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Acupuncture, Placebo Have Same Effect on Knee Arthritis

Study Also Finds That Patients Fare Better When Acupuncturist Expects Successful Treatment
By Katrina Woznicki
WebMD Health News
Reviewed by Laura J. Martin, MD

Aug. 20, 2010 -- Traditional Chinese acupuncture proved no more effective for treating osteoarthritis of the knee than sham acupuncture, a new study says. People who got either form of therapy showed significant improvement in pain.

The findings are published online and will appear in the September issue of Arthritis Care & Research, a journal of the American College of Rheumatology.

Also, the communication style of the acupuncture practitioner had an effect on pain improvement and satisfaction with treatment. Patients whose health care provider said they expected the therapy to help the pain had significantly more improvement in pain, compared to patients whose provider was neutral about the therapy.

The findings suggest that the way health care providers communicate to their patients and manage patients’ expectations could affect outcomes.

The Study

Acupuncture is an ancient Chinese healing practice in which very thin needles are placed in various locations of body to help reduce pain and improve the body’s flow of energy. According to the National Center for Complementary and Alternative Medicine, an estimated 3.1 million U.S. adults have used acupuncture.

Researchers led by Maria Suarez-Almazor, MD, PhD, a rheumatologist at the University of Texas M.D. Anderson Cancer Center in Houston, compared traditional Chinese acupuncture to sham acupuncture in 455 patients with osteoarthritis of the knee. It's a condition that affects 27 million Americans aged 25 and older. Symptoms include pain, stiffness, and swelling in the knee joints.

The goal of the study was to evaluate the effects of the treatments and the impact of interactions between the health care provider and the patient. Acupuncturists were trained to interact with patients using one of two communication styles. One style, called "high expectation," had the health care provider telling patients he or she has "had a lot of success treating knee pain," therefore increasing a patient’s expectations. The second style, called "neutral," had providers telling patients the treatment "may or may not work for you."

Patients were randomly chosen to either visit a provider trained in a “high” communication style, visit one trained to be “neutral,” or receive no treatment. Patients who received treatments did so for six weeks. Patient and provider visits were recorded, and patients answered questionnaires to determine how their pain and symptoms had changed, if at all.

Overall, there were no major differences between patients who received traditional Chinese acupuncture and those who received sham acupuncture. Those who received some form of acupuncture reported greater improvements in their symptoms than those who received no treatment.

After six weeks of treatment, 41.2% of patients who were treated by providers trained to deliver “high” expectations reported a 50% improvement in symptoms, compared with 33.6% trained by those to deliver “neutral” expectations.

“We found a small but significant effect on pain and satisfaction with treatment, demonstrating a placebo effect related to the clinician’s communications style,” Suarez-Almazor says in a news release. “The improvement in pain and satisfaction suggests that the benefits of acupuncture may be partially mediated through placebo effects related to the behavior of the acupuncturist.”

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