AP in osteoarthritis of the knee

[Guest guest]

Hi All,

 

I take this opportunity to wish each one of you a happy and peaceful

Christmas and a most fulfilling and productive year in 2005.

 

Prof. Alan Klide (Vet School Philadelphia) flagged a publication (Dec

21, 2004) by Berman et al., who have confirmed an effect of

acupuncture (AP) in knee osteoarthritis. See details at end. What a

pity that there was not a positive western medical treatment (WM Tx)

included for comparison! The abstract is at

http://www.annals.org/cgi/content/abstract/141/12/901

 

For other Medline abstracts on AP by Dr. Berman et al., see:

http://tinyurl.com/5ndf9

 

IMO, future AP / herbal research should forget sham or placebo Txs

and compare the BEST that TCM can offer with the BEST that WM can

offer, including a risks assessment AND cost-benefit analysis.

 

Best regards,

Phil

 

PS: Alan, Many thanks for this nice Christmas present! Shalom.

 

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Brian M. Berman, MD; Lixing Lao, PhD; Patricia Langenberg, PhD; Wen

Lin Lee, PhD; Adele M.K. Gilpin, PhD; and Marc C. Hochberg, MD

Effectiveness of AP as Adjunctive Therapy in Osteoarthritis of the

Knee: A Randomized, Controlled Trial Annals of Internal Medicine 21

December 2004 | Volume 141 Issue 12 | Pages 901-910 Background:

Evidence on the efficacy of AP for reducing the pain and dysfunction

of osteoarthritis is equivocal. Objective: To determine whether AP

provides greater pain relief and improved function compared with sham

AP or education in patients with osteoarthritis of the knee. Design:

Randomized, controlled trial. Setting: Two outpatient clinics (an

integrative medicine facility and a rheumatology facility) located in

academic teaching hospitals and 1 clinical trials facility. Patients:

570 patients with osteoarthritis of the knee (mean age [±SD], 65.5 ±

8.4 years). Intervention: 23 true AP sessions over 26 weeks. Controls

received 6 two-hour sessions over 12 weeks or 23 sham AP sessions

over 26 weeks. Measurements: Primary outcomes were changes in the

Western Ontario and McMaster Universities Osteoarthritis Index

(WOMAC) pain and function scores at 8 and 26 weeks. Secondary

outcomes were patient global assessment, 6-minute walk distance, and

physical health scores of the 36-Item Short-Form Health Survey (SF-

36). Results: Participants in the true AP group experienced greater

improvement in WOMAC function scores than the sham AP group at 8

weeks (mean difference, –2.9 [95% CI, –5.0 to –0.8]; P = 0.01) but

not in WOMAC pain score (mean difference, –0.5 [CI, –1.2 to 0.2]; P =

0.18) or the patient global assessment (mean difference, 0.16 [CI,

–0.02 to 0.34]; P > 0.2). At 26 weeks, the true AP group experienced

significantly greater improvement than the sham group in the WOMAC

function score (mean difference, –2.5 [CI, –4.7 to –0.4]; P = 0.01),

WOMAC pain score (mean difference, –0.87 [CI, –1.58 to –0.16];P =

0.003), and patient global assessment (mean difference, 0.26 [CI,

0.07 to 0.45]; P = 0.02). Limitations: At 26 weeks, 43% of the

participants in the education group and 25% in each of the true and

sham AP groups were not available for analysis. Conclusions: AP seems

to provide improvement in function and pain relief as an adjunctive

therapy for osteoarthritis of the knee when compared with credible

sham AP and education control groups.

 

Editors' Notes: Context: Previous studies of AP for osteoarthritis

have had conflicting results. This may have occurred because most

studies have included small samples, a limited number of treatment

sessions, or other limitations.

 

Contribution: This randomized, controlled trial compared 24 AP

sessions over 26 weeks with sham AP or arthritis education in 570

patients with osteoarthritis of the knee. AP led to greater

improvements in function but not pain after 8 weeks and in both pain

and function after 26 weeks. No adverse effects were associated with

AP.

 

Cautions: Many participants dropped out of the study, so readers

should interpret the findings at 26 weeks with caution. –The Editors

For further details and links, see:

http://www.annals.org/cgi/content/abstract/141/12/901

 

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Best regards,

 

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