Acupuncture may not be effective for knee pain: study

By Kathryn Doyle NEW YORK (Reuters Health) - Acupuncture won't improve chronic knee pain in middle-aged people, researchers say. In their study, real acupuncture using needles and lasers was no more helpful than sham acupuncture for chronic knee pain among people 50 years old and older. “It is surprising that our study showed acupuncture was not effective compared to sham acupuncture, because many people with chronic knee pain report that treatment with acupuncture is beneficial for their symptoms,” said Rana S. Hinman, the study’s lead author from the University of Melbourne, Australia. Previous research showed acupuncture to be effective, although the benefits compared to mock acupuncture have been generally small and of questionable benefit, she told Reuters Health by email. The researchers write in JAMA - the Journal of the American Medical Association - that many people over age 50 are plagued with chronic knee pain. Many of them turn to alternative treatments, such as acupuncture. Acupuncturists may use a combination of traditional Chinese and Western techniques with needles or low-intensity lasers. However, the effectiveness of laser acupuncture had been uncertain, the researchers write. To test whether needle or laser acupuncture is superior to no acupuncture or sham acupuncture, the researchers divided 282 patients over age 50 with chronic knee pain and morning stiffness into four groups. The type of knee pain in the study is common with osteoarthritis, which is the result of normal joint wear and tear over the years. One group didn’t receive acupuncture. Another group received needle acupuncture, another laser acupuncture and the last group received sham laser acupuncture. All of the treatments were delivered by family physicians who were trained in acupuncture. Patients received eight to 12 treatments over three months. Each treatment session lasted about 20 minutes. The laser and sham laser treatments looked the same to both patients and acupuncturists, but the laser was not turned on for the sham group. The patients rated their average knee pain and physical function on questionnaires at the beginning of the study, after three months of treatment and again at one year. There were "modest improvements" in pain at three months in the needle and laser acupuncture groups compared to the no-treatment group, but not compared to the sham group. And there were no differences between any of the groups on measures of knee pain and function after one year. This suggests that there were no “real” or “direct” effects of needle or laser acupuncture, Hinman said. The improvements patients felt were likely due to the placebo effect. “Acupuncture tends to be more effective for people who believe in the benefits of acupuncture,” she said. “In our study, people did not know that were signing up for an acupuncture study, so our participants were less likely to be ‘believers’ in acupuncture, which probably explains why acupuncture was ineffective in our study.” The new results are very similar to those of a review of individual patient data in 2012, said Andrew Vickers. Vickers, who led the previous review, is an attending research methodologist at Memorial Sloan Kettering Cancer Center in New York City and was not involved in the new study. The new review may have found a benefit from real acupuncture compared to sham acupuncture if the study included more people, he told Reuters Health by email. “About three million Americans try acupuncture per year, and chronic pain is the most common indication,” he said. People with chronic pain should see a pain specialist, as there are many options for treatment, including acupuncture, he said. “As the authors suggest, the findings of this study are applicable to patients with moderate to severe persistent knee pain, and acupuncture may be effective in some people with neuropathic (nerve related) pain,” said Dr. A. Abhishek, an arthritis researcher and associate professor at the University of Nottingham in the UK. The UK’s National Institute for Clinical Excellence and Health does not recommend acupuncture for treating knee osteoarthritis, but does recommend it for persistent low back pain as it can be effective in that scenario, Abhishek, who was not part of the new study, told Reuters Health by email. As alternatives to acupuncture, Hinman said physical therapy, knee braces and exercise can all help alleviate chronic knee pain. SOURCE: http://bit.ly/WddS8K JAMA, online September 30, 2014.