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Try it, Use it or Lose it! Hands-In approach to forget pain, useful tips

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Old 12-05-2004, 09:16 PM   #1
emad
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Default Ultrasound Therapy !

Hi all :

Are you still using ultrasound therapy?

I am still using it to treat pain ,at least inturrepted :!: :idea:

Let us begin a discussion around this therapy .


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Old 13-05-2004, 08:59 PM   #2
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Hi Bernard :

now , i am trying to search pubmed , to ind evidences to use US in treating pain , i will support if it is available.

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Old 13-05-2004, 09:18 PM   #3
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Phys Ther. 2001 Jul;81(7):1339-50.
review of therapeutic ultrasound: effectiveness studies.

Robertson VJ, Baker KG.

School of Physiotherapy, La Trobe University, Bundoora, Victoria 3086, Australia. V.Robertson@latrobe.edu.au

BACKGROUND AND PURPOSE: Therapeutic ultrasound is one of the most widely and frequently used electrophysical agents. Despite over 60 years of clinical use, the effectiveness of ultrasound for treating people with pain, musculoskeletal injuries, and soft tissue lesions remains questionable. This article presents a systematic review of randomized controlled trials (RCTs) in which ultrasound was used to treat people with those conditions. Each trial was designed to investigate the contributions of active and placebo ultrasound to the patient outcomes measured. Depending on the condition, ultrasound (active and placebo) was used alone or in conjunction with other interventions in a manner designed to identify its contribution and distinguish it from those of other interventions. METHODS: Thirty-five English-language RCTs were published between 1975 and 1999. Each RCT identified was scrutinized for patient outcomes and methodological adequacy. RESULTS: Ten of the 35 RCTs were judged to have acceptable methods using criteria based on those developed by Sackett et al. Of these RCTs, the results of 2 trials suggest that therapeutic ultrasound is more effective in treating some clinical problems (carpal tunnel syndrome and calcific tendinitis of the shoulder) than placebo ultrasound, and the results of 8 trials suggest that it is not. DISCUSSION AND CONCLUSION: There was little evidence that active therapeutic ultrasound is more effective than placebo ultrasound for treating people with pain or a range of musculoskeletal injuries or for promoting soft tissue healing. The few studies deemed to have adequate methods examined a wide range of patient problems. The dosages used in these studies varied considerably, often for no discernable reason.

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Review, Tutorial

PMID: 11444997 [PubMed - indexed for MEDLINE



===================
Ned Tijdschr Geneeskd. 2000 Mar 11;144(11):502-5.

[Insufficient scientific evidence for efficacy of widely used electrotherapy, laser therapy, and ultrasound treatment in physiotherapy]

[Article in Dutch]

Bouter LM.

Instituut voor Extramuraal Geneeskundig Onderzoek, Faculteit der Geneeskunde Vrije Universiteit, Amsterdam. lm.bouter.emgo@med.vu.nl

The Dutch Health Council recently published a report on the efficacy of electrotherapy, laser therapy and ultrasound treatment for musculoskeletal disorders. The assessment was based on three systematic reviews, including 169 randomized clinical trials, and focused on a best-evidence synthesis. Virtually no conclusive clinically relevant effects of the three forms of physical therapy were found. Possible exceptions are electrotherapy for osteoarthrosis of the hip or knee, laser therapy for pain treatment and rheumatoid arthritis, and ultrasound treatment for epicondylitis lateralis. But even for these putative indications, further research is clearly needed before implementation in practice is justifiable. It is strongly recommended that the current widespread use of electrotherapy, laser therapy and ultrasound treatment should be reduced, preferably by self-regulation within the profession itself.

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PMID: 10735134 [PubMed - indexed for MEDLINE]
====================

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Old 14-05-2004, 12:06 AM   #4
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I have found similar evidence that US does not do anything more than very temporary or placebo relief.
Rarely, I have found it useful for very acute conditions - eg sprains - but as I do not see acute orthopaedic injury anymore (thankfully) it is not on my agenda of Rx choices.

