Osteoarthritis involves damage to articular cartilage & other structures in & around joints, with variable levels of inflammation. The most commonly affected joints are the knee & the hip. About 10% of people aged over 55 years in the UK have painful knee osteoarthritis associated with mild to moderate disability. Many patients with osteoarthritis have significant pain & loss of function, often episodically & will require treatment to control their symptoms.
Treatment options for osteoarthritis involve a combination of non-drug & drug interventions. The non-drug interventions include ongoing access to appropriate information; lifestyle measures (e.g. weight loss, exercise); walking aids; wedged insoles; local therapy involving heat or cold; physiotherapy; transcutaneous electrical nerve stimulation (TENS); cognitive behavioural therapy; and food supplements (e.g. glucosamine). Drugs used include paracetamol, oral or topical NSAIDs, capsaicin, opioids and intra-articular corticosteroid injections. Joint replacement surgery is an option if pain relief & functional improvements are inadequate with other treatments, and there is a significant impact on quality of life.
The most up-to-date, highest quality evidence, based on very large numbers of trials & patients, is in the Vickers 2018 paper listed under chronic pain: acupuncture is better than sham or usual care. A recent systematic review specifically focused on acupuncture for chronic knee pain (Zhang et al 2017) concluded that acupuncture provided significant benefits & was as safe as the control groups.
Osteoarthritic knee pain is one of very few conditions where acupuncture has been compared against many other possible treatments using a statistical technique known as network meta-analysis. Acupuncture was ranked second out of 21 physical treatments, better than those (such as exercise) that NICE recommended in its 2014 guideline (when it rejected acupuncture) (Corbett et al 2013).
For hip, rather than knee, osteoarthritis there is much less data: a 2018 systematic review (Manheimer et al) included only six trials & 413 people. Acupuncture was beneficial as an add-on to usual GP care, which is likely to be of more practical interest for patients & clinicians than that it was also found to be similar to sham. Given that sham acupuncture can be considered to be a diluted form of ‘real’ acupuncture rather than an inert placebo it’s not unexpected to see only small differences. More trials, larger & better quality, are needed to reach stronger conclusions:
There have been more than 50 NHS publications recommending acupuncture for osteoarthritis (largely knee or hip) since 2005, & many more worldwide (Birch et al 2018). NICE is again an exception, in its 2014 guideline, but SIGN, the Scottish guideline body, endorses acupuncture.
Arthritis Research UK gives support for acupuncture in treatment of arthritic & muscle pain. A recent study, published by Arthritis Research UK, into the efficacy of alternative medicine for conditions such as osteoarthritis, low back pain & fibromyalgia, found that acupuncture came out tops in treating these conditions. They concluded that there was good evidence for the use of acupuncture in alleviating these symptoms. Interestingly, evidence also backed the use of the Chinese health exercise, Tai Qi, in combating these conditions.
In general, acupuncture is believed to stimulate the nervous system & cause the release of neurochemical messenger molecules. The resulting biochemical changes influence the body's homeostatic mechanisms, thus promoting physical & emotional well-being. Stimulation of certain acupuncture points has been shown to affect areas of the brain that are known to reduce sensitivity to pain & stress.