Knee pain and acupuncture, does it really work?

Acupuncture is a form of alternative medicine and has been practiced in traditional Chinese medicine for thousands of years. Acupuncture involves stimulating so called ‘acupuncture points’ along the skin by various methods including inserting thin needles, application of heat, pressure or recently laser light. While most modern acupuncturists have done away with the idea of qi and body energy lanes as pseudoscience, many people still use acupuncture as a treatment for their ailments and believe it works. So the question is, does it? While there have been many attempts to answer this question, most of the results have been mixed and suggest that it may be good for only certain types of pain or not useful at all. There are still more people who suggest that any beneficial effects from the treatment are placebo in nature. The results are far from clear, but one recent study has tried to weigh in on the use of acupuncture and its effectiveness (or lack of) in the treatment of knee pain.

The study, by Hinman and colleagues and published in the Journal of the American Medical Association, looked at 282 volunteers with chronic knee pain who were randomly assigned to four treatment groups: no acupuncture, needle acupuncture, laser acupuncture and sham (or fake) laser acupuncture. They delivered the treatment for 12 weeks and then measured average knee pain (scale of 1-10) of the participants and the function of the knee (scale of 0 – no difficulty functioning to 68 – extreme difficulty functioning). These measures were also done a year after the treatment to determine if there was any long lasting benefit to acupuncture. One thing to be noted about the results is that the authors used something called the Minimal Clinically Important Difference (MCID), which is a way to determine how much a difference in a measurement is needed for it to be relevant to treating patients. In this study, the minimal difference in pain was 1.8 units (eg. From 5 to 3.2 on the pain scale) and was 6 units on the function scale. Now let’s look at the results.

After the 12 weeks of treatment, there was a small but significant reduction in pain with the use of needles and laser acupuncture although this did not meet the MCID and was small. In the case of acupuncture needles, the pain reduction would have been like going from a 5 to a 4 on a scale of 1-10 when compared to not using any acupuncture. For laser therapy it was even smaller, like going from a 5 to a 4.2. It is interesting to note that the sham laser treatment decreased pain by 0.7 units (although this was not quite significant). Acupuncture needles also had a small but significant effect on the function of the knee (by 3.9 units) but was again below the MCID and so must be questioned about how relevant it is. When the measurements where taken again at 1 year the beneficial effects all disappeared. There was no significant decrease in pain or increase in knee function for either the needle acupuncture or the laser acupuncture. The authors conclude that beyond the small, not clinically significant effect on pain, there is no benefit to using acupuncture in the treatment of knee pain.

You may be asking where this leaves acupuncture as a treatment? While the results did not reach the threshold of clinical significance in this study, there was a small effect after the 12 weeks of treatment and so it may be able to help treat pain initially, especially when coupled with a placebo effect. However, the beneficial effects disappear after a year and so therefore are not likely helping to treat the underlying cause of the pain. Acupuncture, however, is not likely to help beyond the pain management since there was no real effect on the knee function. Acupuncture studies are hard to perform because there is the problem of a proper control, how do you give someone sham needles? They will know they are not being stuck with real needles. At any rate, science has shown there to be no evidence to the ideas of acupuncture like qi and acupuncture points so the original ideas behind why acupuncture offers any meaningful benefit are out-dated and incorrect. While some people have suggested there was an analgesic effect of acupuncture, a review from 2009 found that the effect was not clinically relevant. The study reviewed here seems to suggest no effect of acupuncture for knee pain, and while it may prove to be useful for other forms of pain, at this point science can only say it is likely placebo in nature. I can’t fathom how sticking needles in your skin can help heal you, but the negative effects of acupuncture are minimal and usually amount to risk of bacterial infection so if used with other forms of treatment, there is no reason that acupuncture can’t be used to help patients with pain. However currently, there are no definitive results with most reviews saying the effectiveness of acupuncture depends on the type of pain. There is more consensus about other chronic conditions with reviews indicating no evidence of acupuncture benefiting diseases like autism, asthma, epilepsy, anaphylactic allergies and many others. Use acupuncture in combination with your current medical treatments for pain and you should have nothing to worry about. If you have questions about studies on acupuncture or other medical topics, Cochrane Reviews are good for scientifically valid information. They even has plain language reviews for the non-scientific audience.

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