Neither traditional nor laser acupuncture is more effective than sham acupuncture at lessening pain or improving function in patients older than 50 years who have moderate to severe chronic knee pain, according to a report published online September 30 in JAMA.
In a randomized, partially blinded clinical trial, 282 participants aged 50 and older were randomly assigned to receive traditional needle acupuncture (70 patients), laser acupuncture (71 patients), sham laser acupuncture (70 patients), or no acupuncture (71 control subjects) in 20-minute sessions delivered once or twice weekly for 12 weeks.
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Acupuncture-based treatment did not appear to decrease knee pain or improve functional outcomes in patients over 50.
At baseline, all the participants reported having moderate to severe knee pain and morning stiffness lasting less than 30 minutes on most days. They completed detailed questionnaires at baseline, 12 weeks, and 1 year measuring pain on walking or standing, physical function, activity restriction, health-related quality of life, and global change in knee pain and function over time, said Rana S. Hinman, Ph.D., of the Centre for Health, Exercise, and Sports Medicine, University of Melbourne, and her associates.
At 12 weeks and at 1 year, there were no significant differences in any of these outcomes between active acupuncture and sham acupuncture. Both needle and laser acupuncture improved pain at 12 weeks when compared with the control group, but this improvement was “of a clinically unimportant magnitude” and did not persist, the investigators said (JAMA 2014 September 30 [doi:10.1001/jama.2014.12660]).
Clinical guidelines vary with regard to acupuncture for knee osteoarthritis. The American College of Rheumatology “conditionally recommends” the treatment in patients who are candidates for arthroplasty, the Osteoarthritis Research Society International is “uncertain” about its efficacy, the European League Against Rheumatism failed to reach consensus on the treatment and doesn’t address it in final recommendations, the American Academy of Orthopedic Surgeons “cannot recommend” it, and the National Institute for Health and Care Excellence’s guidelines recommend against it. “The findings from our trial support these latter recommendations,” Dr. Hinman and her associates said.