**5. Conclusion**

wMHz frequency and 0.8 W/cm<sup>2</sup>

272 Pain Relief - From Analgesics to Alternative Therapies

tained in the two groups.

degree in horses [24].

US group.

power, applied with a 5-cm diameter applicator. The study

a week during 4 weeks. In the

in the same area for the same time.

results showed that TENS, as well as US, are effective for reducing pain and improving the WOMAC score. Ng et al. [21] studied 24 patients and compared electroacupuncture treatment and TENS, using the same parameters for both (low frequency = 2 Hz, continuous mode, pulsation of 200 μs for 20 minutes of application) and showed that either electroacupuncture treatment or TENS is effective in pain reduction because a prolonged analgesic effect main-

Recently, ESWT has become one of the leading therapeutic alternatives. It can treat such diseases as chronic tendinopathies, nonunion of long bone fracture, and early stage of avascular necrosis of the formal head [22]. Moreover, ESWT diffused to the treatment of OA in animals [23, 24]. It improved the rats' walking ability [23]. It significantly improved the lameness

The results achieved in people only confirm these findings. Zhao et al. [25] used ESWT to treat knee OA over 12 weeks and compared it with placebo treatment. Seventy patients were randomized to receive either placebo (n = 36) or ESWT (n = 34). In the ESWT group, the

The authors found the effect on OA by pain on VAS and perceived of health on WOMAC. The evaluation was performed at baseline and after 1, 4, and 12 weeks. The authors found that ESWT was more effective than placebo in reducing pain and improving perceived of health at

In our study following 5 weeks of the treatment the results were similar to the results of the other authors, although we applied another treatment protocol. We found that pain in knees decreased in both the experimental (US) and the control (ESWT) groups, but there were the significant between-group differences after the intervention in favor for ESWT, and also the effects sizes were always more far-reaching in the patients treated with ESWT, than those ones in the patients treated with US. In this study, we also found that both treatment methods improved the total score of WOMAC, but the health benefits in the patients treated with ESWT and their effect size were also more important than those ones in the patients from the

Our study had as strengths as limitations. The strengths included the fact that the study was analyzed using the intention-to-treat principle, the patients were randomly assigned to the two groups—an experimental and a control one. The interventions were provided by the same blinded to outcome measures experienced physiotherapist. Also, they were adminis-

The major limitation was the short follow-up period. Therefore, the future study ought to be a minimal follow up of 1–2 years for all subjects, it would significantly increase the impact of this kind of the study, unfortunately we had no chances to prolong the study. The second limitation is the small sample size. Our findings are therefore to be read as preliminary ones in view of possible future long-term studies with a larger sample size to confirm these results

patients received 4000 pulses of shockwave at 0.25 mJ/mm<sup>2</sup>

placebo group, the patients got shockwave at 0 mJ/mm<sup>2</sup>

tered by the same assistant, blind to the group allocation.

each time assessment of the research.

Despite all the limitations of this study, the obtained results may be valuable for doctors, physiotherapists, and patients with knee OA in choosing the most appropriate types of treatment based on the patients' preference and convenience. Among the people, who were treated for knee OA, ESWT led to greater benefits in reduce pain and perception of health, than a protocol which included US.
