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 Acupuncture Relieves Pain, Improves Function in Knee
Osteoarthritis
Dec. 22, 2004 Acupuncture does provide pain
relief and improve function for older people with osteoarthritis of the
knee, according to a landmark study funded by two components of the
National Institutes of Health. The report says acupuncture can serve as an
effective complement to standard care.
The study, which the researchers say is the longest
and largest randomized, controlled phase III clinical trial of
acupuncture ever conducted, was funded by the National Center for
Complementary and Alternative Medicine (NCCAM) and the National
Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS).
The findings were published in the December 21, 2004, issue of the
Annals of Internal Medicine.
The multi-site study team, including
rheumatologists and licensed acupuncturists, enrolled 570 patients, aged
50 or older with osteoarthritis of the knee. Participants had
significant pain in their knee the month before joining the study, but
had never experienced acupuncture, had not had knee surgery in the
previous 6 months, and had not used steroid or similar injections.
Participants were randomly assigned to receive one
of three treatments: acupuncture, sham acupuncture, or participation in
a control group that followed the Arthritis Foundation's self-help
course for managing their condition. Patients continued to receive
standard medical care from their primary physicians, including
anti-inflammatory medications, such as COX-2 selective inhibitors,
non-steroidal anti-inflammatory drugs, and opioid pain relievers.
"For the first time, a clinical trial with sufficient rigor, size, and
duration has shown that acupuncture reduces the pain and functional
impairment of osteoarthritis of the knee," said Stephen E. Straus, M.D.,
NCCAM Director. "These results also indicate that acupuncture can serve
as an effective addition to a standard regimen of care and improve
quality of life for knee osteoarthritis sufferers. NCCAM has been
building a portfolio of basic and clinical research that is now
revealing the power and promise of applying stringent research methods
to ancient practices like acupuncture."
"More than 20 million Americans have osteoarthritis.
This disease is one of the most frequent causes of physical disability
among adults," said Stephen I. Katz, M.D., Ph.D., NIAMS Director. "Thus,
seeking an effective means of decreasing osteoarthritis pain and
increasing function is of critical importance."
During the course of the study, led by Brian M.
Berman, M.D., Director of the Center for Integrative Medicine and
Professor of Family Medicine at the University of Maryland School of
Medicine, Baltimore, Maryland, 190 patients received true acupuncture
and 191 patients received sham acupuncture for 24 treatment sessions
over 26 weeks. Sham acupuncture is a procedure designed to prevent
patients from being able to detect if needles are actually inserted at
treatment points. In both the sham and true acupuncture procedures, a
screen prevented patients from seeing the knee treatment area and
learning which treatment they received. In the education control group,
189 participants attended six, 2-hour group sessions over 12 weeks based
on the Arthritis Foundation's Arthritis Self-Help Course a proven,
effective model.
On joining the study, patients' pain and knee
function were assessed using standard arthritis research survey
instruments and measurement tools, such as the Western Ontario McMasters
Osteoarthritis Index (WOMAC). Patients' progress was assessed at 4, 8,
14, and 26 weeks. By week 8, participants receiving acupuncture were
showing a significant increase in function and by week 14 a significant
decrease in pain, compared with the sham and control groups. These
results, shown by declining scores on the WOMAC index, held through week
26. Overall, those who received acupuncture had a 40 percent decrease in
pain and a nearly 40 percent improvement in function compared to
baseline assessments.
"This trial, which builds upon our previous
NCCAM-funded research, establishes that acupuncture is an effective
complement to conventional arthritis treatment and can be successfully
employed as part of a multidisciplinary approach to treating the
symptoms of osteoarthritis," said Dr. Berman.
Acupuncture the practice of inserting thin
needles into specific body points to improve health and well-being
originated in China more than 2,000 years ago. In 2002, acupuncture was
used by an estimated 2.1 million U.S. adults, according to the Centers
for Disease Control and Prevention's 2002 National Health Interview
Survey. The acupuncture technique that has been most studied
scientifically involves penetrating the skin with thin, solid, metallic
needles that are manipulated by the hands or by electrical stimulation.
In recent years, scientific inquiry has begun to shed more light on
acupuncture's possible mechanisms and potential benefits, especially in
treating painful conditions such as arthritis.
The National Center for Complementary and
Alternative Medicine (NCCAM) is dedicated to exploring complementary and
alternative medical (CAM) practices in the context of rigorous science,
training CAM researchers, and disseminating authoritative information to
the public and professionals. For additional information, call NCCAM's
Clearinghouse toll free at 1-888-644-6226, or visit the NCCAM Web site
at
nccam.nih.gov.
The mission of the National Institute of
Arthritis and Musculoskeletal and Skin Diseases (NIAMS) is to support
research into the causes, treatment, and prevention of arthritis and
musculoskeletal and skin diseases, the training of basic and clinical
scientists to carry out this research, and the dissemination of
information on research progress in these diseases. For additional
information, call NIAMS's Clearinghouse toll free at 1-877-22-NIAMS, or
visit the NIAMS Web site at
www.niams.nih.gov.
The Web site for the Center for Integrative
Medicine at the University of Maryland School of Medicine is
www.compmed.umm.edu.
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