RESUMEN
INTRODUCTION: Obesity has become a worldwide public health problem and is directly linked to loss of quality of life, complications and comorbidities. One of them is chronic pain, especially in the knees, which increases significantly and proportionally with weight gain. In patients with severe obesity, with indication for bariatric surgery, the presence of chronic pain disables and often prevents their participation in a pre-surgical rehabilitation programme. As an analgesic therapy, photobiomodulation (PBM) has been studied with safety, efficacy, well-tolerated used and low costs. Thus, this study aims to evaluate the use of PBM for the treatment of chronic knee pain in obese patients undergoing a pre-surgical rehabilitation programme for bariatric surgery. METHODS AND ANALYSES: This is a double-blinded, randomised, placebo-controlled clinical, superiority, trial protocol. The PBM will be applied in bilateral knees and lumbar paraspinal points levels referring to the roots of innervation of the knee. The outcomes evaluated will be pain intensity, functionality, quality of life and clinical signs of neurological sensitization of chronic knee pain pathways. ETHICS AND DISSEMINATION: This protocol has already been approved by the Comitê de Ética em Pesquisa do Hospital das Clínicas da Universidade Federal de Goiás/EBSERH-Ethics Committee and it is following SPIRIT guidelines. The results will be statistically analysed and subsequently published in peer-reviewed journals. TRIAL REGISTRATION NUMBER: Clinical Trials Platform (https://clinicaltrials.gov/) with the number NCT05816798.
Asunto(s)
Cirugía Bariátrica , Dolor Crónico , Terapia por Luz de Baja Intensidad , Ensayos Clínicos Controlados Aleatorios como Asunto , Humanos , Método Doble Ciego , Dolor Crónico/etiología , Dolor Crónico/terapia , Terapia por Luz de Baja Intensidad/métodos , Obesidad/complicaciones , Calidad de Vida , Articulación de la Rodilla , Dimensión del Dolor , Adulto , Artralgia/etiología , Artralgia/terapiaRESUMEN
BACKGROUND: The role of Platelet-rich Plasma injections as a complementary therapy, together with other minimally invasive procedures, has been analyzed previously, however, there are no articles that evaluate the effects of intra-articular infiltration in the Temporomandibular Joint by itself. The aim of this article is to evaluate the effectiveness of intra-articular infiltration with Platelet-rich Plasma, as a single procedure, to both reduce pain and improve clinical parameters in painful joint disorders. MATERIAL AND METHODS: A systematic search was performed using the terms "Temporomandibular Joint Disorders" and "Platelet-rich plasma" in May 2021. Only the Clinical Trials found in the Pubmed/Medline, Embase, Cochrane Library/Cochrane CENTRAL, Google Scholar, and LILACS databases were selected. RESULTS: Only four articles were selected for full-text review. Statistically significant differences were found in pain reduction Platelet-rich Plasma-based interventions with respect to preoperative measurements up to six months. Only two studies found significant intergroup differences favoring Platelet-rich Plasma over other interventions. In relation to maximum mouth opening, three studies reported an increase compared to the preoperative measurements. CONCLUSIONS: Platelet-rich Plasma might potentially be effective in reducing pain levels and improving clinical parameters such as interincisal distance. However, studies with better methodological quality, larger sample sizes, and lower risk of bias are required to assess the real value of this intervention in the management of painful joint disorders.
Asunto(s)
Plasma Rico en Plaquetas , Trastornos de la Articulación Temporomandibular , Humanos , Trastornos de la Articulación Temporomandibular/terapia , Inyecciones Intraarticulares , Resultado del Tratamiento , Artralgia/terapiaRESUMEN
BACKGROUND: Chikungunya virus (CHIKV) is a globally prevalent pathogen, with outbreaks occurring in tropical regions. Chronic pain is the main symptom reported and is associated with decreased mobility and disability. Transcranial direct current stimulation (tDCS) is emerging as a new therapeutic tool for chronic arthralgia. OBJECTIVE: To evaluate the effectiveness of 10 consecutive sessions of anodal tDCS on pain (primary outcome) in participants with chronic CHIKV arthralgia. Secondary outcomes included functional status, quality of life, and mood. METHODS: In this randomized, double-blind, placebo-controlled trial, 30 participants with chronic CHIKV arthralgia were randomly assigned to receive either active (n = 15) or sham (n = 15) tDCS. The active group received 10 consecutive sessions of tDCS over M1 using the C3/Fp2 montage (2 mA for 20 min). Visual analog scale of pain (VAS), health assessment questionnaire (HAQ), short-form 36 health survey (SF-36), pain catastrophizing scale, Hamilton anxiety scale (HAS), timed up and go (TUG) test, lumbar dynamometry, 30-s arm curl and 2-min step test were assessed at baseline, day 10 and at 2 follow-up visits. RESULTS: There was a significant interaction between group and time on pain (p = 0.03; effect size 95 % CI 0.9 (-1.67 to -0.16), with a significant time interaction (p = 0.0001). There was no interaction between time and group for the 2-minute step test (p = 0.18), but the groups differed significantly at day 10 (p = 0.01), first follow-up (p = 0.01) and second follow-up (p = 0.03). HAQ and SF-36 improved but not significantly. There was no significant improvement in mental health, and physical tests. CONCLUSION: tDCS appears to be a promising intervention for reducing pain in participants with chronic CHIKV arthralgia, although further research is needed to confirm these findings and explore potential long-term benefits. TRIAL REGISTRATION: Brazilian Registry of Clinical Trials (ReBEC): RBR-245rh7.
