Acupuncture Relieves Pain and Improves Function in Knee Osteoarthritis
Acupuncture provides pain relief and improves function for people
with osteoarthritis of the knee and serves as an effective complement
to standard care. This landmark study was funded by the National
Center for Complementary and Alternative Medicine (NCCAM) and
National Institute of Arthritis and Musculoskeletal and Skin Diseases
(NIAMS), both components of the National Institutes of Health.
findings of the study the longest and largest randomized,
controlled phase III clinical trial of acupuncture ever conducted
were published in the December 21, 2004, issue of the Annals
of Internal Medicine *.
The multi-site study team, including rheumatologists and licensed
acupuncturists, enrolled 570 patients, aged 50 or older with osteoarthritis
of the knee. Participants had significant pain in their knee the
month before joining the study, but had never experienced acupuncture,
had not had knee surgery in the previous 6 months, and had not used
steroid or similar injections. Participants were randomly assigned
to receive one of three treatments: acupuncture, sham acupuncture,
or participation in a control group that followed the Arthritis
Foundation's self-help course for managing their condition. Patients
continued to receive standard medical care from their primary physicians,
including anti-inflammatory medications, such as COX-2 selective
inhibitors, non-steroidal anti-inflammatory drugs, and opioid pain
"For the first time, a clinical trial with sufficient rigor,
size, and duration has shown that acupuncture reduces the pain and
functional impairment of osteoarthritis of the knee," said
Stephen E. Straus, M.D., NCCAM Director. "These results also
indicate that acupuncture can serve as an effective addition to
a standard regimen of care and improve quality of life for knee
osteoarthritis sufferers. NCCAM has been building a portfolio of
basic and clinical research that is now revealing the power and
promise of applying stringent research methods to ancient practices
"More than 20 million Americans have osteoarthritis. This
disease is one of the most frequent causes of physical disability
among adults," said Stephen I. Katz, M.D., Ph.D., NIAMS Director.
"Thus, seeking an effective means of decreasing osteoarthritis
pain and increasing function is of critical importance."
During the course of the study, led by Brian M. Berman, M.D., Director
of the Center for Integrative Medicine and Professor of Family Medicine
at the University of Maryland School of Medicine, Baltimore, Maryland,
190 patients received true acupuncture and 191 patients received
sham acupuncture for 24 treatment sessions over 26 weeks. Sham acupuncture
is a procedure designed to prevent patients from being able to detect
if needles are actually inserted at treatment points. In both the
sham and true acupuncture procedures, a screen prevented patients
from seeing the knee treatment area and learning which treatment
they received. In the education control group, 189 participants
attended six, 2-hour group sessions over 12 weeks based on the Arthritis
Foundation's Arthritis Self-Help Course a proven, effective model.
On joining the study, patients' pain and knee function were assessed
using standard arthritis research survey instruments and measurement
tools, such as the Western Ontario McMasters Osteoarthritis Index
(WOMAC). Patients' progress was assessed at 4, 8, 14, and 26 weeks.
By week 8, participants receiving acupuncture were showing a significant
increase in function and by week 14 a significant decrease in pain,
compared with the sham and control groups. These results, shown
by declining scores on the WOMAC index, held through week 26. Overall,
those who received acupuncture had a 40 percent decrease in pain
and a nearly 40 percent improvement in function compared to baseline
"This trial, which builds upon our previous NCCAM-funded research,
establishes that acupuncture is an effective complement to conventional
arthritis treatment and can be successfully employed as part of
a multidisciplinary approach to treating the symptoms of osteoarthritis,"
said Dr. Berman.
Acupuncture the practice of inserting thin needles into
specific body points to improve health and well-being originated
in China more than 2,000 years ago. In 2002, acupuncture was
by an estimated 2.1 million U.S. adults, according to the Centers
for Disease Control and Prevention's 2002 National Health Interview
Survey **. The acupuncture technique that
has been most studied scientifically involves penetrating the
with thin, solid, metallic needles that are manipulated by the
hands or by electrical stimulation. In recent years, scientific
has begun to shed more light on acupuncture's possible mechanisms
and potential benefits, especially in treating painful conditions
such as arthritis.
The National Center for Complementary and Alternative Medicine
(NCCAM) is dedicated to exploring complementary and alternative
medical (CAM) practices in the context of rigorous science, training
CAM researchers, and disseminating authoritative information to
the public and professionals. For additional information, call NCCAM's
Clearinghouse toll free at 1-888-644-6226, or visit the NCCAM Web
site at nccam.nih.gov.
The mission of the National Institute of Arthritis and Musculoskeletal
and Skin Diseases (NIAMS) is to support research into the causes,
treatment, and prevention of arthritis and musculoskeletal and skin
diseases, the training of basic and clinical scientists to carry
out this research, and the dissemination of information on research
progress in these diseases. For additional information, call NIAMS's
Clearinghouse toll free at 1-877-22-NIAMS, or visit the NIAMS Web
site at www.niams.nih.gov.
For credentialed media: B-roll of acupuncture of the knee will
be available through NCCAM. To request B-roll, call NCCAM's press
office at 301-496-7790. A video news release (VNR) will also be available
from the American College of Physicians, publishers of Annals of Internal
Medicine. For VNR information, please contact Leigh Fazzina at 1-800-523-1546,
ext. 2514. Interviews with the principal investigator, Dr. Brian Berman,
may be arranged through Sharon Boston of the University of Maryland
School of Medicine public affairs office at 410-328-8919. The Web
site for the Center for Integrative Medicine at the University of
Maryland School of Medicine is www.compmed.umm.edu.
* Berman BM, Lao L, Langenberg P, Lee WL,
Gilpin AMK, Hochberg MC. Effectiveness of Acupuncture as Adjunctive
Therapy in Osteoarthritis of the Knee: A Randomized, Controlled Trial.
Annals of Internal Medicine. 2004; 141(12):901-910.
** Barnes P, Powell-Griner E, McFann K,
Nahin R. CDC Advance Data Report #343. Complementary and
Alternative Medicine Use Among Adults: United States, 2002. May