Visual Analog Scale

Results of a systematic review and meta-analysis of interventions for treatment of DeQuervain tendonitis. Yet another reason to become proficient at ultrasonography. James W. Mold, MD, MPH

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Importance: There is a plethora of treatment options for patients with de Quervain tenosynovitis (DQT), but there are limited data on their effectiveness and no definitive management guidelines.

Objective: To assess and compare the effectiveness associated with available treatment options for DQT to guide musculoskeletal practitioners and inform guidelines.

Data sources: Medline, Embase, PubMed, Cochrane Central, Scopus, OpenGrey.eu, and WorldCat.org were searched for published studies, and the World Health Organization International Clinical Trials Registry Platform, ClinicalTrials.gov, The European Union Clinical Trials Register, and the ISRCTN registry were searched for unpublished and ongoing studies from inception to August 2022.

Study selection: All randomized clinical trials assessing the effectiveness of any intervention for the management of DQT.

Data extraction and synthesis: This study was prospectively registered on PROSPERO and conducted and reported per Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension Statement for Reporting of Systematic Reviews Incorporating Network Meta-analyses of Health Care Interventions (PRISMA-NMA) and PRISMA in Exercise, Rehabilitation, Sport Medicine and Sports Science (PERSIST) guidance. The Cochrane Risk of Bias tool and the Grading of Recommendations, Assessment, Development, and Evaluations tool were used for risk of bias and certainty of evidence assessment for each outcome.

Main outcomes and measures: Pairwise and network meta-analyses were performed for patient-reported pain using a visual analogue scale (VAS) and for function using the quick disabilities of the arm, shoulder, and hand (Q-DASH) scale. Mean differences (MD) with their 95% CIs were calculated for the pairwise meta-analyses.

Results: A total of 30 studies with 1663 patients (mean [SD] age, 46 [7] years; 80% female) were included, of which 19 studies were included in quantitative analyses. From the pairwise meta-analyses, based on evidence of moderate certainty, adding thumb spica immobilization for 3 to 4 weeks to a corticosteroid injection (CSI) was associated with statistically but not clinically significant functional benefits in the short-term (MD, 10.5 [95% CI, 6.8-14.1] points) and mid-term (MD, 9.4 [95% CI, 7.0-11.9] points). In the network meta-analysis, interventions that included ultrasonography-guided CSI ranked at the top for pain. CSI with thumb spica immobilization had the highest probability of being the most effective intervention for short- and mid-term function.

Conclusions and relevance: This network meta-analysis found that adding a short period of thumb spica immobilization to CSI was associated with statistically but not clinically significant short- and mid-term benefits. These findings suggest that administration of CSI followed by 3 to 4 weeks immobilization should be considered as a first-line treatment for patients with DQT.

Author/s:

Dimitris Challoumas, Rohan Ramasubbu, Elliot Rooney, Emily Seymour-Jackson, Amit Putti, Neal L. Millar

The Effectiveness of Intraosseous Basivertebral Nerve Radiofrequency Ablation for the Treatment of Vertebrogenic Low Back Pain: An Updated Systematic Review with Single-Arm Meta-analysis

Aubrey Delammermore — Wed, 27 Jul 2022 05:00:00 +0000

Date Added:

July 27, 2022

Journal/Publication:

Pain Medicine

Publisher:

Oxford University Press

Publication Date:

July 20, 2022

Issue:

Issue Supplement 2

Volume:

Pages:

S50-S62

URL:

The Effectiveness of Intraosseous Basivertebral Nerve Radiofrequency Ablation for the Treatment of Vertebrogenic Low Back Pain: An Updated Systematic Review with Single-Arm Meta-analysis

Type:

Meta-analyses, Reviews, and Guidelines

Format:

Article

DOI (1):

10.1093/pm/pnac070

Keywords

PMID (1):

35856331

MeSH

Confidence Intervals

low back pain

Visual Analog Scale

Radiofrequency Ablation

MEDLINE

Basi-vertebral nerve radiofrequency ablation is a new approach to management of chronic low back pain that appears to be fairly effective though more research is needed. James W. Mold, MD, MPH

