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Vu PD, Gul F, Robinson CL, Chen GH, Hasoon J. Peripheral Nerve Stimulation After Total Knee Arthroplasty and Non-Operable Patella Fracture. Orthop Rev (Pavia) 2024; 16:115599. [PMID: 38586247 PMCID: PMC10994825 DOI: 10.52965/001c.115599] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2024] [Accepted: 02/01/2024] [Indexed: 04/09/2024] Open
Abstract
Chronic knee pain, affecting over 25% of adults in the United States, has surged by 65% over the past two decades leading to rising functional deficits, mobility problems, and a diminished quality of life. While conservative management with pharmacologic and minimally invasive injections are pursued early in the disease process, total knee arthroplasty for refractory osteoarthritis of the knee is often considered. This procedure usually improves pain and functionality within the first three months. However, a significant portion of patients often suffer from postoperative pain that can become chronic and debilitating. We detail the case of a patient with a previous TKA as well as a non-operable patella fracture who obtained significant relief with PNS despite prior conservative and minimally invasive management.
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Affiliation(s)
- Peter D Vu
- Department of Physical Medicine & Rehabilitation The University of Texas Health Science Center at Houston
| | | | - Christopher L Robinson
- Department of Anesthesiology, Critical Care, and Pain Medicine Beth Israel Deaconess Medical Center
| | - Grant H Chen
- Department of Anesthesiology, Critical Care, and Pain Medicine The University of Texas Health Science Center at Houston
| | - Jamal Hasoon
- Department of Anesthesiology, Critical Care, and Pain Medicine The University of Texas Health Science Center at Houston
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2
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Johns N, Naylor J, McKenzie D, Brady B, Olver J. High pain reported at 3 months post-total knee arthroplasty often persists for the next 3 years and is associated with reduced function and quality of life. Musculoskeletal Care 2024; 22:e1866. [PMID: 38348944 DOI: 10.1002/msc.1866] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2024] [Revised: 01/28/2024] [Accepted: 01/29/2024] [Indexed: 02/15/2024]
Abstract
BACKGROUND AND AIMS Five to ten percent of people having a knee arthroplasty for osteoarthritis continue to experience high pain levels more than 3 months after surgery. The primary aim of this study was to determine the relative risk (RR) of having high pain at 12 and 36 months based on the presence of high pain at 3 and 12 months, respectively. METHODS A retrospective analysis of data from a prospective study of participants who had a total knee arthroplasty for osteoarthritis. A score of ≤14 on the Oxford Knee Pain Subscale was defined as 'High Pain', and RRs were calculated comparing those with high or low pain. RESULTS There were 718 participants and 13.8% reported high pain at any time point, 2.5% reported high pain at all time points and 10.3% and 4.7% and 6.6% reported high pain at 3-, 12- and 36-months, respectively, post-surgery. For participants with high pain at 3 months, 33.8% had high pain at 12 months with a RR of 24.2 (95% CI 11.7-49.8, p < 0.001) and 35.1% had high pain at 36 months with a RR of 10.8 (95% CI 6.4-18.2, p < 0.001). For participants with high pain at 12 months, 67.6% had high pain at 36 months, with a RR of 19.3 (95% CI 12.2-30.4, p < 0.01). CONCLUSIONS Although high pain rates are low overall following knee arthroplasty, once high pain is established there is an elevated RR of it persisting at 12- and 36 months post-surgery. TRIAL REGISTRATION The data were collected in the Evidence-based Processes and Outcomes of Care (EPOC) study, ClinicalTrials.gov Identifier: NCT01899443.
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Affiliation(s)
- Nathan Johns
- Epworth Monash Rehabilitation Medicine Unit. Suite 2.4, Richmond, Victoria, Australia
| | - Justine Naylor
- Whitlam Orthopaedic Research Centre, Orthopaedic Department, Liverpool Hospital, Liverpool, New South Wales, Australia
| | - Dean McKenzie
- Research Development and Governance Unit, Epworth HealthCare, Richmond, Victoria, Australia
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Bernadette Brady
- Physiotherapy Department & Department of Pain Medicine, Liverpool Hospital, Liverpool, Sydney, New South Wales, Australia
| | - John Olver
- Epworth Monash Rehabilitation Medicine Unit. Suite 2.4, Richmond, Victoria, Australia
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3
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Albaker AB, Al-Awn RMM, Basalem SM, Alharbi L, Al Salhi R, Alkhalifah KM, Alhazmi N, Almasary M, Almohammadi YM. Awareness and Management of Knee Pain and Osteoarthritis in Saudi Arabia: A Cross-Sectional Analysis. Cureus 2024; 16:e52736. [PMID: 38384606 PMCID: PMC10880876 DOI: 10.7759/cureus.52736] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/20/2024] [Indexed: 02/23/2024] Open
Abstract
OBJECTIVE The study sought to assess the level of awareness regarding osteoarthritis and its management. METHODS This study was cross-sectional, using data from a sample of 389 individuals from the central region of Saudi Arabia. The participants completed an online questionnaire and ensured anonymity. Results: A total of 389 participants made up the sample for this study, which had a predominance of females (56.6%, n=220), a majority aged <50 years (66.6%, n=259), and most of them (51.7%, n=201) weighing 60-80 kg, substantial proportion lived in the Riyadh region (27.5%, n=107), with more than half (59.4%, n=231) having a university education and working in offices (28.3%, n=110). The majority (73.3%, n=285) of participants were married, and a vast majority (87.9%, n=342) were not smokers. The findings revealed that only 32.9% (n=128) of the participants had good knowledge about osteoarthritis. The study found that stiffness (80.2%, n=312) and swelling (97.9%, n = 381) are the most common signs and symptoms of osteoarthritis; the risk factors for osteoarthritis were genetic factors (79.7%, n=310) and age (91.3%, n=355). The treatment of osteoarthritis identified in the study included exercises such as swimming (85.1%, n=331), physical therapy (86.6%, n=337), and joint replacement surgery (92.0%, n=358). The study established a statistically significant association between age, education level, previous diagnosis of osteoarthritis, family history of osteoarthritis (p = 0.004, 0.001, 0.002, and 0.001, respectively), and level of knowledge about osteoarthritis. However, there was no statistically significant association between gender, marital status, smoking status, previous knee injuries, physical activity level, and the level of knowledge about osteoarthritis (p > 0.05). Conclusion: Overall, the study revealed that 32.9% (n=128) of the participants had good knowledge about osteoarthritis. Participants aged 50-60 years, those with a university and post-graduate level of education, as well as those who had a previous diagnosis of osteoarthritis and those with a family history of osteoarthritis, had greater and better knowledge and awareness about osteoarthritis. Joint stiffness and swelling were identified, as the most common signs and symptoms of osteoarthritis. The risk factors identified in the study were genetic factors and age, while the treatment options noted by the study were exercise, such as swimming, physical therapy, and joint replacement surgery. The study notes the need for enhanced public awareness of the problems associated with osteoarthritis among the Saudi Arabian population.
