Knee Osteoarthritis Pain Research Articles

Effectiveness and mechanism of action of rTMS combined with quadriceps strength training in individuals with knee osteoarthritis: study protocol for a randomized controlled trial

BackgroundQuadriceps training is necessary in function and activity of daily living for patients with knee osteoarthritis (KOA). However, it did not reduce the rate of surgical treatment for end-stage KOA in the long term. This may be related to brain structure changes and maladaptive plasticity in KOA patients. Transcranial Magnetic Stimulation (TMS) could enhance the functional connectivity of brain regions and improves maladaptive plasticity. However, the synergistic effect of the combination of the two for treat KOA is still unclear. Therefore, the purpose of this study is to investigate whether the High-Frequency rTMS combined with quadriceps strength training can improve the pain and function in KOA more effectively than quadriceps training alone and explore the mechanism of action.MethodsThis study is an assessor-blind, sham-controlled, randomized controlled trial involving 12 weeks of intervention and 6 months follow-up. 148 participants with KOA will receive usual care management and be randomized into four subgroups equally, including quadriceps strength training, high-frequency rTMS training, sham rTMS and quadriceps strength training, high-frequency rTMS and quadriceps strength training. The rehabilitation interventions will be carried out 5 days per week for a total of 12 weeks. All outcomes will be measured at baseline, 4 weeks, 8 weeks, and 12 weeks during the intervention and 1 month, 3 months and 6 months during the follow-up period. The effectiveness outcomes will be included visual analog scale, isokinetic knee muscle strength, Knee Injury and Osteoarthritis Outcome score and 36-Item Short-Form Health Survey score; The act mechanism outcomes will be included motor evoked potential, grey matter density, white matter, subcortical nuclei volumes, cortical thickness and functional connectivity by MRI. Two-way of variance with repeated measures will be used to test the group and time effect for outcome measures.DiscussionThe study will be the first protocol to examine whether there are synergistic effects following high-frequency rTMS combined with quadriceps strength training for treat KOA and clarify the mechanism of action. High-frequency rTMS can be added into the training program for KOA patients if it is proven effective.Trial registrationChinese Clinical Trial Registry ChiCTR2300067617. Registered on Jan.13,2023.

Effects of low-level laser therapy on acupuncture points on knee pain and function in knee osteoarthritis.

Knee osteoarthritis is a common and disabling disease. We aimed to examine the effect of low-level laser therapy in addition to routine physical therapy modalities (transcutaneous electrical stimulation, superficial heating modality of infrared, ultrasound, and exercise) on the functional status and pain in knee osteoarthritis. Patients with knee osteoarthritis (n=71) who underwent physical therapy (transcutaneous electrical stimulation, infrared, ultrasound, exercise therapy, and low-level laser therapy) were retrospectively screened. Patients who received low-level laser therapy on acupuncture points, transcutaneous electrical stimulation, infrared, ultrasound, and exercise were included in the low-level laser therapy (+) (n=35), and patients who received only transcutaneous electrical stimulation, ultrasound, infrared, and exercise were included in the low-level laser therapy (-) group (n=36). The Visual Analog Scale for activity pain, Lysholm Knee Scoring Scale, and walking and stair climbing tests were used before and after treatment obtained from patient files. The post-treatment Visual Analog Scale activity score and walking and stair climbing test results were statistically significantly lower in the low-level laser therapy (+) group than in the low-level laser therapy (-) group. There was no significant difference in post-treatment Lysholm Knee Scoring Scale scores between the two groups. In both groups, the Visual Analog Scale activity, Lysholm Knee Scoring Scale, and walking and stair climbing test scores statistically significantly decreased after treatment. Knee osteoarthritis increases with aging and creates significant functional limitations. low-level laser therapy with routine physiotherapy contributed to the improvement in the pain and functional status of the patients with knee osteoarthritis. Low-level laser therapy can be recommended in osteoarthritis treatment guidelines with the support of further studies, which is an easy-to-apply, effective, and reliable method.

