RESUMO
BACKGROUND: Chronic low back pain (LBP) is defined as pain lasting longer than 3 months and is one of the conditions with the most significant social impact. Treatment is complex and includes proliferative agents used in prolotherapy. The mechanism is not known, but osmotic agents (hypertonic solutions of dextrose or glucose) cause cellular rupture and an inflammatory response that releases cytokines and growth factors that lead to scarring and reinnervation. METHODS: Patients with chronic LBP (>12 weeks) who were non-traumatic and unresponsive to at least 1 month of physical therapy were selected. All patients were followed up at a return visit at 1, 3, and 6 months for pain assessment using validated pain questionnaires and scales. RESULTS: Nineteen patients were included in the conservative group and 19 in the glucose group, with the majority being women (57.9%). The patients were between 47 and 59 years of age (39.5%), mixed race (76.33%), married or in a committed relationship (73.7%), and had completed the study for 5.2 years. Overall mean body mass index was 27.3 ± 4.4 kg/m 2 and was higher in the conservative group (28.0 ± 4.7 kg/m 2 ). The groups showed differences in Visual Analog Scale scores, with median and amplitude values close to each other between the time points evaluated and increasing values in the glucose group, which had significantly higher values for this scale at the third evaluation ( P = .031). When comparing the Rolland-Morris scale scores between the groups, there was a significant difference only in the 3-m assessment ( P = .021). In the follow-up assessment, both groups showed significant improvement between T0 and the other assessment time points ( P < .05) in all evaluations. CONCLUSION: Both groups significantly improved on the evaluated scales during follow-up. Overall, no effects were attributable to the glucose components or the prolotherapy protocol.
Assuntos
Dor Lombar , Proloterapia , Humanos , Feminino , Masculino , Dor Lombar/tratamento farmacológico , Modalidades de Fisioterapia , Medição da Dor , Proloterapia/métodos , Glucose/uso terapêutico , Resultado do TratamentoRESUMO
The objective of this study is to compare the effectiveness of dextrose-prolotherapy with other substances for pain relief in patients with primary knee osteoarthritis. The literature screening was done in January 2021 through Medline (PubMed), EMBASE, and Database of the National Institute of Health based on the following criteria: randomized clinical trials that subjected patients with primary knee osteoarthritis who underwent treatment with dextrose-prolotherapy and other substances for pain relief. Paired reviewers independently identified 3381 articles and included 8 trials that met the eligibility criteria. According to the findings of this review, participants that underwent dextrose-prolotherapy showed improvements between baseline and posterior assessments and when compared to saline injections, but when compared to other substances, the results were not clear. Although dextrose-prolotherapy is a useful treatment method by itself, it is still not possible to clearly affirm that it is superior or inferior to its counterparts. There is an urgent need for further studies to bring more evidence to the field.
Assuntos
Osteoartrite do Joelho , Proloterapia , Glucose/uso terapêutico , Humanos , Injeções Intra-Articulares , Osteoartrite do Joelho/tratamento farmacológico , Dor/tratamento farmacológico , Proloterapia/métodos , Resultado do TratamentoRESUMO
RESUMEN La gonartrosis es una entidad muy frecuente y afecta a un grupo numeroso de pacientes en especial a los mayores de 40 años. El tratamiento conservador constituye la primera línea e incluye la proloterapia. El propósito de este estudio es actualizar los conocimientos en relación al uso de la proloterapia en pacientes con gonartrosis. La búsqueda y análisis de la información se realizó en un periodo de 2 meses (primero de febrero de 2020 al 30 de abril de 2020) y se emplearon las siguientes palabras: prolotherapy, regenerative injection therapy and chronic musculoskeletal pain. A partir de la información obtenida se realizó una revisión bibliográfica de un total de 203 artículos publicados en las bases de datos PubMed, Hinari, SciELO y Medline mediante el gestor de búsqueda y administrador de referencias EndNote, de ellos se utilizaron 39 citas seleccionadas para realizar la revisión, de ellas 32 de los últimos cinco años, además se consultó un libro. Se mencionan las concentraciones a emplear tanto intra- como periarticular, indicaciones y mecanismos de acción. Se describen la frecuencia de su aplicación, así como la comparación con otros métodos de tratamiento por vía intraarticular. Se hace referencia a la duración de su efecto y complicaciones. La proloterapia mediante la administración de dextrosa hipertónica intraarticular es un método útil en el tratamiento de pacientes con gonartrosis, su fácil aplicación, disponibilidad y bajo índice de complicaciones lo convierten en un método conservador factible y eficaz.
