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Acupuncture and Osteoarthritis

Research is mixed when it comes to needle sticks relieving OA pain. But does the research tell the whole story?

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People with osteoarthritis (OA) who seek symptom relief outside of mainstream medicine have many options, from herbal preparations to hands-on treatments such as massage and chiropractic. Acupuncture may also provide some symptom improvement when used as an add-on therapy for people struggling with aching joints.

Yet proving this treatment’s benefits has been tricky. Even though patients offer anecdotal evidence that acupuncture has helped them, most studies have found acupuncture offers minimal pain and stiffness relief for osteoarthritis.

How – and How Well – Does Acupuncture Work?

Acupuncture has been practiced for thousands of years and plays an important role in traditional Chinese medicine (TCM). Acupuncturists treat medical conditions by inserting slender metal needles into the skin at specific points on the body. According to principles of TCM, health is governed by the flow of energy (known as qi, pronounced “chee”) throughout the body along pathways called meridians. Illness occurs when this energy flow is disrupted or becomes unbalanced, the theory goes. Precise insertion of acupuncture needles is said to restore the flow of qi and improve health.

Western medicine doesn’t recognize the concepts of qi and meridians. However, a solid body of scientific evidence suggests alternate explanations for why acupuncture might provide pain relief.

“There’s a lot of research that says when we put an acupuncture needle into the body, a number of physiological mechanisms occurs,” says Brian Berman, MD, professor of family & community medicine and director of the Center for Integrative Medicine at the University of Maryland School of Medicine.

A well-placed needle sets off a cascade of events, Dr. Berman explains, producing a signal that travels along the spinal cord to the brain, triggering a release of neurotransmitters called endorphins and enkephalins, which scientists believe reduce the sensation of pain. Research also shows that inserting an acupuncture needle induces production of cortisol, a hormone that helps control inflammation. Acupuncture may stimulate activity of other pain-relieving chemicals in the body as well.

But do all these biochemical changes relieve sore, stiff joints? A 2004 study by Dr. Berman and his colleagues found that after 26 weeks, patients receiving real acupuncture felt significantly less pain and functioned better (as measured by how far they could walk in six minutes) than their counterparts who received sham acupuncture.

Other studies haven’t been as positive. In a 2014 study of patients with knee OA, published in JAMA, Australian researchers found that acupuncture led to only slightly less pain than no treatment, and was similar in effect to sham treatment. The authors concluded that the evidence didn’t support the use of acupuncture for chronic knee pain.

Not For Everyone

Acupuncture doesn’t work for everyone, but slightly more than half of patients with moderate OA will experience some benefit, says pain specialist James N. Dillard, MD, former medical director of Columbia University’s Rosenthal Center for Complementary and Alternative Medicine in New York City.  

One advantage acupuncture has over nonsteroidal anti-inflammatory drugs (NSAIDs) and other OA medications is its relative lack of side effects. “It’s incredibly safe,” Dr. Dillard says. “The adverse side effects a patient may have with those drugs are way, way worse.”

Certain forms of OA may respond better than others to acupuncture. Patients with OA of the knee and spine appear to have the most success, says rheumatologist Scott Zashin, MD, a clinical assistant professor of internal medicine at the University of Texas Southwestern Medical School at Dallas. Dr. Zashin, who practices electro-acupuncture, says it can take three or more sessions before symptoms begin to improve, and benefits usually last a month or so, after which follow-up treatment is necessary. A 2015 study published in International Journal of Clinical and Experimental Medicine showed that electro-acupuncture (in which the needles transmit a small electrical current) performed on patients with OA of the knee improved pain, stiffness and physical function, and it reduced markers of inflammation.

If you decide to try acupuncture, ask your doctor for a referral or check with an organization such as the The National Certification Commission for Acupuncture. Find out if the practitioner is licensed and ask what type of acupuncture he or she practices. Some health insurance plans cover the cost of acupuncture. If it isn’t covered under your plan, expect to pay anywhere from $75 to $200 per session.

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