Archive for the ‘acupuncture’ Category


Aug. 20, 2010 (By Katrina Woznicki)– Traditional Chinese acupuncture proved no more effective for treating osteoarthritis of the knee than sham acupuncture, a new study says. People who got either form of therapy showed significant improvement in pain.

The findings are published online and will appear in the September issue of Arthritis Care & Research, a journal of the American College of Rheumatology.

Also, the communication style of the acupuncture practitioner had an effect on pain improvement and satisfaction with treatment. Patients whose health care provider said they expected the therapy to help the pain had significantly more improvement in pain, compared to patients whose provider was neutral about the therapy.

The findings suggest that the way health care providers communicate to their patients and manage patients’ expectations could affect outcomes.

The Study
Acupuncture is an ancient Chinese healing practice in which very thin needles are placed in various locations of body to help reduce pain and improve the body’s flow of energy. According to the National Center for Complementary and Alternative Medicine, an estimated 3.1 million U.S. adults have used acupuncture.

Researchers led by Maria Suarez-Almazor, MD, PhD, a rheumatologist at the University of Texas M.D. Anderson Cancer Center in Houston, compared traditional Chinese acupuncture to sham acupuncture in 455 patients with osteoarthritis of the knee. It’s a condition that affects 27 million Americans aged 25 and older. Symptoms include pain, stiffness, and swelling in the knee joints.

The goal of the study was to evaluate the effects of the treatments and the impact of interactions between the health care provider and the patient. Acupuncturists were trained to interact with patients using one of two communication styles. One style, called “high expectation,” had the health care provider telling patients he or she has “had a lot of success treating knee pain,” therefore increasing a patient’s expectations. The second style, called “neutral,” had providers telling patients the treatment “may or may not work for you.”

Patients were randomly chosen to either visit a provider trained in a “high” communication style, visit one trained to be “neutral,” or receive no treatment. Patients who received treatments did so for six weeks. Patient and provider visits were recorded, and patients answered questionnaires to determine how their pain and symptoms had changed, if at all.

Overall, there were no major differences between patients who received traditional Chinese acupuncture and those who received sham acupuncture. Those who received some form of acupuncture reported greater improvements in their symptoms than those who received no treatment.

After six weeks of treatment, 41.2% of patients who were treated by providers trained to deliver “high” expectations reported a 50% improvement in symptoms, compared with 33.6% trained by those to deliver “neutral” expectations.

“We found a small but significant effect on pain and satisfaction with treatment, demonstrating a placebo effect related to the clinician’s communications style,” Suarez-Almazor says in a news release. “The improvement in pain and satisfaction suggests that the benefits of acupuncture may be partially mediated through placebo effects related to the behavior of the acupuncturist.”


An acupuncture session may relieve itching in those with an allergic skin condition known as atopic eczema.

Eczema is a general term for conditions marked by inflammation and dry, red, itchy patches on the skin. The most common form, atopic eczema, is seen in people with a predisposition to allergies, like hay fever or asthma. Acupuncture has been used for more than 2,000 years in Chinese medicine to treat a wide variety of ailments. According to traditional medicine, specific acupuncture points on the skin are connected to internal pathways that conduct energy, or qi (“chee”), and stimulating these points with a fine needle promotes the healthy flow of qi.

Researchers looked at the short-term effects of acupuncture on skin inflammation and itching in 30 people with atopic eczema in Germany under three different test conditions. In one, patients had their skin exposed to either pollen or dust-mite allergens, then received true, or point-specific, acupuncture – in which needles were placed in traditional acupuncture points that, according to
Chinese medicine, are related to itchy skin. In another situation, the allergen exposure was followed by placebo-point acupuncture, where the needles were inserted into skin areas not used in traditional Chinese medicine. In the third situation, patients received no treatment.

It was found that overall patients’ itchiness ratings were lower after they received true acupuncture, compared with both no treatment and placebo acupuncture. Then, when the researchers exposed patients’ skin to the allergens a second time, skin flare-ups tended to be less-severe following the point-specific acupuncture. As for itchiness, however, both the true and placebo therapies had similar benefits compared with no treatment.