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Objective. To provide an estimate of the effectiveness of basivertebral nerve (BVN) radiofrequency ablation (RFA) to
treat vertebrogenic low back pain (LBP). Design. Systematic review with single-arm meta-analysis. Population.
Persons 18 years of age with chronic LBP associated with type 1 or 2 Modic changes. Intervention. Intraosseous
BVN RFA. Comparison. Sham, placebo procedure, active standard care treatment, or none. Outcomes. The proportion
of patients treated with BVN RFA who reported 50% pain score improvement on a visual analog scale or numeric
rating scale. The main secondary outcome was 15-point improvement in Oswestry Disability Index score. Methods.
Three reviewers independently assessed articles published before December 6, 2021, in MEDLINE and Embase. The
Grades of Recommendation, Assessment, Development, and Evaluation (GRADE) framework was used to evaluate
the overall quality of evidence. Results. Of the 856 unique records screened, 12 publications met the inclusion criteria,
representing six unique study populations, with 414 participants allocated to receive BVN RFA. Single-arm metaanalysis showed a success rate of 65% (95% confidence interval [CI] 51–78%) and 64% (95% CI 43–82%) for 50%
pain relief at 6 and 12 months, respectively. Rates of 15-point Oswestry Disability Index score improvement were
75% (95% CI 63–86%) and 75% (95% CI 63–85%) at 6 and 12 months, respectively. Conclusion. According to GRADE,
there is moderate-quality evidence that BVN RFA effectively reduces pain and disability in most patients with vertebr

Author/s:

Conger, A., Burnham, T. R., Clark, T., Teramoto, M, McCormick, Z. L.

Efficacy of Intra-Articular Hypertonic Dextrose (Prolotherapy) for Knee Osteoarthritis: A Randomized Controlled Trial

Brian Desmarais — Wed, 13 May 2020 23:54:05 +0000

Date Added:

May 13, 2020

Journal/Publication:

Annals of Family Medicine

Publication Date:

May 1, 2020

Issue:

Volume:

Pages:

235-242

URL:

Efficacy of Intra-Articular Hypertonic Dextrose (Prolotherapy) for Knee Osteoarthritis: A Randomized Controlled Trial

Type:

Clinical Research Results

Format:

Article

DOI (1):

10.1370/afm.2520

MeSH

Personal Satisfaction

In this relatively small RCT, prolotherapy was more effective than saline injections for relieving pain and improving function in patients with OA of the knee at 4, 6, and 12 months. James W. Mold, MD, MPH

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Purpose: To test the efficacy of intra-articular hypertonic dextrose prolotherapy (DPT) vs normal saline (NS) injection for knee osteoarthritis (KOA).

Methods: A single-center, parallel-group, blinded, randomized controlled trial was conducted at a university primary care clinic in Hong Kong. Patients with KOA (n = 76) were randomly allocated (1:1) to DPT or NS groups for injections at weeks 0, 4, 8, and 16. The primary outcome was the Western Ontario McMaster University Osteoarthritis Index (WOMAC; 0-100 points) pain score. The secondary outcomes were the WOMAC composite, function and stiffness scores; objectively assessed physical function test results; visual analogue scale (VAS) for knee pain; and EuroQol-5D score. All outcomes were evaluated at baseline and at 16, 26, and 52 weeks using linear mixed model.

Results: Randomization produced similar groups. The WOMAC pain score at 52 weeks showed a difference-in-difference estimate of -10.34 (95% CI, -19.20 to -1.49, P = 0.022) points. A similar favorable effect was shown on the difference-in-difference estimate on WOMAC function score of -9.55 (95% CI, -17.72 to -1.39, P = 0.022), WOMAC composite score of -9.65 (95% CI, -17.77 to -1.53, P = 0.020), VAS pain intensity score of -10.98 (95% CI, -21.36 to -0.61, P = 0.038), and EuroQol-5D VAS score of 8.64 (95% CI, 1.36 to 5.92, P = 0.020). No adverse events were reported.

Conclusion: Intra-articular dextrose prolotherapy injections reduced pain, improved function and quality of life in patients with KOA compared with blinded saline injections. The procedure is straightforward and safe; the adherence and satisfaction were high.

Keywords: intra-articular hypertonic dextrose; knee osteoarthritis; normal saline; prolotherapy; randomized clinical trial.

Author/s:

Sit, R.W.S., Wu, R.W., Reeves, K.D., Chan, D.C.C., Yip, B.H.K., Chung, V.C.H., Wong, S.