A recent systematic review and meta-analysis of randomized clinical trials (RCTs) provides a comprehensive evaluation of acupuncture’s efficacy in treating knee osteoarthritis (KOA). The study analyzed 11 RCTs with 2,484 patients and offers a nuanced view of acupuncture techniques, outcomes, and clinical applications for KOA management, particularly for licensed acupuncturists looking to optimize their practice based on scientific evidence.
Acupuncture For Pain and Function Improvement
The meta-analysis demonstrated that acupuncture significantly reduced pain and improved functional activities in patients with KOA. Acupuncture showed a beneficial effect in pain reduction, with a standardized mean difference (SMD) of -0.12 (95% CI: -0.20 to -0.04; I² = 0%) and an improvement in function as measured by the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) function scores, with an SMD of -1.25 (95% CI: -1.97 to -0.53; I² = 0%) compared to sham acupuncture.
Acupuncture Points and Techniques
The trials included in the analysis utilized a variety of acupoints and techniques, reflecting the diverse approaches within clinical practice:
Distal and Local Acupuncture
Local points near the knee, such as ST34 (Liangqiu), ST35 (Dubi), ST36 (Zusanli), EX-LE2 (Heding), EX-LE5 (Waixiyan), GB33 (Xiyangguan), GB34 (Yanglingquan), SP9 (Yinlingquan), and SP10 (Xuehai), were frequently employed. These points are associated with improving knee mobility, reducing pain, and enhancing blood circulation in the local area. Distal points, such as LI4 (Hegu), SP6 (Sanyinjiao), KI3 (Taixi), GB39 (Xuanzhong), and ST40 (Fenglong), were used to address underlying systemic factors contributing to KOA, including dampness, qi stagnation, and blood stasis.
Needle Techniques
- Manual Acupuncture: Most studies emphasized the importance of achieving the “Deqi” sensation, a composite of dull aching, heaviness, or tingling that indicates effective needle stimulation. The practitioners used a standard needling depth of 0.5 to 1.5 cun with manual manipulation, such as lifting, thrusting, and rotating, to enhance therapeutic efficacy.
- Electroacupuncture (EA): Electroacupuncture was performed using electrical stimulation devices connected to the needles inserted at key acupoints like ST36, GB34, SP9, and EX-LE5. Frequency settings varied between 2 Hz and 100 Hz, typically alternating to prevent habituation. EA was applied for 20–30 minutes per session, two to three times per week for 6–12 weeks. This modality showed promising results in pain reduction, particularly when paired with manual needle manipulation to achieve “Deqi.”
Treatment Regimens
Frequency and Duration: Most RCTs administered acupuncture two to three times per week over a period of 6 to 13 weeks. The sessions lasted 20 to 35 minutes, depending on the study. A subset of trials recommended a longer treatment course for chronic KOA patients, with some regimens extending up to 26 weeks.
Biomedical Results
Acupuncture’s effectiveness in KOA is supported by various biomedical mechanisms. Acupuncture is thought to promote the release of endogenous opioids and neurotransmitters such as serotonin and norepinephrine, which modulate pain pathways. Additionally, needling at specific points activates local anti-inflammatory responses, improves microcirculation, and reduces joint stiffness by stimulating peripheral nerve endings.
True vs. Sham Acupuncture
The trials compared true acupuncture to sham acupuncture, which involved superficial needling at non-acupuncture points or the use of non-penetrating needles. The meta-analysis confirmed that true acupuncture was significantly more effective than sham acupuncture in reducing pain and enhancing function in KOA patients.
Conclusion
The systematic review and meta-analysis indicate that acupuncture is a viable and effective treatment for KOA, particularly for pain relief and functional improvement. The research shows that acupuncturists should consider employing a combination of local and distal points, focusing on techniques that achieve the “Deqi” sensation and incorporating electroacupuncture where appropriate. The frequency of treatment should ideally be two to three sessions per week for at least six weeks to achieve optimal results. Given the relatively low risk of adverse effects, acupuncture represents a safe alternative or adjunct to conventional treatments for KOA .
Source:
1. Tian, H., Huang, L., Sun, M., Xu, G., He, J., Zhou, Z., Huang, F., Liu, Y., Liang, F. (2022). Acupuncture for Knee Osteoarthritis: A Systematic Review of Randomized Clinical Trials with Meta-Analyses and Trial Sequential Analyses. BioMed Research International, Volume 2022, Article ID 6561633. doi.org/10.1155/2022/6561633.
