Researches about Acupuncture and Osteoarthritis

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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