Treatment Of Chronic Joint Pain Research Articles

The Use of Botulinum Toxin for the Treatment of Chronic Joint Pain: Clinical and Experimental Evidence.

Chronic osteoarthritis pain is an increasing worldwide problem. Treatment for osteoarthritis pain is generally inadequate or fraught with potential toxicities. Botulinum toxins (BoNTs) are potent inhibitors of neuropeptide release. Paralytic toxicity is due to inhibition at the neuromuscular junction, and this effect has been utilized for treatments of painful dystonias. Pain relief following BoNT muscle injection has been noted to be more significant than muscle weakness and hypothesized to occur because of the inhibition of peripheral neuropeptide release and reduction of peripheral sensitization. Because of this observation, BoNT has been studied as an intra-articular (IA) analgesic for chronic joint pain. In clinical trials, BoNT appears to be effective for nociceptive joint pain. No toxicity has been reported. In preclinical models of joint pain, BoNT is similarly effective. Examination of the dorsal root ganglion (DRG) and the central nervous system has shown that catalytically active BoNT is retrogradely transported by neurons and then transcytosed to afferent synapses in the brain. This suggests that pain relief may also be due to the central effects of the drug. In summary, BoNT appears to be safe and effective for the treatment of chronic joint pain. The long-term effects of IA BoNT are still being determined.

Total Hip and Knee Replacement in Eastern Libya: A Post-Conflict Case Series

Background: Total knee replacement (TKR) and total hip replacement (THR) are effective procedures for alleviating pain and improving hip and knee function. Literature has not covered the experience of developing countries with arthroplasty – especially in an unstable post-conflict setting. Methods: Patient records were obtained from a major surgical center in Benghazi where total joint arthroplasties (TJA) are performed for a period of twenty months and key parameters were analyzed. The patients were followed up on an outpatient basis at regular time intervals (one week, one month, three months and six months) and any complications were documented. Results: A total of 135 total knee (81.5%, n=110) and total hip (18.5%, n=25) replacements were done in Benghazi mostly on elderly (mean age=60.2 years) females (72.2%, n=100). The most common causative pathology in both groups was osteoarthritis (80.6%, n=108). The most common complication was superficial infection (4.4%, n=6) by Staph aureus. The Harris Hip Score and Knee Society Score were used to determine the functional outcomes of THR and TKR respectively – both showing high values. The Short form 36 (SF36) health survey was carried out to assess the patients' satisfaction levels. For all the axes, the obtained score was over 80%. Discussions: THR and TKR are major orthopedic surgeries that constitute an advancement in the treatment of chronic joint pain. Most of the demographic features of our patients match up well with previous literature – with certain exceptions. There was no difference in thromboembolic incidence between the group of patients who received LMWH and those who simply started early mobilization and physiotherapy. Despite a number of hindrances faced by the hospital due to the conflict (i.e. funding limitations and drug shortages), a low rate of complications was maintained. No thromboembolic incidents or mortalities occurred.

(247) Successful interdisciplinary pain management in the treatment of chronic joint pain in a patient with Noonan Syndrome: a case report

Noonan Syndrome is a rare genetic disorder that results in the abnormal development of various body parts that can present as short stature, unusual facial features and is most commonly associated with cardiac defects. Chronic joint pain is a clinical finding that is associated with Noonan Syndrome (54% prevalence).1 We present a case of a 51 year-old male with a history of scoliosis status post correction who presented with back, neck and bilateral knee pain. The back and neck pain were described as dull in nature and the knee pain was sharp. The neck and back pain improved with lying down, however, there were no clear alleviating factors for the knee pain. Prior to being evaluated by the chronic pain program, he had been taking hydrocodone/acetaminophen 10/325mg, one to two tablets, four times a day. Without pain medications, the patient’s pain was rated a 90/100 on a visual analog scale (VAS), and decreased to 40/100 on the VAS with opioid medication usage. Prior to participating in an interdisciplinary pain management program, the patient tried land based physical therapy with limited success. Through participation in an interdisciplinary pain management program, which included occupational therapy, physical therapy, biofeedback, pool therapy, feldenkrais, twice weekly medication monitoring and pain psychology, the patient was able to improve his functionality and tolerance to pain. He also learned coping strategies which helped him manage his pain on a more productive basis. This case highlights the importance of using an interdisciplinary approach in the treatment of complex disorders when other treatments have been unsuccessful. (1. Smpokou, P, American Journal Medical Genetics, 2012.) Noonan Syndrome is a rare genetic disorder that results in the abnormal development of various body parts that can present as short stature, unusual facial features and is most commonly associated with cardiac defects. Chronic joint pain is a clinical finding that is associated with Noonan Syndrome (54% prevalence).1 We present a case of a 51 year-old male with a history of scoliosis status post correction who presented with back, neck and bilateral knee pain. The back and neck pain were described as dull in nature and the knee pain was sharp. The neck and back pain improved with lying down, however, there were no clear alleviating factors for the knee pain. Prior to being evaluated by the chronic pain program, he had been taking hydrocodone/acetaminophen 10/325mg, one to two tablets, four times a day. Without pain medications, the patient’s pain was rated a 90/100 on a visual analog scale (VAS), and decreased to 40/100 on the VAS with opioid medication usage. Prior to participating in an interdisciplinary pain management program, the patient tried land based physical therapy with limited success. Through participation in an interdisciplinary pain management program, which included occupational therapy, physical therapy, biofeedback, pool therapy, feldenkrais, twice weekly medication monitoring and pain psychology, the patient was able to improve his functionality and tolerance to pain. He also learned coping strategies which helped him manage his pain on a more productive basis. This case highlights the importance of using an interdisciplinary approach in the treatment of complex disorders when other treatments have been unsuccessful. (1. Smpokou, P, American Journal Medical Genetics, 2012.)

Treatment of chronic pain with millimetre wave therapy (MWT) in patients with diffuse connective tissue diseases: a pilot case series study

Background. Pain relief is reported to be the most common clinical application of electromagnetic millimetre waves. Aim. To evaluate safety and pain relief effect of millimetre wave therapy (MWT) for treatment of chronic joint pain in a group of patients with diffuse connective tissue diseases. Methods. Twelve patients with diffuse connective tissue diseases received MWT in addition to their analgesic medication with non-steroidal anti-inflammatory drugs. MWT procedure included the exposure of tender points around the painful joints to electromagnetic waves with frequency 54–78 GHz and power density of 2.5 mW/cm 2 . The time of exposure was 35±5 min and the total number of sessions ranged from 5 to 10 (median 6). Intensity of pain, medication requirement, joint stiffness and subjective assessment of therapy success were measured before, during and immediately after the treatment, and after a 6-months follow-up. Results. No adverse effects of MWT were noted. Pain intensity and required medication decreased significantly after the treatment ( p<0.05) and remained at the same level throughout the follow-up period. The joint stiffness decreased and the subjective assessment of the treatment success after 6 month did not change except in only one patient. Conclusion. MWT applied to tender points around the affected joints was safe under the conditions of our study and after an appropriate full-scale double-blind clinical study, may be recommended as an effective adjunct therapy for chronic pain treatment in patients with diffuse connective tissue diseases.