Ultrasound plus low-level laser therapy for knee osteoarthritis rehabilitation: a randomized, placebo-controlled trial.

This study evaluated the synergistic effects of ultrasound (US) and low-level laser therapy (LLLT) with or without therapeutic exercises (TE) in women with knee osteoarthritis. Forty-two Caucasian women with knee osteoarthritis were allocated into three groups: (1) the placebo group who did not perform TE, but the prototype without emitting light or ultrasonic waves was applied, (2) the US + LLLT group in which only the prototype was applied and (3) the TE + US + LLLT group that performed TE before the prototype was applied. However, 35 women completed the full clinical trial. Pressure pain thresholds (PPT) using an algometer and functional performance during the sit-to-stand test were carried out. The average PPT levels increased for US + LLLT (41 ± 9 to 54 ± 15 N, p < 0.01) and TE + US + LLLT (32 ± 8 to 45 ± 9 N, p < 0.01) groups. The number of sit-to-stands was significantly higher for all groups. However, the change between pre-treatment and post-treatment (delta value) was greater for the US + LLLT (4 ± 1) and TE + US + LLLT groups (5 ± 1) than for the placebo group (2 ± 1) with a significant intergroup difference (p < 0.05). This study showed reduced pain and increased physical functionality after 3 months of US + LLLT with and without TE.

Inflammation and post-operative recovery in patients undergoing total knee arthroplasty-secondary analysis of a randomized controlled trial.

OBJECTIVE: Reduced function persists for many patients after total knee arthroplasty (TKA). Inflammation is part of osteoarthritis' pathophysiology, and surgery induces a marked inflammatory response. We therefore wanted to explore the role of inflammation in long-term recovery after TKA, and thus conducted this secondary analysis of our randomized controlled trial (RCT) of physical rehabilitation ± progressive strength training (PST). We aimed to investigate whether (1) inflammation is associated with functional performance, knee-extension strength, and knee pain before TKA; (2) PST affects inflammation, and the inflammatory state over time; (3) baseline or surgery-induced inflammation modifies the effect of rehabilitation ± PST on change in 6-min walk test (Δ6MWT); and (4) baseline or surgery-induced inflammation is associated with Δ6MWT following TKA. DESIGN: In the primary trial report's per-protocol analysis, 72/82 patients were included. Sixty had ≥1 blood sample before and after TKA, and were included in this secondary analysis. Inflammation was measured by interferon γ-inducible protein (IP)-10, soluble urokinase plasminogen activator receptor (suPAR), interleukin (IL)-6, IL-10, and tumor necrosis factor (TNF)-α at baseline; day 1, week 4, 8, and 26 after TKA. RESULTS: At baseline, suPAR (P = 006) was negatively associated with 6MWT. Neither baseline nor surgery-induced inflammation modified the response to rehabilitation ± PST. Only surgery-induced IL-10 was associated with Δ6MWT26 weeks-baseline (P = 0.001), also adjusted for 6MWTbaseline, age, sex and body mass index (BMI). CONCLUSION: In this secondary analysis, only increased surgery-induced IL-10 response was associated with decreased long-term functional performance after TKA. The importance of controlling the surgery-induced immune response remains to be investigated further. TRIAL IDENTIFICATION: NCT01351831.

Low-dose external beam radiotherapy for greater trochanteric pain syndrome : Target volume definition and treatment outcome.

