01 Oct Randomized Trial Shows Acupuncture Not Helpful For Chronic Knee Pain
MedicalResearch.com Interview with:
Ben Metcalf BsC (co-author) on behalf or A/Prof Rana Hinman PhD
Centre for Health, Exercise and Sports Medicine, Department of Physiotherapy,
School of Health Sciences, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, Australia
Medical Research: What are the main findings of the study?
Dr. Metcalf: This study investigated whether acupuncture is an effective treatment for people aged more than 50 years with chronic knee pain. Participants in our study were randomly assigned to one of four groups; needle acupuncture, laser acupuncture, sham laser acupuncture or no treatment. The people in the treatment groups received acupuncture treatment from a family physician for 12 weeks. Participants were assessed after treatment and again after one year.
There were no significant differences in knee pain or physical function between active and sham laser acupuncture at 12 weeks or at one year. Both needle and laser acupuncture resulted in modest improvements in pain compared with no treatment at 12 weeks that were not maintained at one year. Needle acupuncture improved physical function at 12 weeks compared with no treatment but was not different from sham acupuncture and was not maintained at one year.
Medical Research: What was unique about the study?
Dr. Metcalf: There were several unique aspects about the study. It was the first study to investigate the efficacy of laser acupuncture in people with chronic knee pain and to include a 12 month follow up to assess longer-term maintenance of any effects. It also used a Zelen design. In this design, participants initially consented to a natural history study that involved completion of questionnaires about knee pain and symptoms over a one year period. Once participants were enrolled, they were covertly randomised to one of the 4 groups in a clinical trial investigating acupuncture. Participants allocated to one of the 3 treatment groups, were invited to take part while those in the control group continued unaware that they were part of a clinical trial.
This design ensured that we did not recruit only patients with positive acupuncture attitudes, which is a limitation of previous studies, as patient preference for acupuncture can influence treatment outcomes. It also ensured that participants in the no treatment group were not disappointed from being allocated to the control group which can adversely influence outcomes.
Medical Research: What was most surprising about the results?
Dr. Metcalf: We were mostly surprised by the comparison of results from both needle and laser acupuncture to sham laser acupuncture as we had hypothesised that acupuncture would be superior to sham. Participants in the sham laser group, as well as their treating physicians, were unaware as to whether they were receiving real laser or sham laser acupuncture. Participants underwent the same number of treatment sessions with the same set of physicians. There were no significant differences in any outcomes between needle or laser acupuncture compared to sham laser.
Medical Research: What is the take away message from your report?
Dr. Metcalf: Our findings do not support the use of acupuncture for the treatment of chronic knee pain in people 50 years or older. While participants in the needle and laser acupuncture groups showed improvements in pain over no treatment, the size of the improvements was clinically unimportant and improvements were not sustained at one year.