Revista de Medicina Desportiva (English) March 2018 - Page 22

Topic 3

Revista Medicina Desportiva informa , 2018 ; 9 ( 2 ): 20-22 .

Mesotherapy in Musculoskeletal Pathology

Dr . Pedro Miguel Tavares Prata Post-Graduation on Sports Medicine , S . C . S . João Ver ; Resident of General medical practitioner , UCSP Anadia I
ABSTRACT
Pain is an unpleasant symptom that sooner or later hits any Human Being . There are several alternatives to relieve the pain , pharmacological and non-pharmacological . Mesotherapy is the administration of small doses of drug mixtures in the skin as close as possible to the injury , allowing a decrease on the side effects associated with non-steroidal anti-inflammatory drugs ( NSAIDs ) prescribed for the painful symptomatology . There are several theories that explain the mechanism of action of this technique , increasingly used in the musculoskeletal pathology . The published studies demonstrate its benefit and efficacy in the orthotraumatic , rheumatologic and sports pathologies with the use of analgesic drugs and myorelaxants . Mesotherapy is an additional therapeutic measure and alternative to other usual treatments prescribed for the treatment of pain .
KEYWORDS
Pain , mesoderm , analgesia , low doses , efficacy
Pain is an unpleasant symptom experienced by man , regardless of his acute or chronic character , in this case , when he persists more than three months . 1 . 2 Chronic pain is a frequent state , affecting approximately 20 % of the world ’ s population , accounting for 15-20 % of medical consultations . 2
In Europe , non-steroidal antiinflammatory drugs ( NSAIDs ) are the first therapeutic line in combating pain , associated with nonpharmacological therapies , namely physical exercise , physiotherapy and acupuncture . 3 The systemic adverse side effects of NSAIDs 3 , notably gastrointestinal toxicity , renal dysfunction , cardiovascular complications , especially in the elderly , introduces mesotherapy , if well tolerated , an alternative technique in combating pain . 3 . 4
Mesotherapy began in the fifties of the last century , was founded by the french physician Michel Pistor , who defined it as the “ injection in the skin of very low doses of medication , as close as possible to the injury or its origin , where the pain is expressed ” and “ with minimal undesirable effects .” In 1964 , he founded the French Society of Mesotherapy . 5
There are several theories about the mechanism of action of this technique 6 . 7 :
• Pistoriane theory
• Bicheron ’ s microcirculation theory
• Theory of mesoderm or of the three units of Dalloz-Bourguignon
• Mrejen ’ s punctual systematized mesotherapy theory
• Theory of the third circulation of Multedo
• Unified Theory of Kaplan
• Ballesteros ’ energetic mesotherapy theory These microinjections of drugs produce a mechanical distension of the surrounding tissues and sensitive fibers . At the same time , the needle activates the cutaneous receptors ( reflex arc ), increasing the levels of endorphins after the “ needle prick ”, although this hypothesis is not yet fully confirmed . 3 None of the above theories clarifies in itself the mechanism of action of mesotherapy . However , each of them explains part of a whole . 7
The correct practice of this technique requires clinical and pharmacological knowledge , in particular of the drugs to be administered , as well as aseptic care . 8
The mesotherapy can be applied by the manual technique or by the assisted technique . The first is done with a syringe and needle , the second uses a syringe holder – the pistol , the sight and the anti-reflux valve . When compared , the first is more painful , the depth of the injection is not constant , and the dose is not uniform . 6
We can also subdivide the application techniques into four categories 6 :
• As a burts or nappage – 2 to 4 injections , 2 to 4mm deep , spaced 2 to 4mm from one another
• Continuous with small volume – 0,05ml
• Continuous with high volume – intradermal papule
• Hypodermic – 4 to 10mm deep . The purpose of this technique It is the modelling of the pharmacokinetics of injected active substances , in order to prolong the pharmacological effect at Venue level . 3 Binaglia , in 1981 , revealed that the intradermal microinjections with ketoprofen sodium had an action more durable than the intramuscular injection , also demonstrating that , when injected to a depth greater than 10mm , it remained less time in the tissues , even reaching the systemic circulation . 8 . 9
A more recent study of 2011 demonstrated that the intradermal injection of the human follicular recombinant hormone ( rhFSH ), when injected at the abdominal level with a depth of 1-2mm , instead of a subcutaneous administration of 10-13mm , increased the absorption of FSH , allowing to maintain high FSH levels , for longer and with fewer adverse effects . 10
To fight the pain , associated with musculoskeletal pathology , small volume mixtures of various active principles are used , notably , NSAIDs ( piroxicam , tenoxicam , meloxicam ), muscle relaxants and salmon calcitonin . 5 The sodium diclofenac , so widely used by intramuscular route , has a less important role in mesotherapy , since it has to be diluted , and can , when isolated , cause subcutaneous necrosis and lead to the formation of a precipitate when mixed with lidocaine . 6
