Article

Acupuncture and Knee Osteoarthritis: A Three-Armed Randomized Trial

Ruhr-Universität Bochum, Bochum, North Rhine-Westphalia, 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

Full-text

Available from: Christoph Maier
  • Source
    • "Some authors had more significant results after cessation of treatment as the case in our study, and in 2008 in an interesting explanation[23]for the more significant difference after cessation of treatment as it might be due to deterioration in the sham group rather than change in the acupuncture group. Also in a meta-analyses[26]also concluded that acupuncture was not better than controls in reducing the WOMAC score of knee OA. Others[18]concluded in disagreement to our study that acupuncture is not superior to sham-needling in reducing stiffness of osteoarthritis; both are equally effective. "

    Full-text · Article · Sep 2015
  • Source
    • "Both ST35 and Xiyan points are located near the knee. They are typically used in knee pain treatment and have been previously used in osteoarthritis clinical trials (Berman et al., 2004; Cheng, 1987; Scharf et al., 2006; Stux, 1997; Witt et al., 2005). Placebo acupuncture was performed in 6 spots on the lower leg, where no meridians pass through. "
    [Show abstract] [Hide abstract]
    ABSTRACT: Acupuncture, an ancient East Asian therapy, is aimed at rectifying the imbalance within the body caused by disease. Studies evaluating the efficacy of acupuncture with neuroimaging tend to concentrate on brain regions within the pain matrix, associated with acute pain. We, however, focused on the effect of repeated acupuncture treatment specifically on brain regions known to support functions dysregulated in chronic pain disorders. Transition to chronic pain is associated with increased attention to pain, emotional rumination, nociceptive memory and avoidance learning, resulting in brain connectivity changes, specifically affecting the periaqueductal gray (PAG), medial frontal cortex (MFC) and bilateral hippocampus (Hpc). We demonstrate that the PAG-MFC and PAG-Hpc connectivity in patients with chronic pain due to knee osteoarthritis indeed correlates with clinical severity scores and further show that verum acupuncture-induced improvement in pain scores (compared to sham) is related to the modulation of PAG-MFC and PAG-Hpc connectivity in the predicted direction. This study shows that repeated verum acupuncture might act by restoring the balance in the connectivity of the key pain brain regions, altering pain-related attention and memory.
    Full-text · Article · Sep 2015 · Clinical neuroimaging
  • 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.
    Full-text · Article · Sep 2014 · Scientific Reports
Show more