Article

Acupuncture and knee osteoarthritis: A three-armed randomized trial

University of Heidelberg, Heidelberg, Germany.
Annals of internal medicine (Impact Factor: 16.1). 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.

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    • "It is described as a sensory perception of varying character and is mostly ascribed to metal needle acupuncture. The importance of Deqi has been investigated on the modern biological and medical framework in recent years [2] [3] [4] [5] [6] [7] [8] [9] [10] [11] [12] [13] [14]. Such work was started a couple of years ago by Kou et al. [15]. "
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    ABSTRACT: Acupuncture as an essential component of complementary and alternative medicine is gradually recognized and accepted by the mainstream of contemporary medicine. For obtaining preferable clinical effectiveness, Deqi is commonly regarded as efficacy predictor and parameter which is necessary to be achieved. Influential factors for acupuncture efficacy, like Deqi sensation as well as propagated sensation along channels (PSCs), enjoyed a long history in acupuncture basic research. Concerning this study, taking into account different positions on acupuncture Deqi sensation and PSCs, we would like to attest whether different body positions for subjects during needling procedure yield differed acupuncture Deqi sensation, particularly in terms of intensity, and PSCs. Methods. We used self-controlled method and selected 30 healthy subjects to perform needle insertion at Futu point (ST32) bilaterally. Then they were instructed to record the value of intensity of acupuncture sensation and the length and width of PSCs after removing the needle. Results. In regard to intensity of Deqi, kneeling seat position is stronger than supine position, accounting for 90% of the total number of subjects. In length of PSCs, kneeling seat position is greater than supine position, accounting for 56.7%. In width of PSCs, kneeling seat position is greater than supine position, accounting for 66.7%. Conclusion. Our findings show that needle inserting at Futu point (ST32) in kneeling seat position achieve better needle sensation and provide reference for clinical.
    Evidence-based Complementary and Alternative Medicine 10/2013; 2013:897048. DOI:10.1155/2013/897048 · 1.88 Impact Factor
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    • "In recent years, the importance of de-qi has been investigated based on the modern biological and medical framework [2] [3] [4] [5] [6] [7] [8] [9] [10] [11] [12] [13] [14]. Several studies reported the correlation between the de-qi sensations and analgesic effects [2–4, 10–12] or the electroencephalogram changes [9], whereas others do not [8] [13] [14]. Therefore, the role of de-qi in acupuncture treatment is still controversial [1] [5] [6] [15]. "
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    ABSTRACT: , comprising mostly subjective sensations during acupuncture, is traditionally considered as a very important component for the possible therapeutic effects of acupuncture. However, the neural correlates of are still unclear. In this paper, we reviewed previous fMRI studies from the viewpoint of the neural responses of . We searched on Pubmed and identified 111 papers. Fourteen studies distinguishing and sharp pain and eight studies with the mixed sensations were included in further discussions. We found that the blood oxygenation level-dependent (BOLD) responses associated with were activation dominated, mainly around cortical areas relevant to the processing of somatosensory or pain signals. More intense and extensive activations were shown for the mixed sensations. Specific activations of sharp pain were also shown. Similar BOLD response patterns between evoked by acupuncture stimulation and -like sensations evoked by deep pain stimulation were shown. We reckon that a standardized method of qualification and quantification of , deeper understanding of grouping strategy of and sharp pain, and making deep pain stimulation as a control, as well as a series of improvements in the statistical method, are crucial factors for revealing the neural correlates of and neural mechanisms of acupuncture.
    Evidence-based Complementary and Alternative Medicine 02/2013; 2013:297839. DOI:10.1155/2013/297839 · 1.88 Impact Factor
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    • "In an attempt to clarify this issue, we found corresponding inconsistencies in the study designs themselves: the sham or minimal acupuncture procedures used as controls in the aforementioned trials differed systematically from the actual acupuncture groups regarding number, size and length of needles, and intensity and duration of the doctor-patient encounter. Moreover, the trials failed to achieve complete blinding [8] [9] [10] [11] [12]. Any attempt to clarify the issue of efficacy in acupuncture requires a more controlled study design. "
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    ABSTRACT: Introduction. 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. Conclusion. 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 and specific effects of needling in pain relief.
    Evidence-based Complementary and Alternative Medicine 01/2013; 2013:427265. DOI:10.1155/2013/427265 · 1.88 Impact Factor
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