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Najafi Z, Rahmanian-Devin P, Baradaran Rahimi V, Nokhodchi A, Askari VR. Challenges and opportunities of medicines for treating tendon inflammation and fibrosis: A comprehensive and mechanistic review. Fundam Clin Pharmacol 2024:e12999. [PMID: 38468183 DOI: 10.1111/fcp.12999] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2023] [Revised: 01/20/2024] [Accepted: 02/19/2024] [Indexed: 03/13/2024]
Abstract
BACKGROUND Tendinopathy refers to conditions characterized by collagen degeneration within tendon tissue, accompanied by the proliferation of capillaries and arteries, resulting in reduced mechanical function, pain, and swelling. While inflammation in tendinopathy can play a role in preventing infection, uncontrolled inflammation can hinder tissue regeneration and lead to fibrosis and impaired movement. OBJECTIVES The inability to regulate inflammation poses a significant limitation in tendinopathy treatment. Therefore, an ideal treatment strategy should involve modulation of the inflammatory process while promoting tissue regeneration. METHODS The current review article was prepared by searching PubMed, Scopus, Web of Science, and Google Scholar databases. Several treatment approaches based on biomaterials have been developed. RESULTS This review examines various treatment methods utilizing small molecules, biological compounds, herbal medicine-inspired approaches, immunotherapy, gene therapy, cell-based therapy, tissue engineering, nanotechnology, and phototherapy. CONCLUSION These treatments work through mechanisms of action involving signaling pathways such as transforming growth factor-beta (TGF-β), mitogen-activated protein kinases (MAPKs), and nuclear factor kappa-light-chain-enhancer of activated B cells (NF-κB), all of which contribute to the repair of injured tendons.
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Affiliation(s)
- Zohreh Najafi
- Applied Biomedical Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Pouria Rahmanian-Devin
- Department of Pharmaceutics, School of Pharmacy, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Vafa Baradaran Rahimi
- Department of Cardiovascular Diseases, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Ali Nokhodchi
- Lupin Pharmaceutical Research Center, 4006 NW 124th Ave., Coral Springs, Florida, Florida, 33065, USA
- Pharmaceutics Research Laboratory, School of Life Sciences, University of Sussex, Brighton, BN1 9QJ, UK
| | - Vahid Reza Askari
- Applied Biomedical Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
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Lin LC, Lee YH, Chen YW, Hsu TH, Vitoonpong T, Liou TH, Huang SW. Comparison Clinical Effects of Hypertonic Dextrose and Steroid Injections on Chronic Subacromial Bursitis: A Double-Blind Randomized Controlled Trial. Am J Phys Med Rehabil 2023; 102:867-872. [PMID: 36897810 DOI: 10.1097/phm.0000000000002232] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/11/2023]
Abstract
OBJECTIVE The aim of the study is to determine and compare the treatment efficacy of subacromial steroid injections and dextrose prolotherapy for chronic subacromial bursitis patients. DESIGN Fifty-four patients with chronic subacromial bursitis were enrolled in this double-blind randomized controlled trial. Shoulder Pain and Disability Index and visual analog scale were the primary outcomes. RESULTS The steroid group ( n = 26) exhibited significant visual analog scale score improvements comparing with baseline at weeks 2, 6, and 12; the dextrose prolotherapy group ( n = 28) exhibited visual analog scale score improvements at weeks 6 and 12. The steroid group displayed significant Shoulder Pain and Disability Index score improvements compared with baseline at weeks 2, 6, and 12; the dextrose prolotherapy group exhibited significant score decreases at weeks 2 and 6. Compared with the dextrose prolotherapy group, the steroid group demonstrated significantly greater decreases in visual analog scale scores at weeks 2 and 6; the steroid group showed significantly greater decreases in Shoulder Pain and Disability Index scores at weeks 2, 6, and 12. CONCLUSIONS Both hypertonic dextrose prolotherapy and steroid injections can provide short-term improvements of pain and disability among chronic subacromial bursitis patients. Moreover, steroid injections showed better effectiveness than hypertonic dextrose prolotherapy in ameliorating pain and improving function.
