Treatment outcomes of peri-articular steroid injection for patients with work-related sacroiliac joint pain and lumbar para-spinal muscle strain.

OBJECTIVES: Evaluating treatment outcomes of local corticosteroid injections for work-related lower back pain (LBP) as the current evidence for the American College of Occupational and Environmental Medicine guidelines is considered insufficient to recommend this practice. MATERIAL AND METHODS: The authors conducted a retrospective study involving the patients who were treated with peri-articular and lower lumbar corticosteroid injections for work-related LBP at their occupational medicine clinic. RESULTS: Sixty-four patients met the inclusion criteria. The average pain level was reduced from M±SD 5.1±2.0 to M±SD 3.1±2.3 after the corticosteroid injection (p < 0.0001). Thirty-five patients (55%) were discharged to regular duty; 23 (36%) were transferred to orthopedics due to persistent pain; and 6 (9%) were lost to follow-up. CONCLUSIONS: Corticosteroid injections for work-related LBP are effective in reducing pain and enhancing discharge to regular duty. Nonetheless, larger prospective trials are needed to validate these findings. Int J Occup Med Environ Health. 2021;34(1):111-20.

Oral non-steroidal anti-inflammatory drugs versus other oral analgesic agents for acute soft tissue injury.

BACKGROUND: Acute soft tissue injuries are common and costly. The best drug treatment for such injuries is not certain, although non-steroidal anti-inflammatory drugs (NSAIDs) are often recommended. There is concern about the use of oral opioids for acute pain leading to dependence. This is an update of a Cochrane Review published in 2015. OBJECTIVES: To assess the benefits or harms of NSAIDs compared with other oral analgesics for treating acute soft tissue injuries. SEARCH METHODS: We searched the CENTRAL, 2020 Issue 1, MEDLINE (from 1946), and Embase (from 1980) to January 2020; other databases were searched to February 2019. SELECTION CRITERIA: We included randomised or quasi-randomised controlled trials involving people with acute soft tissue injury (sprain, strain, or contusion of a joint, ligament, tendon, or muscle occurring within 48 hours of inclusion in the study), and comparing oral NSAIDs versus paracetamol (acetaminophen), opioid, paracetamol plus opioid, or complementary and alternative medicine. The outcomes were pain, swelling, function, adverse effects, and early re-injury. DATA COLLECTION AND ANALYSIS: Two review authors independently assessed studies for eligibility, extracted data, and assessed risk of bias. We assessed the quality of the evidence using GRADE methodology. MAIN RESULTS: We included 20 studies, with 3305 participants. Three studies included children only. The others included predominantly young adults; approximately 60% were male. Seven studies recruited people with ankle sprains only. Most studies were at low or unclear risk of bias; however, two were at high risk of selection bias, three were at high risk of bias from lack of blinding, and five were at high risk of selective outcome reporting bias. Some evidence relating to pain relief was high certainty. Other evidence was either moderate, low or very low certainty, reflecting study limitations, indirectness, imprecision, or combinations of these. Thus, we are certain or moderately certain about some of the estimates, and uncertain or very uncertain of others. Eleven studies, involving 1853 participants compared NSAIDs with paracetamol. There were no differences between the two groups in pain at one to two hours (1178 participants, 6 studies; high-certainty evidence), at days one to three (1232 participants, 6 studies; high-certainty evidence), and at day seven or later (467 participants, 4 studies; low-certainty evidence). There was little difference between the groups in numbers of participants with minimal swelling at day seven or later (77 participants, 1 study; low-certainty evidence). Very low-certainty evidence from three studies (386 participants) means we are uncertain of the finding of little difference between the two groups in return to function at day seven or later. There was low-certainty evidence from 10 studies (1504 participants) that NSAIDs may slightly increase the risk of gastrointestinal adverse events compared with paracetamol. There was low-certainty evidence from nine studies (1679 participants) of little difference in neurological adverse events between the NSAID and paracetamol groups. Six studies, involving 1212 participants compared NSAIDs with opioids. There was moderate-certainty evidence of no difference between the groups in pain at one hour (1058 participants, 4 studies), and low-certainty evidence for no difference in pain at days four or seven (706 participants, 1 study). There was very low-certainty evidence of no important difference between the groups in swelling (84 participants, 1 study). Participants in the NSAIDs group were more likely to return to function in 7 to 10 days (542 participants, 2 studies; low-certainty evidence). There was moderate-certainty evidence (1143 participants, 5 studies) that NSAIDs were less likely to result in gastrointestinal or neurological adverse events compared with opioids. Four studies, involving 240 participants, compared NSAIDs with the combination of paracetamol and an opioid. The applicability of findings from these studies is in question because the dextropropoxyphene combination analgesic agents used are no longer in general use. Very low-certainty evidence means we are uncertain of the findings of no differences between the two interventions in the numbers with little or no pain at day one (51 participants, 1 study), day three (149 participants, 2 studies), or day seven (138 participants, 2 studies); swelling (230 participants, 3 studies); return to function at day seven (89 participants, 1 study); and the risk of gastrointestinal or neurological adverse events (141 participants, 3 studies). No studies reported re-injury rates. No studies compared NSAIDs with oral complementary and alternative medicines, AUTHORS' CONCLUSIONS: Compared with paracetamol, NSAIDs make no difference to pain at one to two hours and at two to three days, and may make no difference at day seven or beyond. NSAIDs may result in a small increase in gastrointestinal adverse events and may make no difference in neurological adverse events compared with paracetamol. Compared with opioids, NSAIDs probably make no difference to pain at one hour, and may make no difference at days four or seven. NSAIDs probably result in fewer gastrointestinal and neurological adverse effects compared with opioids. The very low-certainly evidence for all outcomes for the NSAIDs versus paracetamol with opioid combination analgesics means we are uncertain of the findings of no differences in pain or adverse effects. The current evidence should not be extrapolated to adults older than 65 years, as this group was not well represented in the studies.

