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I've heard about studies where they use the real treatment and compare it against "pretend" or "sham" treatments to find out what really works for a problem. What has been done like this for knee arthritis pain? I don't just want a "feel good" treatment that doesn't last or a "pretend" treatment that fools my body into believing I'm better. I want the real meal deal.

There is no cure for chronic pain caused by knee osteoarthritis. But there are ways to help reduce the pain and improve function. Physical therapy modalities such as diathermy, interferential current, electrical stimulation, and exercise can be very helpful. To help support this statement a group of researchers from four different health care centers in Turkey conducted this study. They compared the effectiveness of each of these treatment tools. They used pain levels, measures of stiffness, ability to walk 15 meters, range of motion, and use of pain medications as measures of outcomes for 203 patients. The patients were divided randomly into one of six groups. There were three active treatment groups (transcutaneous electrical stimulation or TENS), interferential current or IFC, diathermy) and three "sham" groups. TENS and IFC provide an electrical current designed to inhibit pain messages from going up the spinal cord to the brain. Diathermy is a form of electromagnetic therapy that produces heat deep in the soft tissues. No one administering the treatment or receiving the treatment knew whether the treatment was real or a sham. The combination of random assignment and lack of knowledge of the treatment type makes this study a randomized, double-blind, controlled study. Everyone in the six treatment groups received their therapy every day Monday through Friday for three weeks. They also received education and exercise from their therapists making the overall treatment approach a multimodal one (in other words, a group of different treatments combined together). Comparing their measurements before and after treatment they found that everyone in all six groups made significant improvements. The use of Tylenol was much lower in the true physical therapy groups and much higher in the sham treatment groups. There did not appear to be any difference among the different modalities. TENS, IFC, and diathermy all delivered the same amount of pain relief. In summary, the results of this study show that a combination of physical therapy modality, education, and exercise gives the best improvements in patients with chronic pain, stiffness, and loss of function from knee osteoarthritis. Education and exercise provided more improvements in pain and function up to six months. The use of modalities seemed to give the most improvements in the first three months following treatment.


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