PURPOSE: Low-dose external beam radiotherapy (ED-EBRT) is frequently used in the therapy of refractory greater trochanteric pain syndrome (GTPS). As studies reporting treatment results are scarce, we retrospectively analyzed our own patient collectives. PATIENTS AND METHODS: In all, 60 patients (74 hips) received LD-EBRT (6 × 0.5 Gy in 29 hips, 6 × 1 Gy in 45). The endpoint was the patient's reported subjective response to treatment. The influence of different patient and treatment characteristics on treatment outcome was investigated. RESULTS: At the end of LD-EBRT, 69% reported partial remission, 4% complete remission, no change 28%. A total of 3 months later (n = 52 hips), the results were 37, 33, and 30% and 18 months after LD-EBRT (n = 47) 21, 51, and 28%. In univariate analysis "inclusion of the total femoral head into the PTV" and "night pain before LD-EBRT" were correlated with symptom remission at the end of LD-EBRT, while "initial increase in pain during LD-EBRT" was significantly associated with treatment failure. In multivariable modeling "initial increase in pain" was identified as a risk factor for treatment failure (p = 0.007; odds ratio [OR] 0.209; 95% confidence interval [CI] 0.048-0.957), while "night pain" was an independent factor for remission (p = 0.038; OR 3.484; 95% CI 1.004-12.6). Three months after LD-EBRT "night pain" and "inclusion of the complete femoral neck circumference into the PTV" were predictive for remission. CONCLUSION: LD-EBRT represents a useful treatment option for patients suffering from GTPS. Three months after therapy two-thirds of the patients reported a partial or complete symptom remission. Especially patients who suffered from nocturnal pain seemed to benefit. Treatment appeared to be more effective when the entire circumference of the femoral neck was encompassed.

LLLT for the management of patients with ankylosing spondylitis.

This study aimed to compare the effectiveness of the combined low-level laser therapy (LLLT) and passive stretching with combined placebo LLLT laser and the same passive stretching exercises in patients suffering from Αnkylosing spondylitis. Forty-eight patients suffering from Αnkylosing spondylitis participated in the study and were randomized into two groups. Group A (n = 24) was treated with a λ = 820 Ga-Al-As laser CW, with power intensity = 60 mW/cm(2), energy per point in each session = 4.5 J, total energy per session = 27.0 J, in contact with specific points technique, plus passive stretching exercises. Group B (n = 24), received placebo laser plus the same passive stretching exercises. Both groups received 12 sessions of laser or placebo within 8 weeks; two sessions per week (weeks 1-4) and one session per week (weeks 5-8). Pain and function scales were completed before the treatment, at the end of the fourth and eighth week of treatment, and 8 weeks after the end of treatment (follow-up). Group A revealed a significant improvement after 8 weeks of treatment in all pain and function scales. At 8-week follow-up, the improvement remained only for the pain, while for all other function outcomes the differences were not statistically significant. The results suggested that after an 8-week treatment and after a follow-up, the combination of LLLT and passive stretching exercises decreased pain more effectively than placebo LLLT along with the same passive stretching exercises in patients with Αnkylosing spondylitis. Future studies are needed to establish the relative and absolute effectiveness of the above protocol.

DEGRO guidelines for the radiotherapy of non-malignant disorders. Part II: Painful degenerative skeletal disorders.

BACKGROUND AND PURPOSE: The purpose of this article is to summarize the updated DEGRO consensus S2e guideline recommendations for the treatment of benign painful degenerative skeletal disorders with low-dose radiotherapy. MATERIALS AND METHODS: This overview reports on the role of low-dose radiotherapy in the treatment of enthesiopathies (shoulder syndrome, trochanteric bursitis, plantar fasciitis, and elbow syndrome) and painful arthrosis (knee, hip, hand, and finger joints). The most relevant aspects of the DEGRO S2e Consensus Guideline Radiation Therapy of Benign Diseases 2014 regarding diagnostics, treatment decision, dose prescription as well as performance of radiotherapy and results are summarized. RESULTS: For all indications mentioned above, retrospective and some prospective analyses have shown remarkable effects in terms of pain relief. Nevertheless, the Level of Evidence (LoE) and the Grade of Recommendation (GR) vary: LoE 1b-4 and GR A-C. CONCLUSION: Low-dose radiotherapy for painful degenerative skeletal disorders is effective in the majority of the patients and therefore it may be a reasonable therapeutic alternative when simple and non-invasive methods have been used without persistent success. For all discussed entities, single fraction doses of 0.5-1.0 Gy and total doses of 3.0-6.0 Gy/series applied with 2-3 fractions per week are recommended.

Effects of low-level laser therapy on joint pain, synovitis, anabolic, and catabolic factors in a progressive osteoarthritis rabbit model.

