Study Says Acupuncture Eases Arthritis Pain

"For the first time, a clinical trial with sufficient rigor, size and duration has shown that acupuncture reduces the pain and functional impairment of osteoarthritis of the knee," said Stephen E. Straus, director of the National Center for Complementary and Alternative Medicine (NCCAM), the National Institutes of Health center that helped fund the $2.7 million study. "NCCAM has been building a portfolio of basic and clinical research that is now revealing the power and promise of applying stringent research methods to ancient practices like acupuncture."

Skeptics, however, called the study another in a series of examples of wasting taxpayer money on shoddy research that benefits only the purveyors of quack therapies.

"It won't surprise me if this study is touted as some kind of big breakthrough and a validation of acupuncture. But the fact is that it's a dismal piece of work that does little but show that placebos do have some small effects on measurements that depend on subjective interpretations," said Timothy Gorski, associate editor of the Scientific Review of Alternative Medicine. "For the money spent, this is a terrible return on the investment and one more argument for closing down the NCCAM, which has yet to produce anything of actual clinical value. These are considerable funds, and it is a scandal that they are not being devoted to something more promising."

Arthritis experts were less critical, saying the study appeared to be well conducted and suggested that acupuncture might provide some benefit as a complement to standard care, though the improvements the patients experienced were fairly modest.

"The good news is this is a very well done, very large study," said David Felson, a Boston University rheumatologist, speaking on behalf of the Arthritis Foundation. "But the effect is almost so small as to be almost undetectable. Individual patients are going to have a hard time getting noticeable benefit from this treatment."

More than 20 million Americans suffer from arthritis, also known as osteoarthritis. Painkillers can help, but they can also have side effects. Patients have been seeking alternatives, especially in light of recent concerns about side effects of Vioxx, Celebrex and similar drugs.

"This disease is one of the most frequent causes of physical disability among adults," said Stephen I. Katz, director of the National Institute of Arthritis and Musculoskeletal and Skin Diseases, which also helped fund the study. "This well-done study shows that acupuncture is an effective complement . . . to standard care."

Acupuncture is an ancient Chinese treatment that involves inserting very thin metal needles in specific spots that are then manipulated by hand or sometimes stimulated with electricity. About 2 million Americans are estimated to have used acupuncture.

Berman and his colleagues gave the participants, who were experiencing moderate or severe pain despite taking standard painkillers, either real acupuncture, simulated acupuncture or information about arthritis.

The researchers took a number of steps to prevent patients from knowing whether they were getting real or sham treatment. A screen blocked their view of the treatment area. Those receiving the sham acupuncture did not have needles inserted into their skin in most places. Instead, they had needles, needle guides and adhesive tape placed on the skin so they could not tell the difference, because insertion of acupuncture needles is usually painless. When the acupuncturists applied electrical stimulation to the needles, lights flashed even though no power was applied.

The participants who received the real or sham acupuncture underwent 24 treatments over a 26-week period and had their pain and mobility measured using standard scales. After 26 weeks, those receiving the real thing experienced a 40 percent reduction in pain and improvement in function, the researchers reported in the Annals of Internal Medicine.

"They weren't pain-free, but there was a significant difference," Berman said. "We concluded that acupuncture is safe and effective for reducing pain and improving physical function, and these were people with moderate or greater pain despite being on their medical therapy."

Those receiving the sham treatment experienced a 30 percent reduction, which the researchers attributed to a placebo effect.

It remains unclear how acupuncture might work, but Berman said some research has suggested that inserting the needles may stimulate the body to release chemicals that reduce pain and inflammation.

Reproduced with permission of the copyright owner. Further reproduction or distribution is prohibited without permission.