BACKGROUND & AIMS: Musculoskeletal pain, the most common cause of disability globally, is most frequently managed in primary care. People with musculoskeletal pain in different body regions share similar characteristics, prognosis, and may respond to similar treatments. This overview aims to summarise current best evidence on currently available treatment options for the five most common musculoskeletal pain presentations (back, neck, shoulder, knee and multi-site pain) in primary care.
METHODS: A systematic search was conducted. Initial searches identified clinical guidelines, clinical pathways and systematic reviews. Additional searches found recently published trials and those addressing gaps in the evidence base. Data on study populations, interventions, and outcomes of intervention on pain and function were extracted. Quality of systematic reviews was assessed using AMSTAR, and strength of evidence rated using a modified GRADE approach.
RESULTS: Moderate to strong evidence suggests that exercise therapy and psychosocial interventions are effective for relieving pain and improving function for musculoskeletal pain. NSAIDs and opioids reduce pain in the short-term, but the effect size is modest and the potential for adverse effects need careful consideration. Corticosteroid injections were found to be beneficial for short-term pain relief among patients with knee and shoulder pain. However, current evidence remains equivocal on optimal dose, intensity and frequency, or mode of application for most treatment options.
CONCLUSION: This review presents a comprehensive summary and critical assessment of current evidence for the treatment of pain presentations in primary care. The evidence synthesis of interventions for common musculoskeletal pain presentations shows moderate-strong evidence for exercise therapy and psychosocial interventions, with short-term benefits only from pharmacological treatments. Future research into optimal dose and application of the most promising treatments is needed.
La artrosis de rodilla es una enfermedad crónica, invalidante, de evolución progresiva e irreversible. Los corticoides intraarticulares han sido comúnmente utilizados con el fin de disminuir sus síntomas y retrasar la resolución quirúrgica. Sin embargo, hasta el día de hoy, existe debate sobre su eficacia y seguridad. Utilizando la base de datos Epistemonikos, la cual es mantenida mediante búsquedas en 30 bases de datos, se identificaron 12 revisiones sistemáticas que en conjunto incluyen 41 estudios que contestan la pregunta de interés, entre los cuales se cuentan 40 estudios aleatorizados. Realizamos un metanálisis y tablas de resumen de los resultados utilizando el método GRADE. Concluimos que los corticoides intraarticulares probablemente llevan a una leve disminución del dolor a corto plazo, hacen poca o ninguna diferencia a mediano plazo y podrían no tener ningún efecto a largo plazo.
ANTECEDENTES: osteoartritis degenerativa de la rodilla (OA) afecta a 35% de las personas mayores de 65 años. Si el dolor persiste después del tratamiento no invasivo, algunos medicamentos intraarticulares pueden ser juzgados antes del tratamiento quirúrgico.
PREGUNTAS / FINES: El propósito de este artículo es revisar la literatura a partir de 2006 con el objetivo de responder a dos preguntas: (1) ¿Las inyecciones intraarticulares de corticosteroides (CS), ácido hialurónico (HA) y el plasma rico en plaquetas (PRP ) eficaz en la OA de rodilla dolorosa? y (2) ¿Cuál de estos fármacos es más eficaz?
MÉTODOS: Los motores de búsqueda fueron Medline y Cochrane Library. Las palabras clave utilizadas fueron: la rodilla, la osteoartritis, y las inyecciones intra-articulares. Se encontraron ocho cientos cuarenta y cuatro artículos, pero sólo 142 habían sido publicados después de 2006. De ellos, fueron seleccionados y revisados, ya que se han centrado estrictamente en el tema y las preguntas de este artículo sólo 14.
Resultados: La eficacia clínica de las inyecciones intraarticulares de AH y SC en pacientes con artrosis de rodilla, se ha demostrado. La reducción del dolor después de tres a cinco inyecciones semanales de HA dura entre 5 a 13 semanas (a veces hasta 1 año). La reducción del dolor es menos duradero después de las inyecciones de CS (2 a 3 semanas). Informes recientes indican que el PRP podría tener un mejor rendimiento que los HA en pacientes más jóvenes.
CONCLUSIONES: De tres a cinco inyecciones intraarticulares semanales de HA son recomendables en pacientes con artrosis de rodilla antes del tratamiento quirúrgico. Inyecciones CS tienen un efecto muy corto. La eficacia y la duración de las inyecciones de PRP requieren estudios adicionales.
INTRODUCTION: Osteoarthritis of the knee affects about 10% of adults aged over 60 years, with risk increased in those with obesity, and joint damage or abnormalities. Progression of disease on x rays is commonplace, but x ray changes don't correlate well with clinical symptoms.
METHODS AND OUTCOMES: We conducted a systematic review and aimed to answer the following clinical questions: What are the effects of non-surgical treatments for osteoarthritis of the knee? What are the effects of surgical treatments for osteoarthritis of the knee? We searched: Medline, Embase, The Cochrane Library and other important databases up to October 2006 (Clinical Evidence reviews are updated periodically, please check our website for the most up-to-date version of this review). We included harms alerts from relevant organisations such as the US Food and Drug Administration (FDA) and the UK Medicines and Healthcare products Regulatory Agency (MHRA).
RESULTS: We found 74 systematic reviews, RCTs, or observational studies that met our inclusion criteria. We performed a GRADE evaluation of the quality of evidence for interventions.
CONCLUSIONS: In this systematic review we present information relating to the effectiveness and safety of the following interventions: acupuncture, capsaicin, chondroitin, education to aid self-management, exercise and physiotherapy, glucosamine, insoles, intra-articular corticosteroids, intra-articular hyaluronan, joint bracing, knee replacement, non-steroidal anti-inflammatory drugs (including topical non-steroidal anti-inflammatory drugs), opioid analgesics, osteotomy, simple analgesics, and taping.
Musculoskeletal pain, the most common cause of disability globally, is most frequently managed in primary care. People with musculoskeletal pain in different body regions share similar characteristics, prognosis, and may respond to similar treatments. This overview aims to summarise current best evidence on currently available treatment options for the five most common musculoskeletal pain presentations (back, neck, shoulder, knee and multi-site pain) in primary care.
METHODS:
A systematic search was conducted. Initial searches identified clinical guidelines, clinical pathways and systematic reviews. Additional searches found recently published trials and those addressing gaps in the evidence base. Data on study populations, interventions, and outcomes of intervention on pain and function were extracted. Quality of systematic reviews was assessed using AMSTAR, and strength of evidence rated using a modified GRADE approach.
RESULTS:
Moderate to strong evidence suggests that exercise therapy and psychosocial interventions are effective for relieving pain and improving function for musculoskeletal pain. NSAIDs and opioids reduce pain in the short-term, but the effect size is modest and the potential for adverse effects need careful consideration. Corticosteroid injections were found to be beneficial for short-term pain relief among patients with knee and shoulder pain. However, current evidence remains equivocal on optimal dose, intensity and frequency, or mode of application for most treatment options.
CONCLUSION:
This review presents a comprehensive summary and critical assessment of current evidence for the treatment of pain presentations in primary care. The evidence synthesis of interventions for common musculoskeletal pain presentations shows moderate-strong evidence for exercise therapy and psychosocial interventions, with short-term benefits only from pharmacological treatments. Future research into optimal dose and application of the most promising treatments is needed.
