Investigation the efficacy of intra-articular prolotherapy with erythropoietin and dextrose and intra-articular pulsed radiofrequency on pain level reduction and range of motion improvement in primary osteoarthritis of knee

Poupak Rahimzadeh, Farnad Imani, Seyed Hamid Reza Faiz, Saeed Reza Entezary, Ali Akbar Nasiri, Mohsen Ziaeefard, Poupak Rahimzadeh, Farnad Imani, Seyed Hamid Reza Faiz, Saeed Reza Entezary, Ali Akbar Nasiri, Mohsen Ziaeefard

Abstract

Background: Osteoarthritis is one of the most common diseases and the knee is the most commonly affected joint. Intra-articular prolotherapy is being utilized in acute and chronic pain management setting. This study was designed to compare the efficacy of three methods of intra-articular knee joint therapies with erythropoietin, dextrose, and pulsed radiofrequency.

Materials and methods: After approval by the Ethics Committee and explaining the therapeutic method to volunteers, 70 patients who were suffering from primary knee osteoarthrosis went through one of the treatment methods (erythropoietin, dextrose, and pulsed radiofrequency). The study was double-blind randomized clinical trial performed from December 2012 to July 2013. Patients' pain level was assessed through the visual analog pain scale (VAS), and range of motion (ROM) was measured by goniometric method. Furthermore, patients' satisfaction was assessed before and after different treatment methods in weeks 2, 4, and 12. For analysis, Chi-square, one-way ANOVA, and repeated measured ANOVA were utilized.

Results: The demographic results among the three groups did not indicate any statistical difference. The mean VAS in erythropoietin group in the 2(nd), 4(th), and 12(th) weeks was 3.15 ± 1.08, 3.15 ± 1.08, and 3.5 ± 1.23, respectively (P ≤ 0.005). Knee joint ROM in the erythropoietin group in the 2(nd), 4(th), and 12(th) weeks was 124 ± 1.50, 124 ± 1.4, and 123 ± 1.53 respectively (P ≤ 0.005). Satisfaction score in the 12(th) week in erythropoietin group was extremely satisfied 15%, satisfied 55%, and moderately satisfied 30%, (P = 0.005). No specific side-effects were observed.

Conclusion: Intra-articular prolotherapy with erythropoietin was more effective in terms of pain level reduction and ROM improvement compared with dextrose and pulsed radiofrequency.

Keywords: Erythropoietin; knee osteoarthritis; prolotherapy; pulsed radiofrequency; visual analogue pain scale.

Conflict of interest statement

Conflict of Interest: None declared.

