Quantitative assessment of light discomfort thresholds in a patient with photoallodynia treated with topical naltrexone 0.01 %☆

Research Type: Level 3 - Retrospective cohort study, Case-control study, Meta-analysis of Level 3 studies Introduction/Purpose: Hallux rigidus, a degenerative condition of the first metatarsophalangeal joint, causes joint stiffness and pain. Although non-surgical treatments such as orthotics, physical therapy, platelet-rich plasma, and corticosteroid injections are initially employed, they are effective in only 55% of patients. For those unresponsive to conservative management, cheilectomy is a common surgical intervention. Various approaches include Open Cheilectomy, Minimally Invasive Dorsal Cheilectomy (MIDC), and MIDC with subsequent first-MTP arthroscopy (MIDC-scope). Despite the prevalence of cheilectomy for treating hallux rigidus, the impact of different surgical approaches on parameters of postoperative pain, range of motion (ROM), and patient-reported outcomes (PROMS) remains underexplored. This study evaluated postoperative outcomes to determine whether the type of cheilectomy significantly impacts these key parameters, providing insights into optimizing surgical strategies for hallux rigidus management. Methods: A retrospective review was performed on 31 patients (23 female, 8 males; 13 lefts, 18 right feet) who underwent cheilectomy performed by a single surgeon at tertiary orthopaedic centers in Boston, MA between December 2019 and July 2024. Among them, 8 patients underwent an open cheilectomy, 10 underwent MIDC-scope cheilectomy, and 13 underwent MIDC cheilectomy. Pre- and postoperative measures include ROM (active AROM and passive PROM), Visual Analog Scale (VAS) pain scores, PROMS (Pain Intensity (PI), Pain Interference (PIF), Physical Function (PF), Depression Score, Mental Score), and complications including extensor hallucis longus (EHL) tendon lacerations. Welch’s ANOVA and Welch’s t-tests were utilized to compare pre- and postoperative outcomes due to a sizeable proportion of independently missing data, which precluded the use of paired t-tests. Covariance correlations between patient demographics, preoperative measures, and postoperative findings were also analyzed. Results are presented as mean values with significance set at p < 0.05. Results: VAS pain scores decreased significantly postoperatively in all groups (MIDC: 3.85, MIDC-scope: 5.21, Open: 4.12; p < 0.01, Welch's T-Test). While most PROMs showed no significant improvement (p > 0.17), PI pain scores in the MIDC-scope group decreased by 11.37 (p < 0.05, Welch's T-Test). The open group demonstrated lower mean postoperative PI scores compared to MIDC/MIDC-scopegroups (p < 0.025, ANOVA). Notably, older patients showed increased postoperative PI scores (r(31)=0.61, p < 10^-4) and less reduction in VAS scores (r(31)=-0.64, p < 10^-4). Finally, postoperative complications include one EHL tendon laceration (recognized and treated intraoperatively) and two superficial infections in the MIDC-scope group, and six minor wound complications equally distributed amongst the MIDC, MIDC-scope, and Open groups, all in female patients. Conclusion: Minimally invasive surgery (MIS) cheilectomy approaches have been demonstrated to be a safe and effective treatment for hallux rigidus, with significant postoperative improvements in VAS and PI pain scores. MIS meets the improvement in VAS scores seen in Open Cheilectomies and outperforms them in pain intensity scores. Further longitudinal research is necessary to best understand how this technique compares to other available treatment options and to explore cost analyses between approaches. Additionally, future studies should further investigate the minimal pain improvement post-cheilectomy in older patients to determine age-stratified surgical strategies for optimal hallux rigidus management.

