Acupuncture and Knee Osteoarthritis: A Three-Armed Randomized Trial

University of Heidelberg, Heidelberg, Germany.
Annals of internal medicine (Impact Factor: 17.81). 08/2006; 145(1):12-20. DOI: 10.1016/S1887-8369(07)70193-X
Source: PubMed

ABSTRACT Despite the popularity of acupuncture, evidence of its efficacy for reducing pain remains equivocal.
To assess the efficacy and safety of traditional Chinese acupuncture (TCA) compared with sham acupuncture (needling at defined nonacupuncture points) and conservative therapy in patients with chronic pain due to osteoarthritis of the knee.
Randomized, controlled trial.
315 primary care practices staffed by 320 practitioners with at least 2 years' experience in acupuncture.
1007 patients who had had chronic pain for at least 6 months due to osteoarthritis of the knee (American College of Rheumatology [ACR] criteria and Kellgren-Lawrence score of 2 or 3). Interventions: Up to 6 physiotherapy sessions and as-needed anti-inflammatory drugs plus 10 sessions of TCA, 10 sessions of sham acupuncture, or 10 physician visits within 6 weeks. Patients could request up to 5 additional sessions or visits if the initial treatment was viewed as being partially successful.
Success rate, as defined by at least 36% improvement in Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) score at 26 weeks. Additional end points were WOMAC score and global patient assessment.
Success rates were 53.1% for TCA, 51.0% for sham acupuncture, and 29.1% for conservative therapy. Acupuncture groups had higher success rates than conservative therapy groups (relative risk for TCA compared with conservative therapy, 1.75 [95% CI, 1.43 to 2.13]; relative risk for sham acupuncture compared with conservative therapy, 1.73 [CI, 1.42 to 2.11]). There was no difference between TCA and sham acupuncture (relative risk, 1.01 [CI, 0.87 to 1.17]).
There was no blinding between acupuncture and traditional therapy and no monitoring of acupuncture compliance with study protocol. In general, practitioner-patient contacts were less intense in the conservative therapy group than in the TCA and sham acupuncture groups.
Compared with physiotherapy and as-needed anti-inflammatory drugs, addition of either TCA or sham acupuncture led to greater improvement in WOMAC score at 26 weeks. No statistically significant difference was observed between TCA and sham acupuncture, suggesting that the observed differences could be due to placebo effects, differences in intensity of provider contact, or a physiologic effect of needling regardless of whether it is done according to TCA principles.

