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Background: A significant number of patients on long-term treatment and users of biologics complain of wrist pain due to synovial proliferation and arthropathic changes. Synovectomy or joint arthroplasty is often indicated for such patients, but many refuse surgery. For these patients triamcinolone acetonide was injected into the dorsum of the wrist, and evaluated the clinical benefit and safety of the wrist joint.

Methods: We injected triamcinolone acetonide into the dorsum of the wrist. We evaluated the clinical benefit and safety of intraarticular triamcinolone acetonide by analyzing data on (1) the number of injections, (2) decrease in visual analog scale pain, (3) changes in carpal height ratio, radio carpal distance ratio, and radial rotation angle in X-ray imaging, and (4) the adverse reactions of triamcinolone acetonide injection on the subcutaneous tissue and extensor tendons.

Results: 1. The number of injections per patient over 3 years 8 months was 1 for 44 wrists, 2 for 21 wrists, 3 for 17 wrists, 4 for 6 wrists, 5 for 3 wrists, 6 for 3 wrists, 7 for 2 wrists, 9 for 2 wrists, 12 for 4 wrists, and 13 for 1 wrist. 2. The overall mean VAS improved from 79 mm at baseline to 11 mm post-injection. 3. In the grade I and II group, CHS, RCDR and RRA were not statistically significant. In the grade III and IV group, CHR showed a significant decrease. 4. Neither subcutaneous atrophy nor extensor tendon rupture was reported.

Conclusions: More than 90% of patients of all disease grades responded to an average of 1 to 4 injections per year.

This study was to objectively evaluate the treatment effect of acupuncture-like transcutaneous electrical nerve stimulation (AL-TENS) on patients with low back pain. Fifty patients suffering from low back pain for at least three months were involved in the study from Chang Gung Memorial Hospital. The subjects were treated with TENS (100 Hz) on acupuncture points (BL23 and BL25). Two electrodes were placed on two right acupoints and two electrodes on the left. Pulse duration of electrical stimulation was fixed at 0.1 ms. The intensity of stimulation was adjusted at a tolerable level for each subject. Patients were treated for twenty minutes per visit, three times a week for two weeks. Visual analog scale (VAS) was used to rank the degree of pain before and two weeks after the treatment. A device, the design of which is based on the Ryodoraku theorem, was used to measure the electrical conductance of 12 meridians and 2 acupoints (BL23 and BL25) on both sides of the subjects. The effect of age difference on the pain score was also evaluated with the electrical conductance. The correlation between the VAS and the electrical conductance in the patients before and after treatment of AL-TENS was determined by linear regression analysis. The results showed that: (1) after the AL-TENS treatment in this study, the electrical conductances of either meridians or acupuncture points increased with the decrease of VAS of the patients; (2) the correlation was higher in the acupoints than that in the meridians; (3) the correlation was higher in the younger group than that in the older group; (4) the effect of AL-TENS on the change of VAS is more related to the change of electrical conductances of acupoints than that of meridians. These findings suggest that electrical conductance of meridian or acupoint can be used to evaluate the degree of pain more objectively, especially in the younger patients.

The purpose of this research was to evaluate the treatment effect of modulated-frequency mode of acupuncture-like transcutaneous electrical nerve stimulation (AL-TENS) on patients with tennis elbow pain. Twenty patients suffering from tennis elbow pain for at least three months were involved in the study from Chung Yuan Christian University. The subjects were randomly assigned to three treatment groups in different time slots as repeated measures design. Each group (n = 20) was respectively treated with either 5 KHz modulated by 2 Hz frequency mode (LF group), 5 KHz modulated by 100 Hz frequency mode of TENS (HF group) on acupuncture points (LI10 and LI11) located in the area of elbow, or sham TENS (control group). Two electrodes were placed on two right acupoints and two electrodes on the left. The intensity of stimulation was adjusted at a tolerable level for each subject. Patients were treated for twenty minutes per visit, three times a week for two weeks. Visual analog scale (VAS) was used to rank the degree of pain before and two weeks after the treatment. A device, the design of which is based on the Ryodoraku theorem, was used to measure the electrical conductance of 12 meridians and 2 acupoints (LI10 and LI11) on both sides of the subjects. The results showed that: (1) after the AL-TENS treatment in this study, the electrical conductances of either meridians or acupuncture points increased with the decrease of VAS of the patients; the correlation was higher in the acupoints than that in the meridians; (2) the effect of AL-TENS on the percentage change of VAS is more related to the percentage change of electrical conductances of acupoints than that of meridians; (3) 5 KHz modulated by 2 Hz or 100 Hz frequency mode of AL-TENS was effective in the treatment of the patients with tennis elbow pain.

In our previous study, a novel fuzzy pain demand (FPD) derived from the interval of each bolus of patient-controlled analgesia (PCA) according to a fuzzy modeling algorithm can show the patients' dynamic demand and past efforts to overcome the postoperative pain. Hence, this study investigated whether FPD index can distinguish the analgesic efficacy using different amounts and combination drugs. Six hundred and seventy-nine patients with upper and lower abdominal, spinal, and extremity procedures receiving intravenous PCA were compared between morphine (1 mg/ml) alone and a combination of morphine (1 mg/ml) and ketorolac (1.2 mg/ml) in the postoperative setting of pain management. Moreover, we also compared the effect of dosage (1 ml versus 2 ml per delivery). The conventional parameters, standard mean drug consumption (MDC), demand/delivery ratio (D/D ratio), and clinical observation pain using the visual analog scale (VAS) measured at rest and during movements, were compared with the FPD index. The FPD index demonstrated a better sensitivity than the D/D ratio in the morphine and ketorolac combination group than morphine alone, regardless of the dosage (1 versus 2 ml per delivery). Moreover, it also demonstrated a better sensitivity than the MDC at 1 ml per delivery but similar results at 2 ml per delivery. However, when the FPD index is compared with the VAS score in terms of most pain and rest pain, there is no any relationship between these two parameters' pattern. This result indicates that the FPD index can only assess the intensity of pain better than the D/D ratio and MDC but it cannot replace the VAS which is not entirely determined by the nociceptive stimuli but rather as a result of both sensory-discriminative and emotional-cognitive components of patient's suffering.