Acupuncture, although used for at least 5000 years in China, was not well known or widely accepted as a therapeutic treatment in the Western medical community, until recently. Acupuncture is based on Eastern philosophical premise that all matter is permeated with energy–called Chi–which flows in patterns in the body called meridians. An obstruction of these patterns interferes with basic vitality by disrupting the energy flow. This is analogous to cholesterol plaques clogging the precious flow of blood through our circulatory system. The needles used in acupuncture are inserted into the skin at precisely mapped meridian points which affect the flow of the Chi, redirecting or restoring it until the energy flow patterns are balanced and health is restored.
Acupuncture needles act as “magnetic” attractants to steer the Chi energy into proper channels. However, acupuncture needles can also be used in a pecking fashion and reach the same end as trigger point therapy or regenerative medicine injections. The deep tissue injection of the trigger point attacks the problem directly, causing physical changes and subsequent, histological composition of the tissue provoked by the needle.
Since acupuncture works on the energy flowing through the entire body, it is effective on all parts including the organs. At present, trigger point is used exclusively for myofascial pain and dysfunction.
What does the research say about the benefits of acupuncture for knee osteoarthritis?
There is a lot of positive research on the use of acupuncture for people with knee osteoarthritis, however, much of that positive research comes with the understanding that much of that research may be subjected to bias by the investigator or the study itself was no done very well. Listen to the most research research:
An April 2022 study: (1) found more positively: “Acupuncture has beneficial effect on pain relief and improves function activities, and this treatment can be recommended as a beneficial alternative therapy in patients with knee osteoarthritis, particularly for chronic patients and those currently undergoing long-term pain and help them increasing quality of life. . . . (this study) found that significant effects were demonstrated with respect to pain intensity, function when compared with sham, or placebo acupuncture. This finding could be used to guide doctors. Additionally, in the standardization of the outcome measures and the duration of acupuncture sessions, patient status such as weight and duration of illness used in trials should be focused in future studies. ”
A January 2022 paper however (2) did not find acupuncture benefits patients with knee osteoarthritis. The researcher here wrote: “At short-term, there was low to very low evidence and there were statistically significant differences in pain intensity and knee function in favor of acupuncture versus control interventions in patients with knee osteoarthritis. However, these differences were not clinically important. For the acupuncture versus sham, in the short-term, no differences clinical neither statistically significant to favor of acupuncture in pain intensity and knee function.
These papers continued on from earlier research which would conclude that acupuncture may help people with knee osteoarthritis but it could not be confirmed from research. A July 2019 study (3) demonstrated this by saying: “According to the high-quality evidence, we concluded that acupuncture may have some advantages in treating knee osteoarthritis. However, there are some risk of bias and reporting deficiencies still needed to be improved.” In other words, the evidence was not reliable.
More recently, a June 2023 paper (4) suggests that although increasingly used in the clinical setting, acupuncture is not mentioned or weakly recommended in guidelines for the treatment of knee osteoarthritis. Then should a clinician use it? The paper suggests using acupuncture rather than no treatment in adult knee osteoarthritis (weak recommendation, moderate certainty evidence), and acupuncture combined with nonsteroidal anti-inflammatory drugs (NSAIDs) rather than acupuncture alone when knee osteoarthritis symptoms are severe (weak recommendation, moderate certainty evidence), with duration of acupuncture for 4-8 weeks depending on knee osteoarthritis severity and treatment response (weak recommendation, moderate certainty evidence), and discussing with patients in shared decision-making.
Acupuncture and moxibustion
(Moxibustion is a traditional Chinese medicine therapy which burns dried mugwort on particular points on the body causing pain)
Moxibustion acupuncture needles heat on woman shoulder.
Moxibustion is practiced in two ways. One is directly applied to the skin. Typically a small mushroom or cone shaped amount of dried mugwort (moxa) is placed at the site of an acupuncture point and burned. Depending on the practitioners, the burning moxa can be left on the skin until it burns out or it can be removed from the skin before it directly burns on the skin. The danger of course is that the moxa is left on the skin too long and burns the patients. Most practitioners use “indirect Moxibustion.” The moxa is burned in stick form a few inches from the skin or indirect moxibustion in combined with acupuncture needles.
A June 2022 study (5) found that a combination treatment of Acupuncture / moxibustion has superior therapy efficacy than sham treatment.
Acupuncture as part of an integrative medicine program
An August 2022 paper (6) compared the effect of integrative medicine treatments (lifestyle change education, use of anti-inflammatory drugs, acupuncture, manual therapy-type massage) and conventional medical treatments (lifestyle change education and use of anti-inflammatory drugs) on pain control, knee function improvement, and quality of life improvement in patients with degenerative knee arthritis.
- In this study, 30 patients were randomly divided into the control group (15 people) and the experimental group (15 people). Both groups were prescribed anti-inflammatory drugs and lifestyle change education for 12 weeks.
- The experimental group underwent acupuncture including electroacupuncture, moxibustion, and manual therapy-type massage 12 times during the first 6 weeks. The findings in this group was: “Integrative medicine treatment has superior effects in pain control over conventional medical treatment. In integrative medicine treatment, pain control tends to decrease with time, but still superior over conventional medical treatment up to 6 weeks after treatment (12 weeks after initial treatment).”