Modern research has suggested that acupuncture may help ease pain by altering signals among nerve cells or affecting the release of various chemicals of the central nervous system. The researchers explained that pain and itchiness have similarities in their underlying mechanisms, so acupuncture’s effects on pain mechanisms may also account for the benefits seen in this study.

The findings show that in this experimental setting, acupuncture seems to ease the itch of atopic eczema. The study does not, however, answer the question of whether acupuncture as practiced in the real world would have similar benefits. However, more research is needed to see whether and why acupuncture might be helpful for people with eczema.

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A large German trial has found that acupuncture is of significant benefit in controlling the pain of osteoarthritis of the hip and knee. Of 3633 patients, 357 were randomised to receive acupuncture (15 treatments over three months), 355 were randomised to a non-acupuncture control group, and 2921 did not accept randomisation and opted for acupuncture treatment. All patients received usual medical care in addition to acupuncture. The randomised acupuncture group showed significant improvement over controls at both three and six months in osteoarthritis severity (WOMAC scale) and quality of life. Improvements were comparable to those in the non randomised acupuncture group. The authors report that ” P h y s i c i a n c h a r a c t e r i s t i c s , s u c h a s t h e l e v e l o f f o r m a l a c u p u n c t u r e t r a i n i n g o r c e r t i f i c a t i o n , d i d n o t i n f l u e n c e t r e a t m e n t o u t c o m e s ” , although only 140 hours of certified training was a minimum requirement of participating physicians. Partly as a result of this trial, the German Ministry of Health is considering a recommendation from a federal committee of doctors and health insurers that acupuncture should be covered by medical insurance. (Acupuncture in patients with osteoarthritis of the knee or hip: A randomized, controlled trial with an additional nonrandomized arm. Arthritis & Rheumatism, 54; 11: 3485 – 3493).

A small study has demonstrated that acupuncture, and particularly electro-acupuncture, appears to be effective in reducing joint pain, stiffness and swelling in rheumatoid arthritis (RA). 36 patients, average age 58, suffering from RA that was unresponsive to other therapies, were assigned to three groups and received either electro-acupuncture, traditional acupuncture or ‘placebo acupuncture’. All received twenty treatments over ten weeks. The points used in the first two groups were Yangchi SJ-4, Waiguan SJ-5, Yangxi L.I.-5, Wangu SI-4, Dazhui DU-14 and Quchi L.I.-11. A total of 29 patients completed the study and most of the drop-outs (because of inefficacy) were in the placebo group. In both the acupuncture groups the number of tender joints and physician’s global scores were significantly reduced. (Efficacy of Traditional Chinese Acupuncture in the Treatment of Rheumatoid Arthritis (RA): A Double-blind Controlled Pilot Study. American College of Rheumatology Annual Scientific Meeting, November 2006).

Another German trial has shown a significant benefit for acupuncture treatment (in this case in the treatment of osteoarthritis of the knee), yet with no significant difference between true and sham acupuncture. In this large trial of 1007 patients (treated by 320 different practitioners in 315 primary care practices), who had had chronic pain from knee arthritis for over six months, a minimum 36% improvement was seen at 26 weeks (after ten acupuncture treatments) in 53.1% of true acupuncture patients, 51.0% of sham acupuncture patients and 29.1% for patients receiving conservative therapy (standard physician visits). This batch of German studies raises important questions for acupuncturists. While some attention has been focused on what might be the physiological effects of sham needling (usually very superficial insertion at non-points with no deqi), it is also necessary to examine the true acupuncture, and specifically how effectively practitioners succeeded in obtaining deqi, which was a necessary part of the true acupuncture protocol. (Acupuncture and Knee Osteoarthritis: A Three-Armed Randomized Trial, Annals of Internal Medicine, 4 July 2006).

In a study of the treatment of chronic arthritis of the knee, 150 patients were assigned to receive ‘true’ acupuncture, 76 to minimal acupuncture (superficial needling at non-acupuncture points) and 76 to a waiting list control. Both acupuncture groups received 12 treatment sessions over 8 weeks at 28 different outpatient centres. Patients completed standard questionnaires at 8, 26 and 52 weeks after onset of treatment. The study found that patients in both acupuncture groups improved compared to a waiting list group, but that those receiving true acupuncture suffered significantly less pain and joint dysfunction at 8 weeks than the sham acupuncture group. The difference was no longer significant, however, at 52 weeks. (The Lancet 2005; 366:136-143).

