-Yagüe E, Sánchez Romero EA. What Concept of Manual Therapy Is More Effective to Improve Health Status in Women with Fibromyalgia Syndrome? A Study Protocol with Preliminary Results. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:1061. [PMID: 36673817 PMCID: PMC9858983 DOI: 10.3390/ijerph20021061] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Revised: 01/03/2023] [Accepted: 01/04/2023] [Indexed: 06/01/2023]
Abstract
BACKGROUND Fibromyalgia (FM) is defined as a chronic syndrome characterized by diffuse musculoskeletal pain, associated with characteristic signs and symptoms such as fatigue and/or sleep and mood disorders, and whose etiology, pathogenesis and prognosis may or may not be known. There is growing evidence of manual therapy as a treatment for pain in the short and medium term, also in patients affected by FM. However, the heterogeneity of the manual therapy treatments administered are a very common clinical practice, as they are based more on the judgment or tendency of the physiotherapist, rather than on clear scientific evidence. Therefore, the aim of the present study protocol will be to determine which manual therapy approach is more effective in addressing health status by improving symptoms (sensory, cognitive, emotional and social) in patients with FM. METHODS a randomized controlled clinical trial with a 3-month follow-up will be carried out with 52 female patients affected by rheumatologist-diagnosed FM will be recruited and evaluated at the Asociación de Fibromialgia y Síndrome de Fatiga Crónica (AFINSYFACRO) in Móstoles, Madrid, Spain. For more details on the protocol, a pilot study was carried out using a non-probability method of judgmental or purposive sampling. Thirteen patients were also evaluated, treated and reevaluated; eight patients were assigned to the myofascial techniques approach (MTA) group and five to the Maitland's mobilization approach (MMA) group. RESULTS the preliminary results presented here are intended to show how the planned randomized controlled clinical trial will develop. Patients who received MTA had significantly improved pain and health status outcomes after treatment and at 1-month follow-up, with no significant change in those who received MMA. CONCLUSIONS the exact details of the study protocol on which the manual therapy approach is more effective in addressing health status by improving symptoms (sensory, cognitive, emotional, and social) in patients with FM are presented. Preliminary results show that manual therapy is effective in improving pain and health status in patients with fibromyalgia at short and medium term, with significant results in those who received MTA.
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Affiliation(s)
- Carine Romane Audoux
- Musculoskeletal Pain and Motor Control Research Group, Faculty of Sport Sciences, Universidad Europea de Madrid, 28670 Madrid, Spain
- Department of Physiotherapy, Faculty of Sport Sciences, Universidad Europea de Madrid, Villaviciosa de Odón, 28670 Madrid, Spain
| | - Cecilia Estrada-Barranco
- Department of Physiotherapy, Faculty of Sport Sciences, Universidad Europea de Madrid, Villaviciosa de Odón, 28670 Madrid, Spain
| | - Oliver Martínez-Pozas
- Musculoskeletal Pain and Motor Control Research Group, Faculty of Sport Sciences, Universidad Europea de Madrid, 28670 Madrid, Spain
- Escuela Internacional de Doctorado, Department of Physical Therapy, Occupational Therapy, Rehabilitation and Physical Medicine, Universidad Rey Juan Carlos, 28933 Alcorcón, Spain
| | - Rodrigo Gozalo-Pascual
- Musculoskeletal Pain and Motor Control Research Group, Faculty of Sport Sciences, Universidad Europea de Madrid, 28670 Madrid, Spain
- Facultad de Enfermería, Fisioterapia y Podología, Universidad Complutense de Madrid, 28040 Madrid, Spain
| | - Juan Montaño-Ocaña
- Musculoskeletal Pain and Motor Control Research Group, Faculty of Sport Sciences, Universidad Europea de Madrid, 28670 Madrid, Spain
- Department of Physiotherapy, Faculty of Sport Sciences, Universidad Europea de Madrid, Villaviciosa de Odón, 28670 Madrid, Spain
- Musculoskeletal Pain and Motor Control Research Group, Faculty of Health Sciences, Universidad Europea de Canarias, 38300 La Orotava, Canary Islands, Spain
