Kim Kyung-Hee, Suh Jung-Woo, Oh Ki Young
Department of Laboratory Medicine, Gachon University Gil Medical Center, Korea.
Department of Physical Medicine and Rehabilitation, Soonchunhyang University Cheonan Hospital, Korea.
J Back Musculoskelet Rehabil. 2017 Aug 3;30(4):913-920. doi: 10.3233/BMR-160641.
Local administration of opioids causes effective analgesia without adverse effects related to the central nervous system. After the beneficial demonstration of peripheral opioid receptors in joint synovia, intra-articular opioid injections were used for pain treatment. Clinical studies have reported the safety and efficacy of hyaluronate injection in the shoulder joint of patients with osteoarthritis, periarthritis, rotator cuff tears, and adhesive capsulitis.
To estimate the efficacy of intra-articular hyaluronate and tramadol injection for adhesive capsulitis of the shoulder compared with that of intra-articular hyaluronate injection alone.
Thirty patients with adhesive capsulitis of the shoulder were randomized to the hyaluronate group (n= 16) or the tramadol group (n= 14). Hyaluronate group members were administered five weekly intra-articular hyaluronate injections; tramadol group members were administered three weekly intra-articular hyaluronate and tramadol injections and then two weekly intra-articular injections of hyaluronate. Visual Analog Scale (VAS), passive range of motion (PROM) of the shoulder joint, and Shoulder Pain and Disability Index (SPADI) scores were assessed at baseline and weeks 1, 2, 3, 4, and 6 after the initial injection.
A significant improvement was observed in VAS, PROM, and SPADI scores between time points in both groups. In comparison in both groups at weeks 1 and 2 after the initial injection the VAS scores of the tramadol group were significantly lower than those of the hyaluronate group.
Intra-articular hyaluronate with tramadol showed more rapid and strong analgesic effects than intra-articular hyaluronate alone and did not induce any adverse effects.
局部使用阿片类药物可产生有效的镇痛作用，且无中枢神经系统相关不良反应。在关节滑膜中证实存在外周阿片受体后，关节内注射阿片类药物被用于疼痛治疗。临床研究报道了透明质酸盐注射治疗骨关节炎、肩周炎、肩袖撕裂和粘连性关节囊炎患者肩关节的安全性和有效性。
比较关节内注射透明质酸盐和曲马多与单独关节内注射透明质酸盐治疗肩周炎的疗效。
30例肩周炎患者被随机分为透明质酸盐组（n = 16）或曲马多组（n = 14）。透明质酸盐组患者每周接受5次关节内透明质酸盐注射；曲马多组患者每周接受3次关节内透明质酸盐和曲马多注射，然后每周接受2次关节内透明质酸盐注射。在基线以及首次注射后第1、2、3、4和6周评估视觉模拟评分（VAS）、肩关节被动活动范围（PROM）和肩痛及功能障碍指数（SPADI）评分。
两组各时间点的VAS评分、PROM评分和SPADI评分均有显著改善。首次注射后第1周和第2周，两组比较，曲马多组的VAS评分显著低于透明质酸盐组。
关节内注射透明质酸盐联合曲马多比单独关节内注射透明质酸盐显示出更快、更强的镇痛效果，且未引起任何不良反应。
