Acupuncture Treats Osteoarthritis of the Knee
Osteoarthritis is the commonest joint disorder that arises due to wear and tear of a joint. This leading cause of disability is mainly related to aging. The most commonly affected joint is the knee. Nonsteroidal anti-inflammatory drugs (NSAIDs) and paracetamol are used worldwide for pain relief. Paracetamol may be the safer drug as it does not cause gastric damage like NSAIDs. However, it is modestly less effective and its clinical significance is often questioned.
A recent review found that the effects of NSAIDs are probably too small to be meaningful to patients. They were found to be only slightly better than placebo in providing short-term pain relief. NSAIDs cause significant damage to the linings of the stomach leading to gastritis. Gastrointestinal bleeding appears to be the most clinically substantial effect raising concerns about the prescription of NSAIDs for older patients.
Owing to the adverse effects of over-the-counter pain killers, nonpharmacological treatment is eagerly sort after despite lack of conclusive evidence. Exercise and weight loss, though effective are not applicable to all. Some patients with osteoarthritis find it difficult to exercise and lose weight.
Acupuncture originated in China more than 2000 years ago and has been vogue ever since. Thin needles are inserted into specific body parts and manipulated. Acupuncture is claimed to correct imbalances in the flow of an energy-like entity called qi.
Several large scale studies suggested that acupuncture would be effective in treating older patients with osteoarthritis of the knee. The exact underlying mechanism remains in the shadow. Whether acupuncture is nothing but placebo or if it is a biological agent is yet to be known. A recent study compared trials that weighed needle acupuncture against a sham, usual care, or waiting list control group for patients with knee osteoarthritis.
The usual care control group of subjects included those who received some additional standard care therapy that was not provided to the acupuncture group. Waiting list group included subjects who awaited acupuncture, and did not receive any care during this waiting period. The sham group included patients who received sham interventions that were designed to mimic the feel of getting the actual treatment. For example, sham treatment involves using nonpenetrating needles or patch electrodes. A patient receiving sham treatment does not actually know that it is so. Sham treatments are designed to be as credible as actual acupuncture.
The study found out that the effects of acupuncture were clinically relevant when compared with the waiting list and usual care controls. This points out at the placebo effects of acupuncture that may be superior to that of usual care therapies. Certain findings however make the picture confusing. Acupuncture did produce small short-term improvements in pain and function compared with sham, indicating genuine biological effect.
It is too early to advise acupuncture as a part of routine care for patients with osteoarthritis. It is however worth a try, since the studies did not find any adverse events associated with acupuncture. Acupuncture would be a safe bet for older people with osteoarthritis rather than subjecting them to the side effects of pain-killer abuse.
Reference: Acupuncture for Osteoarthritis of the Knee; Eric Manheimer et al; Annals of Internal Medicine