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