Acupuncture for
knee osteoarthritis
Study reports that acupuncture relieves pain and improves
function in knee osteoarthritis
(Posted December 29, 2004)
According to a recently completed research study, acupuncture provides
pain relief and improves function for people with osteoarthritis of the
knee and serves as an effective complement to standard care. This landmark
study was funded by the National Center for Complementary and Alternative
Medicine (NCCAM) and the National Institute of Arthritis and Musculoskeletal
and Skin Diseases (NIAMS), both components of the U.S. National Institutes
of Health. The findings of the study -- the longest and largest randomized,
controlled phase III clinical trial of acupuncture ever conducted -- were
published in the December 21, 2004, issue of the Annals of Internal Medicine.
The multi-site study team, including rheumatologists and licensed
acupuncturists, enrolled 570 patients, aged 50 or older with osteoarthritis
of the knee. Participants had significant pain in their knee the
month before joining the study, but had never experienced acupuncture,
had not had knee surgery in the previous 6 months, and had not used
steroid or similar injections. Participants were randomly assigned
to receive one of three treatments: acupuncture, sham acupuncture,
or participation in a control group that followed the U.S. Arthritis
Foundation's self-help course for managing their condition. Patients
continued to receive standard medical care from their primary physicians,
including anti-inflammatory medications, such as COX-2 selective
inhibitors, non-steroidal anti-inflammatory drugs, and opioid pain
relievers.
"For the first time, a clinical trial with sufficient rigor,
size, and duration has shown that acupuncture reduces the pain and
functional impairment of osteoarthritis of the knee," said Dr.
Stephen E. Straus, NCCAM Director. "These results also indicate
that acupuncture can serve as an effective addition to a standard
regimen of care and improve quality of life for knee osteoarthritis
sufferers. NCCAM has been building a portfolio of basic and clinical
research that is now revealing the power and promise of applying
stringent research methods to ancient practices like acupuncture."
"More than 20 million Americans have osteoarthritis. This disease
is one of the most frequent causes of physical disability among adults," said
Stephen I. Katz, M.D., Ph.D., NIAMS Director. "Thus, seeking
an effective means of decreasing osteoarthritis pain and increasing
function is of critical importance."
During the course of the study, led by Dr. Brian M. Berman, Director
of the Center for Integrative Medicine and Professor of Family Medicine
at the University of Maryland School of Medicine, Baltimore, Maryland,
190 patients received true acupuncture and 191 patients received
sham acupuncture for 24 treatment sessions over 26 weeks. Sham acupuncture
is a procedure designed to prevent patients from being able to detect
if needles are actually inserted at treatment points. In both the
sham and true acupuncture procedures, a screen prevented patients
from seeing the knee treatment area and learning which treatment
they received. In the education control group, 189 participants attended
six, 2-hour group sessions over 12 weeks based on the Arthritis Foundation's
Arthritis Self-Help Course -- a proven, effective model.
On joining the study, patients' pain and knee function were assessed
using standard arthritis research survey instruments and measurement
tools, such as the Western Ontario McMasters Osteoarthritis Index
(WOMAC). Patients' progress was assessed at 4, 8, 14, and 26 weeks.
By week 8, participants receiving acupuncture were showing a significant
increase in function and by week 14 a significant decrease in pain,
compared with the sham and control groups. These results, shown by
declining scores on the WOMAC index, held through week 26. Overall,
those who received acupuncture had a 40 percent decrease in pain
and a nearly 40 percent improvement in function compared to baseline
assessments.
"This trial, which builds upon our previous NCCAM-funded research,
establishes that acupuncture is an effective complement to conventional
arthritis treatment and can be successfully employed as part of a
multidisciplinary approach to treating the symptoms of osteoarthritis," said
Dr. Berman.
Acupuncture--the practice of inserting thin needles into specific
body points to improve health and well-being -- originated in China
more than 2,000 years ago. In 2002, acupuncture was used by an estimated
2.1 million U.S. adults, according to the Centers for Disease Control
and Prevention's 2002 National Health Interview Survey. The acupuncture
technique that has been most studied scientifically involves penetrating
the skin with thin, solid, metallic needles that are manipulated
by the hands or by electrical stimulation. In recent years, scientific
inquiry has begun to shed more light on acupuncture's possible mechanisms
and potential benefits, especially in treating painful conditions
such as arthritis.
|