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Affiliation(s)
- Lien-Chieh Lin
- From the Department of Physical Medicine and Rehabilitation, Shuang Ho Hospital, Taipei Medical University, Taipei, Taiwan (L-CL, Y-HL, Y-WC, T-HH, T-HL, S-WH); Department of Physical Medicine and Rehabilitation, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan (L-CL, Y-HL, Y-WC, T-HH, T-HL, S-WH); and Rehabilitation Department, King Chulalongkorn Memorial Hospital, Bangkok, Thailand (TV)
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Pereira Pires JA, Rey Moura EC, de Oliveira CMB, Vieira Dibai-Filho A, Soares Brandão Nascimento MDD, da Cunha Leal P. Hypertonic glucose in the treatment of low back pain: A randomized clinical trial. Medicine (Baltimore) 2023; 102:e35163. [PMID: 37747016 PMCID: PMC10519545 DOI: 10.1097/md.0000000000035163] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Revised: 08/12/2023] [Accepted: 08/21/2023] [Indexed: 09/26/2023] Open
Abstract
BACKGROUND Chronic low back pain (LBP) is defined as pain lasting longer than 3 months and is one of the conditions with the most significant social impact. Treatment is complex and includes proliferative agents used in prolotherapy. The mechanism is not known, but osmotic agents (hypertonic solutions of dextrose or glucose) cause cellular rupture and an inflammatory response that releases cytokines and growth factors that lead to scarring and reinnervation. METHODS Patients with chronic LBP (>12 weeks) who were non-traumatic and unresponsive to at least 1 month of physical therapy were selected. All patients were followed up at a return visit at 1, 3, and 6 months for pain assessment using validated pain questionnaires and scales. RESULTS Nineteen patients were included in the conservative group and 19 in the glucose group, with the majority being women (57.9%). The patients were between 47 and 59 years of age (39.5%), mixed race (76.33%), married or in a committed relationship (73.7%), and had completed the study for 5.2 years. Overall mean body mass index was 27.3 ± 4.4 kg/m 2 and was higher in the conservative group (28.0 ± 4.7 kg/m 2 ). The groups showed differences in Visual Analog Scale scores, with median and amplitude values close to each other between the time points evaluated and increasing values in the glucose group, which had significantly higher values for this scale at the third evaluation ( P = .031). When comparing the Rolland-Morris scale scores between the groups, there was a significant difference only in the 3-m assessment ( P = .021). In the follow-up assessment, both groups showed significant improvement between T0 and the other assessment time points ( P < .05) in all evaluations. CONCLUSION Both groups significantly improved on the evaluated scales during follow-up. Overall, no effects were attributable to the glucose components or the prolotherapy protocol.
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Affiliation(s)
- Jose Alberto Pereira Pires
- Department of Neuro-Orthopedics, University Hospital of the Federal University of Maranhão, São Luís, Maranhão, Brazil
| | - Ed Carlos Rey Moura
- Department of Medicine I, Federal University of Maranhão, São Luís, Maranhão, Brazil
| | | | | | | | - Plinio da Cunha Leal
- Department of Medicine I, Federal University of Maranhão, São Luís, Maranhão, Brazil
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Stewart ZE, Lee K. Lower extremity ultrasound-guided interventions: tendon, ligament, and plantar fascia. Skeletal Radiol 2023; 52:991-1003. [PMID: 36326878 DOI: 10.1007/s00256-022-04212-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Revised: 10/14/2022] [Accepted: 10/17/2022] [Indexed: 11/06/2022]
Abstract
Lower extremity tendinopathy and soft tissue injury are common clinical problems that can cause significant disability. Ultrasound-guided minimally invasive treatments using orthobiologics and image-guided percutaneous treatments continue to gain relevance with an ever-growing body of literature. We review the indications, technique, risks, and benefits according to the literature of common ultrasound-guided interventions utilized in the lower extremities.
