Emerging Treatment Offers Hope for Patients with Chronic Musculoskeletal Pain
In This Article
- Trans-arterial embolization (TAE) is emerging as a minimally invasive treatment for chronic musculoskeletal conditions such as knee osteoarthritis, frozen shoulder and plantar fasciitis
- Early studies suggest TAE may significantly reduce pain and improve function for patients who have not responded to physical therapy, medications or injections
- New clinical trials are underway, including a randomized study evaluating TAE for chronic rotator cuff tendinopathy
Chronic musculoskeletal pain can be stubborn, debilitating and difficult to treat—especially for patients who do not respond to physical therapy, medications or injections, and are not candidates for surgery. Trans-arterial embolization (TAE) is an emerging, minimally invasive treatment for conditions such as knee osteoarthritis, frozen shoulder, plantar fasciitis and rotator cuff tendinopathy. In this Q&A, Yan Epelboym, MD, MPH, a physician-scientist in the Mass General Brigham Department of Radiology, discusses the promise of TAE and how he is incorporating it into his own practice.
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Q: What is trans-arterial embolization—and why is it important?
Trans-arterial embolization is a minimally invasive procedure that selectively targets painful areas of inflamed tissue, which often exhibit abnormal blood vessel overgrowth. The goal of the procedure is to reduce inflammation-related pain by decreasing blood flow to these affected areas.
TAE is a procedure used to treat various chronic and painful musculoskeletal conditions, including knee osteoarthritis, adhesive capsulitis (frozen shoulder), and plantar fasciitis.
Emerging data on these procedures suggest that TAE may address an unmet need for patients who suffer from these musculoskeletal conditions and do not respond to conservative treatments such as physical therapy or injection therapies and are not surgical candidates.
TAE for refractory and painful shoulder tendinopathy is an area of research that we are exploring in collaboration with our orthopedic, physical therapy, and radiology colleagues. It’s an important area to explore since this entity is common and can be difficult to treat with conservative measures.
Q: Can you describe some of your current research in the area?
“The Efficacy of Lipiodol Embolization for Chronic Tendinopathy of the Rotator Cuff (ELECTRC): A Randomized Controlled Trial” is an ongoing clinical trial at Brigham and Women’s Hospital. We were motivated to pursue this study given the unmet need of patients who suffer from tendinopathy related shoulder pain. These patients experience limited shoulder function in addition to chronic pain. We aim to explore TAE as a potential therapeutic option for this population.
Q: What role does TAE play in your practice?
TAE for musculoskeletal pain has become a central component of my clinical and research practice and is offered to patients with moderate to severe, refractory pain due to knee osteoarthritis, frozen shoulder, and plantar fasciitis. Although research on these interventions is still evolving, current evidence suggests that patients may experience significant reductions in pain.
Q: What work remains in the development and application of the technique?
Further research is needed to clarify the efficacy of these interventions through randomized controlled trials, identify the patients most likely to experience symptomatic relief, and assess the long-term durability of pain reduction.