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BMC Musculoskeletal Disorders Sep 2017Mechanical neck pain is a highly prevalent problem in primary healthcare settings. Many of these patients have restricted mobility of the cervical spine. Several manual... (Randomized Controlled Trial)
Randomized Controlled Trial
Effectiveness of a specific manual approach to the suboccipital region in patients with chronic mechanical neck pain and rotation deficit in the upper cervical spine: study protocol for a randomized controlled trial.
BACKGROUND
Mechanical neck pain is a highly prevalent problem in primary healthcare settings. Many of these patients have restricted mobility of the cervical spine. Several manual techniques have been recommended for restoring cervical mobility, but their effectiveness in these patients is unknown. The aim of the present study is to compare the effectiveness of two types of specific techniques of the upper neck region: the pressure maintained suboccipital inhibition technique (PMSIT) and the translatory dorsal glide mobilization (TDGM) C0-C1 technique, as adjuncts to a protocolized physiotherapy treatment of the neck region in subjects with chronic mechanical neck pain and rotation deficit in the upper cervical spine.
METHODS
A randomized, prospective, double-blind (patient and evaluator) clinical trial. The participants (n = 78) will be randomly distributed into three groups. The Control Group will receive a protocolized treatment for 3 weeks, the Mobilization Group will receive the same protocolized treatment and 6 sessions (2 per week) of the TDGM C0-C1 technique, and the Pressure Group will receive the same protocolized treatment and 6 sessions (2 per week) of the PMSIT technique. The intensity of pain (VAS), neck disability (NDI), the cervical range of motion (CROM), headache intensity (HIT-6) and the rating of clinical change (GROC scale) will be measured. The measurements will be performed at baseline, post-treatment and 3 months after the end of treatment, by the same physiotherapist blinded to the group assigned to the subject.
DISCUSSION
We believe that an approach including manual treatment to upper cervical dysfunction will be more effective in these patients. Furthermore, the PMSIT technique acts mostly on the musculature, while the TDGM technique acts on the joint. We expect to clarify which component is more effective in improving the upper cervical mobility.
TRIAL REGISTRATION
ClinicalTrials.gov NCT02832232 . Registered on July 13th, 2016.
Topics: Cervical Vertebrae; Chronic Pain; Double-Blind Method; Female; Humans; Male; Manipulation, Spinal; Neck Pain; Occipital Bone; Pain Measurement; Prospective Studies; Range of Motion, Articular; Rotation; Treatment Outcome
PubMed: 28870191
DOI: 10.1186/s12891-017-1744-5 -
Regional Anesthesia and Pain Medicine Jan 2022The past two decades have witnessed a surge in the use of cervical spine joint procedures including joint injections, nerve blocks and radiofrequency ablation to treat...
BACKGROUND
The past two decades have witnessed a surge in the use of cervical spine joint procedures including joint injections, nerve blocks and radiofrequency ablation to treat chronic neck pain, yet many aspects of the procedures remain controversial.
METHODS
In August 2020, the American Society of Regional Anesthesia and Pain Medicine and the American Academy of Pain Medicine approved and charged the Cervical Joint Working Group to develop neck pain guidelines. Eighteen stakeholder societies were identified, and formal request-for-participation and member nomination letters were sent to those organizations. Participating entities selected panel members and an ad hoc steering committee selected preliminary questions, which were then revised by the full committee. Each question was assigned to a module composed of 4-5 members, who worked with the Subcommittee Lead and the Committee Chairs on preliminary versions, which were sent to the full committee after revisions. We used a modified Delphi method whereby the questions were sent to the committee en bloc and comments were returned in a non-blinded fashion to the Chairs, who incorporated the comments and sent out revised versions until consensus was reached. Before commencing, it was agreed that a recommendation would be noted with >50% agreement among committee members, but a consensus recommendation would require ≥75% agreement.
RESULTS
Twenty questions were selected, with 100% consensus achieved in committee on 17 topics. Among participating organizations, 14 of 15 that voted approved or supported the guidelines en bloc, with 14 questions being approved with no dissensions or abstentions. Specific questions addressed included the value of clinical presentation and imaging in selecting patients for procedures, whether conservative treatment should be used before injections, whether imaging is necessary for blocks, diagnostic and prognostic value of medial branch blocks and intra-articular joint injections, the effects of sedation and injectate volume on validity, whether facet blocks have therapeutic value, what the ideal cut-off value is for designating a block as positive, how many blocks should be performed before radiofrequency ablation, the orientation of electrodes, whether larger lesions translate into higher success rates, whether stimulation should be used before radiofrequency ablation, how best to mitigate complication risks, if different standards should be applied to clinical practice and trials, and the indications for repeating radiofrequency ablation.
CONCLUSIONS
Cervical medial branch radiofrequency ablation may provide benefit to well-selected individuals, with medial branch blocks being more predictive than intra-articular injections. More stringent selection criteria are likely to improve denervation outcomes, but at the expense of false-negatives (ie, lower overall success rate). Clinical trials should be tailored based on objectives, and selection criteria for some may be more stringent than what is ideal in clinical practice.
