Efficacy of periosteal stimulation for chronic pain associated with advanced knee osteoarthritis: a randomized, controlled clinical trial.
Periosteal stimulation therapy (PST) is a technique that delivers high-frequency electrical stimulation to periosteum using acupuncture needles. It has been hypothesized that PST exerts its effect primarily by stimulating sympathetic fibers in proximity to the periosteum. Electrical stimulation is associated with decreased levels of the pro-inflammatory cytokines and with release of endogenous opioids that may have anti-inflammatory effects on peripheral receptors. The purpose of this randomized, controlled clinical trial was to evaluate the efficacy of PST for older adults with advanced knee OA.
190 patients with advanced knee OA were included. Patients were treated with PST (once a week for 10 weeks), and either or not post-treated with PST for 6 months. The control group was treated with electrical stimulation at non-periosteal points. Immediately after completion of the 10-week intervention, 42.9% in the PST w/ post-treatment group, 37%in the PST w/o post-treatment group, and 32.2% in the control group experienced clinically significant improvement. At 9 months follow up, 47.2%, 40.7%, and 30.9% of the groups experienced significant improvement (Although no between-group significance was reached). Mean pain reduction based on the WOMAC pain scale was approximately 30% in all 3 groups.
The authors suggest that their findings support modest efficacy of PST for the treatment of chronic pain associated with advanced knee OA. The high placebo effect of PST asks for additional research that uses other study designs > From Weiner et al., Clinical Therapeutics 2013 (Epub ahead of print) All rights reserved to Elsevier Inc.
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