- Department of Physiotherapy, Faculty of Health Sciences, Universidad Europea de Canarias, 38300 La Orotava, Canary Islands, Spain
- OnelifeCenter, Multidisciplinary Center for the Prevention and Treatment of Pain, 28924 Alcorcón, Spain
| | - David García-Jiménez
- Musculoskeletal Pain and Motor Control Research Group, Faculty of Sport Sciences, Universidad Europea de Madrid, 28670 Madrid, Spain
- Department of Physical Therapy, Faculty of Medicine, CEU-San Pablo University, 28668 Madrid, Spain
| | - Gonzalo Vicente de Frutos
- Musculoskeletal Pain and Motor Control Research Group, Faculty of Sport Sciences, Universidad Europea de Madrid, 28670 Madrid, Spain
- Department of Physiotherapy, Faculty of Sport Sciences, Universidad Europea de Madrid, Villaviciosa de Odón, 28670 Madrid, Spain
- Musculoskeletal Pain and Motor Control Research Group, Faculty of Health Sciences, Universidad Europea de Canarias, 38300 La Orotava, Canary Islands, Spain
- Department of Physiotherapy, Faculty of Health Sciences, Universidad Europea de Canarias, 38300 La Orotava, Canary Islands, Spain
- OnelifeCenter, Multidisciplinary Center for the Prevention and Treatment of Pain, 28924 Alcorcón, Spain
| | - Elena Cabezas-Yagüe
- Department of Physiotherapy, Faculty of Sport Sciences, Universidad Europea de Madrid, Villaviciosa de Odón, 28670 Madrid, Spain
| | - Eleuterio A. Sánchez Romero
- Musculoskeletal Pain and Motor Control Research Group, Faculty of Sport Sciences, Universidad Europea de Madrid, 28670 Madrid, Spain
- Department of Physiotherapy, Faculty of Sport Sciences, Universidad Europea de Madrid, Villaviciosa de Odón, 28670 Madrid, Spain
- Musculoskeletal Pain and Motor Control Research Group, Faculty of Health Sciences, Universidad Europea de Canarias, 38300 La Orotava, Canary Islands, Spain
- Department of Physiotherapy, Faculty of Health Sciences, Universidad Europea de Canarias, 38300 La Orotava, Canary Islands, Spain
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9
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Fernández-Carnero J, Beltrán-Alacreu H, Arribas-Romano A, Cerezo-Téllez E, Cuenca-Zaldivar JN, Sánchez-Romero EA, Lerma Lara S, Villafañe JH. Prediction of Patient Satisfaction after Treatment of Chronic Neck Pain with Mulligan's Mobilization. LIFE (BASEL, SWITZERLAND) 2022; 13:life13010048. [PMID: 36675997 PMCID: PMC9860852 DOI: 10.3390/life13010048] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Revised: 12/16/2022] [Accepted: 12/20/2022] [Indexed: 12/28/2022]
Abstract
Chronic neck pain is among the most common types of musculoskeletal pain. Manual therapy has been shown to have positive effects on this type of pain, but there are not yet many predictive models for determining how best to apply manual therapy to the different subtypes of neck pain. The aim of this study is to develop a predictive learning approach to determine which basal outcome could give a prognostic value (Global Rating of Change, GRoC scale) for Mulligan's mobilization technique and to identify the most important predictive factors for recovery in chronic neck pain subjects in four key areas: the number of treatments, time of treatment, reduction of pain, and range of motion (ROM) increase. A prospective cohort dataset of 80 participants with chronic neck pain diagnosed by their family doctor was analyzed. Logistic regression and machine learning modeling techniques (Generalized Boosted Models, Support Vector Machine, Kernel, Classsification and Decision Trees, Random Forest and Neural Networks) were each used to form a prognostic model for each of the nine outcomes obtained before and after intervention: disability-neck disability index (NDI), patient satisfaction (GRoC), quality of life (12-Item Short Form Survey, SF-12), State-Trait Anxiety Inventory (STAI), Beck Depression Inventory (BDI II), pain catastrophizing scale (ECD), kinesiophobia-Tampa scale of kinesiophobia (TSK-11), Pain Intensity Visual Analogue Scale (VAS), and cervical ROM. Pain descriptions from the subjects and pain body diagrams guided the physical examination. The most important predictive factors for recovery in chronic neck pain patients indicated that the more anxiety and the lower the ROM of lateroflexion, the higher the probability of success with the Mulligan concept treatment.