Clinical effects of Zingiber cassumunar (Plai): A systematic review.

Zingiber cassumunar Roxb. known locally as "Plai" in Thai, has been used for treating bruise, sprain and musculoskeletal pain. Several pre-clinical studies demonstrated the anti-inflammatory effect of Plai. However, current evidence of clinical effects of Plai is still unclear. This study aimed to determine the clinical efficacy and safety of Plai among all identified indications. Of the 808 articles identified by a systematic review, six studies were included. Four studies were randomized controlled trials, while two studies were quasi-experimental studies involving 178 patients in intervention group and 177 patients in control group. Duration of treatment ranged from 7days to 2 months. Our findings showed that 14% Plai cream had a strong trend of benefits in pain reduction for muscle pain and ankle sprain. However, evidence supporting the effects of Plai on acne vulgaris treatment and anti-histamine effect are still unclear.

Oral non-steroidal anti-inflammatory drugs versus other oral analgesic agents for acute soft tissue injury.

BACKGROUND: Acute soft tissue injuries are common and costly. The best drug treatment for such injuries is not certain, although non-steroidal anti-inflammatory drugs (NSAIDs) are often recommended. OBJECTIVES: To assess the effects (benefits and harms) of NSAIDs compared with other oral analgesics for treating acute soft tissue injuries. SEARCH METHODS: We searched the Cochrane Bone, Joint and Muscle Trauma Group Specialised Register (12 September 2014), the Cochrane Central Register of Controlled Trials (The Cochrane Library, 2014 Issue 8), MEDLINE (1966 to September 2014), EMBASE (1980 to September 2014), CINAHL (1937 to November 2012), AMED (1985 to November 2012), International Pharmaceutical Abstracts (1970 to November 2012), PEDro (1929 to November 2012), and SPORTDiscus (1985 to November 2012), plus internet search engines, trial registries and other databases. We also searched reference lists of relevant articles and contacted authors of retrieved studies and pharmaceutical companies to obtain relevant unpublished data. SELECTION CRITERIA: We included randomised or quasi-randomised controlled trials involving people with acute soft tissue injury (sprain, strain or contusion of a joint, ligament, tendon or muscle occurring up to 48 hours prior to inclusion in the study) and comparing oral NSAID versus paracetamol (acetaminophen), opioid, paracetamol plus opioid, or complementary and alternative medicine. The outcomes were pain, swelling, function, adverse effects and early re-injury. DATA COLLECTION AND ANALYSIS: At least two review authors independently assessed studies for eligibility, extracted data and assessed risk of bias. We assessed the quality of the evidence using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) methodology. MAIN RESULTS: We included 16 trials, with a total of 2144 participants. Two studies included children only. The other 14 studies included predominantly young adults, of whom over 60% were male. Seven studies recruited people with ankle sprains only. Most studies were at low or unclear risk of bias; however, two were at high risk of selection bias, three were at high risk of bias from lack of blinding, one was at high risk of bias due to incomplete outcome data, and four were at high risk of selective outcome reporting bias. The evidence was usually either low quality or very low quality, reflecting study limitations, indirectness such from as suboptimal dosing of single comparators, imprecision, or one or more of these. Thus we are either uncertain or very uncertain of the estimates.Nine studies, involving 991 participants, compared NSAIDs with paracetamol. While tending to favour paracetamol, there