Optimizing treatment of Osteoporosis

Optimizing treatment of Osteoporosis

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Prolotherapy - in Chronic Low Back Ache

"Prolotherapy, also known as 'sclerotherapy,' is a controversial treatment that has been the subject of much skepticism by traditional medicine. It consists of a series of intraligamentous and intratendinous injections of irritant solutions administered near trigger points to treat chronic pain. Although it has a strong foothold in the alternative and osteopathic medical communities, its efficacy has not been supported in clinical trials. Proponents of the therapy suggest that laxity in the ligaments and tendons around the joints causes pain by inducing muscles to contract and irritate nerve endings. Repeated injections with irritant solutions is believed to produce new collagen deposition, which is intended to support the injured or loosened ligaments, creating a more stable and strong muscle base, thus alleviating pain and disability. There are 3 classes of proliferant solutions: chemical irritants (eg, phenol, guaiacol, tannic acid, and pumice flour), osmotic agents (eg, hypertonic dextrose, zinc sulfate, and glycerin), and chemotactic agents (eg, sodium morrhuate, a fatty acid derivative of cod liver oil). Prolotherapy protocols usually include co-interventions to enhance the effectiveness of the injections."

Glucosamine in OA - an Internet based RCT

"The investigators' goal was to demonstrate the feasibility of performing a clinical trial purely over the Internet, rather than assess the efficacy of glucosamine alone. However, their findings were consistent with another recent study by Cibere and colleagues,[1] who evaluated patients with knee osteoarthritis who had experienced at least moderate subjective improvement with previous glucosamine use in whom the medication was discontinued. In their trial, no evidence of symptomatic benefit from continued use of glucosamine sulfate was demonstrated, and no differences were found in severity of disease flare or other secondary outcomes between placebo and glucosamine patients.[1] (This is in contrast to several industry-sponsored glucosamine trials that have demonstrated positive results.) Furthermore, physicians should be aware that supplements are costly and not covered by insurance; further studies are needed to resolve the question of efficacy."

Complex Regional Pain Syndrome

The National Institute of Neurological Disorders and Stroke (NINDS) defines complex regional pain syndrome (CRPS) as a chronic pain condition that is believed to be the result of dysfunction in the central or peripheral nervous system.[1] It describes the key symptom of CRPS as a continuous, intense pain out of proportion to the severity of the injury (if an injury has occurred), which worsens over time.

Long-Term NSAIDs May Not Be Useful for Osteoarthritis

"Nonsteroidal anti-inflammatory drugs (NSAIDs) offer only a small, short-term benefit that may not be clinically significant for people with knee osteoarthritis (OA), according to the results of a meta-analysis published in the Nov. 30 Online First issue of the BMJ. Due to the long-term harm and lack of demonstrated benefit, the investigators recommend against long-term use of NSAIDs for OA."

Vertebroplasty May Reduce Kyphosis in Selected Patients

Percutaneous vertebroplasty (PV) may reduce kyphosis in selected patients, according to the results of a study published in the December issue of Radiology. "Since its description, the objective of performing percutaneous vertebroplasty (PV) has been to treat pain in vertebral metastatic or compression fractures that are unresponsive to conventional treatments," write Robert Y. Carlier, MD, from the Hôpital Raymond Poincaré, in Garches, France, and colleagues. "To our knowledge, no randomized controlled study has shown a benefit beyond that of placebo in osteoporotic vertebral collapse fractures."

Facet Syndrome

Facet syndrome occurs as a result of synovitis or disruption. It is expressed as local pain in the region of the transverse processes, and referred pain radiating to corresponding segments if the nerve root emerging between the transverse processes is also damaged. Affected patients complain of low back pain, which is often prolonged. The pain may radiate to the groin, trochanter region, sacroiliac region, front or anterolateral aspect of the thigh as far as the knee, and even through the lower leg as far as the foot. Dull cervical pain radiating to the shoulder and arm may also be reported by some patients. The pain of facet syndrome is position-dependent and is experienced – often as ‘darts' of pain – when the patient stands up or takes his or her first few steps in the morning. Unlike intervertebral disc prolapse, facet syndrome is not associated with segmental pain, paraesthesia or neurological deficits (including sciatic malposture and the Lasègue phenomenon).

Facet Syndrome

Facet syndrome occurs as a result of synovitis or disruption. It is expressed as local pain in the region of the transverse processes, and referred pain radiating to corresponding segments if the nerve root emerging between the transverse processes is also damaged. Affected patients complain of low back pain, which is often prolonged. The pain may radiate to the groin, trochanter region, sacroiliac region, front or anterolateral aspect of the thigh as far as the knee, and even through the lower leg as far as the foot. Dull cervical pain radiating to the shoulder and arm may also be reported by some patients. The pain of facet syndrome is position-dependent and is experienced – often as ‘darts' of pain – when the patient stands up or takes his or her first few steps in the morning. Unlike intervertebral disc prolapse, facet syndrome is not associated with segmental pain, paraesthesia or neurological deficits (including sciatic malposture and the Lasègue phenomenon).

Unlike Rofecoxib, Celecoxib Not Linked to Increased Risk of MI

"Unlike rofecoxib, celecoxib does not appear to increase risk of myocardial infarction (MI), according to the results of a case-control study posted online Dec. 7 and published in the Feb. 1, 2005, print issue of the Annals of Internal Medicine."

Course of Nonsurgical Management of Burst Fractures

"The present study revealed that an intact posterior ligamentous complex might not prevent loss of correction gained by nonsurgical management of burst fractures. Significant loss occurs in the first 3 months despite external stabilization. However, the magnitude of residual deformity usually remains close to the initial deformity. Although changes in the shape of adjacent discs occur due to trauma and/or natural course, significant loss in signal intensity of nucleus pulposus is unlikely. Patient outcome seems to be highly satisfactory despite residual deformity."