Objectifying Specific and Nonspecific Effects of Acupuncture: A Double-Blinded Randomised Trial in Osteoarthritis of the Knee

Department of Internal Medicine, Heidelberg University Hospital, Im Neuenheimer Feld 410, 69120 Heidelberg, Germany.
Evidence-based Complementary and Alternative Medicine (Impact Factor: 1.88). 01/2013; 2013(5):427265. DOI: 10.1155/2013/427265
Source: PubMed


. Acupuncture was recently shown to be effective in the treatment of knee osteoarthritis. However, controversy persists whether the observed effects are specific to acupuncture or merely nonspecific consequences of needling. Therefore, the objective of this study is to determine the efficacy of different acupuncture treatment modalities.
Materials and Methods
. We compared between three different forms of acupuncture in a prospective randomised trial with a novel double-blinded study design. One-hundred and sixteen patients aged from 35 to 82 with osteoarthritis of the knee were enrolled in three study centres. Interventions were individualised classical/ modern semistandardised acupuncture and non-specific needling. Blinded outcome assessment comprised knee flexibility and changes in pain according to the WOMAC score.
Results and Discussion
. Improvement in knee flexibility was significantly higher after classical Chinese acupuncture (10.3 degrees; 95% CI 8.9 to 11.7) as compared to modern acupuncture (4.7 degrees; 3.6 to 5.8). All methods achieved pain relief, with a patient response rate of 48 percent for non-specific needling, 64 percent for modern acupuncture, and 73 percent for classical acupuncture.
. This trial establishes a novel study design enabling double blinding in acupuncture studies. The data suggest a specific effect of acupuncture in knee mobility and both non-specific
specific effects of needling in pain relief.

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Available from: Joachim E Fischer, Apr 24, 2014
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    • "All of the findings pointed to the outcome of acupuncture as effective in genuinely improving illness, and not just a placebo. Relevant research confirming this has been conducted [16, 17]. "
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    • "In an earlier study by Takeda and colleagues, researchers investigated the effect of real and sham acupunctures on osteoarthritis (OA) and found that the experience of deqi can be used as a predictor for significant improvement [17]. In four subsequent OA studies comparing the effect of real acupuncture treatment to sham (minimal depth needling) acupuncture, three studies [21] [22] [41] found that real acupuncture produced significantly better therapeutic effects than sham acupuncture. The fourth study [23] showed no significant difference between real and sham acupuncture treatments and further concluded that " deqi sensation[s] do not result in marked effect, " which calls into questioning " whether deep needling with stimulation and deqi sensation is superior to shallow needling. "
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    ABSTRACT: Deqi is one of the core concepts in acupuncture theory and encompasses a range of sensations. In this study, we used the MGH Acupuncture Sensation Scale (MASS) to measure and assess the reliability of the sensations evoked by acupuncture needle stimulation in a longitudinal clinical trial on knee osteoarthritis (OA) patients. The Knee injury and Osteoarthritis Outcome Score (KOOS) was used as the clinical outcome. Thirty OA patients were randomized into one of three groups (high dose, low dose, and sham acupuncture) for 4 weeks. We found that, compared with sham acupuncture, real acupuncture (combining high and low doses) produced significant improvement in knee pain (P = .025) and function in sport (P = .049). Intraclass correlation analysis showed that patients reliably rated 11 of the 12 acupuncture sensations listed on the MASS and that heaviness was rated most consistently. Overall perceived sensation (MASS Index) (P = .014), ratings of soreness (P = .002), and aching (P = .002) differed significantly across acupuncture groups. Compared to sham acupuncture, real acupuncture reliably evoked stronger deqi sensations and led to better clinical outcomes when measured in a chronic pain population. Our findings highlight the MASS as a useful tool for measuring deqi in acupuncture research.
    Evidence-based Complementary and Alternative Medicine 07/2013; 2013(5):204259. DOI:10.1155/2013/204259 · 1.88 Impact Factor
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    ABSTRACT: Patients with knee osteoarthritis who do not improve with pharmacological treatment seek for options in acupuncture. This treatment, even when it has sufficient evidence, remains left out of most clinical practice guidelines. We have analyzed in depth the originals referring to knee osteoarthritis and acupuncture that appear on our last published meta-analysis, compiling the relevant information in order to try to explain its heterogeneous results. Out of the 7 analyzed trials, the variety of the environment where they have been carried out, the skills and number of therapists that performed the technique, the different techniques applied, styles and doses, and the different control groups are emphasized. Relative improvement in acupuncture cases ranged from 86.5% and 7.1%; the improvement in groups of patients treated with fake acupuncture (on its various branches) was more uniform, around 30%. To sum up, if we pursue an optimal treatment, we must observe the diagnosis of the condition according to traditional Chinese medicine, design a personalized treatment, behold the environment, combine both local (based on canal diagnosis) and distal (in order to work directly on the substrate) points, add low frequency electroacupuncture in local points and, should it be deemed necessary (due to meteorological or etiopathogenic reasons) add moxibustion to the treatment. Patients will receive an average of 8 to 12 sessions, at a pace of one session per week, although the first sessions could be performed twice per week.
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