Wearable transcutaneous electrical nerve stimulation (actiTENS®) is effective and safe for the treatment of knee osteoarthritis pain: a randomized controlled trial versus weak opioids

Author:

Maheu Emmanuel1ORCID,Soriot-Thomas Sandrine2,Noel Eric3,Ganry Hervé4,Lespessailles Eric5,Cortet Bernard6

Affiliation:

1. Rheumatology Department, St-Antoine Hospital–APHP, 75011 Paris, FrancePrivate Office, 283, Bd Voltaire, Paris, France

2. Clinical Research Centre and Orthopaedic and Traumatology Surgery Department, CHU Amiens Picardie, Amiens, France

3. Rheumatologist, Ramsay Santé, Hôpital Privé Jean Mermoz, Centre Orthopédique Santy, Lyon, France

4. Hergan Consulting 4U, Amiens, France

5. Rheumatology Department, Regional Hospital of Orleans, University of Orléans, Orléans, France

6. Department of Rheumatology, Centre Hospitalier Universitaire de Lille, 59000 Lille, France

Abstract

Introduction: Despite their poor tolerance, especially in the elderly, weak opioids (WO) remain commonly prescribed for patients with knee osteoarthritis (KOA). We compared the efficacy and safety of a new wearable transcutaneous electrical nerve stimulation (W-TENS) device with WO for the treatment of moderate-to-severe, nociceptive KOA chronic pain. Methods: The study was a non-inferiority, multicentric, prospective, randomized, single-blind, controlled, 2-parallel groups Trial. A total of 110 patients with KOA were included (Kellgren-Lawrence radiographic grade ⩾2; American College of Rheumatology criteria), with chronic moderate-to-severe nociceptive pain (mean 8-day pain intensity (PI) ⩾ 4 on an 11-point numerical rating scale), in failure to non-opioid analgesics, including nonsteroidal anti-inflammatory drugs (NSAIDs). Patients with neuropathic pain were excluded. The co-primary endpoints were mean PI at 3 months (M3) and number of potentially treatment-related adverse events (TRAEs). Secondary outcomes included Western Ontario MAC Master University function subscale (range, 0–68), additional pain and quality of life measures, and responder rates. Results: The non-inferiority of W-TENS was demonstrated in both the per protocol (PP) and intent-to-treat (ITT) populations. At M3, PI in PP population was 3.87 (2.12) compared with 4.66 (2.37) [delta: −0.79 (0.44); 95% CI (−1.65, 0.08)] in W-TENS and WO groups, respectively. A planned superiority analysis showed a significant superiority of W-TENS over WO on PI at M3 ( p = 0.0124). The number of TRAEs was significantly lower in the W-TENS group ( n = 7) than in the WO group ( n = 36) ( p < 0.001). Other secondary outcomes also favored W-TENS. Conclusion: W-TENS was more effective and better tolerated than WO in the treatment of chronic nociceptive KOA pain and offers an interesting non-pharmacological analgesic alternative in the management of KOA. Trial Registration: ClinicalTrials.gov: NCT03902340

Funder

SUBLIMED

Laboratoires Expanscience

Publisher

SAGE Publications

Subject

Orthopedics and Sports Medicine,Rheumatology

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