The longest and largest randomised, controlled phase III clinical trial of acupuncture ever conducted has found that acupuncture can significantly improve the symptoms of arthritis of the knee. The study of 570 patients was carried out at the University of Maryland School of Medicine. The patients were randomly assigned to receive 23 treatments of either true or sham (no actual insertion of needles) acupuncture or a 12-week knee osteoarthritis education course. At the end of the study, the true acupuncture group had the greatest reduction (40%) in knee pain and the greatest improvement (nearly 40%) in knee function. The study was funded by the National Center for Complementary and Alternative Medicine (NCCAM) and the National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS), both components of the US National Institutes of Health. “For the first time, a clinical trial with sufficient rigour, size, and duration has shown that acupuncture reduces the pain and functional impairment of osteoarthritis of the knee,” said Stephen E. Straus, NCCAM Director. “These results also indicate that acupuncture can serve as an effective addition to a standard regimen of care and improve quality of life for knee osteoarthritis sufferers. (Ann Intern Med, Dec 2004; 141: 901-910.)

In a separate Spanish study of the potential benefits of acupuncture in the treatment of knee osteoarthritis, 97 patients were randomly assigned to receive either acupuncture plus diclofenac, or placebo acupuncture plus diclofenac. The true acupuncture consisted of needling (followed by electroacupuncture at the local points) at Yanglingquan GB-34, Yinlingquan SP-9, Xiyan (MN-LE-16), Zusanli ST-36, Taixi KID-3, Sanyinjiao SP-6, Hegu L.I.-4 and Fenglong ST-40 (all with deqi). The placebo acupuncture was administered using retractable needles (with adhesive cylinders) at the same points, and sham electroacupuncture was also given. Both groups received twelve weekly treatments. At the end of the study, the true acupuncture group had a greater reduction in pain and stiffness, improved physical functioning, and an improved quality of life. (BMJ 2004;329:1216).ACUPUNCTURE FOR NECK PAIN
This very large German study compared the effects of fifteen acupuncture treatments over three months with no acupuncture in the treatment of chronic neck pain (longer than six months). 1753 patients were randomly allocated to receive acupuncture and 1698 to the non-acupuncture control group, and a further 10,395 patients rejected randomisation and elected to receive acupuncture. At the end of the three-month treatment period, chronic pain and disability scores and quality of life scores improved significantly in both acupuncture groups compared to controls, with no significant differences between the randomised and non-randomised acupuncture groups. (11th Annual Symposium on Complementary Health Care 2004).

30 patients with osteoarthritis of the knee were randomised to one of three groups: 1. acupuncture alone at Hegu L.I.-4, Xuehai SP-10, Xiyan (MN-LE-16), Yinlingquan SP-9, Yanglingquan GB-34, Zusanli ST-36, Taichong LIV-3, Weizhong BL-40 and Chengshan BL-57 (twice weekly treatment, obtaining of deqi, 10 treatments in total, using electro-acupuncture at most points); 2. identical acupuncture plus continuation of their symptomatic Western medication; 3. symptomatic medication alone for five weeks, followed by a course of acupuncture as above. Outcome measures (visual analogue pain scale/VAS and Western Ontario McMaster questionnaire/WOMAC) were administered by a blinded observer. Highly significant improvements in both measures were observed in the first two groups, and there was no change in the third group until they received acupuncture, when significant changes were observed. The benefits were maintained one month after the end of the course of acupuncture. (Acupuncture in Medicine 2004;22(1):14-22). In another study, 563 patients with arthritis of the knee (54% of 5-10 year duration; 23% more than 10 years) were treated with acupuncture for a maximum of 15 sessions, with treatment cessation if no improvement was noted after three treatments (these patients were included in the study results). Of the 85% of patients who completed treatment (standard points and additional points according to TCM pattern, with deqi, average 8.9 sessions per patient), 75% experienced a greater than 45% relief in pain scores. There was a significant difference in quantity of analgesics taken at completion of treatment (most of the 45% pain-relief responders ceased medication entirely). Cost analysis showed a reduction from a mean of .91 euros a day before treatment, to .18 euros a day after treatment, representing a daily saving of 349.50 euros a day for the 478 patients who stayed in the study. (Acupuncture in Medicine 2004;22(1):23-28).