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Affiliation(s)
| | | | | | - Lama Alharbi
- Medicine and Surgery, Al Maarefa University, Riyadh, SAU
| | | | - Khalid M Alkhalifah
- Unaizah College of Medicine and Medical Sciences, Qassim University, Unaizah, SAU
| | - Nawaf Alhazmi
- College of Medicine, Umm Al-Qura University, Makkah, SAU
| | - Manal Almasary
- College of Medicine, Umm Al-Qura University, Makkah, SAU
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Deere R, Chowdhury E, Tabor A, Thompson D, Bilzon JLJ. The effects of upper- vs. lower-body aerobic exercise on perceived pain in individuals with chronic knee pain: a randomised crossover trial. Front Pain Res (Lausanne) 2023; 4:1277482. [PMID: 38124706 PMCID: PMC10731310 DOI: 10.3389/fpain.2023.1277482] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Accepted: 11/20/2023] [Indexed: 12/23/2023] Open
Abstract
Background and objectives Some patients with chronic knee pain experience an increase in knee pain following a single bout of exercise involving their knee joint, which can negatively affect exercise adherence and thus result in reduced overall health and lack of disease management. We want to determine whether a single bout of upper-body (UB) aerobic arm-ergometry exercise is effective in reducing the experience of pain in those with chronic knee pain compared with lower-body (LB) aerobic leg ergometry exercise. Methods A total of 19 individuals (women = 11, men = 8; age = 63 ± 8 years; body mass index = 24 ± 3 kg/m2) who suffered from chronic knee pain for ≥3 months took part in this study. Arm-ergometry and cycle-ergometry exercises were performed for 30 min at a moderate intensity, separated by 7 days. Pain intensity was assessed by means of a visual analogue scale (VAS) pre- and post-exercise and for 7 days post-exercise. Pressure pain threshold (PPT) and mechanical detection threshold (MDT) were measured pre- and post-exercise at both local and distal anatomical sites. Data are presented as mean ± SD. Results VAS pain was significantly reduced (p = 0.035) at 1 day post-exercise following the UB exercise trial (-1.4 ± 0.8) when compared with the LB exercise trial (+0.1 ± 2.1). Both UB and LB exercises were effective in reducing local and distal PPT. MDT responses were heterogeneous, and no differences between the UB and LB exercise conditions were noted. Conclusion An acute bout of upper-body aerobic arm-ergometry exercise evoked a significant decrease in the affected knee joint pain in individuals with chronic knee pain of up to 24 h/1 day post-exercise compared with lower-body aerobic exercise. While the exact mechanisms remain unclear, upper-body exercise may offer a viable, novel therapeutic treatment for patients with chronic knee pain.
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Affiliation(s)
- Rachel Deere
- Centre for Clinical Rehabilitation and Exercise Medicine (CREM), Department for Health, University of Bath, Bath, United Kingdom
- Centre for Nutrition and Exercise Metabolism (CNEM), Department for Health, University of Bath, Bath, United Kingdom
- Centre for the Analysis of Motion, Entertainment Research and Applications (CAMERA), University of Bath, Bath, United Kingdom
- Centre for Trials Research, Cardiff University, Cardiff, United Kingdom
| | - Enhad Chowdhury
- Centre for Clinical Rehabilitation and Exercise Medicine (CREM), Department for Health, University of Bath, Bath, United Kingdom
- Centre for Nutrition and Exercise Metabolism (CNEM), Department for Health, University of Bath, Bath, United Kingdom
- Centre for the Analysis of Motion, Entertainment Research and Applications (CAMERA), University of Bath, Bath, United Kingdom
| | - Abby Tabor
- Faculty of Health and Applied Sciences, University of West England, Bristol, United Kingdom
| | - Dylan Thompson
- Centre for Clinical Rehabilitation and Exercise Medicine (CREM), Department for Health, University of Bath, Bath, United Kingdom
- Centre for Nutrition and Exercise Metabolism (CNEM), Department for Health, University of Bath, Bath, United Kingdom
| | - James L. J. Bilzon
- Centre for Clinical Rehabilitation and Exercise Medicine (CREM), Department for Health, University of Bath, Bath, United Kingdom
- Centre for Nutrition and Exercise Metabolism (CNEM), Department for Health, University of Bath, Bath, United Kingdom
- Centre for the Analysis of Motion, Entertainment Research and Applications (CAMERA), University of Bath, Bath, United Kingdom
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5
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Kelly TD, Pazzol ML, Rahimi Darabad R. Peripheral Nerve Stimulation in Chronic Knee Pain: A Case Series. Cureus 2023; 15:e50127. [PMID: 38186428 PMCID: PMC10771261 DOI: 10.7759/cureus.50127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/06/2023] [Indexed: 01/09/2024] Open
Abstract
Introduction Chronic knee pain is increasing in prevalence and is associated with substantial limitations in functional mobility. Peripheral nerve stimulation (PNS) has been increasingly used to treat various chronic pain conditions. However, there is a paucity of research exploring the potential therapeutic benefit of PNS for chronic knee pain. Methods This research is a retrospective case series of all patients who received PNS for the treatment of chronic knee pain performed at a single-center academic medical institution between March 2021 and June 2022. The primary outcome was percent pain reduction six months after implantation. Outcome data was obtained via chart review and phone calls to patients. Secondary outcomes included percent pain reduction two weeks and two months after implantation and adverse medical events related to the procedure and nerve stimulation. Results Fourteen individual patients received PNS for chronic knee pain during the study period. Three of these patients received bilateral PNS for a total of 17 cases. The mean percent pain reduction six months after implantation was 52% (SD=28.2) (N=12). A total of 75.0% of participants (9/12) reported ≥50% reductions in pain six months after implantation. No adverse events were reported relating to the implantation procedure and/or nerve stimulation. Conclusion PNS is a safe and efficacious treatment modality for chronic knee pain with demonstrated long-term benefit. Further research should clarify patient factors associated with improved treatment response.