Asunto(s)
Fiebre Chikungunya , Dolor Crónico , Corteza Motora , Calidad de Vida , Estimulación Transcraneal de Corriente Directa , Humanos , Masculino , Femenino , Persona de Mediana Edad , Estimulación Transcraneal de Corriente Directa/métodos , Fiebre Chikungunya/complicaciones , Fiebre Chikungunya/terapia , Método Doble Ciego , Adulto , Dolor Crónico/terapia , Dolor Crónico/etiología , Dolor Crónico/psicología , Corteza Motora/fisiopatología , Artralgia/terapia , Artralgia/etiología , Resultado del Tratamiento , Dimensión del Dolor , Enfermedad CrónicaRESUMEN
INTRODUCTION: The chikungunya virus infection is still an epidemic in Brazil with an incidence of 59.4 cases per 100 000 in the Northeast region. More than 60% of the patients present relapsing and remitting chronic arthralgia with debilitating pain lasting for years. Transcranial direct current stimulation (tDCS) appears promising as a novel neuromodulation approach for pain-related networks to alleviate pain in several pain syndromes. Our objective is to evaluate the effectiveness of tDCS (C3/Fp2 montage) on pain, muscle strength, functionality and quality of life in chronic arthralgia. METHODS AND ANALYSIS: This protocol is a single-centre, parallel-design, double-blind, randomised, sham-controlled trial. Forty participants will be randomised to either an active or sham tDCS. A total of 10 sessions will be administered over 2 weeks (one per weekday) using a monophasic continuous current with an intensity of 2 mA for 20 min. Participants will be evaluated at baseline, after the 10th session, 2 weeks and 4 weeks after intervention. PRIMARY OUTCOME: pain assessed using numeric rating scale and algometry. SECONDARY OUTCOMES: muscle strength, functionality and quality of life. The effects of stimulation will be calculated using a mixed analysis of variance model. ETHICS AND DISSEMINATION: The study was approved by the ethics committee of the Faculty of Health Sciences of Trairí, Federal University of Rio Grande do Norte (No. 2.413.851) and registered on the Brazilian Registry of Clinical Trials. Study results will be disseminated through presentations at conferences and publications in peer-reviewed journals. TRIAL REGISTRATION NUMBER: RBR-469yd6.
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Fiebre Chikungunya , Estimulación Transcraneal de Corriente Directa , Humanos , Artralgia/terapia , Fiebre Chikungunya/complicaciones , Fiebre Chikungunya/terapia , Método Doble Ciego , Dolor , Calidad de Vida , Ensayos Clínicos Controlados Aleatorios como Asunto , Estimulación Transcraneal de Corriente Directa/métodos , Resultado del TratamientoRESUMEN
ABSTRACT: Ulnar-sided wrist injuries are common in sports that require repeated pronosupination, wrist radial/ulnar deviation, axial loading, and gripping equipment. Common anatomic structures affected include the triangular fibrocartilage complex, extensor carpi ulnaris tendon, distal radioulnar and ulnocarpal joints, and hamate bone. Presenting symptoms include pain with activity, swelling, possible snapping or clicking, and reproduction of symptoms with provocative maneuvers. Imaging may confirm or rule out pathologies, but abnormal findings also may present in asymptomatic athletes. Initial treatment is usually nonoperative with splinting, load management, activity modification, strengthening the components of the kinetic chain of the particular sport, and pain management. Surgery is usually indicated in ulnar-wrist pain pathology such as hook of hamate fractures and required in associated instability. Future research should address specific treatment and rehabilitation protocols, emphasizing the complete kinetic chain along with the injured wrist.