A root extract of Lei Gong Teng (Tripterygium Wilfordii Hook) has been shown to safely and effectively reduce pain and inflammation in a randomised, double-blind, placebo-controlled trial of a small group of people with treatment-resistant rheumatoid arthritis (RA). In the 20-week clinical trial, 21 RA patients were randomly assigned to one of three treatment groups: placebo, low-dose extract, or high-dose extract. After four weeks, 80% of patients in the high-dose group and 40% in the low-dose group showed rapid improvement in symptoms compared with no improvement in the placebo group. Side effects were minor for all three treatment groups. According to the researchers Lei Gong Teng is unique, because it slows down the overactive immune system, reduces inflammation by turning off inflammatory genes such as tumour necrosis factor alpha, and reduces the activity of B and T cells. It has the potential to treat other immune diseases such as lupus, and further studies are planned. The extraction process used in the trial transforms the otherwise toxic Lei Gong Teng. (Arthritis & Rheumatism 2002;46(7):1735-43). Meanwhile Fujisawa Pharmaceutical, the Japanese company who manufacture Prograf, a prescription medicine used to prevent the immune system from rejecting transplants, has entered into collaboration with Pharmagenesis, the US company which develops pharmaceuticals derived from Chinese herbal medicines, to explore triptolide derivatives, novel and potent immunosuppressants created by Pharmagenesis from Lei Gong Teng. Triptolide and its derivatives inhibit cytokine production in T cells through a different mechanism of action from Prograf and are expected to be effective in prevention of acute and chronic rejection for patients undergoing organ transplants.

60 patients on a waiting list for total knee replacement were randomly divided into two groups. 30 received “medical acupuncture” using one inch needles inserted “deeply” at Yinlingquan SP-9, Xuehai SP-10, Liangqiu ST 34, Zusanli ST-36 and Hegu L.I.-4. The needles were manipulated manually 4 times during a 15 minute retention and patients received a total of 6 weekly treatments. The 30 patients in the control group received no treatment. At a 2-month follow up, scores for the time to walk 50 metres and the time to climb 20 steps fell significantly in the acupuncture group compared to the control, as did pain scores, whilst HSS knee scores – which gives marks for pain, functional ability, range of motion, muscle strength, flexion deformity and knee stability – improved significantly in the acupuncture group. Scores for all measures deteriorated in the non-treatment group. 3 patients in the acupuncture group requested suspension from the waiting list due to the improvement in their symptoms. (Acupunct Med 2002; 20(1): 19-21).

44 patents with advanced osteoarthritis of the knee who were awaiting total knee joint replacements were given acupuncture either on the most affected knee only, or on both knees. Points needled were Yinlingquan SP-9, Xuehai SP-10, Liangqiu ST-34, Zusanli ST-36 and Hegu L.I.-4. Results showed a significant reduction in symptoms in both groups with no signficant dfference between the two groups, suggesting hat unilateral acupuncture is as effective as bilateral acupuncture for this condition. (Acupuncture in Medicine 2001;19(1):15-18).

It is estimated that the majority of the over-50’s in the USA have osteoarthritic bony hypertrophy (osteophytes), with the disease present in 90% of 80-year olds. In a study carried out at Guangzhou Hospital of TCM, 183 patients were treated by warm needling (Shenshu BL-23, Pangguangshu BL-28, Yaoyangguan DU-3 plus Weizhong BL-40 for cold-damp type and Taixi KID-3 for Kidney deficient type) followed by cupping to the lumbo-sacral area. After treatment, although x-rays showed no change to the degree of bony malformation, the symptoms of 48% of patients were cured and 50% were improved (American Journal of Acupuncture Vol.24, No.1).