Exercise therapy for knee osteoarthritis pain: how does it work? A study protocol for a randomised controlled trial

IntroductionMuscle strengthening training (MST) and behavioural graded activity (BGA) show comparable effects on knee osteoarthritic (KOA) pain, but the mechanisms of action remain unclear. Both exercise-induced anti-inflammation and central sensitisation...

Trajectories and Predictors of Weight-Bearing and Non-Weight-Bearing Pain in Knee Osteoarthritis: A 9-Year Follow-Up Study.

To identify distinct developmental trajectories of weight-bearing pain (WBP) and non-weight-bearing pain (NWBP) and examine the trajectory predictors in individuals with or at risk of knee osteoarthritis. We included 971 participants from the Osteoarthritis Initiative whose baseline magnetic resonance imaging data and 9-year follow-up data on pain were available. We applied group-based trajectory modeling to identify WBP and NWBP trajectories over 9 years. Univariate and multivariate multinomial logistic regression analyses were performed to examine the predictors of identified trajectories. Three distinct WBP trajectories were identified: "no pain" (32.4%), "mild pain" (44.6%), and "moderate pain" (23%). Three distinct NWBP trajectories were identified: "no pain" (50.9%), "mild pain" (33.4%), and "moderate pain" (15.7%). In multivariate analyses, high body mass index, depression, multisite pain, radiographic knee OA, and comorbidities were associated with worse development trajectories for WBP and NWBP. Weak quadriceps strength and bone marrow lesion were only associated with worse WBP trajectories, whereas low education level was only associated with worse NWBP trajectories. The developmental course of pain is heterogeneous in WBP or NWBP. Quadriceps strength and bone marrow leisure may be WBP-specific predictors, whereas education level may be a NWBP-specific predictor. The assessment of knee pain should be more accurate, which may help select appropriate therapeutic targets.

A retrospective assessment of the effectiveness of pulsed radiofrequency ablation in the treatment of chronic pain caused by advanced knee osteoarthritis.

Patients suffering from severe chronic pain often have problems finding an appropriate combination of painkillers. We retrospectively evaluated the effectiveness and safety of pulsed radiofrequency ablation (pRFA) of the genicular nerves in 96 patients with knee osteoarthritis (KO). We hypothesized that age, sex, and body mass index (BMI) may influence the quality of the pRFA treatment. A diagnostic blockade with total volume of 9 ml of 1% lidocaine (WZF, Poland) combined with 4 mg of dexamethasone with subsequent pRFA with a radio frequency of 300-500 kHz under ultrasound guidance was used during the procedure. The study participants were assessed during regular monthly visits until 12 months. The nerves' ultrasound identification was successful in 90.62% of the cases. According to the numeric rating scale (NRS), pain was reduced by 50% or more in 64.06% of the cases. The average pain relief period lasted just over 7 and a half months. There were no pRFA-related complications or side effects of the drugs used. pRFA seems to be safe and effective for the treatment of chronic pain in KO. The outcome of the treatment may be related to the patient's age (block duration increased with patient age) and sex (in women, the therapeutic effect was more effectively prolonged) in our study group. There was also higher effectiveness of pRFA in high-BMI patients, which was close to statistical significance ( P = 0.053).

Dispositional traits help explain individual differences in relationships between a radiographic knee osteoarthritis measure, pain, and physical function.

