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 = 0.03) and T2 (Cohen's d 2.57, p = 0.39) but not at T3 (p = 0.41) and T4 (p = 0.75). rTMS with MT resulted in less pain reduction than rTMS alone (Cohen's d 0.75, p = 0.04). 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 = 0.04). 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.
Reprinted from the Journal of Manipulative and Physiological Therapeutics with copyright permission from the National University of Health Sciences.

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