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      Journal of Pain Research (submit here)

      This international, peer-reviewed Open Access journal by Dove Medical Press focuses on reporting of high-quality laboratory and clinical findings in all fields of pain research and the prevention and management of pain. Sign up for email alerts here.

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      Beyond the muscular effects – onabotulinumtoxinA injections for pain control in chronic knee osteoarthritis: a case report

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          Abstract

          We present a long-standing case of an 88-year-old woman with multiple comorbidities receiving intra-articular Botox ® (onabotulinumtoxinA) injections for bilateral chronic knee osteoarthritis. She reported improved pain control and function supported by validated outcome measures.

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          Knee osteoarthritis prevalence, risk factors, pathogenesis and features: Part I.

          Osteoarthritis (OA) a common disease of aged population and one of the leading causes of disability. Incidence of knee OA is rising by increasing average age of general population. Age, weight, trauma to joint due to repetiting movements in particular squatting and kneeling are common risk factors of knee OA. Several factors including cytokines, leptin, and mechanical forces are pathogenic factors of knee OA. In patients with knee pain attribution of pain to knee OA should be considered with caution. Since a proportion of knee OA are asymptomatic and in a number of patients identification of knee OA is not possible due to low sensitivity of radiographic examination. In this review data presented in regard to prevalence, pathogenesis, risk factors.
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            BOTULINUM TOXIN

            Botulinum toxin, one of the most poisonous biological substances known, is a neurotoxin produced by the bacterium Clostridium botulinum. C. botulinum elaborates eight antigenically distinguishable exotoxins (A, B, C1, C2, D, E, F and G). All serotypes interfere with neural transmission by blocking the release of acetylcholine, the principal neurotransmitter at the neuromuscular junction, causing muscle paralysis. The weakness induced by injection with botulinum toxin A usually lasts about three months. Botulinum toxins now play a very significant role in the management of a wide variety of medical conditions, especially strabismus and focal dystonias, hemifacial spasm, and various spastic movement disorders, headaches, hypersalivation, hyperhidrosis, and some chronic conditions that respond only partially to medical treatment. The list of possible new indications is rapidly expanding. The cosmetological applications include correction of lines, creases and wrinkling all over the face, chin, neck, and chest to dermatological applications such as hyperhidrosis. Injections with botulinum toxin are generally well tolerated and side effects are few. A precise knowledge and understanding of the functional anatomy of the mimetic muscles is absolutely necessary to correctly use botulinum toxins in clinical practice.
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              Current interventions in the management of knee osteoarthritis

              Osteoarthritis (OA) is progressive joint disease characterized by joint inflammation and a reparative bone response and is one of the top five most disabling conditions that affects more than one-third of persons > 65 years of age, with an average estimation of about 30 million Americans currently affected by this disease. Global estimates reveal more than 100 million people are affected by OA. The financial expenditures for the care of persons with OA are estimated at a total annual national cost estimate of $15.5-$28.6 billion per year. As the number of people >65 years increases, so does the prevalence of OA and the need for cost-effective treatment and care. Developing a treatment strategy which encompasses the underlying physiology of degenerative joint disease is crucial, but it should be considerate to the different age ranges and different population needs. This paper focuses on different exercise and treatment protocols (pharmacological and non-pharmacological), the outcomes of a rehabilitation center, clinician-directed program versus an at home directed individual program to view what parameters are best at reducing pain, increasing functional independence, and reducing cost for persons diagnosed with knee OA.
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                Author and article information

                Journal
                J Pain Res
                J Pain Res
                Journal of Pain Research
                Journal of Pain Research
                Dove Medical Press
                1178-7090
                2018
                21 September 2018
                : 11
                : 1967-1970
                Affiliations
                [1 ]Canadian Centre for Integrative Medicine, Markham, ON, Canada, isabellek.lam@ 123456gmail.com
                [2 ]Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
                Author notes
                Correspondence: Kim Isabelle Lam, Canadian Centre for Integrative Medicine, University of Toronto, 12 Main Street North, Markham, ON L3P 1X2, Canada, Tel +1 647 462 4880, Email isabellek.lam@ 123456gmail.com
                Article
                jpr-11-1967
                10.2147/JPR.S159841
                6160270
                c1c8c836-b68b-42fe-a915-a04e8a1c8833
                © 2018 Ko et al. This work is published and licensed by Dove Medical Press Limited

                The full terms of this license are available at https://www.dovepress.com/terms.php and incorporate the Creative Commons Attribution – Non Commercial (unported, v3.0) License ( http://creativecommons.org/licenses/by-nc/3.0/). By accessing the work you hereby accept the Terms. Non-commercial uses of the work are permitted without any further permission from Dove Medical Press Limited, provided the work is properly attributed.

                History
                Categories
                Case Report

                Anesthesiology & Pain management
                osteoarthritis,pain management,injection,botox,knee
                Anesthesiology & Pain management
                osteoarthritis, pain management, injection, botox, knee

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