The concordance between radiograph-derived Kellgren-Lawrence (KL) scores for knee osteoarthritis (KOA) and experimental and clinical pain and KOA-related physical function is conflicting. We investigate whether the inclusion of dispositional traits reduces variability between KOA radiographic findings, experimental pain, clinical pain, and function in individuals with knee pain. This study is a cross-sectional, secondary analysis of data collected from the UPLOAD-II study. Adults aged 45-85 years with and without knee pain were enrolled. Data collected included sociodemographics, knee radiographs, experimental pain, clinical pain and function, and trait affect. Vulnerable and protective dispositional traits were classified from combined positive and negative trait affect measures. KL scores were determined from the knee radiographs. Unadjusted and adjusted (age, sex, comorbidities, and body mass index) regression analyses were completed with SAS version 9.4 (Cary, NC, USA). The study included 218 individuals with a mean age of 58 years, 63.6% women, and 48.2% non-Hispanic black adults. Dispositional traits were associated with the experimental pain measures. No association between radiographic KOA and experimental pain was observed. In a combined and adjusted analysis, dispositional traits were predictive of knee punctate pain temporal summation (p = 0.0382). Both dispositional traits and radiographic KOA scores independently and combined were predictive of Graded Chronic Pain Scale pain and function, and Western Ontario and McMaster University pain and function (ps ⩽ 0.01). Improvements in R2 were noted across all models with the inclusion of dispositional traits. Consideration of dispositional traits reduces the variability between radiographic KOA and pain and function. Non-pathological and associated pain-related psychological factors and dispositional traits might serve as parsimonious proxy tools to improve clinical assessments. N/A.

Efficacy of Combining Whole-body Vibration Training and Closed Kinetic Chain Exercises in Early Knee Osteoarthritis: A Preliminary Study.

We aimed to conduct a preliminary evaluation of the effectiveness of integrating whole-body vibration training (WBVT) into conventional closed kinetic chain (CKC) exercises as an intervention strategy for early knee osteoarthritis (KOA). : This non-randomized comparative study conducted at an orthopedic clinic involved 53 patients (with Kellgren-Lawrence grades 1-2); 37 patients received only physical therapy (CKC group), and 16 patients received both physical therapy and WBVT (WBVT group). The primary outcome was the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) subscale score for pain, and the secondary outcomes were the WOMAC subscale score for physical function and muscle-strength assessments [isometric knee extension strength and the 30-second chair-stand test (CS-30) score]. Propensity score matching (PSM) was used to adjust for bias between the control and intervention groups. : After PSM adjustment, 13 patients were selected from each group. The WBVT group showed a significant improvement in the WOMAC pain score (d=1.16, P=0.007) and a significant increase in the CS-30 score (d=0.81, P=0.049). However, for the WOMAC physical function score, the between-group difference remained statistically insignificant (d=0.59, P=0.146). : WBVT may be effective in reducing the pain of early KOA. WBVT is a non-invasive and convenient method, underscoring its potential as a novel therapeutic option.

Reduction in Healthcare Resource Utilization Following Treatment With a Home-Based Footworn Device in Patients With Knee Osteoarthritis: A Retrospective Claims Analysis.

Background: One in 7 US adults has knee osteoarthritis (OA) and almost two-thirds of them suffer from low back pain. OA is the third most rapidly rising condition associated with disability and leads to a significant burden on the healthcare system and society. Objective: This study looked at the healthcare resource utilization (HCRU) in patients with knee OA and low back pain before and after the utilization of a new, home-based, noninvasive, biomechanical intervention. Methods: This was a retrospective claims analysis of 585 patients treated with a personalized, noninvasive, home-based, biomechanical treatment that aims to alleviate knee pain and improve function (AposHealth®). The date of the first AposHealth claim was the index date. Data prior to the index date and post-index date were used to monitor changes in HCRU while in treatment. Descriptive statistics, including frequencies, means and standard deviations, were used to present patient characteristics. To standardize the results, an average monthly claims data rate was calculated and an expected annual rate was extrapolated. Annual HCRU rate per 1000 members was calculated. Results: HCRU decreased after utilizing the new intervention including a decrease of 79% in diagnostic claims, a 70% decrease in outpatient services, a 22% decrease in non-operative treatments, a 61% decrease in pain medications including an 85% drop in opioids use, and a 44% decrease in intra-articular injections. The pre-index estimated rate for total knee replacement (TKR), which is based on existing literature, was 15.1%, whereas the post-index rate of TKR was 0.9%. Conclusions: Patients with knee OA treated with a home-based, noninvasive, biomechanical intervention incurred fewer healthcare resources, leading to an overall reduction in the cost of care.