was a lack of clinically important differences between the two groups in pain at less than 24 hours (377 participants, 4 studies; moderate-quality evidence), at days 1 to 3 (431 participants, 4 studies; low quality), and at day 7 or over (467 participants, 4 studies; low quality). A similar lack of difference between the two groups applied to swelling at day 3 (86 participants, 1 study; very low quality) and at day 7 or over (77 participants, 1 study; low quality). There was little difference between the two groups in return to function at day 7 or over (316 participants, 3 studies; very low quality): based on an assumed recovery of function of 804 per 1000 participants in the paracetamol group, 8 fewer per 1000 recovered in the NSAID group (95% confidence interval (CI) 80 fewer to 73 more). There was low-quality evidence of a lower risk of gastrointestinal adverse events in the paracetamol group: based on an assumed risk of gastrointestinal adverse events of 16 per 1000 participants in the paracetamol group, 13 more participants per 1000 had a gastrointestinal adverse event in the NSAID group (95% CI 0 to 35 more).Four studies, involving 958 participants, compared NSAIDs with opioids. Since a study of a selective COX-2 inhibitor NSAID (valdecoxib) that was subsequently withdrawn from the market dominates the evidence for this comparison (706 participants included in the analyses for pain, function and gastrointestinal adverse events), the applicability of these results is in doubt and we give only a brief summary. There was low quality evidence for a lack of clinically important differences between the two groups regarding pain at less than 24 hours, at days 4 to 6, and at day 7. Evidence from single studies showed a similar lack of difference between the two groups for swelling at day 3 (68 participants) and day 10 (84 participants). Return to function at day 7 or over favoured the NSAID group (low-quality), and there were fewer gastrointestinal adverse events in the selective COX-2 inhibitor NSAID group (very low quality).Four studies, involving 240 participants, compared NSAIDs with the combination of paracetamol and an opioid. The applicability of findings from these studies is partly in question because the dextropropoxyphene combination analgesic agents used are no longer in general use. While the point estimates favoured NSAID, the very low-quality evidence did not show a difference between the two interventions in the numbers with little or no pain at day 1 (51 participants, 1 study), day 3 (149 participants, 2 studies), or day 7 (138 participants, 2 studies). Very low-quality evidence showed a similar lack of difference between the two groups applied to swelling at day 3 (reported in two studies) and at day 7 (reported in two studies), in return to function at day 7 (89 participants, 1 study), and in gastrointestinal adverse events (141 participants, 3 studies).No studies compared NSAIDs with complementary and alternative medicines, and no study reported re-injury rates. AUTHORS' CONCLUSIONS: There is generally low- or very low-quality but consistent evidence of no clinically important difference in analgesic efficacy between NSAIDs and other oral analgesics. There is low-quality evidence of more gastrointestinal adverse effects with non-selective NSAID compared with paracetamol. There is low- or very low-quality evidence of better function and fewer adverse events with NSAIDs compared with opioid-containing analgesics; however, one study dominated this evidence using a now unavailable COX-2 selective NSAID and is of uncertain applicability. Further research is required to determine whether there is any difference in return to function or adverse effects between both non-selective and COX-2 selective NSAIDs versus paracetamol.

