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Painful knees? What about acupuncture?

The Bottom Line

  • Osteoarthritis affects millions of Canadians; it causes joint pain, impacts mobility, and gets in the way of everyday activities.
  • Acupuncture may help reduce short-term pain and improve physical functioning in the short- and long-term in people with knee osteoarthritis.
  • More recent research shows that the pain relieving effects of acupuncture may even last for at least 12 months.

Many people have a love-hate relationship with their joints. While healthy joints allow a person to enjoy many of life’s activities, painful joints can be extremely debilitating.


Osteoarthritis is one of the most common sources of joint pain, affecting almost five million Canadians (1) and almost half of people over the age of 65 with arthritis. It often rears its ugly head at or after age 50 (2;5) when the cartilage that normally protects the joints starts to wear down (2;3). Women are more at risk than men (3;4), and certain jobs, sports (3), and lifestyle factors (e.g., obesity, lack of exercise) can also increase the risk.


Unfortunately, osteoarthritis can severely impact a person’s quality of life (4;6). Along with pain, it decreases joint mobility, weakens muscles, and makes it more difficult to carry out daily activities (2;8). Although osteoarthritis can affect any joint, it’s most often found in the knees, hands, spine, and hips (2;9). In fact, it makes older adults quite literally ‘weak in the knees’, with knees being the joints where they most often experience osteoarthritis pain (7).


While there is no cure for osteoarthritis (2), many treatments are available to help manage it (10;11). These include medication, exercise (11), physical therapy, assistive devices, and surgery (12). A more recent addition to this arsenal is…acupuncture (11;14)! This ancient practice in Traditional Chinese Medicine (TCM) (13) uses needles to stimulate specific points around the body. These points represent the vital energy ‘qi’ that flows through the body (15). Sustaining the flow of ‘qi’ is believed to play an important role in improving and maintaining health (16;17).


Although there are several theories, it is not clear exactly how acupuncture works (15), but for those in pain, the more relevant question is…how well does it work? Two systematic reviews aimed to answer this question.


What the research tells us

The first systematic review looked at whether acupuncture could improve pain and joint function in people with chronic osteoarthritis knee pain (e.g., lasting more than three months), compared to ‘fake’ acupuncture, usual care, or no treatment. People received 6 to 23 sessions of acupuncture at least once per week for 3 to 36 weeks. Each session involved at least four acupuncture points, and was carried out for at least 20 minutes.


Overall, the results were promising! People who received acupuncture had less short-term pain (up to 13 weeks) and better short-term (up to 13 weeks) and long-term (up to 26 weeks) physical functioning, although there was no effect seen on long-term pain (11). However, one newer review provided evidence that acupuncture could relieve chronic pain for 12 months or more, and to a degree that was clinically significant (14).


Painful joints from osteoarthritis can have a huge negative impact on quality of life. Acupuncture may offer an alternative way to treat this debilitating condition.

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References

  1. Government of Canada. Canadian Chronic Disease Indicators (CCDI). [Internet] 2018. [cited March 2019]. Available from https://infobase.phac-aspc.gc.ca/ccdi-imcc/data-tool/?l=eng&edi=2018&Dom=5&Ind=1&MS=11 
  2. Regnaux JP, Lefevre-Colau MM, Trinquart L, et al. High-intensity versus low-intensity physical activity or exercise in people with hip or knee osteoarthritis. Cochrane Database Syst Rev. 2015; (10):CD010203. doi: 10.1002/14651858.CD010203.pub2. 
  3. Doherty M, Abhishek A. Patient education: Osteoarthritis symptoms and diagnosis (beyond the basics). [Internet] 2017. [cited February 2019]. Available from https://www.uptodate.com/contents/osteoarthritis-symptoms-and-diagnosis-beyond-the-basics 
  4. Puljak L, Marin A, Vrdoljak D, et al. Celecoxib for osteoarthritis. Cochrane Database Syst Rev. 2017; (5):CD009865. doi: 10.1002/14651858.CD009865.pub2. 
  5. Woolf AD, Pfleger R. Burden of major musculoskeletal conditions. Bull World Health Organ. 2003; 81(9):646-56.
  6. Garner SE, Fidan DD, Frankish R, et al. Rofecoxib for osteoarthritis. Cochrane Database of Systematic Reviews. 2008; (4):CD005115. doi: 10.1002/14651858.CD005115. 
  7. MacDonald KV, Sanmartin C, Langlois K, et al. Symptom, onset, diagnosis and management of osteoarthritis. [Internet] 2015. [cited February 2019]. Available from https://www150.statcan.gc.ca/n1/pub/82-003-x/2014009/article/14087-eng.htm
  8. Moskowitz RW. The burden of osteoarthritis: Clinical and quality‐of‐life issues. Am J Manag Care. 2009; 15(8 Suppl):S223‐229. 
  9. Vos T, Flaxman AD, Naghavi M, et al. Years lived with disability (YLDs) for 1160 sequelae of 289 diseases and injuries 1990‐2010: A systematic analysis for the Global Burden of Disease Study 2010. Lancet. 2012; 380(9859):2163‐2196.
  10. White A, Foster NE, Cummings M, et al. Acupuncture treatment for chronic knee pain: A systematic review. Rheumatology. 2007; 46(3):384-390. 
  11. Lin X, Huang K, Zhu G, et al. The effects of acupuncture on chronic knee pain due to osteoarthritis: A meta-analysis. J Bone Joint Surg Am. 2016; 98(18): 1578-1586. doi: 10.2106/JBJS.15.00620. 
  12. Deveza LA, Bennell K. Patient education: Osteoarthritis treatment (beyond the basics). [Internet] 2018. [cited February 2019]. Available from https://www.uptodate.com/contents/osteoarthritis-treatment-beyond-the-basics 
  13. Linde M, Mulleners W, Chronical E, et al. Topiramate for the prophylaxis of episodic migraine in adults. Cochrane Database Syst Rev. 2013; (6):CD010610. doi: 10.1002/14651858.CD010610. 
  14. Vickers AJ, Vertosick EA, Lewith G, et al. Acupuncture for chronic pain: Update of an individual patient data meta-analysis. J Pain. 2018; 19(5):455-475. doi: 10.1016/j.pain.2017.11.005. 
  15. Choi GH, Wieland LS, Lee H, et al. Acupuncture and related interventions for the treatment of symptoms associated with carpal tunnel syndrome. Cochrane Database Syst Rev. 2018; (12):CD011215. doi: 10.1002/14651858.CD011215.pub2. 
  16. Yu X, Chau JPC, Huo L. The effectiveness of traditional Chinese medicine-based lifestyle interventions on biomedical, psychosocial, and behavioural outcomes in individuals with type 2 diabetes: A systematic review with meta-analysis. Int J Nurs Stud. 2018; 80:165-180. doi: 10.1016/j.ijnurstu.2018.01.009.  
  17. Lao L, Xu L, Xu S. Traditional Chinese medicine. In: Längler A, Mansky P, Seifert G. (Eds.). Integrative Pediatric Oncology. 2012; Springer: Heidelberg, pp.125-135.

DISCLAIMER: The blogs are provided for informational purposes only. They are not a substitute for advice from your own healthcare professionals.

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