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Affiliation(s)
- Zachary E Stewart
- Department of Radiology - Musculoskeletal Imaging and Intervention, Massachusetts General Hospital/Harvard Medical School, 55 Fruit Street, Yawkey Bldg Room 6033, Boston, MA, 02114, USA.
| | - Kenneth Lee
- University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
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Ahadi T, Cham MB, Mirmoghtadaei M, Raissi GR, Janbazi L, Zoghi G. The effect of dextrose prolotherapy versus placebo/other non-surgical treatments on pain in chronic plantar fasciitis: a systematic review and meta-analysis of clinical trials. J Foot Ankle Res 2023; 16:5. [PMID: 36759882 PMCID: PMC9912486 DOI: 10.1186/s13047-023-00605-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2022] [Accepted: 02/06/2023] [Indexed: 02/11/2023] Open
Abstract
BACKGROUND Prolotherapy is the injection of a small volume of sclerosing or irritant solutions into an injured tissue. We aimed to investigate the effect of dextrose prolotherapy (DPT) versus placebo/other non-surgical treatments on pain in chronic plantar fasciitis. METHODS We searched seven electronic databases (PubMed/MEDLINE, Web of Science, EMBASE, Scopus, ProQuest, CENTRAL, PEDro) from inception to December 31, 2021 with no language restriction for publications comparing the effect of DPT with placebo/other non-surgical treatments in patients with chronic plantar fasciitis. Our primary outcome was pain and the secondary outcomes were foot function and plantar fascia thickness. The risk of bias was assessed using the Cochrane Collaboration's tool. RESULTS Overall, eight studies with a total of 449 patients were included in the meta-analysis. All the included studies reported short-term pain. A large effect size (dppc2 = -0.97, 95% confidence interval [CI] -1.84 to -0.10) was observed favoring the use of DPT to reduce pain in patients with chronic plantar fasciitis in the short-term. The results for foot function improvement (dppc2 = -1.28, 95% CI -2.49 to -0.07) and plantar fascia thickness reduction (dppc2 = -1.02, 95% CI -1.99 to -0.05) in the short-term were also in favor of DPT. CONCLUSIONS Since almost all the included studies had high risk of bias and multiple trials lacked long-term follow-ups, further high-quality research is required to determine the long-term effects of DPT vs placebo/other non-surgical interventions.
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Affiliation(s)
- Tannaz Ahadi
- grid.411746.10000 0004 4911 7066Department of Physical Medicine and Rehabilitation, School of Medicine, Neuromusculoskeletal Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Masumeh Bagherzadeh Cham
- Department of Physical Medicine and Rehabilitation, School of Medicine, Neuromusculoskeletal Research Center, Iran University of Medical Sciences, Tehran, Iran.
| | - Mahtab Mirmoghtadaei
- Department of Physical Medicine and Rehabilitation, School of Medicine, Neuromusculoskeletal Research Center, Iran University of Medical Sciences, Tehran, Iran.
