Dec. 20, 2004 -- An ancient Chinese medical treatment that has been used by millions of Americans finally has a stamp of approval from western medicine. In what investigators are calling a "landmark" study, acupuncture was found to reduce pain and improve movement among patients with osteoarthritis of the knee when used with other treatments.
Findings from the study, funded by the National Institutes of Health, were reported at a Monday news conference and are published in the Dec. 21 issue of the Annals of Internal Medicine.
The director of the NIH's National Center for Complementary and Alternative Medicine (NCCAM) called the investigation the "largest, longest, and most rigorous study of acupuncture" ever conducted. He said the 2,000-year-old practice can now be considered a "new" addition to therapies for degenerative osteoarthritis.
Principal investigator Brian M. Berman, MD, of the Center for Integrative Medicine at the University of Maryland, said osteoarthritis of the knee was a logical choice for the large, government-funded acupuncture study because so many people with the condition have already turned to alternative medicines.
"(Osteoarthritis) is a big public health problem affecting many millions of people in the U.S.," he said. "It is associated with a significant reduction in quality of life and is an area where traditional medicine does not have all the answers. Adequate pain relief is often not achieved, and many drugs have undesirable side effects, especially in the elderly."
Traditional Treatments Under Fire
The safety of the most widely prescribed of the traditional medicines -- the pain relievers known as Cox-2 inhibitors -- has been much in the news lately. The arthritis drug Vioxx was voluntarily pulled from the market earlier this fall after a large trial linked its use to an increase in heart attacks and strokes. In another trial, reported last week, Pfizer's popular Cox-2 inhibitor Celebrex was also found to increase heart attack risk. The company says it has no plans to pull Celebrex from the market until it studies the data.
Just under a third of the patients in the acupuncture trial were also taking a Cox-2 inhibitor. But study co-investigator Marc Hochberg, MD, PhD, said Monday that the Cox-2 inhibitors have not been shown to be superior to other pain relievers for the treatment of osteoarthritis.
He added that recent studies suggest that side effects such as ulcers and bleeding that result from the prolonged use of nonsteroidal anti-inflammatory drugs such as ibuprofen and naproxen can be minimized by also taking ulcer drugs, known as proton-pump inhibitors or H2 blockers.
"There is actually very little indication for the use of Cox-2 selective inhibitors in managing patients with symptomatic osteoarthritis," Hochberg said.
40% Improvement With Acupuncture
The newly reported study included 570 patients with knee osteoarthritis who were already taking anti-inflammatory drugs or other pain relievers. The patients continued on their pain relievers during the 26-week trial, but a third of them also got aggressive acupuncture treatments consisting of 23 total sessions. Another group of patients unknowingly got sham acupuncture, which involved the use of fake needles to mimic the real needles used for true acupuncture. A third group underwent an intensive 12-week education course on the management of osteoarthritis.
All the patients were assessed at weeks 4, 8, 12, and 26 for pain and knee function. By week 8, the patients who got the true acupuncture were showing significant increases in knee function, and by week 14 they showed significant decreases in pain compared with the sham acupuncture and the education groups.
The acupuncture group had a 40% decrease in pain as compared with their initial pain scores. They also experienced a 40% improvement in function at the end of the trial, and there were no major treatment-related side effects.
Research in animals suggests that acupuncture works by affecting genes involved in the production of chemicals within the body that regulate pain. But it is not yet clear if the ancient practice can actually slow progression of the degenerative joint condition, says Stephen I. Katz, MD, PhD, director of the National Institute of Arthritis and Musculoskeletal and Skin Diseases, which co-sponsored the study.
"More than 20 million Americans have osteoarthritis," Katz said. "This disease is one of the most frequent causes of physical disability among adults. Seeking an effective means of decreasing osteoarthritis pain and increasing function is of critical importance."