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Affiliation(s)
- Josué Fernández-Carnero
- Department of Physical Therapy, Occupational Therapy, Rehabilitation and Physical Medicine, Universidad Rey Juan Carlos, 28922 Alcorcón, Spain
- Musculoskeletal Pain and Motor Control Research Group, Faculty of Sport Sciences, Universidad Europea de Madrid, 28670 Madrid, Spain
- Department of Physiotherapy, Faculty of Sport Sciences, Universidad Europea de Madrid, 28670 Villaviciosa de Odón, Spain
- Musculoskeletal Pain and Motor Control Research Group, Faculty of Health Sciences, Universidad Europea de Canarias, C/Inocencio García 1, 38300 La Orotava, Spain
- Department of Physiotherapy, Faculty of Health Sciences, Universidad Europea de Canarias, 38300 Santa Cruz de Tenerife, Spain
- Motion in Brains Research Group, Institute of Neuroscience and Sciences of the Movement (INCIMOV), Centro Superior de Estudios Universitarios La Salle, Universidad Autónoma de Madrid, 28023 Madrid, Spain
| | - Hector Beltrán-Alacreu
- Toledo Physiotherapy Research Group (GIFTO), Faculty of Physical Therapy and Nursing, Universidad de Castilla-La Mancha, Avenida de Carlos III s/n, 45071 Toledo, Spain
- CranioSPain Research Group, Centro Superior de Estudios Universitarios La Salle, Calle de la Salle 10, 28023 Madrid, Spain
| | - Alberto Arribas-Romano
- Department of Physical Therapy, Occupational Therapy, Rehabilitation and Physical Medicine, Universidad Rey Juan Carlos, 28922 Alcorcón, Spain
- International Doctoral School, Rey Juan Carlos University, 28933 Móstoles, Spain
| | - Ester Cerezo-Téllez
- Facultad de Medicina y Ciencias de la Salud, Departamento de Enfermería y Fisioterapia, Grupo de Investigación en Fisioterapia y Dolor, Universidad de Alcalá, 28801 Alcalá de Henares, Spain
| | - Juan Nicolás Cuenca-Zaldivar
- Facultad de Medicina y Ciencias de la Salud, Departamento de Enfermería y Fisioterapia, Grupo de Investigación en Fisioterapia y Dolor, Universidad de Alcalá, 28801 Alcalá de Henares, Spain
- Research Group in Nursing and Health Care, Puerta de Hierro Health Research Institute-Segovia de Arana (IDIPHISA), Manuel de Falla s/n, 28220 Majadahonda, Spain
- Primary Health Center "El Abajón", Calle Principado de Asturias 30, 28231 Las Rozas, Spain
| | - Eleuterio A Sánchez-Romero
- Musculoskeletal Pain and Motor Control Research Group, Faculty of Sport Sciences, Universidad Europea de Madrid, 28670 Madrid, Spain
- Department of Physiotherapy, Faculty of Sport Sciences, Universidad Europea de Madrid, 28670 Villaviciosa de Odón, Spain
- Musculoskeletal Pain and Motor Control Research Group, Faculty of Health Sciences, Universidad Europea de Canarias, C/Inocencio García 1, 38300 La Orotava, Spain
- Department of Physiotherapy, Faculty of Health Sciences, Universidad Europea de Canarias, 38300 Santa Cruz de Tenerife, Spain
| | - Sergio Lerma Lara
- Motion in Brains Research Group, Institute of Neuroscience and Sciences of the Movement (INCIMOV), Centro Superior de Estudios Universitarios La Salle, Universidad Autónoma de Madrid, 28023 Madrid, Spain
