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Comparison of the effectiveness of medicinal leech and TENS therapy in the treatment of primary osteoarthritis of the knee

A randomized controlled trial

Vergleich der Wirksamkeit von medizinischer Blutegel- und TENS-Therapie zur Behandlung der primären Gonarthrose

Eine randomisierte kontrollierte Studie

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Abstract

Objectives

The aim of this study was to evaluate the effects of leech therapy in the treatment of knee osteoarthritis in terms of duration of effectiveness and symptom relief and to compare these results with transcutaneous electrical nerve stimulation (TENS) therapy.

Material and methods

This study was designed as a prospective, single center, randomized, single-blind and parallel group study. A total of 90 patients were included in the study, 46 in the leech group and 44 in the TENS group. Primary outcome measures were changes of the pain scores in visual analogue scale (VAS) and Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) on the measurements day 0, 21 and 180. Secondary outcome measures were the changes in the sub-groups of the WOMAC scores. Five leeches were applied to the affected knee, once every week for 3 weeks.

Results

The VAS pain score showed a similar decrease in both groups in the evaluation on day 21 (p < 0.001). The course of the change of the VAS pain score in both groups was similar in the comparisons between groups. Long-term benefits of the TENS therapy group were slightly more than the leech therapy group. All the sub-scores of WOMAC in both therapy groups showed a similar decrease (p = 0.819). Throughout the study this decrease was statistically significant in both groups (p < 0.001).

Conclusion

Leech therapy relieves symptoms in patients with osteoarthritis of the knee and is as effective as TENS therapy in the management of osteoarthritis of the knee. This treatment has the potential of being an additional or alternative therapy for the non-surgical management of osteoarthritis of the knee.

Zusammenfassung

Ziel

Ziel dieser Studie war es, die Wirkung der Blutegeltherapie zur Behandlung einer Gonarthrose bezüglich Wirksamkeitsdauer und Symptomlinderung zu beurteilen und diese Ergebnisse mit denen der transkutanen elektrischen Nervenstimulation (TENS) zu vergleichen.

Material und Methoden

Es handelte sich um eine prospektive, randomisierte, einfach verblindete Parallelgruppenstudie an einem Studienzentrum. Insgesamt 90 Patienten wurde in die Studie eingeschlossen, davon 46 in der Blutegelgruppe und 44 in der TENS-Gruppe. Primärer Endpunkt waren Veränderungen der Schmerzscores auf der visuellen Analogskala (VAS) und dem Western Ontario sowie dem McMaster Universities Osteoarthritis Index (WOMAC) an den Tagen 0, 21 und 180. Sekundärer Endpunkt waren Veränderungen in den Subgruppen des WOMAC-Scores. Fünf Blutegel wurden auf dem betroffenen Knie aufgesetzt, 1‑mal pro Woche für 3 Wochen.

Ergebnisse

Der VAS-Schmerzscore zeigte bei der Beurteilung an Tag 21 einen ähnlichen Rückgang in beiden Gruppen (p < 0,001). Die Veränderungen des VAS-Schmerzscores zeigten im Vergleich beider Gruppen einen ähnlichen Verlauf. In der TENS-Gruppe überwogen die langfristigen Vorteile geringfügig im Vergleich zur Blutegelgruppe. Alle Subscores des WOMAC zeigten über die gesamte Studiendauer (p = 0,001) in beiden Therapiegruppen einen vergleichbaren Rückgang (p = 0,819).

Schlussfolgerung

Die Blutegeltherapie lindert die Symptome bei Patienten mit Gonarthrose und ist bei der Behandlung einer Gonarthrose genauso wirksam wie die TENS-Therapie. Diese Behandlung hat das Potenzial einer Zusatz- oder Alternativbehandlung bei der nichtoperativen Therapie der Gonarthrose.

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Acknowledgements

The authors disclose that no external writing assistance with the manuscript was received. We thank Prof. Dr. Zekeriya Akturk for support and encouragement.

Funding

This study was funded by the Scientific and Technological Research Council of Turkey (TÜBİTAK). Research protocol number: 111S387. The funding source had a role in the design and conducting of the study including statistical analysis.

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Authors and Affiliations

  1. Department of Family Medicine, Ataturk University, 25240, Yakutiye/Erzurum, Turkey

    M. Isik, R. S. Yakisan & T. Sari

  2. Department of Physical Medicine and Rehabilitation, Ataturk University, 25240, Yakutiye/Erzurum, Turkey

    M. Ugur & N. Yilmaz

Authors
  1. M. Isik
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  2. M. Ugur
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  3. R. S. Yakisan
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  4. T. Sari
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  5. N. Yilmaz
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Corresponding author

Correspondence to M. Isik.

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Conflict of interests

M. Isik, M. Ugur, R. S. Yakisan, T. Sari and N. Yilmaz declare that they have no conflict of interests.

All studies on humans described in this manuscript were carried out with the approval of the responsible ethics committee and in accordance with national law and the Helsinki Declaration of 1975 (in its current revised form). Informed consent was obtained from all participants in the study.

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Redaktion

U. Müller-Ladner, Bad Nauheim

U. Lange, Bad Nauheim

M. Isik conceived and led the investigation, developed the study protocol and guided the statistical analyses. M. Ugur performed the initial patient examination and allocation. R. S. Yakisan and T. Sari performed leech therapy, followed patients and collected data. N. Yilmaz performed the initial baseline measurement, guided the TENS therapy in the physical medicine and rehabilitation and collected data.

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Isik, M., Ugur, M., Yakisan, R.S. et al. Comparison of the effectiveness of medicinal leech and TENS therapy in the treatment of primary osteoarthritis of the knee. Z Rheumatol 76, 798–805 (2017). https://doi.org/10.1007/s00393-016-0176-1

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  • DOI: https://doi.org/10.1007/s00393-016-0176-1

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