| | - Gholam Reza Raissi
- grid.411746.10000 0004 4911 7066Department of Physical Medicine and Rehabilitation, School of Medicine, Neuromusculoskeletal Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Lobaneh Janbazi
- grid.411746.10000 0004 4911 7066Department of Physical Medicine and Rehabilitation, School of Medicine, Neuromusculoskeletal Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Ghazal Zoghi
- grid.412237.10000 0004 0385 452XEndocrinology and Metabolism Research Center, Hormozgan University of Medical Sciences, Bandar Abbas, Iran
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Ciftci YGD, Tuncay F, Kocak FA, Okcu M. Is Low-Dose Dextrose Prolotherapy as Effective as High-Dose Dextrose Prolotherapy in the Treatment of Lateral Epicondylitis? A Double-Blind, Ultrasound Guided, Randomized Controlled Study. Arch Phys Med Rehabil 2023; 104:179-187. [PMID: 36243123 DOI: 10.1016/j.apmr.2022.09.017] [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: 06/16/2022] [Revised: 09/24/2022] [Accepted: 09/26/2022] [Indexed: 02/07/2023]
Abstract
OBJECTIVES To investigate the effects of prolotherapy (PrT) on pain, functionality, clinical improvement and to compare the 5% low and 15% high dose dextrose PrT in chronic lateral epicondylitis. DESIGN A double-blind, parallel groups, randomized controlled study. SETTINGS Outpatient Clinic. PARTICIPANTS Sixty patients (N=60), aged 44.30±10.31 years old, with chronic lateral epicondylitis were allocated randomly into 3 groups. INTERVENTIONS To Group 1 5% dextrose PrT, to Group 2 15% dextrose PrT, to Group 3 0.9% saline injections were done at 3 times (weeks 0, 3, 6), to the entheses of forearm extensors and annular ligament. MAIN OUTCOME MEASURES The primary outcomes were handgrip strength, visual analog scale-rest (VAS-R), visual analog scale-activity (VAS-A), pressure-pain threshold, and Quick Disability of the Arm, Shoulder and Hand (Q-DASH). The secondary outcomes were clinical improvement (Disease Global Assessment Questionnaire), side effects, and complications. Primary outcomes were collected at baseline week 0, week 3, and 12. Secondary outcomes were collected at weeks 3 and 12. RESULTS In Group 2, VAS-A and VAS-R (at week 3), handgrip strength and pressure-pain threshold (at week 12) were significantly different than other groups (P<.05). In Groups 1 and 2, there was a difference in primary outcomes at week 12 than baseline (P<.05). In Group 3, there was no difference in VAS-R, VAS-A, and handgrip strength at weeks 3 and 12 than baseline (P>.05). CONCLUSION In chronic lateral epicondylitis, 5% and 15% dextrose PrT is more effective in pain, handgrip strength, functionality, and clinical improvement than %0.9 saline. There was no difference in functionality, clinical improvement, side effects, and complications between the PrT groups. 15% dextrose PrT was more effective in handgrip strength and pressure-pain threshold at week 12 and pain at week 3. We recommend 15% dextrose PrT based on this study.
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Affiliation(s)
- Yıldız Gonca Dogru Ciftci
- Department of Physical Medicine and Rehabilitation, Sisli Etfal Hamidiye Research Hospital, Istanbul, Turkey.
| | - Figen Tuncay
- Department of Physical Medicine and Rehabilitation, Kirsehir Ahi Evran University Faculty of Medicine, Kirsehir, Turkey
| | - Fatmanur Aybala Kocak
- Department of Physical Medicine and Rehabilitation, Kirsehir Ahi Evran University Faculty of Medicine, Kirsehir, Turkey
| | - Mehmet Okcu
- Department of Physical Medicine and Rehabilitation, Marmara University Faculty of Medicine, Istanbul, Turkey
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Kersschot J, Mathieu T. Treatment of Painless Nodules With Glucopuncture in Dupuytren's Disease in Men: A Clinical Case. Cureus 2022; 14:e31445. [DOI: 10.7759/cureus.31445] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/13/2022] [Indexed: 11/14/2022] Open
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Dextrose prolotherapy for chronic tendinopathy: a scoping review. Eur J Integr Med 2022. [DOI: 10.1016/j.eujim.2022.102191] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Liao HY, Lin MC, Lin YW. Acupuncture points injection mitigates chronic pain through transient receptor potential V1 in mice. IRANIAN JOURNAL OF BASIC MEDICAL SCIENCES 2022; 25:451-459. [PMID: 35656078 PMCID: PMC9150811 DOI: 10.22038/ijbms.2022.60121.13327] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/02/2021] [Accepted: 08/13/2022] [Indexed: 11/22/2022]
Abstract
OBJECTIVES Tissue injury in peripheral sites can result in long-term potentiation in nociceptive neurons and surrounding glial cells, potentially resulting in the development of chronic inflammatory pain (CIP). Acupoint injection (AI) is similar to Western phototherapy, which injects solutions at specific sites to mitigate chronic pain. AI has shown greater benefits compared with acupuncture. In this study, we examined the therapeutic effect and explored the underlying mechanisms of AI in mice CIP model. MATERIALS AND METHODS We injected thrice complete Freund's adjuvant (CFA) into the mouse's hind paw to induce CIP. RESULTS We found that, after two weeks, CFA injection significantly induced mechanical and thermal hyperalgesia which were attenuated by AI treatment. Transient receptor potential V1 (TRPV1) channels and associated molecules were all increased in CIP in mice dorsal root ganglion (DRG), spinal cord (SC), thalamus, and somatosensory cortex (SSC). The aforementioned molecules were mitigated in AI and Trpv1 knockout mice. Furthermore, Iba1-positive cells (microglial marker) were also potentiated and shared a similar tendency with TRPV1. CONCLUSION These findings suggest that AI can alleviate chronic pain by reducing TRPV1 overexpression in both neuronal and microglial cells. Our results suggest new potential therapeutic targets for AI in chronic pain.
