The effectiveness of ultrasound therapy and phonophoresis in the treatment of ankylosing spondylitis

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Abstract

BACKGROUND: In Bekhterev's disease, an autoimmune inflammatory process develops in the intervertebral joints and paravetebral muscles and leads to severe pain syndrome and progressive fusion of articular surfaces. Anti-inflammatory and analgesic therapy should be carried out daily with the use of large doses of nonsteroidal anti-inflammatory drugs. With the progression of the disease, drug therapy is not effective enough to relieve pain and to restore the volume of movement in the joints. In this regard, the use of non-drug treatment is a necessary measure for the treatment of such patients.

AIM: comparison of the effectiveness of phonophoresis and ultrasound in the treatment of pain syndrome in patients with ankylosing spondylitis.

MATERIALS AND METHODS: 30 patients with Bekhterev's disease were included in our study. All patients were found to carry the HLA antigen and high value of C-reactive protein with an increase in the rate of erythrocyte sedimentation. Radiographs revealed signs of arthrosis of the sacroiliac joint and signs of arthritis and arthrosis of the intervertebral joints of the spine in one or several departments. The severity of the pain syndrome was 9.4 points on the visual analog scale (VAS) and 31.1 points on the McGill Pain Questionnaire (MPQ). 10 patients underwent ultrasound therapy, 10 patients underwent phonophoresis with karepain and 10 patients underwent placebo (Simulation of ultrasound exposure).

RESULTS: The analgesic effect of ultrasound therapy was 57.9% at rest, 55.3% with spinal movement. The overall reduction in pain syndrome determined by MPQ was 50%, 49.54% in the sensory class and 51.8% in the affective class. Regression of pain syndrome against the background of the use of phonophoresis with karipain was 60.4% at rest, 54.5% with spinal movement. According to MPQ, the pain syndrome decreased by 46.7% in the sensory class and 52.8% in the affective class and by 49.5% in general. In patients who underwent a placebo course, the pain syndrome according to VAS and MPQ remained without significant dynamics.

CONCLUSION: The significant effectiveness of ultrasound therapy and phonophoresis in the treatment of severe pain syndrome in of patients with ankylosing spondylitis has been proven, but it was not possible, to identify significant differences in the analgesic effect between ultrasound therapy and phonophoresis.

About the authors

Mustafa Kh. Al-Zamil

Peoples' Friendship University of Russia; Brain and Spine Clinic

Author for correspondence.
Email: alzamil@mail.ru
ORCID iD: 0000-0002-3643-982X
SPIN-code: 3434-9150

MD, Dr. Sci. (Med.), Professor

Russian Federation, Moscow; Podolsk

Maria А. Stepanovich

Peoples' Friendship University of Russia; Brain and Spine Clinic

Email: m.stepanovich@mail.ru
ORCID iD: 0000-0001-5735-1555
Russian Federation, Moscow; Podolsk

Natalia G. Kulikova

Peoples' Friendship University of Russia; National Medical Research Center for Rehabilitation and Balneology

Email: alzamil@mail.ru
SPIN-code: 1827-7880

MD, Dr. Sci. (Med.), Professor

Russian Federation, Moscow; Moscow

Ekaterina S. Vasilieva

Petrovsky National Research Centre of Surgery; Moscow State University of Medicine and Dentistry named after A.I. Evdokimov

Email: alzamil@mail.ru
ORCID iD: 0000-0003-3087-3067
SPIN-code: 5423-8408

MD, Dr. Sci. (Med.), Professor

Russian Federation, Moscow; Moscow

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Supplementary files

Supplementary Files
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2. Fig. 1. Radiograph of the lumbosacral spine of a patient with Bekhterev's disease: the image visualizes ankylosis of the sacroiliac joints and lumbar vertebrae.

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3. Fig. 2. Typical pose of a patient with Bekhterev's disease.

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4. Fig. 3. Ultrasound exposure to the paravertebral points L5–S1 on the right using the BTL-4000 apparatus.

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5. Fig. 4. The severity of pain syndrome at rest according to the visual analog scale (VAS) before and after treatment in the observation groups.

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6. Fig. 5. Severity of pain syndrome when moving on a visual analog scale (VAS) before and after treatment in observation groups.

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7. Fig. 6. The severity of pain syndrome in the sensory class according to the McGill Pain Questionnaire (MPQ) before and after treatment in the observation groups.

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8. Fig. 7. The severity of pain syndrome in the affective class according to the McGill Pain Questionnaire (MPQ) before and after treatment in the observation groups.

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9. Fig. 8. Severity of pain syndrome in all classes according to the McGill Pain Questionnaire (MPQ) before and after treatment in the observation groups.

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