Examinando por Autor "Cleland, Joshua A."
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Ítem The cervical spine in tension type headache(Elsevier, 2023) Fernández-de-las-Peñas, César; Cook, Chad; Cleland, Joshua A.; Florencio, Lidiane L.Introduction: The concept that headaches may originate in the cervical spine has been discussed over decades and is still a matter of debate. The cervical spine has been traditionally linked to cervicogenic headache; however, current evidence supports the presence of cervical musculoskeletal dysfunctions also in tension-type headache. Purpose: This position paper discusses the most updated clinical and evidence-based data about the cervical spine in tension-type headache. Implications: Subjects with tension-type headache exhibit concomitant neck pain, cervical spine sensitivity, forward head posture, limited cervical range of motion, positive flexion-rotation test and also cervical motor control disturbances. In addition, the referred pain elicited by manual examination of the upper cervical joints and muscle trigger points reproduces the pain pattern in tension-type headache. Current data supports that the cervical spine can be also involved in tension-type headache, and not just in cervicogenic headache. Several physical therapies including upper cervical spine mobilization or manipulation, soft tissue interventions (including dry needling) and exercises targeting the cervical spine are proposed for managing tension-type headache; however, the effectiveness of these interventions depends on a proper clinical reasoning since not all will be equally effective for all individuals with tension-type headache. Based on current evidence, we propose to use the terms cervical “component” and cervical “source” when discussing about headache. In such a scenario, in cervicogenic headache the neck can be the cause (source) of the headache whereas in tension-type headache the neck will have a component on the pain pattern, but it will be not the cause since it is a primary headache.Ítem Ultrasound-guided percutaneous electrical nerve stimulation versus surgery for women with unilateral carpal tunnel syndrome: A randomized parallel-group trial(Wiley, 2023) Fernández-de- las- Peñas, César; Ortega-Santiago, Ricardo; Llave- Rincón, Ana I. de la-; Cleland, Joshua A.; Pareja, Juan A.; Saddi- Díaz, Homid Fahandezh; Arias-Buría, José LObjectiveThe aim of this clinical trial was to compare the outcomes of the application of ultrasound-guided percutaneous nerve stimulation (PENS) targeting the median nerve versus surgery for improving pain and function in women with CTS.MethodsIn this randomized parallel-group trial (ClinicalTrials.gov, NCT04246216), 70 women with CTS were randomly allocated to either PENS (n = 35) or surgery (n = 35) group. Hand pain intensity (mean pain and the worst pain experienced) was the primary outcome. Functional status and symptoms severity (Boston Carpal Tunnel Questionnaire, BCTQ) and self-perceived improvement (Global Rating of Change, GROC) were the secondary outcomes. Outcomes were assessed at baseline and 1, 3, 6 and 12 months after each intervention. Analysis was performed with intention to treat with mixed ANCOVAs adjusted for baseline outcomes.ResultsAnalyses showed an adjusted advantage for PENS at 1 (Δ −2.0, 95% CI −2.9 to −1.1) and 3 (Δ −1.4, 95% CI −2.3 to −0.5) months for mean pain, at 1 (Δ −2.2, 95% CI −3.3 to −1.1), 3 (Δ −1.75, 95% CI −2.9 to −0.6) and 6 (Δ −1.7, 95% CI −2.8 to −0.6) months in the worst pain intensity, and at 1 (Δ −0.95, 95% CI −1.1 to −0.8), 3 (Δ −0.55, 95% CI −0.8 to −0.3) and 6 (Δ −0.4, 95% CI −0.6 to −0.8) months in function. Both groups exhibited similar changes in symptom severity. Both groups reported similar improvement at 12 months in all outcomes. Symptoms and function improved in both groups, with PENS leading to better short-term outcomes than surgery.ConclusionThis clinical trial confirms that PENS applied with current understanding of pain mechanisms in CTS is as useful as surgery in women with CTS without denervation. The potential placebo effect of both interventions should not be ignored.SignificanceThe application of percutaneous nerve stimulation was more effective at short-term, but similar effective at mid and long-term, than surgery in women with carpal tunnel syndrome.