Background: It is well known that rotator cuff repair is associated with an overall retear rate of 21% to 26%. However, a cuff retear may not necessarily be associated with poor clinical outcomes. Hypothesis: There would be no difference in clinical outcomes between patients with a cuff retear and those with an intact repair at a midterm follow-up of 5 years. Study Design: Cohort study; Level of evidence, 3. Methods: A retrospective study was conducted involving patients who received arthroscopic complete repair of the supraspinatus tendon between January 2009 and December 2017. Patients who did not have a postoperative magnetic resonance imaging (MRI) scan or who had a follow-up of <5 years were excluded. Clinical outcomes, including the visual analog scale (VAS) score, American Shoulder and Elbow Surgeons (ASES) score, and active forward flexion (FF) of the involved shoulder were assessed at the 2-year and 5-year follow-up points. Results: The study group included 105 patients with a mean follow-up of 85 months. MRI scans were performed at a mean of 20 months. Fourteen full-thickness cuff retears and 91 intact repairs were identified using postoperative MRI scans. Significant improvement in VAS score, ASES score, and FF were found between the preoperative assessment and the 2 designated follow-up points (2 years and 5 years) in both the cuff retear and the intact repair groups (P < .001). The VAS and ASES scores at the 2-year follow-up for the intact repair group were 1.8 ± 2.0 and 80.7 ± 18.1, respectively. The corresponding values for the retear group were 2.3 ± 2.2 and 71.9 ± 19.5, respectively. No significant difference was found between the 2 groups in the VAS and ASES scores at the 2-year follow-up. However, patients with an intact repair had a better VAS score (1.4 ± 1.8; P = .049) and ASES score (81.7 ± 17; P = .019) than those with a cuff retear at the 5-year assessment (3.0 ± 2.8 and 67.1 ± 22.9, respectively). In the intact repair group, 91% of patients achieved the minimal clinically important difference for the 5-year VAS score, compared with 54% in the cuff retear group (P < .001). The corresponding values for the 5-year ASES score were 80% and 54%, respectively (P = .044). FF measurements at the 5-year follow-up in patients with intact repair and those with a cuff retear were 161°± 23° and 144°± 37°, respectively (P = .059). Continuous improvement in VAS score and FF between the 2-year and 5-year follow-up was observed in the intact repair group (P = .005 and P = .04, respectively). Conclusion: The patients with an intact repair had better VAS and ASES scores compared with those who had a cuff retear at a midterm follow-up of 5 years. Between the 2-year and the 5-year follow-up, some further improvement was observed in the VAS score and FF in the intact repair group.

Background: Full-thickness radial meniscal tears render the meniscus nonfunctional and have historically been treated with partial meniscectomy. As preservative techniques evolve for radial repair, comparisons with other tear patterns are necessary to evaluate repair efficacy and prognosis. Purpose: To assess clinical outcomes and reoperation rates of radial meniscal repair and to compare them to bucket-handle meniscal repair. Study Design: Cohort study; Level of evidence, 3. Methods: Radial and bucket-handle meniscal tears without concurrent root injuries undergoing surgical repair at a single institution between 2007 and 2015 were analyzed, including both all-inside and inside-out suturing techniques. Propensity matching was performed on the basis of age at surgery, sex, meniscus laterality, body mass index (BMI), and concomitant anterior cruciate ligament reconstruction (ACLR) using a comparison pool of 70 bucket-handle repairs. Reoperation-free survival rates and Tegner, visual analog scale (VAS) for pain, and International Knee Documentation Committee (IKDC) scores were analyzed. Results: Twenty-four patients (18 male, 6 female; mean age, 22.8 ± 11.9 years) who underwent repair of a radial meniscal tear were followed for a mean of 3.5 years (range, 2.0-6.3 years). Significant postoperative improvements in VAS scores at rest and with use and IKDC scores were noted postoperatively (P < .001). Five patients (20.8%) required a reoperation. Subsequently, 18 patients with radial tears (mean age, 19.1 ± 9.1 years; 12 male; mean BMI, 27.0 ± 6.2 kg/m2; 3 medial; 11 ACLR) were propensity matched to 18 patients with bucket-handle tears (mean age, 20.8 ± 5.1 years; 13 male; mean BMI, 25.0 ± 3.5 kg/m2; 3 medial; 11 ACLR). The matched radial and bucket-handle groups demonstrated similar (P = .17) reoperation-free survival rates at 2 years (88.9% and 94.4%, respectively) and 5 years (77.8% and 87.7%, respectively). VAS and IKDC scores improved significantly after surgery (P < .001), with no difference noted between the groups (P ≥ .17). Patients with radial and bucket-handle meniscal repairs achieved mean postoperative Tegner scores (6.6 and 6.6, respectively) not significantly different from their preinjury levels (6.9 and 6.7, respectively) (P ≥ .32). Conclusion: Satisfactory clinical outcomes are achievable for radial meniscal tear repair at short-term follow-up. In a robustly matched comparison, radial and bucket-handle meniscal tears demonstrate similar improvements in VAS and IKDC scores, restoration of preoperative Tegner scores, and acceptable reoperation rates. Full-thickness radial meniscal tears should be considered for repair.

