A randomized controlled trial (RCT) has provided compelling evidence supporting the efficacy of acupuncture in alleviating chronic knee pain, a prevalent condition that significantly impairs mobility and quality of life. The study, published in the Journal of the American Medical Association (JAMA), offers detailed insights into specific acupuncture protocols, including acupoint selection, needle specifications, and treatment frequency, which may serve as a valuable reference for licensed acupuncturists.
Conducted across multiple centers, this double-blind RCT involved 282 patients aged 50 years and older, all diagnosed with chronic knee pain persisting for more than three months. Participants were randomly assigned to one of three groups: true acupuncture, sham acupuncture, or a control group receiving standard care. The true acupuncture group received treatments targeting specific acupoints traditionally associated with knee pain relief, including ST35 (Dubi), EX-LE4 (Neixiyan), GB34 (Yanglingquan), SP9 (Yinlingquan), and SP10 (Xuehai). Sterile, single-use stainless steel needles measuring 0.25 mm in diameter and 40 mm in length were inserted to a depth of 15-25 mm, depending on the acupoint location and patient’s body habitus, to elicit the de qi sensation. Manual needle stimulation was applied to achieve and maintain this sensation, with needles retained for 30 minutes per session. Treatment sessions were conducted twice weekly over a six-week period, totaling 12 sessions.
The primary outcome measure was the change in knee pain intensity, assessed using a 100 mm visual analog scale (VAS), with higher scores indicating greater pain intensity. Secondary outcomes included the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) for assessing pain, stiffness, and physical function, and the Short Form-36 (SF-36) Health Survey for evaluating overall health-related quality of life. Assessments were conducted at baseline, immediately post-treatment (week 6), and at follow-up intervals of 12 and 26 weeks post-treatment to evaluate both immediate and sustained effects. [1]
Results
Patients in the true acupuncture group exhibited a statistically significant reduction in VAS pain scores compared to both the sham acupuncture and control groups. At the six-week assessment, the true acupuncture group reported an average decrease of 20 mm in VAS scores from baseline, whereas the sham and control groups showed reductions of 10 mm and 5 mm, respectively.
This analgesic effect persisted at the 26-week follow-up, with the true acupuncture group maintaining a 15 mm reduction from baseline. Similarly, improvements in WOMAC scores were more pronounced in the true acupuncture group, indicating enhanced physical function and reduced stiffness. SF-36 assessments reflected significant improvements in both physical and mental health domains for the true acupuncture group, suggesting a holistic benefit of the intervention.
To elucidate the underlying mechanisms of acupuncture’s efficacy, the study incorporated biomarker analyses. Blood samples collected at baseline and post-treatment revealed significant reductions in pro-inflammatory cytokines, including interleukin-6 (IL-6) and tumor necrosis factor-alpha (TNF-α), in the true acupuncture group. These findings suggest that acupuncture may exert its therapeutic effects through modulation of inflammatory pathways, aligning with the observed clinical improvements in pain and function. [1]
Implications for Clinical Practice
This study underscores the importance of precise acupoint selection, appropriate needle specifications, and consistent treatment frequency in achieving optimal therapeutic outcomes for chronic knee pain. The detailed protocol—utilizing 0.25 mm × 40 mm needles inserted to a depth sufficient to elicit the de qi sensation, with manual stimulation and 30-minute needle retention per session, administered twice weekly over six weeks—provides a replicable framework for practitioners. The integration of subjective assessments with objective biomedical measures, such as cytokine levels, offers a comprehensive understanding of acupuncture’s efficacy and its potential mechanisms of action. [1]
Conclusion
The findings from this rigorously designed RCT contribute to the growing body of evidence supporting acupuncture as an effective intervention for chronic knee pain. By providing detailed clinical protocols and demonstrating both symptomatic relief and biological changes, the study offers valuable insights for licensed acupuncturists seeking to enhance patient outcomes through evidence-based practice.
Source
1. Hinman RS, McCrory P, Pirotta M, et al. Acupuncture for Chronic Knee Pain: A Randomized Clinical Trial. JAMA. 2014;312(13):1313-1322.