Topics: Arthralgia; Cervical Vertebrae; Humans; Injections, Intra-Articular; Neck Pain; Zygapophyseal Joint
PubMed: 34764220
DOI: 10.1136/rapm-2021-103031 -
Canadian Family Physician Medecin de... Mar 1996The Ottawa ankle rule project demonstrated that more than 95% of patients with ankle injuries had radiographic examinations but that 85% of the films showed no... (Clinical Trial)
Clinical Trial
The Ottawa ankle rule project demonstrated that more than 95% of patients with ankle injuries had radiographic examinations but that 85% of the films showed no fractures. A group of Ottawa emergency physicians developed two rules to identify clinically important fractures of the malleoli and the midfoot. Use of these rules reduced radiographic examinations by 28% for the ankle and 14% for the foot.
Topics: Algorithms; Ankle Injuries; Diagnosis, Differential; Fractures, Bone; Humans; Pain; Palpation; Radiography; Reproducibility of Results; Sensitivity and Specificity; Tarsal Bones; Weight-Bearing
PubMed: 8616287
DOI: No ID Found -
Current Osteoporosis Reports Dec 2018The goal of this review is to provide a broad overview of the current understanding of mechanisms underlying bone and joint pain. (Review)
Review
PURPOSE OF REVIEW
The goal of this review is to provide a broad overview of the current understanding of mechanisms underlying bone and joint pain.
RECENT FINDINGS
Bone or joint pathology is generally accompanied by local release of pro-inflammatory cytokines, growth factors, and neurotransmitters that activate and sensitize sensory nerves resulting in an amplified pain signal. Modulation of the pain signal within the spinal cord and brain that result in net increased facilitation is proposed to contribute to the development of chronic pain. Great strides have been made in our understanding of mechanisms underlying bone and joint pain that will guide development of improved therapeutic options for these patients. Continued research is required for improved understanding of mechanistic differences driving different components of bone and/or joint pain such as movement related pain compared to persistent background pain. Advances will guide development of more individualized and comprehensive therapeutic options.
Topics: Arthralgia; Bone and Bones; Humans; Hyperalgesia; Joints; Nociception; Pain Measurement
PubMed: 30370434
DOI: 10.1007/s11914-018-0493-1 -
Internal Medicine (Tokyo, Japan) Jan 2022
Topics: Bone Diseases; Chest Pain; Humans; Musculoskeletal Pain; Xiphoid Bone
PubMed: 34219108
DOI: 10.2169/internalmedicine.7395-21 -
Nature Reviews. Disease Primers Jul 2017Tumour-induced osteomalacia (TIO), also known as oncogenic osteomalacia, is a rare paraneoplastic disorder caused by tumours that secrete fibroblast growth factor 23... (Review)
Review
Tumour-induced osteomalacia (TIO), also known as oncogenic osteomalacia, is a rare paraneoplastic disorder caused by tumours that secrete fibroblast growth factor 23 (FGF23). Owing to the role of FGF23 in renal phosphate handling and vitamin D synthesis, TIO is characterized by decreased renal tubular reabsorption of phosphate, by hypophosphataemia and by low levels of active vitamin D. Chronic hypophosphataemia ultimately results in osteomalacia (that is, inadequate bone mineralization). The diagnosis of TIO is usually suspected when serum phosphate levels are chronically low in the setting of bone pain, fragility fractures and muscle weakness. Locating the offending tumour can be very difficult, as the tumour is often very small and can be anywhere in the body. Surgical removal of the tumour is the only definitive treatment. When the tumour cannot be located or when complete resection is not possible, medical treatment with phosphate salts or active vitamin D is necessary. One of the most promising emerging treatments for unresectable tumours that cause TIO is the anti-FGF23 monoclonal antibody KRN23. The recent identification of a fusion of fibronectin and fibroblast growth factor receptor 1 (FGFR1) as a molecular driver in some tumours not only sheds light on the pathophysiology of TIO but also opens the door to a better understanding of the transcription, translocation, post-translational modification and secretion of FGF23, as well as suggesting approaches to targeted therapy. Further study will reveal if the FGFR1 pathway is also involved in tumours that do not harbour the translocation.
Topics: Adult; Aged; Aged, 80 and over; Antibodies, Monoclonal; Antibodies, Monoclonal, Humanized; Bone and Bones; Female; Fibroblast Growth Factor-23; Fibroblast Growth Factors; Fibronectins; Fractures, Bone; Humans; Hypophosphatemia; Japan; Male; Middle Aged; Muscle Weakness; Neoplasms, Connective Tissue; Osteomalacia; Pain; Paraneoplastic Syndromes; Phosphates; Protein Processing, Post-Translational; Receptor, Fibroblast Growth Factor, Type 1; Vitamin D
PubMed: 28703220
DOI: 10.1038/nrdp.2017.44 -
Current Osteoporosis Reports Apr 2017In this article, we will discuss the current understanding of bone pain and muscle weakness in cancer patients. We will describe the underlying physiology and mechanisms... (Review)
Review
PURPOSE OF REVIEW
In this article, we will discuss the current understanding of bone pain and muscle weakness in cancer patients. We will describe the underlying physiology and mechanisms of cancer-induced bone pain (CIBP) and cancer-induced muscle wasting (CIMW), as well as current methods of diagnosis and treatment. We will discuss future therapies and research directions to help patients with these problems.