References

    1. Waldman SD. Philadelphia: Elsevier; 2011. Pain Management. 9 (9 what's mean?) pp. 384–95.
    1. Altman R, Asch E, Bloch D, Bole G, Borenstein D, Brandt K, et al. Development of criteria for the classification and reporting of osteoarthritis. Classification of osteoarthritis of the knee. Diagnostic and Therapeutic Criteria Committee of the American Rheumatism Association. Arthritis Rheum. 1986;29:1039–49.
    1. Klinge SA, Sawyer GA. Effectiveness and safety of topical versus oral nonsteroidal anti-inflammatory drugs: A comprehensive review. Phys Sportsmed. 2013;41:64–74.
    1. Ryan M, Wong A, Rabago D, Lee K, Taunton J. Ultrasound-guided injections of hyperosmolar dextrose for overuse patellar tendinopathy: A pilot study. Br J Sports Med. 2011;45:972–7.
    1. Reeves KD, Hassanein K. Randomized prospective double-blind placebo-controlled study of dextrose prolotherapy for knee osteoarthritis with or without ACL laxity. Altern Ther Health Med. 2000;6:68–74. 77.
    1. Reeves KD, Hassanein K. Randomized, prospective, placebo-controlled double-blind study of dextrose prolotherapy for osteoarthritic thumb and finger (DIP, PIP, and trapeziometacarpal) joints: Evidence of clinical efficacy. J Altern Complement Med. 2000;6:311–20.
    1. Marui T, Niyibizi C, Georgescu HI, Cao M, Kavalkovich KW, Levine RE, et al. Effect of growth factors on matrix synthesis by ligament fibroblasts. J Orthop Res. 1997;15:18–23.
    1. van Beuningen HM, Glansbeek HL, van der Kraan PM, van den Berg WB. Differential effects of local application of BMP-2 or TGF-beta 1 on both articular cartilage composition and osteophyte formation. Osteoarthritis Cartilage. 1998;6:306–17.
    1. Otsuka Y, Mizuta H, Takagi K, Iyama K, Yoshitake Y, Nishikawa K, et al. Requirement of fibroblast growth factor signaling for regeneration of epiphyseal morphology in rabbit full-thickness defects of articular cartilage. Dev Growth Differ. 1997;39:143–56.
    1. Rundqvist H, Rullman E, Sundberg CJ, Fischer H, Eisleitner K, Ståhlberg M, et al. Activation of the erythropoietin receptor in human skeletal muscle. Eur J Endocrinol. 2009;161:427–34.
    1. Arcasoy MO. The non-haematopoietic biological effects of erythropoietin. Br J Haematol. 2008;141:14–31.
    1. Lappin TR, Maxwell AP, Johnston PG. EPO's alter ego: Erythropoietin has multiple actions. Stem Cells. 2002;20:485–92.
    1. Brines M, Grasso G, Fiordaliso F, Sfacteria A, Ghezzi P, Fratelli M, et al. Erythropoietin mediates tissue protection through an erythropoietin and common beta-subunit heteroreceptor. Proc Natl Acad Sci U S A. 2004;101:14907–12.
    1. Dagenais S, Haldeman S, Wooley JR. Intraligamentous injection of sclerosing solutions (prolotherapy) for spinal pain: A critical review of the literature. Spine J. 2005;5:310–28.
    1. McGee SJ, Havens AM, Shiozawa Y, Jung Y, Taichman RS. Effects of erythropoietin on the bone microenvironment. Growth Factors. 2012;30:22–8.
    1. Garcia P, Speidel V, Scheuer C, Laschke MW, Holstein JH, Histing T, et al. Low dose erythropoietin stimulates bone healing in mice. J Orthop Res. 2011;29:165–72.
    1. Holstein JH, Menger MD, Scheuer C, Meier C, Culemann U, Wirbel RJ, et al. Erythropoietin (EPO): EPO-receptor signaling improves early endochondral ossification and mechanical strength in fracture healing. Life Sci. 2007;80:893–900.
    1. Betsch M, Thelen S, Santak L, Herten M, Jungbluth P, Miersch D, et al. The role of erythropoietin and bone marrow concentrate in the treatment of osteochondral defects in mini-pigs. PLoS One. 2014;9:e92766.
    1. Geiger F, Bertram H, Berger I, Lorenz H, Wall O, Eckhardt C, et al. Vascular endothelial growth factor gene-activated matrix (VEGF165-GAM) enhances osteogenesis and angiogenesis in large segmental bone defects. J Bone Miner Res. 2005;20:2028–35.
    1. Ogilvie M, Yu X, Nicolas-Metral V, Pulido SM, Liu C, Ruegg UT, et al. Erythropoietin stimulates proliferation and interferes with differentiation of myoblasts. J Biol Chem. 2000;275:39754–61.
    1. Sluijter ME, Imani F. Evolution and mode of action of pulsed radiofrequency. Anesth Pain Med. 2013;2:139–41.
    1. Van Zundert J, Raj P, Erdine S, van Kleef M. Application of radiofrequency treatment in practical pain management: State of the art. Pain Pract. 2002;2:269–78.