Is radiofrequency ablation effective in treating patients with chronic knee osteoarthritis? A meta-analysis of randomized controlled trials.

This meta-analysis aimed to evaluate the short-term and long-term efficacy of radiofrequency ablation (RFA) and explore the role of diagnostic genicular nerve blocks in predicting treatment outcomes. A comprehensive literature search was conducted, and nine randomized controlled trials involving 714 participants were included in the analysis. Data extraction, risk of bias assessment, and subgroup analyses were performed. The primary outcome measures were pain scores at 6 and 12 months, assessed using visual analogue scale and Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC). The quality of evidence was assessed using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) methodology. The meta-analysis revealed that RFA demonstrated a significant short-term efficacy in reducing pain compared to the control group at 6 months, as indicated by the pain scores [weighted mean difference (WMD): -2.69, 95% CI: -3.99, -1.40]. Similarly, WOMAC scores at 6 months favored the RFA group (WMD: -4.40, 95% CI: -7.12, -1.68). However, the long-term efficacy of RFA at 12 months remained uncertain for both pain scores (WMD: -0.88, 95% CI: -2.36, 0.61) and WOMAC (WMD: 0.03, 95% CI: -0.25, 0.32). Subgroup analysis suggested that a positive result from the diagnostic genicular nerve blocks test was associated with a more favourable short-term outcome. This meta-analysis provides moderate-quality evidence supporting the short-term efficacy of RFA in reducing pain in patients with knee osteoarthritis. The inclusion of a diagnostic genicular nerve blocks test prior to RFA may help identify patients likely to benefit from the procedure. But it still needs more large sample studies to verify the results. However, further research is needed to determine the long-term efficacy of RFA in managing knee osteoarthritis pain.

BMAC Injection Improves 65-Year Old’s Knee Osteoarthritis Pain

This case study presents the challenging scenario of a 65-year-old male who suffered from debilitating knee pain resulting from preexisting arthritis. Despite various attempts to alleviate the pain, including a corticosteroid injection and activity modification, the patient’s condition continued to deteriorate, leading to limited mobility and reliance on a cane to ambulate. With the failure of conservative measures, the patient’s orthopedic surgeon contemplated the possibility of a total knee replacement. However, the patient opted for an alternative treatment plan involving bone marrow aspirate concentrate (BMAC) injections. After an initial left knee aspiration, two injections of BMAC were administered. Remarkably, three weeks after the first injection, the patient’s condition improved by 90%, and the pain during physical activities reduced significantly. At the patient’s final appointment, he reported being able to walk up and down the stairs without pain. Four months after treatment, the patient embarked on a journey to the Swiss Alps where he spent upwards of four hours a day climbing in the mountainous terrain. He expressed a total absence of pain while navigating up and down the steep landscape. This case study highlights the potential efficacy of BMAC injections as a non-surgical treatment option for knee osteoarthritis pain management. Further research is necessary to evaluate long-term outcomes of this treatment approach.

Comparative effects of transcutaneous electrical nerve stimulation [TENS] along with therapeutic exercises and theraband exercises on pain, disability and muscle strength in knee osteoarthritis

Purpose: to examined the effects of resistance exercise using the theraband on the pain and function of patients with degenerative knee arthritis. Material & Methods: thirty patients with degenerative knee arthritis were classified into an one group of 20 patients on whom resistance exercise using the elastic band was applied and a other group of 20 patients on whom conventional physical therapy was delivered. Both groups received treatments three times a week for four weeks. Pain and disability and function were measured by the WOMAC index and muscle strength was evaluated by the Oxford scale on 1st day and after 4th week to follow-up the treatment. Results: the intragroup comparison Table 2, showed significant improvements in WOMAC index and Oxford scale in both groups. In the intergroup comparison after treatment, the group-2 showed significantly changes in the values with respect to pre to post intervention WOMAC index score; 33.7250±3.61879 to14.1800±1.76355 than the group-1 32.2305±7.88301 to 18.4400±2.62546. Furthermore there were significant improvement in Oxford scale score i.e. 2.6000±.50262 to 4.5000±.51299 found in group-2 than group-1 i.e. 2.4500±.51042 to 3.6000±.50262. Conclusion: the results suggest that resistance exercise using the theraband is an effective intervention for the pain and function of patients with degenerative knee arthritis.