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Artralgia , Traumatismos en Atletas , Traumatismos de los Tendones , Cúbito , Traumatismos de la Muñeca/complicaciones , Artralgia/diagnóstico , Artralgia/etiología , Artralgia/terapia , Atletas , Traumatismos en Atletas/diagnóstico , Traumatismos en Atletas/etiología , Traumatismos en Atletas/terapia , Béisbol/lesiones , Béisbol/fisiología , Fenómenos Biomecánicos , Golf/lesiones , Golf/fisiología , Gimnasia/lesiones , Gimnasia/fisiología , Hueso Ganchoso/lesiones , Hockey/lesiones , Hockey/fisiología , Humanos , Traumatismos de los Tendones/diagnóstico , Traumatismos de los Tendones/etiología , Traumatismos de los Tendones/terapia , Tenis/lesiones , Tenis/fisiología , Fibrocartílago Triangular/lesiones , Traumatismos de la Muñeca/epidemiología , Articulación de la Muñeca/anatomía & histología , Articulación de la Muñeca/fisiologíaRESUMEN
OBJECTIVE: To investigate the effect of Pilates compared with circuit-based exercise in reducing arthralgia in women during hormone therapy for breast cancer. DESIGN: Single-blind randomized controlled trial, parallel. SETTING: University hospital of Brasilia and Brazilian Association for Assistance to People with Cancer. PARTICIPANTS: Sixty women with arthralgia were recruited. Eligibility criteria included women complaining of arthralgia during hormone therapy for breast cancer. The exclusion criteria were women with active cancer, lymphedema, limitations to physical exercise, or limitation to answer some questionnaires. MAIN OUTCOME MEASURES: Primary: Pain. Secondary: Function, flexibility, and sleep quality. Outcomes were assessed at baseline and the end of the intervention (8 weeks) by the same blinded evaluator. INTERVENTION: Sixty participants were randomly assigned 20 to each of the three groups: Pilates, circuit-based exercise, and control groups. Exercise was performed twice per week for 75 min, over a period of 8 weeks. Participants in the control group were instructed to continue their usual activities. The Kolmogorov-Smirnov test was used to verify the normality of the outcomes. Intergroup differences were calculated using Kruskal-Wallis test with post hoc Mann Whitney U testing and the parametric data between the three groups with ANOVA of repeated measures with Bonferroni post hoc. RESULTS: The Pilates group demonstrated a significant difference in pain reduction compared to the circuit group (mean difference: -1.95 points, p = 0.020). CONCLUSION: Pilates was more effective than circuit-based exercise in reducing arthralgia in women during hormone therapy for breast cancer. TRIAL REGISTRATION: http://www.ensaiosclinicos.gov.br/rg/RBR-3wsdhs/ Registered on Octob 16th 2017.
Asunto(s)
Neoplasias de la Mama , Ejercicio en Circuitos , Técnicas de Ejercicio con Movimientos , Artralgia/inducido químicamente , Artralgia/terapia , Neoplasias de la Mama/tratamiento farmacológico , Terapia por Ejercicio , Femenino , Hormonas , Humanos , Método Simple CiegoRESUMEN
AIM: To assess the effects of laying on of hands (LooH) as a complementary therapy to kinesiotherapy, on pain, joint stiffness, and functional capacity of older women with knee osteoarthritis (KOA) compared to a control group. METHODS: In this randomized controlled clinical trial, participants were assigned into 3 groups: LooH with a spiritual component ("Spiritist passe" Group - SPG), LooH without a spiritual component (LooH Group - LHG), and a control group receiving no complementary intervention (Control Group - CG). Patients were assessed at baseline, 8 weeks, and 16 weeks. Primary outcomes were joint stiffness and functional capacity (Western Ontario and McMaster Universities Osteoarthritis Index [WOMAC]), and pain (WOMAC and visual analog scale). Secondary outcomes were anxiety, depression, mobility, and quality of life. Differences between groups were evaluated using an intention-to-treat approach. RESULTS: A total of 120 women (mean age = 69.2 ± 5.2 years) with KOA were randomized (40 participants per group). At 8 weeks, SPG differed significantly from the LHG for WOMAC Functional Status (between-group difference in the change = 0.97; 95% CI: 0.35 to 1.59, P = .001); Anxiety levels (between-group difference in the change = 1.38; 95% CI: 0.11 to 2.65, P = .027); and also from the CG for all outcomes with exception of WOMAC Stiffness. After 16 weeks, SPG differed significantly from the LHG only for WOMAC Functional Status (between-group difference in the change = 0.92; 95% CI: 0.32 to 1.52, P = .001]) and also from the CG for all outcomes with exception of WOMAC Stiffness and timed up-and-go. CONCLUSION: Our results suggest that LooH with a "spiritual component" may promote better long-term functional outcomes than both LooH without a "spiritual component" and a control group without LooH.