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Affiliation(s)
- Timothy D Kelly
- Department of Emergency Medicine Residency, Indiana University School of Medicine, Indianapolis, USA
| | - Michael L Pazzol
- Department of Anesthesiology and Perioperative Medicine, University of Rochester School of Medicine and Dentistry, Rochester, USA
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6
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Kong C, Bubic IJ, Tran AA, Tan G, Medak AJ, Oswald J. Genicular nerve block for emergency department patient: a successful management of subacute osteoarthritic knee pain. Pain Manag 2023; 13:373-378. [PMID: 37458263 DOI: 10.2217/pmt-2022-0104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/28/2023] Open
Abstract
The genicular nerve block (GNB) performed under ultrasound is a common procedure in the perioperative and outpatient setting for the treatment of surgical knee pain and osteoarthritis. It provides motor-sparing analgesia to the knee, making it a potential alternative to other modes of pain management in the emergency department (ED). We present an elderly woman with acute-on-chronic osteoarthritic knee pain which was relieved for a week after a GNB during her ED visit. In patients with knee pain, the ultrasound guided GNB has the potential to provide short-term analgesia for patients with pain refractory to other modes of analgesia. The GNB shows promise as a reliable contribution to a multimodal approach to pain management in the ED setting.
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Affiliation(s)
- Clarence Kong
- Department of Emergency Medicine, Zucker School of Medicine at Hofstra/Northwell - North Shore University Hospital/Long Island Jewish Medical Center, Long Island, NY 11040, USA
| | - Irvan J Bubic
- Department of Emergency Medicine, UC San Diego Health, San Diego, CA 92037, USA
| | - Audrey A Tran
- Oregon Health & Sciences University School of Medicine, Portland, OR 97239, USA
| | - Gary Tan
- Department of Internal Medicine, Zucker School of Medicine at Hofstra/Northwell - North Shore University Hospital/Long Island Jewish Medical Center, Long Island, NY 11040, USA
| | - Anthony J Medak
- Department of Emergency Medicine, UC San Diego Health, San Diego, CA 92037, USA
| | - Jessica Oswald
- Department of Emergency Medicine, Department of Anesthesiology, Center for Pain Medicine, UC San Diego Health, La Jolla, CA 92037, USA
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7
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Jinnouchi H, Kitamura A, Matsudaira K, Kakihana H, Oka H, Yamagishi K, Kiyama M, Iso H. Brief self-exercise education for adults with chronic knee pain: A randomized controlled trial. Mod Rheumatol 2023; 33:408-415. [PMID: 35134993 DOI: 10.1093/mr/roac009] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2021] [Revised: 01/01/2022] [Accepted: 01/24/2022] [Indexed: 11/13/2022]
Abstract
OBJECTIVES Effective brief instructions for self-management of chronic knee pain are needed. METHODS Forty-six participants with chronic knee pain were randomly allocated into two programmes: material-based education alone or brief self-exercise education (brief-See), which comprised a 100-minute instruction for self-exercise combined with compact pain education. Total function (KOOS4, 4-subscale average of knee injury and osteoarthritis outcome score), pain intensity (NRS, numeric rating scale), self-efficacy (PSEQ, pain self-efficacy questionnaire), and health-related quality of life (EQ-5D, European quality of life-5 dimensions) were evaluated at baseline and 4 and 12 weeks after the initial intervention. A generalized mixed linear model estimated average group differences in changes from baseline and 95% confidence intervals (95% CIs) using intention-to-treat principle. RESULTS Compared to material-based education alone, the brief-See provided significant additional improvements of 9.4% (95% CI: 2.3 to 16.4) on the KOOS4 and 5.4 points (0.3 to 10.4) on the PSEQ at 12 weeks but did not on the NRS and EQ-5D. Adherence and satisfaction were favourable in the brief-See without any notable adverse event. CONCLUSIONS Adding the brief-See to material-based education could be more acceptable and restore total function and self-efficacy, which could contribute to the self-management of chronic knee pain in primary care.
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Affiliation(s)
- Hiroshige Jinnouchi
- Department of Hygiene and Public Health, Nippon Medical School, Tokyo, Japan.,Department of Cardiovascular Disease Prevention, Osaka Center for Cancer and Cardiovascular Disease Prevention, Osaka, Japan.,Department of Social Medicine, Public Health, Osaka University Graduate School of Medicine, Osaka, Japan.,Department of Public Health Medicine, and Health Services Research and Development Center, University of Tsukuba, Ibaraki, Japan
| | - Akihiko Kitamura
- Department of Cardiovascular Disease Prevention, Osaka Center for Cancer and Cardiovascular Disease Prevention, Osaka, Japan.,Research Team for Social Participation and Community Health, Tokyo Metropolitan Institute of Gerontology, Tokyo, Japan
| | - Ko Matsudaira
- Department of Medical Research and Management for Musculoskeletal Pain, 22nd Century Medical & Research Center, The University of Tokyo, Tokyo, Japan
| | - Hironobu Kakihana
- Department of Physical Therapy, Faculty of Rehabilitation, Kobe Gakuin University, Kobe, Hyôgo, Japan
| | - Hiroyuki Oka
- Department of Medical Research and Management for Musculoskeletal Pain, 22nd Century Medical & Research Center, The University of Tokyo, Tokyo, Japan
| | - Kazumasa Yamagishi
- Department of Public Health Medicine, and Health Services Research and Development Center, University of Tsukuba, Ibaraki, Japan
| | - Masahiko Kiyama
- Department of Cardiovascular Disease Prevention, Osaka Center for Cancer and Cardiovascular Disease Prevention, Osaka, Japan
| | - Hiroyasu Iso
- Department of Social Medicine, Public Health, Osaka University Graduate School of Medicine, Osaka, Japan.,Department of Public Health Medicine, and Health Services Research and Development Center, University of Tsukuba, Ibaraki, Japan
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Hirohama K, Tamura H, Hamada K, Mitsutake T, Imura T, Tanaka S, Tanaka R. Effects of Non-Face-to-Face and Noncontact Interventions on Knee Pain and Physical Activity in Older Adults With Knee Osteoarthritis: A Systematic Review and Meta-Analysis. J Aging Phys Act 2022;:1-11. [PMID: 35961641 DOI: 10.1123/japa.2022-0037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2022] [Revised: 06/03/2022] [Accepted: 06/22/2022] [Indexed: 11/18/2022]
Abstract
Increased physical activity is an effective treatment for knee osteoarthritis that causes knee pain. However, due to the coronavirus disease 2019, noncontact and non-face-to-face interventions have increased, but the quality of evidence supporting their effectiveness remains unclear. The purpose of the study was to assess the quality of evidence of the effects of non-face-to-face and noncontact interventions on knee pain and physical activity in older adults with knee osteoarthritis. A meta-analysis was conducted to determine the effects of different intervention methods (education and exercise). The Cochrane Central Register of Controlled Trials, PubMed, Cumulative Index to Nursing and Allied Health Literature, and Physiotherapy Evidence Database were systematically searched. Four randomized controlled trials were included in the analysis. The meta-analysis demonstrated that the educational intervention group was significantly effective, although supportive evidence was low quality. Educational intervention may be effective, but the effects need to be confirmed by higher quality clinical trials.