An Online Program for Primary Care Practitioners to Enhance Confidence in Ability to Care for Patients With or at Risk of Painful Knee Osteoarthritis.

Primary care practitioners (PCPs) care for the majority of patients with knee osteoarthritis (KOA). Despite the existing evidence-based guidelines, PCPs often feel unequipped to evaluate and effectively treat patients with KOA. To address this need, we designed and implemented a free internet-based program focusing on the diagnosis and treatment of KOA. We assessed whether the program led to improvements in participants' confidence in their knowledge and skills related to effectively recognizing and caring for patients with or at risk of KOA. We used Caffarella's integrative model to develop a program aligned with the American College of Rheumatology 2019 Guideline for the treatment of KOA. The program incorporated 18 case-based questions to provide retrieval practice and mastery experiences. We assessed changes in participants' confidence in their KOA knowledge and skills after program completion. Of the first 353 learners completing the program, 53.8% were women, 41.9% had a clinical focus in primary care, and 69.1% were nonphysicians. Overall confidence in KOA knowledge and skills improved after program completion (P < 0.001; effect size=1.28, 95% confidence interval 1.12-1.45), with largest improvements among participants with lower pre-program confidence. A total of 95.8% of participants indicated they would recommend the program to others. A free online program focusing on the effective care for patients with KOA attracted a wide range of learners, even though it targeted PCPs. Participants overwhelmingly endorsed it as highly relevant and would recommend it to others. Whether improvements in confidence translate into better patient outcomes is an important area for future research.

Relationship between the Serum Cartilage Oligomeric Matrix Protein Concentration against Degree of Knee Osteoarthritis Pain in Elderly Patients at the Public Health Service Clinic

This study aims to assess the relationship between the serum concentration of Cartilage Oligomeric Matrix Protein (COMP) and the degree of osteoarthritis pain in elderly patients. The study was conducted at a public health service clinic, Faculty of Medicine, Syarif Hidayatullah State Islamic University (UIN) Jakarta, Indonesia. The indexes used to assess patients with OA in the knee are the Western Ontario and Mcmaster University Osteoarthritis Index (WOMAC). Sampling using the cross-sectional technique as many as 146 respondents with elderly knee OA patients. First, a physical and radiological examination is performed to confirm the diagnosis of knee OA. Second, measuring the degree of pain WOMAC. Third, the measurement of the COMP serum concentration used the ELISA test. Based on the Spearman correlation test, it was found that there was a statistically significant relationship between the COMP serum concentration and the degree of knee OA pain with the WOMAC scale in the elderly (p = 0.012). From the results of the study, it is suggested that patients maintain effective health management. Elderly patients come to community health service clinics to carry out routine/periodic checks to reduce pain. The main reason is that there is no truly effective and consistent method to prevent and cure this disease, especially for patients with age-related risk factors, excessive joint load, and a history of joint injury. AO also has an impact on a person's psychosocial well-being. These findings contribute to the study of the risk of degenerative diseases and the use of biomarkers with a level of evidence that will be more valid in the future.

