Injection therapies for lateral epicondylalgia: a systematic review and Bayesian network meta-analysis

Dong, Wei; Goost, H.; Lin, Xiangbo; Burger, C.; Paul, C.; Wang, Zengli; Kong, Fanrong; Welle, Kristian; Jiang, Zhichao; Kabir, K.

doi:10.1136/bjsports-2014-094387

Cited by 72 publications

(70 citation statements)

References 57 publications

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“…Specific comparisons made by each investigation can be found in Data . The majority of studies found the treatment(s) studied were relatively effective in treating tendinopathy as assessed by pain and patient‐reported outcomes 29‐32,34‐37,40‐52,54 …”

Section: Resultsmentioning

confidence: 99%

Clinical management of tendinopathy: A systematic review of systematic reviews evaluating the effectiveness of tendinopathy treatments

Irby

Gutierrez

Chamberlin

et al. 2020

Scandinavian Med Sci Sports

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While the pathoetiology is disputed, a wide array of treatments is available to treat tendinopathy. The most common treatments found in the literature include therapeutic modalities, exercise protocols, and surgical interventions; however, their effectiveness remains ambiguous. The purpose of this study was to perform a systematic review of systematic reviews to determine the ability of therapeutic interventions to improve pain and dysfunction in patients with tendinopathy regardless of type or location. Five databases were searched for systematic reviews containing only randomized control trials to determine the effectiveness of treatments for tendinopathies based on pain and patient‐reported outcomes. Systematic reviews were assessed via the Assessment of Multiple Systematic Reviews (AMSTAR) for methodological quality. From the database search, 3,295 articles were found, 107 passed the initial inclusion criteria. After further review, 25 systematic reviews were included in the final qualitative analysis. The AMSTAR scores were relatively high (8.8 ± 1.0) across the 25 systematic reviews. Eccentric exercises were the most common and consistently effective treatment for tendinopathy across systematic reviews. Low‐level laser therapy and extracorporeal shockwave therapy demonstrated moderate effectiveness, while platelet‐rich plasma injections demonstrated inconclusive evidence on their ability to decrease tendinopathy‐related pain and improve function. Corticosteroids also showed some effectiveness for short‐term pain, but for the long‐term use deemed ineffective and at times contraindicated. Regarding surgical options, minimally invasive procedures were more effective compared to open surgical interventions. When treating tendinopathy regardless of location, eccentric exercises were the best treatment option to improve tendinopathy‐related pain and improve self‐reported function.

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Section: Resultsmentioning

confidence: 99%

Clinical management of tendinopathy: A systematic review of systematic reviews evaluating the effectiveness of tendinopathy treatments

Irby

Gutierrez

Chamberlin

et al. 2020

Scandinavian Med Sci Sports

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“…A recent Bayesian network meta-analysis that compared different injection therapies for lateral epicondylitis showed a not significant trend towards better effect than placebo for BoNT-A [32]. …”

Section: Resultsmentioning

confidence: 99%

Botulinum neurotoxin type A for the treatment of pain: not just in migraine and trigeminal neuralgia

et al. 2017

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BackgroundDespite their huge epidemiological impact, primary headaches, trigeminal neuralgia and other chronic pain conditions still receive suboptimal medical approach, even in developed countries. The limited efficacy of current pain-killers and prophylactic treatments stands among the main reasons for this phenomenon. Botulinum neurotoxin (BoNT) represents a well-established and licensed treatment for chronic migraine, but also an emerging treatment for other types of primary headache, trigeminal neuralgia, neuropathic pain, and an increasing number of pain conditions.MethodsWe searched and critically reviewed evidence for the efficacy of BoNT for the treatment of chronic pain.ResultsMeta-analyses and randomized controlled trials (RCTs) suggest that BoNT potentially represents a multi-purpose drug for the treatment of pain in several disorders due to a favorable safety profile and a long-lasting relief after a single injection.ConclusionsBoNT is an emerging treatment in different pain conditions. Future RCTs should explore the use of BoNT injection therapy combined with systemic drugs and/or physical therapies as new pain treatment strategies.

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“…(7) Prolotherapy, autologous blood or botulinic toxin injections, and others in ltrative therapies are less studied and therefore not clearly supported by the current literature. (8)(9)(10) Stem cells might be an alternative in the future. (11) Platelet-rich-plasma (PRP) is nowadays widely used for tendinopathies, considered as safe, and currently supported by the strongest scienti c journals (12).…”

Section: Introductionmentioning

confidence: 99%

Tennis Elbow, Study Protocol for Randomized Clinical Trial: Needling With and Without Platelet-Rich Plasma After Failure of Up-to-Date Rehabilitation

Schwitzguébel

Bogoev²,

Nikolov³

et al. 2020

Preprint

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Background: The conservative management of lateral epicondylitis is known to be a difficult-to-treat annoying condition. A treatment with platelet-rich plasma (PRP) is often performed, but its efficacy remains controversial.Methods: This study is a single-center, randomized double-blind controlled trial, preceded by a case series.This monocentric study including 232 patients will occur in two steps. During the first step, all patients will undergo an up-to-date rehabilitation, including epicondylar stretching and strengthening, periscapular tonification, epicondylar brace or taping, and focused extracorporeal shock waves therapy. Unsatisfied patients after the first step will be allocated for the 1:1 randomized trial of second step. Stratification is planned on age and lesion pattern. The masking will be quadruple (Participant, Care Provider, Investigator & Outcome Assessor). The patients will undergo ultrasound (US)-guided needling combined with either PRP (intervention group) or saline (Control group). Outcome data will be collected at -3, 0, 3, 6, and 12 months of the intervention.The primary endpoint is the pain improvement between months 0 and 3 on a 0-10 visual analog scale (VAS) during a maximal strength isometric contraction of the extensor carpialis brevis muscle. The secondary endpoints include the proportion of patients for which the tendon needling is not necessary after rehabilitation protocol, pain changes on VAS at rest and during maximal strength isometric contraction, changes of Single Assessment Numeric Evaluation (SANE) score, changes of Patient-Rated Tennis Elbow Evaluation (PRTEE) score, changes of maximal grip strength on Jamar test, and changes of the US of the epicondylar tendons (i.e. Volume of the lesion in mm3; Doppler reaction classified at the proportion of the tendon marked with the Doppler signal; Solution of continuity in mm3; Tendon thickness in mm; Concomitant superficial lesion & volume in mm3; Pain on a 0-10 VAS scale during sonopalpation).Discussion: The study results will provide insight into the effect of PRP as adjuvant therapy to tendon fenestration, and may contribute to identify the best preceding and concomitant rehabilitation protocol.Trial registration: ClinicalTrials.gov: NCT03987256, registered 20 August 2019

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Injection therapies for lateral epicondylalgia: a systematic review and Bayesian network meta-analysis

Cited by 72 publications

References 57 publications

Clinical management of tendinopathy: A systematic review of systematic reviews evaluating the effectiveness of tendinopathy treatments

Clinical management of tendinopathy: A systematic review of systematic reviews evaluating the effectiveness of tendinopathy treatments

Botulinum neurotoxin type A for the treatment of pain: not just in migraine and trigeminal neuralgia

Tennis Elbow, Study Protocol for Randomized Clinical Trial: Needling With and Without Platelet-Rich Plasma After Failure of Up-to-Date Rehabilitation

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