Acupuncture for knee arthritis fails one test but may still be worth a try

Daniel Pendick
Daniel Pendick, Former Executive Editor, Harvard Men's Health Watch

Acupuncture is a popular form of complementary and alternative therapy, but it has yet to win universal endorsement in the medical community—and usually isn’t covered by health insurance. Many satisfied customers continue to pay for treatment out of pocket in spite of mixed findings on the effectiveness of this ancient healing art.

A report published this week in the Journal of the American Medical Association (JAMA) offers weak-to-no proof that acupuncture helps ease the pain of knee arthritis. On the other hand, it’s just one moderately sized study in a long and continuing series, and there’s still credible evidence to suggest that acupuncture helps some people with common pain conditions.

“I would be careful saying acupuncture doesn’t work for all pain conditions and no one should do it; we simply do not know enough yet,” says Peter Wayne, PhD, research director of the Osher Center for Integrative Medicine at Harvard-affiliated Brigham and Women’s Hospital.

Testing acupuncture

In the JAMA study, Australian researchers recruited 282 people over age 50 with moderate to severe knee pain from osteoarthritis. They were assigned at random to one of four options:

  • no treatment
  • traditional needle acupuncture
  • laser acupuncture, which uses laser beams to stimulate acupuncture points on the body
  • sham laser acupuncture, which looks like the real thing to study participants but doesn’t deliver any laser light

Including the sham treatment was important. When comparing acupuncture to no treatment at all, part of the pain relief is attributable to the placebo effect. That’s when people report feeling better after undergoing a treatment that they expect to work. Comparing real to “fake” acupuncture could reveal the effect of the treatment itself, minus the placebo effect.

In reality, though, it’s more complicated than that. Just talking to and touching an acupuncture client during the treatment can exert a subtle healing power.

Weak results

As in previous studies, people who had needle or laser acupuncture reported less pain and better physical function compared with the group that had no treatment at all. Keep in mind that the differences were quite small—like a 1-point reduction in pain on a scale of 0 to 10. That’s unlikely to impress someone with significant arthritis pain.

As for the sham acupuncture, the benefit disappeared when researchers compared the real and simulated treatment groups. Does it mean the effect of acupuncture was all placebo in this study—essentially, all in the participants’ heads?

Not necessarily. The study had only 70 people in each of the four groups. That would make it difficult to pick up differences in the effect of real and fake acupuncture. Wayne, a board member of the Society for Acupuncture Research, believes the totality of the evidence suggests acupuncture does actually relieve pain for many conditions—although exactly how remains a mystery.

“This is a small study that replicates what we already know,” Wayne says. “When you compare acupuncture to no treatment, there seems to be clinically meaningful differences for many pain conditions, including back pain and knee pain. Based on this pragmatic comparison, if I were deciding whether to send a family member or friend for a pain-related acupuncture treatment, I would say ‘yes’.”

Give it a try?

It’s common for people to use acupuncture to enhance their existing treatment with pain relievers and physical therapy—not to replace it. “Most of the studies have treated people once or twice a week for a couple of weeks, and then continued with monthly maintenance after that,” Wayne says. If after a few months you see no change, consider stopping.

One caveat is that there are multiple forms of acupuncture, such as needles that deliver a weak electrical stimulation. Also, acupuncture styles vary quite a bit from one practitioner to the next. That means if acupuncture doesn’t help, you can’t always be sure if the treatment didn’t work for you, or the acupuncturist.

The typical cost of acupuncture in the United States ranges from $65 to $125 per session. Private insurers usually don’t pay for it, nor do Medicare or Medicaid. A handful of plans may reimburse for physician-acupuncturists.

Harms from acupuncture are rare. Make sure you find a skilled practitioner who follows best practices for sterilizing needles and hand washing.

Ask your doctor to recommend a trusted provider. You can search for a trained acupuncturist in your area on the website of the National Certification Commission for Acupuncture and Oriental Medicine (www.nccaom.org) or call the organization at 904-598-1005.

