Article    Table of Contents                    Full Text of this article    PDF of this article (PDFs free after 6 months)    Summary for Patients    Summary for Patients (PDF)    Figures/Tables List    Related articles in Annals  Services    Send comment/rapid response letter    Published comments/rapid response letters    Notify a friend about this article    Alert me when this article is cited    Add to Personal Archive    Download to Citation Manager    ACP Search                            Get Permissions  Google Scholar    Search for Related Content  PubMed Articles in PubMed by Author:    Berman, B. M.    Hochberg, M. C.    Related Articles in PubMed    PubMed Citation    PubMed

ARTICLE

Effectiveness of Acupuncture as Adjunctive Therapy in Osteoarthritis of the Knee

A Randomized, Controlled Trial

Brian M. Berman, MD; Lixing Lao, PhD; Patricia Langenberg, PhD; Wen Lin Lee, PhD; Adele M.K. Gilpin, PhD; and Marc C. Hochberg, MD

21 December 2004 | Volume 141 Issue 12 | Pages 901-910

Background: Evidence on the efficacy of acupuncture for reducing the pain and dysfunction of osteoarthritis is equivocal.

Objective: To determine whether acupuncture provides greater pain relief and improved function compared with sham acupuncture or education in patients with osteoarthritis of the knee.

Design: Randomized, controlled trial.

Setting: Two outpatient clinics (an integrative medicine facility and a rheumatology facility) located in academic teaching hospitals and 1 clinical trials facility.

Patients: 570 patients with osteoarthritis of the knee (mean age [±SD], 65.5 ± 8.4 years).

Intervention: 23 true acupuncture sessions over 26 weeks. Controls received 6 two-hour sessions over 12 weeks or 23 sham acupuncture sessions over 26 weeks.

Measurements: Primary outcomes were changes in the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) pain and function scores at 8 and 26 weeks. Secondary outcomes were patient global assessment, 6-minute walk distance, and physical health scores of the 36-Item Short-Form Health Survey (SF-36).

Results: Participants in the true acupuncture group experienced greater improvement in WOMAC function scores than the sham acupuncture group at 8 weeks (mean difference, –2.9 [95% CI, –5.0 to –0.8]; P = 0.01) but not in WOMAC pain score (mean difference, –0.5 [CI, –1.2 to 0.2]; P = 0.18) or the patient global assessment (mean difference, 0.16 [CI, –0.02 to 0.34]; P > 0.2). At 26 weeks, the true acupuncture group experienced significantly greater improvement than the sham group in the WOMAC function score (mean difference, –2.5 [CI, –4.7 to –0.4]; P = 0.01), WOMAC pain score (mean difference, –0.87 [CI, –1.58 to –0.16];P = 0.003), and patient global assessment (mean difference, 0.26 [CI, 0.07 to 0.45]; P = 0.02).

Limitations: At 26 weeks, 43% of the participants in the education group and 25% in each of the true and sham acupuncture groups were not available for analysis.

Conclusions: Acupuncture seems to provide improvement in function and pain relief as an adjunctive therapy for osteoarthritis of the knee when compared with credible sham acupuncture and education control groups.

Editors' Notes Context Previous studies of acupuncture for osteoarthritis have had conflicting results. This may have occurred because most studies have included small samples, a limited number of treatment sessions, or other limitations. Contribution This randomized, controlled trial compared 24 acupuncture sessions over 26 weeks with sham acupuncture or arthritis education in 570 patients with osteoarthritis of the knee. Acupuncture led to greater improvements in function but not pain after 8 weeks and in both pain and function after 26 weeks. No adverse effects were associated with acupuncture. Cautions Many participants dropped out of the study, so readers should interpret the findings at 26 weeks with caution. –The Editors

 

Author and Article Information

From University of Maryland School of Medicine, Baltimore, Maryland.

Acknowledgments: The authors thank Mary Bahr, study coordinator; Jody Boone, arthritis educator; Marcos Hsu, ND, LAc, acupuncturist; Michelle Sittig and Deborah Taber, research assistants; Danuta Bujak, RN, CRNP, PhD, nurse practitioner; and Amy Martin Burns, administrative assistant, for their contributions.

Grant Support: By the National Center for Complementary and Alternative Medicine (National Institutes of Health Cooperative Agreement U01 AT-00171), with advice and encouragement by the National Institute of Arthritis and Musculoskeletal and Skin Diseases.

Potential Financial Conflicts of Interest: None disclosed.

Requests for Single Reprints: Brian Berman, MD, Center for Integrative Medicine, University of Maryland School of Medicine, 2200 Kernan Drive, Baltimore, MD 21207.

Current Author Addresses: Drs. Berman, Lao, Lee, and Gilpin: Center for Integrative Medicine, University of Maryland School of Medicine, 2200 Kernan Drive, Baltimore, MD 21207.

Dr. Langenberg: EPM Gender Based, 102 A, HH, University of Maryland School of Medicine, 660 West Redwood Street, Baltimore, MD 21201.

