Osteoarthritis and Acupuncture a review
Management of Osteoarthritis with Traditional Acupuncture
Overview of Osteo-Arthritis
Osteoarthritis (OA) is a progressive degenerative joint disease that is characterised by the gradual loss of cartilage and subsequent loss of joint movement and pain. It is a leading cause of disability among adults and is associated with major impacts on physical function and mobility. Diagnosis is based on radiological changes and the clinical presentation of joint pain; including tenderness, limitation of movement, crepitus (crunching sounds), and variable degrees of localized inflammation. The prevalence, disability, and associated costs of treating osteoarthritis are expected to steadily increase due to our aging population. It is estimated that approximately 10% of men and 18% of women aged 60 years or older have symptomatic osteoarthritis worldwide. As there is currently no known cure for osteo-arthritis treatment focuses on management of symptoms. It is common practice to prescribe non-steroidal anti-inflammatory medication, paracetamol or in severe cases opioid drugs for pain management. These strategies come with potential side effects so alternate strategies may be desired by patients suffering from the condition.
Research
Included is a summary of a meta-analysis of the studies that have been undertaken on the use of acupuncture in the treatment of osteoarthritis. Additionally an individual study performed in the UK notes the response and cost effectiveness of acupuncture. Also of interest is the inclusion of electro acupuncture for patients who are poor responders to traditional acupuncture and suggestions for treatment frequency and duration.
The systemic review and meta-analysis is titled “Pain management with acupuncture in osteo- arthritis” by Manyanga et al. The stated objective of the review was to identify and synthesize data from previous randomized controlled trials comparing acupuncture to sham acupuncture, usual care, or no treatment, in adults diagnosed with osteoarthritis. Usual care refers to conservative therapy, pharmacological treatments, and rehabilitative exercises. In most trials acupuncturists employed traditional hand stimulation of the acupuncture points. The most commonly used acupuncture points were ST34, ST36, Xiyan, GB34 and SP9. These are considered local points and belong to the traditional channel network of Chinese Medicine. Please see our previous articles on Sports Medicine Acupuncture to understand the importance of local, adjacent and distal acupuncture in traditional protocols.
The analysis includes 12 trials and a total of 1763 participants. Duration of interventions ranged from two to twelve weeks, with total follow-up durations ranging from four to 52 weeks. Through the review the researchers found acupuncture administered to adults with osteoarthritis to be associated with a statistically significant reduction in pain intensity, improved functional mobility and improved health-related quality of life. Reductions in pain were greater in trials with longer intervention periods. Major adverse events with acupuncture were not reported. The researchers suggest that acupuncture is most effective for reducing osteoarthritic pain when administered for more than four weeks. The researchers also postulate that due to the chronic inflammatory nature of OA it may be necessary for a “threshold dose” to obtain benefits and as such recommend 10 treatments on average with the aim of reversing the pathological changes that may have occurred in the central nervous system in regards to pain modulation.[i]
The second study noted above reports on a nurse led acupuncture study with the aim of postponing or avoiding knee surgery for patients with OA of the knee. 90 patients agreed to participate and after 1 month the trial achieved clinically significant improvements in pain, stiffness and function which continued for up to 2 years for over a third of patients. Acupuncture was given at weekly intervals for 1 month, then reduced progressively to 6 weekly which mirrors common clinical practice. Patients who did not respond to manual acupuncture are given electroacupuncture and treatment was discontinued at 6 weeks if there is still no response. The researchers concluded that the use of acupuncture was associated with significant reductions in pain intensity and an improvement in functional mobility and quality of life. [ii]
Treatment recommendations
As noted in the above studies acupuncture treatment of OA is best performed weekly for 4-6 weeks and then gradually spread out to a maintenance dose as pain and stiffness decreases. Maintenance schedule depends on a patients response to treatment which will be determined by the underlying level of degeneration, their tendencies towards inflammation and the amount of activity required in their day to day lives.
[i] Pain management with acupuncture in osteoarthritis: a systematic review and meta-analysis
Manyanga et al. BMC Complement Altern Med. 2014; 14: 312.
[ii] Group acupuncture for knee pain: evaluation of a cost-saving initiative in the health service, White et al, Acupunct Med. 2012 Sep; 30(3): 170–175.