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9
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Gillis J, Southerland WA, Kaye AD, Eskander JP, Pham AD, Simopoulos T. Spinal Cord Stimulation for Post Total Knee Replacement Pain: A Case Series. Orthop Rev (Pavia) 2022; 14:33835. [PMID: 35936805 PMCID: PMC9353541 DOI: 10.52965/001c.33835] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2021] [Accepted: 12/01/2021] [Indexed: 09/22/2023] Open
Abstract
It is not uncommon for orthopedic patients to experience pain following a total knee replacement (TKR). Use of oral pain medications, nerve blocks, and periarticular injections are implemented to provide multimodal analgesia and to reduce postoperative chronic pain. Spinal cord stimulation (SCS) can also be used to control pain in patients who are refractory to conservative measures. Few studies have explored this possibility for patients with chronic pain status post TKR. We present three cases that demonstrate the effectiveness of SCS in this challenging patient population.
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Affiliation(s)
- Justin Gillis
- Department of Anesthesia, Critical Care, and Pain Medicine, Beth Israel Deaconess Medical Center
| | - Warren A Southerland
- Department of Anesthesia, Critical Care, and Pain Medicine, Beth Israel Deaconess Medical Center
| | - Alan D Kaye
- Department of Anesthesiology, Louisiana State University Shreveport; Department of Anesthesiology, Louisiana State University New Orleans
| | | | - Alex D Pham
- Department of Anesthesiology, Louisiana State University New Orleans
| | - Thomas Simopoulos
- Department of Anesthesia, Critical Care, and Pain Medicine, Beth Israel Deaconess Medical Center
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10
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Lyman J, Khalouf F, Zora K, DePalma M, Loudermilk E, Guiguis M, Beall D, Kohan L, Chen AF. Cooled radiofrequency ablation of genicular nerves provides 24-Month durability in the management of osteoarthritic knee pain: Outcomes from a prospective, multicenter, randomized trial. Pain Pract 2022; 22:571-581. [PMID: 35716058 PMCID: PMC9541208 DOI: 10.1111/papr.13139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Revised: 03/29/2022] [Accepted: 05/11/2022] [Indexed: 11/28/2022]
Abstract
Objective To assess long‐term outcomes of cooled radiofrequency ablation (CRFA) of genicular nerves for chronic knee pain due to osteoarthritis (OA). Methods A prospective, observational extension of a randomized, controlled trial was conducted on adults randomized to CRFA. Subjects were part of a 12‐month clinical trial comparing CRFA of genicular nerves to a single hyaluronic injection for treatment of chronic OA knee pain, who then agreed to visits at 18‐ and 24‐months post CRFA and had not undergone another knee procedure since. The subjects were evaluated for pain using the Numeric Rating Scale (NRS) function using the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), subjective benefit using the Global Perceived Effect (GPE) scale, quality of life using the EuroQol‐5‐Dimensions‐5 Level (EQ‐5D‐5L) questionnaire, and safety. Results Of 57 subjects eligible, 36 enrolled; 32 completed the 18‐month visit with a mean NRS score of 2.4 and 22 (69%) reporting ≥50% reduction in pain from baseline (primary endpoint); 27 completed the 24‐month visit, with a mean NRS of 3.4 and 17 (63%) reporting ≥50% pain relief. Functional and quality of life improvements persisted similarly, with mean changes from baseline of 53.5% and 34.9% in WOMAC total scores, and 24.8% and 10.7% in EQ‐5D‐5L Index scores, at 18‐ and 24‐months, respectively. There were no identified safety concerns in this patient cohort. Conclusion In this subset of subjects, CRFA of genicular nerves provided durable pain relief, improved function, and improved quality of life extending to 24 months post procedure, with no significant safety concerns.
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Affiliation(s)
- Jeffrey Lyman
- Institute for Orthopedic Research and Innovation, Coeur d'Alene, Idaho, USA
| | - Fred Khalouf
- University Orthopedics Center, Altoona, Pennsylvania, USA
| | - Keith Zora
- University Orthopedics Center, State College, Pennsylvania, USA
| | | | - Eric Loudermilk
- University of Virginia School of Medicine, Charlottesville, Virginia, USA
| | - Maged Guiguis
- Ochsner Clinic Foundation, New Orleans, Louisiana, USA
| | | | - Lynn Kohan
- PCPMG Clinical Research Unit LLC, Anderson, South Carolina, USA
| | - Antonia F Chen
- Department of Orthopaedics, Brigham and Women's Hospital, Boston, Massachusetts, USA
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11
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Nagasawa Y, Shibata A, Ishii K, Oka K. Psychological inflexibility and physical disability in older patients with chronic low back pain and knee pain. Pain Manag 2022; 12:829-835. [PMID: 35311355 DOI: 10.2217/pmt-2022-0011] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Aim: This study examined the associations between psychological inflexibility (PI) and physical disability (PD) among older patients with chronic low back and knee pain. Methods: Pain avoidance and cognitive fusion were assessed in outpatients as components of PI and PD, and sociodemographic and pain-related variables were used as covariates. Hierarchical multiple linear regression was used. The covariates were first entered, followed by PI. Results: Age and pain intensity had significant positive associations with PD. After adding PI, only pain avoidance was significantly and positively associated with PD. Conclusion: Focusing on pain avoidance may be effective for physical disability when acceptance and commitment therapy is administered to older patients with chronic low back and knee pain.
