Periosteal Stimulation for Knee Osteoarthritis

We have performed a promising initial trial of periosteal stimulation (PST, that is, electrical stimulation of 4 acupuncture needles around the knee that touch periosteum) as an analgesic for older veterans with advanced knee osteoarthritis (OA) and daily pain. The primary aim of the proposed trial is to optimize and sustain the efficacy of PST for reducing pain in veterans with advanced knee OA and unrelieved pain by combining it with booster PST. Our secondary aims are to 1) improve physical performance in these individuals, and 2) ascertain the physical and psychological predictors of response to PST. In a randomized controlled clinical trial, 180 veterans (age 50 and older) with persistent knee pain who have x-ray evidence of advanced OA will be assigned to one of three intervention groups: 1) control PST once a week for 10 weeks (i.e., needle placement with brief stimulation of non-periosteal needles), 2) PST once a week for 10 weeks followed by tapering PST boosters over 6 months, or 3) PST once a week for 10 weeks followed by tapering control-PST boosters over 6 months. Prior to initiating the intervention, immediately after the last session, and 6 months later, the following parameters will be assessed: 1) pain severity (WOMAC), 3) physical performance (gait velocity, stair climb, repetitive chair rise, timed up and go), and 4) psychological function (mood, coping, self-efficacy). Monthly telephone calls will assess pain, interim illness and physical activity.

Inclusion criteria

• English speaking,
• Knee pain on most days of the past 3 months that is more severe than pain in other parts of the lower body,
• Advanced knee OA by x-ray,
• age 50-89

Exclusion criteria

• Non-ambulatory or severely impaired mobility (i.e., require the use of a walker),
• Folstein MMSE < 24,
• Severe uncorrected visual or hearing impairment,
• Knee pain due to factors other than OA,
• Large knee effusion,
• History of corticosteroid or hyaluronic acid injection in the affected knee(s) during the preceding 3 months,
• Acute or terminal illness,
• Immune suppression,
• Anticoagulation therapy,
• Pacemaker,
• Prior PST treatment
• Active participation in other studies currently
• Age >89