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Autologous blood injections reduce pain

A 2013 RCT assessed the effectiveness of ABI (2 mL venous blood and 1 mL 2% lidocaine) compared with injection of 40 mg methylprednisolone and 1 mL 2% lidocaine in 50 patients with tennis elbow (mean age 38.2 years, mean duration of symptoms 4.5 weeks).¹ The degree of pain and disability were evaluated at baseline, 2 weeks, and 6 weeks using a visual analog pain scale (VAS) and Nirschl functional staging, respectively, both measured on 10-point scales. Researchers found no statistical difference between the groups at baseline or 2 weeks. At 6 weeks, however, the ABI group showed significant improvements over the steroid group in pain (mean VAS=1.52 vs 2.28; P=.0396) and disability (mean Nirschl stage=1.40 vs 2.40; P=.0045).

A previous RCT, in 2012, compared ABI (2 mL of venous blood and 1 mL of 0.5% bupivacaine) in 30 patients (mean age 42.9 years, mean duration of symptoms 9.5 weeks) with a corticosteroid injection (80 mg of methylprednisolone and 1 mL of 0.5% bupivacaine) in another 30 patients (mean age 42.2 years, mean duration of symptoms 7.7 weeks). Outcomes were assessed at 12 weeks and 6 months on a 10-point VAS and 7-point Nirschl stage.²

The ABI group showed a significant decrease in pain and disability compared with the steroid group (mean VAS at 12 weeks=0.6 vs 1.5, P=.0127; mean VAS at 6 months=0.5 vs 1.8; P=.0058; mean Nirschl stage at 12 weeks=0.43 vs 1.0; P=.0184; mean Nirschl stage at 6 months=0.36 vs 1.2; P=.0064).

PRP: Some efficacy, little significance

A 2014 double-blinded RCT analyzed the efficacy of PRP injection vs control injection for treating tennis elbow of at least 3 months’ duration.³ A total of 112 patients (mean age 48.4 years) received a 2- to 3-mL injection of PRP at a site blocked with bupivacaine; 113 patients (mean age 47.4 years) received an injection of 2 to 3 mL 0.5% bupivacaine only. Success was defined as a ≥25% improvement in pain score on a 100-point VAS.

At 24 weeks, the PRP group demonstrated a success rate of 83.9% compared with 68.3% in the control group (number needed to treat=6; P=.037). However, the difference between the mean VAS improvement of 38 points in the PRP group and the mean decrease of 36 points in the control group carries little clinical significance.

Autologous blood injections reduce pain

A 2013 RCT assessed the effectiveness of ABI (2 mL venous blood and 1 mL 2% lidocaine) compared with injection of 40 mg methylprednisolone and 1 mL 2% lidocaine in 50 patients with tennis elbow (mean age 38.2 years, mean duration of symptoms 4.5 weeks).¹ The degree of pain and disability were evaluated at baseline, 2 weeks, and 6 weeks using a visual analog pain scale (VAS) and Nirschl functional staging, respectively, both measured on 10-point scales. Researchers found no statistical difference between the groups at baseline or 2 weeks. At 6 weeks, however, the ABI group showed significant improvements over the steroid group in pain (mean VAS=1.52 vs 2.28; P=.0396) and disability (mean Nirschl stage=1.40 vs 2.40; P=.0045).

A previous RCT, in 2012, compared ABI (2 mL of venous blood and 1 mL of 0.5% bupivacaine) in 30 patients (mean age 42.9 years, mean duration of symptoms 9.5 weeks) with a corticosteroid injection (80 mg of methylprednisolone and 1 mL of 0.5% bupivacaine) in another 30 patients (mean age 42.2 years, mean duration of symptoms 7.7 weeks). Outcomes were assessed at 12 weeks and 6 months on a 10-point VAS and 7-point Nirschl stage.²

The ABI group showed a significant decrease in pain and disability compared with the steroid group (mean VAS at 12 weeks=0.6 vs 1.5, P=.0127; mean VAS at 6 months=0.5 vs 1.8; P=.0058; mean Nirschl stage at 12 weeks=0.43 vs 1.0; P=.0184; mean Nirschl stage at 6 months=0.36 vs 1.2; P=.0064).

PRP: Some efficacy, little significance

A 2014 double-blinded RCT analyzed the efficacy of PRP injection vs control injection for treating tennis elbow of at least 3 months’ duration.³ A total of 112 patients (mean age 48.4 years) received a 2- to 3-mL injection of PRP at a site blocked with bupivacaine; 113 patients (mean age 47.4 years) received an injection of 2 to 3 mL 0.5% bupivacaine only. Success was defined as a ≥25% improvement in pain score on a 100-point VAS.