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Affiliation(s)
- Hsien-Yin Liao
- College of Chinese Medicine, School of Post-Baccalaureate Chinese Medicine, China Medical University, Taichung 40402, Taiwan
| | - Ming-Chia Lin
- Department of Nuclear Medicine, E-DA Hospital, College of Medicine, I-Shou University, Kaohsiung 82445, Taiwan
| | - Yi-Wen Lin
- College of Chinese Medicine, Graduate Institute of Acupuncture Science, China Medical University, Taichung 40402, Taiwan,Chinese Medicine Research Center, China Medical University, Taichung 40402, Taiwan,Corresponding author: Yi-Wen Lin. Graduate Institute of Acupuncture Science, College of Chinese Medicine, China Medical University, No. 91, Hsueh-Shih Road, North District, Taichung 404, Taiwan. Tel: 886-970055508;
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Kazempour Mofrad M, Rezasoltani Z, Dadarkhah A, Hamidi Panah S, Tabatabaee SM, Azarakhsh A. Neurofascial Dextrose Prolotherapy for Managing Chronic Ankle Ligament Injury. Anesth Pain Med 2022; 12:e118317. [PMID: 35433383 PMCID: PMC8994863 DOI: 10.5812/aapm.118317] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2021] [Revised: 12/19/2021] [Accepted: 12/19/2021] [Indexed: 11/16/2022] Open
Abstract
Objectives Due to the anti-inflammatory effects of dextrose prolotherapy, we evaluated the effectiveness of extra-articular, neurofascial dextrose prolotherapy in chronic ankle ligament injury. Methods Patients with chronic ankle ligament injury entered this uncontrolled before-after study based on eligibility criteria. Patients who consented to participate in the study filled out the prepared questionnaire containing demographic data, the Cumberland ankle instability tool (CAIT), and the Visual Analogue Scale (VAS). The initial CAIT score of less than 25 indicated functional instability following an ankle sprain. Patients underwent neurofascial prolotherapy with dextrose 12.5%. Two injections within one month were done. The CAIT was completed one, three, and six months after the intervention. Results Twenty-five patients with chronic ankle ligament injury were investigated. The mean CAIT score was 1.88 (± 2.35) before the intervention, which increased significantly over the study (P < 0.001). The CAIT score reached 21.84 (± 6.04) in the sixth month after the intervention. Moreover, the VAS score decreased significantly over the study from 6.12 (± 2.35) before the intervention to 1.24 (± 0.43) in the sixth month after the intervention (P < 0.001). Conclusions Our findings revealed the therapeutic effectiveness of dextrose neurofascial prolotherapy in decreasing pain and functional instability in patients suffering chronic ankle pain due to ligamentous injury accompanied by chronic ankle instability.
