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
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.
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.
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.
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.
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.
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.
for Osteoarthritis of the Knee; Eric Manheimer et al; Annals of Internal Medicine