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Acupuncture better than surgery for severe knee arthritis

Acupuncture – the alternative therapy that isn’t supposed to work – can relieve the pain of knee osteoarthritis so effectively that surgery isn’t needed.

Patients were still saying they weren’t feeling any pain even two years after acupuncture, whereas, by then, one in seven of those who have conventional surgery complain of suffering severe pain.

Knee arthritis affects around 17 per cent of the over-50s who suffer significant pain. The most common remedy is knee surgery, although this is offered only when the pain is constant and walking becomes almost impossible.

A group of 90 sufferers, with an average age of 71 years, were treated with acupuncture. In each case, the arthritis was so severe that it warranted surgery. Instead, they were given acupuncture once a week for a month, and then once every six weeks. Thirty-one were still having regular acupuncture sessions two years later.

In each case, the patients reported a dramatic reduction in pain, stiffness, and an improvement in mobility. The improvements were so dramatic that none needed to have surgery.

(Source: Acupuncture in Medicine, 2012; doi:10.1136/acupmed-2012-010151). Published November 2012 by What Doctors Don’t Tell You, Volume 23

 

Please see our posts section for more research and news into this field.

Following years of research and controlled clinical trials, acupuncture’s use for certain conditions has been endorsed by the United States National Institutes of Health, the National Health Service of the United Kingdom, the World Health Organisation, and the National Centre for Complementary and Alternative Medicine.

It has been shown to be one of the safest medical treatments, both conventional and complementary, on offer in the UK. Two surveys conducted independently of one another were published in the British Medical Journal in 2001. They concluded that the risk of a serious adverse reaction to acupuncture is less than 1 in 10,000, far less than many orthodox medical treatments. Another survey reviewed 66,000 treatments performed by traditional acupuncturists and doctors who practise acupuncture and found very few minor and transient side effects were recorded. A similar survey in 2003 of 6,000 patients receiving acupuncture recorded almost identical figures.

Sceptics had previously argued that any benefits gained from acupuncture were due to the placebo effect – a person’s expectation that the treatment would work. Researchers at University College London and Southampton University conducted research using brain scan results to nullify this placebo effect. Patients receiving acupuncture treatment for arthritis underwent 3 interventions in a random order. They were either touched with blunt needles, treated with a ‘trick’ needle, which visually and sensually mimicked the insertion of a needle, or given real acupuncture. Only with the real acupuncture were two important regions of the brain activated – an area associated with the production of natural opiates (substances that act to relieve pain) and the ‘insular’ region, thought to be associated in pain modulation.


The use of acupuncture to treat depression and psychiatric disorders is increasing.

Acupuncture has been shown to be as effective as conventional medication (including amitriptyline) in a number of controlled trials. It was noted in these trials that acupuncture produced the positive effects without the side effects experienced by the pharmaceutically medicated group.

Research

Clinical observation of electro-acupuncture on 133 patients with depression in comparison with tricyclic amytriptyline. (Luo et al, 1988)

Subjects suffering from depression were treated with either electric acupuncture or pharmaceutical medication (amitriptyline). There was a similar improvement in the two groups but a greater effect on anxiety and fewer side effects in the acupuncture group.

A control study of clinical therapeutic effects of laser-acupuncture on depressive neurosis. (Zhang 1996)

The effects of laser acupuncture were compared with conventional antidepressants (doxepine, amitriptyline or aprazolam). The therapeutic effects were similar in the two groups, however side effects occurred in all cases of the antidepressant group but none in the group receiving acupuncture.


Acupuncture has been applied to a wide range of Gastro-intestinal disorders and studies report encouraging results.

Epigastric pain and gastrointestinal spasm, have both been shown to be relieved by acupuncture, which may be of benefit to patients with peptic ulcer, gastritis and irritable bowel.

A systematic review of randomised, placebo controlled trials using acupuncture for nausea and vomiting showed that 11 of the 12 trials (involving nearly 2000 patients) found positive benefits from the treatment.

Acupuncture has been shown to have analgesic and anti-spasmodic effects on the biliary tract, making it useful in cases of biliary colic and further studies have shown that it aids the expulsion of gallstones. (Zhao et al, 1979)

Research

Observation of 70 cases of Biliary ascariasis treated by acupuncture, Chinese acupuncture and moxibustion, (Mo, T W, 1987 )

In a group comparison study of 146 patients with biliary colic, acupuncture was compared with an injection of Atropine and Pethidine. The results found that the analgesic effect was better in the group receiving acupuncture.

Postoperative nausea is relieved by acupressure. (Barsoum et al. 1990 )

In a randomised, controlled trial of 162 patients with postoperative nausea, one group received acupuncture via a wristband with a pressure button and the control group received either placebo bands (with no pressure button) or an injection of prochlorperazine. The severity of the nausea was found to be far less in the group receiving acupuncture.


