A recent study conducted in Melbourne, Australia, has addressed the current debate regarding the benefits of acupuncture for chronic knee pain associated with osteoarthritis. The study reported a lack of positive effect in patients treated with either needle or laser acupuncture in terms of pain or function. The findings do not support the use of acupuncture for pain associated with knee osteoarthritis.
Chronic knee pain is commonly associated with osteoarthritis. There are several treatment options for pain associated with knee osteoarthritis. We have previously reported on treatment options and clinical developments for knee osteoarthritis pain management:
- Exploring Treatment Options for Osteoarthritis
- Latest Clinical Developments in Osteoarthritis of the Knee
Alternative medicine is also commonly used to alleviate the pain associated with knee osteoarthritis, with acupuncture being the most popular method of alternative therapy. While there has been some evidence in the past supporting the use of needle acupuncture for osteoarthritis pain, the current study suggests that previous studies may be biased due to patients acupuncture preconceptions and positive attitudes, thereby influencing results of the clinical trials. For this reason, a group in Melbourne, Australia, conducted a clinical trial using a ‘Zelen design’ where the participants were randomised to treatment groups prior to consent, and the control group were completely unaware of the trial. In this way the Zelen design reduces the risk of bias due to recruitment of only patients who have positive attitudes towards acupuncture.
The aims of the study were to assess the effectiveness of needle and laser acupuncture for osteoarthritis knee pain. Laser acupuncture used in this trial consisted of low-intensity laser therapy at the acupuncture points, and is a non-invasive alternative to traditional acupuncture. Participants from Melbourne and regional Victoria were recruited for the study between February 2010 and December 2011. Participants were eligible if they were 50 years or older with knee pain that had lasted for longer than 3 months, knee pain on most days classified on a rating scale of 4 or more out of 10, and morning stiffness of the affected knee lasting for less than half an hour. Participants were randomised to one of four groups: laser acupuncture, sham acupuncture, needle acupuncture, and control group (no acupuncture). In all there were 282 participants enrolled in the trial. The acupuncture treatment was given in accordance to usual practice, using standardised acupuncture points.
The study reported no significant differences between the needle acupuncture, laser acupuncture, and sham acupuncture groups. However, there was a small improvement seen in both the needle and laser acupuncture groups when compared with the no acupuncture control. These improvements however were not maintained at the 1 year time point. The authors state that their results support recommendations from the National Institute for Health & Care Excellence osteoarthritis clinical guidelines and The American Academy of Orthopedic Surgeons, who do not recommend the use of acupuncture for chronic knee pain associated with osteoarthritis.
The authors suggest that the participants in their study could have held less-positive expectations in regards to acupuncture treatment, thus explaining the lack of effect compared with previous studies. Another clinical trial is currently recruiting participants assessing the efficacy of acupuncture for pain associated with knee osteoarthritis. This trial is also aiming to address the issue of bias caused by positive attitudes towards treatment. The study is being conducted at the Massachusetts General Hospital, in collaboration with the National Center for Complementary and Alternative Medicine (NCCAM), Beth Israel Deaconess Medical Center, and Brigham and Women’s Hospital. The study is recruiting volunteers who are 40-70 years old and meet the criteria of the American College of Rheumatology for osteoarthritis of the right and/or left knee for at least the past 3 months, with radiographic evidence of grade 2 or 3 knee osteoarthritis.
Hinman, RS, McCrory, P, Pirotta, M, Relf, I, Forbes, A, Crossley, KM, Williamson, E, Kyriakides, M, Novy, K, Metcalf, BR, Harris, A, Reddy, P, Conaghan, PG, Bennell, KL. “Acupuncture for Chronic Knee Pain: : A Randomized Clinical Trial” JAMA. 2014;312(13):1313-1322.
Clinicaltrials.gov “A Functional Magnetic Resonance Imaging (fMRI) Study of Expectancy on Acupuncture Treatment Outcomes in Knee Osteoarthritis (OA) (KOA)” Available from: http://www.clinicaltrials.gov/ct2/show/NCT01040754?term=osteoarthritis+AND+acupuncture&recr=Open&no_unk=Y&rank=2Last Accessed: Oct 7, 2014.
Image courtesy of Praisaeng at FreeDigitalPhotos.net
Written by Deborah Tallarigo, PhD