Very few studies have comprehensively examined specific symptom outcomes of endoscopic sinus surgery (ESS). The purpose of this study was to define the individual symptoms of a cohort of patients with medically refractory chronic rhinosinusitis (CRS) using visual analog scale (VAS) scores as well as report symptom-based outcomes after ESS. Patients with medically refractory CRS presenting for surgical management were asked to evaluate baseline symptoms using 10-cm VAS measures. Participants were asked to rank their most debilitating symptoms in descending order. VAS scores were assessed postoperatively at 3, 6, 12, and 18 months. The Kruskal-Wallis test was used to assess improvement in mean symptom VAS scores at each of the postoperative time points. Nasal congestion elicited the highest preoperative VAS score with an average of 6.5, followed by fatigue (6.0), headache (5.8), decreased sense of smell (5.5), nasal drainage (5.5), and facial pain-pressure (5.5). Headache was the most commonly reported disabling condition. Follow-up data after ESS was available for 207 patients. Average VAS scores for 6 of 7 symptoms showed significant and sustainable postoperative improvement at 3, 6, 12, and 18 months after surgery (p < 0.001). Improvement in VAS score for headache was not statistically significant (p > 0.700). This study indicates that patients with medically refractory CRS presenting for surgery complain of associated symptoms with great frequency. ESS results in both statistically and clinically significant improvements in six of seven symptoms. Headache, which was the most highly ranked disabling symptom, did not show significant improvement from baseline.

The aim of this study was to explore the usefulness of unilateral, combined unilateral (left + right), and bilateral peak nasal inspiratory flow (PNIF) measurements in assessing the results of nasal septal surgery. Nasal obstruction was recorded subjectively and objectively before and 4 months after nasal septoplasty using a visual analogue scale (VAS) and a PNIF meter. Nasal septoplasty (58 patients) and septoplasty with turbinoplasty (68 patients) were performed on 126 patients (85 males; 41 females) with a mean age of 32.8 years. The results showed a significant improvement in VAS scores, as well as unilateral, combined unilateral, and bilateral PNIF values after both septoplasty and septoplasty with turbinoplasty. Septoplasty with turbinoplasty showed better improvement in VAS and PNIF scores than septoplasty alone and this was significant for bilateral PNIF scores. The best unilateral pre- and postoperative correlations between VAS and PNIF measurements were found using the lower of the two unilateral PNIF scores, irrespective of side. In the total material, VAS/PNIF correlations were mostly significant, but weak (all r<0.30). We found VAS and PNIF to be useful instruments in reporting results of surgery. The weak correlations between VAS and PNIF measurements suggest that these subjective and objective instruments may target different aspects of nasal obstruction.