ABSTRACT Gonarthrosis is a very frequent entity and affects a large group of patients especially above 40 years, conservative treatment is the first line and includes prolotherapy. To update knowledge regarding the use of prolotherapy in patients with gonarthrosis. The information was searched and analyzed over a period of two months (February 1, 2020 to April 30, 2020) and the following words were used: prolotherapy, regenerative injection therapy and chronic musculoskeletal pain. Based on the information obtained, a bibliographic review of a total of 203 articles published in the PubMed, Hinari, SciELO and Medline databases was carried out using the search manager and reference manager EndNote, 39 selected citations were used to make the review, including 32 of the last five years, also consulted a book. The concentrations to be used both intra and periarticular, indications and mechanisms of action are mentioned. The frequency of its application is described, as well as the comparison with other intra-articular treatment methods. Reference is made to the duration of its effect and complications. Prolotherapy by administering intra-articular hypertonic dextrose is a useful method in the treatment of patients with gonarthrosis, its easy application, availability and low complication rate make it a feasible and effective conservative method.
Assuntos
Humanos , Dor Musculoesquelética/terapia , Proloterapia/métodosRESUMO
Objective: Several intraarticular injections, including dextrose and lidocaine, are reported to reduce pain and dysfunction in temporomandibular dysfunction (TMD) and increase maximal jaw opening; our goal was to determine whether dextrose/lidocaine outperforms sterile water/lidocaine for TMD. Design: Pragmatic randomized controlled trial. Setting: Outpatient clinic. Subjects: Chronic (≥3 months) of moderate-to-severe (≥6/10) jaw or facial pain meeting research-specific TMD criteria. Intervention: Blinded intraarticular dextrose prolotherapy (DPT) (20% dextrose/0.2% lidocaine) versus intraarticular lidocaine (0.2% lidocaine in sterile water) at 0, 1, and 2 months. Participants were then unblinded and offered DPT by request for 9 additional months. Main outcome measures: Primary: Numerical Rating Scale (0-10 points) score for facial pain and jaw dysfunction; percentage achieving ≥50% improvement in pain and dysfunction (0, 3, and 12 months). Secondary: Maximal interincisal opening (MIO; 0 and 3 months). Intention-to-treat analysis was by joint using mixed-model regression. Results: Randomization of 29 participants (25 female, 47 ± 17 years, 43 joints) produced similar groups. Three-month pain and dysfunction improvements were similar, but more DPT-treated joints improved by ≥50% in pain (17/22 vs. 6/21; p = 0.028). The MIO improved in both groups (5.6 ± 5.8 mm vs. 5.1 ± 7.0 mm; p = 0.70). From 3 to 12 months, minimal DPT was received by original DPT and lidocaine recipients, 0.5 ± 0.9 and 0.6 ± 1.5 injections, respectively, with only 2 out of 21 joints in the original lidocaine group receiving more than 1 dextrose injection after 3 months. Twelve-month analysis revealed that joints in the original DPT group improved more in jaw pain (4.8 ± 2.4 points vs. 2.6 ± 2.9 points; p = 0.026) and jaw dysfunction (5.3 ± 2.6 points vs. 2.7 ± 2.3 points; p = 0.013). More DPT than lidocaine-treated joints improved by ≥50% in both pain (19/22 vs. 5/21; p = 0.003) and dysfunction (17/22 vs. 7/21; p = 0.040). There were no adverse events; satisfaction was high. Conclusions: Intraarticular DPT resulted in clinically important and statistically significant improvement in pain and dysfunction at 12 months compared to lidocaine injection (ClinicalTrials.gov identifier NCT01617356).
Assuntos
Dor Facial/tratamento farmacológico , Glucose/administração & dosagem , Proloterapia/métodos , Transtornos da Articulação Temporomandibular/tratamento farmacológico , Articulação Temporomandibular/fisiopatologia , Idoso , Feminino , Homeopatia/métodos , Humanos , Injeções Intra-Articulares , Masculino , Pessoa de Meia-Idade , Medição da Dor , Resultado do TratamentoRESUMO
El dolor asociado a heridas complejas se erige como una gran barrera para la resolución de estas, debido a la complejidad de abordaje y a la imposibilidad de establecer un patrón de algoritmo por diversos factores y su carácter heterogéneo, así como por la presencia de manifestaciones múltiples asociadas. Este dolor provoca al paciente un daño no solo físico sino también psicosocial, porque la escasa respuesta a los tratamientos habituales, y si bien es sensible a la medicación con opiáceos, los resultados son insufi cientes a largo plazo en un significativo número de pacientes, en quienes provoca además efectos no deseables. Se establece en el presente trabajo la administración subcutánea de dextrosa 5% a través de una técnica de infiltración perineural para el tratamiento de la infl amación neurogénica responsable del mencionado padecimiento, en las terminaciones libres de los nervios sensitivos cutáneos. Para ello se decidió realizar un estudio descriptivo multicéntrico a partir de junio del 2016 hasta mayo del 2017 en 60 pacientes que presentaban dolor crónico en ulceras de miembro inferior de diferente etiología con antecedente de medicación analgésica previa con resultado parcial (no controlado) y que tuviera evolución de su dolor entre 3 meses y 4 años.