Neither is interferential.


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Old 14-05-2004, 02:56 PM   #5
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Hi Bernard :

do u mean using of US somtimes be have palcebo effect , for example patients feel that u r using an apparatus .

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Old 14-05-2004, 03:31 PM   #6
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Emad,

Not only US but all apparatuses and my hands, my words, the movements I make... Placebo is everywhere!

The specialist of Placebo is of course our friend Ian!
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Old 15-05-2004, 03:00 AM   #7
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Bernard

I think the placebo effect is widespread, as stated elsewhere; we use it consciously and unconsciously. So is nocebo.

It does not change my outlook; I do not like the principle of using magic machines to treat, which can lead to dependence on passive therapy. Words and actions speak louder.

It is not proven - it is just my preference!


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Old 15-05-2004, 11:18 AM   #8
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Hi Nari & Bernard:

Since 2 weeks a physiotherapist from a town beside my town died in an accident , so i was invited to do the work in that clinic , really , i know how he works , as sometimes patients go between me and He.

all his work is electrical , for long periods, high intenistey of all apparatus, all patients most neurological since year , 2 years more , taking 3 sessons per week .

i find my self in a very bad position , i can not work as he was doing , at the same time i can not refuse to work in the clinic , also it was extremely difficult to change the patient s mind of our work.

i suffered a lot to see human beings are abused like that ,i want to change , i can not the issue is like addication ,they want the session in the same way , i tried to change with 3 consumers ,who we lost , the problem was that the psychologically go with the past electrical facilities .


but ,
i can say US is not like thus what i narrated before , i mean is not addiction .

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Old 15-05-2004, 01:55 PM   #9
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emad-

Your experience in this other clinic must be very difficult to handle.
What makes these people keep on returning when there is no good being done to them? That is addiction, and the other PT is fostering that addiction. How long will you be there? You have little hope of changing that unless you are very strong with your views.

Similar things happen here too - private physios often keep the same person coming once or twice a week for years. It is guaranteed income, and that is all; and that is depressing and fraudulent.

Bernard -

Seriously, I do not like the idea of puncturing cell membranes!

I have noticed little effect from US after previous years of using it. Sure, it is one way of conversing in a relaxing manner for 5 minutes, but does one need to hold a magic wand in one hand to do that? :wink:

It does have a good effect on mastitis; and acute swelling. I will not argue that, but not chronic pain, unless there is a clearly defined tiny area which is likely to be quite nociceptive.

We will agree to disagree on this one, mon ami.

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Old 15-05-2004, 03:22 PM   #10
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hi all!

What is placebo or nocebo,nothing else than our possitive and negative way of thinking.
Its an ability in our self ,to heal or be sick ,due to our way of thinking.
As long as the pain ,espesially the chronick pain,maight be a result of the patients way of thinking(nocebo) it will not help in the long run for him or her, just to belive in what we are doing (handson,hands of)US,exercises,manipulation,acupuncture etc,etc.The pain will return quickly,because the main problem,her or his way of thinking(worring,anxiety,etc) has not changed.
As Nari,i have no belive in electrotherapy.nor in acute or chronick conditions.Sorry bernard!People who tells me the benefits of ET in acute conditions has to show me EBS that ET is better than the bodys normal healing prosesses in acute conditions.
Bernard!
Thanks for the topic on mental training(pos.thinking=placebo)
and the immunesystem!
RIN
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Old 15-05-2004, 08:41 PM   #11
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Hi Nari,Bernard & Rin:

Nari,

yes , i am so depressed to work in that clinc with those certain patients .

just now , i have tried to treat a case of facial palsy ,he was dealing with since 8 months , yes it is acse of postoperative in her ear , she is about 18 years , she is not married ( Here all people search for marriage only ) so she is at risk of losing that habit of marriage .

he went on to do electrical physio , doing bad until there is pattern movement in the patient s face , when i ask her to raise her brow it is acompanied by mouth movement deviation ( she has not gone under any
operations of the facial nerve)

any movement i ask her to do is accompanied by another movement .

what i can do ?

yes , alot of probelms , but i do not know if he was doing thus to gain money ????? but i think so

Regarding there in australia , i have not thought the situation is like here .