- Department of Physical Therapy, Centro Superior de Estudios Universitarios La Salle, Universidad Autónoma de Madrid, 28023 Madrid, Spain
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10
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Navarro-Santana MJ, Valera-Calero JA, Romanos-Castillo G, Hernández-González VC, Fernández-de-las-Peñas C, López-de-Uralde-Villanueva I, Plaza-Manzano G. Immediate Effects of Dry Needling on Central Pain Processing and Skin Conductance in Patients with Chronic Nonspecific Neck Pain: A Randomized Controlled Trial. J Clin Med 2022; 11:jcm11226616. [PMID: 36431093 PMCID: PMC9694175 DOI: 10.3390/jcm11226616] [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: 10/17/2022] [Revised: 11/01/2022] [Accepted: 11/07/2022] [Indexed: 11/11/2022] Open
Abstract
Although current evidence supports the use of dry needling for improving some clinical outcomes in people with neck pain, no previous research explored the effects of dry needling on the central processing of pain and autonomic nervous system in this population. Therefore, this clinical trial aimed to compare the effects of real and sham dry needling on autonomic nervous system function, pain processing as well as clinical and psychological variables in patients with chronic nonspecific neck pain. A double-blinded randomized clinical trial including 60 patients with neck pain was conducted. Patients were randomized to the real needling (n = 30) or sham needling (n = 30) group. Skin conductance (SC), pressure pain thresholds (PPTs), temporal summation (TS), conditioned pain modulation (CPM) as well as pain intensity, related-disability, catastrophism, and kinesiophobia levels were assessed by an assessor blinded to the allocation intervention. The results did not find significant group * time interactions for most outcomes, except for the global percentage of change of SC values (mean: F = 35.90, p < 0.001, ηp2 = 0.459; minimum: F = 33.99, p = 0.839, ηp2 = 0.371; maximum: F = 24.71, p < 0.001, ηp2 = 0.037) and PPTs at C5-C6 joint in the same side of needling (F = 9.982; p = 0.003; = 0.147), in favor of the dry needling group. Although the proportion of subjects experiencing moderate to large self-perceived improvement after the intervention was significantly higher (X2 = 8.297; p = 0.004) within the dry needling group (n = 18, 60%) than in the sham needling group (n = 7, 23.3%), both groups experienced similar improvements in clinical and psychological variables. Our results suggested that dry needling applied to patients with chronic nonspecific neck pain produced an immediate decrease in mechanical hyperalgesia at local sites and produced an increase in skin conductance as compared with sham needling. No changes in central pain processing were observed. A single session of sham or real dry needling was similarly effective for decreasing related disability, pain intensity, catastrophism, and kinesiophobia levels. Further studies are needed to better understand the clinical implications of autonomic nervous system activation on central sensitization and pain processing in the long-term after the application of dry needling.