MYOGENIC CONTRIBUTORS TO PHYSICAL FUNCTION IN OLDER ADULTS WITH SYMPTOMATIC KNEE OSTEOARTHRITIS

Abstract Knee osteoarthritis (OA) is a leading cause of mobility disability among middle-aged and older adults, and contributes to significant global disease burden. The impact of knee OA on physical function varies widely across individuals, and the factors contributing to this heterogeneity are poorly understood. Recent compelling research suggests that myogenic factors, including muscle quality (MQ), may underly symptoms in knee OA. While MQ is gaining attention in aging research, the role of MQ on functional outcomes in persons with knee OA remains unknown. This pilot study examined morphological and neuromuscular biomarkers of MQ among adults aged 50 years and older (N=44) who met clinical criteria for symptomatic knee OA. Physical performance was assessed using the Short Physical Performance Battery (SPPB). MQ was quantified using B-mode ultrasound (echo intensity) and isokinetic strength measures (force/body mass). Associations between MQ and physical performance were determined, with consideration for clinical pain, age, sex, and body mass index. Pearson correlation analysis indicated SPPB scores were associated with clinical pain, strength, and MQ (r values ranged -.42 – 0.60, p’s&amp;lt; 0.05). Multivariable backward stepwise linear regression analysis demonstrated that MQ biomarkers contributed 39% to variance for SPPB score independent of clinical pain and strength, after adjustment for age, sex, and BMI (b’s = -0.32 – 0.45; p’s &amp;lt; 0.05). MQ is an important consideration for physical function in older adults with chronic knee OA pain, regardless of pain severity, and represents a potentially potent treatment target for disability prevention.

Pathogenic Mechanisms and Therapeutic Approaches in Obesity-Related Knee Osteoarthritis.

The knee is the joint most frequently involved in osteoarthritis, a common joint disorder in the adult population that is associated with significant chronic joint pain, reduced mobility and quality of life. Recent studies have established an association between obesity and the development of knee osteoarthritis that goes beyond the increased mechanical load on the knees as weight-bearing joints. This link is based on the maintenance of a chronic low-grade inflammation, altered secretion of adipokines by the adipose tissue and development of sarcopenia. Major adipokines involved in the pathogenesis of obesity-related knee osteoarthritis include adiponectin, which appears to have a protective effect, as well as leptin, resistin and visfatin, which are associated with higher pain scores and more severe structural damage. Joint pain in knee osteoarthritis may be both nociceptive and neuropathic and is the result of complex mechanisms driven by nerve growth factor, calcitonin gene-related peptide and pro-inflammatory cytokines. The role of endogenous cannabinoids and gut microbiota in common mechanisms between obesity and knee pain has recently been studied. The aim of the present review is to highlight major pathogenic mechanisms in obesity-related knee osteoarthritis with special attention on pain and to comment on possible therapeutic approaches.

CD146-positive adipose-derived stem cells subpopulation enriched by albumin magnetic sphere ameliorates knee osteoarthritis pain and promotes cartilage repair

BackgroundThe use of adipose stem cell (ADSCs) subpopulations in cartilage repair remains poorly characterized. In this study, we constructed an albumin magnetic sphere with specific targeting of CD146 (CD146-AMs) for sorting a subpopulation of CD146-positive ADSCs (CD146 + ADSCs) and explored the role of CD146 + ADSCs on joint pain and cartilage repair in rats with knee osteoarthritis (KOA).MethodsCD146-AMs were prepared and analyzed in materialistic characterization tests. Subpopulations of CD146 + ADSCs were sorted using CD146-AMs. Surface labeling, viability, and proliferation of a subpopulation of CD146 + ADSCs were evaluated in vitro. Molecular characterization of mRNA and protein expression profiles was analyzed by microarray. A rat KOA pain model was established by the iodoacetic acid method, and KOA pain and the promotion of cartilage repair were assessed after treatment with bilateral joint cavity injections of CD146 + ADSCs.ResultsThe CD146-AMs prepared in this study had an average particle size of 242.63 ± 6.74 nm, an average potential of 33.82 ± 3.53 mv, and high CD146 targeting and low cytotoxicity. The positive rate of enriched CD146 + ADSCs was 98.21% and showed a high level of stem cell marker expression and good cell viability. Gene and protein expression profiles showed that CD146 + ADSCs have different cellular functions, especially in regulating inflammation. In the KOA model, low, medium and high concentrations of CD146 + ADSCs were able to improve KOA pain and promote cartilage repair in a concentration-dependent trend.ConclusionsThe CD146-AMs prepared in this study were able to safely and efficiently sort out the CD146 + ADSCs subpopulation. The subpopulation of CD146 + ADSCs has a unique molecular profile that ameliorates KOA pain and repairs cartilage damage in rats, providing a new idea for KOA treatment.

