Osteoarthritis
Clinical trials evaluating acupuncture for osteoarthritis of the knee constitute some of the highest-quality evidence available regarding acupuncture for any condition. Consequently, researchers can be more certain in their conclusions.
Systematic Reviews
Acupuncture for Chronic Pain: Update of an Individual Patient Data Meta-Analysis
Osteoarthritis of the knee was one of the conditions included in this large systematic review, along with back pain, neck pain migraine, tension headaches, and shoulder pain. This review received data from a total of 20,827 patients from 39 trials. As far as we are aware, this is the largest high-quality systematic review that evaluates acupuncture for any condition. In addition to size, the review’s strengths are that it included only high-quality clinical trials and had access to the individual patient data. In many systematic reviews the meta-analysis combines the summary data from clinical trials: for example, the mean (average) pain scores.
The meta-analysis in this systematic review used the pain scores from each participant, therefore, the analysis has greater statistical ‘precision’. In summary, the Acupuncture for Chronic Pain: Update of an Individual Patient Data Meta-Analysis is the most reliable assessment of acupuncture to date.
For the above chronic pain conditions the review found:
• acupuncture is superior to ‘no acupuncture controls’
• acupuncture is superior to placebo
• the clinically relevant effects of acupuncture on chronic pain persist overtime
Comparison of acupuncture with other physical treatments for pain caused by osteoarthritis of the knee: a network meta-analysis
This is another important study that investigated acupuncture for osteoarthritis of the knee. A network meta-analysis is a way of comparing different treatment options for a particular condition. The different treatment options can then be ranked in order of relative effectiveness. The rankings when compared to usual care, using only better-quality clinical trials, were as follows:
1. Acupuncture
2. Balneotherapy
3. Sham acupuncture
4. Muscle-strengthening exercise
5. Tai ji quan (T’ai chi)
6. Weight Loss
7. Aerobic exercise
8. No intervention
Cochrane Review:
Acupuncture for peripheral joint osteoarthritis
This review found beneficial effects for acupuncture. For acupuncture versus usual care the effect size was 0.96 for pain and 0.89 for function. When compared to sham acupuncture effect sizes were 0.28 for pain and 0.28 for function. The study authors concluded that sham-controlled trials show statistically significant benefits; however, these benefits were small, and probably due at least partially to placebo effects from incomplete blinding. Waiting list-controlled trials of acupuncture for peripheral joint OA suggest statistically significant and clinically relevant benefits.
Clinical Guidelines
Three out of five of these clinical guidelines were found in favor of using acupuncture for osteoarthritis of the knee. Please see the Commentary for further discussion.
National Institute for Health and Clinical Excellence: CG177
The NICE guidelines do not recommend acupuncture for osteoarthritis of the knee.
EULAR recommendations for the non-pharmacological
core management of hip and knee osteoarthritis
The European League Against Rheumatism (EULAR) conducted a Delphi process prior to undertaking the main review. At this stage, the panel of experts decided not to include acupuncture. The reason for this exclusion was not given although two of the recent clinical guidelines, which the panel appears to have considered at this stage, recommended acupuncture (see below ACR & OARSI).
American College of Rheumatology
ACR conditionally recommends acupuncture for severe to chronic osteoarthritis of the knee when the patient is unwilling or unable to undergo total knee arthroplasty.
American College of Rheumatology
ACR conditionally recommends acupuncture for severe to chronic osteoarthritis of the knee when the patient is unwilling or unable to undergo total knee arthroplasty.
Osteoarthritis Research Society International (2008/2010)
OARSI recommends acupuncture for the symptomatic treatment of patients with osteoarthritis of the knee.
The Joint Federal Committee of Physicians and Health Insurance Plans in Germany (Gemeinsamer Bundesausschuss, G-BA)
Recommend acupuncture for osteoarthritis of the knee, since 2006.