Comparing CAM options to treat osteoarthritis knee pain
And how they compare to the fentanyl (Duragesic) patch.
First, the details.
- Researchers from Bergen University College in Norway reviewed 36 studies of 2434 patients.
- All studies had a placebo control group.
- The average patient age was 65 years.
- Baseline pain averaged 63 mm on a 100 mm visual analog scale (VAS), where higher scores mean greater pain.
And, the results.
- After 4 weeks, manual acupuncture, static magnets, and ultrasound therapies were no different than placebo.
- Pulsed electromagnetic fields offered a small reduction in pain (-7 mm).
- Transcutaneous electrical nerve stimulation (TENS, including interferential currents), electro-acupuncture, and low-level laser therapy offered clinically relevant pain relief of -19 mm, -22 mm, and -18 mm on VAS respectively vs placebo.
- In patients where the researchers determined optimal doses were used, short-term efficacy was -22 mm for TENS, and -24 mm for low-level laser therapy.
- Although follow-up data were sparse, positive effects seemed to persist for at least 4 weeks after TENS, electro-acupuncture, and low-level laser therapy were stopped.
The bottom line?
The authors concluded, “TENS, electro-acupuncture, and low-level laser therapy administered at optimal doses in an intensive 2- to 4-week treatment regimen, seem to offer clinically relevant short-term pain relief for pain associated with osteoarthritis of the knee.”
The results from this review look pretty good when compared to the results in another study of 400 patients with osteoarthritis pain (VAS score = 73 mm score) who were randomly assigned to fentanyl (Duragesic) transdermal patch or placebo.
Yes, the fentanyl group had significantly better pain relief, but the differences (reduction in VAS scores of -20 mm in the fentanyl group vs -15 mm with placebo), aren’t that different.
One more point. Only half of the patients completed this study. Fentanyl recipients were less likely than placebo recipients to withdraw because of lack of efficacy (7% vs. 33%) but were more likely to withdraw because of adverse events (27% vs. 10%).
9/1/07 14:31 JR