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A blinded randomised trial of acupuncture has compared the effect of acupuncture with that of a non-penetrating sham in patients with osteoarthritic knee pain. Sixty-eight acupuncture naïve patients with symptomatic and radiological evidence of osteoarthritis of the knee were randomly allocated to a course of either acupuncture or non-penetrating sham acupuncture using a sheathed ‘placebo’ needle. Acupuncture points for pain and stiffness were selected according to TCM acupuncture theory for treating Bi syndrome. Both manual and electrical stimulation were used. Response was assessed using the WOMAC index for osteoarthritis of the knee. Comparison between the two treatment groups found a significantly greater improvement with acupuncture than with sham. Within the acupuncture group there was a significant improvement in pain, which was not seen by those who had sham acupuncture. One month after treatment, the between-group pain difference had been lost, although the acupuncture group still experienced benefit compared with baseline. (A blinded randomised trial of acupuncture (manual and electroacupuncture) compared with a non-penetrating sham for the symptoms of osteoarthritis of the knee. Acupunct Med. 2008 Jun;26(2):69-78.)

A review, carried out by American researchers, of ten randomised, controlled trials (1456 participants) of acupuncture for osteoarthritis of the knee have concluded that it is an effective treatment for the pain and physical dysfunction caused by the condition. (Acupuncture and osteoarthritis of the knee: a review of randomized, controlled trials. Fam Community Health. 2008 Jul-Sep;31(3):247-54).

A meta-analysis by American researchers has evaluated the effects of acupuncture in the treatment of knee osteoarthritis (OA). Biomedical databases were searched for randomised controlled trials (RCTs), longer than six weeks in duration, which compared needle acupuncture with sham, usual care, or a waiting list control group. Eleven trials met the selection criteria and nine reported sufficient data for pooling. Compared with patients in waiting list control groups, patients who received acupuncture reported clinically relevant short-term improvements in pain and function. They also reported clinically relevant short- and long-term improvements in pain and function, when compared with patients in usual care control groups. Compared with sham control, acupuncture was found to provide clinically irrelevant short-term improvements in pain and function and clinically irrelevant long-term improvements in pain and function. The authors blame the variability of acupuncture and sham protocols, patient samples and settings for the heterogeneity displayed by the results of sham controlled trials. They also suggest that some of the clinically relevant benefits of acupuncture may be due to placebo or expectation effects. (Meta-analysis: acupuncture for osteoarthritis of the knee. Ann Intern Med. 2007 Jun 19;146(12):868-77.)

A review of recent research into acupuncture treatment for osteoarthritis (OA) of the knee explores whether any aspects of treatment are more likely to be associated with good outcomes. Based on their evaluation of four recent randomised controlled trials (RCTs) and a systematic review (which included 13 RCTs), the authors speculate that optimal results from acupuncture treatment for OA of the knee may involve: climatic factors (particularly high temperature); high patient expectation; use of a minimum of four needles; use of electroacupuncture (rather than manual acupuncture), in particular, use of strong electrical stimulation to needles placed in muscle; and a course of at least 10 treatments. (Evidence from RCTs on optimal acupuncture treatment for knee osteoarthritis-an exploratory review. Acupunct Med. 2007 Jun;25(1-2):29-35).

Analysis of the results of a large German randomised, controlled trial (RCT) has led to the conclusion that acupuncture can be a cost-effective adjunctive treatment for chronic osteoarthritis pain. Acupuncture treatment plus routine care was evaluated against routine care alone in 418 cases of chronic pain due to osteoarthritis of the knee or hip, using health insurance providers’ data and standardised questionnaires. Patients receiving acupuncture had an improved QoL associated with significantly higher costs over the three-month treatment period, compared with routine care alone. However, having performed a cost-effectiveness calculation, based on calculating quality-life adjusted years (QALYs) the authors concluded that acupuncture was a cost-effective treatment strategy in this patient group, with female patients achieving a better cost-effectiveness ratio than men. (Quality of life and cost-effectiveness of acupuncture treatment in patients with osteoarthritis pain. Eur J Health Econ. 2007 Jul 19; [Epub ahead of print]).

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