Research Review by Dr. Shawn Thistle©

Date:

Dec. 2004

Study Title:

Effectiveness of acupuncture as adjunctive therapy in osteoarthritis of the knee: A randomized, controlled trial.

Authors:

Berman BM et al.

Publication Information:

Annals of Internal Medicine 2004; 141: 901-910

Summary:

On the heels of the Spanish study published on the British Medical Journal, this larger project with a longer follow-up period adds to the growing body of evidence that acupuncture is a useful adjunct in the treatment of knee osteoarthritis.

In this study, 570 patients (average age ~ 65 years) with a diagnosis of knee osteoarthritis confirmed by x-ray were randomized into three groups:
  1. acupuncture group - who received 23 treatments over the course of 6 months according to the following schedule:
    • 2 treatments per week for 8 weeks
    • 1 treatment per week for 2 weeks
    • 1 treatment per month thereafter
  2. sham acupuncture group - received the same number of treatments over the same time period, but treatment involved 2 needle insertions at "irrelevant" abdominal sites and a sham procedure at points utilized in group 1
  3. control group - attended 6 two-hour sessions based on an Arthritis Self-Management Program (Arthritis Foundation) Patients in all groups were allowed to continue taking their current medications including simple analgesics, non-specific NSAIDs, and COX-2 Inhibitors
Measurements of pain and function were taken at 8 weeks, 14 weeks and 26 weeks.

Pertinent Results:

  1. at 8 weeks, patients in the acupuncture group experienced a greater improvement in function compared to the other groups
  2. at 14 weeks, patients in the acupuncture group showed a greater reduction in pain that the other groups
  3. at 26 weeks, the acupuncture maintained their improvements in pain and functional measures
It is important to note that nearly 25% of subjects (spread out over all three groups) in this study did not complete the protocol. This weakens the results of the study somewhat but the authors did perform an analysis on those who dropped out, which indicated no significant change to the outcome of this study. Nonetheless, this is a high dropout rate.

Conclusions & Practical Application:

This study adds to a continuing body of evidence that supports the use of medical acupuncture for many types of painful conditions, in this case osteoarthritis of the knee.

With the recent scientific controversy surrounding the safety of the COX-2 Inhibitors (Vioxx, Celebrex, Bextra etc.), studies such as this are promising for patients seeking an alternative form of pain management, and for physicians who are looking for another treatment alternative to recommend to their patients.

Unfortunately, this study did not assess the cost effectiveness of acupuncture compared to regular care. Future research will be needed to elucidate this information.

Medical acupuncture carries minimal risk in the hands of a qualified practitioner, and appears to be a useful adjunct in the treatment of pain and loss of function caused by osteoarthritis of the knee.