Best practice & research. Clinical rheumatology
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Muscle injuries are one of the most common traumas occurring in sports. Despite their clinical importance, there are only a few clinical studies on the treatment of muscle injuries. Lack of clinical studies is most probably attributable to the fact that there is not only a high heterogeneity in the severity of injuries, but also the injuries take place in different muscles, making it very demanding to carry out clinical trials. ⋯ However, the duration of immobilisation should be limited to a period sufficient to produce a scar of sufficient strength to bear the forces induced by remobilisation without re-rupture and the return to activity (mobilisation) should then be started gradually within the limits of pain. Early return to activity is needed to optimise the regeneration of healing muscle and recovery of the flexibility and strength of the injured skeletal muscle to pre-injury levels. The rehabilitation programme should be built around progressive agility and trunk stabilisation exercises, as these exercises seem to yield better outcome for injured skeletal muscle than programmes based exclusively on stretching and strengthening of the injured muscle.
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Low back pain is an extremely common patient complaint. Most cases resolve fairly quickly after the acute episode. However, a small but significant number of patients develop chronic low back pain; a persistent disabling condition. ⋯ Currently, it is difficult to find clinical guidelines on how best to manage chronic low back pain, and it remains a substantial treatment challenge for both physicians and patients. The causes, risk factors, prognosis and treatment strategies for chronic low back pain will be discussed in this chapter. The evidence regarding different pharmacological and non-pharmacological treatment modalities will be reviewed and a logical, focused treatment strategy will be outlined.
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Best Pract Res Clin Rheumatol · Jun 2006
ReviewAnkylosing spondylitis and symptom-modifying vs disease-modifying therapy.
The main objectives of medical therapy in ankylosing spondylitis (AS) are to relieve pain, stiffness and fatigue and to prevent structural damage. The Assessment in Ankylosing Spondylitis Working Group has proposed different domains with specific instruments to assess the efficacy of therapeutic agents classified as symptom-modifying and disease-controlling antirheumatic drugs. Non-steroidal antiinflammatory drugs (NSAIDs) are still the first-line treatment in the management of AS, and they are effective in controlling symptoms such as pain and stiffness and maintaining mobility in many patients. ⋯ Small studies have reported favourable results with intravenous methylprednisolone pulse therapy, but the effect is temporary. Pamidronate and thalidomide have been used in some preliminary trials but need further studies to assess their potential role in treating AS patients resistant or intolerant to other forms of treatment. Treatment with tumour necrosis factor blockers is not discussed in this review.
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In this review, we outline a rational approach to the complex problem of chronic idiopathic pain syndromes. We focus principally on musculoskeletal pain disorders and emphasize the differences between adults and children. ⋯ The evidence base for the interventions reviewed include both 'medical' and 'non-medical' approaches. Practical problems and issues are dealt with throughout the review in order to construct a pragmatic approach that the authors intend to be of everyday use to the clinician and allied health professionals.
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Best Pract Res Clin Rheumatol · Feb 2006
ReviewAcetaminophen or NSAIDs for the treatment of osteoarthritis.
Although non-pharmacological interventions are the cornerstone of osteoarthritis management, analgesics are an important component of treatment during the symptomatic periods of the disease. In this respect, current practice guidelines advocate the use of a simple analgesic, acetaminophen, or a non-steroidal anti-inflammatory drug (NSAID), given either systemically or topically as first-line or second-line drug therapies. The present paper aims first to assess the evidence for the efficacy and safety of these medications. Given the increasing importance of patient involvement in decision-making, the following key practical issue regarding acetaminophen and NSAIDs will then be addressed: 'which drug do patients prefer?' Regarding NSAIDs, a further question concerns the place for non-selective agents and cyclo-oxygenase-2 (COX-2) selective inhibitors (coxibs) in the light of new warnings and contraindications concerning coxibs in patients with increased risk of cardiovascular thrombotic events.