Acupuncture Relieves Pain and Improves Function in Knee Osteoarthritis

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 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 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 Stephen E. Straus, M.D., 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."

An increasing number of patients are using Acupuncture Medicine as their primary health care therapy. Acupuncture has become well known as a medical treatment for pain relief and many other conditions. Some of the benefits include immune enhancement, an increase in energy, and an overall feeling of well being. When provided by a highly trained licensed practitioner, like
Dr. Glenn Marr, acupuncture and herbal medicine are gentle therapies that are free of side-effects.

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.

Acupuncture Treatments

Acupuncture is a relatively painless, natural technique. It consists of the gentle insertion and stimulation of sterile, disposable, small, hair-width needles placed at precise strategic points on the body. While many acupuncture patients are initially wary about their first treatment, they soon discover that the experience is quite pleasurable and pain-free. Acupuncture has been proven to stimulate and release opiate-like hormones and induce a state of relaxation, balance and healing.

New Support for Acupuncture in Knee Arthritis

Acupuncture Complements Drug Therapy for Knee Osteoarthritis Pain
By Daniel J. DeNoon
WebMD Medical News

Nov. 18, 2004 -- Adding acupuncture to standard treatment for knee arthritis helps patients feel less pain, a new study shows.

The findings come from a research team led by Jorge Vas, MD, chief medical officer at the pain treatment unit of Dos Hermanas Health Center in Dos Hermanas, Spain.

Vas and colleagues treated 88 knee osteoarthritis patients with diclofenac - a standard anti-inflammatory painkiller. Half the patients got 12 weekly acupuncture treatments, too. The other half got sham acupuncture using authentic-looking retractable needles that did not penetrate their skin.

The results: Those who got real acupuncture took less of their pain medication than those who got fake acupuncture. Yet they had less pain, less stiffness, and better physical function.

Vas isn't surprised. Over the last seven years, he's treated more than 100,000 pain patients with acupuncture.

"Acupuncture doesn't work for everyone," Vas tells WebMD. "But for patients seen earlier in the course of knee arthritis, 75% to 85% have less pain and more mobility."

Vas and colleagues report their findings in the Nov. 20 issue of the British Medical Journal. Their study appears on the heels of an October 2004 presentation to the American College of Rheumatology by Marc Hochberg, MD, PhD, of the University of Maryland. In a study of 570 knee arthritis patients, Hochberg's team reported similar findings to those of Vas and colleagues. Acupuncture reduced pain and stiffness and improved physical function.
Doctors, Patients Slow to Accept Acupuncture

Acupuncture is a Chinese medical practice based on improving the flow of energy through the body. It's not like Western medical treatments, which try to heal what ails you. Instead, Chinese medicine tries to get the body to heal itself, says Ka-Kit Hui, MD, professor of medicine and director of the UCLA Center for East-West Medicine.

"The body has an innate, intrinsic healing response," Hui tells WebMD. "It is only when the body cannot repair itself that a problem becomes chronic. With chronic arthritis pain, the body cannot reset the pain/no-pain balance. In contrast with Western medicine, acupuncture and massage and even some physical therapies work through stimulating the body to heal."

Erin Arnold, MD, a rheumatologist at the Illinois Bone and Joint Institute in Morton Grove, treats many of her arthritis patients with acupuncture in combination with medical treatments.

"Among doctors who deal with chronic pain, there is an appreciation of complementary therapies such as acupuncture," Arnold tells WebMD. "It is reasonable to think that in situations where there is chronic pain - where the pain can come from many places and not just the joint -- that no one single therapy provides relief."

Arnold says doctors are becoming more open to referring arthritis patients for acupuncture. But she says many doctors still do not accept it.

"I just gave a talk at medical grand rounds, and most of the doctors were enthusiastic. But quite a few were very pessimistic," she says. "When I talk to students about the theory behind this, at the end of my talk, I say people need to make a leap of faith and be open to the experience of their patients. So I think people will slowly come around."

Hayes Wilson, MD, chief of rheumatology at Piedmont Hospital in Atlanta, says doctors are willing to accept any treatment that helps their patients.

"I think we rheumatologists are pretty open minded," Wilson tells WebMD. "Speaking for myself, I am a pragmatist. I am for anything that works for my patients. There is a group of patients acupuncture works for, a minority of patients, and that is absolutely fine with me."

Wilson says that one of his partners treats arthritis patients with acupuncture and tells him that it works well - with one drawback.

"It is not a cure," Wilson says. "You have to keep coming back. In my experience, patients do it for a while and sort of lose interest."