Effects of low-level laser therapy (LLLT) and diclofenac (topical and intramuscular) as single and combined therapy in experimental model of controlled muscle strain in rats.

Muscle injuries represent ca 30% of sports injuries and excessive stretching of muscle causes more than 90% of injuries. Currently the most used treatments are nonsteroidal anti-inflammatory drugs (NSAIDs), however, in last years, low-level laser therapy (LLLT) is becoming an interesting therapeutic modality. The aim of this study was to evaluate the effect of single and combined therapies (LLLT, topical application of diclofenac and intramuscular diclofenac) on functional and biochemical aspects in an experimental model of controlled muscle strain in rats. Muscle strain was induced by overloading tibialis anterior muscle of rats. Injured groups received either no treatment, or a single treatment with topical or intramuscular diclofenac (TD and ID), or LLLT (3 J, 810 nm, 100 mW) 1 h after injury. Walking track analysis was the functional outcome and biochemical analyses included mRNA expression of COX-1 and COX-2 and blood levels of prostaglandin E2 (PGE2 ). All treatments significantly decreased COX-1 and COX-2 gene expression compared with injury group (P < 0.05). However, LLLT showed better effects than TD and ID regarding PGE2 levels and walking track analysis (P < 0.05). We can conclude that LLLT has more efficacy than topical and intramuscular diclofenac in treatment of muscle strain injury in acute stage.

[Efficacy observation on rear thigh muscles strain of athletes treated with surrounding needling of electroacupuncture and hot compress of Chinese medicine].

OBJECTIVE: To verify the clinical efficacy on rear thigh muscles strain of athletes treated with surrounding needling of electroacupuncture and hot compress of Chinese medicine. METHODS: Eighty-six cases were randomly divided into an observation group and a control group, 43 cases in each one. In the observation group, surrounding needling of electroacupuncture and hot compress of Chinese medicine were used at Ashi points around the local affected area of rear thigh muscles. In the control group, conventional needling method and local cupping were applied at Chengfu (BL 36), Yinmen (BL 37), Weizhong (BL 40), etc. The treatment was given once a day. Ten treatments made one session. Two sessions were required. The score of rear thigh muscles pain, swelling and tenderness, walking function recovery and the total score were compared before and after treatment between two groups. The efficacy was compared between two groups. RESULTS: The score of pain, swelling and tenderness, walking function recovery and the total score were reduced obviously after treatmeat in two groups (all P < 0.01), and the improvements in the observation group were superior to those in the control group (P < 0.01, P < 0.05). The cured and remarkably effective rate was 83.7% (36/43) in the observation group, which was better than 60.5% (26/43) in the control group (P < 0.05). CONCLUSION: The efficacy of the surrounding needling of electroacupuncture and the hot compress of Chinese medicine is significant on rear thigh muscles strain for the athletes, which is superior to that of the conventional needling method and cupping in terms of the improvements in the symptoms and physical signs as well as the recovery of the walking function.

Long-term safety of using local anesthetic injections in professional rugby league.

