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No added benefit seen in acupuncture added to exercise and advice protocol
Similar pain relief noted between acupuncture, sham acupuncture, and exercise groups.
A new Level 1 study indicates that adding acupuncture to exercise and advice delivered by physiotherapists does not provide additional pain relief for patients with clinical knee osteoarthritis.
In a randomized controlled trial, researchers from the United Kingdom studied 352 patients with knee osteoarthritis who received one of the following treatments:
- six sessions of exercise and advice from physiotherapists;
- six sessions of exercise and advice from physiotherapists plus true acupuncture; or
- six sessions of exercise and advice from physiotherapists plus nonpenetrating acupuncture using a sham needle.
The researchers published in a recent British Medical Journal that they discovered no significant differences between the groups regarding changes in the baseline WOMAC scores for pain at 2 weeks, 6 weeks, 6 months and 12 months follow-up.
“The take-home message is that although other studies have shown acupuncture to be effective for knee osteoarthritis, our study has, for the first time, looked at the additional benefit of acupuncture when it is provided alongside mainstream evidence-based intervention – advice and exercise delivered by physiotherapists over a course of treatments,” Nadine E. Foster, DPhil, told Orthopedics Today. “When you add acupuncture to good-quality advice and exercise, it does not appear to add very much in the way of additional pain relief or functional improvement.”
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Slight differences
However, they noted some early differences in a few of the secondary outcomes measures. “We did see small significant differences in the short-term follow-up at 2 weeks and 6 weeks, where there was some suggestion that adding acupuncture might be beneficial for pain intensity and pain unpleasantness. But those differences were small, and they were the same for both the true and the nonpenetrating acupuncture groups,” Foster said.
The multicenter study included patients 50 years old and older of whom 61% were women, according to the study. All patients received exercise and advice from physiotherapists, which included leaflets that focused on pacing activity and rest. “They also had advice about some simple self-help techniques they could use at home to try to help relieve their knee pain,” Foster said.
The researchers selected exercises for the study using a consensus workshop. The exercise regimen included lower limb strengthening exercises, particularly for the quadriceps muscle, as well as stretching and balance exercises. Patients randomized to the true acupuncture group received acupuncture treatment based on traditional Chinese protocols and current clinical practice within the National Health Service in the United Kingdom. Ninety-four percent of all patients in the study were available for 6-month follow-up, Foster said.
Image: Barlas P |
Limited acupuncture
A comparison of the 6-month scores for pain showed a 2.28-point decrease for patients who received advice and exercise alone, a 2.32-point decrease for those who also had true acupuncture and a 2.53-point decrease for the nonpenetrating acupuncture group, according to the study. While the researchers found no significant differences between the groups for pain relief, Foster noted that other studies involving more sessions of acupuncture have pointed to an advantage with the treatment.
“I think that acupuncturists might argue that a limitation of our trial is that we didn’t have sufficient number of acupuncture treatments,” she said. “However, what I would say to that is that after six treatments, certainly in our health service, if there isn’t some sign that the intervention is additionally beneficial, it would be difficult to justify spending money on more treatments.”
Editor’s note: Click here to read about the use of acupuncture in the treatment of lower back pain.
For more information:
- Nadine E. Foster, senior lecturer in therapies (pain management), can be reached at Primary Care Musculoskeletal Research Center, Keele University, Stafford ST5 5BG, England; +44-1782-584705; e-mail: n.foster@keele.ac.uk. She has no direct financial interest in any products or companies mentioned in the article. The Arthritis Research Campaign funded the study.
Reference:
- Foster NE, Thomas E, Barlas P. Acupuncture as an adjunct to exercise based physiotherapy for osteoarthritis of the knee: randomized controlled trial. Brit Med J. 2007 335(7617):436.