{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,3]],"date-time":"2026-10-03T00:21:38Z","timestamp":1790986898290,"version":"4.1.0"},"reference-count":53,"publisher":"MJS Publishing, Medical Journals Sweden AB","license":[{"start":{"date-parts":[[2025,9,23]],"date-time":"2025-09-23T00:00:00Z","timestamp":1758585600000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JRM"],"abstract":"<jats:p>Background: Knee osteoarthritis is the most common form of arthritis in adults and a leading cause of years lived with disability. Knee osteoarthritis is a significant burden on health systems worldwide.\nObjective: This study evaluated the impact of transcranial pulse stimulation in pain intensity on a case series of 8 patients with refractory pain due to primary knee osteoarthritis.\nDesign: Prospective before-and-after case series.\nSetting: Tertiary rehabilitation outpatient clinic at a university hospital.\nMethods: Transcranial pulse stimulation was delivered in 6 sessions per participant on 8 patients, diagnosed with knee osteoarthritis using the American College of Rheumatology and the Kellgren\u2013Lawrence radiographic grading criteria, with a nominal weekly interval but an adaptive schedule that accommodated individual and logistical constraints. Overall adherence to the programme, the effect on pain level on the Visual Analogue Scale and side effects were assessed.\nResults: In total, 8 female patients were evaluated for the visual analogue scale score before and after therapy. Their ages ranged from 63 to 77 years, with an average of 69.3 (\u00b1\u20095.3) years. The mean initial (before therapy) Visual Analogue Scale score for the right knee was 6.4 (\u00b1\u20092.5) across the patients, and that score reduced to an average of 1.1 (\u00b1\u20091.6) by the end of the therapy. Similarly, the average for the left knee reduced from 7.2 (\u00b1\u20091.4) to 1.4 (\u00b1\u20091.8). This resulted in an average reduction in pain of 5.3 points for the right knee and of 5.8 points for the left knee. All patients improved their scores. Proper adherence and tolerance to the transcranial pulse stimulation protocol was observed, with no severe side effects.\nConclusion: Transcranial pulse stimulation reduced pain in patients with refractory pain due to primary knee osteoarthritis. It may be considered as an intervention for knee osteoarthritis patients with chronic disabling pain.<\/jats:p>","DOI":"10.2340\/jrm.v57.42403","type":"journal-article","created":{"date-parts":[[2025,9,23]],"date-time":"2025-09-23T12:43:17Z","timestamp":1758631397000},"page":"jrm42403","source":"Crossref","is-referenced-by-count":1,"title":["A novel application of transcranial pulse stimulation in rehabilitation: pain management in refractory knee osteoarthritis \u2013 a case series"],"prefix":"10.2340","volume":"57","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-0355-9697","authenticated-orcid":false,"given":"Marta","family":"Imamura","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1462-7096","authenticated-orcid":false,"given":"Gilson Tanaka","family":"Shinzato","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Leandro Heidy","family":"Yoshioka","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sabrina Saemy Tome","family":"Uchiyama","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Beatriz Akemi","family":"Tanaka","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lucas Ramos","family":"De Pretto","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9359-8643","authenticated-orcid":false,"given":"Felipe","family":"Fregni","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5275-0733","authenticated-orcid":false,"given":"Linamara Rizzo","family":"Battistella","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1183","published-online":{"date-parts":[[2025,9,23]]},"reference":[{"key":"127413","unstructured":"GBD 2021 Osteoarthritis Collaborators. 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Non-invasive sound wave brain stimulation with Transcranial Pulse Stimulation (TPS) improves neuropsychiatric symptoms in Alzheimer\u2019s disease. Brain Stimul 2024; 17: 413.","DOI":"10.1016\/j.brs.2024.03.007"},{"key":"127417","doi-asserted-by":"crossref","unstructured":"Beisteiner R, Matt E, Fan C, Baldysiak H, Sch\u00f6nfeld M, Philippi Novak T, et al. Transcranial pulse stimulation with ultrasound in Alzheimer\u2019s disease: a new navigated focal brain therapy. Adv Sci (Weinh) 2019; 7: 1902583.","DOI":"10.1002\/advs.201902583"},{"key":"127418","doi-asserted-by":"crossref","unstructured":"D\u00f6rl G, Matt E, Beisteiner R. Functional specificity of TPS brain stimulation effects in patients with Alzheimer\u2019s disease: a follow-up fMRI analysis. Neurol Ther 2022; 11: 