Breaking the Pain Cycle in Osteoarthritis: From Drugs to Rehabilitation

A special issue of Medicina (ISSN 1648-9144). This special issue belongs to the section "Orthopedics".

Deadline for manuscript submissions: 20 December 2026 | Viewed by 457

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U.O. Medicina Generale, Ospedale San Paolo di Civitavecchia, ASL Roma 4, Civitavecchia, 01100 Rome, Italy
Interests: psoriatic arthritis; rheumatology; rheumatoid arthritis
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Special Issue Information

Dear Colleagues,

Osteoarthritis (OA) is one of the leading causes of chronic pain and disability worldwide, significantly impacting quality of life and healthcare systems. Despite its high prevalence, the management of OA pain remains challenging due to its multifactorial nature, involving not only structural joint damage but also inflammatory processes, neuromuscular dysfunction, and central pain sensitization.

In recent years, there has been a growing shift from a purely pharmacological approach toward a more comprehensive, multidisciplinary strategy. While conventional and emerging drug therapies—such as nonsteroidal anti-inflammatory drugs, intra-articular injections, and novel metabolic agents—continue to play a key role in symptom control, non-pharmacological interventions are increasingly being recognized as essential components of effective OA management.

Rehabilitation strategies, including therapeutic exercise, physical therapy modalities, and innovative technologies such as cryoultrasound and neuromodulation, are garnering attention for their potential to reduce pain, improve function, and possibly slow disease progression. Moreover, personalized medicine approaches are beginning to reshape treatment pathways by tailoring interventions to individual patient profiles.

This Special Issue aims to provide an updated and comprehensive overview of current and emerging strategies to “break the pain cycle” in osteoarthritis. We welcome original research articles, reviews, and clinical studies that explore the integration of pharmacological treatments with rehabilitation and other non-invasive approaches.

Topics of interest include, but are not limited to, the following:

  • The pharmacological management of osteoarthritis pain;
  • Rehabilitation and physiotherapy interventions;
  • Innovative technologies (e.g., cryoultrasound therapy);
  • Mechanisms of pain in OA, including central sensitization;
  • Metabolic and systemic factors (e.g., obesity, GLP-1 pathways);
  • Multimodal and personalized treatment strategies;
  • Clinical outcomes and real-world evidence. 

By bringing together diverse perspectives, this Special Issue seeks to advance knowledge and promote more effective, patient-centered approaches to osteoarthritis care.

Dr. Alessandro Conforti
Guest Editor

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Keywords

  • osteoarthritis
  • chronic pain
  • pain management
  • rehabilitation
  • physiotherapy
  • cryoultrasound therapy
  • pharmacological treatment
  • NSAIDs
  • intra-articular injections
  • GLP-1
  • metabolic factors
  • central sensitization
  • multimodal therapy
  • personalized medicine
  • non-pharmacological interventions

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Published Papers (1 paper)

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Review

15 pages, 561 KB  
Review
The Use of Physical Energy-Based Therapies in the Management of Osteoarthritis
by Marco Giuseppe Musorrofiti, Marco Bonifacio, Valerio Cipolloni, Enricomaria Mattia, Rosa Bellomo and Raoul Saggini
Medicina 2026, 62(6), 1119; https://doi.org/10.3390/medicina62061119 - 9 Jun 2026
Viewed by 237
Abstract
Physical energy-based therapies are non-invasive adjunctive interventions that deliver mechanical, electromagnetic, light, or radiofrequency/thermal energy to tissues with the aim of reducing symptoms and improving tolerance of active rehabilitation. Osteoarthritis (OA) is a heterogeneous whole-joint disorder in which cartilage degeneration, subchondral bone remodeling, [...] Read more.
Physical energy-based therapies are non-invasive adjunctive interventions that deliver mechanical, electromagnetic, light, or radiofrequency/thermal energy to tissues with the aim of reducing symptoms and improving tolerance of active rehabilitation. Osteoarthritis (OA) is a heterogeneous whole-joint disorder in which cartilage degeneration, subchondral bone remodeling, synovitis, peri-articular tissue dysfunction, neuromuscular impairment, and pain sensitization may interact to produce pain, stiffness, and activity restriction. As conservative therapy for OA, education, progressive therapeutic exercise, weight management when indicated, and self-management remain the core of care. Nevertheless, some patients cannot fully participate in exercise because of pain, fear of movement, load intolerance, comorbidity, or limited access to supervised rehabilitation. This narrative review synthesizes evidence published mainly between 2016 and 2026 for extracorporeal shock wave therapy (ESWT), photobiomodulation/low-level laser therapy (PBMT/LLLT), pulsed electromagnetic field therapy (PEMF), transfer energy capacitive and resistive/capacitive–resistive electric transfer (TECAR/CRET) therapy, body weight support and aquatic unloading strategies, and mechanosonic vibration therapies. The available literature suggests that ESWT and PBMT/LLLT may provide short- to mid-term pain and function benefits in selected patients with knee OA when parameters are aligned with evidence-supported dosing windows. PEMF and vibration therapies show promising but less consistent effects because protocols, devices, sham conditions, and populations vary. TECAR/CRET and unloading approaches are best interpreted as enabling tools that may reduce guarding, improve walking tolerance, or increase the quality of therapeutic exercise, rather than stand-alone disease-modifying treatments. Current national and society guidelines consistently prioritize exercise, education, and weight management; most of the modalities reviewed here are absent from guidelines or are supported only indirectly, which justifies cautious wording and individualized use. A practical application model is, therefore, time-limited and goal-oriented: identify the barrier to rehabilitation, select a modality with a plausible mechanism and published protocol, monitor pain and functional response, and discontinue the modality if it does not improve participation in active care. Full article
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