There is a lack of consensus on the use of postoperative bracing for lumbar degenerative conditions. Spine surgeons typically determine whether to apply postoperative braces based primarily on clinical experience rather than robust, evidence-based medical data. Thus, the present study sought to assess the impact of postoperative bracing on clinical outcomes, complications, and fusion rates following lumbar fusion surgery in patients with degenerative spinal conditions. Only randomized controlled studies published between January 1990 and 20 October 2023 were included in this meta-analysis. The primary outcome measures consisted of pre- and postoperative assessments of the Oswestry Disability Index (ODI) and visual analog scale (VAS) scores. Improvements in VAS and ODI scores were analyzed in the early postoperative period (1 month after operation) and at final follow-up, respectively. The analysis also encompassed fusion rates and complications. Five studies with 362 patients were included in the present meta-analysis. In the early postoperative period, the brace group showed a relatively better improvement in ODI scores compared with the no-brace group (19.47 vs 18.18), although this difference was not statistically significant (P = 0.34). Similarly, during the late postoperative period, the brace group demonstrated a slightly greater improvement in VAS scores in comparison to the no-brace group (4.05 vs 3.84), but this difference did not reach statistical significance (P = 0.30). The complication rate was relatively lower in the brace group compared with the no-brace group (14.9% vs 17.4%), although there was no statistical difference between the 2 groups (P = 0.83). Importantly, there were no substantial differences in fusion rates between patients with or without braces. The present meta-analysis revealed that the implementation of a brace following lumbar fusion surgery did not yield substantial differences in terms of postoperative pain relief, functional recovery, complication rates, or fusion rates when compared with cases where no brace was employed. This meta-analysis provides valuable insights into the clinical impact of postoperative bracing following lumbar fusion surgery for degenerative spinal conditions.

This study aimed to evaluate the effect of increased body mass index (BMI) on patient-reported outcomes (PROs) and clinically significant outcomes (CSOs) obtained > two years postoperatively following arthroscopic superior capsular reconstruction (ASCR). A retrospective study was conducted on patients who underwent ASCR with a minimum two year follow-up. All patients were divided into normal (BMI < 25.0), overweight (BMI 25-30.0), and obese (BMI ≥ 30) according to preoperative BMI. Patients were assessed using the PROs preoperatively and at six months, one year, and two years postoperatively, including the visual analog scale (VAS), American Shoulder and Elbow Surgeons (ASES), and Constant-Murley scores. The time required to achieve each CSO was analyzed and compared. Multivariate analyses evaluated the predictor variables and time required to achieve CSOs. This study included 63 patients with a mean age of 64.8 ± 8.6 years, including 31 normal BMI, 25 overweight, and seven obese patients. Significant improvements in VAS and ASES scores after ASCR were observed in all three groups. Normal and overweight patients had significant improvements in the Constant score; however, no difference was observed in obese patients. No significant difference was observed in the probability distributions of CSOs between the BMI groups. Similarly, no significant differences were observed in the probability distributions of the CSOs, ASES, and Constant scores at each time point, among the BMI groups. Patients in the normal and overweight groups had significant improvements in the VAS, ASES, and Constant scores after ASCR. Patients in the obese group had a significant improvement in VAS score; however, there is no difference for the ASES and Constant scores in the obese group. However, no differences were observed in all PROMs and the likelihood of achieving CSOs among the different BMI groups.

Endoscopic Plantar Fascia Release by Hooked Soft-Tissue Electrode After Failed Shock Wave Therapy

Study DesignThis investigation was a retrospective observational study.PurposeThe aim of this study was to evaluate whether having diffuse idiopathic skeletal hyperostosis (DISH) as a comorbidity affects the patient’s ability to perform activities of daily living (ADL) after surgical treatment for osteoporotic vertebral fracture (OVF). Overview of LiteratureA few studies have extensively evaluated elderly patients with comorbidities such as DISH and OVF-induced persistent back pain and their ability to perform ADL postoperatively.MethodsIn this study, 63 patients (21 men and 42 women) who underwent surgical treatment for OVF were enrolled. Of these patients, 26 had DISH (D+) and 37 did not have DISH (D-). Patient demographic characteristics and surgical, clinical, and radiological findings were compared between those with and without DISH. The change in their ability to perform ADL after surgery was also evaluated.ResultsAge, number of comorbidities, and 1-year mortality rate were significantly higher in the D+ group (p<0.05). Postoperative Visual Analog Scale (VAS) scores were significantly higher in patients with impaired (n=6, p=0.04) abilities to perform ADL, and improvements in VAS scores were significantly higher in patients with unchanged abilities to perform ADL (n=54, p=0.03) after surgery. The average postoperative VAS scores were 2.2 for the D+ group and 2.3 for the D- group, which were not significantly different.ConclusionsThe frequency of OVF with DISH was higher in elderly men with multiple comorbidities and contributed to a higher 1-year mortality rate than those in patients without DISH. However, preoperative and postoperative VAS scores and improvements in VAS scores were similar between those with and without DISH. Postoperative impaired ability to perform ADL was associated with old age, high postoperative VAS scores, and little improvements in VAS scores, which were limitedly influenced by DISH. Surgical treatment of OVF combined with DISH is effective and appropriate for elderly patients.

