Acupuncture Plus Standard Treatment May Be a Winning Combination for Osteoarthritis
]]>Osteoarthritis]]> , the most common type of arthritis, is caused by the progressive breakdown of cartilage, which normally acts as a cushion between the bones in a joint. More than 20 million people in the United States suffer from the pain and limited movement associated with osteoarthritis.
Treatments for osteoarthritis aim to relieve pain, reduce inflammation, and improve movement of the joints. These treatments range from non-drug therapies, such as patient education, physical therapy, exercise, and weight loss, to pharmaceutical treatments such as nonsteroidal anti-inflammatory drugs (NSAIDs) and steroid injections. These treatments are not always effective, and some can cause serious side effects. As a result, some people with arthritis turn to alternative treatments such as acupuncture.
Acupuncture is a form of ancient Chinese therapy that involves positioning special needles into specific points in the body. Previous studies testing the effectiveness of acupuncture on osteoarthritis have had mixed results.
Now, in the largest randomized, placebo-controlled trial of acupuncture to date, scientists report significant benefits of acupuncture when coupled with standard medical treatment for osteoarthritis. Published in the December 21, 2004 issue of the Annals of Internal Medicine , the study finds that patients receiving true acupuncture had significantly less pain and significantly better physical function than patients receiving sham, or fake, acupuncture.
About the Study
The researchers recruited 570 patients, ages 50 years and older, with osteoarthritis of the knee. The patients had moderate to severe knee pain over the past month, but had not had knee surgery or steroid injections over the past six months. In addition, the patients had never had acupuncture.
The patients were randomly assigned to one of three groups:
- True acupuncture. The true acupuncture group received a gradually tapering course of acupuncture treatment over 26 weeks.
- Sham acupuncture control. The sham acupuncture group received their treatments on the same schedule as the true acupuncture group. Sham acupuncture consisted of placing fake needles on the same areas of the body as the true acupuncture group. The needles did not actually pierce the skin, but created a sensation comparable to that experienced by the true acupuncture group.
- Education control. Patients in the education control group received 12 group sessions during which they were taught strategies for dealing with osteoarthritis.
All of the patients enrolled in the study were able to continue using any additional treatments prescribed by their doctors. At weeks eight and 26, the researchers assessed the patients’ pain and knee function.
About half of the education control group had dropped out by the end of the study, so the researchers focused on the comparison between the true and sham acupuncture groups.
There was no significant difference in pain reduction between the true and sham acupuncture groups at eight weeks. By week 26, however, participants receiving true acupuncture were feeling significantly better than those in the control group. The true acupuncture group also experienced significantly greater improvement in knee function than the sham acupuncture control group by weeks eight and 26. There were no significant side effects associated with acupuncture.
The researchers addressed the potential influence of additional drug treatments by tracking the study participants’ use of analgesics, NSAIDs, and other drugs throughout the study. They found no significant differences in the numbers of patients in the true and sham acupuncture groups taking each type of medication.
This study was limited by the fact that about 25% of participants in the true and sham acupuncture groups had dropped out by the end of the study. As a result, results at week 26 results may be less reliable than those at week eight.
How Does This Affect You?
This large, well-designed study showed that traditional Chinese acupuncture may safely and effectively supplement standard treatment for patients with moderate osteoarthritis of the knee. These findings come at a welcome time, as the cardiovascular risks of the popular arthritis drugs rofecoxib (Vioxx), celecoxib (Celebrex) and naproxen (Aleve) have recently been called into question.
Despite these encouraging findings, it is still hard to draw firm conclusions about acupuncture’s effectiveness for knee osteoarthritis, since many other studies have shown negative or equivocal results. However, given its excellent safety record in the hands of experienced, licensed practitioners, many osteoarthritis sufferers may reasonably wish to complement their current treatment with acupuncture, if they have the means. Few insurers cover a full trial of acupuncture therapy.
If you decide to try acupuncture, choose an acupuncturist with care. The National Center for Complementary and Alternative Medicine recommends the following before choosing a complementary and alternative medicine practitioner:
- Ask your primary healthcare provider if he or she has any recommendations.
- Find out about practitioners’ licenses and credentials, and where they received their training.
- Ask whether your insurer will cover at least part of the cost of therapy.
Finally, be sure to discuss all medications you are taking—for your osteoarthritis and other conditions—with both your doctor and acupuncturist.
National Center for Complementary and Alternative Medicine
National Institutes of Health
National Institute of Arthritis and Musculoskeletal and Skin Diseases
National Institutes of Health
Berman BM et al. Effectiveness of acupuncture as adjunctive therapy in osteoarthritis of the knee. Ann Intern. Med. 2004; 141:901–910.
Last reviewed Dec 22, 2004 by ]]>Richard Glickman-Simon, MD]]>
Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.
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