Efficacy of Intensive Acupuncture Versus Sham Acupuncture in Knee Osteoarthritis: a Randomized Controlled Trial

This is a review of a randomized controlled trial that evaluated the efficacy of acupuncture for patients with knee osteoarthritis (OA) conducted in China.

By Hitomi Asano L.Ac.

OA is one of the most common joint diseases and the leading cause of chronic pain and disability in the United States. Knee OA accounts for more than 80% of the disease’s total burden. The prevalence of knee OA has doubled in prevalence since the mid-20th century.

The study recruited 480 participants between the age of 45-75 years with knee pain for longer than 6 months, with radiologic confirmation of OA, and pain score of >4 (NRS). Eligible participants were randomized into 3 groups: electroacupuncture (EA), manual acupuncture (MA), and sham acupuncture (SA) group.

Each participant received a 30-minute acupuncture treatment delivered three times weekly for 8 weeks (total of 24 treatments). Both knees were needled for patients with bilateral knee OA, whereas only the affected knee was needled for those with unilateral OA symptoms. The acupuncture point prescription consisted of five obligatory points and three adjunct acupoints were used in both EA and MA groups. Obligatory points were ST35 dubi, EX-LE5 neixiyan, LR8 ququan, GB33 xiyangguan, and an ashi point (point where the participant felt the most pain). Adjunct points were selected from the acupoint pool provided in the supplementary table. The SA group received acupuncture at non-acupuncture points provided in the supplementary table.

Electrodes were attached from ST35 dubi to EX-LE5 neixiyan and LR8 ququan to GB33 xiyangguan for both EA and MA groups or at 4 non-acupoints in SA group. The EA group had 2/100 HZ electric current applied until the needles began to vibrate whereas MA and SA group did not have any electrical current applied.

The participants completed questionnaires at baseline and at weeks 4,8,16, and 26. The primary outcome measure was the response rate at week 8. Response rate is defined as the proportion of participants who simultaneously achieved minimal clinically important improvement (MCII) of 2 points on the Numerical Rating Scale (NRS) and 6 points on the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) function subscale.

The response rates at week 8 were 60.3% in the EA group, 58.6% in the MA group, and 47.3% in SA group. The between-group difference between EA and SA group was 13.0% and MA and SA group was 11.3%. The response rate for EA and MA groups were significantly higher than the SA group at weeks 16 and 26.

Both EA and MA significantly decreased NRS and WOMAC pain scores than SA during the 26-week period. In addition, EA significantly decreased WOMAC function and WOMAC stiffness scores than SA during the 26-week period. However, there were no significant differences in the WOMAC function and WOMAC stiffness scores between MA and SA.

In conclusion, participants with knee OA who received EA had higher response rates than SA and experienced significant reduction in pain and improvement in function that was sustained through the 26-week period.

Tu, Jian‐Feng, et al. “Efficacy of Intensive Acupuncture Versus Sham Acupuncture in Knee Osteoarthritis: A Randomized Controlled Trial.” Arthritis & Rheumatology, vol. 73, no. 3, 2021, pp. 448–458., doi:10.1002/art.41584.

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