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  • Effectiveness of Interventi...
    van Middelkoop, Marienke; Huisstede, Bionka M. A; Glerum, Suzanne; Koes, Bart W

    The Clinical journal of pain, 2009-July/August, Letnik: 25, Številka: 6
    Journal Article

    OBJECTIVESThe aim of this study was to provide an evidence-based overview of the effectiveness of (conservative and surgical) interventions for the 4 specific pain disorders of the handtrigger finger, primary Raynaudʼs phenomenon, Dupuytren disease, and De Quervainʼs disease. This information can help clinicians in the selection of interventions in daily practice, and may give direction to future research. METHODSRelevant review publications and randomized clinical trials (RCTs) in PubMed were searched. Data extraction and quality assessment were performed. To summarize the results of the included reviews and RCTs, a best-evidence synthesis was used. RESULTSFor primary Raynaudʼs phenomenon (1 review, 20 RCTs), we found strong evidence for calcium channel blockers and moderate evidence for laser therapy. Limited evidence was found for Ketanserin, Prozasin, Buflomedil, transdermal glyceryl trinitrate patches, Ginkgo biloba, and behavioral treatment with temperature feedback. Other interventions did not show clear favorable treatment effects. For Trigger finger one very small RCT was found that showed limited evidence for steroid injection. For Dupuytren disease (4 RCTs) limited evidence was found in favor of use of staples versus sutures in the Dupuytrenʼs surgery, and for intermittent compression on the postoperative hand after surgery. For other interventions no clear positive effects could be demonstrated. For De Quervainʼs disease (2 RCTs), we found no efficacy of Nimesulide as addition to a Triamcinolone injection, and no clear differences between a corticosteroid injection and a splint in pregnant patients or patients breast-feeding. DISCUSSIONWell-designed and well-conducted RCTs are clearly needed in this field.