The pain associated with complex wounds is established as a great barrier for the irresolution, due to the complexity of the approach and the impossibility of establishing an algorithm pattern due to various factors and their heterogeneous nature, as well as the presence of associated multiple manifestations. . This pain causes not only physical but psychosocial damage to the patient, because of the poor response to the usual treatments, and although it is sensitive to medication with opiates, the results are insufficient in the long-term in a significant number of patients, in whom it also causes undesirable effects. The present work establishes the subcutaneous administration of 5% dextrose through a perineural infi ltration technique for the treatment of the neurogenic inflammation responsible for the afore mentioned condition, in the free terminations of the cutaneous sensory nerves. For this, it was decided to carry out a multicenter descriptive study from June 2016 to May 2017 in 60 patients who presented chronic pain in lower limb ulcers of different etiology with a history of previous analgesic medication with partial (uncontrolled) outcome and had evolution of your pain between 3 months and 4 years.
Assuntos
Humanos , Masculino , Feminino , Úlcera/terapia , Cicatrização , Infiltração-Percolação , Extremidade Inferior/lesões , Dor Crônica/diagnóstico , Proloterapia/métodosRESUMO
Introducción: El pie diabético isquémico y la enfermedad arterial periférica, son dos enfermedades que ocasionan dolor por isquemia crítica y ponen en peligro la viabilidad de las extremidades inferiores. Objetivo: Demostrar la efectividad de la terapia regenerativa con plasma rico en plaquetas en pacientes con las enfermedades citadas. Métodos: Estudio longitudinal, prospectivo y aleatorizado realizado en el Servicio de Angiología del Hospital: Julio Trigo López, entre enero 2016-diciembre 2017. Se incluyeron 26 pacientes en dos grupos de estudios, 10 pacientes no diabéticos con claudicación intermitente y 16 pacientes con lesiones isquémicas en el pie del diabético. Se aplicó plasma rico en plaquetas por vía intramuscular en la pierna afectada, en el primer grupo y de forma intra- y perilesional en el pie del diabético isquémico. Resultados: Se obtuvo alivio del dolor y mejoría en más del 70 por ciento de los pacientes en la distancia de claudicación por encima o cerca de los 200 metros. En los pacientes con pie diabético isquémico, alivio del dolor y cierre de las lesiones isquémicas en el 81,3 por ciento, solo 3 pacientes requirieron amputaciones mayores de los miembros inferiores. Conclusiones: La terapia regenerativa resulta efectiva en el salvataje de las extremidades inferiores en los pacientes estudiados, asociada a los procedimientos convencionales empleados en la cirugía revascularizadora; disminuye la amputación mayor de miembros inferiores y es una posibilidad terapéutica más en manos de especialistas entrenados, por su impacto social y en la calidad de vida de pacientes y familiares(AU)
Introduction: Ischemic diabetic foot and peripheral arterial disease are two conditions that cause pain and put in danger the functionality of lower limbs. Objective: To demonstrate the effectiveness of regenerative therapy with platelet-rich plasma in patients with the above mentioned diseases. Methods: Longitudinal, prospective and randomized study that was conducted in the Angiology Service of Julio Trigo López Hospital, from January 2016 to December 2017. There were 26 patients included in 2 groups: 10 non-diabetic patients with intermittent claudication and 16 patients with ischemic lesions in the diabetic foot. Platelet-rich plasma was used instramuscularly in an affected legs of the first group, and intraperilesional and perilesional in the diabetic foot. Results: There was pain relief and improvement in more than 70 percent of patients in the claudication distance higher or near to 200 meters. In the patients presenting ischemic diabetic foot, pain relief and closing of ischemic lesions in the 81,3 percent , just 3 patients required major amputations of lower limbs. Conclusions: Regenerative therapy results effective in the rescue of lower limbs in patients presenting peripheral arterial disease and ischemic diabetic foot. It also reduces major amputations of lower limbs and it is another therapeutic option in the hands of trained specialists due to its social impact and in the life quality of patients and their families(AU)
Assuntos
Humanos , Masculino , Feminino , Plasma Rico em Plaquetas , Doença Arterial Periférica/terapia , Proloterapia/métodos , Estudos Prospectivos , Estudos Longitudinais , CubaRESUMO
BACKGROUND: To evaluate the efficacy and safety of prolotherapy with hypertonic dextrose in patients with knee osteoarthritis. A systematic search was performed in electronic databases including PUBMED, SCIELO, DIALNET and Google Scholar. MAIN BODY: We searched for randomized clinical trials that evaluated therapeutic interventions in patients with knee osteoarthritis. These trials compared the effect of intra-articular and / or extra-articular infiltrations of hypertonic dextrose vs the effect of intra-articular and / or extra-articular infiltrations of other substances or some interventional procedure application, via assessing pain, physical function and secondary effects and / or adverse reactions. Ten randomized clinical trials were included in this systematic review, the total sample size comprised 328 patients treated with hypertonic dextrose (prolotherapy) vs 348 controls treated with other infiltrations such as local anesthetics, hyaluronic acid, ozone, platelet-rich plasma or interventional procedures like radiofrequency. CONCLUSIONS: In terms of pain reduction and function improvement, prolotherapy with hypertonic dextrose was more effective than infiltrations with local anesthetics, as effective as infiltrations with hyaluronic acid, ozone or radiofrequency and less effective than PRP and erythropoietin, with beneficial effect in the short, medium and long term. In addition, no side effects or serious adverse reactions were reported in patients treated with hypertonic dextrose. Although HDP seems to be a promising interventional treatment for knee OA, more studies with better methodological quality and low risk of bias are needed to confirm the efficacy and safety of this intervention.
