BMJ, doi:10.1136/bmj.38961.584653.AE (published 29 September 2006)
Mobilisation with movement and exercise, corticosteroid injection, or
wait and see for tennis elbow: randomised trial Leanne Bisset et al
Objective: To investigate the efficacy of physiotherapy compared with a wait and see approach or corticosteroid injections over 52 weeks in tennis elbow.
Participants: 198 participants aged 18 to 65 years with a clinical diagnosis of tennis elbow of a minimum six weeks’ duration, who had not received any other active treatment by a health practitioner in the previous six months.
nterventions: Eight sessions of physiotherapy; corticosteroid injections; or wait and see.
Results: Corticosteroid injection showed significantly better effects at six weeks but with high recurrence rates thereafter (47/65 of successes subsequently regressed) and significantly poorer outcomes in the long term compared with physiotherapy. Physiotherapy was superior to wait and see in the short term; no difference was seen at 52 weeks, when most
participants in both groups reported a successful outcome.
Participants who had physiotherapy sought less additional treatment, such as non-steroidal anti-inflammatory drugs, than did participants who had wait and see or injections.
Conclusion: Physiotherapy combining elbow manipulation and exercise has a superior benefit to wait and see in the first six weeks and to corticosteroid injections after six weeks, providing a reasonable alternative to injections in the mid to long term.
The significant short term benefits of corticosteroid injection are paradoxically reversed after six weeks, with high recurrence rates, implying that this treatment should be used with caution in the management of tennis elbow.
I have found the warm laser to be very effective for tennis elbow.
In April 2010 a new list of Chronic Pain Guidelines was published by The American Society of Anesthesiologists.
The new recommendations are designed to help clinicians who treat pain. The objectives are to optimize pain control, enhance physical and psychological well-being, and minimize adverse outcomes.
The new guidelines appeared in the April issue of Anesthesiology. The recommendations apply to patients with chronic noncancer,
neuropathic, somatic, or visceral pain. The taskforce focused on interventional diagnostic procedures including diagnostic joint block, nerve block, and neuraxial opioid trials.
The key to chronic pain is creating an individualized treatment plan focused on optimizing the risk-to-benefit ratio. Treatment should progress from a lesser to greater degree of invasiveness.
The new guidelines advocate for multimodal interventions for patients with chronic pain. The taskforce suggests that a long-term approach that includes periodic follow-up evaluations should be developed and implemented as part of the overall treatment strategy. In addition, when available, multidisciplinary programs may be used.
The new guidelines detail
* ablative techniques,
* botulinum toxin,
* electrical nerve stimulation,
* epidural steroids,
* intrathecal drug therapies,
* minimally invasive spinal procedures,
* pharmacologic management,
* physical therapy,
* psychological treatment, and
* trigger point injections.
Drugs for chronic pain include anticonvulsants, antidepressants, benzodiazepines, N-methyl-D-aspartate receptor antagonists,
nonsterioidal anti-inflammatories, opioid therapy, skeletal muscle relaxants, and topical agents. The taskforce discusses each in detail and recommends strategies for monitoring and managing adverse effects and patient compliance.
Dr. Tucker comment: Over the years my practice has evolved to treating chronic pain patients. I work with my clients medical doctors to design personalized programs. My current approach to chronic pain is to use warm laser, physical therapy, breath and body awareness, gentle corrective exercises, natural topical agents, and nutritional therapy. The exercise rehabilitation approach I use is unique in that I blend several techniques to create a treatment plan that gives clients responsibility for participating in recovery. Clients particularly like the detailed nutritional information I provide.