Jury Still Out on Best Settings, Duration of Ultrasound Treatment for Chronic Joint Pain

By Lorraine L. Janeczko

June 08, 2019

NEW YORK (Reuters Health) - It is still too early to make definite recommendations on the settings or duration of therapeutic ultrasound for chronic pain in the knee, hip or shoulder, the authors of a systematic review say.

"The literature on knee arthritis is most robust, with some evidence supporting therapeutic ultrasound, though the delivery method of ultrasound (pulsed vs continuous) is controversial," they write in Pain Medicine, online May 16. "As a monotherapy, ultrasound treatment may not have a significant impact on functional improvement but can be a reasonable adjunct to consider with other common modalities."

Dr. Rohit Aiyer of New York-Presbyterian Hospital/Weill Cornell Medicine in New York City and his colleagues searched the literature for randomized controlled trials (RCTs) testing the effectiveness of therapeutic ultrasound for chronic pain of any cause in adults with knee, shoulder or hip pain they'd had for at least three months. The primary outcome was change over time in visual analog or pain scores on numerical rating scales.

The team identified eight trials for knee, seven for shoulder and none for hip pain that met the inclusion criteria. All eight trials showed improvement in knee pain, and three of the eight showed statistically significant improvement with therapeutic ultrasound versus the comparator, including sham ultrasound.

For shoulder pain, all seven trials showed decreased pain, but in four studies, therapeutic ultrasound was inferior to the comparator treatment.

Dr. John J. Michalisin Jr., an assistant professor in the Department of Anesthesiology, Perioperative Care, and Pain Medicine at NYU Langone Health in New York City, told Reuters Health by email, "Despite its widespread use, there has been a significant gap in critically evaluating therapeutic ultrasound as a monotherapy for chronic extra-axial joint pain. Previous reviews were published over 20 years ago and they mainly reviewed ultrasound therapy as an adjunct treatment to another modality."

"A focus on improving function and reducing pain is paramount in the treatment of patients with chronic pain," advised Dr. Michalisin, who was not involved in the study. "As a noninvasive treatment with an excellent safety profile, ultrasound can be a reasonable adjunct to consider with other common modalities."

Dr. Eellan Sivanesan, director of neuromodulation in the Division of Pain Medicine at Johns Hopkins School of Medicine in Baltimore, Maryland, said by email that major joint pain is increasingly common, affects millions of people, and that new pain treatments are desperately needed.

"There is a pressing need for opioid alternatives, and this promising treatment needs further research to clearly identify its efficacy for chronic and acute pain conditions," noted Dr. Sivanesan, who also was not involved in the study. "Clinicians treating patients suffering from chronic pain related to major joints may now consider therapeutic ultrasound as another component of a multidimensional treatment plan to combat pain."

"These findings are in line with word-of-mouth reports amongst the community of physicians and other medical providers who treat patients living with pain," he explained. "However, it is surprising that although this treatment has existed for decades, it has still not received the attention and research support necessary to conduct large-scale clinical trials."

"The authors have provided a succinct overview of the handful of quality studies investigating therapeutic ultrasound for pain conditions," Dr. Sivanesan said.

Dr. Aiyer was not able to provide comments by press time.

The authors declare no funding sources or conflicts of interest.

SOURCE: https://bit.ly/2QN4VnU

Pain Med 2019.

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