Efficacy and Safety of Ultrasound-Guided Acupotomy Versus Celecoxib in Patients with Thoracodorsal Myofascial Pain Syndrome: A Randomized Controlled Trial.

Objective: To evaluate the efficacy and safety of ultrasound-guided acupotomy (UgA) for the treatment of thoracodorsal myofascial pain syndrome (TDMPS) and monitor its mid-term efficacy at 3 months after treatment. Methods: A 3-week, evaluator-blinded randomized clinical trial was conducted among 100 patients with TDMPS (visual analogue scale [VAS] score > 3) in the outpatient clinic of the Department of Orthopaedics of the Second Affiliated Hospital of Anhui University of Traditional Chinese Medicine, with a 3-month follow-up starting after completion of treatment. These patients were randomly assigned to receive UgA (n = 50) or oral celecoxib (n = 50). Recruitment was conducted between January 2021 and July 2022. The primary outcome was the VAS score, and the secondary outcomes included the Oswestry Disability Index (ODI), Pain Anxiety Symptoms Scale (PASS), and TNF-α and IL-1ß levels. Outcome data were collected at baseline, week 3 (post-treatment) and week 15 (follow-up). Results: Compared with that in the celecoxib group, the pain in the UgA group was alleviated more strongly, with an adjusted mean group difference of -0.69 (95% CI,-1.07 to -0.31 after multiple imputation) at week 3 and -1.96 (95% CI,-2.33 to -1.59 after multiple imputation) at week 15 (p < 0.001 for overall group × time interaction). Both groups exhibited improvements in the ODI and PASS scores at weeks 3 and 15, but these improvements were significantly greater in the UgA group (p < 0.05). At week 3, the TNF-α and IL-1 levels were significantly lower in both groups, but celecoxib was more effective (p < 0.05). Results from analyses with multilevel multiple imputation for missingness were similar. Conclusion: UgA led to greater and safer alleviation of pain, dysfunction, and pain anxiety in patients treated with TDMPS than did celecoxib and had a durable 3-month efficacy but was inferior to celecoxib in reducing the level of inflammatory factors. These findings may prompt clinicians to recommend UgA as an alternative and supplementary therapy for pain management in patients with TDMPS.

[Effects of acupotomy on partial movement gait and serum tumor necrosis factor-α, interleukin-1ß in patients with knee osteoarthritis].

OBJECTIVE: To explore effects of acupotomy on pain, function, gait and serum inflammatory factors in patients with knee osteoarthritis(KOA). METHODS: From December 2017 to June 2019, 110 patients with KOA were collected and divided into acupotomy group(56 cases) and western medicine group(54 cases) by using random number table method. In acupotomy group, there were 16 males and 40 females, aged from 46 to 74 years old with an average of (62.98±6.68) years old, the course of disease ranged from 1 to 240 months with an average of 24.5(15.25, 33.00) months;were treated with acupotomy on the pain points around knee joint once a week for 3 weeks. In western medicine group, there were 18 males and 36 females, aged from 47 to 73 years old with an average of (64.19±5.98 ) years old;the course of disease ranged from 1 to 220 months with an average of 25.00(13.75, 33.00) months;were took celecoxib capsule orally, 200 mg once a day for 3 weeks. Oxford Knee Score(OKS) was performed before treatment, 3 weeks and 3 months after treatment. Gait kinematics analysis and serum levels of tumor necrosis factor-α(TNF-α) and interleukin-1ß (IL-1ß) were measured before and after treatment for 3 weeks. RESULTS: All patients were followed up from 6 to 24 months with an average of(15.03±4.55) months. OKS between two groups decreased significantly at 3 weeks and 3 months after treatment(P<0.001). Functional scores and overall scores in acupotomology group were significantly decreased at 3 months compared with 3 weeks after treatment(P<0.001). OKS of acupotomy group were significantly lower than those of western medicine group at 3 weeks and 3 months after treatment(P<0.05). Gait speed, frequency and length between two groups were significantly improved at 3 weeks after treatment(P<0.05). At 3 weeks after treatment, gait freguency of acupotomy group was significantly improved compared with western medicine group(P<0.05). TNF-α and IL-1ß were significantly lower in both groups at 3 weeks after treatment than before treatment(P<0.05). At 3 weeks after treatment, level of IL-1 ß was lower in western medicine group than in acupotomy group(P<0.05), and difference in TNF-α level was not statistically significant(P>0.05). CONCLUSION: Acupotomology of pain points could significantly improve pain, function, gait, and decreased serum inflammatory factors at early to mid stage of KOA patients, in particular, it is superior to non-steroidal anti-inflammatory drugs in terms of knee function recovery and cadence improvement.