Dr. Hochberg: University of Maryland School of Medicine, 10 South Pine Street, MSTF 834, Baltimore, MD 21201.

Author Contributions: Conception and design: B. Berman, L. Lao, P. Langenberg, M.C. Hochberg.

Analysis and interpretation of the data: B. Berman, P. Langenberg, W.L. Lee, A.M.K. Gilpin, M.C. Hochberg.

Drafting of the article: B. Berman, L. Lao, P. Langenberg.

Critical revision of the article for important intellectual content: B. Berman, L. Lao, P. Langenberg, A.M.K. Gilpin, M.C. Hochberg.

Final approval of the article: B. Berman, L. Lao, P. Langenberg, W.L. Lee, A.M.K. Gilpin, M.C. Hochberg.

Statistical expertise: P. Langenberg.

Obtaining of funding: B. Berman, L. Lao.

Administrative, technical, or logistic support: L. Lao.

Collection and assembly of data: W.L. Lee.

Related articles in Annals:

Articles
Acupuncture versus Placebo for the Treatment of Chronic Mechanical Neck Pain: A Randomized, Controlled Trial
Peter White, George Lewith, Phil Prescott, AND Joy Conway

Annals 2004 141: 911-919. [ABSTRACT][SUMMARY][Full Text]  

Articles
A Clinical Prediction Rule To Identify Patients with Low Back Pain Most Likely To Benefit from Spinal Manipulation: A Validation Study
John D. Childs, Julie M. Fritz, Timothy W. Flynn, James J. Irrgang, Kevin K. Johnson, Guy R. Majkowski, AND Anthony Delitto

Annals 2004 141: 920-928. [ABSTRACT][SUMMARY][Full Text]  

Summaries for Patients
Acupuncture for Treating Knee Osteoarthritis

Annals 2004 141: I-20. [Full Text]  

Letters
Acupuncture and Knee Osteoarthritis
Richard H. Baker

Annals 2005 142: 871. [Full Text]  

Letters
Acupuncture and Knee Osteoarthritis
Dan C. Cherkin AND Karen J. Sherman

Annals 2005 142: 872. [Full Text]  

Letters
Acupuncture and Knee Osteoarthritis
Brian Berman, Adele M.K. Gilpin, AND Lixing Lao

Annals 2005 142: 872-873. [Full Text]  

Editorials
Mainstream and Alternative Medicine: Converging Paths Require Common Standards
Stuart Bondurant AND Harold C. Sox

Annals 2005 142: 149-150. [Full Text]  

Letters
Acupuncture and Knee Osteoarthritis
Michal R. Pijak

Annals 2007 146: 147. [Full Text]  

This article has been cited by other articles:

				C. Greco, A. Kao, K Maksimowicz-McKinnon, R. Glick, M Houze, S. Sereika, J Balk, and S Manzi Acupuncture for systemic lupus erythematosus: a pilot RCT feasibility and safety study Lupus, December 1, 2008; 17(12): 1108 - 1116. [Abstract] [PDF]

				A. Burke, T. Kuo, R. Harvey, and J. Wang An International Comparison of Attitudes Toward Traditional and Modern Medicine in a Chinese and an American Clinic Setting Evid. Based Complement. Altern. Med., October 7, 2008; (2008) nen065v1. [Abstract] [Full Text] [PDF]

				C. Zaslawski Ethical Considerations for Acupuncture and Chinese Herbal Medicine Clinical Trials: A Cross-cultural Perspective Evid. Based Complement. Altern. Med., August 21, 2008; (2008) nen055v1. [Abstract] [Full Text] [PDF]

				H. G. Endres, A. Molsberger, and M. Haake Acupuncture Ineffective, Attention Effective?--Reply Arch Intern Med, March 10, 2008; 168(5): 551 - 552. [Full Text] [PDF]

				C. Shang Prospective Tests on Biological Models of Acupuncture Evid. Based Complement. Altern. Med., November 21, 2007; (2007) nem122v1. [Abstract] [Full Text] [PDF]

				Acupuncture for osteoarthritis of the knee DTB, October 1, 2007; 45(10): 76 - 79. [Abstract] [Full Text] [PDF]

				B. Kavoussi and B. E. Ross The Neuroimmune Basis of Anti-inflammatory Acupuncture Integr Cancer Ther, September 1, 2007; 6(3): 251 - 257. [Abstract] [PDF]

				N. E Foster, E. Thomas, P. Barlas, J. C Hill, J. Young, E. Mason, and E. M Hay Acupuncture as an adjunct to exercise based physiotherapy for osteoarthritis of the knee: randomised controlled trial BMJ, September 1, 2007; 335(7617): 436 - 436. [Abstract] [Full Text] [PDF]

				B. R. Cassileth, G. E. Deng, J. E. Gomez, P. A. S. Johnstone, N. Kumar, and A. J. Vickers Complementary Therapies and Integrative Oncology in Lung Cancer: ACCP Evidence-Based Clinical Practice Guidelines (2nd Edition) Chest, September 1, 2007; 132(3_suppl): 340S - 354S. [Abstract] [Full Text] [PDF]