Most mesotherapy protocols use 1 % lidocaine or 1 % procaine , depending on the acute or chronic pathology , respectively , minimizing the pain associated with the needle prick in both cases . 5 Active principles , such as buflomedil and the pentoxifylline , due to the vasodilator action , are also used , as they increase the blood microcirculation in tissues , allowing a greater elimination of the toxic metabolites . 5
20 march 2018 www . revdesportiva . pt
Revista Medicina Desportiva informa, 2018; 9(2):20-22. Mesotherapy in Musculoskeletal Pathology Dr. Pedro Miguel Tavares Prata Post-Graduation on Sports Medicine, S. C. S. João Ver; Resident of General medical practitioner, UCSP Anadia I ABSTRACT Pain is an unpleasant symptom that sooner or later hits any Human Being. There are several alternatives to relieve the pain, pharmacological and non-pharmacological. Mesotherapy is the administration of small doses of drug mixtures in the skin as close as possible to the injury, allow- ing a decrease on the side effects associated with non-steroidal anti-inflammatory drugs (NSAIDs) prescribed for the painful symptomatology. There are several theories that explain the mechanism of action of this technique, increasingly used in the musculoskeletal pathology. The published studies demonstrate its benefit and efficacy in the orthotraumatic, rheumatologic and sports pathologies with the use of analgesic drugs and myorelaxants. Mesotherapy is an additional therapeutic meas- ure and alternative to other usual treatments prescribed for the treatment of pain. KEYWORDS Pain, mesoderm, analgesia, low doses, efficacy Pain is an unpleasant symptom experienced by man, regardless of his acute or chronic character, in this case, when he persists more than three months. 1.2 Chronic pain is a frequent state, affecting approxi- mately 20% of the world’s popula- tion, accounting for 15-20% of medi- cal consultations. 2 In Europe, non-steroidal anti- inflammatory drugs (NSAIDs) are the first therapeutic line in com- bating pain, associated with non- pharmacological therapies, namely physical exercise, physiotherapy and acupuncture. 3 The systemic adverse side effects of NSAIDs 3 , notably gas- trointestinal toxicity, renal dysfunc- tion, cardiovascular complications, especially in the elderly, introduces mesotherapy, if well tolerated, an alternative technique in combating pain. 3.4 Mesotherapy began in the fifties of the last century, was founded by the french physician Michel Pistor, who defined it as the “injection in the skin of very low doses of medi- cation, as close as possible to the injury or its origin, where the pain is expressed” and “with minimal unde- sirable effects.” In 1964, he founded the French Society of Mesotherapy. 5 There are several theories about the mechanism of action of this technique 6.7 : • Pistoriane theory 20 march 2018 www.revdesportiva.pt • Bicheron’s microcirculation theory • Theory of mesoderm or of the three units of Dalloz-Bourguignon • Mrejen’s punctual systematized mesotherapy theory • Theory of the third circulation of Multedo • Unified Theory of Kaplan • Ballesteros’ energetic mesotherapy theory These microinjections of drugs produce a mechanical distension of the surrounding tissues and sensitive fibers. At the same time, the needle activates the cutaneous receptors (reflex arc), increasing the levels of endorphins after the “needle prick”, although this hypoth- esis is not yet fully confirmed. 3 None of the above theories clarifies in itself the mechanism of action of mesotherapy. However, each of them explains part of a whole. 7 The correct practice of this tech- nique requires clinical and pharma- cological knowledge, in particular of the drugs to be administered, as well as aseptic care. 8 The mesotherapy can be applied by the manual technique or by the assisted technique. The first is done with a syringe and needle, the second uses a syringe holder – the pistol, the sight and the anti-reflux valve. When compared, the first is more painful, the depth of the injection is not con- stant, and the dose is not uniform. 6 We can also subdivide the applica- tion techniques into four categories 6 : • As a burts or nappage – 2 to 4 injections, 2 to 4mm deep, spaced 2 to 4mm from one another • Continuous with small volume – 0,05ml • Continuous with high volume – intradermal papule • Hypodermic – 4 to 10mm deep. The purpose of this technique It is the modelling of the pharmacokinet- ics of injected active substances, in order to prolong the pharmacologi- cal effect at Venue level. 3 Binaglia, in 1981, revealed that the intradermal microinjections with ketoprofen sodium had an action more dura- ble than the intramuscular injec- tion, also demons ][] [[XYH\ܙX]\[L][XZ[Y\[YH[B\Y\][XX[H\[ZX˜\[][ۋ BH[ܙHX[YHو LB[[ۜ]Y]H[Y\X[[X[ۈوH[X[X[\XX[[ܛ[ۙH  K[[XY]HXZ[[][]H\و KL[K[XYوHX][[\YZ[\][ۈقL LL[K[ܙX\YHXܜ[ۂو [[XZ[Z[Y][܈ۙ\[]]\Y\HYXˈ LYHZ[\X]Y]]\[[][]KX[[YHZ^\\و\[\X]B[\\\H\Y XKRQŠ\X[K[X[KY[X[JK]\H[^[[[[ۈ[ B]ۚ[ HH][HXٙ[XY[H\YH[[]\[\]K\H\[\ܝ[H[Y\B\\K[H]\H[]Y [[[\]Y ]\BX][[\Xܛ\[XYHܛX][ۈوHX\]]H[Z^Y]YZ[K [Y\\\H\H IHYZ[H܈ IHZ[K\[[ۈHX]H܈ۚXœ]K\X][KZ[[Z^B[HZ[\X]Y]BYYHX[\\ˈ HX]B[\\X\YYY[[H[Y[[KYHB\[]܈X[ۋ\H[\Y \^H[ܙX\HHZXܛB\[][ۈ[\Y\[[BܙX]\[[Z[][ۈوHX›Y]X]\ˈ