Effects of MRgFUS Treatment on Musculoskeletal Pain: Comparison between Bone Metastasis and Chronic Knee/Lumbar Osteoarthritis

Abstract

Local bone denervation by magnetic resonance-guided focused ultrasound (MRgFUS) is a promising tool for alleviation of pain in patients with painful bone metastasis (BM). Considering the underlying mechanism of pain alleviation, MRgFUS might be effective for various bone and joint diseases associated with local tenderness. This study was conducted to clarify the therapeutic effect of focused ultrasound in patients with various painful bone and joint diseases that are associated with local tenderness. Ten patients with BM, 11 patients with lumbar facet joint osteoarthritis (L-OA), and 19 patients with knee osteoarthritis (K-OA) were included. MRgFUS treatment was applied to the bone surface with real-time temperature monitoring at the target sites. Pain intensity was assessed using a 100 mm numerical rating scale (NRS) at various time points. Pressure pain threshold (PPT) was evaluated on the sonication area and control sites. Compared to baseline, the pain NRS scores significantly decreased in all groups 1 month after treatment, and PPT at the treated sites significantly increased in all groups 3 months after treatment. The percentage of patients who showed a ≥ 50% decrease in pain NRS scores at 1 month after treatment was 80% in BM, 64% in L-OA, and 78% in K-OA groups. PPTs were significantly higher after treatment at all evaluation time points. This study indicated that MRgFUS is effective in reducing pressure pain at the site of most severe tenderness in patients with painful bone and joint diseases. Treatment response was comparable between patients with BM, L-OA, and K-OA.

Efficacy and safety of magnetic resonance-guided focused ultrasound for the treatment of painful bone metastases: a systematic review and meta-analysis

“…Only five studies (N = 102) reported data on patient quality of life before and after MRgFUS treatment. Three studies (N = 58) utilized the Brief Pain Inventory Quality of Life (BPI QoL) questionnaire [50] with a mean baseline and 3-month follow-up scores of 36.2 and 28.5, respectively [13,17,22]. The pooled mean difference was − 8.5 (95% CI − 14.6; − 2.4).…”

Anatomic thermochromic tissue-mimicking phantom of the lumbar spine for pre-clinical evaluation of MR-guided focused ultrasound (MRgFUS) ablation of the facet joint

“…In recent years, an innovative ablation technique known as MRI-guided focused ultrasound surgery (MRgFUS) has been developed for treatment of low back pain, based on earlier successes in treating patients with pain derived from other bone and joint diseases [6]. Trials targeting lumbar facet joints have demonstrated that MRgFUS can be a safe and effective noninvasive method for treatment of facet joint pathology [7,8].…”

Efficacy and safety of magnetic resonance-guided focused ultrasound treatment for refractory chronic pain of medial knee osteoarthritis

“…Magnetic resonance image-guided focused ultrasound (MRgFUS) treatment enables accurate targeting and noninvasive real-time monitoring of temperature at the treatment site [12,13]. In recent years, the potential of palliative therapy for various pain conditions of bone and joint diseases has been demonstrated by accurately and reliably producing local bone denervation utilizing these crucial advantages of this system [14][15][16][17]. In a previous preliminary study, we confirmed the feasibility of this treatment targeted to the tibial plateau for painful knee OA and reported the early pain-relieving effects on chronic knee pain, although the long-lasting effects of pain alleviation and improvement of physical function remain unclear [16].…”

“…In a previous preliminary study, we confirmed the feasibility of this treatment targeted to the tibial plateau for painful knee OA and reported the early pain-relieving effects on chronic knee pain, although the long-lasting effects of pain alleviation and improvement of physical function remain unclear [16]. In addition, a tendency that severe tenderness of medial knee joints was likely to be more reduced in patients who responded to the treatment than in patients who did not respond to the treatment was reported by evaluation of pressure pain thresholds (PPTs) using a handheld algometer [17]. PPTs are validated, reliable, and widely used as an additional objective method for assessing pain sensitization, involving the quantification of a patient's response to a standardized pressure stimulation of nociceptors in patients with knee OA [5,18,19].…”