The effects of small-needle-knife therapy on pain and mobility from knee osteoarthritis: a pilot randomized-controlled study.

OBJECTIVE: To investigate the effect of small needle-knife therapy in people with painful knee osteoarthritis. DESIGN: Pilot randomised, controlled trial. SETTING: Rehabilitation hospital. SUBJECTS: In-patients with osteo-arthritis of the knee. INTERVENTIONS: Either 1 to 3 small needle-knife treatments over seven days or oral Celecoxib. All patients stayed in hospital three weeks, receiving the same mobility-focused rehabilitation. MEASURES: Oxford Knee Score (OKS), gait speed and kinematics were recorded at baseline, at three weeks (discharge) and at three-months (OKS only). Withdrawal from the study, and adverse events associated with the small needle knife therapy were recorded. RESULTS: 83 patients were randomized: 44 into the control group, of whom 10 were lost by three weeks and 12 at 3 months; 39 into the experimental group of whom eight were lost at three weeks and three months. The mean (SE) OKS scores at baseline were Control 35.86 (1.05), Exp 38.38 (0.99); at three weeks 26.64 (0.97) and 21.94 (1.23); and at three months 25.83 (0.91) and 20.48 (1.14) The mean (SE) gait speed at baseline was 1.07 (0.03) m/sec (Control) and 0.98 (0.03), and at three weeks was 1.14 (0.03) and 1.12 (0.03) (P < 0.05). Linear mixed model statistical analysis showed that the improvements in the experimental group were statistically significant for total OKS score at discharge and three months. CONCLUSIONS: Small needle-knife therapy added to standard therapy for patients with knee osteoarthritis, was acceptable, safe and reduced pain and improved global function on the Oxford Knee Score. Further research is warranted.

[Experimental study on improvement of blood supply timeliness of rabbits with vertebral artery type of cervical spondylosis by massage].

OBJECTIVE: Establishing a rabbit model of vertebral artery type of cervical spondylosis(CSA) and to observe the characteristics of timeliness in improving the blood flow of vertebral artery by massage, and discusse the material basis of this timeliness based on NPY and ET-1. METHODS: Fifty New Zealand healthy and white rabbits, 6-month-old, the body mass of (2.0±0.5) kg, with half males and half females, were randomly divided into blank group, model group, three massage groups(including massage for 10 min, 20 min, and 30 min group by random number table), 10 rabbits in each group. In addition to the blank group, CSA rabbit model was made by injection of sclerosing agent in other groups. The rabbits of massage for 10 min, 20 min, and 30 min groups received the massage therapy of corresponding duration, one times a day, continuous 10 days. The blood flow of vertebral artery in each group was detected by PeriFlux5000 laser doppler, and the contents of NPY and ET-1 in serum were detected by ELISA before and after treatment. RESULTS: Changes in blood flow of vertebral artery before and after treatment:there was no significant difference between model group and massage for 10 min group;there was significant difference between model group and massage for 20, 30 min groups(P<0.01); there was significant difference between massage for 10 min group and massage for 20, 30 min groups(P<0.01); there was no significant difference between massage for 20 min group and massage for 30 min group. Changes of NPY content before and after treatment: there was significant difference between model group and massage for 10 min group(P<0.05); there was significant difference between model group and massage for 20, 30 min groups(P<0.01); there was significant difference between massage for 10 min group and massage for 20, 30 min groups(P<0.01); there was no significant difference between massage for 20 min group and massage for 30 min group. Changes of ET-1 content before and after treatment:there was no significant difference between model group and massage for 10 min group;there was significant difference between model group and massage for 20, 30 min groups(P<0.01); there was significant difference between massage for 10 min group and massage for 20 min, 30 groups (P<0.01); there was no significant difference between massage for 20 min group and massage for 30 min group. CONCLUSIONS: Massage needed 20 min for rabbits with CSA can only significantly improve the blood flow of vertebral artery. However, prolonging the time of massage has no obvious effect. The material basis of this timeliness characteristic of massage is closely related to the change of NPY and ET-1 levels in serum.