Pulsed Shortwave Therapy in Cervical Osteoarthritis: An NSAID- Controlled, Randomized Clinical Trial

Abstract

Objective Assess treatment superiority of Pulsed Shortwave Therapy (PSWT) against COX-2 NSAID therapy, in reducing disability and pain due to cervical osteoarthritis.Design 200chronic pain suffers (average pain duration about 2 years)diagnosed with cervical osteoarthritis by radiological imaging were randomized into one of two treatmentarms: COX-2 NSAID treatment: Etoricoxib 60mg/day for 4 weeks; or, PSWT treatmentworn 24 hours/day for 4 weeks. The primary outcome measure was the 4-week score on the Neck Disability Index (NDI): a 10-question assessment on a 50-point scale. Secondary outcome measures included pain(at rest and during activity)measured on a Visual Analog Scale (VAS)of0-100 mm, dose count of rescue pain medication (paracetamol)use and a treatment satisfaction rating. These 4-week scores were compared across the two arms to assess superiority.Results After 4 weeks of treatment,subjects in both study arms reported significantly lower (p<0.0001) 4-week measures (11.24-NSAID;9.34-PSWT; 0-50 points),VASrest (30.08-NSAID;22.76-PSWT; 0-100 mm) and VASactivity (36.40-NSAID; 27.42-PSWT; 0-100 mm).The absolute reduction from baseline in NDI was significantly greater in the PSWT arm than NSAID arm(by 3.66 points; 95% CI 2.3 to 5.02; p<0.0001). Similarly, the reductions from baseline inVASrest and VASactivitywere significantly greater in the PSWT arm than NSAID arm(by 10.89 mm;95% CI 6.90 to 14.87; p<0.0001 and 12.05 mm;95% CI 7.76 to 16.33; p<0.0001 respectively).The PSWT arm used 50% less rescue pain medication. Eleven adverse effects were reported in the NSAID arm and zero in the PSWT arm.Conclusion Both NSAID and PSWT treatments resulted in clinically meaningful increases in quality of life(NDI) and decreases in pain (VAS) associated with cervicalosteoarthritis. However, the PSWT armshowed superior improvements in all outcome measures when compared to the NSAID armwith no adverse effects.