1
|
Jeyaraman N, Migliorini F, Ramkumar V, Ramasubramanian S, Patro BP, Maffulli N, Jeyaraman M. Angioembolization in the management of joint pain: current concepts. ORTHOPADIE (HEIDELBERG, GERMANY) 2024; 53:688-697. [PMID: 39060549 DOI: 10.1007/s00132-024-04531-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 06/19/2024] [Indexed: 07/28/2024]
Abstract
Joint pain is a common complaint owing to its origin in inflammatory and degenerative joint diseases. Recent research has helped narrow down inadequate angiogenesis as one of the causes. Angioembolization has emerged as a treatment option for this condition when it is refractory to conservative treatment. This review describes angioembolization by elaborating on the mechanism, safety, efficacy, comparative analysis of treatment and the road ahead, in addition to summarizing the existing data on this treatment. The inferences from this review further consolidate transcatheter arterial embolization as one of the prime options for managing joint pain when it is refractory to conservative treatment and label it as one of the most exciting prospects. A limitation of this review is that most of the data were from open label case series or case reports.
Collapse
Affiliation(s)
- Naveen Jeyaraman
- Department of Orthopaedics, ACS Medical College and Hospital, Dr MGR Educational and Research Institute, 600077, Chennai, Tamil Nadu, India
| | - Filippo Migliorini
- Department of Orthopaedic and Trauma Surgery, Academic Hospital of Bolzano (SABES-ASDAA), Via Lorenz Bohler 5, 39100, Bolzano, Italy
- Department of Life Sciences, Health, and Health Professions, Link Campus University, 00165, Rome, Italy
| | - Varunkumar Ramkumar
- Department of Orthopaedics, Madurai Medical College and Hospital, 625020, Madurai, Tamil Nadu, India
| | - Swaminathan Ramasubramanian
- Department of Orthopaedics, Government Medical College, Omandurar Government Estate, 600002, Chennai, Tamil Nadu, India
| | - Bishnu Prasad Patro
- Department of Orthopaedics, All India Institute of Medical Sciences, 751019, Bhubaneswar, Odisha, India
| | - Nicola Maffulli
- Department of Trauma and Orthopaedic Surgery, Faculty of Medicine and Psychology, University La Sapienza, 00185, Roma, Italy.
- School of Pharmacy and Bioengineering, Keele University Faculty of Medicine, ST4 7QB, Stoke on Trent, UK.
- Centre for Sports and Exercise Medicine, Barts and the London School of Medicine and Dentistry, Mile End Hospital, Queen Mary University of London, E1 4DG, London, UK.
| | - Madhan Jeyaraman
- Department of Orthopaedics, ACS Medical College and Hospital, Dr MGR Educational and Research Institute, 600077, Chennai, Tamil Nadu, India
| |
Collapse
|
2
|
Francis A, Erridge S, Holvey C, Coomber R, Guru R, Darweish Medniuk A, Sajad M, Searle R, Usmani A, Varma S, Rucker J, Platt M, Holden W, Sodergren MH. Assessment of clinical outcomes in patients with inflammatory arthritis: analysis from the UK Medical Cannabis Registry. Int Clin Psychopharmacol 2024:00004850-990000000-00145. [PMID: 38976497 DOI: 10.1097/yic.0000000000000556] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/10/2024]
Abstract
The aim of this study was to assess changes in validated patient-reported outcome measures after initiation of cannabis-based medicinal products (CBMPs) and the safety of CBMPs in patients with inflammatory arthritis. A prospective case series from the UK Medical Cannabis Registry was analyzed. The primary outcomes changes were in Brief Pain Inventory, McGill Pain Questionnaire, EuroQol 5-dimension 5-level (EQ-5D-5L), Generalised Anxiety Disorder-7 questionnaire, and Single-Item Sleep Quality Scale at 1, 3, 6, and 12 months of follow-up compared with baseline. Adverse events were analyzed in accordance with Common Terminology Criteria for Adverse Events, v.4.0. Statistical significance was defined as a P-value less than 0.050. Eighty-two patients met the inclusion criteria. Initiation of CBMP treatment was associated with improvements in Brief Pain Inventory, McGill Pain Questionnaire, EQ-5D-5L, Generalised Anxiety Disorder-7 questionnaire, and Single-Item Sleep Quality Scale at 1, 3, 6, and 12 months compared with baseline (P < 0.050). There were 102 (44.35%) mild adverse events, 97 (42.17%) moderate adverse events, and 31 (13.48%) severe adverse events recorded by 21 (25.61%) participants. This study suggests that CBMP treatment is associated with pain improvement and increased health-related quality of life for inflammatory arthritis patients. While causality cannot be inferred in this observational study, the results support the development of randomized control trials for inflammatory arthritis pain management with CBMPs.