BACKGROUND: Local anesthetic pain-killing injections are commonly used by some professional football teams to allow continued play for certain injuries; however, the long-term safety of this practice has not been studied. HYPOTHESIS: The majority of local anesthetic injections administered in professional football are helpful and safe, not leading to long-term sequelae. STUDY DESIGN: Case series; Level of evidence, 4. METHODS: A retrospective survey was conducted of 100 players over 10 seasons who had been injected with local anesthetic on 1023 occasions for 307 injuries (81% follow-up; average follow-up, 5 years; minimum, 1 year). A comparison of match performance statistics was made from 3 seasons between players using and not using local anesthetic. RESULTS: The majority (98%) of players would repeat the procedure if they had their injury again, although 32% felt that there were side effects associated with the procedure (including 22% who thought that the recovery of the primary injury was delayed and 6% who thought that the injury was worsened by playing with local anesthetic). On long-term follow-up, only 6% of players had significant residual pain in the body part injected. The satisfaction rates for acromioclavicular injuries, finger injuries, rib injuries, and iliac contusions were higher than for sternum injuries, wrist injuries, and ankle injuries. Player performance between those players injected and not injected with local anesthetic was not substantially different and mainly reflected a positional bias for the players who used local anesthetic. CONCLUSION: The most commonly injected injuries-acromioclavicular joint sprains, finger and rib injuries, and iliac crest contusions-appear to be quite safe (in the context of professional sport) to inject at long-term follow-up. Conversely, ankle, wrist, and sternum injections appear to be less safe. A few injuries may have been substantially worsened by playing after an injection.

Iridoid glycosides from Gardeniae Fructus for treatment of ankle sprain.

The iridoid glycosides, genipin 1-O-beta-D-isomaltoside (1) and genipin 1,10-di-O-beta-D-glucopyranoside (2), together with six known iridoid glycosides, genipin 1-O-beta-D-gentiobioside (3), geniposide (4), scandoside methyl ester (5), deacetylasperulosidic acid methyl ester (6), 6-O-methyldeacetylasperulosidic acid methyl ester (7), and gardenoside (8) were isolated from an EtOH extract of Gardeniae Fructus. The structures and relative stereochemistries of the metabolites were elucidated on the basis of 1D- and 2D-NMR spectroscopic techniques, high-resolution mass spectrometry, and chemical evidence. Geniposide (4), one of the main compounds of Gardeniae Fructus, was tested for treatment of ankle sprain using an ankle sprain model in rats. From the second to fifth day, the geniposide (4) (100mg/ml) treated group exhibited significant differences (p<0.01) with approximately 21-34% reduction in swelling ratio compared with those of the vehicle treated control group. This indicated the potential effect of geniposide (4) for the treatment of disorders such as ankle sprain.

[Clinical study of the infra-patellar fat pad strain treated by galvanism penetration of traditional Chinese medicine combined with ultrasonic wave and manipulation].

OBJECTIVE: To evaluate the therapeutic effects of galvanism penetration of traditional Chinese medicine combined with ultrasonic wave and manipulation in the treatment of strain of the infrapatellar fat pad, to study an effective approach in the treatment of this diseas. METHODS: Eighty patients were divided randomly into treatment group and control group, there were 40 cases in each group. In treatment group 40 cases were treated by galvanism penetration of traditional Chinese medicine, ultrasonic wave and manipulation, included 22 males and 18 females with an average age of (63.15 +/- 8.10) years old and a mean disease course of (6.84 +/- 3.50) years. In control group, 40 cases were treated with ultrasonic wave and manipulation, included 23 males and 17 females with an average age of (62.63 +/- 8.20) years old and the course was (6.59 +/-3.70) years. visual analogue scale (VAS) and the scales for pain with finger press were evaluated before and after treatment in two groups. The clinical effects were researched and analysed statistically. RESULTS: In treatment group,12 patients were in remarkable effects, 17 in good effective, 9 in effective and 2 in ineffective. As well in control group, above data were 8,15, 8 and 9 respectively. There was a significant difference in the rate of general effective between treatment group and control group (P < 0.05). In treatment group, the scales for VAS before and after treatment were (7.92 +/- 2.21) and (2.16 +/- 1.87) and the scales for pain with finger press before and after treatment were (3.01 +/- 0.63) and (0.86 <-- 0.46). As well in control group, above data were (7.71 +/2.65), (3.83 +/- 2.45), (2.98 +/- 0.61) and (1.32 +/- 0.52) respectively. The comparison of the scales for VAS and pain with finger press before and after treatment in two groups had significant difference (P < O.01). CONCLUSION: Ultrasonic wave and manipulation have a good effect in the treatment of stain of the infrapatellar fat pad, when the galvanism penetration of traditional Chinese medicine is applied at the same time, the therapeutic efficiency can be improved significantly. Three therapies are used in treatment at the same, it can improve the therapeutic effect, and it is an easy, economic, practical and effective comprehensive approach.