RECENT FINDINGS
There are several pharmacologic therapies that are currently in preclinical and clinical testing that appear to be promising adjuncts to current CIBP and CIMW therapies. Such therapies include resiniferitoxin, which is a targeted inhibitor of noceciptive nerve fibers, and selective androgen receptor modulators, which show promise in increasing lean mass. CIBP and CIMW are significant causes of morbidity in affected patients. Current management is mostly palliative; however, targeted therapies are poised to revolutionize how these problems are treated.
Topics: Bone Diseases; Bone Neoplasms; Bone and Bones; Cachexia; Cancer Pain; Humans; Hypercalcemia; Muscle Weakness; Neoplasms; Sarcopenia
PubMed: 28497213
DOI: 10.1007/s11914-017-0354-3 -
Journal of Bone and Mineral Research :... Aug 2019The innervation of bone has been described for centuries, and our understanding of its function has rapidly evolved over the past several decades to encompass roles of... (Review)
Review
The innervation of bone has been described for centuries, and our understanding of its function has rapidly evolved over the past several decades to encompass roles of subtype-specific neurons in skeletal homeostasis. Current research has been largely focused on the distribution and function of specific neuronal populations within bone, as well as their cellular and molecular relationships with target cells in the bone microenvironment. This review provides a historical perspective of the field of skeletal neurobiology that highlights the diverse yet interconnected nature of nerves and skeletal health, particularly in the context of bone anabolism and pain. We explore what is known regarding the neuronal subtypes found in the skeleton, their distribution within bone compartments, and their central projection pathways. This neuroskeletal map then serves as a foundation for a comprehensive discussion of the neural control of skeletal development, homeostasis, repair, and bone pain. Active synthesis of this research recently led to the first biotherapeutic success story in the field. Specifically, the ongoing clinical trials of anti-nerve growth factor therapeutics have been optimized to titrated doses that effectively alleviate pain while maintaining bone and joint health. Continued collaborations between neuroscientists and bone biologists are needed to build on this progress, leading to a more complete understanding of neural regulation of the skeleton and development of novel therapeutics. © 2019 The Authors. Journal of Bone and Mineral Research published by Wiley Periodicals, Inc.
Topics: Animals; Bone and Bones; Cellular Microenvironment; Humans; Neurons; Pain
PubMed: 31247122
DOI: 10.1002/jbmr.3822 -
JPMA. the Journal of the Pakistan... Feb 2022We share the concept of a multisystemic syndrome which affects the muscle, bone, joints and nerves, in varying manners. The MOAN (musculo-osteo-arthro-neuropathic)...
We share the concept of a multisystemic syndrome which affects the muscle, bone, joints and nerves, in varying manners. The MOAN (musculo-osteo-arthro-neuropathic) syndrome highlights the close relationship between these four organ-systems, and their contribution to each other's health and disease. The mnemonic MOAN also underscores the discomfort and pain associated with the condition and encourages health professionals to address these patients in a holistic manner, rather than just addressing one of the components.
Topics: Bone and Bones; Humans; Pain; Peripheral Nervous System Diseases; Syndrome
PubMed: 35320199
DOI: 10.47391/JPMA.022-37 -
Clinical and Experimental Rheumatology 2019Rheumatoid arthritis is a chronic autoimmune disease characterised by unbearable joint pain as well as bone and cartilage destruction. Although RA development is greatly... (Review)
Review
Rheumatoid arthritis is a chronic autoimmune disease characterised by unbearable joint pain as well as bone and cartilage destruction. Although RA development is greatly controlled, the pain and bone damage failed to be relieved and managed. Leukotriene B4 (LTB4) has been proved to play an essential role in the induction of pain and bone damage. The nerve injury of RA can promote the production of LTB4, which act on their receptors, leading to the increased release of pro-inflammatory cytokines and ROS to reduce neuron viability and pain threshold. Moreover, LTB4-BLT1 activation can also increase intracellular calcium concentration and neuron excitability as well as NF-κB pathway activation, which further promote the production of MMP-9 and CXC3R-1. The mutual promotion between LTB4 and neutrophil accumulation accelerates the release of TNF-α and IL-β, which enhance both peripheral and central nerve system sensitisation. LTB4 also involve in TrpV1 channel activation and modulation of P2X3 receptor activation. All above mechanisms contribute to the development of RA pain. IL-23, cPLA2 and PI3K increase the production of CD11b+Gr1high myeloid subtype and calcium concentration, which promote the production of LTB4 and further accelerate IL-17 and TNF activation as well as calcium influx to conduce to osteoclastogenesis, resulting in aggregated bone damage. Our review is the first to conclude the signalling pathways and associated molecules in LTB4-induced pain and bone damage.
Topics: Arthritis, Rheumatoid; Bone and Bones; Humans; Leukotriene B4; Molecular Targeted Therapy; Pain; Receptors, Leukotriene B4; Signal Transduction
PubMed: 30943138
DOI: No ID Found