Thursday, January 29, 2009

Sportsmedicine: The pain game

sports medicine evolution:
Sportsmedicine as an apparent subclass of medicine has developed apace over the past 30 years. Its recent trajectory has been evidenced by the emergence of specialist international research journals, standard texts, annual conferences, academic appointments, and postgraduate courses. A major advance in this emerging field is the ability to appropriately diagnose and treat sports-related injuries and to develop ongoing research related to better diagnosis and more effective treatment of pain and tissue healing. This approach will ultimately impact return-to-play performance.

It is noteworthy that sportsmedicine physicians recognize the athlete and the entire rehabilitation team as being a special breed that is determined and progressive in their thinking. It is not sufficient to deprive them of the very thing that motivates their lives by simply saying "Stop what you are doing and the pain will go away." Instead, our challenge is to diagnose and find the most appropriate treatment which will not only reduce pain but also induce a rapid tissue healing process. Pagliano, correctly points out that appropriate treatment resulting in return to the playing field is the major goal of the sportsmedicine physician. He states, "Not only will the athlete be delighted, but it will give the practitioner immense satisfaction to see the athletes happy and running." While there have been many anti-pain treatment modalities widely utilized in the field, including sports massage, prescription drugs, phonophoresis, cryotherapy, sonotherapy, pulsed electrical stimulation, transcutaneous electrical nerve stimulation (TENS), high-volt pulsed current, iontophoresis, dry needle and electro acupuncture, magnetic field therapy, and biofeedback, scientists have pointed out the pitfalls of research related to these treatment modalities. A universal problem in the assessment of efficacy related to all these modalities involves the clinical usefulness of the placebo method. Brooling et al found that a total of 94% of physicians and 98% of scientists, but only 44% of athletes, indicated a good understanding of the placebo effect. A majority of scientists (63%) and physicians (59%) administered placebo at least once a year. Most scientists (95%) and a majority of physicians (71%) either mildly or strongly encouraged use of the placebo in their clinical practice to assess the medical status of their patients, especially as it relates long lasting to pain. About 60% of athletes indicated they would not care if they were unknowingly administered a placebo; however, 30% of them would not appreciate being misled. This kind of data is at least 1 stumbling block in separating real benefits of the many modalities utilized in the treatment of pain in sportsmedicine.

The author of this article K.blum et al recognized that a number of modalities including electrotherapeutic devices may have some benefit, the need for a nonpharmacologic analgesic alternative having tissue healing properties requires significant attention.

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