title: A study to evaluate the effect of ultrasound treatment on nodules in multiple sclerosis patients.
abstract: Purpose/aim: Ultrasound has demonstrated anti-inflammatory and pain-relief benefits in several conditions such as cellulite or trauma events. We assessed the efficacy of ultrasound therapy on nodules associated with first-line treatments in multiple sclerosis patients.
  
  
  METHODS
  Twenty-two multiple sclerosis patients were enrolled during 2013 and randomized to two groups: in the control group patients were treated only with a conventional gel prescribed for cellulite and nodules, while in the experimental group the gel was combined with ultrasound therapy. Patients were treated during 10 weeks and followed up for 10 additional weeks. Three nodules were assessed for each patient, measuring size, pain and redness at 0, 10 and 20 weeks.
  
  
  RESULTS
  We found a significant decrease in both groups in size, pain and redness across the three visits (p < 0.0001 for size, p = 0.01 and p < 0.0001 for pain, and p = 0.0002 and p < 0.0001 for redness, respectively for the difference at visit 2 and 3 with respect to visit 1). More interestingly, we observed a greater reduction in pain and redness in the ultrasound-treated group, but the difference was only statistically significant at 10 weeks (p = 0.01 for both pain and redness). On the third visit, no differences between control and experimental groups were detected, both achieving the same levels in measured variables.
  
  
  CONCLUSIONS
  Both treatments are useful to improve skin reaction after first-line treatments, but ultrasound in combination with gel achieves a faster reduction in pain and redness, suggesting that ultrasound treatment might be a good analgesic for nodule management in multiple sclerosis patients.
authors.affiliation: a a Neurology Department-Multiple Sclerosis Unit, Hospital Universitario Arnau de Vilanova and Institut de Recerca Biomèdica Lleida , Lleida , Spain.
authors.forename: Anna Gil
authors.initials: AG
authors.lastname: Sánchez
authors.affiliation: b b Multiple Sclerosis Unit, Hospital de Día Miquel Martí i Pol, Fundación Esclerosis Múltiple (FEM) , Lleida , Spain.
authors.forename: Eugenia Lacasa
authors.initials: EL
authors.lastname: Andrade
authors.affiliation: c c Biostatistics Unit, Institut de Recerca Biomèdica Lleida , Lleida , Spain.
authors.forename: Joan Valls
authors.initials: JV
authors.lastname: Marsal
authors.affiliation: b b Multiple Sclerosis Unit, Hospital de Día Miquel Martí i Pol, Fundación Esclerosis Múltiple (FEM) , Lleida , Spain.
authors.forename: Lourdes Assens
authors.initials: LA
authors.lastname: Tauste
authors.affiliation: a a Neurology Department-Multiple Sclerosis Unit, Hospital Universitario Arnau de Vilanova and Institut de Recerca Biomèdica Lleida , Lleida , Spain.
authors.forename: Cristina González
authors.initials: CG
authors.lastname: Mingot
authors.affiliation: a a Neurology Department-Multiple Sclerosis Unit, Hospital Universitario Arnau de Vilanova and Institut de Recerca Biomèdica Lleida , Lleida , Spain.
authors.forename: Jorge Lecina
authors.initials: JL
authors.lastname: Monge
authors.affiliation: b b Multiple Sclerosis Unit, Hospital de Día Miquel Martí i Pol, Fundación Esclerosis Múltiple (FEM) , Lleida , Spain.
authors.forename: Margarita Casalilla
authors.initials: MC
authors.lastname: Puértolas
authors.affiliation: b b Multiple Sclerosis Unit, Hospital de Día Miquel Martí i Pol, Fundación Esclerosis Múltiple (FEM) , Lleida , Spain.
authors.forename: Nuria Sáez
authors.initials: NS
authors.lastname: Calero
authors.affiliation: b b Multiple Sclerosis Unit, Hospital de Día Miquel Martí i Pol, Fundación Esclerosis Múltiple (FEM) , Lleida , Spain.
authors.forename: Albert Sacristán
authors.initials: AS
authors.lastname: Argemí
authors.affiliation: a a Neurology Department-Multiple Sclerosis Unit, Hospital Universitario Arnau de Vilanova and Institut de Recerca Biomèdica Lleida , Lleida , Spain.
authors.forename: Blanca Guiu
authors.initials: BG
authors.lastname: Badia
authors.affiliation: b b Multiple Sclerosis Unit, Hospital de Día Miquel Martí i Pol, Fundación Esclerosis Múltiple (FEM) , Lleida , Spain.
authors.forename: Silvia Peralta
authors.initials: SP
authors.lastname: Moncusí
authors.affiliation: a a Neurology Department-Multiple Sclerosis Unit, Hospital Universitario Arnau de Vilanova and Institut de Recerca Biomèdica Lleida , Lleida , Spain.
authors.forename: Hugo Gonzalo
authors.initials: HG
authors.lastname: Benito
authors.affiliation: a a Neurology Department-Multiple Sclerosis Unit, Hospital Universitario Arnau de Vilanova and Institut de Recerca Biomèdica Lleida , Lleida , Spain.
authors.forename: Lara Nogueras
authors.initials: LN
authors.lastname: Peñabad
authors.affiliation: b b Multiple Sclerosis Unit, Hospital de Día Miquel Martí i Pol, Fundación Esclerosis Múltiple (FEM) , Lleida , Spain.
authors.forename: Marta Lordan
authors.initials: ML
authors.lastname: Pujol
authors.affiliation: b b Multiple Sclerosis Unit, Hospital de Día Miquel Martí i Pol, Fundación Esclerosis Múltiple (FEM) , Lleida , Spain.
authors.forename: Mónica
authors.initials: M
authors.lastname: Nieves I Collado
authors.affiliation: a a Neurology Department-Multiple Sclerosis Unit, Hospital Universitario Arnau de Vilanova and Institut de Recerca Biomèdica Lleida , Lleida , Spain.
authors.forename: Luis Brieva
authors.initials: LB
authors.lastname: Ruiz
mesh_terms: D000328:Adult; D000970:Antineoplastic Agents / Q000009:adverse effects; D005260:Female; D000068717:Glatiramer Acetate / Q000009:adverse effects; D006801:Humans; D007166:Immunosuppressive Agents / Q000009:adverse effects; D007372:Interferons / Q000009:adverse effects; D016014:Linear Models; D008297:Male; D008875:Middle Aged; D009103:Multiple Sclerosis / Q000628:therapy*; D017063:Outcome Assessment, Health Care; D010865:Pilot Projects; D012871:Skin Diseases / Q000139:chemically induced / Q000628:therapy*; D014464:Ultrasonic Therapy / Q000379:methods*
chemical_list: D000970:Antineoplastic Agents; D007166:Immunosuppressive Agents; D000068717:Glatiramer Acetate; D007372:Interferons
keywords: first-line treatment; nodule; skin reaction; therapeutic ultrasound