Acupuncture should be considered to be one of the most effective treatments for short-term alleviation of knee pain from osteoarthritis (OA), according to a network meta-analysis of randomised controlled studies by UK authors. This type of meta-analysis is gaining popularity among clinicians, as it allows comparison between multiple interventions that have been used to treat the same condition, even if there has not been a ‘head-to-head’ comparison in the original studies. Data suitable for analysis came from 114 trials which used a total of 22 different treatment modalities to treat 9,709 patients. Eight interventions, including acupuncture, were found to result in statistically significant reductions in pain, compared with standard care. Most trials studied only short-term effects of treatment and many were classed as being of poor quality. The trials that were judged to be of high quality were mostly studies involving acupuncture (11 trials) or muscle-strengthening exercise (9 trials). Both of these interventions were found to be significantly better than standard care, with acupuncture performing better than muscle-strengthening exercise. Acupuncture was shown to be significantly superior to sham, and in addition it was shown to outperform most of the physical therapies recommended by the UK’s National Institute for Health and Care Excellence (NICE) in its 2008 guidelines on treatment of knee OA. The authors report that the effect sizes for acupuncture compare favourably with those of pharmacological treatments, and recommend that acupuncture should be considered to be an evidence-based treatment option with a credible role to play in the management of knee OA pain. (Acupuncture and other physical treatments for the relief of pain due to osteoarthritis of the knee: network meta-analysis. Osteoarthritis Cartilage. 2013 Sep;21(9):1290-8).
Meanwhile, a small US-based longitudinal study of 30 knee OA patients has found that, compared with sham acupuncture, real acupuncture produces better clinical outcomes for both pain and function. Sensations of soreness and aching during needling were implicated as the two key sensations that differentiate real acupuncture from superficial acupuncture. (A longitudinal study of the reliability of acupuncture deqi sensations in knee osteoarthritis. Evid Based Complement Alternat Med. 2013;2013:204259).