Evidence-based pain management: is the concept of integrative medicine applicable?

Rostyslav V Bubnov, Rostyslav V Bubnov

Abstract

This article is dedicated to the concept of predictive, preventive, and personalized (integrative) medicine beneficial and applicable to advance pain management, overviews recent insights, and discusses novel minimally invasive tools, performed under ultrasound guidance, enhanced by model-guided approach in the field of musculoskeletal pain and neuromuscular diseases. The complexity of pain emergence and regression demands intellectual-, image-guided techniques personally specified to the patient. For personalized approach, the combination of the modalities of ultrasound, EMG, MRI, PET, and SPECT gives new opportunities to experimental and clinical studies. Neuromuscular imaging should be crucial for emergence of studies concerning advanced neuroimaging technologies to predict movement disorders, postural imbalance with integrated application of imaging, and functional modalities for rehabilitation and pain management. Scientific results should initiate evidence-based preventive movement programs in sport medicine rehabilitation. Traditional medicine and mathematical analytical approaches and education challenges are discussed in this review. The physiological management of exactly assessed pathological condition, particularly in movement disorders, requires participative medical approach to gain harmonized and sustainable effect.

Figures

Figure 1
Figure 1
Transverse scan and the trigger point. (A) Transverse scan of the jugular region. Ultrasound visualization of the trigger points (trigger) and the needle inserted under ultrasound guidance. plex. brach, brachial plexus; m.SCM, sternocleidomastoid muscle; m. scalenus ant., anterior scalenus muscle. (B) The trigger point in anterior scalene muscle. Sonoelastography application depicts the blue area of rigid muscle tissue (arrows).
Figure 2
Figure 2
Diagram of VAS score changes in two groups.
Figure 3
Figure 3
Ultrasound visualization of the affected muscle in patient with hereditary myopathy. The case shows contracted muscle tissue (hypoechoic) vs. background of increased tissue echogenicity (bright) (arrows).
Figure 4
Figure 4
Models of needle direction for medial pterygopalatine muscle puncture. Left, on the muscle-bone model; right, projection on the skin. Fine needle is indicated by arrows.
Figure 5
Figure 5
Scheme of the irradiation pattern, ultrasonogram, and puncture. Irradiation pattern of the pain (right top), ultrasonogram of needling trigger points in the medial pterygoid muscle (left). m.pter.lat (caput sup.), lateral pterygoid muscle (superior head); proc.coronoideus, coronoid process of the mandible; caput mandibulae, head of the mandible; m.pter.medialis, medial pterygoid muscle. Puncture of the lateral pterygoid muscle under ultrasound guidance (right bottom).
Figure 6
Figure 6
Ultrasound of brachial plexus neuropathy. Arrows indicate enlarged (swollen) brachial plexus trunks up to 8 mm (contralateral trunks were about 3 mm). Sonoelastography (left) indicates rigid tissues of trunks (colored blue). Gray-scale ultrasonogram (right).
Figure 7
Figure 7
Spontaneus muscle activity in the trigger point, needled with US guidance, while LTR effect is evoked.

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Source: PubMed

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