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Artralgia/terapia , Articulación de la Rodilla/fisiopatología , Osteoartritis de la Rodilla/terapia , Manejo del Dolor , Espiritualidad , Tacto Terapéutico , Factores de Edad , Anciano , Artralgia/diagnóstico , Artralgia/fisiopatología , Brasil , Femenino , Humanos , Persona de Mediana Edad , Osteoartritis de la Rodilla/diagnóstico , Osteoartritis de la Rodilla/fisiopatología , Dimensión del Dolor , Estudios Prospectivos , Factores Sexuales , Factores de Tiempo , Resultado del TratamientoRESUMEN
Introducción: la luxación de la rótula es el tipo de luxación más frecuente de la rodilla y consiste en que la rótula se desplaza súbitamente hacia el lateral abandonando su posición normal en la zona anterior del fémur otro tipo de luxación es extraordinariamente raro, la misma se reduce fácilmente en la sala de emergencias con manipulaciones gentiles sin necesidad de anestesia en ocasiones el mismo paciente logra llevar la rótula a su lugar. Caso clínico: paciente masculino de 43 años de edad que en el trascurso de un partido de futbol impacta con otro jugador sufriendo trauma en la cara interna de la rodilla izquierda que lo deja tendido en el suelo con dolor intenso. El mismo presentaba bloqueo articular de la rodilla en extensión con imposibilidad para flexionarla, así como deformidad de la misma y ligero edema. Se le diagnostica un raro caso de luxación intrarticular de rótula donde la misma gira 90 grados sobre su eje vertical. Discusión: este caso de luxación intraarticular de rotula rotada en su eje vertical es característico en deportistas, como nuestro paciente, luego de sufrir un trauma severo en la articulación. Casos producidos por un trauma de menor intensidad han sido presentados, pero son extremadamente raros. Conclusiones: la luxación interarticular de rotula es una lesión rara que puede sorprender a cualquier ortopedista por lo que es indispensable realizar un examen físico adecuado y estudios radiológicos previos al tratamiento y así evitar peores consecuencias(AU)
Introduction: patella dislocation is the most common type of knee dislocation and consists of the patella suddenly moving to the side, leaving its normal position in the anterior area of the femur, another type of dislocation is extremely rare. Reduced easily in the emergency room with gentle manipulations without the need for anesthesia, sometimes the same patient is able to bring the patella into place. Clinical case: 43-year-old male patient who, in the course of a soccer match, impacted another player suffering trauma to the inside of the left knee that left him lying on the floor with intense pain. He presented joint blockage of the knee in extension with inability to flex it, as well as deformity of the knee and slight edema. A rare case of intra-articular dislocation of the patella is diagnosed where the patella rotates 90 degrees on its vertical axis. Discussion: this case of intra-articular dislocation of a patella rotated in its vertical axis is characteristic in athletes, such as our patient, after suffering severe trauma to the joint. Cases produced by a trauma of less intensity have been presented, but they are extremely rare. Conclusions: patellar inter-articular dislocation is a rare lesion that can surprise any orthopedist, so it is essential to carry out an adequate physical examination and radiological studies prior to treatment in order to avoid worse consequences(EU)
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Humanos , Masculino , Adulto , Luxación de la Rótula/diagnóstico por imagen , Artralgia/terapia , Radiografía/métodosRESUMEN
INTRODUCTION: Patients with osteoarthritis (OA) suffer from a degenerative disease that causes several physical disabilities and pain. Despite the few studies involving exercise combined with geotherapy (a therapy using poultices made from earth materials such as clay or mud) for patients with OA, this subject is still under debate, as effect of the earth material remains unclear. The aim of this study was to compare pain, joint stiffness and disability in patients who underwent kinesiotherapy (K) or geotherapy combined with kinesiotherapy (GK). METHOD: This was a clinical randomized single-blinded prospective study, in which 48 individuals participated. Volunteers were evaluated for pain perception, pressure pain tolerance thresholds, and responded to questionnaires about pain, joint stiffness and physical disability (WOMAC) and about symptoms and disability (Lequesne Algofunctional Index). Patients in K group underwent 15 twice-weekly sessions of kinesiotherapy consisting of stretching and strengthening exercises for lower limbs. GK patients received a poultice of powder dolomite mixed with hot water on the knees for 25â¯min before each of the 15 sessions of the same kinesiotherapy program. RESULTS: Both interventions were effective in reducing pain, joint stiffness and physical disability (pâ¯<â¯0.001), and in increasing pressure pain thresholds (pâ¯<â¯0.05); however, patients who underwent GK presented a more pronounced reduction in pain perception (pâ¯=â¯0.006) than those in K group. They also exhibited more tolerance to pain in all sites evaluated. CONCLUSION: Both interventions were effective in reducing pain, joint stiffness and physical disability, but GK produced significantly better results in pain perception.