BackgroundIn this study we analyze new clinical data in the use of spinal cord stimulation (SCS) for the treatment of pain and motor symptoms in patients with Parkinson’s Disease (PD), as both a singular bioelectric therapy and as a salvage therapy after deep brain stimulation (DBS).MethodsFifteen patients were recruited and had percutaneous electrodes implanted at the level of the thoracic or cervical spine. Participants were set to one of three stimulation modes: continuous tonic stimulation, continuous Burst stimulation (40 Hz, 500 Hz, 1000 μs), or cycle mode (on time of 10–15 s, off time of 15–30 s) with Burst (40 Hz, 500 Hz, 1000 μs). Patients completed the Visual Analogue Scale (VAS), Unified Parkinson’s Disease Rating Scale, Self-Rating Depression Scale, Hamilton Depression Rating Scale, Profile of Mood State, 10-meter walking test, and the Timed Up and Go (TUG).ResultsAll patients experienced significant improvement in VAS scores with a mean reduction of 59% across all patients. Patients who chose the cycling burst stimulation parameter had an average 67% reduction in VAS scores, as compared to the continuous burst parameter group, which had an average 48% reduction in VAS scores. Seventy-three percent of patients experienced improvement in the 10-meter walk, with an average improvement of 12%. Sixty-four percent of patients experienced clinically relevant improvements in the TUG, with an average improvement of 21%.ConclusionsThis study points to the potential utility of SCS to address both pain and certain aspects of motor symptoms in PD patients who have and have not received DBS therapy.

Prospective cohort study. To compare the novel treatment procedure with nonoperative treatment for low back pain (LBP) in elderly patients with degenerative lumbar scoliosis (DLS). Treatment of LBP associated with elderly DLS is controversial. We developed a novel treatment procedure, termed percutaneous intervertebral-vacuum polymethylmethacrylate injection (PIPI). We included patients with de novo DLS aged ≥65 years who had LBP with a visual analogue scale (VAS) score of >50 for ≥6 months with intervertebral vacuum and vertebral bone marrow edema (BME) defined on fat-saturated T2-weighted or gadolinium-enhanced T1-weighted magnetic resonance imaging. The primary outcomes were evaluated using the VAS score and modified Oswestry Disability Index (ODI). As an objective measurement, we scored BME on magnetic resonance imaging. Between August 2004 and July 2011, 109 patients underwent PIPI and 53 received nonoperative treatment. At 1 month, mean improvements in VAS scores were -55.3 (95% CI, -60.5 to -50.1) and -1.9 (CI, -7.7 to 3.8) and mean improvements in ODI were -22.7 (CI, -27.3 to -18.2) and -0.6 (CI, -6.6 to 5.4) for the PIPI and nonoperative groups, respectively. At 2 years, mean improvements in VAS scores were -52.2 (CI, -59.9 to -44.4) and -4.0 (CI, -10.9 to 3.0) and mean improvements in ODI were -20.7 (CI, -27.3 to -14.5) and -1.0 (CI, -7.7 to 5.7) for the PIPI and nonoperative groups, respectively. BME substantially decreased in the PIPI group compared with the nonoperative group (P <0.001) and correlated with VAS score and ODI improvements (VAS score: r = 0.502, P <0.001; ODI: r = 0.372, P <0.001). PIPI improved treatment for LBP, with a sustained clinical benefit for at least 2 years. 3.