Limbic system plasticity after electroacupuncture intervention in knee osteoarthritis rats

Knee osteoarthritis (KOA) is characterized by debilitating pain. Electroacupuncture (EA), a traditional Chinese medical therapy, has shown promise in KOA pain management. This study investigated the therapeutic potential of EA in KOA and its impact on limbic system neural plasticity. Sixteen rats were randomly assigned into two groups: EA group and sham-EA group. EA or sham-EA interventions were administered at acupoints ST32 (Futu) and ST36 (Zusanli) for three weeks. Post-intervention resting-state fMRI was scanned, assessing parameters including Amplitude of low frequency fluctuations (ALFF), regional homogeneity (ReHo), functional connectivity (FC) and nodal characterizations of network within limbic system. The results showed that EA was strategically directed towards the limbic system, resulting in discernible alterations in neural activity, FC, and network characteristics. Our findings demonstrate that EA had a significant impact on the limbic system neural plasticity in rats with KOA, presenting a novel nonpharmacological approach for KOA treatment.

The effectiveness of using pulsed electromagnetic fields for osteoarthritis of the knee joint

BACKGROUND: Osteoarthritis is one of the most common forms of pathology of the musculoskeletal system with significant impairment of motor function, which is one of the main causes of disability in the population.&#x0D; AIM: This study was aimed at testing the effectiveness of the portable device "ALMAG+" with pulsed electromagnetic fields in the treatment of pain in patients with osteoarthritis of the knee joint.&#x0D; MATERIALS AND METHODS: This randomized, double-blind, placebo-controlled clinical trial included patients with radiographic evidence of knee osteoarthritis and persistent pain greater than 40 mm on a visual analogue scale (VAS). The study included daily treatment with pulsed electromagnetic fields from the ALMAG+ device for 1 month in 60 patients with knee osteoarthritis. The primary outcome measure was reduction in pain intensity assessed by VAS and WOMAC scales. Secondary outcomes included the 36-item Short Form Medical Outcomes Study version 2 (SF-36 v2) quality of life, pressure pain threshold, and changes in non-steroidal anti-inflammatory drug/analgesic use.&#x0D; RESULTS: Sixty-six patients were enrolled in the study, and 60 completed the study. After 1 month of treatment, pulsed electromagnetic fields caused a significant reduction in pain VAS and WOMAC scores compared to placebo. In addition, patients receiving pulsed electromagnetic fields improved pain tolerance, which was reflected in changes in pain threshold, and physical condition. We obtained a significant and statistically significant effect of the organized pulsed electromagnetic fields factor on VAS pain scores (F=47.6; p=0.00006); assessments of the severity of pain, joint function and stiffness on the scales of the WOMAC questionnaire also significantly changed under the influence of the pulsed electromagnetic fields factor (F=14.7; p=0.001). 26% of patients in the pulsed electromagnetic fields group discontinued non-steroidal anti-inflammatory drug/analgesic therapy. No adverse events were identified during treatment.&#x0D; CONCLUSION: These results suggest that pulsed electromagnetic fields therapy is effective in relieving pain in patients with knee osteoarthritis and also affects pain threshold, stiffness, and physical functioning. In the future, it is desirable to conduct larger studies, including those comparing the effectiveness of pulsed electromagnetic fields therapy with standard pharmacological approaches for osteoarthritis.