Collapse
Affiliation(s)
- Ann Francis
- Department of Surgery and Cancer, Medical Cannabis Research Group, Imperial College London
| | - Simon Erridge
- Department of Surgery and Cancer, Medical Cannabis Research Group, Imperial College London
- Department of Medicine, Curaleaf Clinic
| | | | - Ross Coomber
- Department of Medicine, Curaleaf Clinic
- Department of Trauma and Orthopaedics, St. George's Hospital NHS Trust, London
| | - Rahul Guru
- Department of Medicine, Curaleaf Clinic
- Department of Pain Management, Cardiff and Vale University Health Board, Cardiff
| | - Alia Darweish Medniuk
- Department of Medicine, Curaleaf Clinic
- Anaesthetic Department, Southmead Hospital, North Bristol NHS Trust, Bristol
| | | | | | | | | | - James Rucker
- Department of Medicine, Curaleaf Clinic
- Department of Pain Management, Cardiff and Vale University Health Board, Cardiff
- Anaesthetic Department, Southmead Hospital, North Bristol NHS Trust, Bristol
| | | | | | - Mikael H Sodergren
- Department of Surgery and Cancer, Medical Cannabis Research Group, Imperial College London
- Department of Medicine, Curaleaf Clinic
| |
Collapse
|
3
|
Francis A, Erridge S, Holvey C, Coomber R, Holden W, Rucker J, Platt M, Sodergren M. Assessment of Clinical Outcomes in Patients With Osteoarthritis: Analysis From the UK Medical Cannabis Registry. J Pain Palliat Care Pharmacother 2024; 38:103-116. [PMID: 38669060 DOI: 10.1080/15360288.2024.2340076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2024] [Accepted: 03/30/2024] [Indexed: 06/06/2024]
Abstract
Osteoarthritis accounts for 0.6% of disability-adjusted life years globally. There is a paucity of research focused on cannabis-based medicinal products (CBMPs) for osteoarthritic chronic pain management. This study aims to assess changes in validated patient-reported outcome measures (PROMs) and CBMP clinical safety in patients with osteoarthritis. A prospective case series from the UK Medical Cannabis Registry was analyzed. Primary outcomes were changes in the Brief Pain Inventory (BPI), McGill Pain Questionnaire (MPQ2), EQ-5D-5L, Generalized Anxiety Disorder-7 (GAD-7) questionnaire, and Single-Item Sleep Quality Scale (SQS) at 1-, 3-, 6-, and 12-month follow-ups from baseline. Common Terminology Criteria for Adverse Events v.4.0 was used for adverse event (AE) analysis. Statistical significance was defined as p < 0.050. Seventy-seven patients met inclusion criteria. CBMP initiation correlated with BPI pain severity (p = 0.004), pain interference (p = 0.005), and MPQ2 (p = 0.017) improvements at all follow-ups compared to baseline. There were improvements in the EQ-5D-5L index (p = 0.026), SQS (p < 0.001), and GAD-7 (p = 0.038) up to 6 and 3 months, respectively. Seventeen participants (22.08%) recorded 76 mild AEs (34.86%), 104 moderate AEs (47.71%), and 38 severe AEs (17.43%). Though causality cannot be assumed in this observational study, results support development of randomized control trials for osteoarthritis pain management with CBMPs.