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Artralgia/terapia , Terapia por Ejercicio/métodos , Quinesiología Aplicada/métodos , Peloterapia/métodos , Osteoartritis de la Rodilla/terapia , Artralgia/etiología , Terapia Combinada , Femenino , Humanos , Masculino , Persona de Mediana Edad , Osteoartritis de la Rodilla/complicaciones , Dimensión del Dolor , Estudios Prospectivos , Rango del Movimiento Articular , Resultado del TratamientoRESUMEN
BACKGROUND: Intra-articular injections of platelet-rich plasma to treat symptoms of knee osteoarthritis have been successfully used in young patients. However in most of these studies the control and test knees were present in different patients thus incorporating a large amount of bias in the results. Therefore, the present study was designed in which patients with bilateral osteoarthritis knee were included and platelet-rich plasma was administered in one knee and normal saline in another knee of same patient. METHODS: 20 patients aged 30-65 years with bilateral osteoarthritis knees (ASA class I and II) of either gender were included in the study. Patients were randomized to receive platelet-rich plasma and normal saline in one of the two knees. The primary outcome was VAS and WOMAC score at 6months after procedure. The secondary outcome included changes in joint stiffness, physical function, any adverse effects noted during the course of study. RESULTS: The baseline VAS score in platelet-rich plasma knee was 8.4 ± 0.88 which improved significantly to 4.85 ± 2.48 (p < 0.001) at 6months as compared to normal saline knee (p = 0.017). The WOMAC pain score also improved from baseline (14.5 ± 1.3) to over 6month 7.00 ± 4.24 (p < 0.001) in platelet-rich plasma knee while in the normal saline knee, no significant change occurred from baseline to six months (10.2 ± 1.2 to 10.05 ± 1.23). There was also significant decrease in stiffness and improvement of physical activity in the platelet-rich plasma knee as compared to normal saline knee. CONCLUSION: The present study showed significant decrease in pain and stiffness and improvement of physical functions of knee joint with intra-articular platelet-rich plasma injection as compared to normal saline.
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Artralgia/etiología , Artralgia/terapia , Articulación de la Rodilla , Osteoartritis de la Rodilla/complicaciones , Manejo del Dolor/métodos , Plasma Rico en Plaquetas , Adulto , Anciano , Método Doble Ciego , Femenino , Humanos , Inyecciones Intraarticulares , Masculino , Persona de Mediana Edad , Resultado del TratamientoRESUMEN
OBJECTIVE: Does short-term cryotherapy improve pain, function and quality of life in people with knee osteoarthritis (OA)? DESIGN: Randomised controlled trial with concealed allocation, blinded assessment of some outcomes, and intention-to-treat analysis. PARTICIPANTS: People living in the community with knee OA. INTERVENTIONS: The experimental group received cryotherapy, delivered as packs of crushed ice applied to the knee with mild compression. The control group received the same regimen but with sham packs filled with sand. The interventions were applied once a day for 4 consecutive days. OUTCOME MEASURES: Participants were assessed at baseline and on the day after the 4-day intervention period. The primary outcome was pain intensity according to a visual analogue scale. Secondary outcomes were baseline to post-intervention changes according to the Western Ontario and McMaster Universities Osteoarthritis, Knee injury and Osteoarthritis Outcome; Timed Up and Go test; and 30-Second Chair to Stand test. RESULTS: Sixty participants were randomised into the experimental group (n = 30) or the control group (n = 30). Twenty-nine participants from each group completed the trial. The mean between-group difference in change in pain severity was -0.8 cm (95% CI -1.6 to 0.1), where negative values favour the experimental group. This result did not reach the nominated smallest worthwhile effect of 1.75 cm. The secondary outcomes had less-precise estimates, with confidence intervals that spanned worthwhile, trivial and mildly harmful effects. CONCLUSION: Short-term cryotherapy was not superior to a sham intervention in terms of relieving pain or improving function and quality of life in people with knee OA. Although cryotherapy is considered to be a widely used resource in clinical practice, this study does not suggest that it has an important short-term effect, when compared with a sham control, as a non-pharmacological treatment for people with knee osteoarthritis. REGISTRATION: NCT02725047.
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Artralgia/terapia , Crioterapia , Osteoartritis de la Rodilla/terapia , Manejo del Dolor/métodos , Anciano , Evaluación de la Discapacidad , Femenino , Humanos , Análisis de Intención de Tratar , Masculino , Persona de Mediana Edad , Dimensión del Dolor , Calidad de VidaRESUMEN
OBJECTIVE: To investigate the effectiveness of cryotherapy on pain and physical function in knee osteoarthritis. DATA SOURCES: An electronic search was performed up to February 2019 on PubMed/MEDLINE, EMBASE, CINAHL, Lilacs, Cochrane, Web of Science, Ibecs, and Scielo databases with keywords knee osteoarthritis and cryotherapy. METHODS: Two authors independently performed the study selection. All languages and publication dates were considered. The PEDro scale was used to assess the methodological quality of the studies, and the body of evidence was analyzed and synthesized using the Grading of Recommendations, Assessment, Development, and Evaluation approach. The clinical relevance of the included studies was evaluated using the criteria proposed in the Cochrane Handbook for Systematic Reviews of Interventions. RESULTS: Of the five studies, 202 subjects were included. All studies included participants with established knee osteoarthritis. The mean PEDro score was 4.20/10, and meta-analysis was not possible due to heterogeneity among the studies. The mean clinical relevance was 3/5. Only two studies were considered for analysis based on the GRADE approach, and low level of evidence was synthesized regarding the effectiveness of cryotherapy for pain management, knee stiffness, knee range of motion, and physical function. Application techniques, frequency, and duration did not affect outcomes. CONCLUSIONS: There were insufficient primary studies to draw any conclusions about the effectiveness of cryotherapy on pain and physical function on individuals with knee osteoarthritis.