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Affiliation(s)
- Yasuhiro Nagasawa
- Department of Rehabilitation, Hasegawa Hospital, 85 Yachimatani, Yachimata, Chiba, 289-1103, Japan.,Graduate School of Sport Sciences, Waseda University, 2-579-15 Mikajima, Tokorozawa, Saitama, 359-1192, Japan
| | - Ai Shibata
- Faculty of Health & Sports Sciences, University of Tsukuba, 1-1-1 Tennodai, Tsukuba, Ibaraki, 305-8574, Japan
| | - Kaori Ishii
- Faculty of Sport Sciences, Waseda University, 2-579-15 Mikajima, Tokorozawa, Saitama, 359-1192, Japan
| | - Koichiro Oka
- Faculty of Sport Sciences, Waseda University, 2-579-15 Mikajima, Tokorozawa, Saitama, 359-1192, Japan
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12
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Belba A, Vanneste T, Van Kuijk SMJ, Mesotten D, Mestrum R, Van Boxem K, Van Lantschoot A, Bellemans J, Van de Velde M, Van Zundert J. A retrospective study on patients with chronic knee pain treated with ultrasound-guided radiofrequency of the genicular nerves (RECORGEN trial). Pain Pract 2021; 22:340-348. [PMID: 34716965 PMCID: PMC9299475 DOI: 10.1111/papr.13088] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2021] [Revised: 08/27/2021] [Accepted: 08/31/2021] [Indexed: 12/27/2022]
Abstract
INTRODUCTION Radiofrequency (RF) treatment of the genicular nerves is a promising treatment for chronic osteoarthritic and persistent postsurgical knee pain (PPSP), refractory to conventional medical management. METHODS The RECORGEN study is a retrospective single-center cohort study of patients treated with ultrasound-guided conventional RF of the genicular nerves for chronic knee pain in Hospital Oost-Limburg, Genk from September 2017 to June 2020. Subgroup analysis based on etiology of pain (PPSP and degenerative knee pain) was performed in addition to the total study population analysis. Outcome parameters were global perceived effect (GPE), Numeric Rating Scale for pain, consumption of strong opioids, and safety of the treatment at 6 weeks and cross-sectionally at a variable time point. Treatment success was defined as GPE≥50%. RESULTS Sixty-eight cases were screened of which 59 (46 diagnosed with PPSP and 13 with degenerative knee pain) were included in the study. Treatment success at 6 weeks was achieved in 19 of 59 interventions (32.2%) and was similar in both groups. Seventeen responders were evaluated at follow-up. 45.1% (8/17) continued to have a positive effect at the second time point. The mean duration of effect of the RF treatment was 8.3 months. Safety analysis at 6 weeks and at the second time point showed a good safety profile of the treatment. CONCLUSION Conventional RF of the genicular nerves was clinically successful in more than 30% of the study population refractory to conventional medical management. Overall, the treatment was well tolerated. The mean duration of effect was 8.3 months.
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Affiliation(s)
- Amy Belba
- Department of Anesthesiology, Intensive Care Medicine, Emergency Medicine and Pain Therapy, Hospital Oost-Limburg, Genk, Belgium.,Faculty of Medicine and Life Sciences, Hasselt University, Diepenbeek, Belgium
| | - Thibaut Vanneste
- Department of Anesthesiology, Intensive Care Medicine, Emergency Medicine and Pain Therapy, Hospital Oost-Limburg, Genk, Belgium
| | - Sander M J Van Kuijk
- Department of Clinical Epidemiology & Medical Technology Assessment, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Dieter Mesotten
- Department of Anesthesiology, Intensive Care Medicine, Emergency Medicine and Pain Therapy, Hospital Oost-Limburg, Genk, Belgium.,Faculty of Medicine and Life Sciences, Hasselt University, Diepenbeek, Belgium
| | - Roel Mestrum
- Department of Anesthesiology, Intensive Care Medicine, Emergency Medicine and Pain Therapy, Hospital Oost-Limburg, Genk, Belgium.,Department of Anesthesiology, Intensive Care Medicine and Pain Therapy, Regional Hospital Heilig Hart Tienen, Tienen, Belgium
| | - Koen Van Boxem
- Department of Anesthesiology, Intensive Care Medicine, Emergency Medicine and Pain Therapy, Hospital Oost-Limburg, Genk, Belgium
| | - Astrid Van Lantschoot
- Department of Anesthesiology, Intensive Care Medicine, Emergency Medicine and Pain Therapy, Hospital Oost-Limburg, Genk, Belgium
| | - Johan Bellemans
- Faculty of Medicine and Life Sciences, Hasselt University, Diepenbeek, Belgium.,GRIT Belgian Sports Clinic, Leuven, Belgium.,Department of Orthopedic Surgery, Hospital Oost-Limburg, Genk, Belgium
| | - Marc Van de Velde
- Department of Anesthesiology, UZ Leuven, Leuven, Belgium.,Department of Cardiovascular Sciences, Group Biomedical Sciences, KU Leuven, Leuven, Belgium
| | - Jan Van Zundert
- Department of Anesthesiology, Intensive Care Medicine, Emergency Medicine and Pain Therapy, Hospital Oost-Limburg, Genk, Belgium.,Department of Anesthesiology and Pain Medicine, University Medical Centre Maastricht, Maastricht, The Netherlands
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Sobel J, Oswald J. Novel Use of 3-Point Genicular Nerve Block for Acute Knee Pain in the Emergency Department. J Emerg Med 2021:S0736-4679(21)00385-1. [PMID: 34176690 DOI: 10.1016/j.jemermed.2021.04.012] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Revised: 04/01/2021] [Accepted: 04/26/2021] [Indexed: 11/20/2022]
Abstract
BACKGROUND Ultrasound-guided genicular nerve blocks (GNBs) in the emergency department (ED) have easily identifiable anatomic targets and offer an opportunity to provide safe, effective, motor-sparing analgesia for acute knee pain. Case Report A 68-year-old woman presented with acute, 8/10 right knee pain due to an isolated right lateral tibial plateau fracture. After informed consent and with the ultrasound in the sagittal plane, the superior lateral (SLGN), superior medial (SMGN), and inferior medial (IMGN) genicular nerves were identified at the junction of their respective femoral or tibial epicondyle and femoral or tibial epiphysis. The skin was anesthetized and an echogenic needle was inserted under ultrasound guidance to inject 1.0 mL of 0.5% bupivacaine around the right SLGN, SMGN, and IMGN. Approximately 30 minutes after the GNBs, the patient reported 0/10 pain at rest and 1/10 pain with movement. She did not require opioids during her ED visit or upon discharge. Why Should an Emergency Physician Be Aware of This? GNBs show promise as a useful tool to provide acute and medium-term motor-sparing analgesia in a patient with acute knee pain. GNBs have easy-to-recognize anatomic targets on ultrasound and may be a suitable adjunct or alternative to a multimodal pain regimen in the emergency department.
