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Senior Citizen Health & Medicine
Osteoarthritis Patients Treated with Acupuncture
Show Significant Improvement
Magazine editorial encourages wider use for chronic
pain conditions
 October
30, 2006 A large study of over 3500 osteoarthritis patients has found
that those with chronic pain of the knee or the hip, who were treated
with acupuncture in addition to routine care, showed significant
improvements in symptoms and quality of life compared with patients who
received routine care alone. And, the benefits continued after
treatment. The report in Arthritis & Rheumatism also has an editorial
that says this evidence proves acupuncture should get extensive use in
various chronic pain conditions.
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Health & Medicine |
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Osteoarthritis (OA) has a major impact on patients'
mobility and quality of life but the anti-inflammatory drugs used to
treat it are associated with a number of side effects, according to the
artivle.
In recent years, patients have turned increasingly
to acupuncture to relieve the chronic pain associated with OA. This new
study examined the use of acupuncture as an extension of routine medical
care and whether the effects of treatment last after therapy is
discontinued.
Led by Claudia M. Witt of the University Medical
Center in Berlin, Germany, researchers conducted a randomized,
controlled trial of a large number of patients with chronic pain due to
OA of the knee or hip. Between July 2001 and July 2004, a total of 3,553
patients were divided into three groups: 322 immediately received up to
15 sessions of acupuncture in the initial three month period; 310
controls received no acupuncture for the first three months; and 2,921
(those who did not consent to randomization) received the same treatment
as the acupuncture group.
Each patient was followed for a total of six months
and the control group received acupuncture during the last three months
of their study period. The Western Ontario and McMaster Universities
Osteoarthritis Index (WOMAC) and a health-related quality of life survey
(Short Form 36) were used to measure outcomes when the study began and
at three and six months.
"Patients with chronic pain due to OA of the knee
or the hip who were treated with acupuncture in addition to routine care
showed significant improvements in symptoms and quality of life compared
with patients who received routine care alone," the authors state.
This was true for both the randomized and the
non-randomized groups. Furthermore, patients in the control group who
received acupuncture only after three months showed similar improvements
at six months. In addition, WOMAC and SF-36 scores at six months were
only slightly lower than at three months for those receiving acupuncture
right away.
Although the study was not a blind trial, its
design was chosen to reflect general medical practice. It was one of the
largest randomized trials of acupuncture to date and based in part on
the results, the German Federal Committee of Physicians and Health
Insurers is considering a proposal that acupuncture will be reimbursed
by state health insurance funds. If approved, it will probably be
provided as a routine medical option in treating OA.
The authors conclude that "the present results show
that, in patients with chronic pain due to OA of the knee or hip who
were receiving routine primary care, addition of acupuncture to the
treatment regimen resulted in a clinically relevant and persistent
benefit."
Editorial Supports Wider Use
In an accompanying editorial in the same issue, Tao
Liu and Chen Liu of Jilin University, Changchun, Jilin, China, point out
that acupuncture is part of traditional Chinese medicine, which views
the body differently than biomedicine in that it emphasizes the body's
healing ability and aims for long-term healing, not necessarily a cure.
In addition, acupuncture features close
patient-provider relationships that involve enhanced interaction and
communication, which can be beneficial in managing OA. They also suggest
that in reality, few OA patients use acupuncture as the sole treatment
and that a lack of information about how well it works has probably
meant that acupuncture is an undervalued treatment option that could be
an important element of a multidisciplinary approach to treating OA.
The authors note that the current study "reflects
as closely as possible the conditions of daily medical practice, and as
the authors point out, maximizes external validity and clinical
relevance."
They state that the study was limited in that the
patient informed consent process was unclear and there were some patient
characteristics that were not described, such as whether patients had
previously tried acupuncture and what their experience was.
They also maintain that an acupuncturist's
experience is the most important factor in treatment outcome.
They conclude: "Given that the biologic mechanism
of acupuncture is still unclear, the study by Witt et al furthers our
understanding of acupuncture and adds to the accumulated evidence
supporting its efficacy. Such evidence warrants extensive use of
acupuncture in various chronic pain conditions."
Editor's Notes:
Article: "Acupuncture in Patients With
Osteoarthritis of the Knee or Hip," Claudia M. Witt, Susanne Jena, Benno
Brinkhaus, Bodo Liecker, Karl Wegscheider, Stefan N. Willich, Arthritis
& Rheumatism, November 2006; 54:11; pp. 3485-3493; (DOI:
10.1002/art.22154).
Editorial:
"Acupuncture for Treating Osteoarthritis of the
Knee and the Hip," Tao Liu and Chen Liu, Arthritis & Rheumatism,
November 2006; 54:11; pp. 3375-3377; (DOI: 10.1002/art.22155).
November 2006 issue of Arthritis & Rheumatism (http://www.interscience.wiley.com/journal/arthritis)
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