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Artralgia/terapia , Crioterapia , Osteoartritis de la Rodilla/terapia , Rango del Movimiento Articular/fisiología , Humanos , Osteoartritis de la Rodilla/fisiopatología , Ensayos Clínicos Controlados Aleatorios como AsuntoRESUMEN
The Chikungunya (CHIK) virus is epidemic in Brazil, with 170,000 cases in the first half of 2016. More than 60% of patients present relapsing and remitting chronic arthralgia with debilitating pain lasting years. There are no specific therapeutic agents to treat and rehabilitee infected persons with CHIK. Persistent pain can lead to incapacitation, requiring long-term pharmacological treatment. Advances in non-pharmacological treatments are necessary to promote pain relief without side effects and to restore functionality. Clinical trials indicate transcranial direct current stimulation (tDCS) can treat a broad range of chronic pain disorders, including diffuse neuromuscular pain and arthralgia. Here, we demonstrate that the tDCS across the primary motor cortex significantly reduces pain in the chronic phase of CHIK. High-resolution computational model was created to analyze the cortical electric field generated during tDCS and a diffuse and clustered brain current flow including M1 ipsilateral and contralateral, left DLPFC, nucleus accumbens, and cingulate was found. Our findings suggest tDCS could be an effective, inexpensive and deployable therapy to areas lacking resources with a significant number of patients with chronic CHIK persistent pain.
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Artralgia/etiología , Artralgia/terapia , Fiebre Chikungunya/complicaciones , Manejo del Dolor , Adulto , Anciano , Artralgia/diagnóstico , Fiebre Chikungunya/virología , Dolor Crónico , Femenino , Humanos , Procesamiento de Imagen Asistido por Computador , Imagenología Tridimensional , Masculino , Persona de Mediana Edad , Neurotransmisores/uso terapéutico , Manejo del Dolor/métodos , Dimensión del Dolor , Estimulación Transcraneal de Corriente Directa , Estimulación Magnética Transcraneal , Resultado del TratamientoRESUMEN
Sacroiliac joint (SIJ)-based pain can be difficult to diagnose definitively through physical examination and conventional radiography. A fluoroscopically guided injection into the SIJ can be both diagnostic and therapeutic. The initial phase of treatment involves nonsurgical modalities such as activity modification, use of a sacroiliac (SI) belt, NSAIDs, and physical therapy. Prolotherapy and radiofrequency ablation may offer a potential benefit as therapeutic modalities, although limited data support their use as a primary treatment modality. Surgical treatment is indicated for patients with a positive response to an SI injection with >75% relief, failure of nonsurgical treatment, and continued or recurrent SIJ pain. Percutaneous SI arthrodesis may be recommended as a first-line surgical treatment because of its improved safety profile compared with open arthrodesis; however, in the case of revision surgery, nonunion, and aberrant anatomy, open arthrodesis should be performed.
