|
National Center for Complementary and Alternative Medicine
Alternative Approaches
Acupuncture Relieves Pain
and Improves Function in Knee Osteoarthritis
Acupuncture provides pain relief and improves function for
people with osteoarthritis of the knee and serves as an effective
complement to standard care. This landmark study was
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. 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 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 antiinflammatory
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, two-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 (II). 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 tollfree
at 1-888-644-6226, or visit the NCCAM Web site at
www.nccam.nih.gov.
|