The aim of this study was to investigate the effect of low-level laser therapy (LLLT) on short-term and long-term joint pain, synovitis, anabolic, and catabolic factors in the cartilage of a rabbit model with progressive osteoarthritis (OA) induced by anterior cruciate ligament transection (ACLT). A total of 160 New Zealand white rabbits were randomly assigned into two groups (ACLT group and LLLT group). All rabbits received ACLT surgery, and 2-, 4-, 6-, and 8-week treatment after the surgery, with 20 rabbits being tested biweekly over every study period. The LLLT group received LLLT with a helium-neon (He-Ne) laser (830 nm) of 1.5 J/cm(2) three times per week, and the ACLT group received placebo LLLT with the equipment switched off. Long-term and short-term pain was tested via weight-bearing asymmetry; synovitis was assessed histologically; and knee joint cartilage was evaluated by gross morphology, histology, and gene expression analysis of anabolic and catabolic factors. The histological assessment of pain and synovitis showed that at least 6-week intermittent irradiation of LLLT could relief knee pain and control synovium inflammation. Gross morphologic inspection and histological evaluation showed that 6 weeks of LLLT could decrease cartilage damage of medical femoral condyle and 8 weeks of LLLT could decrease cartilage damage of medical and lateral femoral condyles and medical tibial plateau. Gene expression analysis revealed two results: At least 6 weeks of LLLT could decrease production of catabolic factors, for example, interleukin 1ß (IL-1ß), inducible nitric oxide synthase (iNOS), and MMP-3, and slow down the loss of anabolic factors, mainly TIMP-1. Eight weeks of LLLT treatment could slow down the loss of collagen II, aggrecan, and anabolic factors, mainly transforming growth factor beta (TGF-ß). The study suggests that LLLT plays a protective role against cartilage degradation and synovitis in rabbits with progressive OA by virtue of the regulation of catabolic and anabolic factors in the cartilage.

The Erlangen Dose Optimization trial for low-dose radiotherapy of benign painful elbow syndrome. Long-term results.

BACKGROUND AND PURPOSE: To evaluate the long-term efficacy of pain reduction by two dose fractionation schedules used for low-dose radiotherapy of painful elbow syndrome. PATIENTS AND METHODS: Between February 2006 and February 2010, 199 evaluable patients were recruited for this prospective trial. All patients received low-dose orthovoltage radiotherapy. One course consisted of 6 fractions in 3 weeks. In the case of insufficient pain remission after 6 weeks, a second course was administered. Patients were randomly assigned to one of two groups to receive single doses of either 0.5 or 1.0 Gy. Endpoint was pain reduction. Pain was measured before radiotherapy, as well as immediately after (early response), 6 weeks after (delayed response) and approximately 3 years after (long-term response) completion of radiotherapy using a questionnaire-based visual analogue scale (VAS) and a comprehensive pain score (CPS). RESULTS: Median follow-up was 35 months (range 9-57 months). The overall early, delayed and long-term response rates for all patients were 80, 90 and 94 %, respectively. The mean VAS scores before treatment and those for early, delayed and long-term response in the 0.5- and 1.0-Gy groups were 59.6 ± 20.2 and 55.7 ± 18.0 (p = 0.46); 32.1 ± 24.5 and 34.4 ± 22.5 (p = 0.26); 27.0 ± 27.7 and 23.5 ± 21.6 (p = 0.82) and 10.7 ± 15.0 and 21.5 ± 26.9 (p = 0.12), respectively. The mean CPS values before treatment and those for early, delayed and long-term response were 8.7 ± 2.9 and 8.1 ± 3.1 (p = 0.21); 4.5 ± 3.2 and 5.0 ± 3.4 (p = 0.51); 3.9 ± 3.6 and 2.8 ± 2.8 (p = 0.19) and 1.5 ± 2.3 and 2.4 ± 3.5 (p = 0.27), respectively. No significant differences in the quality of the long-term response were found between the 0.5- and 1.0-Gy arms (p = 0.28). CONCLUSION: Low-dose radiotherapy is an effective treatment for the management of benign painful elbow syndrome. For radiation protection reasons, the dose for a radiotherapy series should not exceed 3.0 Gy.