At 24 weeks, the PRP group demonstrated a success rate of 83.9% compared with 68.3% in the control group (number needed to treat=6; P=.037). However, the difference between the mean VAS improvement of 38 points in the PRP group and the mean decrease of 36 points in the control group carries little clinical significance.

Autologous blood injections reduce pain

A 2013 RCT assessed the effectiveness of ABI (2 mL venous blood and 1 mL 2% lidocaine) compared with injection of 40 mg methylprednisolone and 1 mL 2% lidocaine in 50 patients with tennis elbow (mean age 38.2 years, mean duration of symptoms 4.5 weeks).¹ The degree of pain and disability were evaluated at baseline, 2 weeks, and 6 weeks using a visual analog pain scale (VAS) and Nirschl functional staging, respectively, both measured on 10-point scales. Researchers found no statistical difference between the groups at baseline or 2 weeks. At 6 weeks, however, the ABI group showed significant improvements over the steroid group in pain (mean VAS=1.52 vs 2.28; P=.0396) and disability (mean Nirschl stage=1.40 vs 2.40; P=.0045).

A previous RCT, in 2012, compared ABI (2 mL of venous blood and 1 mL of 0.5% bupivacaine) in 30 patients (mean age 42.9 years, mean duration of symptoms 9.5 weeks) with a corticosteroid injection (80 mg of methylprednisolone and 1 mL of 0.5% bupivacaine) in another 30 patients (mean age 42.2 years, mean duration of symptoms 7.7 weeks). Outcomes were assessed at 12 weeks and 6 months on a 10-point VAS and 7-point Nirschl stage.²

The ABI group showed a significant decrease in pain and disability compared with the steroid group (mean VAS at 12 weeks=0.6 vs 1.5, P=.0127; mean VAS at 6 months=0.5 vs 1.8; P=.0058; mean Nirschl stage at 12 weeks=0.43 vs 1.0; P=.0184; mean Nirschl stage at 6 months=0.36 vs 1.2; P=.0064).

PRP: Some efficacy, little significance

A 2014 double-blinded RCT analyzed the efficacy of PRP injection vs control injection for treating tennis elbow of at least 3 months’ duration.³ A total of 112 patients (mean age 48.4 years) received a 2- to 3-mL injection of PRP at a site blocked with bupivacaine; 113 patients (mean age 47.4 years) received an injection of 2 to 3 mL 0.5% bupivacaine only. Success was defined as a ≥25% improvement in pain score on a 100-point VAS.

At 24 weeks, the PRP group demonstrated a success rate of 83.9% compared with 68.3% in the control group (number needed to treat=6; P=.037). However, the difference between the mean VAS improvement of 38 points in the PRP group and the mean decrease of 36 points in the control group carries little clinical significance.

Evidence summary

A 2014 systematic review included 8 RCTs in adults (3954 patients) and one RCT in children (669 patients) with influenza and compared time to alleviation of symptoms with oseltamivir and placebo.¹ Symptoms were defined as local (nasal discharge, dry cough, sore throat) and systemic (fever, myalgia, headache, fatigue). Methodology for diagnosis varied by trial.

Oral oseltamivir (75, 150, or 300 mg for 5 to 10 days) reduced time to first alleviation of symptoms by 17 hours (95% confidence interval [CI], 8.4-25 hours) compared with placebo for adults and 29 hours (95% CI, 12-47 hours) for the otherwise healthy children.

The systematic review also included 2 RCTs involving 660 children with chronic asthma who received treatment with oseltamivir. Researchers found no reduction in time to symptom alleviation with the oseltamivir.

Treatment with oseltamivir increased the risk of nausea (number needed to harm [NNH]=28) and vomiting (NNH=22) in adults and the risk of vomiting (NNH=19) in children. Sources of bias included industry sponsorship of all trials, differing placebo components, inadequate recruitment, and use of other medication.

Shorter fever duration?

A 2012 meta-analysis of 6 observational studies (5842 patients) compared the effect of oral oseltamivir with no treatment on duration of signs and symptoms (definition not given) in patients with influenza (method of diagnosis not stated).² Oseltamivir reduced fever duration by 33 hours (95% CI, 21-45 hours) compared with no treatment.

The authors describe the evidence as being of very low quality because of study heterogeneity, lack of control for confounding variables, selection bias, and study sources (many unpublished industry studies).

There’s benefit even with late Tx

A 2014 double-blind RCT, not included in the previously described reviews, of 130 adults and 1070 children with a positive rapid influenza test examined the effect of oseltamivir and placebo on symptom duration.³ Research assistants visited participants at home each day until patients were asymptomatic for 7 consecutive days.