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Artralgia/diagnóstico , Artralgia/terapia , Manejo de la Enfermedad , Articulación Sacroiliaca , Artrodesis/métodos , Fluoroscopía/métodos , Humanos , Inyecciones Intraarticulares , Modalidades de Fisioterapia , Proloterapia/métodos , Ablación por Radiofrecuencia/métodosRESUMEN
Introducción: la luxación de la articulación acromioclavicular es frecuente en la práctica ortopédica diaria, estimándose su incidencia en aproximadamente el 10 por ciento de todas las luxaciones alrededor del hombro. Existen numerosas técnicas quirúrgicas descritas para su tratamiento con resultados variables. Objetivo: describir la evolución clínica del dolor, la movilidad del hombro y la reincorporación de los pacientes a sus actividades habituales, con el uso de la técnica de transposición del ligamento acromioclavicular. Métodos: se realizó un estudio de descriptivo de 22 pacientes con diagnóstico de luxación acromioclavicular aguda tratados quirúrgicamente mediante la técnica mencionada; se tuvo en cuenta la evolución clínica del dolor, la movilidad del hombro y la reincorporación de los pacientes a sus actividades después de la cirugía, y para ello se empleó el test funcional de Imatani. Resultados: la transposición del ligamento coracoacromial resultó ser una técnica útil y relativamente sencilla para el tratamiento quirúrgico de la luxación acromioclavicular aguda, con muy buenos resultados inmediatos, se logró considerable disminución o alivio total del dolor y recuperación completa o casi completa del rango de movilidad de la articulación del hombro, que le permite al paciente una vez rehabilitado, reincorporarse a sus actividades habituales. Conclusiones: la transposición del ligamento coracoacromial resultó útil en el tratamiento quirúrgico de la luxación acromioclavicular aguda, en cuanto al alivio del dolor, la movilidad y reincorporación a las actividades habituales(AU)
Introduction: Dislocation of the acromioclavicular joint is frequent in daily orthopedic practice, with an estimated incidence of approximately 10 percent of all dislocations around the shoulder. There are numerous surgical techniques described for its treatment with variable results. Objective: to describe the clinical evolution of pain, shoulder mobility and reincorporation of patients to their usual activities, using the technique of transposition of the acromioclavicular ligament. Methods: A descriptive study of 22 patients diagnosed with acute acromioclavicular dislocation treated surgically using the aforementioned technique was performed; the clinical evolution of pain, shoulder mobility and the reincorporation of patients to their activities after surgery were taken into account, and the functional test of Imatani was used. Results: Coracoacromial ligament transposition proved to be a useful and relatively simple technique for the surgical treatment of acute acromioclavicular dislocation, with very good immediate results, considerable reduction or total pain relief was achieved and full or near complete recovery of the range of mobility of the shoulder joint, which allows the patient once rehabilitated, to rejoin his usual activities. Conclusions: The transposition of the coracoacromial ligament was useful in the surgical treatment of acute acromioclavicular dislocation aboutpain evolution, shoulder mobility and reincorporation of patients to their usual activities(AU)
Asunto(s)
Humanos , Articulación Acromioclavicular/cirugía , Artralgia/terapia , Luxaciones Articulares/rehabilitación , Epidemiología DescriptivaRESUMEN
BACKGROUND: Aquatic therapy promotes short-term benefits for patients with knee osteoarthritis (OA), and it may be the first therapeutic option for this pathological condition. The objective of this study was to investigate the effects of an aquatic therapy program on pain intensity, functional ability, and quality of life in older people with knee OA. METHODS/DESIGN: This is a parallel, two-arm, open, randomized controlled clinical trial with older people with knee OA. Volunteers will be allocated to an aquatic intervention group (WG), subjected to the intervention, or to a control group, not be subjected to any kind of intervention. Data collection pre- and postintervention will be composed of the evaluation of the perception of pain by visual analogue scale with application of nociceptive stimuli in four anatomical points of the knee, functional fitness tests, and application of the World Health Organization Quality of Life Scale abbreviated version and Western Ontario and McMaster Universities Osteoarthritis Index. The program will last 12 weeks, consisting of aerobic and functional exercises in the form of circuit training. DISCUSSION: The objective of this clinical trial is to evaluate the effect of aquatic therapy in elderly patients with knee OA. The study is guided by practice-based scientific evidence for the use of aquatic rehabilitation exercises. It is expected that the WG volunteers will show reduced pain intensity, increased flexibility, and improved functional capacity and quality of life. It is believed that the desired results can be attributed to physical and physiological effects of immersion in warm water associated with the exercise protocol proposed. The data will be published after completion of the study. TRIAL REGISTRATION: Brazilian Registry of Clinical Trials (ReBEC) registration number: RBR-78h48d . Registered on 19 August 2015.