Effect of energy compound on skeletal muscle strain injury and regeneration in rats.

This study was designed to determine whether the supplement of energy compound could attenuate strain-induced damage to skeletal muscle in rats. Energy compound is a saline mixture of the following ingredients: ATP (10mg), Coenzyme-A (50 units), Coenzyme-Q(10) (50mg), Cytochrome C (30 mg) and Vitamin B(6) (50mg). Experimental animals were injured in right gastrocnemius muscles by a strain injury model. Energy compound groups were given energy compound 10 ml/kg body weight per day since injured, while saline groups were given saline at the same dose. And a sham operation was performed on the right hindlimb of control group. Plasma was centrifuged to measure lactate dehydrogenase (LDH), lactic acid (La) and creatine kinase (CK) on 3, 7 and 14 d post injury. Muscles were removed and fixed for histology observation and immunohistochemistry assay of desmin and vimentin. The results showed a similar tendency of plasma CK, La and LDH in saline and energy compound groups, while the lower level was found in the energy-compound group. The histological examination of muscle sections revealed a lower degree of damage in the energy compound group in which the expression levels of desmin and vimentin were higher than in the saline group. It is suggested that energy compound supplement may attenuate strain-induced muscle damage and facilitate its regeneration.

Comfrey extract ointment in comparison to diclofenac gel in the treatment of acute unilateral ankle sprains (distortions).

OBJECTIVES: A previously published study comparing the efficacy of comfrey extract to a commercial diclofenac (CAS 78213-16-8) preparation in the treatment of unilateral ankle sprains is critically re-evaluated. The study was designed to show non-inferiority of the comfrey extract. The data were re-evaluated for superiority according to CPMP guidelines. The study was an observer-blind, randomised, multi-centre clinical trial with two independent treatment groups "comfrey extract" and "diclofenac gel" (parallel group design) and included a total of 164 patients (82 in the comfrey group and 82 in the diclofenac group, intention-to-treat (ITT) analysis). Key variables were the area under the curve (AUC) from Visits 1 to 2 of the difference of the tenderness values contra-lateral minus injured side (primary variable), pain assessment (Visual Analogue Scale, VAS) at rest and on movement by patient, swelling (figure-of-eight method) and ankle movement (neutral zero method). On average (mean difference comfrey extract minus diclofenac), the AUC was +61.1 h x N/cm2 greater for patients treated with comfrey extract compared to diclofenac treated patients (95% confidence interval: 19.08; 103.09 h x N/cm2). The difference between the two treatment groups was statistically significant (analysis of variance with factors "study drug", "centre", and "drug x centre interaction"). Safety was excellent in both treatment groups. The re-evaluation of the data showed superiority of the plant based ointment over the diclofenac gel in the treatment of distortions. It is encouraging and impressive to realize that a natural product seems to be an effective and safe alternative to the standard topical treatment with diclofenac.

Efficacy of a comfrey root extract ointment in comparison to a diclofenac gel in the treatment of ankle distortions: results of an observer-blind, randomized, multicenter study.