Functional endoscopic sinus surgery (FESS) is considered to be the standard procedure for chronic rhinosinusitis with nasal polyps (CRSwNP). However, for CRSwNP that accompanies asthma, the results are not satisfying. Extensive endoscopic sinus surgery (EESS) aimed at reducing the inflammatory load has been indicated as a viable option for refractory chronic rhinosinusitis. To evaluate the clinical outcomes and safety of EESS (middle turbinate and superior turbinate resection and total ethmoidectomy) for patients with CRSwNP and with asthma. This was a prospective, single-institute cohort study conducted in a tertiary teaching hospital. Patients with CRSwNP and with asthma who were proceeding to surgery were enrolled. There were 23 patients in the EESS group and 24 patients in the FESS group. The preoperative disease severity was evaluated by the visual analog scale (VAS), Lund-Kennedy (L-K) endoscopy score, computed tomography Lund-Mackay score, asthma control test (ACT), and pulmonary function test. Clinical outcomes were comparatively evaluated between the two groups after a 1-year follow-up by using the VAS score, the postoperative endoscopic score (E score), L-K score, ACT score, and pulmonary function test. The disease severity (general VAS score, endoscopic L-K score, computed tomography score, ACT score) showed no significant differences between the two groups before surgery (p > 0.05). One year after surgery, both groups achieved significant improvement in the VAS score and endoscopic L-K score. The EESS group showed better improvement in the olfactory VAS score and E score compared with the FESS group (mean [standard deviation] change of olfactory VAS, 6.00 ± 3.67 versus 3.30 ± 3.44, p = 0.015; mean [standard deviation] E score, 0.31 ± 0.18 versus 0.66 ± 0.26, p < 0.001). No significant differences were found in the change of general nasal symptom VAS score, other individual VAS scores (nasal congestion, discharge, headache and/or facial pain), L-K score, ACT score, and pulmonary function between the two groups (p > 0.05). EESS for patients with CRSwNP and with asthma may help to improve the subjective olfaction and endoscopic appearance.

Objective Chronic rhinosinusitis with nasal polyp (CRSwNP) is one of the major phenotypes of chronic rhinosinusitis (CRS) with a high symptom burden. Doxycycline can be used as add-on therapy in CRSwNP. We aimed to evaluate short-term efficacy of oral doxycycline on visual analog scale (VAS) and SNOT-22 (Sino-nasal outcome test) score for CRSwNP. Methods Visual analog score (VAS) for nasal symptoms and total SNOT-22 scores of 28 patients who applied with the diagnosis of CRSwNP and received 100 mg doxycycline for 21 days were analyzed in this retrospective cohort study. Doxycycline efficacy was also evaluated in subgroups determined according to asthma, presence of atopy, total IgE and eosinophil levels. Results After 21-day doxycycline treatment, there was a significant improvement in VAS score for post-nasal drip, nasal discharge, nasal congestion, and sneeze, and total SNOT-22 score (p = 0.001, p < 0.001, p < 0.001, p < 0.001, p < 0.001, respectively). No significant improvement was observed in VAS score for the loss of smell (p = 0.18). In the asthmatic subgroup, there were significant improvements in all VAS scores and total SNOT-22 score after doxycycline. In the non-asthmatic subgroup, there was no significant change in any of the VAS scores, but total SNOT-22 score was significantly improved (42 [21–78] vs. 18 [9–33]; p = 0.043). Improvement in VAS score for loss of smell is significant in only some subgroups like asthmatic patients, non-atopic patients, and patients with eosinophil >300 cell/µL. Conclusions Doxycycline can be considered as an add-on treatment for symptom control in patients especially with CRSwNP comorbid with asthma.

