Research Review by Dr. Shawn Thistle©

Date:

Nov. 2004

Study Title:

Acupuncture as a complimentary therapy to the pharmacological treatment of osteoarthritis of the knee: randomized controlled trial

Authors:

Vas J, Méndez C, Perea-Milla E, Vega E, Panadero D, León JM, Borge MA, Gaspar O, Sánchez-Rodriguez F, Aguilar I, Jurando R

Publication Information:

British Medical Journal 2004

Summary:

This study investigated the efficacy of acupuncture as an adjunct to traditional pharmacological treatment of knee osteoarthritis, one of the most common, and disabling joint conditions. Osteoarthritis in the knees becomes more common as people age. Common symptoms include pain, loss of motion, stiffness, and joint crepitus (noise) with movement. This condition can be associated with severe loss of function and mobility, as well as a general decline in quality of life.

As such, this condition is generally treated by medical or surgical intervention. The most common medical intervention is oral anti-inflammatory medications (NSAIDs). In patients who are unresponsive, or decline, such treatment there are alternative management strategies.

Manual therapies, exercise, nutritional supplements such as glucosamine sulphate, and acupuncture have all been reported to have some benefit.

This study compared a more traditional treatment (oral NSAID - anti-inflammatory medication Diclofenac) with and without acupuncture in a randomized, controlled, single-blinded trial. Patients had to be 45 years of age or older, and have pain in one or both knees for the preceding 3 months or longer in order to be included in the study. 97 patients were divided into two groups:
  1. intervention group acupuncture plus Diclofenac
  2. control group placebo acupuncture plus Diclofenac
Each patient was given 21 Diclofenac (50 mg) tablets for the week (1 every 8 hours). A doctor specializing in medical acupuncture selected acupuncture points based on traditional treatment methods for osteoarthritis of the knee (for those interested, see full text of paper for specific points utilized). Treatment time in both groups was 12 weeks.

The primary outcomes assessed in this study were pain intensity (measured via visual analogue scale), pain, stiffness, and physical function subscales of the WOMAC (Western Ontario and McMaster Universities Osteoarthritis Index), dosage of Diclofenac taken during treatment, and the profile of quality of life in the chronically ill instrument (PQLC). Each outcome was assessed before and after the treatment schedule.

88 patients completed the trial. In all outcome measures, there was a greater, and significant reduction in the acupuncture group, indicating that these patients had a greater reduction in pain, and more improved function, than the group receiving the placebo acupuncture and Diclofenac.

Conclusions & Practical Application:

This study provides promising data suggesting that medical acupuncture can be a valuable adjunct to traditional treatment of knee osteoarthritis. For many people contemplating surgery, or stronger prescription medications, acupuncture could provide sufficient pain relief to allow proper rehabilitation and strengthening of the knees. This could significantly delay, or eliminate the need for, invasive surgery that itself requires lengthy rehabilitation.

Future studies should attempt to employ a longer-term follow-up, and use a greater number of subjects to strengthen the applicability of the results.