Background
Platelet-rich plasma (PRP) is a minimally invasive treatment option to reduce pain and promote tissue healing. At the time this study was performed, there was limited published literature analyzing outcomes for patients treated with PRP for hip osteoarthritis.
Methods
Thirty-six patients aged 49–85 (66.0 ± 12.1) years with chronic hip pain who met inclusion criteria underwent image-guided intra-articular hip PRP injection. Outcomes were measured at baseline, two weeks, three months, and up to six months using the visual analog scale (VAS) for pain and the Hip Disability and Osteoarthritis Outcome Score (HOOS). The proportion of responders, as defined by a ≥50% reduction in VAS pain score, was assessed at three and six months.
Results
At two weeks, there was a significant improvement (P < 0.05) of function in two HOOS subscales: Symptoms and Activities of Daily Living. There was a significant improvement in all HOOS categories at six months. A significant improvement in VAS was observed at six months (baseline VAS = 6.9 ± 0.7 &→ 4.3 ± 1.8, 95% confidence interval = 2.0 to 3.2, P < 0.05). Sixty-seven percent (24/36) of the patients reported a ≥50% improvement in pain at three months; 58% (21/36) reported a ≥50% improvement in pain at six months. Stratification by Kellgren-Lawrence grades revealed that 86% and 82% of the KL grades 1 and 2 were responders at six months, respectively.
Conclusions
In patients with mild/moderate hip osteoarthritis, PRP may provide pain relief and functional improvement for up to six months.
AbstractObjectivesLow-intensity ultrasound (LIU)/low-intensity pulsed ultrasound (LIPUS) may influence nerve tissue regeneration and axonal changes in the context of carpal tunnel syndrome (CTS) and in the animal model. The purpose of this pragmatic review is to understand the current knowledge for the effects of low-intensity therapeutic ultrasound in the animal and human model and determine the future directions of this novel field.DesignPragmatic review.MethodsWe performed a literature search of available material using OVID, EmBase, and PubMed for LIU/LIPUS, all of which were preclinical trials, case reports, and case series using animal models. For CTS, a literature search was performed on PubMed (1954 to 2019), CENTRAL (the Cochrane Library, 1970 to 2018), Web of Science (1954 to 2019), and SCOPUS (1954 to 2019) to retrieve randomized controlled trials.ResultsEight articles were discussed showing the potential effects of LIU on nerve regeneration in the animal model. Each of these trials demonstrated evidence of nerve regeneration in the animal model using LIPUS or LIU. Seven randomized controlled trials were reviewed for ultrasound effects for the treatment of carpal tunnel syndrome, each showing clinical efficacy comparable to other treatment modalities.ConclusionsLIU/LIPUS is a promising and noninvasive means of facilitating nerve regeneration in the animal model and in the treatment of carpal tunnel syndrome. Although many of the trials included in this review are preclinical, each demonstrates promising outcomes that could eventually be extrapolated into human studies.
Objectives
Cancer-related neuropathic pain (CNP) affects an increasing proportion of cancer patients given improved survival but remains difficult to treat. There are no studies on an extended intravenous (IV) ketamine protocol and its synergies with common neuropathy treatments to treat CNP. This study aims to (1) evaluate the safety and effectiveness of an IV ketamine protocol to treat refractory CNP and (2) uncover synergies between ketamine and common neuropathy treatments.
Methods
This is a single-center, retrospective review of 57 patients and 192 infusions with prospective follow-up on fourteen enrolled patients during the COVID-19 pandemic.
Results
The etiologies of CNP were 13 from tumor compression, 25 with chemotherapy-induced peripheral neuropathy, 13 from surgery, and 6 from radiation therapy. Overall, 42 out of 57 patients (73.7%) were responders. 71.8% of responders received >3 weeks of pain relief on their last infusion. Analysis of adjuvant treatments revealed the combination of serotonin-norepinephrine reuptake inhibitors (SNRI) and ketamine resulted in an increase in responders compared to non-responders (p < 0.01). Adverse events occurred in 32 of 192 infusions (16.7%). All side-effects self-resolved or resolved with intervention per the adverse events protocol. During the pandemic, all fourteen currently enrolled patients did not receive ketamine infusions. Thirteen of the fourteen patients returned to baseline pain with 61.5% increasing medications. All experienced worsened function, mobility, mood, and/or anorexia.
Conclusion
IV ketamine may be a safe and effective adjuvant treatment for CNP, especially with SNRIs. Larger, prospective studies are warranted and should explore parameters to help prognosticate response to ketamine infusions.
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