A novel application of transcranial pulse stimulation in rehabilitation: pain management in refractory knee osteoarthritis – a case series
DOI:
https://doi.org/10.2340/jrm.v57.42403Keywords:
Knee Osteoarthritis, Chronic Pain, noninvasive brain stimulation, Neuromodulation, TPS, Transcranial Pulse Stimulation, refractory painAbstract
Background: Knee osteoarthritis is the most common form of arthritis in adults and a leading cause of years lived with disability. Knee osteoarthritis is a significant burden on health systems worldwide.
Objective: This study evaluated the impact of transcranial pulse stimulation in pain intensity on a case series of 8 patients with refractory pain due to primary knee osteoarthritis.
Design: Prospective before-and-after case series.
Setting: Tertiary rehabilitation outpatient clinic at a university hospital.
Methods: Transcranial pulse stimulation was delivered in 6 sessions per participant on 8 patients, diagnosed with knee osteoarthritis using the American College of Rheumatology and the Kellgren–Lawrence radiographic grading criteria, with a nominal weekly interval but an adaptive schedule that accommodated individual and logistical constraints. Overall adherence to the programme, the effect on pain level on the Visual Analogue Scale and side effects were assessed.
Results: In total, 8 female patients were evaluated for the visual analogue scale score before and after therapy. Their ages ranged from 63 to 77 years, with an average of 69.3 (± 5.3) years. The mean initial (before therapy) Visual Analogue Scale score for the right knee was 6.4 (± 2.5) across the patients, and that score reduced to an average of 1.1 (± 1.6) by the end of the therapy. Similarly, the average for the left knee reduced from 7.2 (± 1.4) to 1.4 (± 1.8). This resulted in an average reduction in pain of 5.3 points for the right knee and of 5.8 points for the left knee. All patients improved their scores. Proper adherence and tolerance to the transcranial pulse stimulation protocol was observed, with no severe side effects.
Conclusion: Transcranial pulse stimulation reduced pain in patients with refractory pain due to primary knee osteoarthritis. It may be considered as an intervention for knee osteoarthritis patients with chronic disabling pain.
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Copyright (c) 2025 Marta Imamura, Gilson Tanaka Shinzato, Leandro Heidy Yoshioka, Sabrina Saemy Tome Uchiyama, Beatriz Akemi Tanaka, Lucas Ramos De Pretto, Felipe Fregni, Linamara Rizzo Battistella
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