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Affiliation(s)
| | - Zahra Rezasoltani
- Clinical Biomechanics and Ergonomics Research Center, Department of Physical Medicine and Rehabilitation, Faculty of Medicine, Aja University of Medical Sciences, Tehran, Iran
- Corresponding Author: Clinical Biomechanics and Ergonomics Research Center, Department of Physical Medicine and Rehabilitation, Faculty of Medicine, Aja University of Medical Sciences, 1411718541, Tehran, Iran.
| | - Afsaneh Dadarkhah
- Clinical Biomechanics and Ergonomics Research Center, Department of Physical Medicine and Rehabilitation, Emam Reza Hospital, Aja University of Medical Sciences, Tehran, Iran
| | - Sanaz Hamidi Panah
- Clinical Biomechanics and Ergonomics Research Center, Department of Physical Medicine and Rehabilitation, Faculty of Medicine, Aja University of Medical Sciences, Tehran, Iran
| | - Seyed Morteza Tabatabaee
- Clinical Biomechanics and Ergonomics Research Center, Department of Physical Medicine and Rehabilitation, Faculty of Medicine, Aja University of Medical Sciences, Tehran, Iran
| | - Arezoo Azarakhsh
- Clinical Biomechanics and Ergonomics Research Center, Department of Physical Medicine and Rehabilitation, Faculty of Medicine, Aja University of Medical Sciences, Tehran, Iran
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Drake C, Whittaker GA, Kaminski MR, Chen J, Keenan AM, Rathleff MS, Robinson P, Landorf KB. Medical imaging for plantar heel pain: a systematic review and meta-analysis. J Foot Ankle Res 2022; 15:4. [PMID: 35065676 PMCID: PMC8783477 DOI: 10.1186/s13047-021-00507-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Accepted: 12/22/2021] [Indexed: 01/22/2023] Open
Abstract
Background Medical imaging can be used to assist with the diagnosis of plantar heel pain. The aim of this study was to synthesise medical imaging features associated with plantar heel pain. Methods This systematic review and meta-analysis conducted searches in MEDLINE, CINAHL, SPORTDiscus, Embase and the Cochrane Library from inception to 12th February 2021. Peer-reviewed articles of cross-sectional observational studies written in English that compared medical imaging findings in adult participants with plantar heel pain to control participants without plantar heel pain were included. Study quality and risk of bias was assessed using the National Institutes of Health quality assessment tool for observational cohort and cross-sectional studies. Sensitivity analyses were conducted where appropriate to account for studies that used unblinded assessors. Results Forty-two studies (2928 participants) were identified and included in analyses. Only 21% of studies were rated ‘good’ on quality assessment. Imaging features associated with plantar heel pain included a thickened plantar fascia (on ultrasound and MRI), abnormalities of the plantar fascia (on ultrasound and MRI), abnormalities of adjacent tissue such as a thickened loaded plantar heel fat pad (on ultrasound), and a plantar calcaneal spur (on x-ray). In addition, there is some evidence from more than one study that there is increased hyperaemia within the fascia (on power Doppler ultrasound) and abnormalities of bone in the calcaneus (increased uptake on technetium-99 m bone scan and bone marrow oedema on MRI). Conclusions People with plantar heel pain are more likely to have a thickened plantar fascia, abnormal plantar fascia tissue, a thicker loaded plantar heel fat pad, and a plantar calcaneal spur. In addition, there is some evidence of hyperaemia within the plantar fascia and abnormalities of the calcaneus. Whilst these medical imaging features may aid with diagnosis, additional high-quality studies investigating medical imaging findings for some of these imaging features would be worthwhile to improve the precision of these findings and determine their clinical relevance. Supplementary Information The online version contains supplementary material available at 10.1186/s13047-021-00507-2.