Background: Lateral epicondylitis (LE), commonly referred to as tennis elbow, is characterized by micro-tears to the tendon origin that attaches to the outer portion of the elbow, with the extensor carpi radialis brevis being the most commonly affected tendon. It presents most often amongst manual workers and athletes that participate in repetitive movements. Patients may experience burning and aching sensations that can potentially radiate down to the wrist. Hyaluronic acid is a primary component of synovial fluid and has anti-inflammatory properties and also provides lubrication to joints. Prolotherapy involves injection of an irritant, most commonly dextrose, into the common extensor origin space to stimulate the body’s natural immune response and induce proliferation of new cells. Both hyaluronic acid and prolotherapy injections have proven to be an effective treatment for lateral epicondylitis. Purpose: This systematic review and meta-analysis compares the effectiveness of hyaluronic acid and dextrose prolotherapy injections in the treatment of lateral epicondylitis 4 weeks and 12 weeks post-injection. Methods: The systematic review and meta-analysis followed the 2020 PRISMA guidelines. Five databases were screened (PubMed, Embase, Web of Science, Cochrane Library, Scopus) for studies that utilized either hyaluronic acid or dextrose prolotherapy. A total of 8 studies contained pre- and post-treatment Visual Analogue Scale (VAS) or Quick Disabilities of the Arm, Shoulder and Hand (QuickDASH). All included studies contained follow up data up to 12 weeks post-injection. 2 dextrose prolotherapy studies contained 1 year VAS follow-up data and were excluded as there were no HA comparison group with 1 year data. The remaining studies consisted of 4 double-blinded, 3 single-blinded randomized controlled trials (RCTs) and 1 prospective clinical trial with a total of 427 for final analysis. Statistical analyses were performed using SPSS. Results: Following treatment of the dextrose prolotherapy injections, there was a strong clinically significant decrease in VAS at 12 weeks compared to the hyaluronic acid injection (Cohen’s d = 3.31). Within the HA subgroup, there was slight improvement in VAS scores between 4 and 12 weeks (Difference of Cohen’s d = 0.86). Within the dextrose prolotherapy subgroup, there was significant improvement in VAS scores between 4 and 12 weeks (Cohen’s d = 4.15). No significant difference was identified for QuickDash scores between the two treatment modalities at 12 weeks. Conclusion: While HA had a slight increase in VAS scores between 4 and 12 weeks, dextrose prolotherapy showed a significant improvement in VAS scores over the same time period. Throughout the studies analyzed, both injection therapies produced similar results at 4 weeks, with clinically significant improvements VAS scores seen at 12 weeks following dextrose prolotherapy.

Chronic prostatitis (CP) is one of the diseases that reduce the quality of life (QoL) of young men. To date, there is no consensus on the management of these patients. It is essential to continue research into the treatment of CP, despite the use of various therapies, including low-energy extracorporeal shockwave therapy (ESWT). The main objective of this study is to observe and record the clinical symptomatology of patients during a 48-week follow-up period after ESWT treatment. Between 2019 and 2021, 28 patients with type IIIB CP/chronic pelvic pain syndrome were enrolled. Patients underwent ESWT once weekly for 4 weeks (3,000 individual sessions, maximum total energy flux density 0.25 mJ/mm2, frequency 3 Hz). Participants were assessed at 0, 4, 12, 24, 36 and 48 weeks post-treatment using the visual analogue scale (VAS), National Institutes of Health Chronic Prostatitis Symptom Index (NIH-CPSI), and International Index of Erectile Function (IIEF)-5. The mean age of patients was 47.1 ± 13.7 years (range 28–4 years). The positive effect of LI-ESWT was reflected in improvements in VAS, NIH-CPSI, and IIEF-5 scores. Regression of patients’ symptoms was observed as early as 4 weeks after treatment. The greatest progress was achieved at week 24. In addition, a slight worsening was observed at week 36 and 48, with stable progress. The treatment significantly improved the QoL of the patients, with the most significant improvement in the VAS score. In conclusion, this treatment approach is safe, most effective in the first 6 months. Thereafter, the efficacy of the treatment diminishes, but is sustained over a longer period.