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Efficacy of Periosteal Stimulation Therapy for the Treatment of Osteoarthritis-Associated Chronic Knee Pain: An Initial Controlled Clinical Trial

Authors

  • Debra K. Weiner MD,

    1. From the Departments of *Medicine, Psychiatry, Anesthesiology, and Biostatistics, and §Pain Evaluation and Treatment Institute, University of Pittsburgh, Pittsburgh, Pennsylvania#Center for Health Equity Research and Promotion, Veterans Administration Pittsburgh Healthcare System, Pittsburgh, Pennsylvania.
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  • Thomas E. Rudy PhD,

    1. From the Departments of *Medicine, Psychiatry, Anesthesiology, and Biostatistics, and §Pain Evaluation and Treatment Institute, University of Pittsburgh, Pittsburgh, Pennsylvania#Center for Health Equity Research and Promotion, Veterans Administration Pittsburgh Healthcare System, Pittsburgh, Pennsylvania.
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  • Natalia Morone MD, MSc,

    1. From the Departments of *Medicine, Psychiatry, Anesthesiology, and Biostatistics, and §Pain Evaluation and Treatment Institute, University of Pittsburgh, Pittsburgh, Pennsylvania#Center for Health Equity Research and Promotion, Veterans Administration Pittsburgh Healthcare System, Pittsburgh, Pennsylvania.
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  • Ronald Glick MD,

    1. From the Departments of *Medicine, Psychiatry, Anesthesiology, and Biostatistics, and §Pain Evaluation and Treatment Institute, University of Pittsburgh, Pittsburgh, Pennsylvania#Center for Health Equity Research and Promotion, Veterans Administration Pittsburgh Healthcare System, Pittsburgh, Pennsylvania.
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  • C. Kent Kwoh MD

    1. From the Departments of *Medicine, Psychiatry, Anesthesiology, and Biostatistics, and §Pain Evaluation and Treatment Institute, University of Pittsburgh, Pittsburgh, Pennsylvania#Center for Health Equity Research and Promotion, Veterans Administration Pittsburgh Healthcare System, Pittsburgh, Pennsylvania.
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Address correspondence to Debra K. Weiner, Department of Medicine, University of Pittsburgh, 5750 Centre Ave, Suite 400, Pittsburgh, PA 15206. E-mail: dweiner@pitt.edu

Abstract

OBJECTIVES: To examine the efficacy of periosteal stimulation therapy (PST, osteopuncture) for the treatment of chronic pain associated with advanced knee osteoarthritis.

DESIGN: Randomized, controlled clinical trial.

SETTING: Outpatient pain clinic.

PARTICIPANTS: Eighty-eight community-dwelling older adults with moderate knee pain or greater for 3 months or longer and Kellgren-Lawrence (K-L) grade 2 through 4 radiographic severity (80% had K-L 4).

INTERVENTION: Participants were randomized to receive PST or control PST once a week for 6 weeks.

MEASUREMENTS: Pain severity and self-reported function (Western Ontario and McMasters University Osteoarthritis Index (WOMAC)) and physical performance (Short Physical Performance Battery (SPPB)) were assessed at baseline, after the last PST session (post), and 3 months later (follow-up). Pain severity was also assessed monthly using the multidimensional pain inventory short form.

RESULTS: Pain was reduced significantly more in the PST group than in the control PST group at post (P=.003; mean WOMAC pain subscale baseline 9.4 vs 6.4) and 1 month later (P<.001), but by 2 months, pain levels had regressed to pre-intervention levels. The group-by-time interaction for the WOMAC function scale was significant at post (P=.04) but not at follow-up (P=.63). No significant group differences were found for the SPPB. Neither analgesic use nor global improvement differed between groups. There were four treatment dropouts.

CONCLUSION: PST affords short-term modest pain reduction for older adults with advanced knee OA. Future research should test the effectiveness of booster treatments in sustaining analgesic benefits and of combining PST with therapeutic exercise in ameliorating disability risk.

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