1391.","DOI":"10.1007\/s40120-022-00362-8"},{"key":"127419","doi-asserted-by":"crossref","unstructured":"Cont C, Stute N, Galli A, Schulte C, Logmin K, Trenado C, et al. Retrospective real-world pilot data on transcranial pulse stimulation in mild to severe Alzheimer\u2019s patients. Front Neurol 2022; 13: 948204.","DOI":"10.3389\/fneur.2022.948204"},{"key":"127420","doi-asserted-by":"crossref","unstructured":"Sprick U, K\u00f6hne M. Brain stimulation by noninvasive transcranial pulse stimulation (TPS) improves cognitive deficits and mood in Alzheimer\u2019s disease. Presented at 2022 International Conference on Electrical, Computer, Communications and Mechatronics Engineering (ICECCME); 2022 Maldives, Maldives. Available from: https:\/\/doi.org\/10.1109\/ICECCME55909.2022.9988704","DOI":"10.1109\/ICECCME55909.2022.9988704"},{"key":"127421","doi-asserted-by":"crossref","unstructured":"Fong TKH, Cheung T, Ngan STJ, Tong K, Lui WYV, Chan WC, et al. Transcranial pulse stimulation in the treatment of mild neurocognitive disorders. 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Curr Alzheimer Res 2023; 20: 244.","DOI":"10.2174\/1567205020666230727102025"},{"key":"127425","doi-asserted-by":"crossref","unstructured":"Giannoni-Luza S, Pacheco-Barrios K, Cardenas-Rojas A, Mejia-Pando PF, Luna-Cuadros MA, Barouh JL, et al. Noninvasive motor cortex stimulation effects on quantitative sensory testing in healthy and chronic pain subjects: a systematic review and meta-analysis. Pain 2020; 161: 1955.","DOI":"10.1097\/j.pain.0000000000001893"},{"key":"127426","doi-asserted-by":"crossref","unstructured":"Kummer K, Sheets PL. Targeting prefrontal cortex dysfunction in pain. J Pharmacol Exp Ther 2024; 389: 268.","DOI":"10.1124\/jpet.123.002046"},{"key":"127427","unstructured":"Chaim Filho F, Imamura M, Squarzoni P, Duran FLS, Busatto Filho G, Fregni F, et al. Neuroimage of patients with severe knee osteoarthritis brain volumetric evaluation. J Int Soc Phys Rehabil Med 2020; 3: S569."},{"key":"127428","doi-asserted-by":"crossref","unstructured":"Popescu T, Pernet C, Beisteiner R. Transcranial ultrasound pulse stimulation reduces cortical atrophy in Alzheimer\u2019s patients: a follow-up study. Alzheimers Dement (N Y) 2021; 7(1): e12121.","DOI":"10.1002\/trc2.12121"},{"key":"127429","doi-asserted-by":"crossref","unstructured":"Cheung T, Li TMH, Ho YS, Kranz G, Fong KNK, Leung SF, et al. Effects of transcranial pulse stimulation (TPS) on adults with symptoms of depression: a pilot randomized controlled trial. Int J Environ Res Public Health 2023; 20: 2333.","DOI":"10.3390\/ijerph20032333"},{"key":"127430","doi-asserted-by":"crossref","unstructured":"Abicalaf CARP, Nakada LN, Santos FRA, Akiho I, Santos ACA, Imamura M, et al. Ultrasonography findings in knee osteoarthritis: a prospective observational cross-sectional study of 100 patients. 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Sci Rep 2022; 12: 1480.","DOI":"10.1038\/s41598-022-04957-x"},{"key":"127434","doi-asserted-by":"crossref","unstructured":"Simis M, Pacheco-Barrios K, Vasquez-Avila K, Rebello-Sanchez I, Parente J, Castelo-Branco L, et al. Functional and neural correlates associated with conditioned pain modulation in patients with chronic knee osteoarthritis pain: a cross-sectional study. Life (Basel) 2023; 13: 1697.","DOI":"10.3390\/life13081697"},{"key":"127435","doi-asserted-by":"crossref","unstructured":"Imamura M, Rebello-Sanchez I, Parente J, Marduy A, Vasquez-Avila K, Pacheco-Barrios K, et al. Factors associated with pain pressure threshold in both local and remote sites in knee osteoarthritis. PM R 2024; 16: 132.","DOI":"10.1002\/pmrj.13038"},{"key":"127436","doi-asserted-by":"crossref","unstructured":"Marques LM, Castellani A, Barbosa SP, Imamura M, Battistella LR, Simis M, et al. 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Mechanotransduction in hippocampal neurons operates under localized low picoNewton forces. iScience 2022; 25: 103807.","DOI":"10.1016\/j.isci.2022.103807"},{"key":"127444","doi-asserted-by":"crossref","unstructured":"Lohse-Busch H, Reime U, Falland R. Symptomatic treatment of unresponsive wakefulness syndrome with transcranially focused extracorporeal shock waves. NeuroRehabilitation 2014; 35: 235.","DOI":"10.3233\/NRE-141115"},{"key":"127445","doi-asserted-by":"crossref","unstructured":"Ciampa AR, Prati AC, Amelio E, Cavalieri E, Persichini T, Colasanti M, et al. Nitric oxide mediates anti-inflammatory action of extracorporeal shock waves. FEBS Lett 2005; 579: 6839.","DOI":"10.1016\/j.febslet.2005.11.023"},{"key":"127446","doi-asserted-by":"crossref","unstructured":"Mariotto S, Cavalieri E, Amelio E, Ciampa AR, Prati AC, Marlinghaus E, et al. Extracorporeal shock waves: from lithotripsy to anti-inflammatory action by NO production. 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