Comments:

  1. Tammy

    I have had acupuncture on several occasions for my neck and shoulder. It has been extremely effective in helping not only the pain but the range of motion. It has had a last effect and has allowed me to keep running my business.

  2. Kino

    As arthritis is an autoimmune disease, we need to look at the cause of the immune reaction that is the underlying issue of this inflammation. Just ‘treating’ with whatever method is not sufficient. Foods Cause Arthritis! 
    The body can be allergic to any food; therefore any food allergy is capable of causing inflammation and arthritis. This includes RA, juvenile arthritis, and undefined joint pains. This is why it can be so difficult for one to recognize the relationship between their diet and their symptoms.
    Let’s use a dairy allergy as an example. If you eat any form of dairy, be it milk, butter, cheese, yogurt, or even dairy in the form of casein or whey in another food product, such as bread or milk chocolate, then you can potentially trigger the symptoms of your food allergy, in this case arthritis. You should also know that allergy symptoms may show up hours or even a day later, well after a food is absorbed into your system. 

    “In reality, cow’s milk, especially processed cow’s milk, has been linked to a variety of health problems, including: mucous production, hemoglobin loss, childhood diabetes, heart disease, atherosclerosis, arthritis, kidney stones, mood swings, depression, irritability,
    ALLERGIES.”
    Townsend Medical Letter, May, 1995, Julie Klotter, MD

    The only way to overcome this allergic reaction is by avoidance of the allergen.

  3. Quick Care Walk-In Medical Clinic

    Although acupuncture is indeed not endorsed by the medical community, some of our patients do report successful treatments. Thank you for an informative article.

    • Kino

      This is silly! many doctors ‘work’ with Acupuncture, Kinesiology, Chiropractic and more. Many in the medical profession are disillusioned by the ‘a pill for every ill and hide the symptoms’ attitude to disease which the AMA forces them to work with.
      In an editorial in the highly esteemed ‘British Medical Journal’, titled ‘Where is the Wisdom? The Poverty of Medical Evidence, BMJ’s editor Dr. Richard Smith recounts a lecture he attended with renowned health policy consultant Dr. David Eddy.

      Eddy found, after doing significant research, that only about 13% of medical interventions are supported by solid scientific evidence and that only 1% of the articles in medical journals are scientifically sound.

      Why is that? Because most of those articles quote from other articles which make unsupported and unfounded claims.

      The High Risks of the Medical Approach

      Dr. Lucian Leape, researcher at the Harvard Medical School of Public Health, also states that only 13% of medical procedures have ever been tested for appropriateness by randomized trials.
      He noted that adverse events occurred in 3.7 percent of all hospitalizations. Worse yet, 13.6 percent of those adverse events led to death!
      He is quoted as saying, “Medicine is now a high risk industry, like aviation.
      But, the chance of dying in an aviation accident is one in 2 million, while the risk of dying from a medical accident is one in 200!”
      I think I’ll take acupuncture anytime!

  4. WhatsUp Markets

    Although, so far acupuncture is not a medically proven method there are plenty of examples of being healed by acupuncture even from knee pain.

  5. Cricket(http://mazahub.com)

    But i will also love for this checkup

  6. Cricket

    This is really very painful

  7. Jesscia Alderson

    Acupuncture is best alternative treatment for low back pain. All expert’s physiotherapists always suggest for it. One of my friends also had the knee arthritis problem, and she is taking acupuncture treatment from Hcr solution Edmonton, and now she is getting free from her back pain. This is really informative article.

  8. stronglymen

    This indicates that there is always an alternative treatment for our health, even that is the most ancient way.

  9. Progressive Dental

    I have always encouraged my patients to seek alternative treatment such as acupuncture.

  10. recipepaleo

    Acupuncture is one of the alternative treatments for The Knee Arthritis Fails. The surplus is acupuncture does not have side effects so it is safe for the patient.
    The article is very helpful, Good !!

  11. Los Angeles Hospice Care

    Good blog, Harvard always has good and interesting articles

  12. Hardwood Flooring

    Great blog post.