Acupuncture and Trigger Point Therapy
Trigger Point Therapy also uses needles to eliminate irregularities in the body’s normal functioning, in this case the taut bands of pathological muscle tissue are known as trigger points. However, tendons, ligaments and joint capsules may also refer pain to areas distant from the actual trigger point. Tender points, which are points that are sore with pressure or palpation of the doctor’s hand, may also be treated with trigger point injections or regenerative medicine injections. Unlike the dry needle of acupuncture, the trigger point or regenerative medicine injections deliver fluid to the target area to be treated. By puncturing the tissue, trauma to the area is caused, resulting in a rush of white blood cells to the area that provokes a reaction and stimulates the healing process. Frequently, in trigger point therapy the physician will use a local anesthetic solution such as lidocaine to relieve the pain as well. Without surprise, most acupuncture points have been mapped to be the exact same points as trigger points.
A February 2022 paper (7) systematically evaluated the efficacy and safety effectiveness of acupuncture inactivation of myofascial pain trigger points in the treatment of knee osteoarthritis osteoarthritis of the knee. A total of 724 patients from 9 randomized control studies were included, and the results of meta-analysis showed that the acupuncture myofascial pain trigger point group was better than the control group in terms of total effective rate, cure rate, pain and disability scores. However the researchers concluded: “Based on this study, we concluded that acupuncture inactivation of myofascial pain trigger points is a clinically effective, rapid, precise, and safe treatment method for intervention of knee osteoarthritis. At the same time, this study has the shortcomings of low quality of included studies and small sample size.”
Acupuncture and exercise
Researchers publishing their data in a December 2023 paper (8) examined the effectiveness of a combined acupuncture and knee exercise treatment program for patients with knee osteoarthritis. The researchers reviewed the records of 774 knee osteoarthritis patients taken from 11 high-quality studies.
The results showed that acupuncture combined with active exercise training (combined group) was superior to the acupuncture group in improving the total effective rate, reducing the pain level, improving knee joint function, and improving joint range of motion.
Pressure pain threshold reduced
A December 2023 paper (9) observed the pressure pain threshold, skin conductance (a measure of the Sympathetic Nervous System in response to stress and pain among other functions) and blood perfusion (how fast blood gets to painful tissue) of the sensitized acupoints in patients with knee osteoarthritis, and explored acupuncture as a means to downregulate pain at the sensitized acupoints. In this paper, 11 patients with one-sided osteoarthritis knee pain were observed pre and post treatment. Before acupuncture, the patients exhibited a lower pressure pain threshold. After acupuncture treatment, pressure pain threshold at the sensitized acupoints increased significantly. There were also significant increases of skin conductance and blood perfusion in sensitized acupoints of knee osteoarthritis patients after acupuncture. (A healing response).
Many of my patients present with a diagnosis of “bone-on-bone arthritis,” terminology used to describe a knee that has lost all cartilage to cushion the bones. Few actually have true “bone on bone.” If the joint moves, there is typically cartilage present since cartilage is the slippery surface on the end of the bones that allow range of motion.
References
1 Tian H, Huang L, Sun M, Xu G, He J, Zhou Z, Huang F, Liu Y, Liang F. Acupuncture for Knee Osteoarthritis: A Systematic Review of Randomized Clinical Trials with Meta-Analyses and Trial Sequential Analyses. BioMed Research International. 2022 Apr 21;2022.
2 Araya-Quintanilla F, Cuyúl-Vásquez I, Gutiérrez-Espinoza H. Does acupuncture provide pain relief in patients with osteoarthritis knee? An overview of systematic reviews. Journal of Bodywork and Movement Therapies. 2021 Nov 2.
3 Li J, Li YX, Luo LJ, Ye J, Zhong DL, Xiao QW, Zheng H, Geng CM, Jin RJ, Liang FR. The effectiveness and safety of acupuncture for knee osteoarthritis: an overview of systematic reviews. Medicine. 2019 Jul;98(28).
4 Luo X, Liu J, Li Q, Zhao J, Hao Q, Zhao L, Chen Y, Yin P, Li L, Liang F, Sun X. Acupuncture for treatment of knee osteoarthritis: A clinical practice guideline. Journal of Evidence‐Based Medicine. 2023 Mar 31.
5 Ye C, Zhou J, Wang M, Xiao S, Lv A, Wang D. The effectiveness comparison of different acupuncture-related therapies on knee osteoarthritis:: A Meta-Analysis. Evidence-Based Complementary and Alternative Medicine. 2022 Jun 30;2022.
6 Kwak SG, Jung HJ, Choi WK. Integrative medicine in patients with degenerative arthritis of the knee: A pilot randomized control study. Medicine. 2022 Aug 8;101(34).
7 Lin X, Li F, Lu H, Zhu M, Peng TZ. Acupuncturing of myofascial pain trigger points for the treatment of knee osteoarthritis: A systematic review and meta-analysis. Medicine. 2022 Feb 25;101(8).
8 Wang XY, Nie ZY, Yu QQ, Chen W, ZHANG XN, Wan HY, Su YS, He W, Li RY, Jing XH. Acupuncture Enhances Signals at Sensitized Acupoints to Elevate Pressure Pain Threshold in Knee Osteoarthritis Patients. Chinese Journal of Integrative Medicine. 2022 Dec;28(12):1105-10.
9 Li, S., Xie, P., Liang, Z., Huang, W., Huang, Z., Ou, J., Lin, Z. and Chai, S., 2018. Efficacy comparison of five different acupuncture methods on pain, stiffness, and function in osteoarthritis of the knee: a network meta-analysis. Evidence-Based Complementary and Alternative Medicine, 2018.