Acupuncture treatment for chronic knee pain: a systematic review

Abstract

Acupuncture that meets criteria for adequate treatment is significantly superior to sham acupuncture and to no additional intervention in improving pain and function in patients with chronic knee pain. Due to the heterogeneity in the results, however, further research is required to confirm these findings and provide more information on long-term effects.

Meta-analysis: Acupuncture for Osteoarthritis of the Knee

“…Our findings that the pooled effects of acupuncture are statistically significantly superior to those of sham treatments agree with the findings of another recent meta-analysis (24). This is encouraging, considering that the 2 metaanalyses used different definitions of short-term and longterm time points and different data for calculating effect sizes (for example, we obtained unadjusted data directly from RCT investigators, where possible, rather than extracting data from publications).…”

“…Although these sham controls were designed to be inert by involving needles placed superficially and away from acupuncture points, in reality, the avoidance of all 400 estimated acupuncture points in the body (59) may be impossible. In fact, the shams used in these 2 RCTs (45, 47) were judged to be probably physiologically active and inappropriate as controls in another recent systematic review (24). Weak physiologic activity of superficial or sham needle penetration is suggested by several lines of research (53), including RCTs showing larger effects of a superficial needlepenetrating acupuncture than those of a nonpenetrating sham control (44,60), positron emission tomography research indicating that sham acupuncture can stimulate regions of the brain associated with natural opiate production (61), and animal studies showing that sham needle insertion can have nonspecific analgesic effects through a postulated mechanism of "diffuse noxious inhibitory control" (62).…”

“…This is encouraging, considering that the 2 metaanalyses used different definitions of short-term and longterm time points and different data for calculating effect sizes (for example, we obtained unadjusted data directly from RCT investigators, where possible, rather than extracting data from publications). Also, the earlier review (24) did not include the large, very recently published pragmatic trial (48) that we included, but did include 3 small, positive RCTs (66 -68) that we excluded because of short duration. In the earlier review (24), sensitivity analyses were conducted by using overall quality scores, and these analyses were largely uninformative.…”

“…Also, the earlier review (24) did not include the large, very recently published pragmatic trial (48) that we included, but did include 3 small, positive RCTs (66 -68) that we excluded because of short duration. In the earlier review (24), sensitivity analyses were conducted by using overall quality scores, and these analyses were largely uninformative. Because using overall quality scores can be problematic (69,70), we used each individual item related to risk for bias for sensitivity analyses in our review.…”

“…considered older RCTs that were included in previous reviews of acupuncture for osteoarthritis (21)(22)(23)(24) for inclusion.…”