Acupuncture fails to hit the mark for chronic knee pain

By Lucy Piper, Senior medwireNews Reporter

Research findings do not support the use of needle or laser acupuncture for treating chronic knee pain in patients older than 50 years.

“Although needle and laser acupuncture improved pain after treatment compared with control, improvements were not sustained at 1 year and were of a clinically unimportant magnitude”, lead researcher Rana Hinman (University of Melbourne, Victoria, Australia) and team report.

The findings support recommendations by The American Academy of Orthopaedic Surgeons and the National Institute for Health and Care Excellence against the use of acupuncture for knee osteoarthritis.

For the study, which followed a Zelen design, 282 people, aged at least 50 years, volunteered to be observed for a year. They were then randomly assigned to receive no acupuncture, needle acupuncture, laser acupuncture or sham laser acupuncture. Consent for the procedures was sought after randomisation in order to minimise the positive effects of patients knowingly volunteering for an acupuncture trial.

Treatment was declined by 13% to 19% of patients, leaving 71 patients who received no acupuncture, 70 who received needle acupuncture, 71 laser acupuncture and 70 sham laser acupuncture. Treatment was delivered once or twice weekly up to a maximum of eight to 12 sessions over a period of 12 weeks.

At 12 weeks, needle and laser acupuncture groups showed modest improvements in pain compared with control groups, with an average 1.1 and 0.8 point improvement, respectively, on a numeric rating scale of 0 to 10, where higher scores indicated worse pain. But the improvement was not enough to meet the minimal clinically important difference of 1.8 and did not persist at 1 year.

Needle acupuncture was also associated with modest improvements in function on the Western Ontario and McMaster University Osteoarthritis Index at 12 weeks compared with no acupuncture, with a score difference of 3.9. But this was not significantly different to the 1.7-point improvement seen with sham laser acupuncture and the improvement was not maintained at 1 year.

There was also no significant improvement with either type of acupuncture for most of the secondary outcomes, such as pain on walking or standing, activity restriction and quality of life.

The researchers attribute the benefit of acupuncture in their study to incidental effects, such as treatment setting, patient expectations and attitudes, and acupuncturist’s confidence in treatment.

They conclude in JAMA: “Among patients older than 50 years with moderate to severe chronic knee pain, neither laser nor needle acupuncture conferred benefit over sham for pain or function.

“Our findings do no support acupuncture for these patients.”

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