Knee Osteoarthritis Disabling Pain Program for the Brazilian Unified Health System

"Three weekly medical interventions, according to the patient's need as observed at baseline.~1. 3ml paraspinal infusion of 1% Lidocaine (segmental spinal level);~2. 5,000 impulses of Radial Shockwave Therapy (pneumatic generator, 0.16mJ/mm² of energy and 20Hz of frequency) at the most painful spot of the knees;~3. \*6,000 pulses of Focused Shockwave Therapy (electromagnetic generator) at four sites of the painful knee.~ For those with knee pain of 7 or above in Visual Analogue Scale after the treatments above, the interventions below will be delivered in the order they appear:~4. Ultrasound guided genicular nerve block: infusion of up to 10ml 0.50% Levobupivacaine without vasoconstrictor;~5. Hydrodissection of superficial and deep plane nerves: infusion of 10ml 5% dextrose diluted in water (D5W);~6. Intra-articular Infusion of Hyaluronic Acid: ultrasound guided infusion of 2.5ml of sodium hyaluronate at the knee joint.~ * Four weekly applications."

"Three weekly 60-minute educational program sessions with the following services:~Stretching and strengthening exercises for specific muscle groups (hip flexors, extensors, and abductors; knee flexors and extensors; plantar flexors; and abdominal muscles), using one's own body and gravity resistance. Patients will be encouraged to practice them at home at least twice a week after the end of the sessions.~Nutritional guidance: Instructions on the importance of adequate weight management, healthy food consumption, and the adequate intake of nutrients.~Physical activities: Counseling on home-based physical activities, according to their physical capacities, to protect knee joints.~General health: psychology counseling, encouraging participants to apply strategies and self help conduct to improve their general health; Occupational Therapy: Activities of Daily Living strategies to protect knee joints; Nursing: Counseling on strategies for improving healthy sleeping habits."