A pilot study of intraoperative application of cooled radiofrequency to reduce post-operative pain following total knee arthroplasty

BackgroundTotal Knee Arthroplasty (TKA) is a successful treatment for end stage knee osteoarthritis (OA), but can be associated with significant pain in the early post-operative period. Cooled radiofrequency ablation (CRFA) has reported to reduce knee OA pain by targeting the periarticular nerves. The objective of this pilot study was to assess the effectiveness of intra-operative CRFA for reducing pain and opiate use after TKA. MethodsThis was a non randomised prospective study with control group. Participants were sequentially recruited preoperatively and underwent TKA, with CRFA to 6 targeted sites prior to cementing of implants, and were compared to controls who underwent TKA without CRFA. The primary outcome was Day 3 pain scores, and secondary outcomes included week one pain scores, and opiate use up to six weeks post-operative. Results17 participants were recruited to the control group and 12 were recruited to the CRFA group. There was no significant difference in demographics or baseline pain scores between the groups. On day 2 the CRFA group had a lower mean pain VAS score of 3.2 compared to 4.4 in the control group (p = 0.03). The mean post operative VAS pain score did not differ between the groups for Day 1, 3, 4, or any other time points up to 6 weeks. There were no significant reduction in opiate use in the CRFA group compared to the control group. There were no adverse events. ConclusionThis study demonstrated intra-operative CRFA was not effective in reducing pain by 50% after TKA in a pilot study.

Oral cannabidiol (CBD) as add-on to paracetamol for painful chronic osteoarthritis of the knee: a randomized, double-blind, placebo-controlled clinical trial.

Painful knee osteoarthritis (KOA) is common, pharmacological treatment, however, is often hampered by limited tolerability. Cannabidiol, which preclinically showed anti-inflammatory, analgesic activity, could supplement established analgesics, but robust clinical trials are lacking. The aim of our study was to investigate the effects of oral high-dose CBD administered over 8 weeks on pain, function and patient global assessment as an add-on to continued paracetamol in chronic symptomatic KOA. Prospective, randomized, placebo-controlled, double-blind, parallel-group study. Single center, Outpatient Clinic, Department of Special Anaesthesia and Pain Therapy at Medical University of Vienna, Austria. Eligibility criteria included: age: 18-98 years; painful KOA; score ≥5 on the pain subscale of the Western Ontario and McMasters Universities Osteoarthritis (WOMAC) Index; KOA confirmed by imaging. Participants were on continued dosage of paracetamol 3g/d and randomly assigned by web-based software 1:1 to oral cannabidiol 600mg/d (n=43) or placebo (n=43). Study period: 8 weeks. Primary outcome: Change in WOMAC pain subscale scores (0=no pain, 10=worst possible pain) from baseline to week 8 of treatment. Trial Registration: ClinicalTrials.gov Identifier: NCT04607603. Trial is completed. The trial was conducted from October 1, 2020 to March 29, 2022. 159 patients screened, 86 randomized. Among 86 participants (mean age, 62.8 [SD 20.3] years; 60 females [69.8%]), 58 (67.4%) completed the trial. Mean baseline WOMAC pain subscale was 6.0±1.1. Analysis: Intention-to-treat principal. Mean reduction in WOMAC pain subscale was 2.5 (95% CI: 1.8-3.3) in the cannabidiol group and 2.4 (95% CI: 1.7-3.2) in the placebo group with no significant group difference (p=0.80). Adverse events were significantly more frequent with cannabidiol (cannabidiol: 135 [56%]; placebo: 105 [44%]) (p=0.008). Rise above baseline of liver aminotransferases and gamma-glutamyltransferase was significantly more common in the cannabidiol (n=15) than the placebo group (n=5) (p=0.02). In KOA patients, oral high-dose add-on cannabidiol had no additional analgesic effect compared to adding placebo to continued paracetamol. Our results do not support the use of cannabidiol as an analgesic supplement in KOA. Trigal Pharma GmbH.