Asunto(s)
Artralgia/terapia , Terapia por Ejercicio/métodos , Hidroterapia/métodos , Articulación de la Rodilla/fisiopatología , Osteoartritis de la Rodilla/terapia , Percepción del Dolor , Calidad de Vida , Artralgia/diagnóstico , Artralgia/fisiopatología , Artralgia/psicología , Fenómenos Biomecánicos , Brasil , Protocolos Clínicos , Evaluación de la Discapacidad , Prueba de Esfuerzo , Femenino , Estado de Salud , Humanos , Masculino , Osteoartritis de la Rodilla/diagnóstico , Osteoartritis de la Rodilla/fisiopatología , Osteoartritis de la Rodilla/psicología , Dimensión del Dolor , Recuperación de la Función , Proyectos de Investigación , Encuestas y Cuestionarios , Factores de Tiempo , Resultado del TratamientoRESUMEN
OBJECTIVE: To compare the effectiveness of patellar denervation versus non-patellar denervation in reducing anterior knee pain on a follow-up period of at least one year after total knee arthroplasty. METHOD: Data from 84 patients, who underwent total knee arthroplasty were analyzed. Participants were divided into 2 groups; group A: 42 patients who previously underwent total knee arthroplasty with patellar denervation; and group B: 42 patients who previously underwent total knee arthroplasty without patellar denervation. Results were evaluated using WOMAC and KSS questionnaires, and the VAS pain measurement. Knee ranges of motion were measured. Preoperative clinical conditions of both groups were similar. RESULTS: Postoperatively, the following results were observed. (a), the WOMAC scores for group A were significant better when compared to group B (27.95 ± 5.89 vs. 33,55 ± 6.23; (b) better results were also found in KSS scores for group A vs. group B (86.19 ± 7.10 vs. 83,07 ± 4.88); (c) the range of knee flexion was smaller than in group A vs. group B (119.0 ± 10.7 vs 125.5 ± 11.0 degrees); (d) there was no significant difference between the mean of range of knee extension between the two groups groups; (e) in terms pain referred by the patient, no difference was observed according to VAS pain. CONCLUSION: Patellar denervation does not show better effect in pain reduction compared with TKA with non-patellar denervation. However, it had a better beneficial effect on knee function score, as measured through the KSS and WOMAC questionnaires.
OBJETIVO: Comparar a eficácia de denervação patelar em relação à não-denervação patelar na redução da dor anterior do joelho em um período de acompanhamento de no mínimo um ano após a artroplastia total do joelho (ATJ). MÉTODO: Foram analisados dados de 84 pacientes, submetidos a ATJ e divididos em 2 grupos: grupo A formado por 42 pacientes submetidos à ATJ com denervação patelar (PD) e grupo B formado por 42 pacientes submetidos a ATJ sem a denervação (ND). Os resultados foram avaliados utilizando os questionários WOMAC e KSS, além da escala analógica visual da dor (EVA). Também foi avaliada a amplitude de movimento em graus. As condições clínicas pré-operatórias dos dois grupos foram semelhantes. RESULTADOS: Comparando a pontuação do questionário WOMAC, o grupo A apresentou melhores resultados, com media de 27,95 ± 5,89, enquanto o grupo B apresentou média de 33,55 ± 6,23. Melhores resultados foram também observados no KSS para o grupo A, apresentando média de 86,19 ± 7,10, em comparação ao grupo B, com média de 83,07 ± 4,88. Observou-se menor amplitude de flexão do joelho no grupo A, 119,0 ± 10,68 graus, em comparação com o grupo B, com média de 125,5 ± 11,02 graus. Analisando exclusivamente a dor, não foi observada diferença entre a dor referida pelo paciente, de acordo com a escore da escala EVA. CONCLUSÕES: A DP não demonstrou melhores efeitos na redução da dor em comparação com ND na ATJ. No entanto um melhor efeito da denervação nos escores de função, através dos questionários KSS e WOMAC sugerem que a denervação pode ser benéfica neste cenário.
Asunto(s)
Humanos , Rótula/inervación , Artralgia/terapia , Artroplastia de Reemplazo de Rodilla/rehabilitación , Desnervación/métodos , Dimensión del Dolor/métodosRESUMEN
Objective The benefit of the use of some intraoral devices in arthrogenous temporomandibular disorders (TMD) patients is still unknown. This study assessed the effectiveness of the partial use of intraoral devices and counseling in the management of patients with disc displacement with reduction (DDWR) and arthralgia.Materials and Methods A total of 60 DDWR and arthralgia patients were randomly divided into three groups: group I (n=20) wore anterior repositioning occlusal splints (ARS); group II (n=20) wore the Nociceptive Trigeminal Inhibition Clenching Suppression System devices (NTI-tss); and group III (n=20) only received counseling for behavioral changes and self-care (the control group). The first two groups also received counseling. Follow-ups were performed after 2 weeks, 6 weeks and 3 months. In these sessions, patients were evaluated by means of a visual analogue scale, pressure pain threshold (PPT) of the temporomandibular joint (TMJ), maximum range of motion and TMJ sounds. Possible adverse effects were also recorded, such as discomfort while using the device and occlusal changes. The results were analyzed with ANOVA, Tukey’s and Fisher Exact Test, with a significance level of 5%.Results Groups I and II showed improvement in pain intensity at the first follow-up. This progress was recorded only after 3 months in Group III. Group II showed an increased in joint sounds frequency. The PPT values, mandibular range of motion and the number of occlusal contacts did not change significantly.Conclusion The simultaneous use of intraoral devices (partial time) plus behavioral modifications seems to produce a more rapid pain improvement in patients with painful DDWR. The use of NTI-tss could increase TMJ sounds. Although intraoral devices with additional counseling should be considered for the management of painful DDWR, dentists should be aware of the possible side effects of the intraoral device’s design.