Acupuncture improves functioning and provides short-term relief of knee pain due to osteoarthritis

This Evidence Summary is based on the following systematic review:

Lin X, Huang K, Zhu G, et al. The Effects of Acupuncture on Chronic Knee Pain Due to Osteoarthritis: A Meta-Analysis. J Bone Joint Surg Am. 2016 Sep 21;98(18):1578-85. doi: 10.2106/JBJS.15.00620. PubMed

Review questions

In people who have long-term knee pain due to osteoarthritis, does acupuncture improve pain and functioning?

Background

Chronic knee pain is common in older people and can interfere with daily activities. Osteoarthritis is one of the most common causes of knee pain and disability.

Acupuncture is a component of traditional Chinese medicine that involves the insertion of very thin needles through the skin at specific places to help manage pain.

How the review was done

The researchers did a systematic review, searching for studies available until March 2015.

They found 10 randomized controlled trials with 2,007 people (average age 60 to 71 years).

People had knee osteoarthritis and experienced knee pain most days for more than 3 months.
Acupuncture or direct electrical stimulation of the knee was given over 6 to 23 sessions.
Acupuncture was compared with usual care, no treatment, or sham/pretend acupuncture (control group).
The outcomes were measured using a scale that asks people to rate their level of pain (e.g., with activities like walking or using the stairs) and their physical functioning (e.g., ability to rise from a chair, get in and out of the bath). The change in their scores after 3 to 26 weeks of treatment or control was compared.

What the researchers found

Compared with usual care, no treatment, or sham acupuncture, acupuncture:

reduced short-term pain (up to 13 weeks) but not long-term pain (up to 26 weeks); and
improved short-term (up to 13 weeks) and long-term (up to 26 weeks) physical functioning.

However, there were important differences in how acupuncture was performed across the studies.

Conclusions

In people who have long-term knee pain due to osteoarthritis, acupuncture improves short-term and long-term functioning but only short-term pain.

Effects of acupuncture vs control in people with knee osteoarthritis and long-term knee pain

Outcomes	Follow-up	Number of trials	Effect of acupuncture compared with control
Pain	Short term (up to 13 weeks)	10 trials	1.2-point improvement on a 20-point score (but could be as few as 0.6 points or as many as 2 points)
	Long term (up to 26 weeks)	4 trials	No difference
Physical function	Short term (up to 13 weeks)	9 trials	4.6-point improvement on a 68-point score (but could be as few as 2 points or as many as 7 points)
	Long term (up to 26 weeks)	4 trials	2.7-point improvement on a 68-point score (but could be as few as 0.5 points or as many as 5 points)

This Evidence Summary was originally prepared for the McMaster Optimal Aging Portal.

Published: Friday, July 28, 2017