Eficacia y seguridad de la laserterapia en el tratamiento del dolor articular temporomandibular / Effectiveness and security of lasertherapy in the treatment of the temporomandibular articular pain

Introducción: El síntoma más frecuente e importante de los pacientes con trastornos temporomandibulares es el dolor, el cual puede cursar desde una ligera sensibilidad, hasta molestias extremas que obligan a los pacientes a buscar ayuda profesional. Los excelentes beneficios analgésicos y antiinflamatorios encontrados con el uso de la terapia láser de baja potencial, pueden brindar una buena opción de tratamiento en la fase aguda de este padecimiento. Objetivo: Evaluar la eficacia y seguridad de la laserterapia en el tratamiento del dolor articular temporomandibular. Métodos: Se realizó un estudio experimental tipo ensayo clínico, fase II, controlado, aleatorizado, unicéntrico y a ciegas por terceros en 90 pacientes con dolor articular temporomandibular en la Clínica de Especialidades Estomatológicas de Bayamo, 2009. Se constituyeron tres grupos de pacientes al azar. Al primer grupo se le aplicó tratamiento medicamentoso convencional, al segundo grupo en estudio laserterapia y al tercer grupo la combinación de ambos tratamientos. Resultados: La laserterapia resultó eficaz y segura en el tratamiento del dolor articular temporomandibular no describiéndose eventos adversos en ningún paciente de los grupos en estudio. Conclusiones: Se obtuvieron los mejores resultados en el grupo donde se combinaron la radiación láser con el tratamiento medicamentoso pues el 100 por ciento de los pacientes experimentaron ausencia de dolor entre la séptima y la novena aplicación de láser, resultado que se mantuvo al hacer evoluciones al mes y a los tres meses(AU)

Introduction: The most frequent and important symptom of the patients with temporomandibular disorders is the pain, which can be shown since a light sensitivity, until the extreme annoyances that make the patients look for professional help. The excellent analgesic and anti-inflammatory profits found with the use of the low power laser therapy, can offer a good option of the treatment in the acute phase of this disease. Aim: To evaluate the effectiveness and security of the lasertherapy in the treatment of the temporomandibular articular pain. Methods: it was performed an experimental, controlled, randomized, unicentric, type II clinical essay to 90 patients with temporomandibular articular pain in the Stomatological Specialty Clinic of Bayamo in 2009. There were formed three groups of patients taken at random. The conventional drug treatment was applied to the first group, the lasertherapy was applied to the second group and to the third group it was applied the combination of both treatments. Result: The lasertherapy was effective and safe in the treatment of the temporomandibular articular pain, without describing the adverse events in any patient of the study groups. Conclusion: The best results were obtained in the group where the laser radiation was combined with the drug treatment as 100 percent of the patients experienced lack of pain between the seventh and the ninth laser application, a result that was kept with the evolutions after one and three months(EU)

Benign painful elbow syndrome. First results of a single center prospective randomized radiotherapy dose optimization trial.

BACKGROUND AND PURPOSE: The goal of the present study was to evaluate the efficacy of two different dose-fractionation schedules for radiotherapy (RT) of patients with painful elbow syndrome. PATIENTS AND METHODS: Between February 2006 and February 2010, 199 consecutive evaluable patients were recruited for this prospective randomized trial. All patients received RT in orthovoltage technique. One RT course consisted of 6 single fractions/3 weeks. In case of insufficient remission of pain after 6 weeks a second radiation series was performed. Patients were randomly assigned to receive either single doses of 0.5 or 1.0 Gy. Endpoint was pain reduction. Pain was measured before, right after, and 6 weeks after RT by a visual analogue scale (VAS) and a comprehensive pain score (CPS). RESULTS: The overall response rate for all patients was 80% direct after and 91% 6 weeks after RT. The mean VAS values before, after and 6 weeks after treatment for the 0.5 and 1.0 Gy groups were 59.6 ± 20.2 and 55.7 ± 18.0 (p = 0.463), 32.1 ± 24.5 and 34.4 ± 22.5 (p = 0.256), and 27.0 ± 27.7 and 23.5 ± 21.6 (p = 0.818). The mean CPS before, after, and 6 weeks after treatment was 8.7 ± 2.9 and 8.1 ± 3.1 (p = 0.207), 4.5 ± 3.2 and 5.0 ± 3.4 (p = 0.507), 3.9 ± 3.6 and 2.8 ± 2.8 (p = 0.186), respectively. No statistically significant differences between the two single dose trial arms for early (p = 0.103) and delayed response (p = 0.246) were found. CONCLUSION: RT is an effective treatment option for the management of benign painful elbow syndrome. For radiation protection reasons the dose for a RT series is recommended not to exceed 3.0 Gy.