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Vannabouathong C, Zhu M, Chang Y, Bhandari M. Can Medical Cannabis Therapies be Cost-Effective in the Non-Surgical Management of Chronic Knee Pain? Clin Med Insights Arthritis Musculoskelet Disord 2021; 14:11795441211002492. [PMID: 33795939 PMCID: PMC7970188 DOI: 10.1177/11795441211002492] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Accepted: 02/18/2021] [Indexed: 11/15/2022]
Abstract
Introduction: Chronic knee pain is a common musculoskeletal condition, which usually leads
to decreased quality of life and a substantial financial burden. Various
non-surgical treatments have been developed to relieve pain, restore
function and delay surgical intervention. Research on the benefits of
medical cannabis (MC) is emerging supporting its use for chronic pain
conditions. The purpose of this study was to evaluate the cost-effectiveness
of MC compared to current non-surgical therapies for chronic knee pain
conditions. Methods: We conducted a cost-utility analysis from a Canadian, single payer
perspective and compared various MC therapies (oils, soft gels and dried
flowers at different daily doses) to bracing, glucosamine,
pharmaceutical-grade chondroitin oral non-steroidal anti-inflammatory drugs
(NSAIDs), and opioids. We estimated the quality-adjusted life years (QALYs)
gained with each treatment over 1 year and calculated incremental
cost-utility ratios (ICURs) using both the mean and median estimates for
costs and utilities gained across the range of reported values. The final
ICURs were compared to willingness-to-pay (WTP) thresholds of $66 714,
$133 428 and $200 141 Canadian dollars (CAD) per QALY gained. Results: Regardless of the estimates used (mean or median), both MC oils and soft gels
at both the minimal and maximal recommended daily doses were cost-effective
compared to all current knee pain therapies at the lowest WTP threshold.
Dried flowers were only cost-effective up to a certain dosage (0.75 and
1 g/day based on mean and median estimates, respectively), but all dosages
were cost-effective when the WTP was increased to $133 428/QALY gained. Conclusion: Our study showed that MC may be a cost-effective strategy in the management
of chronic knee pain; however, the evidence on the medical use of cannabis
is limited and predominantly low-quality. Additional trials on MC are
definitely needed, specifically in patients with chronic knee pain.
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Affiliation(s)
| | - Meng Zhu
- OrthoEvidence, Burlington, ON, Canada
| | | | - Mohit Bhandari
- OrthoEvidence, Burlington, ON, Canada.,Department of Surgery, McMaster University, Hamilton, Ontario, Canada
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15
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Nagasawa Y, Shibata A, Fukamachi H, Ishii K, Wicksell RK, Oka K. The Psychological Inflexibility in Pain Scale (PIPS): Validity and Reliability of the Japanese Version for Chronic Low Back Pain and Knee Pain. J Pain Res 2021; 14:325-332. [PMID: 33568939 PMCID: PMC7870289 DOI: 10.2147/jpr.s287549] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Accepted: 01/16/2021] [Indexed: 11/23/2022] Open
Abstract
Purpose The aim of this study was to translate the Psychological Inflexibility in Pain Scale Japanese version (PIPS-J) and inspect its validity and reliability in older patients with chronic low back pain and knee pain. Materials and Methods The PIPS was translated into Japanese by a bilingual linguistic expert and three researchers and administered to 120 outpatients with low back pain and knee pain (61.7% women, age 73.8±7.8 years). Construct validity and criterion validity were evaluated using confirmatory factor analysis and the correlations with the Acceptance and Action Questionnaire-II Japanese version (AAQ-II-J) and the Cognitive Fusion Questionnaire Japanese version (CFQ-J), respectively. Internal consistency using Cronbach’s alpha and test–retest reliability (n=43) were also examined. Results Of all, 78.3% had low back pain, 55.6% had knee pain, and 44.2% both. The confirmatory factor analysis reproduced the original PIPS structure with two factors and indicated good model fit (GFI = 0.915, CFI = 0.970, RMSEA = 0.060). All items’ standardized regression weights ranged from 0.35 to 0.80. Criterion validity was shown by correlations of r = 0.58 for PIPS-J pain avoidance with the AAQ-II-J, and r = 0.45 between PIPS-J cognitive fusion and the CFQ-J. Cronbach’s alpha for the PIPS-J total score was α=0.85 (pain avoidance: 0.87; cognitive fusion: 0.68). The test–retest correlation for all 12 items was r = 0.54 (pain avoidance: 0.48; cognitive fusion: 0.54). Conclusion Although a less relevant item was found on each of subscales, the PIPS-J appear to be fairly valid and reliable to evaluate psychological inflexibility in chronic pain among Japanese older adults.