Significant improvements have been recorded in patients suffering with dysmenorrhea (painful periods) in a number of clinical trials. Acupuncture was found to relieve pain and regulate the contractions of the uterus, thereby facilitating blood flow.

Pre-menstrual syndrome has also been studied, with great relief gained through treatment with acupuncture.

Research

Acupuncture for the management of primary dysmenorrhea. (Helms 1987)

90.9% of subjects receiving acupuncture reported improvement in dysmenorrhoea (painful periods) compared with 18.2% receiving conventional treatment and 36.4% receiving placebo acupuncture.

Treatment of 108 cases of pre-menstrual tension by head-acupuncture (Li et al, 1992)

91.7% of 108 subjects experiencing pre-menstrual tension found total relief of symptoms with no recurrence in a 6 month application of acupuncture


The effectiveness of analgesic acupuncture has been established in a number of controlled clinical studies. Acupuncture works better than a placebo for most kinds of pain, but without the side effects or risk of dependence associated with drug therapy. It is for these reasons that acupuncture is the preferred choice for treating chronically painful conditions. In the treatment of chronic pain, acupuncture has been found to be as effective as morphine.

For headaches, including tension headaches and migraine, acupuncture has performed well in trials which compared its effectiveness with standard drug therapy, sham acupuncture and mock Transcutaneous electrical nerve stimulation (TENS), suggesting it could be of significant benefit to these conditions.(Dowson et al, 1985)

Research

Efficacy of Chinese acupuncture on postoperative oral surgery pain. (Lao et al, 1998)

In a randomised-controlled trial, subjects treated with acupuncture reported significantly longer periods without pain following tooth extractions and experienced less intense pain than controls.

‘Three Scalp Needles’ in the treatment of migraine(Liu et a, 1997)

Scalp acupuncture was applied to subjects suffering from migraines in the test group and compared to those receiving flunarizine (a typical migraine pharmaceutical medication) in a control group. Headache was relieved after 1 week of treatment in 73.3% of the test group opposed to 38.2% of the control group.


Acupuncture can be used to treat a range of respiratory disorders and studies have been conducted on its use in allergic rhinitis, acute tonsillitis, sore throats and bronchial asthma.

It has proved particularly effective in the treatment of Allergic Rhinitis and clinically controlled studies have shown that acupuncture is more effective than anti-histamine drugs in its treatment.

Research

Acupuncture therapy in allergic rhinitis. (Chari et al 1988)

Subjects receiving acupuncture for allergic rhinitis reported that the treatment effects were better and lasted longer then those receiving the antihistamine chloropheniramine and produced no adverse effects.

Effect of acupuncture treatment in 230 cases of allergic rhinitis. (Yu et al 1994)

Subjects received either acupuncture or an antihistamine over a 4-week duration. The follow-up one year following treatment found that 94% observed improvement in the acupuncture group compared with 76.7% of the control group.


There is much empirical evidence that skin diseases respond well to acupuncture and therefore its use for these conditions is widespread in many countries, however few clinically controlled studies have been published.

Acupuncture has been shown to have an anti-pruritic effect, which may be of value in skin conditions characterised by itching.

There has also been evidence supporting the use of acupuncture in Herpes zoster and for the treatment of acne vulgaris.

Research

Comparative observation of the curative effects of herpes zoster treated by type JI He-Ne laser and polyinosinic acid (Chen et al 1994)

A randomised, controlled trial compared the effects of laser acupuncture with polyinosinic acid on Herpes zoster. Disappearance of pain occurred after 1.48 days of laser acupuncture and 10.5 days of medication. Formation of scabs, occurred following 5.76 days of acupuncture and 10.4 days of medication.

Auriculo-acupuncture treatment of 32 cases of facial acne vulgaris (Wang et al. 1997)

Wang and associates conducted a group comparison of patients with acne vulgaris, 32 of whom received auricular acupuncture and 20 that were treated with medication (including anti-biotics and vitamin B6). After 10 days of treatment acne cleared in 59 percent of the acupuncture group compared with 35 percent of the control group.

Acupuncture has been used for urinary retention, particularly that of post partum or postoperative retention, with great success.

Studies have also shown that acupuncture can decrease urethral pressure and therefore relieve urethral syndrome.

Chronic prostatitis may also benefit from acupuncture, as was shown in a randomised controlled trial that found acupuncture to be superior to oral sulfamethoxole in improving symptoms and sexual function.

Urinary tract infections have also been shown to be reduced in frequency by treatment with acupuncture.

Research

Acupuncture in the prophylaxis of recurrent lower urinary tract infection in adult women. (Aune et al, 1998)

In a randomised controlled trial 67 subjects with recurrent lower urinary tract infection received acupuncture, sham acupuncture or no treatment.

Over a 6 month observation period 85% of the acupuncture group did not develop infection compared with 58% in the sham acupuncture group and 36% in the untreated group.

