A study funded by the National Center for Complementary and Alternative Medicine (NCCAM) and the National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS), both components of the National Institutes of Health, has found that acupuncture may provide pain relief and improve function for people with knee osteoarthritis.
The findings of the study -- the longest and largest randomized, controlled phase III clinical trial of acupuncture ever conducted -- were published in the December 21, 2004 issue of the journal Annals of Internal Medicine.
The multi-site study assessed 570 people with osteoarthritis of the knee who were aged 50 or older. Participants in the study had significant pain in their knee the month before joining the study, but had not had knee surgery in the prior six months or used steroid or similar injections. None had ever had acupuncture.
Study participants received either acupuncture or "sham" acupuncture or they participated in a self-help group on managing their condition. 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.
All participants 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 medications.
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% decrease in pain and a nearly 40% improvement in function compared to baseline assessments.
"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."