Treatment with oseltamivir reduced symptom duration by a median of one day compared with no treatment (hazard ratio=0.87; 95% CI, 0.79-0.95). This benefit was observed regardless of whether treatment was initiated fewer or more than 48 hours after symptom onset. One notable limitation was failure to control for paracetamol (acetaminophen) usage, a possible confounder for duration of symptoms, such as fever.

Evidence summary

A 2014 systematic review included 8 RCTs in adults (3954 patients) and one RCT in children (669 patients) with influenza and compared time to alleviation of symptoms with oseltamivir and placebo.¹ Symptoms were defined as local (nasal discharge, dry cough, sore throat) and systemic (fever, myalgia, headache, fatigue). Methodology for diagnosis varied by trial.

Oral oseltamivir (75, 150, or 300 mg for 5 to 10 days) reduced time to first alleviation of symptoms by 17 hours (95% confidence interval [CI], 8.4-25 hours) compared with placebo for adults and 29 hours (95% CI, 12-47 hours) for the otherwise healthy children.

The systematic review also included 2 RCTs involving 660 children with chronic asthma who received treatment with oseltamivir. Researchers found no reduction in time to symptom alleviation with the oseltamivir.

Treatment with oseltamivir increased the risk of nausea (number needed to harm [NNH]=28) and vomiting (NNH=22) in adults and the risk of vomiting (NNH=19) in children. Sources of bias included industry sponsorship of all trials, differing placebo components, inadequate recruitment, and use of other medication.

Shorter fever duration?

A 2012 meta-analysis of 6 observational studies (5842 patients) compared the effect of oral oseltamivir with no treatment on duration of signs and symptoms (definition not given) in patients with influenza (method of diagnosis not stated).² Oseltamivir reduced fever duration by 33 hours (95% CI, 21-45 hours) compared with no treatment.

The authors describe the evidence as being of very low quality because of study heterogeneity, lack of control for confounding variables, selection bias, and study sources (many unpublished industry studies).

There’s benefit even with late Tx

A 2014 double-blind RCT, not included in the previously described reviews, of 130 adults and 1070 children with a positive rapid influenza test examined the effect of oseltamivir and placebo on symptom duration.³ Research assistants visited participants at home each day until patients were asymptomatic for 7 consecutive days.

Treatment with oseltamivir reduced symptom duration by a median of one day compared with no treatment (hazard ratio=0.87; 95% CI, 0.79-0.95). This benefit was observed regardless of whether treatment was initiated fewer or more than 48 hours after symptom onset. One notable limitation was failure to control for paracetamol (acetaminophen) usage, a possible confounder for duration of symptoms, such as fever.

Evidence summary

A 2014 systematic review included 8 RCTs in adults (3954 patients) and one RCT in children (669 patients) with influenza and compared time to alleviation of symptoms with oseltamivir and placebo.¹ Symptoms were defined as local (nasal discharge, dry cough, sore throat) and systemic (fever, myalgia, headache, fatigue). Methodology for diagnosis varied by trial.

Oral oseltamivir (75, 150, or 300 mg for 5 to 10 days) reduced time to first alleviation of symptoms by 17 hours (95% confidence interval [CI], 8.4-25 hours) compared with placebo for adults and 29 hours (95% CI, 12-47 hours) for the otherwise healthy children.

The systematic review also included 2 RCTs involving 660 children with chronic asthma who received treatment with oseltamivir. Researchers found no reduction in time to symptom alleviation with the oseltamivir.

Treatment with oseltamivir increased the risk of nausea (number needed to harm [NNH]=28) and vomiting (NNH=22) in adults and the risk of vomiting (NNH=19) in children. Sources of bias included industry sponsorship of all trials, differing placebo components, inadequate recruitment, and use of other medication.

Shorter fever duration?

A 2012 meta-analysis of 6 observational studies (5842 patients) compared the effect of oral oseltamivir with no treatment on duration of signs and symptoms (definition not given) in patients with influenza (method of diagnosis not stated).² Oseltamivir reduced fever duration by 33 hours (95% CI, 21-45 hours) compared with no treatment.

The authors describe the evidence as being of very low quality because of study heterogeneity, lack of control for confounding variables, selection bias, and study sources (many unpublished industry studies).

There’s benefit even with late Tx

A 2014 double-blind RCT, not included in the previously described reviews, of 130 adults and 1070 children with a positive rapid influenza test examined the effect of oseltamivir and placebo on symptom duration.³ Research assistants visited participants at home each day until patients were asymptomatic for 7 consecutive days.

Treatment with oseltamivir reduced symptom duration by a median of one day compared with no treatment (hazard ratio=0.87; 95% CI, 0.79-0.95). This benefit was observed regardless of whether treatment was initiated fewer or more than 48 hours after symptom onset. One notable limitation was failure to control for paracetamol (acetaminophen) usage, a possible confounder for duration of symptoms, such as fever.