I think the law there is very very strong , but you say they are doing like that , so

Why ,and when the human being will go ethical??


nari
sorry to say i will go a long time , but i think the new cases i will deal with them better , but the problem if the whole town is in addication :twisted: :P :wink:

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Old 16-05-2004, 12:08 PM   #12
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hi bernard!
Fat treatment,what is it?
:wink: :wink: :wink: :?:
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Old 16-05-2004, 11:14 PM   #13
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Hi Bernard and everone ,

I have been meaning to write something on the forum but just have been busy with everything in my life. Well done bernard in the website and looking through it this morning briefly, it is impressive!

emad,

With regards to US therapy, I do not use it very often anymore often because I find I can better spend my time on other approaches. I agree with many others who state that most of the literature states that US is no better than placebo. However, if you look closely at the research, there is often a small percentage of the sample population that did respond to US better than placebo. Furthermore, when you look at the model for clinical reasoning, it is the combination of best of the evidence, best of the clinical expertise, and the best of the patient (including patient belief, past experiences etc). When you put these together, if you have a patient who has responded to US in the past say for tennis elbow, and your experience tells you that perhaps US may be useful for this particular patient, then I can see a good reason for using it.

I think Physiotherapy is a combination of art and science, and because we are treating individual human beings who differ so much between themselves, I am probably weary of saying "I never use...."

My opinions anyway.

Regards,
Henry Tsao 8)
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Old 17-05-2004, 02:44 AM   #14
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Hello Henry!

Welcome back into the exNOI group of Somasimplers- we look forward to hearing from you on a regular basis.

I missed your weather reports on the state of the day in Brisbane!

Nari (aka Leigh from NOI)
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Old 17-05-2004, 08:53 PM   #15
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Hi all friends;

Henrry welcome to somasimple

thanks henry,bernard,rin ,Rin and :arrow: for your sharing in the discussion , i am so happy to see the list of us is long


Henry
you are abslouletely right as EBP includes the best evidence besides to the clinical experience and patient education .

yes , it is no more than placebo , may be i am using it here , as patients need to see apparatuses,and red lights , no more than that .


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Old 17-05-2004, 09:53 PM   #16
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Hi all!
Henry!Nice to see you here on the soma simple!
Regarding the use of US,i never use it,BUT if the patients expectaions to treatment is US ,because it helped them earlier,i would consider letting one of my colleges take over the treatment!
I can to little about US to give the patient a"good" treatment.
When the patient belives in a treatment procedure i think that the placebo effect is great,and its ok.The placebo is withinus all.To me its nothing else than pos.expectations,pos.thinking etc.
I have to beleive in it to do it!I cant just hope for a placebo effect even though it might have been the reason for why it worked the last time.
Or it could have been a neurophysiology reason for why i worked .I dont now?

RIN :wink: :wink: :wink:
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Old 25-05-2004, 12:42 AM   #17
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I would like to add my comment on US. You all can see that I am trying to pick up some pace after a recent kick-back from the forum.

The use of US had been frustrating. Its effect is unpredictable (not many cases of flare-up, but I never have a clue of whether it is working or not.
It can't tell me how the patient is responding in a real time, vs. touch provides a lot of sensory-motor feedback not only to patients but to me.

I don't use it.
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Old 25-05-2004, 01:55 AM   #18
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Takao

I agree. I have more negative responses from the rare occasions I use than good ones. Very acute areas around joints often get zapped - even on <1 watt/cm2. The machine is regularly calibrated.

I do not like using something that no knows why it works (or doesn't work).


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