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Affiliation(s)
| | - Juan Antonio Valera-Calero
- VALTRADOFI Research Group, Department of Physiotherapy, Faculty of Health, Universidad Camilo José Cela, Villanueva de la Cañada, Villanueva de la Cañada, 28692 Madrid, Spain
- Department of Physiotherapy, Faculty of Health, Universidad Camilo José Cela, Villanueva de la Cañada, 28692 Madrid, Spain
- Correspondence:
| | - Guillermo Romanos-Castillo
- Department of Physiotherapy, Faculty of Health, Universidad Camilo José Cela, Villanueva de la Cañada, 28692 Madrid, Spain
| | - Victor C. Hernández-González
- Department of Physiotherapy, Faculty of Health, Universidad Camilo José Cela, Villanueva de la Cañada, 28692 Madrid, Spain
| | - César Fernández-de-las-Peñas
- Department of Physical Therapy, Occupational Therapy, Physical Medicine and Rehabilitation, Universidad Rey Juan Carlos, 28922 Alcorcón, Spain
- Cátedra Institucional en Docencia, Clínica e Investigación en Fisioterapia: Terapia Manual, Punción Seca y Ejercicio Terapéutico, Universidad Rey Juan Carlos, 28922 Alcorcón, Spain
| | | | - Gustavo Plaza-Manzano
- Department of Radiology, Rehabilitation and Physiotherapy, Universidad Complutense de Madrid, 28040 Madrid, Spain
- Grupo InPhysio, Instituto de Investigación Sanitaria San Carlos (IdISSC), 28040 Madrid, Spain
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11
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Ultrasound-Guided Dry Needling for Trigger Point Inactivation in the Treatment of Postherpetic Neuralgia Mixed with Myofascial Pain Syndrome: A Prospective and Controlled Clinical Study. Pain Res Manag 2022; 2022:2984942. [PMID: 35958677 PMCID: PMC9363202 DOI: 10.1155/2022/2984942] [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: 03/19/2022] [Accepted: 05/07/2022] [Indexed: 12/03/2022]
Abstract
Objective To evaluate the safety and effectiveness of ultrasound-guided dry needling for trigger point inactivation in the treatment of postherpetic neuralgia (PHN) mixed with myofascial pain syndrome (MPS). Methods A prospective and controlled clinical study was conducted. From January 2020 to December 2020, among the 100 patients who received PHN treatment in the pain department, 54 patients complicated with MPS were randomly divided into the dry needling group D (n = 28) and pharmacotherapeutic group P (n = 26). Visual analogue score (VAS) and McGill Pain Questionnaire (MPQ) were taken as primary indicators. Ultrasound-guided inactivation of myofascial trigger points (MTrPs) with dry needling and intradermal needling combined with press needling were applied on group D and pharmacotherapeutic only treatment on group P respectively. The VAS score <3 and/or the MPQ score <2 represents effective treatment. The VAS score >3 and/or the MPQ score >2 represents recurrent in follow-up study three months after the treatment. Results After four weeks treatment, the effective rate of one month later of the group D was 92.9% and the effective rate of group P was 38.5%, respectively. The recurrent rate of group D was 7.1% and 34.6% for group P, respectively, for follow-up three months later. The satisfactory rate of group D was higher than that of group P. Conclusion Ultrasound-guided dry needling and intradermal needling combined with press needling were more effective than only pharmacotherapeutic treatment for PHN mixed with MPS, with lower recurrent rate and higher patient's satisfactory rate.
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12
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Rampazo ÉP, Liebano RE. Analgesic Effects of Interferential Current Therapy: A Narrative Review. Medicina (B Aires) 2022; 58:medicina58010141. [PMID: 35056448 PMCID: PMC8779694 DOI: 10.3390/medicina58010141] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Revised: 01/12/2022] [Accepted: 01/12/2022] [Indexed: 12/26/2022] Open
Abstract
Background and Objectives: Transcutaneous electrical stimulation of low- and medium-frequency currents is commonly used in pain management. Interferential current (IFC) therapy, a medium frequency alternating current therapy that reportedly reduces skin impedance, can reach deeper tissues. IFC therapy can provide several different treatment possibilities by adjusting its parameters (carrier frequency, amplitudemodulated frequency, sweep frequency, sweep mode or swing pattern, type of application (bipolar or quadripolar), time of application and intensity). The objective of this review article is to discuss the literature findings on the analgesic efficacy of IFC therapy. Conclusions: According to the literature, IFC therapy shows significant analgesic effects in patients with neck pain, low back pain, knee osteoarthritis and post-operative knee pain. Most of the IFC parameters seem not to influence its analgesic effects. We encourage further studies to investigate the mechanism of action of IFC therapy.
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