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Affiliation(s)
- Yasuhiro Nagasawa
- Department of Rehabilitation, Hasegawa Hospital, Yachimata, Chiba, Japan.,Graduate School of Sport Sciences, Waseda University, Tokorozawa, Saitama, Japan
| | - Ai Shibata
- Faculty of Health and Sports Sciences, University of Tsukuba, Tsukuba, Ibaraki, Japan
| | - Hanako Fukamachi
- Sport Sciences Laboratory, Japan Sport Association, Tokyo, Japan.,Faculty of Sport Sciences, Waseda University, Saitama, Japan
| | - Kaori Ishii
- Faculty of Sport Sciences, Waseda University, Saitama, Japan
| | - Rikard K Wicksell
- Department of Clinical Neuroscience, Karolinska Institute, Stockholm, Sweden
| | - Koichiro Oka
- Faculty of Sport Sciences, Waseda University, Saitama, Japan
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Abstract
OBJECTIVE To determine the association between selected biomechanical variables and risk of patellofemoral pain (PFP) in males and females. DESIGN Prospective cohort. SETTING US Service Academies. PARTICIPANTS Four thousand five hundred forty-three cadets (1727 females and 2816 males). ASSESSMENT OF RISK FACTORS Three-dimensional biomechanics during a jump-landing task, lower-extremity strength, Q-angle, and navicular drop. MAIN OUTCOME MEASURES Cadets were monitored for diagnosis of PFP during their enrollment in a service academy. Three-dimensional hip and knee kinematic data were determined at initial contact (IC) and at 50% of the stance phase of the jump-landing task. Logistic regression analyses were performed for each risk factor variable in males and females (P < 0.05). RESULTS Less than 10 degrees of hip abduction at IC [odds ratio (OR) = 1.86, P = 0.03] and greater than 10 degrees of knee internal rotation at 50% of the stance phase (OR = 1.71, P = 0.02) increased the risk of PFP in females. Greater than 20 degrees of knee flexion at IC (OR = 0.47, P < 0.01) and between 0 and 5 degrees of hip external rotation at 50% of the stance phase (OR = 0.52, P = 0.04) decreased the risk of PFP in males. No other variables were associated with risk of developing PFP (P > 0.05). CONCLUSIONS The results suggest males and females have differing kinematic risk factor profiles for the development of PFP. CLINICAL RELEVANCE To most effectively reduce the risk of developing PFP, the risk factor variables specific to males (decreased knee flexion and increased hip external rotation) and females (decreased hip abduction and increased knee internal rotation) should be addressed in injury prevention programs.
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Affiliation(s)
| | | | - Darin A Padua
- University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Kenneth L Cameron
- John A. Feagin Jr. Sports Medicine Fellowship, Keller Army Hospital, West Point, New York; and
| | - Anthony Beutler
- Uniformed Services University of the Health Sciences, Bethesda, Maryland
| | - Stephen W Marshall
- University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
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17
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Han SB, Lee SH, Ha IH, Kim EJ. Association between severity of depressive symptoms and chronic knee pain in Korean adults aged over 50 years: a cross-sectional study using nationally representative data. BMJ Open 2019; 9:e032451. [PMID: 31857309 PMCID: PMC6937089 DOI: 10.1136/bmjopen-2019-032451] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
OBJECTIVES To identify the association between the presence and severity of depressive symptoms and those of chronic knee pain. DESIGN A retrospective cross-sectional study. PARTICIPANTS We used data from the sixth Korea National Health and Nutrition Examination Survey (KNHANES VI-2) performed in 2014. Overall, 7550 patients were included in the KNHANES VI-2. OUTCOME MEASURES Participants were asked whether they had chronic knee pain, and each answer was either 'yes' or 'no'. Patient Health Questionnaire-9 (PHQ-9) was used as a screening tool for depressive symptoms, and PHQ-9 scores of 10 or higher was classified as the depressed group. In total, 527 patients reported that they had pain in their knee, of whom 91 also had depressive symptoms. RESULTS The prevalence of chronic knee pain in the Korean population aged over 50 years was 19.8%. Multiple logistic regression was conducted after adjustment for sex, age, smoking, alcohol drinking, education level, household income, physical activity, sleep duration and comorbidity. The analysis revealed a significant association between depressive symptoms and chronic knee pain (adjusted OR=2.333, p<0.001). In contrast, the severity of depressive symptoms was linearly correlated with the intensity of chronic knee pain (p for trend <0.001). In participants with no chronic knee pain (Numerical Rating Scale; NRS=0) or mild chronic knee pain (NRS=1-4), the prevalence of moderate and severe depressive symptoms was 3.4% and 0.6%, respectively. However, in those with severe chronic knee pain (NRS=8-10), there was a higher prevalence of moderate and severe depressive symptoms (10.1% and 5.8%, respectively) (p<0.001). CONCLUSIONS A strong association was observed between the presence and severity of depressive symptoms and the presence of chronic knee pain. The association became stronger with higher levels of depressive symptoms, indicating a positive correlation between depressive symptoms severity and chronic knee pain.
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Affiliation(s)
- Su-Bin Han
- Jaseng Hospital of Korean Medicine, Seoul, South Korea
| | - Sook-Hyun Lee
- Jaseng Spine and Joint Research Institute, Jaseng Medical Foundation, Seoul, South Korea
| | - In-Hyuk Ha
- Jaseng Spine and Joint Research Institute, Jaseng Medical Foundation, Seoul, South Korea
| | - Eun-Jung Kim
- Department of Acupuncture & Moxibustion, College of Oriental Medicine, Dongguk University, Gyeongju-si, South Korea
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18
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Jadon A, Jain P, Motaka M, Swarupa CP, Amir M. Comparative evaluation of monopolar and bipolar radiofrequency ablation of genicular nerves in chronic knee pain due to osteoarthritis. Indian J Anaesth 2018; 62:876-880. [PMID: 30532324 PMCID: PMC6236782 DOI: 10.4103/ija.ija_528_18] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND AND AIMS Monopolar radiofrequency ablation (MRFA) of the genicular nerve is effective in managing chronic knee pain from osteoarthritis (OA); however, the procedure itself is associated with significant pain due to manipulation of electrode to localise tiny genicular nerves. We hypothesised that inserting two electrodes to target the genicular nerves [bipolar radiofrequency ablation (BRFA)] without sensory localisation can decrease the procedural pain with equal analgesic efficacy in treating knee pain. METHODS Thirty patients with chronic knee pain due to OA were randomised to receive either MRFA (n = 15) or BRFA (n = 15), after having 50% pain relief with diagnostic genicular nerve block. Pain during the procedure (assessed by the Numeric Rating Scale [NRS]), time taken to do the procedure and complications were recorded. Knee pain was assessed by the Oxford Knee Score at baseline, 1 week, 1 month, 3 months and 6 months following the procedure. RESULTS Patients in both groups had good pain relief, and no difference in pain relief and the duration of pain relief was seen between the two groups. The median (range) NRS for procedural pain was significantly lower in the bipolar group [3 (3-5)] than in the monopolar group [5 (3-7), P = 0.013]. There was no significant difference in procedure time and no complications were seen in either group. CONCLUSION BRFA is an effective alternative for ablation of genicular nerves in patients with knee pain due to OA. It causes less procedural pain compared with MRFA.