Collapse
Affiliation(s)
- Ann Francis
- Medical Cannabis Research Group, Imperial College London, London, UK
| | - Simon Erridge
- Medical Cannabis Research Group, Imperial College London, London, UK
- Curaleaf Clinic, London, UK
| | | | - Ross Coomber
- Curaleaf Clinic, London, UK
- St. George's Hospital NHS Trust, London, UK
| | | | - James Rucker
- Curaleaf Clinic, London, UK
- Department of Psychological Medicine, Kings College London, London, UK, and South London & Maudsley NHS Foundation Trust, London, UK
| | | | - Mikael Sodergren
- Medical Cannabis Research Group, Imperial College London, London, UK
- Curaleaf Clinic, London, UK
| |
Collapse
|
4
|
A Comprehensive Assessment of The Eight Vital Signs. THE EUROBIOTECH JOURNAL 2022. [DOI: 10.2478/ebtj-2022-0014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Abstract
The term “vital sign” has been assigned to various phenomena with the presumptive intent to emphasize their importance in health care resulting in the emergence of eight vital signs with multiple designations and overlapping terms. This review developed a case definition for vital signs and identified and described the fifth through eighth vital signs. PubMed/Medline, Google and biographical databases were searched using the individual Medical Subject Headings (MeSH) terms, vital sign and fifth, vital sign and sixth, vital sign and seventh, and vital sign eighth. The search was limited to human clinical studies written in English literature from 1957 up until November 30, 2021. Excluded were articles containing the term vital sign if used alone without the qualifier fifth, sixth, seventh, or eighth or about temperature, blood pressure, pulse, and respiratory rate. One hundred ninety-six articles (122 for the fifth vital sign, 71 for the sixth vital sign, two for the seventh vital sign, and one for the eighth vital sign) constituted the final dataset. The vital signs consisted of 35 terms, classified into 17 categories compromising 186 unique papers for each primary authored article with redundant numbered vital signs for glucose, weight, body mass index, and medication compliance. Eleven terms have been named the fifth vital sign, 25 the sixth vital sign, three the seventh, and one as the eighth vital sign. There are four time-honored vital signs based on the case definition, and they represent an objective bedside measurement obtained noninvasively that is essential for life. Based on this case definition, pulse oximetry qualifies as the fifth while end-tidal CO2 and cardiac output as the sixth. Thus, these terms have been misappropriated 31 times. Although important to emphasize in patient care, the remainder are not vital signs and should not be construed in this manner.
Collapse
|
5
|
Rashid H, Kwoh CK. Should Platelet-Rich Plasma or Stem Cell Therapy Be Used to Treat Osteoarthritis? Rheum Dis Clin North Am 2020; 45:417-438. [PMID: 31277753 DOI: 10.1016/j.rdc.2019.04.010] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Osteoarthritis is the most common form of arthritis and unfortunately lacks disease-modifying treatments. This has led to a growing demand for more effective nonoperative treatment options. Platelet-rich plasma and mesenchymal stem cell therapy offer the potential to modify the natural course of knee osteoarthritis using cell-based technology. Because of the lack of high-quality evidence and the large degree of heterogeneity, in terms of study designs and measured outcomes, the use of platelet-rich plasma or mesenchymal stem cell therapy to treat knee osteoarthritis cannot be recommended at this time.
Collapse
Affiliation(s)
- Hani Rashid
- Division of Rheumatology, University of Arizona College of Medicine, 1501 North Campbell Avenue, PO Box 245093, Tucson, AZ 85724, USA
| | - C Kent Kwoh
- Division of Rheumatology, University of Arizona College of Medicine, 1501 North Campbell Avenue, PO Box 245093, Tucson, AZ 85724, USA; University of Arizona Arthritis Center, University of Arizona College of Medicine, 1501 North Campbell Avenue, PO Box 245093, Tucson, AZ 85724, USA.
| |
Collapse
|
6
|
de Luca K, Parkinson L, Downie A, Blyth F, Byles J. Three subgroups of pain profiles identified in 227 women with arthritis: a latent class analysis. Clin Rheumatol 2016; 36:625-634. [DOI: 10.1007/s10067-016-3343-5] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2016] [Revised: 06/22/2016] [Accepted: 06/25/2016] [Indexed: 12/12/2022]
|
7
|
de Luca KE, Parkinson L, Byles JE, Lo T, Pollard HP, Blyth FM. The Prevalence and Cross-Sectional Associations of Neuropathic-like Pain Among Older, Community-Dwelling Women with Arthritis. PAIN MEDICINE 2016; 17:1308-1316. [DOI: 10.1093/pm/pnv111] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
|
8
|
de Luca K, Parkinson L, Pollard H, Byles J, Blyth F. How is the experience of pain measured in older, community-dwelling people with osteoarthritis? A systematic review of the literature. Rheumatol Int 2015; 35:1461-72. [PMID: 25869349 DOI: 10.1007/s00296-015-3268-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2014] [Accepted: 04/04/2015] [Indexed: 12/11/2022]
Abstract
The objective of the study was to perform a systematic review to identify and appraise outcome measures and measures of pain that are used to assess the experience of pain by older people with osteoarthritis, and to assess whether these measures are effective at capturing the multidimensional nature of the experience of this pain. A systematic review of five electronic databases from January 1996 to March 2013 was done. Inclusion criteria were cohort/observational and cross-sectional studies; specific diagnosis of OA; employed outcome measures of pain and/or health and/or quality of life which included questions about pain; and considered older adults. Articles were reviewed for methodological quality using the Effective Public Health Practice Project Quality Assessment Tool for Quantitative Studies. A total of 14 publications met the inclusion criteria, and 11 discrete studies were included in the review. The studies used 21 different outcome measures, utilizing 13 measures of pain. Sensory, affective and cognitive dimensions of pain were captured by the measures, albeit studies predominantly measured intensity or severity alone. Measures of pain used in epidemiological studies do not adequately capture the multidimensional nature of the experience of pain in osteoarthritis. There is a fraught complexity in the multidimensionality of the experience of pain in osteoarthritis, and studies exploring osteoarthritis pain in older people should attempt to capture this multidimensionality by employing multiple valid and reliable outcome measures that capture specific dimensions of the pain experience.
