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      Radiofrecuencia de los nervios geniculados para el tratamiento del dolor crónico en la osteoartrosis de rodilla Translated title: Genicular nerve radiofrequency in osteoarthritis-related chronic knee pain

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          Abstract

          RESUMEN Introducción: El uso de radiofrecuencia de los nervios geniculados para el tratamiento del dolor crónico de la rodilla secundario a osteoartrosis inició en 2011, y desde entonces se han realizado varios estudios con diferentes metodologías. Sin embargo, continúan generándose muchas dudas con respecto a las dianas anatómicas, los criterios de selección y la evidencia de su efectividad. Materiales y métodos: Se realizó una búsqueda electrónica desde enero de 2011 hasta abril de 2020 en las siguientes bases de datos: PubMed(r), Embase(r), Google Académico y Web of Science (WoS). La búsqueda inicial encontró 106 artículos, de los cuales tomamos 33 para realizar la presente revisión. Resultados: Después de analizar cinco ensayos clínicos abiertos, un estudio de corte transversal, cuatro estudios prospectivos observacionales, ocho estudios de neuroanatomía, tres estudios retrospectivos, cuatro casos clínicos, dos series de casos, tres revisiones de la literatura y tres ensayos clínicos aleatorizados, controlados y doble ciegos; encontramos que la radiofrecuencia de los nervios geniculados disminuye el dolor asociado a la osteoartrosis de rodilla, consiguiendo una mejoría funcional con una duración variable del efecto analgésico entre tres y doce meses. A pesar del avance científico en esta área, aún no hay un consenso en cuanto a la neuroanatomía de la cápsula articular de la rodilla, la ubicación de las dianas, los parámetros empleados en radiofrecuencia y la utilidad de los bloqueos diagnósticos. Conclusiones: Se necesitan más ensayos clínicos que estandaricen los parámetros utilizados y confirmen los resultados positivos de los estudios realizados con radiofrecuencia de los nervios geniculados. Aunque son pocos los casos de eventos adversos asociados a la radiofrecuencia de los nervios geniculados, necesitamos más estudios que avalen la seguridad de esta técnica y sus efectos secundarios a largo plazo en el tratamiento del dolor crónico de la rodilla secundario a osteoartrosis que no responde a otros tratamientos.

          Translated abstract

          ABSTRACT Introduction: The use of genicular nerve radiofrequency procedures to treat chronic knee pain due to osteoarthritis has surged in 2011, though many questions remain regarding anatomical targets, selection criteria, and evidence for effectiveness. Materials and methods: An electronic search was performed from January 2011 to April 2020. Databases searched included PubMed(r), Embase(r), Google Scholar and Web of Science (WoS). The initial search found 106 articles. Thirty-three articles were taken for this review. Results: After analyzing five open clinical trials, one cross-sectional study, four prospective observational studies, eight neuroanatomy studies, three retrospective studies, four clinical cases, two case series, three literature reviews and three randomized, double blind, controlled trials; we found genicular nerve radiofrequency achieves a pain reduction and functional improvement with a variable duration, between three and twelve months. There is no consensus regarding the neuroanatomy of the knee joint capsule, the location of the targets, the radiofrequency parameters used and the usefulness of diagnostic blocks. Conclusion: More clinical trials are needed to standardize the parameters used and confirm the positive results of genicular nerve radiofrequency. Although there are few cases of adverse events associated with radiofrequency of the geniculate nerves, more studies are needed to support the safety of this technique and its long-term side effects in osteoarthritis knee pain management associated that do not respond to other previous medical treatments.

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          Most cited references39

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          OARSI guidelines for the non-surgical management of knee, hip, and polyarticular osteoarthritis

          To update and expand upon prior Osteoarthritis Research Society International (OARSI) guidelines by developing patient-focused treatment recommendations for individuals with Knee, Hip, and Polyarticular osteoarthritis (OA) that are derived from expert consensus and based on objective review of high-quality meta-analytic data.
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            OARSI recommendations for the management of hip and knee osteoarthritis, Part II: OARSI evidence-based, expert consensus guidelines.