Assuntos
Glucose/administração & dosagem , Osteoartrite do Joelho/terapia , Proloterapia/métodos , Anestésicos Locais/administração & dosagem , Eritropoetina/administração & dosagem , Humanos , Ácido Hialurônico/administração & dosagem , Soluções Hipertônicas , Ozônio/administração & dosagem , Plasma Rico em Plaquetas , Terapia por Radiofrequência , Ensaios Clínicos Controlados Aleatórios como Assunto , Resultado do Tratamento , Viscossuplementos/administração & dosagemRESUMO
Introducción: la periodontitis crónica es un proceso inflamatorio de origen bacteriano que afecta a los tejidos del periodonto y provoca la destrucción de los tejidos de soporte del diente. La terapia celular con células mononucleares autólogas constituye una nueva opción terapéutica para lograr la regeneración ósea. Objetivo: evaluar la efectividad del tratamiento con células mononucleares autólogas implantadas en defectos óseos provocados por la periodontitis crónica. Método: estudio cuasiexperimental que se realizó en la Clínica Provincial Docente Antonio Briones Montoto de Pinar del Río, en el periodo comprendido entre enero de 2012 hasta agosto de 2015. A los nueve pacientes del grupo de estudio, se le realizó la perfusión de células mononucleares siete días después de ser intervenidos quirúrgicamente (colgajo periodontal). La movilización a sangre periférica de células mononucleares autólogas se realizó con factor estimulante del crecimiento granulocítico Leukocim (FEC-G). Variables del estudio: dientes afectados, presencia de sangrado al sondeo, bolsas periodontales, movilidad dentaria, pérdida de inserción y evidencia radiográfica. Resultados: posterior a la terapia celular se constató que las encías presentaron características de normalidad a los 7 días de implantados, a los 12 meses se observó hueso de neoformación y aumento de la densidad ósea. Conclusiones: la terapia mostró ser un método factible, simple y seguro en la reparación de defectos óseos provocados por la enfermedad, evidenciando mejoría de los parámetros clínicos y radiográficos(AU)
Introduction: Periodontitis is an inflammatory process of bacterial origin that affects the tissues of the periodontium and causes the destruction of the tissues supporting the tooth. Cell therapy could be an effective therapeutic option to achieve bone regeneration. Objective: To evaluate the effectiveness of treatment with implanted autologous mononuclear cells in bone defects caused by periodontal disease. Methods: A quasiexperimental study was carried out in the Provincial Teaching Clinic Antonio Briones Montoto, Pinar del Río, in the period from January 2012 to August 2015. The nine patients in the study group underwent perfusion of mononuclear cells seven days after surgery (periodontal flap). The mobilization to peripheral blood of autologous mononuclear cells was made with granulocytic leukocyte growth stimulating factor (FEC-G). Study variables: affected teeth, presence of bleeding on probing, periodontal pockets, tooth mobility, loss of insertion and radiographic evidence. Results: After the cell therapy, it was found that the gums showed normality characteristics after 7 days of implantation, after 12 months neoformation bone and increase in bone density was observed. Conclusions: The therapy showed to be a feasible, simple and safe method in the repair of bone defects caused by the disease, evidencing improvement of the clinical and radiographic parameters(AU)
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Humanos , Periodontite/tratamento farmacológico , Periodontite/terapia , Perda do Osso Alveolar/terapia , Terapia Baseada em Transplante de Células e Tecidos/métodos , Leucócitos Mononucleares , Ensaios Clínicos Controlados não Aleatórios como Assunto , Proloterapia/métodosRESUMO
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.