Acupuncture can improve pain and functioning in patients with knee osteoarthritis (OA), but only in the short term, according to a new study published in The Lancet.1
In the investigation, 290 patients with chronic knee OA (Kellgren grade <e;2) randomly received acupuncture or minimal "sham" acupuncture (superficial needling at non-acupuncture points), or were put on a waiting list and served as controls. The acupuncture protocol comprised 12 half-hour sessions over 8 weeks. Patients completed standard questionnaires that solicited information on pain, medications taken, productivity, health-related quality of life, and other disease-related issues at baseline and at 26 and 52 weeks. The primary outcome measure was the Western Ontario and McMaster Universities Osteoarthritis (WOMAC) index at the end of the eighth week.
After 8 weeks of therapy, a decrease of at least 50% in the WOMAC index occurred more frequently in patients in the acupuncture group compared with those in the sham acupuncture and waiting-list groups. However, the benefit declined over time and was no longer significant at 26 or 52 weeks.
"We found short-term effects for acupuncture compared to minimal acupuncture and no acupuncture treatment," lead author Claudia Witt, MD, deputy administrative director of the Institute of Social Medicine, Epidemiology, and Health Economics of Charite' University Medical Centre in Berlin, Germany, tells CIAOMed. "Further studies should assess the long-term effects. In addition, the effectiveness and costs in routine medical care should be assessed."
This study adds to the body of literature about the role of acupuncture in OA treatment, but does not provide any real answers about where it best fits in the overall treatment scheme. Exactly how acupuncture may improve pain and functioning in knee OA is not yet fully understood.
"There exist different models to explain the effects of acupuncture, but there is no detailed and valid explanation of how it works," Dr. Witt says. But "patients with pain due to chronic arthritis of the knee could try acupuncture treatment."
Editorialists not fully convinced of acupuncture's benefits
In an editorial accompanying the study by Dr. Witt and colleagues,2 Andrew Moore, MA, DPhil, DSc, and Henry McQuay, DM, FRCP (Ed), of the pain research unit, Nuffield Department of Anaesthetics, University of Oxford, Oxford, UK, point out that "the bottom line from Witt and colleagues' large, long, and high-quality study of acupuncture of knee OA is that doing something is better than doing nothing. The question is whether one sort of doing something is better than any other sort."
According to these commentators, there remains a lack of conclusive evidence that acupuncture is beneficial in arthritis or in any other condition, other than in a "statistical or artificial way." Further, its cost-effectiveness is not well defined.
No real effect in fibromyalgia
In a related study, acupuncture was reported no more effective than sham acupuncture at relieving pain in persons with fibromyalgia (FM).3 Findings of the trial appeared in the July 5, 2005 issue of the Annals of Internal Medicine.
In this study from the Group Health Cooperative Center for Health Studies and the University of Washington, Seattle, 100 patients with FM received either twice-weekly treatment for 12 weeks with an acupuncture program that was specifically designed to treat FM, or one of three sham acupuncture treatments. Other FM therapies were permitted, so acupuncture was considered an adjunctive treatment in this study. The primary outcome of subjective pain was measured by a 10-cm visual analogue scale ranging from 0 (no pain) to 10 (worst pain ever), with measurements obtained at baseline and at 1, 4, 8, and 12 weeks of treatment, as well as 3 and 6 months post-treatment.
The mean subjective pain rating among patients who received acupuncture for FM did not differ from that in the pooled sham acupuncture group, the researchers report.
The take-home message
Although these investigations add to the body of literature on the role of acupuncture in arthritis and related conditions, the take-home message is that "the need for needles is still in doubt." Acupuncture makes some patients feel better, but it is viewed primarily as a rather ill-defined adjunct to pharmacologic therapy.
References:
- Witt C, Brinkhaus B, Jena S, et al. Acupuncture in patients with osteoarthritis of the knee: a randomised trial. Lancet. 2005;366:136-143.
- Moore A, McQuay H. Acupuncture: not just needles? Lancet. 2005;366:100-101.
- Assefi NP, Sherman KJ, Jacobsen C, et al. A randomized clinical trial of acupuncture compared with sham acupuncture in fibromyalgia. Ann Intern Med. 2005;143:10-19