Trigger point acupuncture for treatment of knee osteoarthritis - A preliminary RCT for a pragmatic trial

Department of Orthopaedic Surgery, Meiji University of Oriental Medicine, Kyoto, Japan.
Acupuncture in Medicine (Impact Factor: 1.5). 03/2008; 26(1):17-26. DOI: 10.1136/aim.26.1.17
Source: PubMed

ABSTRACT There is evidence for the efficacy of acupuncture treatment in knee osteoarthritis, but it remains unclear which acupuncture modes are most effective. We evaluated the effects of trigger point acupuncture on pain and quality of life in knee osteoarthritis patients, compared with acupuncture at standard points, and sham acupuncture.
Thirty patients (27 women, 3 men; aged 61-82 years) with non-radiating knee osteoarthritis pain for at least six months and normal neurological examination were randomised to one of three groups for the study period of 21 weeks. Each group received five acupuncture treatment sessions. The standard acupuncture point group (n=10) received treatment at traditional acupuncture points for knee pain; the trigger point acupuncture group (n=10) received treatment at trigger points; and the third group (n=10) received sham acupuncture treatment at the trigger points. Outcome measures were pain intensity (visual analogue scale, VAS) and WOMAC index (Western Ontario and McMaster Universities Arthritis Index). The groups were compared by the area under the curve method.
Five patients dropped out of the study because of lack of improvement, and one patient (in the trigger point acupuncture group) dropped out because of deterioration of symptoms; the remaining 24 patients were included in the analysis. After treatment, the trigger point acupuncture group reported less pain intensity on VAS than the standard acupuncture or sham treatment group, but both the trigger point acupuncture and standard acupuncture groups reported improvement of function of knee. There was a significant reduction in pain intensity between pre-treatment and five weeks after treatment for the trigger point acupuncture (P<0.01) and standard acupuncture groups (P<0.01) included in the analysis, but not for the sham treatment group. Group comparison using the area under the curves demonstrated a significant difference only between trigger point acupuncture and sham treatment groups analysed (P<0.025 for VAS, and P<0.031 for WOMAC).
These results suggest that trigger point acupuncture therapy may be more effective for osteoarthritis of the knee in some elderly patients than standard acupuncture therapy.

54 Reads
  • Source
    • "As the sham acupuncture needle is non-penetrating it cannot be left in situ for five minutes as is the case for the real intervention group. Therefore, following five minutes of treatment of each MTrP the Chief Investigator will mimic removal of the needle by placing a finger on either side of the point treated and will pretend to remove the sham acupuncture needle [11,13]. The sham needle and guide tube will be placed into a petri dish but will not be disposed of as it will be required to treat all MTrPs. "
    [Show abstract] [Hide abstract]
    ABSTRACT: Background. Plantar heel pain can be managed with dry needling of myofascial trigger points; however, there is only poor-quality evidence supporting its use. Objective. The purpose of this study was to evaluate the effectiveness of dry needling for plantar heel pain. Design. The study was a parallel-group, participant-blinded, randomized controlled trial. Setting. The study was conducted in a university health sciences clinic. Patients. Study participants were 84 patients with plantar heel pain of at least 1 month's duration. Intervention. Participants were randomly assigned to receive real or sham trigger point dry needling. The intervention consisted of 1 treatment per week for 6 weeks. Participants were followed for 12 weeks. Measurements. Primary outcome measures included first-step pain, as measured with a visual analog scale (VAS), and foot pain, as measured with the pain subscale of the Foot Health Status Questionnaire (FHSQ). The primary end point for predicting the effectiveness of dry needling for plantar heel pain was 6 weeks. Results. At the primary end point, significant effects favored real dry needling over sham dry needling for pain (adjusted mean difference: VAS first-step pain= -14.4 mm, 95% confidence interval [95% CI] = -23.5 to -5.2; FHSQ foot pain= 10.0 points, 95% CI=1.0 to 19.1), although the between-group difference was lower than the minimal important difference. The number needed to treat at 6 weeks was 4 (95% CI=2 to 12). The frequency of minor transitory adverse events was significantly greater in the real dry needling group (70 real dry needling appointments [32%] compared with only 1 sham dry needling appointment [<1%]). Limitations. It was not possible to blind the therapist. Conclusion. Dry needling provided statistically significant reductions in plantar heel pain, but the magnitude of this effect should be considered against the frequency of minor transitory adverse events.
    Journal of Foot and Ankle Research 01/2011; 4(8):5. DOI:10.1186/1757-1146-4-5 · 1.46 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: In this work a coplanar waveguide (CPW)-fed slot dipole antenna has been integrated with a three-dimensional woodpile photonic bandgap crystal (PBG) in the W-band regime (67-110 GHz) using silicon. A slot dipole antenna has been designed and tested at 94 GHz which exhibits very poor efficiency and has high levels of loss through the back of the substrate. This integration has shown a large positional dependence of the antenna with respect to the layers of the PBG and has led to the optimisation of a slot dipole antenna on the PBG. This type of integration has shown experimentally that the overall operation of an antenna can be greatly improved due to the reflective properties of the PBG.
    Antennas and Propagation Society International Symposium, 2004. IEEE; 07/2004
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Many different styles of acupuncture practice exist, and lack of agreement on the optimal acupuncture treatment for any particular condition may mean that some patients do not receive the best treatment. This uncertainty also makes the negative results of sham controlled trials difficult to interpret. Unless we can be sure that both adequate acupuncture and an inactive sham were used in a particular trial, then that trial should not be interpreted as dismissing acupuncture for that condition. Acupuncture practice clearly involves much more than needling procedures, but there is a strong argument for elucidating the role of those needling procedures first. The components of acupuncture needling procedures have been described in the STRICTA document, but it is also clear that the patient's perception of needling is relevant for the outcome of treatment. We therefore recommend the concept of 'dose' of acupuncture needling, which should include both the stimulus given to the patient, and certain aspects of the patient's perceptions and response that are known to be linked to the subsequent therapeutic response. We propose the following definition of dose: the physical procedures applied in each session, using one or more needles, taking account of the patient's resulting perception (sensory, affective and cognitive) and other responses (including motor). The dose may be affected by the state of the patient (eg nervous, immune and endocrine systems); different doses may be required for different conditions. The constituents of an adequate dose can be established initially by clinical opinion and subsequently by empirical evidence from experimental studies, which may be either clinical or basic research studies. Systematic reviews which do not consider the adequacy of the acupuncture treatment may have unreliable conclusions. Out of 47 recent systematic reviews, only six have applied some criteria for adequacy. Five used a rating system or conducted a subgroup analysis, and one excluded studies from the analysis altogether if they did not meet criteria for adequacy. Research into what constitutes an adequate dose of acupuncture has long been neglected and is now urgent. Clinical studies that compare the effects of different treatment protocols are probably the most reliable source of evidence, and may also demonstrate a dose-response relationship.
    Acupuncture in Medicine 07/2008; 26(2):111-20. DOI:10.1136/aim.26.2.111 · 1.50 Impact Factor
Show more


54 Reads
Available from