As a leader in the naturopathic medical profession and a doctor for over 30 years, I keep a close eye on research that studies the effects of therapies such as acupuncture, herbal medicine, nutrition and the like. I am also honored to sit on scientific advisory boards and editorial boards for several journals, including the Natural Medicine Journal. Recently, I reviewed an article for NMJ on the effectiveness of acupuncture in treating osteoarthritic pain that I found to be quite interesting and in line with my clinical experience. Thus I decided to share it with you.
Background: The Scope of the Problem
There are many different types of arthritis, diseases that cause inflammation in our joints. Osteoarthritis (OA), also known as degenerative joint disease, is the most common type. It is characterized by a progressive loss of joint cartilage along with bony changes such as deformities and bone spurs, with symptoms of pain, swelling and inflammation of affected joints. It can be secondary to joint overuse or injury, and is very common in aging. It primarily affects the hips, knees, hands and low back.
OA is a very common cause of pain and disability. The Centers for Disease Control and Prevention (CDC) estimates that 26.5 million people have OA in the US alone (figures from 2005). It affects 14% of adults over 25 and 34% of adults over 65.
In 2006, almost 815,000 people were hospitalized for OA, with 35% getting hip and knee replacements. It is a highly costly aspect of the US healthcare system—$42.2 billion was spent in 2009 for hospital knee and hip replacements. In 2000, annual costs of OA per patient were $5,700; and job-related OA costs up to $13.2 billion/year. And OA doesn’t just affect the joints. It increases your risk of mortality from all causes.
These costs do not begin to describe the pain, discomfort and disability of those suffering from OA. Any effective and cost-effective ways to help people manage their OA symptoms has a significant impact both personally and on the overall healthcare system. Thus, it is not surprising that researchers and doctors continue to seek methods that effectively help people manage their OA symptoms and prevent progression of this disease.
Acupuncture and Osteoarthritis Pain
Many studies have looked at the effectiveness of acupuncture in treating osteoarthritic pain. Those who practice acupuncture often think of OA as a “Cold Bi Syndrome,” where the blockage of the flow of Qi leads to stiffness and other symptoms of OA. Acupuncture is thought to improve the circulation of Qi, warming the joints and improving local circulation, thus reducing OA symptoms.
The problem is there is no standard of care with acupuncture treatment of OA. Some acupuncturists use gentle techniques, others stronger ones; some use electroacupuncture or moxibustion, and on it goes. This creates difficult issues when evaluating studies of acupuncture’s effectiveness in treating and managing OA.
Modern Research Points the Way
This is why I found this study so compelling.
Entitled Pain management with acupuncture in osteoarthritis: a systematic review and meta-analysis, the authors independently screened over 14,000 studies investigating acupuncture in the treatment of OA pain, carefully selecting and standardizing them; in the end including the twelve best designed studies. They excluded non-randomized control studies, those on animals, etc, and evaluated internal validity using generally accepted scientific methods. The researchers focused on primary outcome measures of pain intensity, with secondary outcomes of functional mobility and health-related quality of life.
Here’s what they found. Ten trials involving 1699 participants showed significantly reduced osteoarthritic pain, with longer intervention periods (4 weeks) associated with improved treatment response. Functional mobility (decreased disability) assessed at the end of trials was significantly improved in the acupuncture groups compared to the control groups. Three trials involving 958 participants reported improved health-related quality of life (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.
The authors concluded that acupuncture is an effective and cost-effective modality for people with osteoarthritic pain and disability. Based on this review, they note that acupuncture should be considered a central therapy in treatment plans centered on clinical management of osteoarthritic pain and disability.
Most allopathic treatment of osteoarthritis is focused on symptom management—most commonly nonsteroidal anti-inflammatory drugs. While only being proven marginally effective, NSAIDS also come with common adverse side effects such as digestive irritation and bleeding as well as increased risk of cardiovascular disease. Patients should use the smallest effective dose for the shortest amount of time, but their use is often not managed by their doctors. Acupuncture, by comparison, is generally free of significant adverse effects, as well as in general widely used and cost-effective.
Isn’t it time our health care system makes this a “standard of care” and a basic therapy to try for anyone who suffers from OA? It just makes sense.