Nerve Decompression Study Offers Provocative Findings

By Brian McCurdy, Associate Editor

How Does Nerve Decompression Compare To Medications For Neuropathy?

   Does the surgery provide greater relief than the various pharmaceuticals available? Medications for neuropathy, such as gabapentin (Neurontin, Pfizer) or duloxetine HCl (Cymbalta, Eli Lilly), distract the brain from the “pain message” and treatments such as Anodyne (Anodyne Therapy) have no proven long-term efficacy, according to Dr. Dellon. As he asserts, medication neither prevents nor alters the progressive loss of nerve functioning in those with neuropathy.    Furthermore, the JAPMA study suggests peripheral nerve decompression may decrease patients’ post-op need for medications. Ninety-nine patients had taken pain medication before surgery while only 22 continued taking the same dose of medication after surgery, according to the study.    When it comes to treating neuropathy with medication, Dr. Wu says no drug available in the United States would repair the underlying nerve damage and have the effect on balance as the JAPMA study reported of the peripheral nerve decompression. While she notes that alpha lipoic acid has shown promise in treating diabetic peripheral and autonomic neuropathy, Dr. Wu says its affect on proprioception was not assessed during randomized trials.    However, noting that decompression may not be indicated for all those who have diabetic neuropathy, Dr. Wu cautions DPMs to weigh the risks versus benefits preoperatively and thoroughly review them with the patient. Dr. Dellon notes he does not operate on patients with diabetes unless the diabetes is under control.    Dr. Wu does not think patients with neuropathy would be reluctant to undergo surgery.     “In fact, numerous patients inquire about surgical decompression. With technological advances (such as the Internet), patients are more knowledgeable regarding their pathology and treatment options,” explains Dr. Wu. “I have had numerous patients, frustrated with the lack of complete symptomatic relief from their current treatment regimen, inquire about surgical options for their painful diabetic neuropathy.”

Can Saline Mist Ultrasound Jump Start Wound Healing?

By Brian McCurdy, Associate Editor    The use of ultrasound to treat wounds has been well documented in recent years but a recent randomized, double-blind study shows the efficacy of delivering the ultrasound therapy via a saline mist. Researchers conclude the ultrasound not only has a positive effect on healing but also has an antimicrobial effect.    The study, published in Ostomy/Wound Management, tracked 55 patients with diabetic ulcers. Patients received either 40 KHz of ultrasound delivered by the MIST system (Celleration, Inc.) or a placebo treatment. Clinicians also provided all patients with the standard of care, which included facilitating a moist wound environment, debridement and offloading. After 12 weeks, researchers found the rate of wound healing was 40.7 percent in the ultrasound group versus 14.3 percent in the placebo group.    What advantages does ultrasound therapy offer? William J. Ennis, DO, the lead author of the study, cites the four-minute speed of the painless treatment and says there is no contact with the wound bed due to the saline vehicle. Ultrasound therapy also provides benefits such as increasing blood flow to the wound bed, cleansing and debridement, according to Dr. Ennis, the Medical Director of the Wound Treatment Program at Advocate Christ Medical Center in Oak Lawn, Ill.    Dr. Ennis says ultrasound therapy also provides an antimicrobial benefit, citing preliminary data that shows the disruption of methicillin resistant Staph aureus (MRSA) and Pseudomonas. He notes he will be researching the mechanism of the antimicrobial effect next year.    In addition, he notes there are other theoretical benefits that have yet to be proven. Noting that decreased vascular endothelial growth factor (VEGF) may prohibit healing, Dr. Ennis says there may be increased VEGF when tissues are exposed to ultrasound.    Dr. Ennis says the efficacy of ultrasound in treating ulcers is favorable in comparison to treatments such as Regranex, Dermagraft and Apligraf.     “It does seem to be very effective for not only diabetic ulcers but for other wound types,” says Dr. Ennis.

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