Research: SCHARF and others,

Listed in Issue 139

Abstract

SCHARF and others, University of Heidelberg, Heidelberg, Germany, have carried out a trial of acupuncture in the treatment of arthritis of the knee.

Background

The aim of this study was to assess the efficacy and safety of traditional Chinese acupuncture (TCA) compared with sham acupuncture (needling at defined non-acupuncture points) and conservative therapy in patients with chronic pain due to osteoarthritis of the knee.

Methodology

In this randomized, controlled trial, 1007 patients who had had chronic pain for at least 6 months due to osteoarthritis of the knee were randomized to one of three groups. They received either up to 6 physiotherapy sessions and as-needed anti-inflammatory drugs, plus 10 sessions of TCA, 10 sessions of sham acupuncture, or 10 physician visits within 6 weeks. The main outcome measure was a success rate as defined by at least 36% improvement in Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) score at 26 weeks.

Results

Success rates were 53.1% for verum acupuncture, 51.0% for sham acupuncture, and 29.1% for conservative therapy. Acupuncture groups had higher success rates than conservative therapy groups (relative risk for TCA compared with conservative therapy, 1.75; relative risk for sham acupuncture compared with conservative therapy, 1.73). There was no difference between TCA and sham acupuncture (relative risk, 1.01). There was no blinding between acupuncture and traditional therapy and no monitoring of acupuncture compliance with study protocol. In general, practitioner-patient contacts were less intense in the conservative therapy group than in the TCA and sham acupuncture groups.

Conclusion

Compared with conservative management alone, either TCA or sham acupuncture led to greater improvement at 26 weeks. No statistically significant difference was observed between verum and sham acupuncture, suggesting that the observed differences could be due to placebo effects, differences in intensity of provider contact, or a physiological effects of needling regardless of whether it is done according to TCA principles.

References

Scharf HP, Mansmann U, Streitberger K, Witte S, Kramer J, Maier C, Trampisch HJ, Victor N. Acupuncture and knee osteoarthritis: a three-armed randomized trial. Annals of Internal Medicine 145 (1): 12-20, Jul 4,  2006.

Comment

This research demonstrated a 2-fold greater improvement for either verum or sham acupuncture compared with conservative medical treatment for osteoarthritis of the knee patients. Although many researchers have attributed such results to a placebo effect, these authors also posit the possibility that needling, regardless of whether it is performed according to Traditional Chinese Medicine principles could play a role. This harks back to the sham surgical knee operations performed decades ago which appeared to work as well as no surgery. Perhaps operating may stimulate the body’s healing; it may not have to be a placebo effect.

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