  13. Hardwood Flooring

    Very informative blog post. I was very impressed by the information as it was very understandable.

  14. Jeremy Rothenberg, LAc.

    I’m a licensed acupuncturist in California. I work with pain conditions of all kinds, including knee pain. Acupuncture can be very effective, depending on the reason for the pain. I appreciate the author providing the results of this study without dismissing acupuncture out of hand. Most of the other headlines in the news just say it’s not effective for knee pain. This, of course, is silly (as I see its effectiveness every day)… but the public will pay attention to these headlines.

    As another commenter said, acupuncture is difficult to study from an allopathic model. It’s a holistic medicine – meaning that there can be many reasons for a symptom like knee pain – that would require different treatments. There is no one, two, or three protocols for knee pain with acupuncture. It can vary widely from person to person.

    All that being said, thank you for saying it’s worth a try. Many, many of those who try it find it to be surprisingly effective.

    And finally, here in California, many insurance plans cover acupuncture. It has even been included in the Affordable Care Act as an Essential Health Benefit.

    For those who say it’s unproven, there are untold legions of people who have proven acupuncture to be effective… all over the world. That’s why we’re in business. There is a demand for gentle, effective, and non-toxic treatments that support the healthy functioning of human bodies.

    Science, medical doctors, and insurance companies will catch up eventually.

    • Daniel Pendick

      Jeremy,

      Thanks for your thoughtful perspective–and for the update on insurance coverage in CA. I didn’t know that.

      “For those who say it’s unproven, there are untold legions of people who have proven acupuncture to be effective… all over the world. That’s why we’re in business.”

      I think that, respectfully, evidence-based medicine is about higher standards of evidence than anecdote. It is often said that the plural of “anecdote” isn’t “proof” or “data.”

      Many treatments are popular for which there is little definitive evidence. But “not definitive” does not necessarily mean “not effective.” Fortunately, acupuncture presents minimal risk. For other, potentially risky and unproven therapies, many doctors feel the bar needs to be set higher.

      DP

  15. Karen Stopford

    As an acupuncturist with a Master’s degree plus, I find it frustrating to say the least when I encounter such studies blasted all over the media but no recourse (without ponying up the big bucks for a subscription to JAMA) to critique the design or execution of the study. Acupuncture has been around for thousands of years and while it doesn’t work for all conditions or all people, it can produce amazing results without the need for surgery or pharmaceuticals. A licensed, fully trained acupuncturist does not see all knee pain as the same thing, and treatment will vary based on the patient’s presentation, location and quality of the pain, and so forth. The “family physician acupuncturists” in this study may not even be adequately trained, and they certainly did not follow a treatment strategy linked to a Chinese medicine diagnosis. But now that it’s all over the media, people are likely to draw conclusions without once questioning the methodology or quality of treatment. Why? Because JAMA published it, that’s why.

  16. Kathryn

    I have had 5 successful acupuncture treatments for low back pain. These were at different times. Each time, I had instant pain relief that lasted for 4 to 5 months each time. I am a believer for the treatment of low back pain. Three treatments were with 3 different accupuncturists.

    I have had 3 treatments for knee pain and had no pain relief. Still searching.

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  20. Porcupine

    I follow this blog because I trust Harvard university as a reliable source of medical information.

    This entry surprises me because forgets to say that other well designed studies conclude that acupuncture is no better than placebo. Also, half of the entry comes from an interested part that defends expensive placebo (“When you compare acupuncture to no treatment, there seems to be clinically meaningful differences for many pain conditions”. Sham acupuncture does the same.)

    Really, I can’t see why this blog supports such unproven therapy.

  21. Pankaj Bhatt

    Well to be true i have been through acupuncture all because of the head injury because of an accident which i unfortunately met while driving bike, i have received the around 80 sessions of acupuncture within 80 days of rest but it really didn’t helped me out recover the way doctor claimed…why??

  22. John

    Somehow its been around for centuries in Eastern Civilization??? It’s because the medical community cannot profit from it; therefore, it is looked as taboo. I’d take my chances with this rather than modern medicine any day of week!!