Meta-analysis of pain relief effects by laser irradiation on joint areas.

BACKGROUND: Laser therapy has been proposed as a physical therapy for musculoskeletal disorders and has attained popularity because no side effects have been reported after treatment. However, its true effectiveness is still controversial because several clinical trials have reported the ineffectiveness of lasers in treating pain. METHODS: In this systematic review, we investigate the clinical effectiveness of low-level laser therapy (LLLT) on joint pain. Clinical trials on joint pain satisfying the following conditions are included: the laser is irradiated on the joint area, the PEDro scale score is at least 5, and the effectiveness of the trial is measured using a visual analogue scale (VAS). To estimate the overall effectiveness of all included clinical trials, a mean weighted difference in change of pain on VAS was used. RESULTS: MEDLINE is the main source of the literature search. After the literature search, 22 trials related to joint pain were selected. The average methodological quality score of the 22 trials consisting of 1014 patients was 7.96 on the PEDro scale; 11 trials reported positive effects and 11 trials reported negative effects. The mean weighted difference in change of pain on VAS was 13.96 mm (95% CI, 7.24-20.69) in favor of the active LLLT groups. When we only considered the clinical trials in which the energy dose was within the dose range suggested in the review by Bjordal et al. in 2003 and in World Association for Laser Therapy (WALT) dose recommendation, the mean effect sizes were 19.88 and 21.05 mm in favor of the true LLLT groups, respectively. CONCLUSIONS: The review shows that laser therapy on the joint reduces pain in patients. Moreover, when we restrict the energy doses of the laser therapy into the dose window suggested in the previous study, we can expect more reliable pain relief treatments.

Short-term effects of 890-nanometer radiation on pain, physical activity, and postural stability in patients with knee osteoarthritis: a double-blind, randomized, placebo-controlled study.

OBJECTIVE: To investigate the effects of short-term light therapy with 890-nm radiation on pain, physical activity, and postural stability in patients with knee osteoarthritis (OA). DESIGN: A double-blind, randomized, placebo-controlled study. SETTING: Rehabilitation clinic. PARTICIPANTS: Women (n=62) and men (n=10) with a mean age of 61.2 years (range, 40-88y). All patients fulfilled the combined clinical and radiographic criteria for knee OA as established by the American College of Rheumatology, and all had obtained a Kellgren-Lawrence score of 2 or more. INTERVENTIONS: Participants received 6 sessions, lasting 40 minutes each, of active or placebo radiation treatment over the knee joints for 2 weeks (wavelength, 890nm; radiant power output, 6.24W; power density, 34.7mW/cm(2) for 40 minutes; total energy, 41.6J/cm(2) per knee per session). MAIN OUTCOME MEASURES: Participants were assessed weekly over 4 weeks using the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) for pain, stiffness, and physical function. Physical activity (timed stair climbing, 10-m fast-speed walking, and chair-rising time) and postural stability (using the postural stability evaluation system) were also assessed. The pain score on WOMAC was the primary outcome variable. Data were analyzed by repeated-measures analysis of covariance. RESULTS: Compared with baseline, no significant improvement was observed between groups for pain (P=.546), stiffness (P=.573), or physical function (P=.904). No significant improvement was noted for physical activity including the 10-m fast-speed walking time (P=.284), stair-climbing time (P=.202), stair-descending time (P=.468), chair-rising time (P=.499), or postural stability (P=.986) at the 4 follow-up assessments. Follow-up assessments were conducted after 1 week of treatment (thus, after 3 treatments); after 2 weeks of treatment (thus, after 6 treatments); and 1 and 2 weeks, respectively, after treatment was terminated. Although we found a significant time effect for the 10-m fast-speed walking time (P<.001) in the 2 groups, and a significant group effect in the improvement of stair-climbing time in the treatment group (P=.032), the group × time interaction effects were not significant. CONCLUSIONS: Short-term 890-nm radiation therapy for patients with knee OA provided no beneficial effect in improving pain, physical activity, and postural stability.

A shortened radiofrequency denervation method for cervical zygapophysial joint pain based on ultrasound localization of the nerves.

OBJECTIVE: Radiofrequency neurotomy is a recognized treatment for cervical zygapophysial joint pain. In several studies, the method has provided complete pain relief in 60-70% of the patients for approximately 9 months. The validated technique has the disadvantage of procedural times of 2-4 hours because several lesions are performed to take into account the variable nerve course. We tested the hypothesis that ultrasound localization of the nerves would enable us to reduce the number of lesions performed, while reaching the benchmark of at least 80% pain relief in 80% of patients with a median duration of 35 weeks, as achieved by a previous investigation using the standard method. INTERVENTIONS: We prospectively studied 15 consecutive patients with diagnosed cervical zygapophysial joint pain. They were treated using a shortened radiofrequency procedure under fluoroscopic control, based on previous ultrasound localization of the joint supplying nerves, with only two thermal lesions performed per nerve. Successful treatment was defined as at least 80% pain relief in the visual analog scale as compared with pretreatment. Follow-up was performed until 12 months after treatment. RESULTS: Of the 15 patients, 14 were successfully treated (93%, 95% confidence interval [CI] 80-100%) with a median time of pain relief of 44 weeks. At 6 and 12 months, 13 (87%, 95% CI 70-100%) and 6 patients (40%, 95% CI 15-65%) reported successful treatment, respectively. The median duration of the procedure was 35 minutes. CONCLUSION: In patients with cervical zygapophysial joint pain, radiofrequency denervation according to a shortened protocol based on ultrasound localization of the nerves reached the benchmark of the standard technique.

9°Yttrium-hydroxyapatite: a new therapeutic option for radioactive synovectomy in haemophilic synovitis.

Recurrent haemarthroses often lead to chronic synovitis in patients with haemophilia and von Willebrand disease. Radioactive synovectomy with yttrium-90 (9°Y) citrate is frequently used to treat this complication, usually with good results. Since 2006, the Nuclear Energy Research Institute (IPEN, Sao Paulo, Brazil) has produced hydroxyapatite particles labelled with 9°Y for radioactive synovectomy. The aim of this study was to compare the results achieved by both forms of 9°Y in the treatment of haemophilic synovitis. We included 221 joints from 136 patients (age range: 6-20 years), treated by one of the two radiopharmaceuticals, at the Hemocenter of Mato Grosso, Brazil. The outcomes analysed were the annual frequency of haemarthrosis, articular pain and joint range of motion before and 1 year after RS. Similar results were achieved regardless of whether 9°Y hydroxyapatite or 9°Y citrate was used, and results were independent of the joint type, age, gender, radiologic stage and presence of inhibitors. 9°Y hydroxyapatite appears to be equivalent to the reference product 9°Y citrate in the treatment of chronic synovitis associated with bleeding disorders.

[Radiotherapy in painful gonarthrosis. Results of a national patterns-of-care study]. / Strahlentherapie bei schmerzhafter Kniegelenkarthrose (Gonarthrose): Ergebnisse einer deutschen Patterns-of-Care-Studie

BACKGROUND AND PURPOSE: After a patterns-of-care study (PCS) in 2003/2004 addressing benign disorders in general, the German Cooperative Group on Radiotherapy for Benign Diseases (GCG-BD) conducted several multicenter cohort studies including the use of radiotherapy (RT) in painful gonarthrosis (GNA). MATERIAL AND METHODS: From 2006 to 2008, a PCS for GNA was conducted in all German RT institutions using a standardized structured questionnaire. Patient accrual, patient number, pretreatment, pain record, treatment indications, RT technique, and target volume concepts for painful GNA were assessed. In addition, the long-term functional and subjective outcomes were evaluated. RESULTS: 238/248 institutions (95.9%) returned the questionnaire: 50 (21%) reported no clinical experience with RT in GNA, while 188 (79%) institutions treated 4,544 patients annually (median 15; range one to 846 cases per institution). Indications for treatment were acute pain symptoms in 18.9%, chronic pain in 95.3%, and treatment-refractory pain in 81.1%. The median total dose was 6 Gy (range 3-12 Gy), with a median single dose of 1 Gy (0.25-3 Gy). 40.4% of the institutions applied two fractions and 51.4% three fractions weekly. RT was delivered with orthovoltage units (25%), linear accelerators (79.6%), and cobalt-60 units (8.3%). 42 institutions evaluated the long-term clinical outcome in a total of 5,069 cases. Median pain reduction for at least 3 months was reported in 60% (5-100%), median pain reduction for at least 12 months in 40% (10-100%), and median persistent pain reduction in 27.8% (10-85%) of the treated patients. In 30% of patients (7-100%), a second RT series was applied for inadequate pain response or early pain recurrence. No radiogenic acute or chronic side effects were observed. CONCLUSION: This PCS comprises the largest number of cases reported for RT in painful and refractory GNA. Despite variations in daily RT practice, high response and low toxicity for this treatment in a very large number of painful and refractory GNA cases renders low-dose RT an effective conservative therapy which can be applied prior to surgical procedures.

Aplicação do laser 808nm na dor articular crônica de ratos Wistar / Aplication of 808nm laser in chronic joint pain in Wistar rats

Durante o processo inflamatório, alguns tipos de células predominam e estão envolvidos com a produção de dor. O laser de baixa potência mostra-se útil no controle de mediadores inflamatórios, mas a ampla divergência nos parâmetros dosimétricos, conduz a variações nos resultados positivos. O objetivo deste estudo foi analisar o uso do laser 808nm, na dor articular crônica e edema de ratos Wistar submetidos a sinovite. Foram utilizados 10 ratos Wistar, divididos em dois grupos: GC - indução de sinovite em joelho direito e tratamento placebo; GT - indução de sinovite e irradiado com laser 10J/cm². Para a produção de sinovite foram injetados 100µl de formalina a 5 por cento, no espaço articular tibiofemoral direito. A avaliação da dor ocorreu pelo tempo de elevação da pata (TEP). No 10º dia após a indução de sinovite, iniciou-se o tratamento com laser sobre a face articular medial do joelho, procedimento mantido no decorrer de 10 dias. Os resultados mostraram que o laser apresentou efeitos analgésicos, visto que, para o grupo tratado, houve redução significativa nos valores de TEP, indicando redução da dor, quando comparados os valores pós-tratamento com os pré-tratamento, o que não ocorreu para o grupo que recebeu tratamento placebo; para o edema, o laser também mostrou redução significativa do mesmo. Concluiu-se que o laser 808nm, com 10J/cm², é eficaz na redução da dor articular crônica e edema, em animais submetidos a sinovite experimental.

During the inflammatory process some kinds of cells are predominant and are involved with pain production. Low power laser seems to be useful in the control of inflammatory mediators, but wide divergence in the dosemetric parameters leads to variations in its positive results. The aim of this study was to assess the use of the 808nm laser in the chronic joint pain and edema of Wistar rats submitted to synovitis. Sample was composed of 10 Wistar rats divided in two groups: CG - synovitis induction on right knee and placebo treatment; TG - synovitis induction and irradiated with 10J/cm² laser. 100µl of 5 percent phormaline were injected in the right tibiofemoral joint space. Pain assessment occurred by the time of paw elevation (TPE). On the 10th day after synovitis induction, laser treatment began on the knee medial joint surface and this procedure was kept for 10 days. The outcomes showed that laser presented analgesic effects, since significant reduction of the TPE values was observed for the treated group, hence indicating pain reduction when compared with the pre-treatment values; the same situation did not occur to the group which received the placebo treatment. Concerning edema, laser has also shown significant reduction. It can be concluded that laser 808nm with 10J/cm² is efficient in reduction of chronic joint pain and edema in animals submitted to experimental synovitis.