				E. Manheimer, K. Linde, L. Lao, L. M. Bouter, and B. M. Berman Meta-analysis: Acupuncture for Osteoarthritis of the Knee Ann Intern Med, June 19, 2007; 146(12): 868 - 877. [Abstract] [Full Text] [PDF]

				B. Berman A 60-Year-Old Woman Considering Acupuncture for Knee Pain JAMA, April 18, 2007; 297(15): 1697 - 1707. [Abstract] [Full Text] [PDF]

				A. White, N. E. Foster, M. Cummings, and P. Barlas Acupuncture treatment for chronic knee pain: a systematic review Rheumatology, March 1, 2007; 46(3): 384 - 390. [Abstract] [Full Text] [PDF]

				M. R. Pijak Acupuncture and Knee Osteoarthritis Ann Intern Med, January 16, 2007; 146(2): 147 - 147. [Full Text] [PDF]

				F G Miller and T J Kaptchuk Acupuncture trials and informed consent J. Med. Ethics, January 1, 2007; 33(1): 43 - 44. [Abstract] [Full Text] [PDF]

				A. I. Perlman, A. Sabina, A.-L. Williams, V. Y. Njike, and D. L. Katz Massage Therapy for Osteoarthritis of the Knee: A Randomized Controlled Trial Arch Intern Med, December 11, 2006; 166(22): 2533 - 2538. [Abstract] [Full Text] [PDF]

				S. Price, G. Lewith, and K. Thomas Acupuncture care for breast cancer patients during chemotherapy: a feasibility study. Integr Cancer Ther, December 1, 2006; 5(4): 308 - 314. [Abstract] [PDF]

				S. Brien, G. Lewith, A.F. Walker, R. Middleton, P. Prescott, and R. Bundy Bromelain as an adjunctive treatment for moderate-to-severe osteoarthritis of the knee: a randomized placebo-controlled pilot study. QJM, December 1, 2006; 99(12): 841 - 850. [Abstract] [Full Text] [PDF]

				Y. D. Kwon, M. H. Pittler, and E. Ernst Acupuncture for peripheral joint osteoarthritis: A systematic review and meta-analysis Rheumatology, November 1, 2006; 45(11): 1331 - 1337. [Abstract] [Full Text] [PDF]

				E. A. Macklin, P. M. Wayne, L. A. Kalish, P. Valaskatgis, J. Thompson, M. C.M. Pian-Smith, Q. Zhang, S. Stevens, C. Goertz, R. J. Prineas, et al. Stop Hypertension With the Acupuncture Research Program (SHARP): Results of a Randomized, Controlled Clinical Trial Hypertension, November 1, 2006; 48(5): 838 - 845. [Abstract] [Full Text] [PDF]

				H.-P. Scharf, U. Mansmann, K. Streitberger, S. Witte, J. Kramer, C. Maier, H.-J. Trampisch, and N. Victor Acupuncture and Knee Osteoarthritis: A Three-Armed Randomized Trial Ann Intern Med, July 4, 2006; 145(1): 12 - 20. [Abstract] [Full Text] [PDF]

				K.-K. Hui, E. K. Hui, and M. F. Johnston The potential of a person-centered approach in caring for patients with cancer: a perspective from the UCLA center for East-west medicine. Integr Cancer Ther, March 1, 2006; 5(1): 56 - 62. [Abstract] [PDF]

				D. T. Felson Clinical practice. Osteoarthritis of the knee. N. Engl. J. Med., February 23, 2006; 354(8): 841 - 848. [Full Text] [PDF]

				M. C. Hochberg Nutritional supplements for knee osteoarthritis--still no resolution. N. Engl. J. Med., February 23, 2006; 354(8): 858 - 860. [Full Text] [PDF]

				K. Linde, W. Weidenhammer, A. Streng, A. Hoppe, and D. Melchart Acupuncture for osteoarthritic pain: an observational study in routine care Rheumatology, February 1, 2006; 45(2): 222 - 227. [Abstract] [Full Text] [PDF]

				G. T. Lewith, P. J. White, and J. Pariente Investigating Acupuncture Using Brain Imaging Techniques: The Current State of Play Evid. Based Complement. Altern. Med., September 1, 2005; 2(3): 315 - 319. [Abstract] [Full Text] [PDF]

				Other articles noted Evid. Based Med., August 1, 2005; 10(4): 127 - 128. [Full Text] [PDF]

				Evidence based journal watch Br. J. Sports Med., August 1, 2005; 39(8): 579 - 580. [Full Text] [PDF]

				D. C. Cherkin and K. J. Sherman Acupuncture and Knee Osteoarthritis Ann Intern Med, May 17, 2005; 142(10): 872 - 872. [Full Text] [PDF]

				R. H. Baker Acupuncture and Knee Osteoarthritis Ann Intern Med, May 17, 2005; 142(10): 871 - 871. [Full Text] [PDF]

				Acupuncture Relieves Symptoms of Knee OA Journal Watch (General), January 4, 2005; 2005(104): 3 - 3. [Full Text]

Rapid Responses: