Acupuncture; cannot recommend
We cannot recommend using acupuncture in patients with symptomatic osteoarthritis of the knee.
There were five high- and five moderate- strength studies that compared acupuncture to comparison groups receiving non-intervention sham, usual care, or education. The five moderate-strength studies were included because they reported outcomes that were different than the high-strength evidence. High-strength studies included: Berman et al, 61 Suarez-Almazor et al.,62 Weiner et al.,63 Williamson et al.64 and Taechaarpornkul et al.65 Moderate-strength studies included: Sandgee et al.,66 Vas et al.,67 Witt et al.68 and Berman et al.69 The majority of studies were not statistically significant and an even larger proportion of the evidence was not clinically significant. Some outcomes were associated with clinical- but not statistical- significance. The strength of this recommendation was based on lack of efficacy, not on potential harm.
- (63) Weiner DK, Rudy TE, Morone N, Glick R, Kwoh CK. Efficacy of periosteal stimulation therapy for the treatment of osteoarthritis-associated chronic knee pain: an initial controlled clinical trial. J Am Geriatr Soc 2007;55(10):1541-1547. PM:17908057
- (64) Williamson L, Wyatt MR, Yein K, Melton JT. Severe knee osteoarthritis: a randomized controlled trial of acupuncture, physiotherapy (supervised exercise) and standard management for patients awaiting knee replacement. Rheumatology (Oxford) 2007;46(9):1445-1449. PM:17604311
- (65) Taechaarpornkul W, Suvapan D, Theppanom C, Chanthipwaree C, Chirawatkul A. Comparison of the effectiveness of six and two acupuncture point regimens in osteoarthritis of the knee: a randomised trial. Acupunct Med 2009;27(1):3-8. PM:19369186
- (66) Sangdee C, Teekachunhatean S, Sananpanich K et al. Electroacupuncture versus diclofenac in symptomatic treatment of osteoarthritis of the knee: a randomized controlled trial. BMC Complement Altern Med 2002;2):3. PM:11914160
- (67) Vas J, Mendez C, Perea-Milla E et al. Acupuncture as a complementary therapy to the pharmacological treatment of osteoarthritis of the knee: randomised controlled trial. BMJ 2004;329(7476):1216. PM:15494348
- (68) Witt C, Brinkhaus B, Jena S et al. Acupuncture in patients with osteoarthritis of the knee: a randomised trial. Lancet 2005;366(9480):136-143. PM:16005336
- (69) Berman BM, Singh BB, Lao L et al. A randomized trial of acupuncture as an adjunctive therapy in osteoarthritis of the knee. Rheumatology (Oxford) 1999;38(4):346-354. PM:10378713
- (61) Berman BM, Lao L, Langenberg P, Lee WL, Gilpin AM, Hochberg MC. Effectiveness of acupuncture as adjunctive therapy in osteoarthritis of the knee: a randomized, controlled trial. Ann Intern Med 2004;141(12):901-910. PM:15611487
- (62) Suarez-Almazor ME, Looney C, Liu Y et al. A randomized controlled trial of acupuncture for osteoarthritis of the knee: effects of patient-provider communication. Arthritis Care Res (Hoboken ) 2010;62(9):1229-1236. PM:20506122