July 7, 2005 -- Acupuncture may offer some relief from osteoarthritis in the knee - at least in the short run.
Researchers report the finding in The Lancet. They studied nearly 300 people with knee osteoarthritis.
Acupuncture's long-term effects on knee osteoarthritis now need to be tested, write the researchers. They included Claudia Witt, MD, of Berlin's Institute of Social Medicine, Epidemiology, and Health Economics.
Osteoarthritis is the most common form of arthritis; it causes degeneration of body joints. It develops when cartilage, the lining of joints that allows smooth movement between opposing bones, starts to break down. Swelling and inflammation in the affected joint are a major cause of pain and disability. Osteoarthritis most often affects the fingers, hips, knees, feet, or spine.
Year-Long Study, 2-Month Treatment
Witt's study lasted one year. Acupuncture treatments only lasted for eight weeks.
Some patients got 12 sessions of real acupuncture over eight weeks. Others got fake acupuncture treatments.
The fake acupuncture didn't place or use needles correctly. Patients were told that two different types of acupuncture were being tested. They didn't know that one procedure was phony.
For comparison, a third group didn't get either treatment right away. Instead, they went on an eight-week waitlist for real acupuncture.
All patients were also allowed to take pain-relieving drugs during the study. Treatment for osteoarthritis is based on reducing pain and inflammation using anti-inflammatorymedications and physical therapy.
Patients completed surveys about knee pain and functional disability eight weeks, six months, and one year into the study.
Real acupuncture came out on top in the first survey. Patients getting real acupuncture had bigger improvements in knee pain and function than the other two groups. Those receiving real acupuncture treatment reported significantly lower scores on pain and disability compared with participants in the other groups.
At eight weeks, about half of the real acupuncture group had improved their scores by at least 50%.
The same level of improvement was reported by 28% of those getting fake acupuncture and 3% of those on the waitlist, write the researchers.
Those patterns didn't hold in the follow-up surveys.
At six months and one year, there weren't significant differences between the groups, write the researchers.
Those on the waitlist eventually got real acupuncture. They followed the same pattern as the first real acupuncture group -- short-term improvement that faded after treatment ended.
Acupuncture for knee osteoarthritis is also covered in a Lancet editorial.
"Certainly, a major benefit patients report is that acupuncture makes them feel better. Making patients feel better is important," write biochemist Andrew Moore and colleagues. They work at the Pain Research Unit at Churchill Hospital in Oxford, England.
Possibly, some trials have failed to adequately measure that benefit, they continue.
But "we are still some way short of having conclusive evidence that acupuncture is beneficial in arthritis or in any other condition, other than in a statistical or artificial way," write Moore and colleagues.
"Acupuncture is widely used by patients with chronic pain although there is little evidence of its effectiveness," write Witt and colleagues.
Experts from the U.S. Department of Health and Human Services see acupuncture a little differently.
Two years ago, they issued an assessment of acupuncture for osteoarthritis. They had reviewed 19 studies on the topic. Not all dwelt on knee arthritis.
Most studies showed some benefit from acupuncture compared with no treatment, the review states. However, it also states that real acupuncture didn't have an edge over sham acupuncture in most studies.
Overall, "the evidence was probably sufficient' to justify acupuncture as a second- or third-line treatment for a patient who isn't responding to conventional treatments, not tolerating medication, or is experiencing recurrent pain," states the review.
But the evidence didn't justify using acupuncture as an initial treatment, the review continues.
In 1997, a panel of scientists from the National Institutes of Health stated that while acupuncture studies were mixed, they had seen "promising" results for acupuncture in adults with postoperative and chemotherapy-related nausea and vomiting, as well as postoperative dental pain.