Collapse
Affiliation(s)
- Katie de Luca
- Research Centre for Gender Health and Ageing, University of Newcastle, 18 Palm Court South West Rocks, Callaghan, NSW, 2431, Australia,
| | | | | | | | | |
Collapse
|
9
|
de Luca K, Parkinson L, Byles J. A study protocol for the profile of pain in older women: assessing the multi dimensional nature of the experience of pain in arthritis. Chiropr Man Therap 2014. [DOI: 10.1186/s12998-014-0028-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Arthritis is a significant contributor to illness, pain and disability and imposes a considerable burden upon the community. Pain is a cardinal symptom of arthritis and has significant implications on biopsychosocial wellbeing. The multidimensional nature of the experience of pain in arthritis has not been well defined in community-based samples.
Aims
The two aims of this study are to generate profiles of pain from a community sample of older women and to compare profiles for women with and without arthritis.
Methods
The sub study is a cross-sectional postal survey of 700 Australian community-based women. The survey includes a range of measures on health, arthritis and pain that will be used to examine the multidimensional nature of the experience of pain in arthritis and generate profiles of pain.
Discussion
With no core set of measures for the evaluation of arthritis pain, this survey was created from an amalgamation of measures to capture multiple dimensions of pain. Findings from this study will assist in defining the symptom of pain in arthritis and may lead to further research in evidence-based treatment options for people with arthritis.
Collapse
|
10
|
Fitzcharles MA, Shir Y. Management of chronic pain in the rheumatic diseases with insights for the clinician. Ther Adv Musculoskelet Dis 2012; 3:179-90. [PMID: 22870477 DOI: 10.1177/1759720x11408999] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Pain that accompanies musculoskeletal conditions should be regarded as an illness entity in its own right and deserves treatment in parallel with the management of the underlying condition. Recent understanding of the pathophysiology of rheumatic pain invokes interplay of the nociceptive mechanisms driven by local tissue factors and the neurogenic responses that sustain chronic pain. In line with other pain conditions, ideal treatment of rheumatic pain should be through a multimodal approach, integrating nonpharmacologic as well as pharmacologic treatments. In the light of this new concept of pain mechanisms, future pharmacologic treatment options may encompass a wider scope than the use of traditional analgesics and nonsteroidal anti-inflammatory drugs. There is currently limited experience for use of pharmacologic treatments that act primarily on neurogenic mechanisms in rheumatic conditions. Drug combination studies are lacking, but this strategy seems clinically reasonable to allow for an approach to treating pain from different mechanistic perspectives. An added advantage would be the opportunity to use lower doses of individual drugs and thereby reduce the side effect profile. Ideal pain management must also include attention to the important co-associates of pain such as effects on sleep, mood and energy, which all have an impact on the global burden of suffering. Although complete relief of pain is still an unrealistic objective, reasonable outcome goals for symptom relief should be accompanied with an improvement in function.
Collapse
Affiliation(s)
- Mary-Ann Fitzcharles
- Montreal General Hospital Pain Centre, Montreal General Hospital, McGill University, Montreal, Quebec, Canada
| | | |
Collapse
|
11
|
|
12
|
Abstract
Over the past decade, there has been an increasing interest in meditation as a mind-body approach, given its potential to alleviate emotional distress and promote improved well being in a variety of populations. The overall purpose of this review is to provide the practicing rheumatologist with an overview of mindfulness and how it can be applied to Western medical treatment plans to enhance both the medical and psychological care of patients.
Collapse
Affiliation(s)
- Laura A Young
- Division of Endocrinology, Department of Internal Medicine, University of North Carolina School of Medicine, 8023 Burnett Womack Building, Campus Box # 7170 UNC-CH, Chapel Hill, NC 27599-7170, USA.
| |
Collapse
|
13
|
|
14
|
Schieir O, Thombs BD, Hudson M, Boivin JF, Steele R, Bernatsky S, Hanley J, Baron M. Prevalence, severity, and clinical correlates of pain in patients with systemic sclerosis. Arthritis Care Res (Hoboken) 2010; 62:409-17. [DOI: 10.1002/acr.20108] [Citation(s) in RCA: 58] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
|
15
|
|