|31/10/2006 - Acupuncture for chronic Osteoarthritis pain. |
A recent study investigated the efficacy of acupuncture as an additional therapy to the routine medical treatment and itís effect after the discontinuation of the treatment. This study appeared in the November 2006 issue of Arthritis & Rheumatism.
Claudia M. Witt of the University Medical Center in Berlin, Germany and her team carried out a randomized controlled trial on patients with chronic pain due to OA of the knee or hip.
This study was conducted during the period July 2001 to July 2004 on totally 3,553 patients. These patients were divided into 3 groups. The first comprising 322 were given up to 15 sessions of acupuncture right away in the first 3-month period, 310 belonging to the control group did not receive any acupuncture in the initial 3-month period and 2,921 patients who did not agree to randomization were given the same treatment as the first group. The control group was given acupuncture therapy after the initial 3-month period. All the patients were monitored for 6 months.
In the study, the effects were measured at the beginning, after 3 months and after 6 months using the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) and a health-related quality of life survey (Short Form 36).
"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. The effect was the same in both the randomized and the non-randomized groups.
Similar results were observed after 6 months in the control group who received acupuncture 3 months later than the other groups. The WOMAC and SF-36 scores of the first group at 6 months were only a little lower than at 3 months.
This study being one of the largest randomized trials of acupuncture so far had aimed at displaying the general medical practice. The results of this study have influenced the German Federal Committee of Physicians and Health Insurers to consider including acupuncture for reimbursement by state health insurance funds. Acupuncture will become a routine medical option for OA treatment on approval.
The authors conclude "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."
Tao Liu and Chen Liu of Jilin University, Changchun, Jilin, China, reported in a supplementary editorial in the same issue, "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."
Author(s): Witt CM, Jena S, Brinkhaus B, Liecker B, Wegscheider K, Willich SN.
OBJECTIVE: To investigate the effectiveness of acupuncture in addition to routine care, compared with routine care alone, in the treatment of patients with chronic pain due to osteoarthritis (OA) of the knee or hip.
METHODS: In a randomized, controlled trial, patients with chronic pain due to OA of the knee or hip were randomly allocated to undergo up to 15 sessions of acupuncture in a 3-month period or to a control group receiving no acupuncture. Another group of patients who did not consent to randomization underwent acupuncture treatment. All patients were allowed to receive usual medical care in addition to the study treatment. Clinical OA severity (Western Ontario and McMaster Universities Osteoarthritis Index [WOMAC]) and health-related quality of life (Short Form 36) were assessed at baseline and after 3 months and 6 months.
RESULTS: Of 3,633 patients (mean +/- SD age 61.8 +/- 10.8 years; 61% female), 357 were randomized to the acupuncture group and 355 to the control group, and 2,921 were included in the nonrandomized acupuncture group. At 3 months, the WOMAC had improved by a mean +/- SEM of 17.6 +/- 1.0 in the acupuncture group and 0.9 +/- 1.0 in the control group (3-month scores 30.5 +/- 1.0 and 47.3 +/- 1.0, respectively [difference in improvement 16.7 +/- 1.4; P < 0.001]). Similarly, quality of life improvements were more pronounced in the acupuncture group versus the control group (P < 0.001). Treatment success was maintained through 6 months. The changes in outcome in nonrandomized patients were comparable with those in randomized patients who received acupuncture.
CONCLUSION: These results indicate that acupuncture plus routine care is associated with marked clinical improvement in patients with chronic OA-associated pain of the knee or hip.