Effect of Manual Therapy and Transcranial Magnetic Stimulation on Pain in Knee Osteoarthritis: A Randomized Clinical Trial.

OBJECTIVES The purpose of this study was to compare the immediate and long-term effects of repetitive transcranial magnetic stimulation (rTMS) and manual therapy (MT), alone or combined, on knee osteoarthritis (KOA) pain.

METHODS In this single session, double-blind, randomized, and controlled clinical trial, 36 KOA patients were randomly assigned to a single session of real rTMS (rTMS; n = 12), sham rTMS paired with MT (sham rTMS/MT; n = 12), or real rTMS paired with MT (rTMS/MT; n = 12). Pain intensity, pain sensitivity, range of motion, and functional mobility were assessed before (T0) and immediately after the session (T1). Pain intensity was also assessed at follow-ups of five (T2), 15 (T3), and 30 days (T4). Physical disability was assessed in T0 and T2.

RESULTS Pain intensity decreased in rTMS and sham rTMS/MT at T1. The reduction was greater in rTMS than in sham rTMS/MT at T1 (Cohen's d = 0.95, P = .03) and T2 (Cohen's d = 2.57, P = .39) but not at T3 (P = .41) and T4 (P = .75). rTMS with MT resulted in less pain reduction than rTMS alone (Cohen's d = 0.75, P = .04). The groups presented no differences in pain sensitivity, range of motion, or functional mobility. rTMS presented lower physical disability than sham rTMS/MT at T2 (P = .04).

CONCLUSIONS Manual therapy applied immediately after rTMS impaired the analgesic effect of brain stimulation and showed that a single session of rTMS was enough to reduce pain intensity in participants with KOA.