Download full-text


Available from: Christoph Maier, Sep 25, 2015
26 Reads
  • Source
    • "Acupuncture is a component of the “Traditional Chinese Medicine” (TCM) system. Multiple randomized clinical trials have suggested that knee OA patients can benefit from acupuncture treatment9111213. However, the mechanisms underlying the effects of acupuncture treatment in knee OA patients are still poorly understood. "
    [Show abstract] [Hide abstract]
    ABSTRACT: In this study, we investigated cortical thickness and functional connectivity across longitudinal acupuncture treatments in patients with knee osteoarthritis (OA). Over a period of four weeks (six treatments), we collected resting state functional magnetic resonance imaging (fMRI) scans from 30 patients before their first, third and sixth treatments. Clinical outcome showed a significantly greater Knee Injury and Osteoarthritis Outcome Score (KOOS) pain score (improvement) with verum acupuncture compared to the sham acupuncture. Longitudinal cortical thickness analysis showed that the cortical thickness at left posterior medial prefrontal cortex (pMPFC) decreased significantly in the sham group across treatment sessions as compared with verum group. Resting state functional connectivity (rsFC) analysis using the left pMPFC as a seed showed that after longitudinal treatments, the rsFC between the left pMPFC and the rostral anterior cingulate cortex (rACC), medial frontal pole (mFP) and periaquiduct grey (PAG) are significantly greater in the verum acupuncture group as compared with the sham group. Our results suggest that acupuncture may achieve its therapeutic effect on knee OA pain by preventing cortical thinning and decreases in functional connectivity in major pain related areas, therefore modulating pain in the descending pain modulatory pathway.
    Scientific Reports 09/2014; 4:6482. DOI:10.1038/srep06482 · 5.58 Impact Factor
  • Source
    • "While many of these studies directly use the term ‘dry needling’,5,18,21,26,33,56,64,67,104,110 in their methodology, other studies use alternative terminology such as ‘deep dry needling’,67 ‘superficial dry needling’,55,128 ‘TrP acupuncture’,20,80 ‘paraspinal needling’,64 ‘intramuscular and nerve root needling’,65 ‘needle electrical intramuscular stimulation’,129 ‘needle release’,113 ‘acupuncture needling’,63,113 ‘needling therapy’,17 ‘acupuncture’36–38,40,41,47,49–55,61,69,72,81–88,90,92,94–100,105–108,112,115–117,119–123,130–135 and ‘electroacupuncture’.37,46,93,126,127,136–139 Some studies have even chosen to use both ‘acupuncture and dry needling’19,23,24,62,77 in their titles. Importantly, none of the studies used medicine and/or injectate in conjunction with their needling procedure; therefore, all studies fit within the strict definition of dry needling, regardless of terminology. "
    [Show abstract] [Hide abstract]
    ABSTRACT: Background: Wet needling uses hollow-bore needles to deliver corticosteroids, anesthetics, sclerosants, botulinum toxins, or other agents. In contrast, dry needling requires the insertion of thin monofilament needles, as used in the practice of acupuncture, without the use of injectate into muscles, ligaments, tendons, subcutaneous fascia, and scar tissue. Dry needles may also be inserted in the vicinity of peripheral nerves and/or neurovascular bundles in order to manage a variety of neuromusculoskeletal pain syndromes. Nevertheless, some position statements by several US State Boards of Physical Therapy have narrowly defined dry needling as an ‘intramuscular’ procedure involving the isolated treatment of ‘myofascial trigger points’ (MTrPs). Objectives: To operationalize an appropriate definition for dry needling based on the existing literature and to further investigate the optimal frequency, duration, and intensity of dry needling for both spinal and extremity neuromusculoskeletal conditions. Major findings: According to recent findings in the literature, the needle tip touches, taps, or pricks tiny nerve endings or neural tissue (i.e. ‘sensitive loci’ or ‘nociceptors’) when it is inserted into a MTrP. To date, there is a paucity of high-quality evidence to underpin the use of direct dry needling into MTrPs for the purpose of short and long-term pain and disability reduction in patients with musculoskeletal pain syndromes. Furthermore, there is a lack of robust evidence validating the clinical diagnostic criteria for trigger point identification or diagnosis. High-quality studies have also demonstrated that manual examination for the identification and localization of a trigger point is neither valid nor reliable between-examiners. Conclusions: Several studies have demonstrated immediate or short-term improvements in pain and/or disability by targeting trigger points (TrPs) using in-and-out techniques such as ‘pistoning’ or ‘sparrow pecking’; however, to date, no high-quality, long-term trials supporting in-and-out needling techniques at exclusively muscular TrPs exist, and the practice should therefore be questioned. The insertion of dry needles into asymptomatic body areas proximal and/or distal to the primary source of pain is supported by the myofascial pain syndrome literature. Physical therapists should not ignore the findings of the Western or biomedical ‘acupuncture’ literature that have used the very same ‘dry needles’ to treat patients with a variety of neuromusculoskeletal conditions in numerous, large scale randomized controlled trials. Although the optimal frequency, duration, and intensity of dry needling has yet to be determined for many neuromusculoskeletal conditions, the vast majority of dry needling randomized controlled trials have manually stimulated the needles and left them in situ for between 10 and 30 minute durations. Position statements and clinical practice guidelines for dry needling should be based on the best available literature, not a single paradigm or school of thought; therefore, physical therapy associations and state boards of physical therapy should consider broadening the definition of dry needling to encompass the stimulation of neural, muscular, and connective tissues, not just ‘TrPs’.
    Physical Therapy Reviews 08/2014; 19(4):252-265. DOI:10.1179/108331913X13844245102034
  • Source
    • "Many investigators have attempted to assess the relationship between deqi and therapeutic effects [16,17]. Some found better pain relief for acupuncture with deqi[18,19], whereas others did not [20,21]. This result was similar to the results of White P et al., who suggested that the presence and intensity of deqi had no effect on pain relief for osteoarthritis (OA) patients [17]. "
    [Show abstract] [Hide abstract]
    ABSTRACT: Deqi is a central concept in traditional Chinese acupuncture. We performed a secondary analysis on data from a larger randomized controlled trial (RCT) in order to assess the effect of acupuncture on deqi traits and pain intensity in primary dysmenorrhea. A total of 60 primary dysmenorrhea patients were enrolled and randomly assigned to one of three treatment groups. Acupuncture was given at SP6, GB39 or nonacupoint. Subjective pain was measured by a 100-mm visual analogue scale (VAS) before and after acupuncture. The Massachusetts General Hospital acupuncture sensation scales (MASS) with minor modification was used to rate deqi sensations during acupuncture. The results showed that VAS scores of pain after acupuncture were significantly decreased comparing to before acupuncture treatment in all three groups (P = 0.000). However, no significant differences were found among three groups at the beginning or end of acupuncture treatment (P = 0.928, P = 0.419). There was no statistical difference among three groups in terms of intensity of deqi feeling. The types of sensation were similar across the groups with only minor differences among them. Trial registration number: ISRCTN24863192.
    BMC Complementary and Alternative Medicine 02/2014; 14(1):69. DOI:10.1186/1472-6882-14-69 · 2.02 Impact Factor
Show more