In the treatment of minor blunt injuries several topical drugs are known to have anti-inflammatory and analgesic properties. They represent, however, two fundamentally different major pharmacological therapy approaches: the "chemical-synthetical" and the "phytotherapeutical" approach. The main objective of this trial (CODEC_2004) was to compare the efficacy and tolerability of an ointment of Comfrey extract (Extr. Rad. Symphyti) with that of a Diclofenac gel in the treatment of acute unilateral ankle sprain (distortion). In a single-blind, controlled, randomized, parallel-group, multicenter and confirmatory clinical trial outpatients with acute unilateral ankle sprains (n=164, mean age 29.0 years, 47.6% female) received either a 6 cm long ointment layer of Kytta-Salbe f (Comfrey extract) (n=82) or of Diclofenac gel containing 1.16 g of diclofenac diethylamine salt (n=82) for 7 +/- 1 days, four times a day. Primary variable was the area-under-the-curve (AUC) of the pain reaction to pressure on the injured area measured by a calibrated caliper (tonometer). Secondary variables were the circumference of the joint (swelling; figure-of-eight method), the individual spontaneous pain sensation at rest and at movement according to a Visual Analogue Scale (VAS), the judgment of impaired movements of the injured joint by the method of "neutral-zero", consumption of rescue medication (paracetamol), as well as the global efficacy evaluation and the global assessment of tolerability (both by physician and patient, 4 ranks). In this study the primary variable was also to be validated prospectively. It was confirmatorily shown that Comfrey extract is non-inferior to diclofenac. The 95% confidence interval for the AUC (Comfrey extract minus Diclofenac gel) was 19.01-103.09h*N/cm2 and was completely above the margin of non-inferiority. Moreover, the results of the primary and secondary variables indicate that Comfrey extract may be superior to Diclofenac gel.

A clinical and pharmacologic review of skeletal muscle relaxants for musculoskeletal conditions.

Muscle strains and other musculoskeletal disorders (MSDs) are a leading cause of work absenteeism. Muscle pain, spasm, swelling, and inflammation are symptomatic of strains. The precise relationship between musculoskeletal pain and spasm is not well understood. The dictum that pain induces spasm, which causes more pain, is not substantiated by critical analysis. The painful muscle may not show EMG activity, and when there is, the timing and intensity often do not correlate with the pain. Clinical and physiologic studies show that pain tends to inhibit rather than facilitate reflex contractile activity. The decision to treat and choice of therapy are largely dictated by the duration, severity of symptoms, and degree of dysfunction. Trigger point injections are sometimes used with excellent results in the treatment of muscle spasm in myofacial pain and low-back pain. NSAIDs are used with much greater frequency than oral skeletal muscle relaxants (SMRs) or opioids in the treatment of acute MSDs. Unfortunately, remarkably little sound science guides the choice of drug for the treatment of acute, uncomplicated MSDs, and the evaluation of efficacy of one agent over another is complicated by numerous factors. Only a limited number of high-quality, randomized, controlled trials (RCTs) provide evidence of the effectiveness of NSAIDs or SMRs in the treatment of acute, uncomplicated MSDs. The quality of design, execution, and reporting of trials for the treatment of MSDs needs to be improved. The combination of an SMR and an NSAID or COX-2 inhibitor or the combination of SMR and tramadol/acetaminophen is superior to single agents alone.

Effects of Cu/Zn superoxide dismutase on strain injury-induced oxidative damage to skeletal muscle in rats.

This study was designed to determine whether the supplement of superoxide dismutase (SOD) could attenuate strain-induced oxidative damage to skeletal muscle in rats. Experimental animals were injured in right gastrocnemius muscles by a strain injury model. SOD-treated groups were given Cu/Zn SOD 10 000 U/kg body weight per day since injured, while control groups were given normal saline. Parameters of antioxidant and muscle damage were detected in plasma 3 and 7 days postinjury. The injured muscles were removed and fixed for histology observation and immunohisto-chemistry assay of desmin. The results showed that plasma levels of SOD, glutathione peroxidase (GSH-Px), total antioxidant capacity (T-AOC) in SOD group were significantly higher than in the saline group on day 3 or 7, while the plasma creatine kinase (CK) and malondialdehyde (MDA) were lower in the SOD group than in the saline group. The histological examination of muscle sections revealed a lower degree of damage in the SOD group in which the expression level of desmin was higher than in the saline group. It is suggested that SOD supplement may attenuate strain-induced muscle damage and facilitate its regeneration.