    1. Imani F, Rahimzadeh P, Alebouyeh MR, Ghodrati MH. Evaluation of Intra-articular knee pulsed radiofrequency on joint pain and range of motion in knee osteoarthritis. J Anesthesiol pain. 2013;3:180–6.
    1. Masala S, Fiori R, Raguso M, Morini M, Calabria E, Simonetti G. Pulse-dose radiofrequency for knee osteoartrithis. Cardiovasc Intervent Radiol. 2014;37:482–7.
    1. Joint Commission on Accreditation of Healthcare Organizations and the National Pharmaceutical Council, Inc.; December; 2001. [Last accessed on 2001 Sept]. Pain: Current understanding of assessment, management and treatments. Available at: .
    1. Laubenthal KN, Smidt GL, Kettelkamp DB. A quantitative analysis of knee motion during activities of daily living. Phys Ther. 1972;52:34–43.
    1. Magilavy D, Polisson R, Parenti D, Karlsson, et al. Comparison of two hyaluronan drugs and placebo in patients with knee osteoarthritis. A controlled, randomized, double-blind, parallel-design multicentre study. Rheumatology (Oxford) 2003;42:1262.
    1. Holstein JH, Orth M, Scheuer C, Tami A, Becker SC, Garcia P, et al. Erythropoietin stimulates bone formation, cell proliferation, and angiogenesis in a femoral segmental defect model in mice. Bone. 2011;49:1037–45.
    1. Mihmanli A, Dolanmaz D, Avunduk MC, Erdemli E. Effects of recombinant human erythropoietin on mandibular distraction osteogenesis. J Oral Maxillofac Surg. 2009;67:2337–43.
    1. Calvillo L, Latini R, Kajstura J, Leri A, Anversa P, Ghezzi P, et al. Recombinant human erythropoietin protects the myocardium from ischemia-reperfusion injury and promotes beneficial remodeling. Proc Natl Acad Sci U S A. 2003;100:4802–6.
    1. Moon C, Krawczyk M, Ahn D, Ahmet I, Paik D, Lakatta EG, et al. Erythropoietin reduces myocardial infarction and left ventricular functional decline after coronary artery ligation in rats. Proc Natl Acad Sci U S A. 2003;100:11612–7.
    1. Cai Z, Manalo DJ, Wei G, Rodriguez ER, Fox-Talbot K, Lu H, et al. Hearts from rodents exposed to intermittent hypoxia or erythropoietin are protected against ischemia-reperfusion injury. Circulation. 2003;108:79–85.
    1. Sluijter ME, Teixeira A, Serra V, Balogh S, Schianchi P. Intra-articular application of pulsed radiofrequency for arthrogenic pain - Report of six cases. Pain Pract. 2008;8:57–61.
    1. Shah RV, Racz GB. Pulsed mode radiofrequency lesioning of the suprascapular nerve for the treatment of chronic shoulder pain. Pain Physician. 2003;6:503–6.
    1. Halim W, Chua NH, Vissers KC. Long-term pain relief in patients with cervicogenic headaches after pulsed radiofrequency application into the lateral atlantoaxial (C1-2) joint using an anterolateral approach. Pain Pract. 2010;10:267–71.
    1. Wu H, Groner J. Pulsed radiofrequency treatment of articular branches of the obturator and femoral nerves for management of hip joint pain. Pain Pract. 2007;7:341–4.
    1. Taverner MG, Ward TL, Loughnan TE. Transcutaneous pulsed radiofrequency treatment in patients with painful knee awaiting total knee joint replacement. Clin J Pain. 2010;26:429–32.
    1. Akbas M, Luleci N, Dere K, Luleci E, Ozdemir U, Toman H. Efficacy of pulsed radiofrequency treatment on the saphenous nerve in patients with chronic knee pain. J Back Musculoskelet Rehabil. 2011;24:77–82.
    1. Vallejo R, Benyamin RM, Kramer J, Stanton G, Joseph NJ. Pulsed radiofrequency denervation for the treatment of sacroiliac joint syndrome. Pain Med. 2006;7:429–34.
    1. Philip CN, Candido KD, Joseph NJ, Crystal GJ. Successful treatment of meralgia paresthetica with pulsed radiofrequency of the lateral femoral cutaneous nerve. Pain Physician. 2009;12:881–5.
    1. van Kleef M, Barendse GA, Kessels A, Voets HM, Weber WE, de Lange S. Randomized trial of radiofrequency lumbar facet denervation for chronic low back pain. Spine (Phila Pa 1976) 1999;24:1937–42.
    1. Vanelderen P, Rouwette T, De Vooght P, Puylaert M, Heylen R, Vissers K, et al. Pulsed radiofrequency for the treatment of occipital neuralgia: A prospective study with 6 months of follow-up. Reg Anesth Pain Med. 2010;35:148–51.

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