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Affiliation(s)
- Ashok Jadon
- Department of Anesthesia and Pain Relief Services, Tata Motors Hospital, Jamshedpur, Jharkhand, India
| | - Priyanka Jain
- Department of Anesthesia and Pain Relief Services, Tata Motors Hospital, Jamshedpur, Jharkhand, India
| | - Mayur Motaka
- Department of Anesthesia and Pain Relief Services, Tata Motors Hospital, Jamshedpur, Jharkhand, India
| | - Chintala Pavana Swarupa
- Department of Anesthesia and Pain Relief Services, Tata Motors Hospital, Jamshedpur, Jharkhand, India
| | - Mohammad Amir
- Department of Anesthesia and Pain Relief Services, Tata Motors Hospital, Jamshedpur, Jharkhand, India
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Cottrell E, Foster NE, Porcheret M, Rathod T, Roddy E. GPs' attitudes, beliefs and behaviours regarding exercise for chronic knee pain: a questionnaire survey. BMJ Open 2017; 7:e014999. [PMID: 28624759 PMCID: PMC5541518 DOI: 10.1136/bmjopen-2016-014999] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2016] [Revised: 03/22/2017] [Accepted: 04/25/2017] [Indexed: 01/26/2023] Open
Abstract
OBJECTIVES The aim of this study was to investigate general practitioners' (GPs) attitudes, beliefs and behaviours regarding the use of exercise for patients with chronic knee pain (CKP) attributable to osteoarthritis. SETTING Primary care GPs in the UK. PARTICIPANTS 5000 GPs, randomly selected from Binley's database, were mailed a cross-sectional questionnaire survey. OUTCOME MEASURES GPs' attitudes and beliefs were investigated using attitude statements, and reported behaviours were identified using vignette-based questions. GPs were invited to report barriers experienced when initiating exercise with patients with CKP RESULTS: 835 (17%) GPs responded. Overall, GPs were positive about general exercise for CKP. 729 (87%) reported using exercise, of which, 538 (74%) reported that they would use both general and local (lower limb) exercises. However, only 92 (11% of all responding) GPs reported initiating exercise in ways aligning with best-evidence recommendations. 815 (98%) GPs reported barriers in using exercise for patients with CKP, most commonly, insufficient time in consultations (n=419; 51%) and insufficient expertise (n=337; 41%). CONCLUSIONS While GPs' attitudes and beliefs regarding exercise for CKP were generally positive, initiation of exercise was often poorly aligned with current recommendations, and barriers and uncertainties were reported. GPs' use of exercise may be improved by addressing the key barriers of time and expertise, by developing a pragmatic approach that supports GPs to initiate individualised exercise, and/or by other professionals taking on this role.
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Affiliation(s)
- Elizabeth Cottrell
- Arthritis Research UK Primary Care Centre, Research Institute for Primary Care and Health Sciences, Keele University, UK
| | - Nadine E Foster
- Keele Clinical Trials Unit, David Weatherall Building, Keele University, Staffordshire, UK
| | - Mark Porcheret
- Arthritis Research UK Primary Care Centre, Research Institute for Primary Care and Health Sciences, Keele University, UK
| | - Trishna Rathod
- Arthritis Research UK Primary Care Centre, Research Institute for Primary Care and Health Sciences, Keele University, UK
- Keele Clinical Trials Unit, David Weatherall Building, Keele University, Staffordshire, UK
| | - Edward Roddy
- Arthritis Research UK Primary Care Centre, Research Institute for Primary Care and Health Sciences, Keele University, UK
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Abstract
INTRODUCTION The aim of this study is to evaluate the efficacy and safety of acupuncture for patients with chronic knee pain. METHODS AND ANALYSIS MEDLINE, EMBASE, CENTERAL, CINAHL and four Chinese medical databases will be searched from their inception to present. We will also manually retrieve eligible studies. Randomised controlled trials (RCTs) in which acupuncture is assessed as the sole treatment or as an adjunct treatment for chronic knee pain will be included. The primary outcome of our analysis is pain measured by the visual analogue scale (VAS), the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) pain subscale or the 11-point numeric rating scale (NRS). The secondary outcomes will include the quality of life, measured by the 36-item Short-Form Health Survey (SF-36) and adverse events. Two researchers will conduct the study selection, data extraction and quality assessment independently. Any disagreement will be resolved through discussion with a third reviewer. The Cochrane risk-of-bias criteria and the Standards for Reporting Interventions in Controlled Trials of Acupuncture (STRICTA) checklist will be used to assess the methodological quality of the trials. DISSEMINATION This systematic review will assess the current evidence on acupuncture therapy for chronic knee pain. It uses aggregated published data instead of individual patient data and does not require an ethical board review and approval. The findings will be published in a peer-reviewed journal and disseminated in conference presentations. It will provide the latest analysis of the currently available evidence for acupuncture treating chronic knee pain. TRIAL REGISTRATION NUMBER CRD42014015514.
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Affiliation(s)
- Qinhong Zhang
- Department of Acupuncture and Moxibustion, College of Acupuncture and Moxibustion, Heilongjiang University of Chinese Medicine, Harbin, China
- Department of Health Research and Policy, Stanford University, California, USA
| | - Jinhuan Yue
- Department of Acupuncture and Moxibustion, College of Acupuncture and Moxibustion, Heilongjiang University of Chinese Medicine, Harbin, China
| | - Zhongren Sun
- Department of Acupuncture and Moxibustion, College of Acupuncture and Moxibustion, Heilongjiang University of Chinese Medicine, Harbin, China
| | - Ying Lu
- Department of Health Research and Policy, Stanford University, California, USA
- VA Palo Alto Cooperative Studies Program Coordinating Center, VA Palo Alto Health Care System, California, USA
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