Often patients with Osteoarthritis (OA) of the knee get relief of pain and increase of everyday function with acupuncture.
Osteoarthritis is the most common form of arthritis. It is also called degenerative joint disease. OA of the knee is estimated to affect 68% of American over 55 yrs old. That number always surprises me. There is a full spectrum of OA from mild to those needing a total knee replacement surgery.
What happens to the knee?
The joint surface thins and is not smooth any longer. Bone under the cartilage thickens. Boney outgrowths called spurs develop. The cartilage thins and exposes the bone. Ligaments thicken and the synovium around the knee thickens. The picture shows a normal knee and one with OA.
As you can imagine over time this can worsen and it hurts to do activities with the knee. In advanced OA there may just be bone on bone with severe pain on any movement of the knee. This often results in a total knee replacement. However luckily for most people OA of the knee doesn’t progress to the advanced stage but it can still hurt enough to need treatment to help control pain or discomfort to allow for an active life.
Standard treatments hope to decrease pain and allow activity to continue. They include medications to help decrease the pain as listed here:
NSAID such as aleve
Cox 2 inhibitors such as celebrex
Steroid injections into the knee
Hyaluronic injections into the knee
Glucasamine sulfate supplementation is shown in some studies to aid some people. Other studies say it has no effect.
Physical therapy is used to help strengthening exercises for the quadriceps and hamstring muscles.
I have found acupuncture has a very good role in helping improve pain and function in the treatment of osteoarthritis of the knee.
A recently published study done in Tel Aviv, Israel at the Sourasky Medical Center, Department of Orthopedics looked at providing acupuncture to patients with OA of the knee for 8 weeks with followup treatments as adjunctive therapy to standard care in elderly patients. Two groups had acupuncture twice a week for 8 weeks and then one of the groups had followup treatment a month later. There was also a sham acupuncture group. The results of the study showed the acupuncture treated groups had significant improvement in pain levels and function. The researchers were surprised to find that the group that had followup treatment in a month had relief of pain and increase of function for much longer than those who only had the 8 weeks of treatment. They noted that more studies need to be done to see the optimal frequency and length of treatment with follow up treatments.
Another study reported in The Annals of Internal Medicine 12/2004 also showed acupuncture is a good treatment for osteoarthritis of the knee. This was a controlled randomized study with 570 patients assigned to one of 3 groups. One group received 23 acupuncture treatments over 26 weeks. Another group received sham acupuncture (no needles placed in the person). Another group received 6 two hour educations sessions over 12 weeks. The results of the study showed that there was a significant improvement in the true acupuncture group over the 2 other groups. Pain decreased 40% in the true acupuncture group. In this study pain didn’t start to improve significantly until the 16th treatment, but once it started it was a significant decrease in pain.
One of the differences in the 2 studies is that the one out of Israel allowed for different points to be added to the standard points used based on the different Traditional Chinese diagnosis. The study done in the US used the same point combination for all patients.
Over the years I have treated many patients with varying degrees of osteoarthritis of the knee with acupuncture successfully. My approach is to modify the treatment based on the Traditional Chinese diagnosis. Some patients respond quickly and others take many treatments to start to see change. It does require more than just a few treatments as many of us would like. I have found that many patients do well after an initial course of twice weekly treatments and then followup treatments that can vary in the interval for the patient’s individual response and pain level. Acupuncture is a very good adjunctive treatment for the relief of pain and to increase function in those with osteoarthritis of the knee. Yes it does treat other joints with OA too! Also it treats other causes of knee and joint pain.
K Bynum, DO