Joint pain in AML: successful pain control with radiotherapy.

We present a case supporting the use of radiation therapy for palliation of joint pain associated with acute myelogenous leukemia. Prior to radiation therapy to the affected joints, and despite standard pain management, this patient was entirely bedridden and in significant pain. Following radiation, she was able to participate in physiotherapy with minimal to no pain until her death several weeks later. A brief literature review of joint involvement in acute myelogenous leukemia is discussed.

Cyclotronic ion resonance therapy and arthralgia.

A total of 143 patients suffering various musculoskeletal disorders including rheumatoid arthritis, arthritis, osteoporosis, and post-surgical discomfort were subjected to ELF magnetic treatments using the Seqex device. A clear trend in pain reduction was observed over the 10 treatment regimen as well as a stabilization of relevant lab tests, including cholesterol level and blood pressure. Improvements were also noted in posturometric footboard tests. An additional 20 patients with various neuromuscular difficulties were treated with Seqex as well as magentic "concentrators" for periods ranging from 3 to 10 treatments. Similar improvements in pain reduction were observed in this smaller group.

Rhenium-186 hydroxyethylidenediphosphonate (186Re HEDP) for the treatment of hemophilic arthropathy: first results.

OBJECTIVES: The aim of this study was to evaluate the efficacy of a systemic application of rhenium-186 hydroxyethylidenediphosphonate (Re HEDP) for pain treatment in patients with hemophilic arthropathies. METHODS: Twelve patients with hemophilic arthropathy with at least 3 involved joints with persistent pain were included in this prospective study. A single dose of 15 mCi (555 MBq) Re HEDP was administered intravenously. Before and 12 weeks after treatment, pain assessment was performed using the visual analog scale (VAS). The pain status assessment included the general status, pain of all joints affected, and pain of the 3 mostly involved joints. Furthermore, quality of life was assessed. RESULTS: With regard to the 3 most involved joints, an improvement of the pain symptoms in 25 of 36 (69.4%) joints was observed. With regard to all involved joints a median of 3 joints per patient improved after Re HEDP therapy. General pain status after treatment was 2.0 VAS points lower as compared with pretreatment. The total number of involved joints remained unchanged in 7 patients, increased in 1 patient, and decreased in the remaining 4 patients. CONCLUSIONS: The results of this study show an improvement of the pain symptoms of the involved joints 12 weeks after therapy with Re HEDP in patients with hemophilic arthropathy. The only moderate success regarding a reduction of the total number of involved joints is by the fact that despite this improvement most affected joints remained still painful on a lower level after the therapy or due to newly affected joints not painful before initiation of the radionuclide therapy.

Radioactive pain relief: health care strategies and risk assessment among elderly persons with arthritis at radon health mines.

OBJECTIVES: The aim of this study was to examine the use of radioactive radon therapy among persons with arthritis, and to explore their perceptions of risk versus benefit in using this therapy. DESIGN: This was a qualitative study based on loosely-structured and open-ended interviews, which were then analyzed for themes and patterns. SETTING: Participants in the study were recruited over a period of 5 years from clients of a radon health mine in southwestern Montana. RESULTS: Sixty-two mine clients were interviewed, consisting of 36 women and 26 men, ranging in age from 60 to 92 years. Participants believed that radon therapy was an acceptable choice of treatment for arthritis. Perceived benefits of such therapy included more effective pain relief, avoidance of medication side-effects, lower cost, and increased quality of life. The possible future risk of lung cancer from radon exposure was seen as minimal when compared to the perceived benefits. CONCLUSIONS: Fear about radon and its possible health risks seemed to have little influence on the decision-making process for the study subjects.