Techniques in regional anesthesia & pain management最新文献

Both researchers and clinicians have exhibited growing interest in the use of platelet-rich plasma (PRP) and other autologous products for a variety of clinical conditions. Newly published data suggest that PRP injections can be an effective complement to conventional management strategies for knee osteoarthritis (OA) and chondropathy. Using a systematic review approach, we sought to synthesize the published data on the duration of clinical effect of PRP on knee OA and chondropathy. We systematically searched PubMed for all reports published in any language between the earliest available date and July (fourth week) of 2015 using the following key words: platelet, rich, plasma, knee, and osteoarthritis. If double-blind randomized, controlled trials were not available, we included other clinical trials and observational studies. We further searched for the association of the same keywords (platelet, rich, plasma, knee) and chondropathy. After reviewing abstracts, we acquired full-text papers where appropriate. We categorized the level of evidence for the duration of treatment efficacy according to Guyatt and coauthors. Twenty-four relevant studies encompassing 2,385 patients were included in the review. Studies reported clinical outcomes from intra-articular injection of PRP or recounted autologous products. The results showed a consistent improvement in patient pain scores and functional indexes for 6 months after initiation of injections. The residual clinical effect was typically observed beyond 6 months of follow-up in most of the studies. Pain and functional scores decreased after 12 months of follow-up but remained higher than the base scores in the majority of studies. Some suggested that annual injections improved treatment outcomes after 18 months of follow-up. Data from available clinical reports suggest that the PRP administration results in decreased pain and enhanced functional status. The duration of beneficial clinical effects after administration of PRP or recounted autologous products for patients with knee OA and chondropathy was stable up to 6 months following completion of regenerative therapy. The pain and functional scores worsened after 12 months of follow-up but were still better than pre-injection scores according to the majority of publications. The analysis is limited by the wide variability of available studies.

Interest in regenerative medicine for treating musculoskeletal pathology has grown tremendously over the past decade. Part of its appeal lies in the ability to use a patient׳s own cells to potentially heal acute and chronic injuries. While evidence grows supporting its use in certain injuries, a perception exists that regenerative medicine may be a panacea. In this article, we review the evidence for platelet-rich plasma and bone marrow aspirate concentrate in treating muscle, ligament, and fibrocartilage injuries. We also offer our own practice experiences and technical considerations in the uses of these techniques.

Peripheral nerve entrapments are an underrecognized cause of pain and disability. Hydrodissection (perineural deep injections) is one of the techniques that can release the entrapped nerve. Futhermore, discussed are the techniques of neural therapy, neural prolotherapy (perineural injection therapy), and autologous platelet lysate, as well as the use of adipose-derived stem cells.

This study is a systematic review of human clinical studies of stem cell therapy for discogenic pain. To summarize the current human trials and feasibility studies involving mesenchymal stem cell (MSC) therapy for treatment of discogenic pain. A search of Ovid databases and Clinicaltrials.gov was conducted from inception through July 2016. We included human clinical trials and case reports that evaluated treatment with injected MSCs for patients with discogenic back pain. The outcomes of interest for published studies included pain score, Oswestry Disability Index, and T2-weighted magnetic resonance imaging signal intensity indicative of water content of the nucleus pulposus. The initial search in Ovid databases using the selected search terms identified 408 results, of which 11 were included in this review based on selection criteria. This includes 6 completed studies and 5 ongoing clinical trials, 4 of which were confirmed active at the time of retrieval. In the 6 completed studies involving intradiscal stem cell injections, improvement in pain score, Oswestry Disability Index, and T2-weighted magnetic resonance imaging signal intensity of nucleus pulposus were reported. Currently active clinical trials focus on establishing safety, tolerability, and efficacy with respect to injected MSCs for discogenic pain. Although pain and functional benefit have been reported in association with stem cell therapy, longer-term safety studies and more randomized controlled trials are needed to examine the safety and efficacy of stem cell therapy for discogenic pain.

Hip pain is a common complaint that can have both intra-articular and extra-articular origins. Three common causes of hip pain are hip osteoarthritis, iliopsoas tendinopathy, and gluteus medius tendinopathy. Current treatment plans range from conservative measures to surgical replacement. Traditionally, minimally invasive approaches with the use of corticosteroid and local anesthetic injections have served to manage symptoms of pain without altering disease progression. In addition, these agents have been associated with deleterious effects on bone, tendon, and cartilage health. Emerging regenerative medicine techniques are becoming increasingly popular for the management of hip pain, as they have been shown to improve clinical outcomes and potentially alter disease progression. Some of these techniques, such as injection of platelet-rich plasma, mesenchymal stem cells, and percutaneous needle fenestration, have been shown to promote healing of damaged tissue. These techniques are often augmented by the use of ultrasound imaging, which greatly increases ease and accuracy. This article reviews ultrasound-guided regenerative orthopedic injections specifically for hip joint osteoarthritis, gluteus medius tendinopathy, and iliopsoas tendinopathy.

The goal of this case review is to evaluate functional and structural changes with the use of intradiscal PRP in patients with lumbar discogenic pain. The secondary outcomes include improvement in pain, medication use, hospitalization, and surgery. Low back pain affects a large portion of the population causing a major social and economic effect. Current interventional treatments remain inadequate and transient targeting the symptoms without addressing the underlying cause. Platelet-rich plasma (PRP) has been used clinically in various settings for its healing properties attributed to growth factors. A total of 6 patients with chronic discogenic low back and leg pain who tried and failed conservative treatments were administered a single injection of 2-mm autologous PRP into the nucleus pulposus after careful study of the disk anatomy via discography and computed tomography scan. The patients were followed up at 2, 4, 8, 12, 16, 20, and 24 weeks; postinjection and primary and secondary outcomes were recorded. Verbal pain scale score for pain of all patients decreased more than 50% and their function increased for the period of 6 months and beyond. Postprocedure magnetic resonance imaging documented positive structural changes in small percentage of patients. None of the patients presented to the hospital or received surgery after this treatment. Although our preliminary results have been promising, well-designed randomized controlled trials are warranted to understand the full breath of the efficacy, risks, and complications from the use of PRP in the disk.

Regenerative medicine has demonstrated to have significant positive clinical outcomes. Its applications to multiple conditions, and potential for a healing result has caused some patients to seek out regenerative treatment options rather than considering surgical interventions once other conservative and interventional options have not been successful. In particular to the spine, much of the literature and attention has been on discogenic pain in the spine, followed by sacroiliac joint pain or syndrome. The applications of regenerative medicine in the peripheral joints, ligaments, tendons, and muscles can certainly be paralleled to many of the conditions and syndromes in the spine. Limited data and research are available; however, this is the cause for further research to be conducted.

Tendinopathy is characterized by failure of the normal tendon repair mechanism, and is a common malady that leads to chronic pain. Although pain relief is an important goal in treating the patient with tendinopathy, modalities that are intended to decrease pain in the short term do not address the underlying tissue disorder. As no current gold standard exists in the treatment of tendinopathy, physicians face a unique challenge in treating this common pathology. Regenerative medicine applications in pain medicine aim to address this unique challenge.