Reference
Manyanga T, Froese M, Zarychanski R, et al. Pain management with acupuncture in osteoarthritis: a systematic review and meta-analysis. BMC Complement Altern Med. 2014 Aug 23;14:312.
Design
Systemic review and meta-analysis: Studies were selected using a 2-step process with 2 reviewers independently screening 14,449 citations including random controlled trials (RCTs) of acupuncture administered to adults with osteoarthritis (OA). In all, 12 studies were included in this analysis. Non-RCTs, trials involving animals, and studies evaluating electroacupuncture were excluded from the analysis. Data extracted included patient demographics, interventions and comparators, trial outcomes, total number of acupuncture sessions, relevant cointerventions, length of trial, and duration of follow-up. Internal validity of trials was evaluated using the Cochrane Risk of Bias Tool.
Participants
This review’s cohort included 1,763 participants in trials dating from 1989 to 2013 in which acupuncture was compared to sham acupuncture, to no treatment, or to usual care (weight loss, exercise, pharmacological agents).
Outcome Measures
Primary outcome measure was pain intensity with secondary outcomes of functional mobility and health-related quality of life (HRQoL).
Key Findings
Ten trials involving 1,699 participants showed significantly reduced OA pain, with longer intervention periods (4 weeks) associated with improved treatment response. Comparators (sham vs real) and other cointerventions (nonsteroidal antiinflammatories [NSAIDs] vs no pharmaceuticals) did not affect pain scores differently than acupuncture alone.
Functional mobility assessed at the end of trials was significantly improved in the acupuncture groups compared to the control groups.
Three trials involving 958 participants reported HRQoL and found acupuncture was associated with significant improvements in HRQoL at the end of the intervention period.
No significant adverse events were associated with acupuncture treatment.
Practice Implications
This research article supports the use of acupuncture as an effective modality when treating patients with OA-related pain and disability.
OA is the most common form of arthritis and is the leading cause of disability in noninstitutionalized adults.1 It has major impact on physical function and mobility, especially in the elderly population. It is estimated that 10% of men and 18% of women worldwide experience OA symptoms. By 2001, job-related OA cost up to $13 billion in the United States.2
This expansive and careful search and review of numerous studies—focused on patient-centered outcomes and carefully selected and screened to reduce bias as well as other data management factors—consistently showed that acupuncture significantly reduced pain intensity, improved functional mobility, and increased HRQoL. Further, treatment periods of 4 weeks to 10 weeks showed better measured outcomes, suggesting a threshold dose or duration effect.
Since most treatment of OA is focused on symptom management, NSAIDs are a common prescription. These have been proven to be only marginally effective while frequently causing adverse effects.3 Acupuncture, by comparison, is generally free of significant adverse effects and is widely available.
Based on this review, acupuncture should be considered a central therapy in treatment plans centered on clinical management of pain and disability stemming from OA.
Limitations
This review may be limited by methodological challenges inherent in included trials, 75% of which were adjudicated to be "unclear" or "of high risk of bias." Also, a lack of consensus on what defines “usual care” in the trials may have influenced results. Both of these limitations may have inflated effect estimates.
