UTSW Research: Treating shoulder pain, aortic valve procedures, and more
Studies look at nerve stimulation, TAVR vs. SAVR, and how doctors prescribe drugs for heart risk
Minimally invasive therapy effectively treats chronic shoulder pain
Millions of Americans have chronic shoulder pain, which can have a significant impact on quality of life. Although some get relief from medications, physical therapy, or joint injections, those with persistent pain often pursue more aggressive treatments such as surgeries and permanent neurostimulator implants.
Seeking an alternative that spares patients the expense, recovery, and complications that can accompany these interventions, researchers including Chaitanya Konda, D.O., Assistant Professor of Physical Medicine & Rehabilitation at UT Southwestern Medical Center, tested a 60-day course of percutaneous peripheral nerve stimulation (PNS). In this treatment, hair-thin wires are inserted through the skin to deliver electrical stimulation to nerves.
The researchers reported in Pain and Therapy that 83% of patients with chronic shoulder pain, followed for an average of 21 months after PNS therapy, required no subsequent interventions for pain relief, and 87% maintained clinically meaningful improvements in pain, quality of life, function, and/or sleep. The findings were based on surveys given to 489 patients. The authors suggest PNS could offer a new option for treating chronic shoulder pain.
Comparing aortic valve replacement procedures
Many patients with aortic stenosis, a narrowing of the valve that supplies the body’s largest artery, also have atherosclerosis, or hardening of the arteries. Aortic stenosis is commonly treated with a minimally invasive procedure called transcatheter aortic valve replacement (TAVR) or a traditional procedure known as surgical aortic valve replacement (SAVR). Although the use of TAVR has grown significantly in recent years, how its outcomes compare to SAVR for patients with both aortic stenosis and systemic atherosclerosis – defined as involvement of two or more atherosclerotic vascular beds, including coronary artery disease, peripheral arterial disease, or cerebrovascular disease – has not been assessed.
Researchers, including two from UT Southwestern, found answers using the Nationwide Readmissions Database, which tracks data from 14 million U.S. hospital admissions each year. Results from 545,409 hospitalizations for aortic valve replacements between 2016 and 2020, reported in Cardiology and Therapy, showed patients with systemic atherosclerosis who received TAVR were significantly less likely than those who received SAVR to die in the hospital or have a heart attack, stroke, or major bleeding. However, TAVR patients were more likely to receive a pacemaker and/or have nonelective 90-day readmissions. The authors suggest more research is necessary to explore interventions to decrease TAVR complications in this high-risk patient population.
Anthony Bavry, M.D., M.P.H., Professor of Internal Medicine at UT Southwestern, and Dharam Kumbhani, M.D., Professor of Internal Medicine and Section Chief/Director of Interventional Cardiology, contributed to the study.
Deciding between drugs to lower cardiovascular risk
Patients with both Type 2 diabetes and atherosclerosis are at increased risk of heart attacks, strokes, and other major adverse cardiovascular events (MACE). Two classes of drugs, known as sodium glucose co-transporter-2 inhibitors (SGLT2is) and glucagon-like peptide-1 receptor agonists (GLP-1RAs), have shown equal effectiveness in reducing this risk. However, why doctors prescribe one over the other has been unclear.
In a study published in Frontiers in Cardiovascular Medicine, researchers led by a team from UT Southwestern used the hospital’s electronic health records to create a registry of 573 patients who had Type 2 diabetes and atherosclerosis and were prescribed drugs from one of the two classes between January 2019 and October 2024. An analysis of the patients showed those who received prescriptions from a cardiologist were more likely to receive a SLGT2i, while those who received their prescriptions from an endocrinologist, had a higher body mass index, or had a higher glomerular filtration rate (a measure of kidney function) were more likely to receive a GLP-1RA. Future research is needed to understand the most appropriate use of these drug classes for patients beyond their cardioprotective benefits, the authors say.
UTSW researchers who contributed to the study are first author Shubham Agarwal, M.B.B.S., Endocrinology Clinical Fellow; senior author Ildiko Lingvay, M.D., M.P.H., M.S.C.S., Professor of Internal Medicine and in the Peter O’Donnell Jr. School of Public Health; Daniel Heitjan, Ph.D., Professor in the O’Donnell School of Public Health; Mujeeb Basit, M.D., M.M.Sc., Associate Professor of Internal Medicine; Michael Bowen, M.D., Associate Professor of Internal Medicine, Pediatrics, and Public Health; Christine Mai, B.S., Business Analyst; Kelsea Marble, M.S., Programmer/Architect Lead; and Zichang Xiang, Ph.D., Consultant.
Dr. Lingvay receives personal consulting compensation from Boehringer Ingelheim Pharmaceuticals.
About UT Southwestern Medical Center
UT Southwestern, one of the nation’s premier academic medical centers, integrates pioneering biomedical research with exceptional clinical care and education. The institution’s faculty members have received six Nobel Prizes and include 25 members of the National Academy of Sciences, 24 members of the National Academy of Medicine, and 14 Howard Hughes Medical Institute Investigators. The full-time faculty of more than 3,200 is responsible for groundbreaking medical advances and is committed to translating science-driven research quickly to new clinical treatments. UT Southwestern physicians provide care in more than 80 specialties to more than 140,000 hospitalized patients, more than 360,000 emergency room cases, and oversee nearly 5.1 million outpatient visits a year.