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Lai WF, Yoon CH, Chiang MT, Hong YH, Chen HC, Song W, Chin YP(H. The effectiveness of dextrose prolotherapy in plantar fasciitis: A systemic review and meta-analysis. Medicine (Baltimore) 2021; 100:e28216. [PMID: 34941081 PMCID: PMC8702280 DOI: 10.1097/md.0000000000028216] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2021] [Revised: 10/26/2021] [Accepted: 11/22/2021] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND Dextrose prolotherapy (DPT) is considered to be a type of regenerative therapy and is widely used in various musculoskeletal disorders. Plantar fasciitis is a common cause of heel pain that affects the quality of life of many people. We aimed to evaluate the effectiveness and safety of DPT for plantar fasciitis. METHODS PubMed, Embase, and the Cochrane Library were searched from their respective inception dates to June 2021. Only randomized controlled trials comparing DPT and other interventions for plantar fasciitis were included in this review. Standardized mean differences (SMDs) with 95% confidence intervals were calculated for comparison. The outcome measurements included visual analog score, numeric rating scale, Foot Function index, Revised Foot Function index, American Orthopedic Foot and Ankle Score, and plantar fascia thickness. Post-treatment duration was classified as short-term (1-2 months), medium-term (3 months), or long-term (6 months). RESULTS Six studies with 388 adult patients diagnosed with plantar fasciitis were included for the meta-analysis. In terms of pain scores improvement, DPT was superior to placebo or exercise in the short-term (SMD: -1.163, 95%CI: -2.17 to -0.156) and the medium-term (SMD: -1.394, 95%CI: -2.702 to -0.085). DPT was inferior to corticosteroid injection in the short-term (SMD: 0.781, 95%CI: 0.41 to 1.152). For functional improvement, DPT was superior to placebo or exercise in the short-term (SMD: -1.51, 95%CI: -2.96 to -0.059), but inferior to corticosteroid injection (SMD: 0.526, 95%CI: 0.161 to 0.89) and extracorporeal shock wave therapy in the short-term (SMD: 0.484, 95%CI: 0.145 to 0.822). Randomized controlled trials showed a better pain improvement in the long-term for patients treated with DPT compared to corticosteroid (P = .002) and exercise control (P < .05). No significant differences were found between patients treated with DPT and patients treated with platelet-rich plasma. CONCLUSION Dextrose prolotherapy was a safe and effective treatment option for plantar fasciitis that may have long-term benefits for patients. The effects were comparable to extracorporeal shock wave therapy or platelet-rich plasma injection. Further studies with standardized protocols and long-term follow-up are needed to address potential biases.
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Affiliation(s)
- Wei-Fu Lai
- Department of Physical Medicine and Rehabilitation, Taipei City Hospital, Yangming Branch, Taipei, Taiwan
| | - Chang Ho Yoon
- Nuffield Department of Population Health, University of Oxford Richard Doll Building, Old Road Campus, Oxford, UK
- Big Data Institute, Old Road Campus, Oxford, UK
- St. John's College, St. Giles’, Oxford, UK
| | - Meng Ting Chiang
- Department of Nuclear Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Ying-Han Hong
- Department of Physical Medicine and Rehabilitation, Taipei City Hospital, Yangming Branch, Taipei, Taiwan
| | - Hui-Chuan Chen
- Department of Physical Medicine and Rehabilitation, Taipei City Hospital, Yangming Branch, Taipei, Taiwan
| | - Wenyu Song
- Graduate Institute of Biomedical Informatics, College of Medical Science and Technology, Taipei Medical University, Taipei, Taiwan
- Harvard Medical School, Boston, Massachusetts, USA
| | - Yen Po (Harvey) Chin
- Graduate Institute of Biomedical Informatics, College of Medical Science and Technology, Taipei Medical University, Taipei, Taiwan
- Harvard Medical School, Boston, Massachusetts, USA
- Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA
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Nair A. Prolotherapy as an intervention for chronic, refractory musculoskeletal pain. Saudi J Anaesth 2021; 15:463-465. [PMID: 34658744 PMCID: PMC8477775 DOI: 10.4103/sja.sja_374_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2021] [Revised: 05/22/2021] [Accepted: 05/23/2021] [Indexed: 11/24/2022] Open
Affiliation(s)
- Abhijit Nair
- Department of Anaesthesiology, Ibra Hospital, Ministry of Health-Oman, Sultanate of Oman
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