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Physiotherapy, Rehabilitation and Sport medicine

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Analgesic Therapies

Infiltrations

In medicine, especially in orthopaedics, infiltrations (infiltrative therapy) are defined as drug injections (such as hyaluronic acid, local anaesthetics, cortisone, etc.) or biological solutions such as, for example, platelet growth factors or stem cells.

In the orthopaedic field, we can define the following types of infiltration:

  • joint infiltrations
  • periarticular infiltrations.

In the first case, the medicament solution is injected internally into the joint, while in the latter, the drug is inoculated into a site adjacent to the joint.

The main indications for infiltration therapy are related to joint disorders (e.g. arthrosis or non-infectious arthritis, chondropathies, etc.) and pathologies relating to periarticular structures and soft tissues (bursitis, capsulitis, enthesopathies, fasciitis, fibrositis, peritendinitis, root syndromes, tendinitis, tenosynovitis, etc.).

Acupuncture

It is not possible to provide a detailed index of the acupuncture pathologies and the therapeutic results obtained in each of them, since it is often the condition of the individual patients and their physiological recovery capabilities to determine the results of therapy, the effects of which at times can be definitive or only partial or disappointing.

It is up to the physician to submit patients for acupuncture when they see the possibility of a physiological recovery and to direct patients with seriously compromised conditions elsewhere, especially when there are irreversible organic injuries.

Given these premises, however, we can in any case provide a generic list with the elective guidelines for acupuncture therapy, broken down by branches:

Musculoskeletal system

Nervous system

Gynaecology and Obstetrics

Andrology

Urology

Cardiovascular conditions

Gastroenterology

Pulmonology

ENT conditions

Allergic events

Psycho-emotional disorders

 

Analgesic Mesotherapy

Mesotherapy, also called Intra Dermal Therapy (IDT), is a drug therapy consisting in the administration of minimal doses of drugs to a skin layer called dermis. It strictly takes place under medical expertise as it requires a diagnosis, an assessment of the treatment option compared with other therapeutic options, a pharmacological choice and the analysis of the results.

Background

The merit of having the intuition and demonstrating the effectiveness of mesotherapy goes to a French physician, Dr. Michel Pistor, who unexpectedly found the disappearance of deafness in a patient who had been deaf for forty years with an intravenous injection of the drug procaine. At this point, Dr. Pistor had the brilliant idea of performing multiple subcutaneous injections of small quantities of procaine in the periauricular area instead of in a vein. From that moment on, unexpected improvements began, such as the attenuation of symptoms such as tinnitus, vertigo, and pain in the temporomandibular joint.

Mechanism of action

Mesotherapy is performed by injecting very small doses of drugs with short needles into the subcutaneous tissue. The result is a subcutaneous deposit of the injected substance whose molecules directly affect the sites targeted by the treatment hence locally amplifying the therapeutic effects and limiting the general side-effects due to the small amounts of drug (2-4 ml depending on the extension of the anatomical part affected by the condition).

Immediately after the injection, a “bump” appears indicating the build-up of a drug that will be released in the following days as if it were a “depot” formulation (or “slow release”). The bump looks like a small mosquito bite. It does not itch, it’s not painful and it lasts a few minutes. It is evidence of the correctness of the method.

Indications

The most common application of mesotherapy is for pain, inflammatory and degenerative disorders of the musculoskeletal system, such as inflammatory states of arthrosis, tendinitis, bursitis, lumbar disease, cervical pain, muscle-tense headaches, bruises and distortions.

Benefits

Mesotherapy is particularly beneficial and useful when the age of patients and their general health conditions would advise against the use of oral medication hence reducing the overload for organs such as stomach, liver and kidneys. Particularly in rehabilitation, mesotherapy is beneficial because it accelerates functional recovery and enhances the effects of manual therapies and instrumental therapies such as laser, Tecar, shock waves and others.

Frequency of the treatment

The frequency of the therapy is usually weekly, but it may vary depending on the disease and its clinical (acute or chronic) phase from one every 4 days to one every 30 days. The number of sessions is variable, not exceeding, with most patients, six doses per cycle.

Side effects

Although it is a low-invasive therapy and involves inoculation of small pharmacological quantities, mesotherapy is not indicated in allergic subjects with severe circulatory, cardiac and respiratory disorders as well as in pregnant women.