            To develop concise, patient-focussed, up to date, evidence-based, expert consensus recommendations for the management of hip and knee osteoarthritis (OA), which are adaptable and designed to assist physicians and allied health care professionals in general and specialist practise throughout the world. Sixteen experts from four medical disciplines (primary care, rheumatology, orthopaedics and evidence-based medicine), two continents and six countries (USA, UK, France, Netherlands, Sweden and Canada) formed the guidelines development team. A systematic review of existing guidelines for the management of hip and knee OA published between 1945 and January 2006 was undertaken using the validated appraisal of guidelines research and evaluation (AGREE) instrument. A core set of management modalities was generated based on the agreement between guidelines. Evidence before 2002 was based on a systematic review conducted by European League Against Rheumatism and evidence after 2002 was updated using MEDLINE, EMBASE, CINAHL, AMED, the Cochrane Library and HTA reports. The quality of evidence was evaluated, and where possible, effect size (ES), number needed to treat, relative risk or odds ratio and cost per quality-adjusted life years gained were estimated. Consensus recommendations were produced following a Delphi exercise and the strength of recommendation (SOR) for propositions relating to each modality was determined using a visual analogue scale. Twenty-three treatment guidelines for the management of hip and knee OA were identified from the literature search, including six opinion-based, five evidence-based and 12 based on both expert opinion and research evidence. Twenty out of 51 treatment modalities addressed by these guidelines were universally recommended. ES for pain relief varied from treatment to treatment. Overall there was no statistically significant difference between non-pharmacological therapies [0.25, 95% confidence interval (CI) 0.16, 0.34] and pharmacological therapies (ES=0.39, 95% CI 0.31, 0.47). Following feedback from Osteoarthritis Research International members on the draft guidelines and six Delphi rounds consensus was reached on 25 carefully worded recommendations. Optimal management of patients with OA hip or knee requires a combination of non-pharmacological and pharmacological modalities of therapy. Recommendations cover the use of 12 non-pharmacological modalities: education and self-management, regular telephone contact, referral to a physical therapist, aerobic, muscle strengthening and water-based exercises, weight reduction, walking aids, knee braces, footwear and insoles, thermal modalities, transcutaneous electrical nerve stimulation and acupuncture. Eight recommendations cover pharmacological modalities of treatment including acetaminophen, cyclooxygenase-2 (COX-2) non-selective and selective oral non-steroidal anti-inflammatory drugs (NSAIDs), topical NSAIDs and capsaicin, intra-articular injections of corticosteroids and hyaluronates, glucosamine and/or chondroitin sulphate for symptom relief; glucosamine sulphate, chondroitin sulphate and diacerein for possible structure-modifying effects and the use of opioid analgesics for the treatment of refractory pain. There are recommendations covering five surgical modalities: total joint replacements, unicompartmental knee replacement, osteotomy and joint preserving surgical procedures; joint lavage and arthroscopic debridement in knee OA, and joint fusion as a salvage procedure when joint replacement had failed. Strengths of recommendation and 95% CIs are provided. Twenty-five carefully worded recommendations have been generated based on a critical appraisal of existing guidelines, a systematic review of research evidence and the consensus opinions of an international, multidisciplinary group of experts. The recommendations may be adapted for use in different countries or regions according to the availability of treatment modalities and SOR for each modality of therapy. These recommendations will be revised regularly following systematic review of new research evidence as this becomes available.
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              Persistent pain after joint replacement: prevalence, sensory qualities, and postoperative determinants.

              Persistent postsurgical pain is a prevalent but underacknowledged condition. The aim of this study was to assess the prevalence, sensory qualities, and postoperative determinants of persistent pain at 3 to 4years after total knee replacement (TKR) and total hip replacement (THR). Patients completed a questionnaire with included the Western Ontario and McMaster Universities Index of Osteoarthritis (WOMAC) Pain Scale, PainDetect Questionnaire, Short-Form McGill Pain Questionnaire, and questions about general health and socioeconomic status. A total of 632 TKR patients and 662 THR patients completed a questionnaire (response rate of 73%); 44% of TKR patients and 27% of THR patients reported experiencing persistent postsurgical pain of any severity, with 15% of TKR patients and 6% of THR patients reporting severe-extreme persistent pain. The persistent pain was most commonly described as aching, tender, and tiring, and only 6% of TKR patients and 1% of THR patients reported pain that was neuropathic in nature. Major depression and the number of pain problems elsewhere were found to be significant and independent postoperative determinants of persistent postsurgical pain. In conclusion, this study found that persistent postsurgical pain is common after joint replacement, although much of the pain is mild, infrequent, or an improvement on preoperative pain. The association between the number of pain problems elsewhere and the severity of persistent postsurgical pain suggests that patients with persistent postsurgical pain may have an underlying vulnerability to pain. A small percentage of patients have severe persistent pain after joint replacement, and this is associated with depression and the number of pain problems elsewhere. Copyright © 2010 International Association for the Study of Pain. Published by Elsevier B.V. All rights reserved.
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                Author and article information

                Journal
                dolor
                Revista de la Sociedad Española del Dolor
                Rev. Soc. Esp. Dolor
                Inspira Network Group, S.L (Madrid, Madrid, Spain )
                1134-8046
                June 2021
                : 28
                : 3
                : 157-168
                Affiliations
                [2] Majadahonda orgnameHospital Universitario Puerta de Hierro orgdiv1Unidad del Dolor España
                [1] Granada orgnameHospital Universitario Virgen de las Nieves orgdiv1Unidad del Dolor España
                Article
                S1134-80462021000400157 S1134-8046(21)02800300157
                10.20986/resed.2021.3900/2021
                9c51263f-1a65-4f87-baee-922a56e96747

                This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.

                History
                : 17 April 2021
                : 08 February 2021
                Page count
                Figures: 0, Tables: 0, Equations: 0, References: 39, Pages: 12
                Product

                SciELO Spain

                Categories
                Revisión

                radiofrequency,Knee pain,osteoarthritis,ablation,denervation,genicular nerve,Gonalgia,osteoartrosis,radiofrecuencia,ablación,denervación,nervios geniculados

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