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To report the efficacy of a 3-month treatment program consisting of neuromuscular exercise, education, diet, insoles and pain medication (MEDIC-treatment) compared to usual care (two leaflets with information and treatment advice) in reducing pain-related measures and sensitization in patients with knee osteoarthritis (OA) not eligible for total knee replacement (TKR).
According to the
findings in this research, the treatment results may differ depending on what
pain-related measures are evaluated and thus, pain has abundant dimensions.
This is the first study rating the multiple pain-related measures like
sensitization, presented in a randomized setting in patients with knee
osteoarthritis.
To report the
efficacy of a 3-month treatment program consisting of neuromuscular exercise,
education, diet, insoles and pain medication (MEDIC-treatment) compared to
usual care (two leaflets with information and treatment advice) in reducing
pain-related measures and sensitization in patients with knee osteoarthritis
(OA) not eligible for total knee replacement (TKR).
A pre-defined
ancillary analysis of the results at 3 months of a randomized controlled trial
(RCT) of 100 patients randomized to MEDIC-treatment or usual care. Trial
registration: ClinicalTrials.gov (NCT01535001). Outcomes were sensitization
assessed at the knee, the lower leg and forearm using a handheld algometer,
peak pain intensity in the previous 24 h, pain intensity after 30 min of
walking, pain location and pattern, spreading of pain (a region-divided body
chart) and the usage of pain medication.
The MEDIC group
had larger improvements from baseline to 3 months in peak pain intensity (P =
0.02) and pain after 30 min of walking (P < 0.001) and in the number of body
sites with pain (P = 0.04). There was no difference in the change in
sensitization from baseline to 3 months between groups (P = 0.87), but
sensitization decreased in both groups (P < 0.001).
A non-surgical
treatment program is more efficacious in reducing pain-related measures than
usual care, while both are equally efficacious in reducing sensitization,
indicating that mechanisms other than pain sensitization contribute to the
perceived pain. The patients did not have severe symptomatic knee OA and hence
pain sensitization may not yet have developed into a clinically relevant
parameter or subgroups with less sensitization may exist.
Osteoarthritis Cartilage. 2016 Jan;24(1):108-16
The efficacy of non-surgical treatment on pain and sensitization in patients with knee osteoarthritis: a pre-defined ancillary analysis from a randomized controlled trial
S.T. Skou et al.
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