Clinical research on treatment of chronic prostatitis with acupuncture (Luo et al, 1994)

In a randomised controlled trial, subjects with chronic prostatitis received either acupuncture or orthodox medication. Relief of symptoms and improvement in sexual functions were greater in the acupuncture group.


Benefits have been reported in both hypotension and hypertension. For mild and moderate essential hypertension, acupuncture’s effects are comparable with some conventional hypotensive medication.

Positive results have also been documented in the treatment of heart disease with acupuncture, in particular cardiac neurosis and angina pectoris have been shown to respond well.

Research

The hypotensive effect of ear acupressure—an analysis of 274 cases. (Zhou et al, 1990)

In a Group Comparison 135 subjects received auricular acupressure, 68 were given conventional medication and 71 were given a placebo drug. There was a similar improvement with both acupressure and medication, both of which performed better than a placebo.

Acupuncture in severe, stable angina pectoris: a randomised trial. (Ballegaard et al, 1986 )

In a randomised controlled trial cardiac work capacity was measured in subjects with angina pectoris. Those who received acupuncture showed a significant increase in cardiac work capacity compared to those receiving sham acupuncture.

Effects of acupuncture on the left ventricular diastolic function in patients with coronary heart disease. (Xue et al, 1992)

Subjects with Angina Pectoris received either acupuncture or medication (nifedipine and isosorbide dinitrate) in a randomised controlled trial. Acupuncture was found to be more effective in improving symptoms, and ECG results.


The World Health Organisation lists a wide variety of diseases or disorders for which acupuncture therapy has been tested in controlled clinical trials.

  • Adverse reactions to radiotherapy and/or chemotherapy
  • Allergic rhinitis (including hay fever)
  • Biliary colic
  • Depression (including depressive neurosis and depression following stroke)
  • Dysentery, acute bacillary
  • Dysmenorrhoea, primary
  • Epigastralgia, acute (in peptic ulcer, acute and chronic gastritis, and gastrospasm)
  • Facial pain (including craniomandibular disorders)
  • Headache
  • Hypertension, essential
  • Hypotension, primary
  • Induction of labour
  • Knee pain
  • Leukopenia
  • Low back pain
  • Malposition of fetus, correction of
  • Morning sickness
  • Nausea and vomiting
  • Neck pain
  • Pain in dentistry (including dental pain and temporomandibular dysfunction)
  • Periarthritis of shoulder
  • Postoperative pain
  • Renal colic
  • Rheumatoid arthritis
  • Sciatica
  • Sprain
  • Stroke
  • Tennis elbow

Other diseases and conditions are listed for which the therapeutic effect of acupuncture has been shown but for which further research is needed:

  • Abdominal pain (in acute gastroenteritis or due to gastrointestinal spasm)
  • Acne vulgaris
  • Alcohol dependence and detoxification
  • Bell’s palsy
  • Bronchial asthma
  • Cancer pain
  • Cardiac neurosis
  • Cholecystitis, chronic, with acute exacerbation
  • Cholelithiasis
  • Competition stress syndrome
  • Craniocerebral injury, closed
  • Diabetes mellitus, non-insulin-dependent
  • Earache
  • Epidemic haemorrhagic fever
  • Epistaxis, simple (without generalized or local disease)
  • Eye pain due to subconjunctival injection
  • Female infertility
  • Facial spasm
  • Female urethral syndrome
  • Fibromyalgia and fasciitis
  • Gastrokinetic disturbance
  • Gouty arthritis
  • Hepatitis B virus carrier status
  • Herpes zoster (human (alpha) herpesvirus 3)
  • Hyperlipaemia
  • Hypo-ovarianism
  • Insomnia
  • Labour pain
  • Lactation, deficiency
  • Male sexual dysfunction, non-organic
  • Ménière’s disease
  • Neuralgia,
  • Neurodermatitis
  • Obesity
  • Opium, cocaine and heroin dependence
  • Osteoarthritis
  • Pain due to endoscopic examination
  • Pain in thromboangiitis obliterans
  • Polycystic ovary syndrome (Stein–Leventhal syndrome)
  • Postextubation in children
  • Postoperative convalescence
  • Premenstrual syndrome
  • Prostatitis, chronic
  • Pruritus
  • Radicular and pseudoradicular pain syndrome
  • Raynaud’s syndrome, primary
  • Recurrent lower urinary-tract infection
  • Reflex sympathetic dystrophy
  • Retention of urine, traumatic
  • Schizophrenia
  • Sialism, drug-induced
  • Sjögren syndrome
  • Sore throat (including tonsillitis)
  • Spine pain, acute
  • Stiff neck
  • Temporomandibular joint dysfunction
  • Tietze syndrome
  • Tobacco dependence
  • Tourette syndrome
  • Ulcerative colitis, chronic
  • Urolithiasis
  • Vascular dementia
  • Whooping cough (pertussis)

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